Pharmaceutical Schedule - effective 1 August 2009 (text extract)

This is the text extract for Pharmaceutical Schedule - effective 1 August 2009, browse documents here.

Pharmaceutical Management Agency

August 2009

New Zealand Pharmaceutical Schedule

Introducing PHARMAC

August 2009

Volume 16 Number 2

Editors Kaye Wilson & Scott Brydon email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 9, Cigna House 40 Mercer Street PO Box 10 254 Wellington Freephone Information Line 0800 66 00 50 (9am – 5pm weekdays) Circulation Published each April, August and December. Changes to the contents are published in monthly updates. Annual subscription includes three Pharmaceutical Schedule books, 12 updates and occasional information on rule changes and news items. The Schedule is distributed free of charge to over 9,000 health professionals, and is also available on an annual subscription. Prices $22.22 One Schedule book $4.44 One Update $120.00 Annual subscription All prices include postage and exclude GST. Production Typeset automatically from XML and TEX. Source XML suitable for database import available on request. Programmers Peter Ericson & John Geering email: texschedule@pharmac.govt.nz http://www.pharmac.govt.nz ISSN 1172 - 9376 Copyright c 1994 Pharmaceutical Management Agency. 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, PHARMAC takes no responsibility for any errors or omissions, and shall not be liable for any consequences arising therefrom.

Section A Section B

General Rules 12 Alimentary Tract & Metabolism 25

Blood & Blood Forming Organs 39 Cardiovascular System 48 Dermatologicals 58 Genito Urinary System 69 Hormone Preparations – Systemic 75 Infections – Agents For Systemic Use 83 Musculoskeletal System 99 Nervous System 108 Oncology Agents & Immunosuppressants 134 Respiratory System & Allergies 150 Sensory Organs 157 Various 162

Section C Extemporaneous Compounds (ECPs) 163 Section D Section E

Special Foods 169 Supply Orders (PSO & WSO) 189 Rural Areas 193

Section F Section G

Dispensing Period Exemptions 194 Safety Cap Medicines 196 Index 199

Introducing PHARMAC

PHARMAC, the Pharmaceutical Management Agency, is a Crown entity established pursuant to the New Zealand Public Health and Disability Act 2000 (The Act). 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 Kura Denness David Kerr 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. Murray Georgel, CE MidCentral DHB, 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 103 of the Crown Entities 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. The policies and criteria set out in the Pharmaceutical Schedule and PHARMAC’s Operating Policies and Procedures arise out of, and are designed to help PHARMAC achieve and perform, PHARMAC’s objective and functions under the Act. However PHARMAC may, having regard to its public law obligations, depart from the strict application of those policies and criteria in certain exceptional cases where it considers this necessary or appropriate in the proper exercise of its statutory discretion and to give effect to its objective and functions, particularly with respect to: G Determining eligibility and criteria for the provision of subsidies; and G In exceptional circumstances providing for subsidies for the supply of pharmaceuticals not on the Pharmaceutical Schedule. 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: G the health needs of all eligible people within New Zealand (eligible deﬁned by the Government’s then current rules of eligibility); G the particular health needs of M¯ ori and Paciﬁc peoples; a G the availability and suitability of existing medicines, therapeutic medical devices and related products and related things; G the clinical beneﬁts and risks of pharmaceuticals; G the cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health and disability support services; G the budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Pharmaceutical Schedule; G the direct cost to health service users; G 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 G 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: G Pharmaceuticals available in the community and subsidised by the Government with funding from the Pharmaceutical Budget; and G 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 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. 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 Ian Hosford Sisira Jayathissa George Laking Jim Lello Graham Mills Peter Pillans Paul Tomlinson Mark Weatherall Howard Wilson MBChB, MD, MRCP (UK), FRACP, FRCP, physician/clinical pharmacologist, Chair MBChB, FRANZCP, psychiatrist MBBS, MD, MRCP, FAFPHM, FRCP, FRACP, physician PhD, MB, B.Med.Sci, MD, FRACP BHB, MBChB, DCH, FRNZCGP, general practitioner MBChB, MTropHlth, MD, FRACP, infectious disease specialist MBBCh, MD, FCP, FRACP, clinical pharmacologist MBChB, MD, MRCP, FRACP, BSc, paediatrician, Deputy Chair BA, MBChB, MApplStats, FRACP BSc, PhD, MB, BS, Dip Obst, FRNZCGP, general practitioner

Contact PTAC C/-Advisory Committee Manager , Pharmaceutical Management Agency, PO Box 10 254, WELLINGTON, Email: PTAC@pharmac.govt.nz

The PHARMAC Team The PHARMAC team has a wide range of expertise in health, medicine, economics, commerce, critical analysis, and policy development and implementation. Matthew Brougham Chief Executive Trish Mahoney Contract Manager Kate Adams Health Economist Adam McRae Team Leader, Access & Optimal Paul Alexander Health Economist Use Peter Alsop Manager, Corporate and Scott Metcalfe Chief Advisor Population External Relations Medicine / Public Health Jason Arnold Senior Analyst Physician Diana Beswethrick HR Contractor Peter Moodie Medical Director Mike Bignall Therapeutic Group Manager Christina Newman Executive Assistant to Chief Stephen Boxall Creative Director Executive/Ofﬁce Manager Scott Brydon Schedule Analyst Deborah Nisbet Receptionist Davina Carpenter Records Manager Leigh Parish PA to Medical Director Christine Chapman Contract Manager Marama Parore Manager, Access & Optimal Yvonne Chen Tender Analyst Use & M¯ ori Health a Mary Chesterﬁeld High Cost Medicines Chris Peck Analyst Co-ordinator Melanie Pemberton Communications Advisor Steffan Crausaz Manager, Funding and Fisher Procurement Sharon Ponniah Access and Optimal Use Andrew Davies Procurement Initiatives Manager Manager Matthew Poynton Analyst/Health Economist Rachelle Davies Senior Receptionist Rachel Pratt Hospital Exceptional Jessica Dougherty Funding and Procurement Circumstances Panel Assistant Co-ordinator Sean Dougherty Therapeutic Group Manager Jan Quin Team Leader, Medical Team Anrik Drenth Web Developer Dilky Rasiah Deputy Medical Director Kim Ellis Access & Optimal Use Kyle Reid High Cost Medicines Panel Co-ordinator Co-ordinator / Growth Hormone Simon England Communications Manager Brian Roulston Analyst Andy Erceg Senior Network and System Fiona Rutherford Senior Policy Analyst Administrator Rico Schoeler Manager, Analysis and Jackie Evans Therapeutic Group Manager Assessment John Geering Systems Architect Merryn Simmons PHARMAC Seminar Series Rachel Grocott Health Economist / Team Co-ordinator Leader Assessment Liz Skelley Finance Manager Susan Haniel Advisory Committee Manager Moana Tane M¯ ori Health Manager a David Harland Health Economist Jayne Watkins Community Exceptional Karen Jacobs Access & Optimal Use Manager Circumstances Panel Cherie Jacobson Corporate Assistant Co-ordinator Richard Jaine Public Health Registrar Greg Williams Therapeutic Group Manager Geoff Lawn Applications Developer Lisa Williams Legal Counsel Geraldine MacGibbon Therapeutic Group Manager Kaye Wilson Schedule Analyst Janet Mackay Access & Optimal Use Manager Stephen Woodruffe Therapeutic Group Manager Rachel Mackay Manager, Schedule and Contracts

Purpose of the Pharmaceutical Schedule

The purpose of the Schedule is to list: G 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 G 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. G Section A lists the General Rules in relation to Community Pharmaceuticals and related products. G 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. G Section C lists the rules in relation to Extemporaneously Compounded Products (ECPs) and Community Pharmaceuticals that will be subsidised when extemporaneously compounded. G Section D lists the rules in relation to Special Foods and the Special Foods that are subsidised. G Section E Part I lists the Community Pharmaceuticals that are subsidised on a Practitioner’s Supply Order (PSO) and Wholesale Supply Order (WSO). G Section E Part II lists rural areas for the purpose of PSOs. G Section F lists the Community Pharmaceuticals dispensing period exemptions. G 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: G Part I lists the rules in relation to Hospital Pharmaceuticals. G 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. G 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. G 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. 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

ANATOMICAL HEADING

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

Three months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber. Practitioner’s Supply Order (or WSO for Wholesale Supply Order) Safety cap reimbursed Conditions of and restrictions on prescribing (including Special Authority where it applies) Three months or six months, as applicable, dispensed all-at-once

THERAPEUTIC HEADING CHEMICAL L Presentation, form and strength .........................10.00

100

Brand A Brand B Brand C Brand D Brand or manufacturer’s name Sole subsidised supply product Fully subsidised product Original Pack Subsidy is rounded up to a multiple of whole packs

Presentation - Available on a PSO .....................15.00 ‡ Presentation - Retail pharmacy-specialist ..........18.00 a) Prescriptions must be written by a paediatrician or paediatric cardiologist; or b) on the recommnedation of a paediatrician or a paediatric cardiologist CHEMICAL F Presentation, form and strength .........................26 26.53 (35.27)

50 250 ml OP

100 Brand E

Quantity the Subsidy applies to Subsidy paid on a product before mark-ups and GST Manufacturer’s Price if different from Subsidy

Sole Supply Fully Subsidised

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

Glossary

Units of Measure gram ..................................................g kilogram...........................................kg international unit ...............................iu microgram........................................µg milligram .........................................mg millilitre.............................................ml millimole......................................mmol unit.....................................................u

Abbreviations Ampoule ...................................... Amp Granules ......................................Gran Suppository ................................ Supp Capsule ........................................ Cap Infusion............................................Inf Tablet .............................................Tab Cream...........................................Crm Injection ...........................................Inj Tincture.........................................Tinc Device........................................... Dev Linctus .......................................... Linc Trans Dermal Delivery Dispersible................................... Disp Liquid..............................................Liq System.................................. TDDS Effervescent.................................... Eff Long Acting..................................... LA Emulsion..................................... Emul Ointment....................................... Oint Enteric Coated................................EC Sachet ........................................ Sach Gelatinous ..................................... Gel Solution........................................ Soln BSO Bulk Supply Order. CBS Cost Brand Source. There is no set manufacturer’s price, and the Government subsidises the product at the price it is obtained by the 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. ECP Extemporaneously Compounded Preparation. 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. OP Original Pack – subsidy is rounded up to a multiple at whole packs. PSO Practitioner’s Supply Order. Sole Subsidised Supplier Only brand of this medicine subsidised. WSO Wholesale Supply Order. XPharm Pharmacies cannot claim subsidy because PHARMAC has made alternative distribution arrangements. L Three months supply may be dispensed at one time if the exempted medicine is endorsed ‘certiﬁed exemption’ by the practitioner. F 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 initialled 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. S29 This medicine 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, judgement, expertise and discretions, 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. Note: Where medicines supplied under Section 29 that are used for emergency situations, patient details required under Section 29 of the Medicines Act may be retrospectively provided to the supplier.

Abbrev. [HP1]

[HP3]

[HP4]

Deﬁnitions Pharmacy Services Agreement Subsidised when dispensed from pharmacies that have the Complex Medicines Variation of the Pharmacy Services Agreement Subsidised when dispensed from pharmacies that have the Pharmacy Services Agreement. A Special Food with [HP3] annotation is subsidised when dispensed by a pharmacy that has a Special Foods Service appended to their Pharmacy Services Agreement by their DHB. Subsidised when dispensed from pharmacies that have the Monitored Therapy Variation (for Clozapine Services)

All other Pharmacy Agreements Available from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP1] pharmaceuticals. Available from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP3] pharmaceuticals.

Avaliable from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP4] pharmaceuticals.

Patient costs

Community Pharmaceuitical costs met by the Government 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. SALBUTAMOL Aerosol inhaler 100 µg per dose....................................... 3.80 (6.00) Fully subsidised brand Higher priced brand

Pharmaceutical Co-Payments 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 From 1 September 2008, everyone who is eligible for publicly funded health and disability services should in most circumstances pay only $3 for subsidised medicines. All prescriptions from a public hospital, a midwife and a Family Planning Clinic are covered for $3 co-payments. Prescriptions from the following providers are approved for $3 co-payments on subsidised medicines if they meet the speciﬁed criteria: G After Hours Accident and Medical Services with a DHB or a PHO contract. G Youth Health Clinics with a DHB or a PHO contract. G Dentists who write a prescription that relates to a service being provided under a DHB contract. G Private specialists (for example, opthalmologists and orthopaedics) who write a prescription for a patient receiving a publicly funded service contracted by the DHB. G General practitioners who write a prescription during normal business hours to a person who is not enrolled in the general practice provided the person is eligible for publicly funded health and disability services and the general practice is part of a PHO. G Hospices that have a contract with a DHB. Patients can check whether they are eligible for publicly funded health and disability services by referring to the Eligibility Direction on the Ministry of Health’s website. To check if a medicine is fully subsidised, refer to the Pharmaceutical Schedule on PHARMAC’s website or ask your pharmacist or general practitioner. DHBs have a list of eligible providers in their respective regions. Any provider/prescriber not speciﬁcally listed by a DHB as an approved provider/prescriber should be regarded as not approved. NOTE: Information sourced from Ministry of Health Website, for more information please visit www.moh.govt.nz 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 surchage to patient = (price − subsidy) × 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 surchage 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 and Pharmaceutical Cancer Treatment Costs The cost of purchasing Hospital Pharmaceuticals and Pharmaceutical Cancer Treatments (for use in DHB hospitals and/or in association with Outpatient services provided in DHB hospitals) is met by the Funder (in particular, the relevant DHB) from its own budget. As required by section 23(7) of the Act, in performing any of their functions in relation to the supply of Pharmaceuticals including Pharmaceutical Cancer Treatments, DHBs must not act inconsistently with the Pharmaceutical Schedule. 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 prescibed 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

Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular person. Applications must be submitted to the Ministry of Health by the prescriber for the request to be processed. Subsidy Once approved, the presciber will be 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 available 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 the Ministry of Health, and should be sent to: Ministry of Health Sector Services, Fax: (06) 349 1983 or free fax 0800 100 131 Private Bag 3015, WANGANUI 4540 For enquiries, phone the Ministry of Health Sector Services Call Centre, free phone 0800 243 666 Note: The Ministry of Health can only provide information on Special Authority applications to prescribers and pharmacists. Each application must: G Include the patients name, date of birth and NHI number (codes for AIDS patients’ applications) G Include the practitioner’s name, address and Medical Council registration number G Clearly indicate that the relevant criteria, have been met. G Be signed by the practitioner.

Exceptional Circumstances policies

The purpose of the Exceptional Circumstances policies are to provide: G 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 G an assessment process for the 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”); or G an assessment process for DHB Hospitals to determine whether they can fund pharmaceuticals for the treatment of cancer in their DHB Hospital, or in association with Outpatient services provided in their DHB hospital, in circumstances where the pharmaceutical is not identiﬁed as a Pharmaceutical Cancer Treatment (“Cancer Exceptional Circumstances”) in Sections A-H of the Pharmaceutical Schedule. 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. Cancer Exceptional Circumstances is a separate process.

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 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 Phone: (04) 916 7521 PHARMAC, PO Box 10 254 or fax (09) 523 6870 Wellington Email: ecpanel@pharmac.govt.nz

Cancer Exceptional Circumstances

Permission to fund a pharmaceutical for the treatment of cancer from the Hospital’s own budget under Cancer Exceptional Circumstances will only be granted by PHARMAC where it has been demonstated that the proposed use meets the criteria. If the patient being treated with a pharmaceutical under Cancer 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.

Community Exceptional Circumstances

In order to qualify for Community Exceptional Circumstances approval one of the following 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, Hospital Exceptional Circumstances and Cancer 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 Phone (04) 916 7553 PO Box 10 254 or fax (09) 523 6870 Wellington 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: G the quantities, forms, and strengths, of subsidised Community Pharmaceuticals dispensed under valid prescription by each Contractor; G the amount of the Subsidy on the Manufacturer’s Price payable for each unit of the Community Pharmaceuticals dispensed by each Contractor and; G 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 1 August 2009 and is to be referred to as the Pharmaceutical Schedule Volume 16 Number 2, 2009. Distribution will be from 20 August 2009. This Schedule comes into force on 1 August 2009.

PART I INTERPRETATIONS 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. “Authority to Substitute” means an authority for the dispensing pharmacist to change a prescribed medicine in accordance with regulation 42(4) of the Medicines Regulations 1984. An authority to substitute letter, which may be used by Practitioners, is available on the ﬁnal page of the Schedule. “Bulk Supply Order” means a written order, on a form supplied by the Ministry of Health, or approved by the Ministry of Health, 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. “Cancer Exceptional Circumstances” means the policies and criteria administered by PHARMAC relating to the ability to fund, from a DHB hospital’s own budget, pharmaceuticals for the treatment of cancer that are not identiﬁed as Pharmaceutical

SECTION A: GENERAL RULES

Cancer Treatments in Sections A-H of the Pharmaceutical Schedule. “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 for 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, where any of a), b) or c) apply. a) All of the following conditions are met: i) the Community Pharmaceutical has been prescribed for a patient who: 1) is not a resident in a Penal Institution, Rest Home or Residential Disability Care Institution; and 2) either of the following: i) in the opinion of the prescribing Practitioner is: a) frail; or b) inﬁrm; or c) unable to manage their medication without additional support; or d) intellectually impaired; or e) requires close monitoring due to recent initiation onto, or dose change for, the Community Pharmaceutical (applicable to the patient’s ﬁrst changed Prescription only); and f) requires that Community Pharmaceutical to be dispensed in a smaller quantity than that for which it is currently funded, or ii) the Community Pharmaceutical is any of the following: a) a tri-cyclic antidepressant; or b) an antipsychotic; or c) a benzodiazepine; or d) a Class B Controlled Drug; and ii) the prescribing Practitioner has: A) endorsed each Community Pharmaceutical on the Prescription clearly with the words “Close Control” or “CC”; and B) initialled the endorsement in their own handwriting; and C) speciﬁed the maximum quantity or period of supply to be dispensed at any one time. b) All of the following conditions are met: i) The Community Pharmaceutical is prescribed for a patient who is a resident in a Rest Home or Residential Disability Care Institution; and A) the quantity or period of supply to be dispensed at any one time is not less than 28 days’ supply; and B) the prescriber or pharmacist has written the name of the Rest Home or Residential Disability Care Institution on the prescription; and C) the prescriber or pharmacist has: 1) written on the Prescription the words “Close Control” or “CC” (this applies to all medicines prescribed on the prescription), and 2) initialled the endorsement/annotation in their own handwriting; and 3) speciﬁed the maximum quantity or period of supply to be dispensed at any one time. c) All of the following conditions are met: i) where PHARMAC has approved and notiﬁed pharmacists to annotate prescriptions for a speciﬁed Community Pharmaceutical(s) “Close Control”without prescriber endorsement for a speciﬁed time; and ii) the dispensing pharmacist has: A) clearly annotated each of the approved Community Pharmaceuticals that appear on the prescription with the words “Close Control” or “CC”; and B) initialled the annotation in their own handwriting; and C) speciﬁed the maximum quantity or period of supply to be dispensed at any one time, as speciﬁed by PHARMAC at the time of notiﬁcation. “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

SECTION A: GENERAL RULES

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 Care Operator” means a person for the time being in charge of providing hospital care, in accordance with the Health and Disability Services (Safety) Act 2001. “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 Circumstances. “Hospital Pharmaceuticals” means National Contract Pharmaceuticals, DV Pharmaceuticals, Discretionary Community Supply Pharmaceuticals and Assessed Pharmaceuticals. “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 person on the Prescription of a Practitioner. “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;

SECTION A: GENERAL RULES

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. For the purposes of this deﬁnition, a “specialist” means a doctor who holds a current annual practicing certiﬁcate and who satisﬁes the criteria set out in paragraphs (a) or (b) or (c) of the deﬁnitions of Specialist below. “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 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 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. “Optometrist” means a person registered as an optometrist with the Optometrists and Dispensing Opticians Board, who holds a current annual practising certiﬁcate under the HPCA Act 2003, and who is authorised by regulations under the Medicines Act 1981 and approved by the Optometrists and Dispensing Opticians Board to prescribe speciﬁed medicines. “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. “PCT” means Pharmaceutical Cancer Treatment in respect of which DHB hospital pharmacies and other Contractors can claim Subsidies. “PCT only” means Pharmaceutical Cancer Treatment in respect of which only DHB hospital pharmacies can claim Subsi-

SECTION A: GENERAL RULES

dies. “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 Treatment” means Pharmaceuticals for the treatment of cancer, listed in Sections A to G of the Schedule and identiﬁed therein as a “PCT” or “PCT only” Pharmaceutical 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, a Nurse Prescriber or an Optometrist 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 the Ministry of Health, 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 supplied on a Prescription, or Practitioner’s Supply Order, signed by a Specialist. For the purposes of this deﬁnition, a “specialist” means a doctor who holds a current annual practicing certiﬁcate and who satisﬁes the criteria set out in paragraphs (a) or (b) or (c) of the deﬁnitions of Specialist below. “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 A: GENERAL RULES

“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 and Assessed Pharmaceuticals 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. “Special Authority” means that the Community Pharmaceutical or Pharmaceutical Cancer Treatment 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, oral and maxillofacial surgery, 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. For the purposes of a DHB hospital pharmacy claiming for Pharmaceutical Cancer Treatments, Subsidy refers to any payment made to the DHB hospital pharmacy or service provider to which that pharmacy serves, and does not relate to a speciﬁc payment that might be made on submission of a claim. “Supply Order” means a Bulk Supply Order, a Practitioner’s Supply Order or a Wholesale Supply Order. “Unapproved Indication” means, for a Pharmaceutical, an indication for which it is not approved under the Medicines Act 1981. Practitioners prescribing Pharmaceuticals for Unapproved Indications should be aware of, and comply with, their obligations under Section 25 and/or Section 29 of the Medicines Act 1981 and as set out in Section A: General Rules, Part IV (Miscellaneous Provisions) rule 4.6. “Wholesale Supply Order” means a written order by a Practitioner, on a form supplied by the Ministry of Health for the 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:

SECTION A: GENERAL RULES

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; 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

SECTION A: GENERAL RULES

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’, Nurse Prescribers’ and Optometrists’ Prescriptions (other than oral contraceptives) The following provisions apply to all Prescriptions, other than those for an oral contraceptive, written by a Doctor, Midwife, Nurse Prescriber or Optometrist: 3.1.1 For a Community Pharmaceutical other than a Class B Controlled Drug, only a quantity suffcient 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, for a Doctor, Midwife or Nurse Prescriber and 3.1.7 for an Optometrist, where a practitioner 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

SECTION A: GENERAL RULES

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: a) is stable for a limited period only, and the Doctor, Midwife, Nurse Prescriber or Optometrist 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

SECTION A: GENERAL RULES

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 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 be paid for the amount prescribed or ordered by the Practitioner in accordance with either clause 3.1 or clause 3.3 of the Schedule, and for the balance of any pack or packs from which the Community Pharmaceutical has been dispensed. At the time of dispensing the Contractor must keep a record of the quantity discarded. To ensure wastage is reduced, the Contractor should reduce the amount dispensed to make it equal to the quantity contained in a whole pack where: a) the difference the amount dispensed and the amount prescribed by the Practitioner is less than 10% (eg; if a prescription is for 105 mls then a 100ml pack would be dispensed); and b) in the reasonable opinion of the Contractor the difference would not affect the efﬁcacy of the course of treatment prescribed by the Practitioner. Note: For the purposes of audit and compliance it is an act of fraud to claim wastage and then use the wastage amount for any subsequent prescription.

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 unless all the requirements in Section B, C or D of the Schedule applicable to that pharmaceutical are met. 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 Hospital Care Operator. 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

SECTION A: GENERAL RULES

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. (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: a) the Practitioner’s Supply Order is made on a form supplied for that purpose by the Ministry of Health, or approved by the Ministry of Health and which: i) is personally signed and dated by the Practitioner; and ii) sets out the Practitioner’s address; and iii) sets out the Community Pharmaceuticals and quantities, and; b) all the requirements of Sections B and C of the Schedule applicable to that pharmaceutical are met. 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 the

SECTION A: GENERAL RULES

Ministry of Health’s routine auditing procedures. 4.5 Pharmaceutical Cancer Treatments 4.5.1 DHBs must provide access to Pharmaceutical Cancer Treatments by funding their use in the treatment of cancers in their DHB hospitals, and/or in association with Outpatient services provided in their DHB hospitals. 4.5.2 DHBs must only provide access to Pharmaceuticals for the treatment of cancer that are listed as Pharmaceutical Cancer Treatments in Sections A to G of the Schedule, provided that DHBs may provide access to an unlisted pharmaceutical for the treatment of cancer where that unlisted pharmaceutical: a) has Cancer Exceptional Circumstances approval; b) has Community Exceptional Circumstances or Hospital Exceptional Circumstances approval; c) is being used as part of a bona ﬁde clinical trial which has Ethics Committee approval; d) is being used and funded as part of a paediatric oncology service; or e) was being used to treat the patient in question prior to 1 July 2005. 4.5.3 A DHB hospital pharmacy that holds a claiming agreement for Pharmaceutical Cancer Treatements with the Funder may claim a Subsidy for a Pharmaceutical Cancer Treatment marked as “PCT” or “PCT only” in Sections A to G of this Schedule subject to that Pharmaceutical Cancer Treatment being dispensed in accordance with: a) Part 1; b) clauses 2.1 to 2.3; c) clauses 3.1 to 3.4; and d) clause 4.5, of Section A of the Schedule 4.5.4 A Contractor (other than a DHB hospital pharmacy) may only claim a Subsidy for a Pharmaceutical Cancer Treatment marked as “PCT” in Sections A to G of the Schedule subject to that Pharmaceutical Cancer Treatment being dispensed in accordance with the rules applying to Sections A to G of the Schedule. 4.5.5 Some indications for Pharmaceutical Cancer Treatments listed in the Schedule are Unapproved Indications. Some of these formed part of the October 2001 direction from the Minister of Health as to pharmaceuticals and indications for which DHBs must provide funding. As far as reasonably practicable, these Unapproved Indications are marked in the Schedule. However, PHARMAC makes no representation and gives no guarantee as to the accuracy of this information. Practitioners prescribing Pharmaceutical Cancer Treatments for such Unapproved Indications should: a) be aware of and comply with their obligations under sections 25 and 29 of the Medicines Act 1981, as applicable, and otherwise under the Medicines Act and the Medicines Regulations 1984; b) be aware of and comply with their obligations under the Health and Disability Comissioner’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, judgement, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical Cancer Treatment or a Pharmaceutical Cancer Treatment for an Unapproved Indication. 4.6 Practitioners prescribing unapproved Pharmaceuticals Practitioners should, where possible, prescribe Pharmaceuticals that are approved under the Medicines Act 1981. However, the access criteria under which a Pharmaceutical is listed on the Pharmaceutical Schedule may: a) in some case, explicitly permit Government funded access to a Pharmaceutical that is not approved under the Medicines Act 1981 or for an Unapproved Indication; or b) not explicitly preclude Government funded access to a Pharmaceutical when it is used for an Unapproved Indication; Accordingly, if Practitioners are planning on prescribing an unapproved Pharmaceutical or a Pharmaceutical for an Unapproved Indication, Practitioners should: a) be aware of and comply with their obligations under sections 25 and 29 of the Medicines Act 1981, as applicable, 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 Unapproved Indication.

SECTION A: GENERAL RULES

Practitioners should be aware that simply by listing a Pharmaceutical on the Pharmaceutical Schedule PHARMAC makes no representations about whether that Pharmaceutical has any form of approval or consent under, or whether the supply or use of the Pharmaceutical otherwise complies with, the Medicines Act 1981. Further, the Pharmaceutical Schedule does not constitute an advertisement, advertising material or a medical advertisement as deﬁned in the Medicines Act or otherwise. Substitution Where a Practitioner has prescribed a brand of a Community Pharmaceutical that has no Subsidy or has a Manufacturer’s Price that is greater than the Subsidy and there is an alternative fully subsidised Community Pharmaceutical available, a Contractor may dispense the fully subsidised Community Pharmaceutical, subject to: a) the Contractor having received a general Authority to Substitute from the Practitioner in relation to the particular medicine or medicines in general; or b) the Practitioner having indicated their Authority to Substitute on the prescription; or c) the Practitioner having given their Authority to Substitute in relation to the particular prescription. Such an Authority to Substitute is valid whether or not there is a ﬁnancial implication for the Pharmaceutical Budget. When dispensing a subsidised alternative brand, the Contractor must annotate and initial the prescription. Alteration to Presentation of Pharmaceutical Dispensed A Contractor, when dispensing a Community Pharmaceutical, may alter the presentation of a Pharmaceutical dispensed but may not alter the total daily dose. If the change will result in additional cost to the DHBs, then: a) the Practitioner must authorise and initial the alteration; or b) in cases where PHARMAC has approved and notiﬁed in writing such a change in dispensing of a named Pharmaceutical due to an out of stock event or short supply, the Contractor must annotate and initial the alteration. 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. 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.

4.7

4.8

4.9

4.10

SECTION B: ALIMENTARY TRACT AND METABOLISM

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

Antacids and Antiﬂatulants Antacids and Reﬂux Barrier Agents

ALGINIC ACID Sodium alginate 225 mg and magnesium alginate 87.5 mg per sachet ....................................................................................4.50

Gaviscon Infant

CALCIUM CARBONATE WITH AMINOACETIC ACID F Tab 420 mg with aminoacetic acid 180 mg – Higher subsidy of $6.30 per 100 with Endorsement..............................................3.00 100 (6.30) Titralac Additional subsidy by endorsement is available for pregnant women. The prescription must be endorsed accordingly. SIMETHICONE F Oral liq aluminium hydroxide 200 mg with magnesium hydroxide 200 mg and activated simethicone 20 mg per 5 ml ...............1.50 500 ml (4.26) Mylanta P SODIUM ALGINATE F Tab 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg - peppermint ﬂavour .......................................1.80 (8.60) F Oral liq 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg per 10 ml ........................................................1.50 (4.95) F Oral liq 500 mg with sodium bicarbonate 267 mg per 10 ml (aniseed) ......................................................................................1.50 (8.64)

60 Gaviscon Double Strength 500 ml Acidex 500 ml Gaviscon

Phosphate Binding Agents

ALUMINIUM HYDROXIDE Tab 600 mg .......................................................................................12.56 100

Alu-Tab

Antidiarrhoeals Agents Which Reduce Motility

DIPHENOXYLATE HYDROCHLORIDE WITH ATROPINE SULPHATE F Tab 2.5 mg with atropine sulphate 25 µg ............................................3.90 LOPERAMIDE HYDROCHLORIDE – Up to 30 tab available on a PSO F Tab 2 mg ...........................................................................................11.50 100 400

Diastop Nodia

Rectal and Colonic Anti-inﬂammatories

BUDESONIDE Cap 3 mg – Special Authority see SA0913 on the next page – Retail pharmacy ................................................................... 166.50

Entocort CIR

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

ALIMENTARY TRACT AND METABOLISM

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

¾SA0913 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 3 months where the treatment remains appropriate and the patient is beneﬁting from treatment. The patient may not have had 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 (14 applications) ................................21.10 21.1 g OP Colifoam MESALAZINE Tab 400 mg .......................................................................................49.50 Tab long-acting 500 mg ....................................................................69.06 Enema 1 g per 100 ml ......................................................................45.96 Suppos 500 mg ................................................................................25.20 Suppos 1 g .......................................................................................50.96 OLSALAZINE Tab 500 mg .......................................................................................59.86 Cap 250 mg ......................................................................................31.51 SODIUM CROMOGLYCATE Cap 100 mg ......................................................................................89.21 SULPHASALAZINE F Tab 500 mg .........................................................................................8.42 F Tab EC 500 mg ...................................................................................9.44 100 100 7 20 28 100 100 100 100 100

Asacol Pentasa Pentasa Asacol Pentasa Dipentum Dipentum Nalcrom Salazopyrin Salazopyrin EN

Antihaemorrhoidals Corticosteroids

FLUOCORTOLONE CAPROATE WITH FLUOCORTOLONE PIVALATE AND CINCHOCAINE Oint 950 µg, with ﬂuocortolone pivalate 920 µg, and cinchocaine hydrochloride 5 mg per g ............................................. 6.35 30 g OP Suppos 630 µg, with ﬂuocortolone pivalate 610 µg, and cinchocaine hydrochloride 1 mg ....................................................... 2.66 12

Ultraproct Ultraproct

Soothing Agents

ZINC OXIDE Oint zinc oxide with balsam peru ........................................................4.50 (6.67) Suppos zinc oxide with balsam peru ..................................................4.47 (6.49) 50 g OP Anusol 12 Anusol

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

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

Antispasmodics and Other Agents Altering Gut Motility

ATROPINE SULPHATE F Inj 600 µg, 1 ml – Up to 5 inj available on a PSO .............................26.00 F Inj 1200 µg, 1 ml – Up to 5 inj available on a PSO ...........................32.00 HYOSCINE N-BUTYLBROMIDE F Tab 10 mg ...........................................................................................1.62 F Inj 20 mg, 1 ml – Up to 5 inj available on a PSO ................................8.04 MEBEVERINE HYDROCHLORIDE F Tab 135 mg .......................................................................................18.00 50 50 20 5 90

AstraZeneca AstraZeneca Gastrosoothe Buscopan Colofac

Antiulcerants Antisecretory and Cytoprotective

MISOPROSTOL F Tab 200 µg ........................................................................................52.70 120

Cytotec

Helicobacter Pylori Eradication

OMEPRAZOLE, AMOXYCILLIN AND CLARITHROMYCIN Omeprazole cap 20 mg × 14, amoxycillin cap 500 mg × 28 and clarithromycin tab 500 mg × 14 .......................................... 55.00

1 OP

Losec Hp7 OAC

H2 Antagonists

CIMETIDINE – Only on a prescription F Tab 200 mg .........................................................................................5.00 (7.50) F Tab 400 mg .......................................................................................10.00 (12.00) FAMOTIDINE – Only on a prescription F Tab 20 mg ...........................................................................................8.10 F Tab 40 mg .........................................................................................11.35 RANITIDINE HYDROCHLORIDE – Only on a prescription F Tab 150 mg .........................................................................................7.99 F Tab 300 mg .......................................................................................10.94 F Oral liq 150 mg per 10 ml ...................................................................7.95 F Inj 25 mg per ml, 2 ml .........................................................................8.75 100 Apo-Cimetidine 100 Apo-Cimetidine 250 250 250 250 300 ml 5

Famox Famox Arrow-Ranitidine Arrow-Ranitidine Peptisoothe Zantac

Proton Pump Inhibitors

LANSOPRAZOLE F Cap 15 mg ..........................................................................................4.30 F Cap 30 mg ..........................................................................................8.59 28 28

Solox Solox

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

ALIMENTARY TRACT AND METABOLISM

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

OMEPRAZOLE For omeprazole suspension refer, page 166 F Cap 10 mg ..........................................................................................2.14 F Cap 20 mg ..........................................................................................3.05 F Cap 40 mg ..........................................................................................3.59 F Inj 40 mg ...........................................................................................38.20 PANTOPRAZOLE F Tab 20 mg ...........................................................................................2.24 F Tab 40 mg ...........................................................................................3.36 F Inj 40 mg .............................................................................................8.75

30 30 30 5

Dr Reddy’s

Omeprazole

Dr Reddy’s

Omeprazole

Dr Reddy’s

Omeprazole

Dr Reddy’s

Omeprazole

28 28 1

Dr Reddy’s

Pantoprazole

Dr Reddy’s

Pantoprazole

Pantocid IV

Site Protective Agents

SUCRALFATE Tab 1 g ..............................................................................................35.50 (48.28) 120 Carafate

Diabetes Hyperglycaemic Agents

GLUCAGON HYDROCHLORIDE Inj 1 mg syringe kit – Up to 5 kit available on a PSO........................27.00 1

Glucagen Hypokit

Insulin - Short-acting Preparations

INSULIN NEUTRAL L Inj human 100 u per ml .....................................................................25.26 L Inj human 100 u per ml, 3 ml ............................................................42.66 10 ml OP 5

Actrapid Humulin R Actrapid Penﬁll Humulin R

Insulin - Intermediate-acting Preparations

INSULIN ISOPHANE L Inj human 100 u per ml .....................................................................17.68 L Inj human 100 u per ml, 3 ml ............................................................29.86 INSULIN ISOPHANE WITH INSULIN NEUTRAL L Inj human with neutral insulin 100 u per ml ......................................25.26 L Inj human with neutral insulin 100 u per ml, 3 ml .............................42.66 10 ml OP 5

Humulin NPH Protaphane Humulin NPH Protaphane Penﬁll Humulin 30/70 Mixtard 30 Humulin 30/70 PenMix 30 PenMix 40 PenMix 50

10 ml OP 5

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

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

INSULIN LISPRO WITH INSULIN LISPRO PROTAMINE L Inj lispro 25% with insulin lispro protamine 75% 100 u per ml, 3 ml ............................................................................................ 52.15 L Inj lispro 50% with insulin lispro protamine 50% 100 u per ml,3 ml ............................................................................................... 52.15

5 5

Humalog Mix 25 Humalog Mix 50

Insulin - Long-acting Preparations

INSULIN GLARGINE – Special Authority see SA0834 below – Retail pharmacy L Inj 100 u per ml, 10 ml ......................................................................63.00 L Inj 100 u per ml, 3 ml ........................................................................94.50 L Inj 100 u per ml, 3 ml disposable pen ...............................................94.50 1 5 5

Lantus Lantus Lantus SoloStar

¾SA0834 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Both: 1.1 Patient has type 1 diabetes and has received an intensive regimen (injections at least three times a day) of an intermediate acting insulin in combination with a rapid acting insulin analogue for at least three months; and 1.2 Either: 1.2.1 Patient has experienced more than one unexplained severe hypoglycaemic episode in the previous 12 months (severe deﬁned as requiring the assistance of another person); or 1.2.2 Patient has experienced unexplained symptomatic nocturnal hypoglycaemia, biochemically documented at <3.0 mmol/L, more than once a month despite optimal management; or 2 Patient has documented severe, or continuing, systemic or local allergic reaction to existing insulins. Note this does not include hypoglycaemic episodes. Renewal only from a relevant specialist or general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Patient is continuing to derive beneﬁt due to reduced hypoglycaemic events whilst maintaining similar or better glycaemic control; or 2 Patient’s allergic reaction has signiﬁcantly decreased, or resolved, following the change to long-acting insulin and patient is continuing to beneﬁt from treatment.

Insulin - Rapid Acting Preparations

INSULIN ASPART L Inj 100 u per ml, 3 ml ........................................................................51.19 L Inj 100 u per ml, 10 ml ......................................................................30.03 INSULIN LISPRO L Inj 100 u per ml, 10 ml ......................................................................34.92 L Inj 100 u per ml, 3 ml ........................................................................59.52 5 1 10 ml OP 5

NovoRapid Penﬁll NovoRapid Humalog Humalog

Alpha Glucosidase Inhibitors

ACARBOSE – Special Authority see SA0925 on the next page – Retail pharmacy F Tab 50 mg .........................................................................................16.50 F Tab 100 mg .......................................................................................26.70 90 90

Glucobay Glucobay

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

ALIMENTARY TRACT AND METABOLISM

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

¾SA0925 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 The patient has type 2 diabetes; and 2 Either: 2.1 Metformin is not tolerated, or is contraindicated; or 2.2 The patient has not responded to the maximum appropriate dose of metformin.

Oral Hypoglycaemic Agents

GLIBENCLAMIDE F Tab 2.5 mg .........................................................................................3.78 F Tab 5 mg ............................................................................................3.31 5.00 (Gliben Tab 2.5 mg to be delisted 1 February 2010) (Gliben Tab 5 mg to be delisted 1 February 2010) GLICLAZIDE F Tab 80 mg .........................................................................................22.24 GLIPIZIDE F Tab 5 mg .............................................................................................3.50 METFORMIN HYDROCHLORIDE F Tab 500 mg .........................................................................................9.75 F Tab 850 mg .........................................................................................8.00 PIOGLITAZONE – Special Authority see SA0959 below – Retail pharmacy Tab 15 mg ...........................................................................................2.61 45.78 Tab 30 mg ...........................................................................................5.23 70.43 Tab 45 mg ...........................................................................................7.80 89.39 (Actos Tab 15 mg to be delisted 1 December 2009) (Actos Tab 30 mg to be delisted 1 December 2009) (Actos Tab 45 mg to be delisted 1 December 2009) 100 100

Gliben Gliben Daonil

500 100 500 250 28 28 28

Apo-Gliclazide Minidiab Arrow-Metformin Arrow-Metformin Pizaccord Actos Pizaccord Actos Pizaccord Actos

¾SA0959 Special Authority for Subsidy Initial application — (Patients with type 2 diabetes) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Patient has not achieved glycaemic control on maximum doses of metformin and/or a sulphonylurea or where either or both are contraindicated or not tolerated; or 2 Patient is on insulin.

Diabetes Management Glucose/Urine Testing

COPPER F Tab, diagnostic – Not on a BSO .........................................................5.02 (31.80) 36 OP Clinitest

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

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

GLUCOSE OXIDASE Urine diagnostic test – Not on a BSO.................................................4.11 (7.00) Urine diagnostic test with peroxidase – Not on a BSO.......................4.11 (6.26) 4.13 (8.65)

50 strip OP Diabur 5000 50 strip OP Diastix Clinistix

Ketone Testing

GLUCOSE OXIDASE Urine diagnostic test with peroxidase, sodium nitroprusside and aminoacetic acid – Not on a BSO........................................4.53 50 stick OP (8.00) Keto-Diabur 5000 Urine diagnostic test with peroxidase, potassium iodide, sodium nitroprusside and aminoacetic acid – Not on a BSO...........................................................................................4.53 50 strip OP (14.87) Keto-Diastix (Keto-Diabur 5000 Urine diagnostic test with peroxidase, sodium nitroprusside and aminoacetic acid to be delisted 1 December 2009) (Keto-Diastix Urine diagnostic test with peroxidase, potassium iodide, sodium nitroprusside and aminoacetic acid to be delisted 1 December 2009) KETONE BLOOD BETA-KETONE ELECTRODES Patient has type 1 diabetes and has had one or more episodes of ketoacidosis (excluding ﬁrst presentation). Maximum quantity of 2 packs per annum. No further prescriptions will be subsidised. Test strip – Not on a BSO...................................................................8.50 10 strip OP Optium Blood Ketone Test Strips SODIUM NITROPRUSSIDE F Test strip – Not on a BSO.................................................................14.14 F Urine diagnostic strips, buffered – Not on a BSO..............................3.39 (6.00) 3.40 (10.94) (Ketur-Test Urine diagnostic strips, buffered to be delisted 1 December 2009) (Ketostix Urine diagnostic strips, buffered to be delisted 1 December 2009) 20 strip OP 50 strip OP

Ketostix

Ketur-Test Ketostix

Blood Glucose Testing

BLOOD GLUCOSE DIAGNOSTIC TEST METER – Subsidy by endorsement a) Maximum of 1 meter per prescription b) 1) A diagnostic blood glucose test meter is subsidised for patients who begin insulin or sulphonylurea therapy after 1 March 2005 or is prescribed for a pregnant woman with diabetes. 2) Only one meter per patient. No further prescriptions will be subsidised. The prescription must be endorsed accordingly. Meter ..................................................................................................9.00 1 FreeStyle Lite Optium Xceed 19.00 Accu-Chek Performa

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

ALIMENTARY TRACT AND METABOLISM

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

BLOOD GLUCOSE DIAGNOSTIC TEST STRIP The number of test strips available on a prescription is restricted to 50 unless: 1) Prescribed with insulin or a sulphonylurea but are on a different prescription and the prescription is endorsed accordingly; or 2) Prescribed on the same prescription as insulin or a sulphonylurea in which case the prescription is deemed to be endorsed; or 3) Prescribed for a pregnant woman with diabetes and endorsed accordingly. SensoCard blood glucose test strips are subsidised only if prescribed for a patient who is severely visually impaired and is using a SensoCard Plus Talking Blood Glucose Monitor. Blood glucose test strips ..................................................................21.65 50 test OP FreeStyle Lite Optium 5 second test 22.00 Accu-Chek Performa Optium 10 second test 26.20 SensoCard (Optium 10 second test Blood glucose test strips to be delisted 1 September 2009)

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. INSULIN PEN NEEDLES – Maximum of 100 dev per prescription F 29 g × 12.7 mm ................................................................................10.50 100 ABM B-D Micro-Fine F 31 g × 5 mm .....................................................................................13.09 100 B-D Micro-Fine F 31 g × 6 mm .....................................................................................10.50 100 ABM (26.00) NovoFine F 31 g × 8 mm .....................................................................................10.50 100 ABM B-D Micro-Fine INSULIN SYRINGES, DISPOSABLE WITH ATTACHED NEEDLE – Maximum of 100 dev per prescription F Syringe 0.3 ml with 29 g × 12.7 mm needle ....................................13.00 100 ABM B-D Ultra Fine F Syringe 0.3 ml with 31 g × 8 mm needle .........................................13.00 100 ABM B-D Ultra Fine II F Syringe 0.5 ml with 29 g × 12.7 mm needle ....................................13.00 100 ABM B-D Ultra Fine F Syringe 0.5 ml with 31 g × 8 mm needle .........................................13.00 100 ABM B-D Ultra Fine II F Syringe 1 ml with 29 g × 12.7 mm needle .......................................13.00 100 ABM B-D Ultra Fine F Syringe 1 ml with 31 g × 8 mm needle ............................................13.00 100 ABM B-D Ultra Fine II

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

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

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 25,000 BP u lipase, 22,500 BP u amylase, 1,250 BP u protease – Retail pharmacy-Specialist ................... 94.40

300 300 300 250 100 100 100

Pancrex V Pancrex V Forte Pancrex V Cotazym ECS Creon 10000 Creon Forte Panzytrat Actigall

URSODEOXYCHOLIC ACID – Special Authority see SA0914 below – Retail pharmacy Cap 300 mg ....................................................................................179.00 100

¾SA0914 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 2 years where 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 F Dry ......................................................................................................5.72 6.69 7.92 (12.71) 8.80 (16.49) F Dry-original ﬂavour, regular texture only .............................................5.91 (12.38) F Sugar Free ..........................................................................................4.84 (10.60) 325 g OP 380 g OP 450 g OP 500 g OP Normacol 336 g OP Metamucil 275 g OP Mucilax

Konsyl-D Mucilax

Isogel

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

ALIMENTARY TRACT AND METABOLISM

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

MUCILAGINOUS LAXATIVES WITH STIMULANTS F Dry ......................................................................................................3.52 (7.69) 8.80 (16.49)

200 g OP Normacol Plus 500 g OP Normacol Plus

Faecal Softeners

DOCUSATE SODIUM – Only on a prescription F Tab 50 mg ...........................................................................................4.89 F Tab 120 mg .........................................................................................6.73 F Enema conc 18% ...............................................................................5.40 DOCUSATE SODIUM WITH SENNOSIDES F Tab 50 mg with total sennosides 8 mg ...............................................7.98 POLOXAMER – Only on a prescription F Oral drops 10% ...................................................................................3.78 100 100 100 ml OP 200 30 ml OP

Coloxyl Coloxyl Coloxyl Laxsol Coloxyl

Osmotic Laxatives

GLYCEROL F Suppos 2.55 g – Only on a prescription ............................................3.12 F Suppos 3.6 g – Only on a prescription ...............................................5.00 (Fleet Glycerin Suppositories Suppos 2.55 g to be delisted 1 September 2009) LACTULOSE – Only on a prescription F Oral liq 10 g per 15 ml ........................................................................6.65 MACROGOL 3350 – Special Authority see SA0891 below – Retail pharmacy Powder 13.125 g, sachets – Maximum of 60 sach per prescription ......................................................................................18.14 12 20

Fleet Glycerin

Suppositories

PSM

1,000 ml

Duphalac

Movicol

¾SA0891 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months where the patient has problematic constipation requiring intervention with a per rectal preparation despite an adequate trial of other oral pharmacotherapies including lactulose where lactulose is not contraindicated. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is compliant and is continuing to gain beneﬁt from treatment. SODIUM ACID PHOSPHATE – Only on a prescription Enema 16% with sodium phosphate 8% ............................................2.50 1 Fleet Phosphate Enema 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

Microlax

Stimulant Laxatives

BISACODYL – Only on a prescription F Tab 5 mg .............................................................................................5.09 F Suppos 5 mg ......................................................................................2.35 (3.00) F Suppos 10 mg ....................................................................................3.96 200 6 12

Lax-Tabs

Dulcolax

Fleet

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

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

SENNA – Only on a prescription F Tab, standardised ...............................................................................2.17 (6.16)

100 Senokot

Metabolic Disorder Agents Gaucher’s Disease

IMIGLUCERASE – Special Authority see SA0473 below – Hospital pharmacy [HP1] Inj 40 iu per ml, 200 iu vial ...........................................................1,072.00 1

Cerezyme

¾SA0473 Special Authority for Subsidy Special Authority approved by the Gaucher’s Treatment Panel Notes: Subject to a budgetary cap. Applications will be considered and approved subject to funding availability. Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Co-ordinator, Gaucher’s Treatment Panel Phone: (04) 460 4990 PHARMAC, PO Box 10 254 Facsimile: (04) 916 7571 Wellington Email: gaucherpanel@pharmac.govt.nz

Mouth and Throat Agents Used in Mouth Ulceration

BENZYDAMINE HYDROCHLORIDE Soln 0.15% .........................................................................................9.00 (15.36) CHLORHEXIDINE GLUCONATE Mouthwash 0.2% ................................................................................3.06 CHOLINE SALICYLATE WITH CETALKONIUM CHLORIDE F Adhesive gel 8.7% with cetalkonium chloride 0.01% .........................2.06 (5.25) SODIUM CARBOXYMETHYLCELLULOSE With pectin and gelatin paste ...........................................................17.20 1.52 (3.60) 4.55 (7.90) With pectin and gelatin powder ..........................................................8.48 (10.95) TRIAMCINOLONE ACETONIDE 0.1% in Dental Paste USP ..................................................................4.38 500 ml Difﬂam 200 ml OP 15 g OP Bonjela 56 g OP 5 g OP 15 g OP Orabase 28 g OP Stomahesive 5 g OP

Orion

Stomahesive

Orabase

Oracort

Oropharyngeal Anti-infectives

AMPHOTERICIN B Lozenges 10 mg .................................................................................5.86 MICONAZOLE Oral gel 20 mg per g ...........................................................................8.70 NYSTATIN Oral liq 100,000 u per ml ....................................................................3.19 20 40 g OP 24 ml OP

Fungilin Daktarin Nilstat

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

ALIMENTARY TRACT AND METABOLISM

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

Other Oral Agents

For folinic mouthwash, pilocarpine oral liquid or saliva substitute formula refer, page 166 HYDROGEN PEROXIDE F Soln 10 vol – Maximum of 200 ml per prescription.............................1.28 100 ml THYMOL GLYCERIN F Compound, BPC .................................................................................9.15 500 ml

PSM PSM

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 (5.51)

10 ml OP Vitadol C

Vitamin B Group

HYDROXOCOBALAMIN F Inj 1 mg per ml, 1 ml – Up to 6 inj available on a PSO .......................9.21 10.84 PYRIDOXINE HYDROCHLORIDE a) No more than 100 mg per dose b) Only on a prescription F Tab 25 mg – No patient co-payment payable .....................................3.06 F Tab 50 mg .........................................................................................17.63 THIAMINE HYDROCHLORIDE – Only on a prescription F Tab 50 mg ...........................................................................................5.62 VITAMIN B COMPLEX F Tab, strong, BPC ..............................................................................12.10 3

ABM

Hydroxocobalamin

Neo-B12

90 500 100 500

Healtheries Apo-Pyridoxine Apo-Thiamine Apo-B-Complex

Vitamin C

ASCORBIC ACID a) No more than 100 mg per dose b) Only on a prescription F Tab 100 mg .......................................................................................17.25

500

Apo-Ascorbic Acid

Vitamin D

ALFACALCIDOL Cap 0.25 µg ......................................................................................26.32 Cap 1 µg ...........................................................................................87.98 Oral drops 2 µg per ml ......................................................................60.68 CALCITRIOL F Cap 0.25 µg ......................................................................................13.45 F Cap 0.5 µg ........................................................................................24.95 F Oral liq 1 µg per ml ...........................................................................39.40 CHOLECALCIFEROL F Tab 1.25 mg (50,000 iu) – Maximum of 12 tab per prescription .........10.35

fully subsidised [HP1], [HP3], [HP4] refer page 8

100 100 20 ml OP 100 100 10 ml OP 12

One-Alpha One-Alpha One-Alpha Calcitriol-AFT Calcitriol-AFT Rocaltrol solution Cal-d-Forte

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

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

Vitamin E

ALPHA TOCOPHERYL ACETATE – Special Authority see SA0915 below – Hospital pharmacy [HP3] Water solubilised soln 156 iu/ml, with calibrated dropper .................18.30 50 ml OP Micelle E ¾SA0915 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Multivitamin Preparations

MULTIVITAMINS – Special Authority see SA0963 below – Retail pharmacy Tab ....................................................................................................19.65 Powder ..............................................................................................36.00 Oral liq ..............................................................................................13.50 100 100 g OP 150 ml OP

Ketovite Paediatric Seravit Ketovite Liquid

¾SA0963 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 The patient has inborn errors of metabolism; or 2 For use as a supplement to a ketogenic diet in patients diagnosed with epilepsy. Note: Use of Paediatric Seravit is not recommended as a supplement to a ketogenic diet. VITAMINS F Tab (BPC cap strength) ....................................................................14.80 1,000 Healtheries Multi-vitamin tablets

Minerals Calcium

CALCIUM F Tab eff 1 g (elemental) ........................................................................6.54 CALCIUM CARBONATE F Tab 1.25 g ...........................................................................................9.18 F Tab 1.5 g ...........................................................................................10.33 CALCIUM GLUCONATE F Inj 10%, 10 ml ...................................................................................21.40 30 250 250 10

Calsource Calci-Tab 500 Calci-Tab 600 Mayne

Fluoride

SODIUM FLUORIDE Tab 1.1 mg ..........................................................................................4.00 100

PSM

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

ALIMENTARY TRACT AND METABOLISM

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

Iron

FERROUS FUMARATE Tab 200 mg .........................................................................................4.35 FERROUS FUMARATE WITH FOLIC ACID Tab 310 mg with folic acid 350 µg ......................................................4.75 FERROUS GLUCONATE WITH ASCORBIC ACID F Tab 170 mg with ascorbic acid 40 mg ..............................................12.04 FERROUS SULPHATE F Tab long-acting 325 mg ......................................................................5.06 (15.58) F‡ Oral liq 150 mg per 5 ml ...................................................................10.30 FERROUS SULPHATE WITH FOLIC ACID F Tab long-acting 325 mg with folic acid 350 µg ....................................1.80 (3.73) IRON POLYMALTOSE Inj 50 mg per ml, 2 ml .......................................................................20.95 100 60 500

Ferro-tab Ferro-F-Tabs Healtheries Iron

with Vitamin C

150 Ferro-Gradumet 500 ml 30 Ferrograd-Folic 5

Ferodan

Ferrum H

Magnesium

For magnesium hydroxide mixture refer, page 166 MAGNESIUM SULPHATE Inj 49.3% ...........................................................................................26.60

Mayne

Zinc

ZINC SULPHATE F Cap 220 mg ......................................................................................10.00 100

Zincaps

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

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

Antianaemics Hypoplastic and Haemolytic

¾SA0922 Special Authority for Subsidy Initial application only from a relevant specialist. 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 ≤ 100g/L; and 2 Any of the following: 2.1 Both: 2.1.1 patient is not diabetic; and 2.1.2 glomerular ﬁltration rate ≤ 30ml/min; or 2.2 Both: 2.2.1 patient is diabetic; and 2.2.2 glomerular ﬁltration rate ≤ 45ml/min; or 2.3 patient is on haemodialysis or peritoneal dialysis. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. Notes: 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) × Ideal Body Weight (kg) / 814 × serum creatinine (mmol/l) GFR (ml/min) (female) = Estimated GFR (male) × 0.85 ERYTHROPOIETIN ALPHA – Special Authority see SA0922 above – Hospital pharmacy [HP3] Inj human recombinant 1,000 iu preﬁlled syringe .............................48.68 6 Eprex Inj human recombinant 2,000 iu, preﬁlled syringe ..........................120.18 6 Eprex Inj human recombinant 3,000 iu, preﬁlled syringe ..........................166.87 6 Eprex Inj human recombinant 4,000 iu, preﬁlled syringe ..........................193.13 6 Eprex Inj human recombinant 5,000 iu, preﬁlled syringe ..........................243.26 6 Eprex Inj human recombinant 6,000 iu, preﬁlled syringe ..........................291.92 6 Eprex Inj human recombinant 10,000 iu, preﬁlled syringe ........................395.18 6 Eprex ERYTHROPOIETIN BETA – Special Authority see SA0922 above – Hospital pharmacy [HP3] Inj 2,000 iu, preﬁlled syringe ...........................................................120.18 6 Inj 3,000 iu, preﬁlled syringe ...........................................................166.87 6 Inj 4,000 iu, preﬁlled syringe ...........................................................193.13 6 Inj 5,000 iu, preﬁlled syringe ...........................................................243.26 6 Inj 6,000 iu, preﬁlled syringe ...........................................................291.29 6 Inj 10,000 iu, preﬁlled syringe .........................................................395.18 6

NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon

Megaloblastic

FOLIC ACID F Tab 0.8 mg ........................................................................................16.50 F Tab 5 mg .............................................................................................6.59 Oral liq 50 µg per ml .........................................................................21.05 1,000 500 25 ml OP

Apo-Folic Acid Apo-Folic Acid Biomed

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

BLOOD AND BLOOD FORMING ORGANS

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

Antiﬁbrinolytics, Haemostatics and Local Sclerosants

SODIUM TETRADECYL SULPHATE F Inj 0.5% 2 ml .....................................................................................23.20 (45.52) F Inj 1% 2 ml ........................................................................................25.00 (48.98) F Inj 3% 2 ml ........................................................................................28.50 (55.91) TRANEXAMIC ACID Tab 500 mg .......................................................................................49.14 5 Fibro-vein 5 Fibro-vein 5 Fibro-vein 100

Cyklokapron

Vitamin K

PHYTOMENADIONE Tab 10 mg ...........................................................................................5.60 Inj 2 mg per 0.2 ml – Up to 5 inj available on a PSO..........................8.00 Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................9.21 10 5 5

Konakion Konakion MM Konakion MM

Antithrombotic Agents Antiplatelet Agents

ASPIRIN F Tab 100 mg .......................................................................................16.83 CLOPIDOGREL – Special Authority see SA0867 below – Retail pharmacy Tab 75 mg .........................................................................................35.00 (73.38) 990 28

Ethics Aspirin EC Apo-Clopidogrel

Plavix

¾SA0867 Special Authority for Subsidy Initial application — (aspirin allergic patients) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 The patient is allergic to aspirin (see deﬁnition below); and 2 Any of the following: The patient has: 2.1 suffered from a stroke, or transient ischaemic attack; or 2.2 experienced an acute myocardial infarction; or 2.3 experienced an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours; or 2.4 had a troponin T or troponin I test result greater than the upper limit of the reference range; or 2.5 had a revascularisation procedure; or 2.6 experienced symptomatic peripheral vascular disease of a severity that has required specialist consultation. Note: Aspirin allergy is deﬁned as a history of anaphylaxis, urticaria or asthma within 4 hours of ingestion of aspirin, other salicylates or NSAIDs. Initial application — (aspirin tolerant patients and aspirin naive patients) from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: Any of the following: The patient has: 1 experienced an acute myocardial infarction; or continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

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

continued. . . 2 had an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours; or 3 had a troponin T or troponin I test result greater than the upper limit of the reference range; or 4 had a revascularisation procedure. Initial application — (patients awaiting revascularisation) from any relevant practitioner. Approvals valid for 6 months where the patient is on a waiting list or active review list for stenting, coronary artery bypass grafting, or percutaneous coronary angioplasty following acute coronary syndrome. Initial application — (post stenting) from any relevant practitioner. Approvals valid for 6 months where the patient has had a stent inserted in the previous 4 weeks. Initial application — (documented stent thrombosis) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis.. Renewal — (aspirin tolerant patients) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where while on treatment with aspirin the patient has experienced an additional vascular event following the recent cessation of clopidogrel. Renewal — (acute coronary syndrome - aspirin tolerant patients and aspirin naive patients) from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: Any of the following: The patient has: 1 experienced an acute myocardial infarction; or 2 had an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours; or 3 had a troponin T or troponin I test result greater than the upper limit of the reference range; or 4 had a revascularisation procedure. Renewal — (patients awaiting revascularisation) from any relevant practitioner. Approvals valid for 6 months where the patient is on a waiting list or active review list for stenting, coronary artery bypass grafting or percutaneous coronary angioplasty following acute coronary syndrome. Renewal — (post stenting) from any relevant practitioner. Approvals valid for 6 months where the patient has had a stent inserted in the previous 4 weeks. Renewal — (documented stent thrombosis) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis. DIPYRIDAMOLE F Tab 25 mg ...........................................................................................8.36 84 Persantin F Tab long-acting 150 mg ....................................................................11.52 60 Pytazen SR

Heparin and Antagonist Preparations

ENOXAPARIN SODIUM – Special Authority see SA0975 on the next page – Retail pharmacy Inj 20 mg ...........................................................................................39.20 10 Inj 40 mg ...........................................................................................52.30 10 Inj 60 mg ...........................................................................................78.85 10 Inj 80 mg .........................................................................................105.12 10 Inj 100 mg .......................................................................................135.20 10 Inj 120 mg .......................................................................................168.00 10 Inj 150 mg .......................................................................................192.00 10

Clexane Clexane Clexane Clexane Clexane Clexane Clexane

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

BLOOD AND BLOOD FORMING ORGANS

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

¾SA0975 Special Authority for Subsidy Initial application — (Pregnancy or Malignancy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Low molecular weight heparin treatment is required during a patients pregnancy; or 2 For the treatment of venous thromboembolism where the patient has a malignancy. Initial application — (Venous thromboembolism other than in pregnancy or malignancy) from any relevant practitioner. Approvals valid for 1 month for applications meeting the following criteria: Any of the following: 1 For the short-term treatment of venous thromboembolism prior to establishing a therapeutic INR with oral anti-coagulant treatment; or 2 For the prophylaxis and treatment of venous thromboembolism in high risk surgery; or 3 To enable cessation/re-establishment of existing warfarin treatment pre/post surgery; or 4 For the prophylaxis and treatment of venous thromboembolism in Acute Coronary Syndrome surgical intervention; or 5 To be used in association with cardioversion of atrial ﬁbrillation. Renewal — (Pregnancy or Malignancy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Low molecular weight heparin treatment is required during a patient’s pregnancy; or 2 For the treatment of venous thromboembolism where the patient has a malignancy. Renewal — (Venous thromboembolism other than in pregnancy or malignancy) from any relevant practitioner. Approvals valid for 1 month where low molecular weight heparin treatment or prophylaxis is required for a second or subsequent event (surgery, ACS, cardioversion, or prior to oral anti-coagulation). HEPARIN SODIUM Inj 1,000 iu per ml, 5 ml ....................................................................66.80 50 Mayne Inj 1,000 iu per ml, 35 ml ..................................................................16.00 1 Mayne Inj 5,000 iu per ml, 1 ml ....................................................................14.00 5 Mayne Inj 5,000 iu per ml, 5 ml ....................................................................43.67 10 Multiparin Inj 25,000 iu per ml, 0.2 ml .................................................................9.50 5 Mayne HEPARINISED SALINE F Inj 10 iu per ml, 5 ml .........................................................................18.00 PROTAMINE SULPHATE F Inj 10 mg per ml, 5 ml .......................................................................22.40 (86.54) 50 10 Artex

AstraZeneca

Oral Anticoagulants

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

50 100 50 100 50 100

Coumadin Marevan Coumadin Marevan Coumadin Marevan

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

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

Fluids and Electrolytes Intravenous Administration

DEXTROSE F Inj 50%, 10 ml – Up to 5 inj available on a PSO...............................22.75 F Inj 50%, 90 ml – Up to 5 inj available on a PSO...............................11.25 POTASSIUM CHLORIDE F Inj 75 mg per ml, 10 ml .....................................................................26.00 F Inj 150 mg per ml, 10 ml ...................................................................26.00 5 1 50 50

Biomed Biomed AstraZeneca AstraZeneca

SODIUM BICARBONATE Inj 8.4%, 50ml ...................................................................................19.95 1 Biomed a) Up to 5 inj available on a PSO b) Not in combination Inj 8.4%, 100 ml ................................................................................20.50 1 Biomed a) Up to 5 inj available on a PSO b) Not in combination SODIUM CHLORIDE Inf 0.9% – Up to 2000 ml available on a PSO ....................................3.06 500 ml Baxter 4.06 1,000 ml Baxter 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 packs) Inj 23.4%, 20 ml ................................................................................26.50 5 Biomed Inj 0.9%, 5 ml – Up to 5 inj available on a PSO................................11.50 50 AstraZeneca Inj 0.9%, 10 ml – Up to 5 inj available on a PSO..............................11.50 50 AstraZeneca Inj 0.9%, 20 ml ....................................................................................7.86 20 Multichem 11.79 30 Pharmacia TOTAL PARENTERAL NUTRITION (TPN) – Hospital pharmacy [HP1]-Specialist Infusion .............................................................................................CBS 1 OP

TPN

WATER 1) 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 2) On a bulk supply order; or 3) When used in the extemporaneous compounding of eye drops. Puriﬁed for inj 5 ml – Up to 5 inj available on a PSO ..........................9.31 50 Multichem 10.51 AstraZeneca Puriﬁed for inj 10 ml – Up to 5 inj available on a PSO ......................10.38 50 Multichem 11.32 AstraZeneca Puriﬁed for inj 20 ml – Up to 5 inj available on a PSO ........................5.04 20 Multichem

Oral Administration

CALCIUM POLYSTYRENE SULPHONATE Powder ............................................................................................169.85 COMPOUND ELECTROLYTES Powder for soln for oral use 5 g – Up to 10 sach available on a PSO...........................................................................................2.86 300 g OP

Calcium Resonium

Enerlyte

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

BLOOD AND BLOOD FORMING ORGANS

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

DEXTROSE WITH ELECTROLYTES Soln with electrolytes ..........................................................................6.66

1,000 ml OP

Pedialyte Bubblegum

6.78 POTASSIUM BICARBONATE Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg ......................................................82.50 For phosphate supplementation POTASSIUM CHLORIDE F Tab eff 548 mg (14 m eq) with chloride 285 mg (8 m eq) ...................5.26 (11.85) F Tab long-acting 600 mg ......................................................................5.20 SODIUM POLYSTYRENE SULPHONATE Powder ..............................................................................................89.10

Pedialyte - Fruit Pedialyte - Plain

100

Phosphate-Sandoz

60 Chlorvescent 200 450 g OP

Span-K Resonium-A

Lipid Modifying Agents Fibrates

BEZAFIBRATE F Tab 200 mg .........................................................................................9.75 F Tab long-acting 400 mg ......................................................................5.70 90 30

Fibalip Bezalip Retard

Other Lipid Modifying Agents

ACIPIMOX F Cap 250 mg ......................................................................................18.75 NICOTINIC ACID F Tab 50 mg ...........................................................................................5.08 F Tab 500 mg .......................................................................................17.60 30 100 100

Olbetam Apo-Nicotinic Acid Apo-Nicotinic Acid

Resins

CHOLESTYRAMINE WITH ASPARTAME Sachets 4 g with aspartame .............................................................19.25 (28.88) COLESTIPOL HYDROCHLORIDE Sachets 5 g .......................................................................................16.17 50 Questran-Lite 30

Colestid

HMG CoA Reductase Inhibitors (Statins)

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

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

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

ATORVASTATIN – Additional subsidy by Special Authority see SA0788 below – Retail pharmacy See prescribing guideline on the preceding page F Tab 10 mg ...........................................................................................4.03 30 (18.32) F Tab 20 mg ...........................................................................................5.87 30 (26.70) 30 F Tab 40 mg ...........................................................................................8.14 (37.02) F Tab 80 mg .........................................................................................16.28 30 (110.50)

Lipitor Lipitor Lipitor Lipitor

¾SA0788 Special Authority for Manufacturers Price Initial application only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notiﬁed 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). Notes: 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: G Constipation, ﬂatulence (may occur in >1% of patients) G Asthenia, abdominal pain, headache (may occur in >1% of patients) G Myopathy, rhabdomyolysis (may occur in <3% of patients) G 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. PRAVASTATIN – Special Authority see SA0932 on the next page – Retail pharmacy See prescribing guideline on the preceding page Tab 10 mg .........................................................................................27.46 30 Pravachol Tab 20 mg .........................................................................................42.58 30 Pravachol Tab 40 mg .........................................................................................65.31 30 Pravachol

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

BLOOD AND BLOOD FORMING ORGANS

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

¾SA0932 Special Authority for Subsidy Initial application — (Conﬁrmed HIV/AIDS) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: All of the following: 1 Patient has dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater; and 2 Conﬁrmed HIV infection; and 3 Patient is being treated with an HIV protease inhibitor. SIMVASTATIN – See prescribing guideline on page 44 F Tab 10 mg ...........................................................................................2.05 90 Arrow-Simva 10mg F Tab 20 mg ...........................................................................................3.00 90 Arrow-Simva 20mg F Tab 40 mg ...........................................................................................5.35 90 Arrow-Simva 40mg F Tab 80 mg .........................................................................................11.65 90 Arrow-Simva 80mg

Selective Cholesterol Absorption Inhibitors

EZETIMIBE – Special Authority see SA0796 below – Retail pharmacy Tab 10 mg .........................................................................................57.60 30

Ezetrol

¾SA0796 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Either: 1.1 ezetimibe is to be used in combination with simvastatin; or 1.2 ezetimibe is to be used without a statin; and 2 Either: 2.1 All of the following: 2.1.1 Patient has a calculated absolute risk of cardiovascular disease >20% over 5 years; and 2.1.2 Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day; and 2.1.3 Either: 2.1.3.1 All of the following: 2.1.3.1.1 Patient has venous CABG; and 2.1.3.1.2 LDL cholesterol ≥ 2.0 mmol/litre (see note); and 2.1.3.1.3 LDL cholesterol ≥ 2.0 mmol/litre (at least 1 week after test 1 – see note); or 2.1.3.2 All of the following: 2.1.3.2.1 Patient does not have venous CABG; and 2.1.3.2.2 LDL cholesterol ≥ 2.5 mmol/litre (see note); and 2.1.3.2.3 LDL cholesterol ≥ 2.5 mmol/litre (at least 1 week after test 1 – see note); or 2.2 All of the following: 2.2.1 Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia; and 2.2.2 Patient has been compliant for at least two months with maximum dose statin therapy; and 2.2.3 LDL cholesterol ≥ 5 mmol/litre (see note); and 2.2.4 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: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 ezetimibe is to be used in combination with simvastatin; or 2.2 ezetimibe is to be used without a statin.

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

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

EZETIMIBE WITH SIMVASTATIN – Special Authority see SA0826 below – Retail pharmacy Tab 10 mg with simvastatin 10 mg ...................................................69.00 30 Tab 10 mg with simvastatin 20 mg ...................................................75.00 30 Tab 10 mg with simvastatin 40 mg .................................................103.50 30 Tab 10 mg with simvastatin 80 mg .................................................123.00 30

Vytorin Vytorin Vytorin Vytorin

¾SA0826 Special Authority for Subsidy 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 where the treatment remains appropriate and the patient is beneﬁting from treatment.

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

CARDIOVASCULAR SYSTEM

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

Alpha Adrenoceptor Blockers

DOXAZOSIN MESYLATE F Tab 2 mg ...........................................................................................22.85 F Tab 4 mg ...........................................................................................30.26 PHENOXYBENZAMINE HYDROCHLORIDE F Cap 10 mg ..........................................................................................7.82 PHENTOLAMINE MESYLATE F Inj 10 mg per ml, 1 ml .......................................................................17.97 (31.65) PRAZOSIN HYDROCHLORIDE F Tab 1 mg .............................................................................................5.53 F Tab 2 mg .............................................................................................7.00 F Tab 5 mg ...........................................................................................11.70 TERAZOSIN HYDROCHLORIDE F Tab 1 mg .............................................................................................2.50 F Tab 7 × 1 mg and 7 × 2 mg ...............................................................0.74 F Tab 2 mg ............................................................................................1.30 23.30 F Tab 5 mg ............................................................................................1.62 29.00 (Hytrin Tab 2 mg to be delisted 1 October 2009) (Hytrin Tab 5 mg to be delisted 1 October 2009) 500 500 30 5 Regitine 100 100 100 28 14 OP 28 500 28 500

Apo-Doxazosin Apo-Doxazosin Dibenyline S29

Apo-Prazo Apo-Prazo Apo-Prazo Apo-Terazosin Hytrin Starter Pack Hytrin Apo-Terazosin Hytrin Apo-Terazosin

Agents Affecting the Renin-Angiotensin System

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%.”

ACE Inhibitors

CAPTOPRIL F Tab 12.5 mg ......................................................................................10.40 F Tab 25 mg .........................................................................................13.40 F Tab 50 mg .........................................................................................19.00 F‡ Oral liq 5 mg per ml ..........................................................................51.04 Oral liquid restricted to children under 12 years of age. CILAZAPRIL F Tab 0.5 mg ..........................................................................................2.20 F Tab 2.5 mg ..........................................................................................4.10 F Tab 5 mg .............................................................................................6.01 500 500 500 95 ml OP

Apo-Captopril Apo-Captopril Apo-Captopril Capoten

30 28 28

Inhibace Inhibace Inhibace

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

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

ENALAPRIL F Tab 5 mg .............................................................................................2.19 F Tab 10 mg ...........................................................................................2.76 F Tab 20 mg ...........................................................................................3.68 LISINOPRIL F Tab 5 mg .............................................................................................2.06 F Tab 10 mg ...........................................................................................2.36 F Tab 20 mg ...........................................................................................2.87 PERINDOPRIL F Tab 2 mg – Higher subsidy of $18.50 per 30 with Endorsement .........3.00 (18.50) F Tab 4 mg – Higher subsidy of $25.00 per 30 with Endorsement .........4.05 (25.00) QUINAPRIL F Tab 5 mg .............................................................................................1.60 F Tab 10 mg ...........................................................................................1.75 F Tab 20 mg ...........................................................................................2.35 TRANDOLAPRIL F Cap 1 mg – Higher subsidy of $18.67 per 28 with Endorsement .........3.06 (18.67) F Cap 2 mg – Higher subsidy of $27.00 per 28 with Endorsement .........4.43 (27.00)

90 90 90 30 30 30 30

m-Enalapril m-Enalapril m-Enalapril Arrow-Lisinopril Arrow-Lisinopril Arrow-Lisinopril

Coversyl 30 Coversyl 30 30 30 28 Gopten 28 Gopten

Accupril Accupril Accupril

ACE Inhibitors with Diuretics

CILAZAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 5 mg with hydrochlorothiazide 12.5 mg .......................................6.30 ENALAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 20 mg with hydrochlorothiazide 12.5 mg .....................................3.32 (8.70) QUINAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 10 mg with hydrochlorothiazide 12.5 mg .....................................3.37 F Tab 20 mg with hydrochlorothiazide 12.5 mg .....................................4.57 28 30 Co-Renitec 30 30

Inhibace Plus

Accuretic 10 Accuretic 20

Angiotension II Antagonists

CANDESARTAN – Special Authority see SA0933 below – Retail pharmacy F Tab 4 mg – No more than 1.5 tab per day ........................................16.22 F Tab 8 mg – No more than 1.5 tab per day ........................................19.30 F Tab 16 mg – No more than 1 tab per day .........................................23.54 F Tab 32 mg – No more than 1 tab per day .........................................38.50 30 30 30 30

Atacand Atacand Atacand Atacand

¾SA0933 Special Authority for Subsidy Initial application from any relevant 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: continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

CARDIOVASCULAR SYSTEM

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

continued. . . 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. LOSARTAN – Special Authority see SA0911 below – Retail pharmacy F Tab 12.5 mg ......................................................................................17.40 30 Cozaar F Tab 25 mg .........................................................................................21.76 30 Cozaar F Tab 50 mg .........................................................................................23.10 30 Cozaar Tab 50 mg with hydrochlorothiazide 12.5 mg ...................................30.00 30 Hyzaar F Tab 100 mg .......................................................................................35.40 30 Cozaar ¾SA0911 Special Authority for Subsidy Initial application — (ACE inhibitor intolerance) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Patient has persistent ACE inhibitor induced cough that is not resolved by ACE inhibitor retrial (same or new ACE inhibitor); or 2 Patient has a history of angioedema. Initial application — (Unsatisfactory response to ACE inhibitor) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where patient is not adequately controlled on maximum tolerated dose of an ACE inhibitor. Initial application — (Patient had an approval for Losartan with hydrochlorothiazide prior to 1 May 2008) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the treatment remains appropriate and the patient is beneﬁting from treatment.

Antiarrhythmics

For lignocaine hydrochloride refer to NERVOUS SYSTEM, Anaesthetics, Local, page 108 AMIODARONE HYDROCHLORIDE L Tab 100 mg – Retail pharmacy-Specialist ........................................18.65 30 L Tab 200 mg – Retail pharmacy-Specialist ........................................30.52 Inj 50 mg per ml, 3 ml – Up to 5 inj available on a PSO ...................60.84 DIGOXIN F Tab 62.5 µg – Up to 30 tab available on a PSO..................................6.94 F Tab 250 µg – Up to 30 tab available on a PSO.................................15.13 F‡ Oral liq 50 µg per ml .........................................................................16.60 DISOPYRAMIDE PHOSPHATE L Cap 100 mg ......................................................................................15.00 (23.87) L Cap 150 mg ......................................................................................26.21 30 10 250 250 60 ml 100 Rythmodan 100

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

Rythmodan

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

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

FLECAINIDE ACETATE – Retail pharmacy-Specialist L Tab 50 mg .........................................................................................42.82 L Tab 100 mg .......................................................................................75.63 L Cap long-acting 100 mg ...................................................................42.82 L Cap long-acting 200 mg ...................................................................75.63 Inj 10 mg per ml, 15 ml .....................................................................49.02 MEXILETINE HYDROCHLORIDE L Cap 50 mg ........................................................................................23.52 L Cap 200 mg ......................................................................................55.05 PROPAFENONE HYDROCHLORIDE – Retail pharmacy-Specialist L Tab 150 mg .......................................................................................40.90

60 60 30 30 5 100 100 50

Tambocor Tambocor Tambocor CR Tambocor CR Tambocor Mexitil Mexitil Rytmonorm

Antihypotensives

MIDODRINE – Special Authority see SA0934 below – Hospital pharmacy [HP3] Tab 2.5 mg ........................................................................................53.00 Tab 5 mg ...........................................................................................79.00 100 100

Gutron Gutron

¾SA0934 Special Authority for Subsidy Initial application from any relevant practitioner. 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. Notes: Treatment should be started with small doses and titrated upwards as necessary. Hypertension should be avoided, and the usual target is a standing systolic blood pressure of 90 mm Hg. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Beta Adrenoceptor Blockers

ACEBUTOLOL F Cap 100 mg .......................................................................................9.50 F Cap 200 mg ......................................................................................15.94 (ACB Cap 100 mg to be delisted 1 February 2010) ATENOLOL F Tab 50 mg ...........................................................................................0.39 6.18 F Tab 100 mg .......................................................................................10.73 CARVEDILOL Tab 6.25 mg ......................................................................................21.00 Tab 12.5 mg ......................................................................................27.00 Tab 25 mg .........................................................................................33.75 CELIPROLOL F Tab 200 mg .......................................................................................19.00 100 100

ACB ACB

30 500 500 30 30 30 180

Noten S29 Paciﬁc Atenolol Paciﬁc Atenolol Dilatrend Dilatrend Dilatrend Celol

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

CARDIOVASCULAR SYSTEM

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

LABETALOL F Tab 50 mg ...........................................................................................8.66 F Tab 100 mg .......................................................................................10.59 F Tab 200 mg .......................................................................................18.47 F Tab 400 mg .......................................................................................34.44 F Inj 5 mg per ml, 5 ml ........................................................................14.77 (22.15) F Inj 5 mg per ml, 20 ml .......................................................................59.06 (88.60) (Trandate S29 Inj 5 mg per ml, 5 ml to be delisted 1 September 2009)

100 100 100 100 5 5

Hybloc Hybloc Hybloc Hybloc

Trandate S29 Trandate

METOPROLOL SUCCINATE Additional subsidy by endorsement for Betaloc CR is available for patients who: 1) were being prescribed metoprolol succinate prior to 1 October 2007; or 2) have experienced a myocardial infarction; or 3) have experienced heart failure and are either intolerant of carvedilol or it is contra-indicated. Pharmacists may annotate prescriptions for patients who were being prescribed metoprolol succinate prior to 1 October 2007 in which case the prescription is deemed to be endorsed. The pharmacist must be able to show a clear documented dispensing history for the patient. The prescription must be endorsed accordingly. F Tab long-acting 23.75 mg – Higher subsidy of up to $6.20 per 30 with Endorsement.................................................................... 2.73 30 Metoprolol - AFT CR 5.20 (6.20) Betaloc CR F Tab long-acting 47.5 mg – Higher subsidy of up to $7.80 per 30 with Endorsement.................................................................... 3.41 30 Metoprolol - AFT CR 6.50 (7.80) Betaloc CR F Tab long-acting 95 mg – Higher subsidy of up to $13.20 per 30 with Endorsement.................................................................... 5.88 30 Metoprolol - AFT CR 11.20 (13.20) Betaloc CR F Tab long-acting 190 mg – Higher subsidy of up to $21.00 per 30 with Endorsement..................................................................10.63 30 Metoprolol - AFT CR 20.25 (21.00) Betaloc CR METOPROLOL TARTRATE F Tab 50 mg .........................................................................................16.50 F Tab 100 mg .......................................................................................21.80 F Tab long-acting 200 mg ....................................................................18.40 F Inj 1 mg per ml 5 ml ..........................................................................24.08 (34.00) NADOLOL F Tab 40 mg .........................................................................................14.97 F Tab 80 mg .........................................................................................22.19 PINDOLOL F Tab 5 mg .............................................................................................4.50 F Tab 10 mg ...........................................................................................8.35 F Tab 15 mg .........................................................................................12.00 100 60 28 5

Lopresor Lopressor Slow-Lopressor

Betaloc

100 100 100 100 100

Apo-Nadolol Apo-Nadolol Pindol Pindol Pindol

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

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

PROPRANOLOL F Tab 10 mg ...........................................................................................3.55 F Tab 40 mg ...........................................................................................4.65 F Cap long-acting 160 mg ...................................................................16.90 SOTALOL F Tab 80 mg .........................................................................................27.50 F Tab 160 mg .......................................................................................10.50 F Inj 10 mg per ml, 4 ml .......................................................................41.34 TIMOLOL MALEATE F Tab 10 mg .........................................................................................10.55

100 100 100 500 100 5 100

Cardinol Cardinol Cardinol LA Mylan Mylan Sotacor Apo-Timol

Calcium Channel Blockers Dihydropyridine Calcium Channel Blockers (DHP CCBs)

AMLODIPINE F Tab 5 mg .............................................................................................7.33 F Tab 10 mg .........................................................................................11.79 FELODIPINE F Tab long-acting 2.5 mg – No more than 1 tab per day .....................10.38 F Tab long-acting 5 mg ........................................................................10.73 F Tab long-acting 10 mg ......................................................................15.60 ISRADIPINE Cap long-acting 2.5 mg ......................................................................7.50 Cap long-acting 5 mg .........................................................................7.85 NIFEDIPINE F Tab long-acting 10 mg ......................................................................17.72 F Tab long-acting 20 mg ........................................................................7.30 F Tab long-acting 30 mg ......................................................................10.70 5.50 (19.90) F Tab long-acting 60 mg ......................................................................15.35 8.00 (29.50) 100 100 30 90 90 30 30 60 100 30

Apo-Amlodipine Apo-Amlodipine Plendil ER Felo 5 ER Felo 10 ER Dynacirc-SRO Dynacirc-SRO Adalat 10 Nyefax Retard Adeﬁn XL Arrow-Nifedipine XR

Adalat Oros

Adeﬁn XL Arrow-Nifedipine XR

Adalat Oros

Other Calcium Channel Blockers

DILTIAZEM HYDROCHLORIDE F Tab 30 mg ...........................................................................................4.60 F Tab 60 mg ...........................................................................................8.50 F Cap long-acting 120 mg (once per day) .............................................4.34 F Cap long-acting 180 mg .....................................................................6.50 F Cap long-acting 240 mg .....................................................................8.67 100 100 30 30 30

Dilzem Dilzem Cardizem CD Cardizem CD Cardizem CD

PERHEXILINE MALEATE – Special Authority see SA0256 on the next page – Hospital pharmacy [HP3] F Tab 100 mg .......................................................................................62.90 100 Pexsig

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

CARDIOVASCULAR SYSTEM

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

¾SA0256 Special Authority for Subsidy 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 where the treatment remains appropriate and the patient is beneﬁting from treatment. VERAPAMIL HYDROCHLORIDE F Tab 40 mg ...........................................................................................7.01 100 Isoptin F Tab 80 mg .........................................................................................11.74 100 Isoptin F Tab long-acting 120 mg ....................................................................15.20 250 Verpamil SR F Tab long-acting 240 mg ....................................................................25.00 250 Verpamil SR 5 Isoptin F Inj 2.5 mg per ml, 2 ml – Up to 5 inj available on a PSO ....................7.54

Centrally Acting Agents

CLONIDINE F TDDS 2.5 mg, 100 µg per day – Only on a prescription...................21.29 F TDDS 5 mg, 200 µg per day – Only on a prescription......................30.79 F TDDS 7.5 mg, 300 µg per day – Only on a prescription...................39.10 CLONIDINE HYDROCHLORIDE F Tab 150 µg ........................................................................................30.33 F Inj 150 µg per ml, 1 ml ......................................................................14.00 METHYLDOPA F Tab 125 mg .......................................................................................12.00 F Tab 250 mg .......................................................................................13.10 F Tab 500 mg .......................................................................................20.85 4 4 4 100 5 100 100 100

Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Catapres Catapres Prodopa Prodopa Prodopa

Diuretics Loop Diuretics

BUMETANIDE F Tab 1 mg ...........................................................................................16.36 F Inj 500 µg per ml, 4 ml ........................................................................7.95 FUROSEMIDE F Tab 40 mg – Up to 30 tab available on a PSO..................................10.75 F Tab 500 mg .......................................................................................12.00 F‡ Oral liq 10 mg per ml ........................................................................10.66 F Infusion 10 mg per ml, 25 ml ............................................................48.14 F Inj 10 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................29.50 100 5 1,000 100 30 ml OP 5 50

Burinex Burinex Diurin 40 Diurin 500 Lasix Lasix Mayne

Potassium Sparing Diuretics

AMILORIDE ‡ Oral liq 1 mg per ml ..........................................................................26.20 SPIRONOLACTONE F Tab 25 mg ...........................................................................................8.50 F Tab 100 mg .......................................................................................21.70 ‡ Oral liq 5 mg per ml ..........................................................................26.80 25 ml OP 100 100 25 ml OP

Biomed Spirotone Spirotone Biomed

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

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

Potassium Sparing Combination Diuretics

AMILORIDE WITH FRUSEMIDE F Tab 5 mg with frusemide 40 mg .........................................................4.67 (8.63) AMILORIDE WITH HYDROCHLOROTHIAZIDE F Tab 5 mg with hydrochlorothiazide 50 mg ........................................13.00 28 Frumil 500

Amizide Triamizide

TRIAMTERENE WITH HYDROCHLOROTHIAZIDE F Tab 50 mg with hydrochlorothiazide 25 mg .......................................5.00 100 (Triamizide Tab 50 mg with hydrochlorothiazide 25 mg to be delisted 1 February 2010)

Thiazide and Related Diuretics

BENDROFLUAZIDE F Tab 2.5 mg – Up to 150 tab available on a PSO...............................13.50 May be supplied on a PSO for reasons other than emergency. F Tab 5 mg ...........................................................................................21.50 CHLOROTHIAZIDE ‡ Oral liq 50 mg per ml ........................................................................22.60 CHLORTHALIDONE F Tab 25 mg ...........................................................................................8.00 INDAPAMIDE F Tab 2.5 mg ..........................................................................................4.00 500 500 25 ml OP 50 100

Neo-Naclex Neo-Naclex Biomed Hygroton Napamide

Nitrates

GLYCERYL TRINITRATE F Tab 600 µg – Up to 100 tab available on a PSO.................................8.00 F Oral pump spray 400 µg per dose – Up to 250 dose available on a PSO......................................................................................5.16 F TDDS 5 mg .......................................................................................16.56 F TDDS 10 mg .....................................................................................19.60 ISOSORBIDE MONONITRATE F Tab 20 mg .........................................................................................18.00 F Tab long-acting 40 mg ......................................................................14.84 F Tab long-acting 60 mg ........................................................................4.15 100 OP 250 dose OP 30 30 100 30 90

Lycinate Nitrolingual

Pumpspray

Nitroderm TTS Nitroderm TTS Ismo 20 Corangin Duride

Sympathomimetics

ADRENALINE Inj 1 in 1,000, 1 ml – Up to 5 inj available on a PSO ..........................4.98 5.25 Inj 1 in 10,000, 10 ml – Up to 5 inj available on a PSO ....................27.00 ISOPRENALINE HYDROCHLORIDE F Inj 200 µg per ml, 1 ml ......................................................................36.80 (135.00) 5 5 25 Isuprel

Aspen Adrenaline Mayne Mayne

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

CARDIOVASCULAR SYSTEM

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

Vasodilators

AMYL NITRITE F Ampoule, 0.3 ml crushable ...............................................................62.92 (73.40) HYDRALAZINE F Inj 20 mg per ml, 1 ml .......................................................................25.90 OXYPENTIFYLLINE – Hospital pharmacy [HP3] Tab 400 mg .......................................................................................36.94 (42.26) PAPAVERINE HYDROCHLORIDE F Inj 12 mg per ml, 10 ml .....................................................................73.12 12 Baxter 5 50 Trental 400 5

Apresoline

Mayne

Endothelin Receptor Antagonists

¾SA0967 Special Authority for Subsidy Special Authority approved by the Pulmonary Arterial Hypertension Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Coordinator, PAH Panel PHARMAC, PO Box 10-254, WELLINGTON Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz BOSENTAN – Special Authority see SA0967 above – Hospital pharmacy [HP1] Tab 62.5 mg .................................................................................4,585.00 Tab 125 mg ..................................................................................4,585.00 60 60

Tracleer Tracleer

Phosphodiesterase Type 5 Inhibitors

¾SA0968 Special Authority for Subsidy Special Authority approved by the Pulmonary Arterial Hypertension Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Coordinator, PAH Panel PHARMAC, PO Box 10-254, WELLINGTON Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz SILDENAFIL – Special Authority see SA0968 above – Hospital pharmacy [HP1] Tab 25 mg .........................................................................................47.00 Tab 50 mg .........................................................................................59.50 Tab 100 mg .......................................................................................66.00 4 4 4

Viagra Viagra Viagra

Prostacyclin Analogues

¾SA0969 Special Authority for Subsidy Special Authority approved by the Pulmonary Arterial Hypertension Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Coordinator, PAH Panel PHARMAC, PO Box 10-254, WELLINGTON Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz ILOPROST – Special Authority see SA0969 above – Hospital pharmacy [HP1] Nebuliser soln 10 µg per ml, 2 ml ................................................1,185.00 30

Ventavis

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

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

Smoking Cessation

NICOTINE – Only on a Quitcard Patch 7 mg .......................................................................................10.53 Patch 14 mg .....................................................................................11.63 Patch 21 mg .....................................................................................12.32 Lozenge 1 mg ...................................................................................11.08 Lozenge 2 mg ...................................................................................11.08 Gum 2 mg (Fruit) ..............................................................................14.97 23.41 Gum 2 mg (Mint) ...............................................................................14.97 23.41 Gum 4 mg (Fruit) ..............................................................................20.02 23.41 Gum 4 mg (Mint) ...............................................................................20.02 23.41 7 7 7 36 36 96 96 96 96

Habitrol Habitrol Habitrol Habitrol Habitrol Habitrol Nicotinell Habitrol Nicotinell Habitrol Nicotinell Habitrol Nicotinell

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

DERMATOLOGICALS

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

Antiacne Preparations

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 83 ISOTRETINOIN – Special Authority see SA0955 below – Retail pharmacy Cap 10 mg ........................................................................................36.00 Cap 20 mg ........................................................................................47.50

100 100

Isotane 10 Isotane 20

¾SA0955 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Patient has had an adequate trial on other available treatments and has failed these treatments or these are contraindicated; and 2 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 3 Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin; and 4 Either: 4.1 Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment; or 4.2 Patient is male. Note: Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body. Renewal from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Patient has had an adequate trial on other available treatments and has failed these treatments or these are contraindicated; and 2 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 3 Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin; and 4 Either: 4.1 Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment; or 4.2 Patient is male. Note: Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body.

Antibacterials Topical

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 83 FUSIDIC ACID Crm 2 % ............................................................................................3.95 a) Maximum of 15 g per prescription b) Only on a prescription c) Not in combination Oint 2 % .............................................................................................3.95 a) Maximum of 15 g per prescription b) Only on a prescription c) Not in combination

fully subsidised [HP1], [HP3], [HP4] refer page 8

15 g OP

Foban

15 g OP

Foban

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

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

HYDROGEN PEROXIDE F Crm 1% ..............................................................................................8.56 MUPIROCIN Oint 2% ...............................................................................................6.60 (9.26) a) Only on a prescription b) Not in combination SILVER SULPHADIAZINE Crm 1% with chlorhexidine digluconate 0.2% ..................................15.04 a) Up to 500 g available on a PSO b) Not in combination

10 g OP 15 g OP

Crystacide

Bactroban

100 g OP

Silvazine

Antifungals Topical

For systemic antifungals, refer to INFECTIONS, Antifungals, page 87 AMOROLFINE a) Only on a prescription b) Not in combination Nail soln 5% ......................................................................................37.86 (61.87) CICLOPIROXOLAMINE a) Only on a prescription b) Not in combination Crm 1% ..............................................................................................1.00 (12.82) Nail soln 8% ......................................................................................19.85 Soln 1% ..............................................................................................4.36 (11.54) CLOTRIMAZOLE F Crm 1% ..............................................................................................0.50 a) Only on a prescription b) Not in combination F Soln 1% ..............................................................................................4.36 (7.55) a) Only on a prescription b) Not in combination ECONAZOLE NITRATE Crm 1% ..............................................................................................1.00 (7.48) a) Only on a prescription b) Not in combination Foaming soln 1%, 10 ml sachets ........................................................9.89 (17.23) a) Only on a prescription b) Not in combination KETOCONAZOLE Crm 2% ..............................................................................................1.00 (9.50) a) Only on a prescription b) Not in combination

5 ml OP Loceryl

20 g OP Batrafen 3.5 ml OP 20 ml OP

Batrafen

20 g OP

Clomazol

20 ml OP Canesten

20 g OP Pevaryl

3 Pevaryl

15 g OP Nizoral

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

DERMATOLOGICALS

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

MICONAZOLE NITRATE F Crm 2% ..............................................................................................0.42 a) Only on a prescription b) Not in combination F Lotn 2% ..............................................................................................4.36 (10.03) a) Only on a prescription b) Not in combination F Tinct 2% ..............................................................................................4.36 (12.10) a) Only on a prescription b) Not in combination NYSTATIN Crm 100,000 u per g ..........................................................................1.00 (5.10) a) Only on a prescription b) Not in combination

15 g OP

Multichem

30 ml OP Daktarin

15 g OP Mycostatin

Antipruritic Preparations

CALAMINE a) Only on a prescription b) Not in combination Crm, aqueous, BP ..............................................................................2.78 3.02 Lotn, BP ............................................................................................16.70 19.44 CROTAMITON a) Only on a prescription b) Not in combination Crm 10% ............................................................................................4.26 (4.45)

100 g 2,000 ml

healthE ABM API ABM

20 g OP Eurax

MENTHOL – Only in combination 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 Crystals ..............................................................................................7.40 25 g PSM 29.60 100 g MidWest

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

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

Corticosteroids Topical

For systemic corticosteroids, refer to CORTICOSTEROIDS AND RELATED AGENTS, page 75

Corticosteroids - Plain

BETAMETHASONE DIPROPIONATE Crm 0.05% .........................................................................................2.96 (6.91) 8.97 (18.36) Crm 0.05% in propylene glycol base ..................................................4.33 (13.83) Oint 0.05% ..........................................................................................2.96 (6.51) 8.97 (17.11) Oint 0.05% in propylene glycol base ..................................................4.33 (13.83) BETAMETHASONE VALERATE F Crm 0.1% ...........................................................................................2.00 F Oint 0.1% ............................................................................................2.20 F Lotn 0.1% .........................................................................................10.05 CLOBETASOL PROPIONATE F Crm 0.05% .........................................................................................2.35 F Oint 0.05% ..........................................................................................1.60 CLOBETASONE BUTYRATE Crm 0.05% .........................................................................................5.38 (7.09) 16.13 (22.00) DIFLUCORTOLONE VALERATE Crm 0.1% ...........................................................................................8.97 (15.86) Fatty oint 0.1% ....................................................................................8.97 (15.86) HYDROCORTISONE F Crm 1% – Only on a prescription .......................................................2.44 15 g OP Diprosone 50 g OP Diprosone 30 g OP Diprosone OV 15 g OP Diprosone 50 g OP Diprosone 30 g OP Diprosone OV 50 g OP 50 g OP 50 ml OP 30 g OP 30 g OP 30 g OP Eumovate 100 g OP Eumovate 50 g OP Nerisone 50 g OP Nerisone 100 g

Beta Cream Beta Ointment Betnovate Dermol Dermol

Lemnis Fatty Cream

HC 12.20 500 g PSM F Powder – Only in combination .........................................................33.00 25 g ABM (37.64) m-Hydrocortisone Up to 5% in a dermatological base (not proprietary Topical Corticosteriod – Plain) with or without other dermatological galenicals. Refer, page 163 (m-Hydrocortisone Powder to be delisted 1 November 2009)

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

DERMATOLOGICALS

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

HYDROCORTISONE BUTYRATE Lipocream 0.1% ..................................................................................5.00 15.00 Oint 0.1% ..........................................................................................15.00 Milky emul 0.1% .................................................................................5.00 15.00 HYDROCORTISONE WITH WOOL FAT AND MINERAL OIL Lotn 1% with wool fat hydrous 3% and mineral oil – Only on a prescription................................................................................ 9.95 METHYLPREDNISOLONE ACEPONATE Crm 0.1% ...........................................................................................4.95 Oint 0.1% ............................................................................................4.95 MOMETASONE FUROATE Crm 0.1% ...........................................................................................3.96 10.82 Oint 0.1% ............................................................................................3.96 10.82 Lotn 0.1% ...........................................................................................4.80 TRIAMCINOLONE ACETONIDE Crm 0.02% .........................................................................................6.63 Oint 0.02% ..........................................................................................6.69

30 g OP 100 g OP 100 g OP 30 ml OP 100 ml OP

Locoid Lipocream Locoid Lipocream Locoid Locoid Crelo Locoid Crelo

250 ml 15 g OP 15 g OP 15 g OP 45 g OP 15 g OP 45 g OP 30 ml OP 100 g OP 100 g OP

DP Lotn HC Advantan Advantan Elocon Elocon Elocon Elocon Elocon Aristocort Aristocort

Corticosteroids - Combination

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) 15 g OP Betnovate-C 15 g OP Betnovate-C

BETAMETHASONE VALERATE WITH FUSIDIC ACID Crm 0.1% with fusidic acid 2% ...........................................................3.49 15 g OP (9.61) a) Maximum of 15 g per prescription b) Only on a prescription HYDROCORTISONE BUTYRATE WITH CHLORQUINALDOL – Only on a prescription Crm 0.1% with chlorquinaldol 3% .......................................................3.49 15 g OP HYDROCORTISONE WITH MICONAZOLE – Only on a prescription F Crm 1% with miconazole nitrate 2% ...................................................2.20 15 g OP

Fucicort

Locoid C Micreme H Pimafucort Pimafucort

HYDROCORTISONE WITH NATAMYCIN AND NEOMYCIN – Only on a prescription Crm 1% with natamycin 1% and neomycin sulphate 0.5% ................4.40 15 g OP Oint 1% with natamycin 1% and neomycin sulphate 0.5% .................4.40 15 g OP

TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g – Only on a prescription ................. 3.49 15 g OP (6.60) Viaderm KC Oint 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g – Only on a prescription ................ 3.00 15 g OP Kenacomb (Kenacomb Oint 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g to be delisted 1 September 2009)

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

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

Disinfecting and Cleansing Agents

CHLORHEXIDINE GLUCONATE – Subsidy by endorsement a) No more than 500 ml per month b) Only if prescribed for a dialysis patient and the prescription is endorsed accordingly. F Handrub 1% with ethanol 70% ...........................................................5.40 500 ml F Soln 4% ..............................................................................................7.20 500 ml SODIUM HYPOCHLORITE – Subsidy by endorsement Only if prescribed for a dialysis patient and the prescription is endorsed accordingly. F Soln ....................................................................................................2.71 2,500 ml

Orion Orion

Janola

Dusting Powders

DIPHEMANIL METHYLSULPHATE – Subsidy by endorsement Only if prescribed for an amputee with an artiﬁcial limb, or for a paraplegic patient and the prescription endorsed accordingly. Powder 2% .........................................................................................6.81 50 g OP (13.54) Prantal

Barrier Creams and Emollients Barrier Creams

ZINC Crm BP ...............................................................................................6.55 (9.79) ZINC AND CASTOR OIL Oint BP ...............................................................................................5.11 500 g PSM 500 g

PSM

Emollients

AQUEOUS CREAM F Crm .....................................................................................................2.28 CETOMACROGOL F Crm BP ...............................................................................................3.50 EMULSIFYING OINTMENT F Oint BP ...............................................................................................3.69 GLYCEROL WITH PARAFFIN AND CETYL ALCOHOL – Only on a prescription F Lotn 5% with parafﬁn liq 5% and cetyl alcohol 2% .............................1.40 (8.10) OIL IN WATER EMULSION F Crm ....................................................................................................2.80 (Lemnis Fatty Cream Crm to be delisted 1 December 2009) OILY CREAM F Crm BP ...............................................................................................2.80 (13.60) (15.40) UREA F Crm 10% ............................................................................................2.52 (3.07) 500 g David Craig PSM 100 g OP Nutraplus 500 g 500 g 500 g 250 ml QV 500 g

AFT PSM AFT

Lemnis Fatty Cream healthE Fatty Cream

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

DERMATOLOGICALS

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

WOOL FAT WITH MINERAL OIL – Only on a prescription F Lotn hydrous 3% with mineral oil .......................................................1.40 250 ml OP (2.92) 5.60 1,000 ml (9.54) 1.40 250 ml OP (3.50) 5.60 1,000 ml (10.90) 1.12 200 ml OP (5.00) 2.10 375 ml OP (9.38) 5.60 1,000 ml (18.43) 1.40 250 ml OP (7.73) 5.60 1,000 ml (23.91) (Hydroderm Lotion Lotn hydrous 3% with mineral oil to be delisted 1 January 2010)

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

Other Dermatological Bases

PARAFFIN White soft – Only in combination .....................................................20.20 2,500 g IPW 3.58 500 g (8.69) PSM Only in combination with a dermatological galenical or as a diluent for a proprietary Topical Corticosteroid – Plain.

Minor Skin Infections

POVIDONE IODINE Oint 10% .............................................................................................2.88 (3.27) a) Maximum of 100 g per prescription b) Only on a prescription Antiseptic soln 10% ............................................................................6.20 Skin preparation, povidone iodine 10% with 30% alcohol ..................8.13 Skin preparation, povidone iodine 10% with 70% alcohol ..................8.13 (18.63) 25 g OP Betadine

500 ml 500 ml 500 ml

Betadine Riodine Betadine Skin Prep

Orion

Parasiticidal Preparations

GAMMA BENZENE HEXACHLORIDE Crm 1% ..............................................................................................3.50 MALATHION Liq 0.5% ..............................................................................................4.99 Shampoo 1% ......................................................................................2.83 50 g OP 200 ml 30 ml OP

Benhex Derbac-M A-Lices

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

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

PERMETHRIN 1) Should be strictly reserved for use as second line therapy in: 1) patients unable to tolerate the other medications, such as infants, young children and patients with allergies or eczema; 2) cases of scabies which are resistent to gamma benzene hexachloride and resistant to malathion. 2) 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: 1) a deﬁnite diagnosis of scabies should be made; 2) it should be ascertained that the medication was administered properly; 3) the possibility of reinfestation should have been excluded. Crm 5% ..............................................................................................4.20 30 g OP Lyderm

Psoriasis and Eczema Preparations

ACITRETIN – Special Authority see SA0954 below – Retail pharmacy Cap 10 mg ........................................................................................75.80 Cap 25 mg ......................................................................................162.96 100 100

Neotigason Neotigason

¾SA0954 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 2 Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin; and 3 Either: 3.1 Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment; or 3.2 Patient is male. Renewal from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 2 Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin; and 3 Either: 3.1 Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment; or 3.2 Patient is male. CALCIPOTRIOL Crm 50 µg per g ...............................................................................20.76 30 g OP Daivonex 57.89 100 g OP Daivonex Oint 50 µg per g ................................................................................20.76 30 g OP Daivonex 57.89 100 g OP Daivonex 30 ml OP Daivonex Soln 50 µg per ml .............................................................................20.78 34.72 60 ml OP Daivonex

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

DERMATOLOGICALS

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

COAL TAR Soln BP – Only in combination ........................................................36.48 500 ml PSM 12.98 200 ml (16.20) David Craig Up to 10 % Only in combination with a dermatological base or proprietary Topical Corticosteriod – Plain, refer, page 163 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 crm 2.5% ....................................................................... 3.43 30 g OP (4.35) Egopsoryl TA 6.59 75 g OP (8.00) Egopsoryl TA COAL TAR WITH SALICYLIC ACID AND SULPHUR Soln 12% with salicylic acid 2% and sulphur 4% oint .........................7.95 DITHRANOL Crm 1% ............................................................................................27.50 40 g OP 50 g OP

Coco-Scalp Micanol

SALICYLIC ACID Powder – Only in combination .........................................................15.00 500 g ABM 18.88 250 g PSM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain or collodion ﬂexible, refer, page 163 2) With or without other dermatological galenicals. 3) Maximum 20 g or 20 ml per prescription when prescribed with white soft parafﬁn or collodion ﬂexible. SULPHUR Precipitated – Only in combination ....................................................6.50 100 g ABM (9.25) PSM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, refer, page 163 2) With or without other dermatological galenicals. TAR WITH CADE OIL Bath emul 7.5% coal tar, 2.5% cade oil, 7.5% compound ..................9.70 350 ml (29.60) Polytar Emollient TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN – Only on a prescription F Soln 2.3% with triethanolamine lauryl sulphate and ﬂuorescein sodium ................................................................................. 2.90 500 ml Pinetarsol

Scalp Preparations

BETAMETHASONE VALERATE F Scalp app 0.1% ..................................................................................5.25 CLOBETASOL PROPIONATE F Scalp app 0.05% ................................................................................3.20 HYDROCORTISONE BUTYRATE Scalp lotn 0.1% ...................................................................................7.52 KETOCONAZOLE Shampoo 2% ......................................................................................3.48 a) Maximum of 100 ml per prescription b) Only on a prescription 100 ml OP 30 ml OP 100 ml OP 100 ml OP

Beta Scalp Dermol Locoid Sebizole

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

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

Sunscreens

SUNSCREENS, PROPRIETARY – Subsidy by endorsement Only if prescribed for a patient with severe photosensitivity secondary to a deﬁned clinical condition and the prescription is endorsed accordingly. Crm .....................................................................................................2.55 100 g OP (5.89) Hamilton Sunscreen 1.28 50 g OP (5.84) Aquasun Oil Free Faces SPF30+ Lotn ....................................................................................................2.55 100 ml OP Marine Blue Lotion SPF 30+ 5.10 200 ml OP Marine Blue Lotion SPF 30+ 3.19 125 ml OP (8.82) Aquasun Sensitive SPF 30+ (9.38) Aquasun 30+

Wart Preparations

For salicylic acid preparations refer to PSORIASIS AND ECZEMA PREPARATIONS, page 65 IMIQUIMOD – Special Authority see SA0923 below – Retail pharmacy Crm 5% sachet ...............................................................................110.40 12

Aldara

¾SA0923 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria: Any of the following: 1 The patient has external anogenital warts and podophyllotoxin has been tried and failed (or is contraindicated); or 2 The patient has external anogenital warts and podophyllotoxin is unable to be applied accurately to the site; or 3 The patient has conﬁrmed superﬁcial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate. Notes: Superﬁcial basal cell carcinoma G Surgical excision remains ﬁrst-line treatment for superﬁcial basal cell carcinoma as it has a higher cure rate than imiquimod and allows histological assessment of tumour clearance. G Imiquimod has not been evaluated for the treatment of superﬁcial basal cell carcinoma within 1 cm of the hairline, eyes, nose, mouth or ears. G Imiquimod is not indicated for recurrent, invasive, inﬁltrating, or nodular basal cell carcinoma. External anogenital warts G Imiquimod is only indicated for external genital and perianal warts (condyloma acuminata). Renewal from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria: Any of the following: 1 Inadequate response to initial treatment for anogenital warts; or 2 New conﬁrmed superﬁcial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate; or 3 Inadequate response to initial treatment for superﬁcial basal cell carcinoma. Note: Conﬁrmation that the lesion is a superﬁcial basal cell carcinoma should be obtained using a biopsy PODOPHYLLOTOXIN Soln 0.5% .........................................................................................33.60 3.5 ml OP Condyline a) Maximum of 3.5 ml per prescription b) Only on a prescription

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

DERMATOLOGICALS

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

Other Skin Preparations Antineoplastics

FLUOROURACIL SODIUM Crm 5% ............................................................................................26.49 20 g OP

Efudix

Topical Analgesia

For aspirin & chloroform application refer, page 166 CAPSAICIN – Subsidy by endorsement Subsidised only if prescribed for post-herpetic neuralgia or diabetic peripheral neuropathy and the prescription is endorsed accordingly. Crm 0.075% .....................................................................................12.50 45 g OP Zostrix HP

Wound Management Products

HYDROGEN PEROXIDE F Soln 20 vol – Maximum of 500 ml per prescription.............................3.13 (7.00) MAGNESIUM SULPHATE Paste ..................................................................................................2.98 (4.90) 500 ml PSM 80 g PSM

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

GENITO-URINARY SYSTEM

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

Contraceptives - Non-hormonal Condoms

CONDOMS F 49 mm – Up to 144 dev available on a PSO.....................................13.36 144

F 52 mm – Up to 144 dev available on a PSO.....................................13.36

144

F 52 mm extra strength – Up to 144 dev available on a PSO..............13.36 F 53 mm – Up to 144 dev available on a PSO.....................................13.36

144 144

F F F F

53 mm (chocolate) – Up to 144 dev available on a PSO..................13.36 53 mm (strawberry) – Up to 144 dev available on a PSO ................13.36 53 mm extra strength – Up to 144 dev available on a PSO..............13.36 54 mm, shaped – Up to 144 dev available on a PSO.......................13.36 (14.84) F 55 mm – Up to 144 dev available on a PSO.....................................13.36 F 56 mm – Up to 144 dev available on a PSO.....................................13.36 F 56 mm extra strength – Up to 144 dev available on a PSO..............13.36 F 56 mm, shaped – Up to 144 dev available on a PSO.......................13.36 F 60 mm – Up to 144 dev available on a PSO.....................................13.36

144 144 144 144 144 144 144 144 144

Gold Knight MarquisTantiliza Shield 49 Marquis Selecta Marquis Sensolite Marquis Supalite Marquis Protecta Gold Knight Marquis Black Marquis Titillata Shield Blue Gold Knight Gold Knight Gold Knight

Lifestyles Flared

Gold Knight Marquis Conforma Durex Select

Flavours

Durex Extra Safe Durex Conﬁdence Shield XL

Spermicidal Agents

APPLICATOR When ordered with a spermicide. F Applicator – Up to 1 dev available on a PSO......................................4.34 NONOXYNOL-9 Jelly 2% – Up to 108 g available on a PSO......................................10.95

1 108 g OP

Ortho Gynol II

Contraceptive Devices

DIAPHRAGM F Diaphragm – Up to 1 dev available on a PSO ..................................42.90 One of each size is permitted on a PSO. INTRA-UTERINE DEVICE – Only on a WSO F IUD ...................................................................................................39.50 Distributed by Pharmaco NZ Ltd, PO Box 4079, Auckland Ph 09 377 3336 1

Ortho All-ﬂex Ortho Coil

Multiload Cu 375 Multiload Cu 375 SL

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

GENITO-URINARY SYSTEM

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

Contraceptives - Hormonal Combined Oral Contraceptives

¾SA0500 Special Authority for Alternate Subsidy 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: 1 Patient is on a Social Welfare beneﬁt; or 2 Patient has an income no greater than the beneﬁt. Notes: 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: G on a Social Welfare beneﬁt; or G 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 and Microgynon 20 ED ETHINYLOESTRADIOL WITH DESOGESTREL F Tab 20 µg with desogestrel 150 µg .....................................................6.62 63 (16.50) Mercilon 21 a) Higher subsidy of $13.80 per 63 with Special Authority see SA0500 above b) Up to 63 tab available on a PSO F Tab 20 µg with desogestrel 150 µg and 7 inert tab .............................6.62 84 (16.50) Mercilon 28 a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO F Tab 30 µg with desogestrel 150 µg .....................................................6.62 63 (16.50) Marvelon 21 a) Higher subsidy of $13.80 per 63 with Special Authority see SA0500 above b) Up to 63 tab available on a PSO F Tab 30 µg with desogestrel 150 µg and 7 inert tab .............................6.62 84 (16.50) Marvelon 28 a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO ETHINYLOESTRADIOL WITH GESTODENE F Tab 30 µg with gestodene 75 µg and 7 inert tab ...............................6.62 84 (14.49) Minulet 28 (16.50) Femodene 28 a) Higher subsidy of $14.49 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO (Minulet 28 Tab 30 µg with gestodene 75 µg and 7 inert tab to be delisted 1 September 2009)

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

GENITO-URINARY SYSTEM

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

ETHINYLOESTRADIOL WITH LEVONORGESTREL F Tab ethinyloestradiol 30 µg with levonorgestrel 50 µg (6) and tab ethinyloestradiol 40 µg with levonorgestrel 75 µg (5), and tab ethinyloestradiol 30 µg with levonorgestrel 125 µg (10) and 7 inert tab ......................................................................6.62 84 Trifeme (9.45) Triquilar ED (14.49) Triphasil 28 a) Higher subsidy of up to $14.49 per 84 with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO F Tab 50 µg with levonorgestrel 125 µg and 7 inert tab – Up to 84 tab available on a PSO............................................................9.45 84 Microgynon 50 ED F Tab 30 µg with levonorgestrel 150 µg .................................................6.62 63 (16.50) Microgynon 30 a) Higher subsidy of $15.00 per 63 with Special Authority see SA0500 on the preceding page b) Up to 63 tab available on a PSO F Tab 30 µg with levonorgestrel 150 µg and 7 inert tab .........................6.62 84 Levlen ED Monofeme (14.49) Nordette 28 (16.50) Microgynon 30 ED a) Higher subsidy of up to $15.00 per 84 with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO (Triquilar ED Tab ethinyloestradiol 30 µg with levonorgestrel 50 µg (6) and tab ethinyloestradiol 40 µg with levonorgestrel 75 µg (5), and tab ethinyloestradiol 30 µg with levonorgestrel 125 µg (10) and 7 inert tab to be delisted 1 December 2009) (Triphasil 28 Tab ethinyloestradiol 30 µg with levonorgestrel 50 µg (6) and tab ethinyloestradiol 40 µg with levonorgestrel 75 µg (5), and tab ethinyloestradiol 30 µg with levonorgestrel 125 µg (10) and 7 inert tab to be delisted 1 September 2009) ETHINYLOESTRADIOL WITH NORETHISTERONE F Tab 35 µg with norethisterone 1 mg – Up to 63 tab available on a PSO......................................................................................6.62 63 Brevinor 1/21 F Tab 35 µg with norethisterone 1 mg and 7 inert tab – Up to 84 tab available on a PSO............................................................6.62 84 Brevinor 1/28 F Tab 35 µg with norethisterone 500 µg – Up to 63 tab available on a PSO......................................................................................6.62 63 Brevinor 21 F Tab 35 µg with norethisterone 500 µg and 7 inert tab – Up to 84 tab available on a PSO............................................................6.62 84 Norimin NORETHISTERONE WITH MESTRANOL F Tab 1 mg with mestranol 50 µg and 7 inert tab ..................................6.62 84 (13.80) Norinyl-1/28 a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO

Combined Oral Contraceptives - Other

ETHINYLOESTRADIOL WITH LEVONORGESTREL F Tab 20 µg with levonorgestrel 100 µg and 7 inert tab – Up to 84 tab available on a PSO............................................................6.62 (16.50) (16.50)

84 Loette Microgynon 20 ED

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

GENITO-URINARY SYSTEM

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

Progestogen-only Contraceptives

¾SA0500 Special Authority for Alternate Subsidy 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: 1 Patient is on a Social Welfare beneﬁt; or 2 Patient has an income no greater than the beneﬁt. Notes: 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: G on a Social Welfare beneﬁt; or G 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 and Microgynon 20 ED LEVONORGESTREL F Tab 30 µg ............................................................................................6.62 84 (16.50) Microlut a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO MEDROXYPROGESTERONE ACETATE F Inj 150 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................8.05 1 Depo-Provera F Inj 150 mg per ml, 1 ml syringe – Up to 5 inj available on a PSO .........8.05 1 Depo-Provera NORETHISTERONE F Tab 350 µg – Up to 84 tab available on a PSO...................................7.15 84

Noriday 28

Emergency Contraceptives

LEVONORGESTREL F Tab 1.5 mg ........................................................................................12.50 a) Maximum of 2 tab per prescription b) Up to 5 tab available on a PSO 1

Postinor-1

Antiandrogen Oral Contraceptives

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: G $3.00 prescription charge (patient co-payment) will apply. G prescription may be written for up to six months supply. 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. CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL F Tab 2 mg with ethinyloestradiol 35 µg and 7 inert tabs ......................6.30 84 Estelle 35-ED

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

GENITO-URINARY SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic 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 (11.32) CLOTRIMAZOLE F Vaginal crm 1% with applicator(s) ......................................................1.45 F Vaginal crm 2% with applicators .........................................................2.75 MICONAZOLE NITRATE F Vaginal crm 2% with applicator ..........................................................2.75 (3.70) NYSTATIN Vaginal crm 100,000 u per 5 g with applicator(s) ...............................4.71

100 g OP Aci-Jel 35 g OP 20 g OP 40 g OP Micreme 75 g OP

Clomazol Clomazol

Nilstat

Myometrial and Vaginal Hormone Preparations

ERGOMETRINE MALEATE Inj 500 µg per ml, 1 ml – Up to 5 inj available on a PSO ..................11.60 METHYLERGOMETRINE Inj 200 µg per ml, 1 ml – Up to 10 inj available on a PSO ..................9.28 OESTRIOL F Crm 1 mg per g with applicator ..........................................................7.00 F Pessaries 500 µg ................................................................................7.25 OXYTOCIN – Up to 5 inj available on a PSO Inj 5 iu per ml, 1 ml .............................................................................5.40 Inj 10 iu per ml, 1 ml ...........................................................................6.80 Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml ........................9.20 5 10 15 g OP 15 5 5 5

Mayne Hospira S29 Ovestin Ovestin Syntocinon Syntocinon Syntometrine

Pregnancy Tests - HCG Urine

PREGNANCY TESTS - HCG URINE – Only on a WSO Cassette ...........................................................................................19.00 25 test Distributed by MDS Diagnostics, PO Box 24-162, Royal Oak, Auckland. Ph 09 570 5761

MDS Quick Card

Urinary Agents

For urinary tract Infections refer to INFECTIONS, Antibacterials, page 94

5-Alpha Reductase Inhibitors

FINASTERIDE – Special Authority see SA0928 on the next page – Retail pharmacy Tab 5 mg ...........................................................................................19.20 30

Fintral

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

GENITO-URINARY SYSTEM

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

¾SA0928 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 Patient has symptomatic benign prostatic hyperplasia; and 2 Either: 2.1 The patient is intolerant of non-selective alpha blockers or these are contraindicated; or 2.2 Symptoms are not adequately controlled with non-selective alpha blockers. Note: Patients with enlarged prostates are the appropriate candidates for therapy with ﬁnasteride.

Other Urinary Agents

OXYBUTYNIN F Tab 5 mg ...........................................................................................44.79 F Oral liq 5 mg per 5 ml .......................................................................50.40 SODIUM CITRO-TARTRATE F Grans eff 4 g sachets .........................................................................2.75 500 473 ml OP 28

Apo-Oxybutynin Apo-Oxybutynin Ural

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

Anabolic Agents

NANDROLONE DECANOATE – Retail pharmacy-Specialist Inj 50 mg per ml, 1 ml .......................................................................21.15 1

Deca-Durabolin

Orgaject

Corticosteroids and Related Agents for Systemic Use

BETAMETHASONE SODIUM PHOSPHATE WITH BETAMETHASONE ACETATE F Inj 3.9 mg with betamethasone acetate 3 mg per ml, 1ml ................19.20 (33.60) 5 Celestone Chronodose

DEXAMETHASONE F Tab 1 mg – Retail pharmacy-Specialist ............................................16.08 100 Up to 30 tab available on a PSO F Tab 4 mg – Retail pharmacy-Specialist ............................................61.89 100 Up to 30 tab available on a PSO Oral liq 1 mg per ml – Retail pharmacy-Specialist ...........................39.90 25 ml OP Oral liq prescriptions: 1) Must be written by a Paediatrician or Paediatric Cardiologist; or 2) On the recommendation of a Paediatrician or Paediatric Cardiologist. DEXAMETHASONE SODIUM PHOSPHATE F Inj 4 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................21.50 5 F Inj 4 mg per ml, 2 ml – Up to 5 inj available on a PSO .....................31.00 5 FLUDROCORTISONE ACETATE F Tab 100 µg ..........................................................................................7.62 HYDROCORTISONE F Tab 5 mg .............................................................................................7.95 F Tab 20 mg .........................................................................................19.95 F Inj 50 mg per ml, 2 ml .........................................................................3.72 a) Up to 5 inj available on a PSO b) Only on a PSO METHYLPREDNISOLONE – Retail pharmacy-Specialist F Tab 4 mg ...........................................................................................48.57 F Tab 100 mg .....................................................................................166.52 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 .........................................................................................16.45 Inj 1 g ................................................................................................42.57 PREDNISOLONE SODIUM PHOSPHATE F Oral liq 5 mg per ml – Up to 30 ml available on a PSO ......................9.95 Restricted to children under 12 years of age. 100 100 100 1

Douglas Douglas Biomed

Mayne Mayne Florinef Douglas Douglas Solu-Cortef

100 20 1 1

Medrol Medrol Depo-Medrol Depo-Medrol with

lidocaine

25 25 1 1 30 ml OP

Solu-Medrol Solu-Medrol Solu-Medrol Solu-Medrol Redipred

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

PREDNISONE F Tab 1 mg ...........................................................................................10.68 F Tab 2.5 mg ........................................................................................12.09 F Tab 5 mg – Up to 30 tab available on a PSO....................................11.09 F Tab 20 mg .........................................................................................29.03 TETRACOSACTRIN F Inj 250 µg ........................................................................................177.18 F 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 (Kenacort-A Inj 10 mg per ml, 1 ml to be delisted 1 September 2009) (Kenacort-A Inj 10 mg per ml, 5 ml to be delisted 1 September 2009)

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 .........................................................................................21.10 Tab 100 mg .......................................................................................41.50 TESTOSTERONE Transdermal patch 2.5 mg per day ...................................................80.00 TESTOSTERONE CYPIONATE – Retail pharmacy-Specialist Inj long-acting 100 mg per ml, 10 ml ................................................61.41 TESTOSTERONE ESTERS – Retail pharmacy-Specialist Inj 250 mg per ml, 1 ml .....................................................................12.98 TESTOSTERONE UNDECANOATE – Retail pharmacy-Specialist Cap 40 mg ........................................................................................60.71 50 50 60 1 1 60

Siterone Siterone Androderm Depo-Testosterone Sustanon Ampoules Panteston

Hormone Replacement Therapy - Systemic

¾SA0312 Special Authority for Alternate Subsidy 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 – where oral oestrogens are contraindicated as determined by a gastroenterologist or general physician. The applicant must keep written conﬁrmation from such a specialist with the patient’s record; or 2 oestrogen induced hypertension requiring antihypertensive therapy – documented evidence must be kept on ﬁle that raised blood pressure levels or inability to control blood pressure adequately occurred post oral oestrogens; or 3 hypertriglyceridaemia – documented evidence must be kept on ﬁle that triglyceride levels increased to at least 2 × normal triglyceride levels post oral oestrogens. 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 where 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”.

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

Oestrogens

OESTRADIOL – See prescribing guideline on the preceding page F Tab 1 mg .............................................................................................4.12 28 OP (10.55) Estrofem F Tab 2 mg .............................................................................................4.12 28 OP (10.55) Estrofem F TDDS 25 µg per day ..........................................................................3.01 8 (10.86) Estraderm TTS 25 a) Higher subsidy of $10.86 per 8 with Special Authority see SA0312 on the preceding page b) No more than 2 patch per week c) Only on a prescription F TDDS 3.9 mg (releases 50 µg of oestradiol per day) ........................4.12 4 (14.50) Climara 50 (32.50) Femtran 50 a) Higher subsidy of $13.18 per 4 with Special Authority see SA0312 on the preceding page b) No more than 1 patch per week c) Only on a prescription F TDDS 50 µg per day ..........................................................................4.12 8 (13.18) Estraderm TTS 50 a) Higher subsidy of $13.18 per 8 with Special Authority see SA0312 on the preceding page b) No more than 2 patch per week c) Only on a prescription F TDDS 7.8 mg (releases 100 µg of oestradiol per day) ......................7.05 4 (17.75) Climara 100 (35.00) Femtran 100 a) Higher subsidy of $16.14 per 4 with Special Authority see SA0312 on the preceding page b) No more than 1 patch per week c) Only on a prescription F TDDS 100 µg per day ........................................................................7.05 8 (16.14) Estraderm TTS 100 a) Higher subsidy of $16.14 per 8 with Special Authority see SA0312 on the preceding page b) No more than 2 patch per week c) Only on a prescription OESTRADIOL VALERATE – See prescribing guideline on the preceding page F Tab 1 mg .............................................................................................8.24 56 Progynova F Tab 2 mg .............................................................................................8.24 56 Progynova OESTROGENS – See prescribing guideline on the preceding page F Conjugated, equine tab 300 µg ..........................................................3.01 (11.48) F Conjugated, equine tab 625 µg ..........................................................4.12 (11.48) 28 Premarin 28 Premarin

Progestogens

MEDROXYPROGESTERONE ACETATE – See prescribing guideline on the preceding page F Tab 2.5 mg ..........................................................................................2.07 30 F Tab 5 mg ...........................................................................................13.75 100 F Tab 10 mg ...........................................................................................7.57 30

Provera Provera Provera

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

Progestogen and Oestrogen Combined Preparations

OESTRADIOL WITH LEVONORGESTREL – See prescribing guideline on page 76 F Tab 2 mg with 75 µg levonorgestrel (36) and tab 2 mg oestradiol (48) .....................................................................................16.20 84 Nuvelle (Nuvelle Tab 2 mg with 75 µg levonorgestrel (36) and tab 2 mg oestradiol (48) to be delisted 1 December 2009) OESTRADIOL WITH NORETHISTERONE – See prescribing guideline on page 76 F Tab 1 mg with 0.5 mg norethisterone acetate .....................................5.40 28 OP (14.52) F Tab 2 mg with 1 mg norethisterone acetate ........................................5.40 28 OP (14.52) F Tab 2 mg with 1 mg norethisterone acetate (10), and 2 mg oestradiol tab (12) and 1 mg oestradiol tab (6) ............................ 5.40 28 OP (14.52) OESTROGENS WITH MEDROXYPROGESTERONE – See prescribing guideline on page 76 F Tab 625 µg conjugated equine with 2.5 mg medroxyprogesterone acetate tab (28) ................................................................ 5.40 28 OP (22.96) F Tab 625 µg conjugated equine with 5 mg medroxyprogesterone acetate tab (28) ................................................................ 5.40 (22.96)

Kliovance Kliogest

Trisequens

Premia 2.5 Continuous

28 OP Premia 5 Continuous

Other Oestrogen Preparations

ETHINYLOESTRADIOL F Tab 10 µg ..........................................................................................17.60 OESTRIOL F Tab 2 mg .............................................................................................7.00 100

NZ Medical and

Scientiﬁc

Ovestin

Other Progestogen Preparations

DYDROGESTERONE Tab 10 mg .........................................................................................27.50 (29.90) LEVONORGESTREL F Levonorgestrel - releasing intrauterine system 20µg/24 hr – Special Authority see SA0782 below – Retail pharmacy ......... 269.50 50 Duphaston

Mirena

¾SA0782 Special Authority for Subsidy Initial application — (No previous use) only from a relevant specialist or general practitioner. Approvals valid for 6 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 µg/l (within the last 12 months); or 3.2 haemoglobin level < 120 g/l. continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

continued. . . 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 6 months for applications meeting the following criteria: All of the following: 1 The patient had a clinical diagnosis of heavy menstrual bleeding; and 2 Patient demonstrated clinical improvement of heavy menstrual bleeding; and 3 Applicant to state date of the previous insertion. 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 6 months for applications meeting the following criteria: Both: 1 Either: 1.1 Patient demonstrated clinical improvement of heavy menstrual bleeding; or 1.2 Previous insertion was removed or expelled within 3 months of insertion; and 2 Applicant to state date of the previous insertion. MEDROXYPROGESTERONE ACETATE F Tab 100 mg – Retail pharmacy-Specialist ......................................104.26 100 Provera F Tab 200 mg – Retail pharmacy-Specialist ........................................78.06 30 Provera NORETHISTERONE F Tab 5 mg – Up to 30 tab available on a PSO....................................25.00 100

Primolut N

Thyroid and Antithyroid Agents

CARBIMAZOLE F Tab 5 mg ...........................................................................................10.80 LEVOTHYROXINE F Tab 50 µg ............................................................................................1.71 45.00 64.28 ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 100 µg ..........................................................................................1.78 46.75 66.78 ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 25 µg ..........................................................................................43.24 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 100 28 1,000

Neo-Mercazole Goldshield Synthroid Eltroxin Goldshield Synthroid Eltroxin Synthroid

28 1,000

1,000

Trophic Hormones Growth Hormones

¾SA0755 Special Authority for Subsidy Special Authority approved by the Growth Hormone Committee Notes: Subject to budgetary cap. Applications will be considered and approved subject to funding availability. Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: NZGHC Coordinator PHARMAC, PO Box 10-254, WELLINGTON Tel: 0800 808 476, Fax: (09) 929 3221, Email: growthhormone@pharmac.govt.nz

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

GROWTH HORMONE BIOSYNTHETIC HUMAN – Special Authority see SA0755 on the preceding page F Cartridge 16 iu per vial ................................................................1,600.00 5 Genotropin F Cartridge 36 iu per vial ................................................................3,600.00 5 Genotropin RECOMBINANT HUMAN GROWTH HORMONE – Special Authority see SA0755 on the preceding page F Inj 5 mg ...........................................................................................300.00 1 Norditropin SimpleXx 5mg F Inj 10 mg .........................................................................................600.00 1 Norditropin SimpleXx 10mg F Inj 15 mg .........................................................................................900.00 1 Norditropin SimpleXx 15mg

GnRH Analogues

BUSERELIN ACETATE – Special Authority see SA0835 below – Hospital pharmacy [HP3] Inj 1 mg per ml, 5.5 ml ....................................................................195.00 2 (272.53)

Suprefact

¾SA0835 Special Authority for Subsidy Initial application — (Breast cancer) from any medical practitioner. Approvals valid for 1 year where the patient is a premenopausal woman with breast cancer. Initial application — (Prostate cancer) only from an oncologist, urologist or endocrinologist. Approvals valid for 1 year where the patient has advanced prostatic cancer. 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: G 3 months to assess whether surgery is appropriate G 3 months for infertile patients after surgery G 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 where the patient is affected by gonadotropin dependent precocious puberty. Renewal — (Breast or prostate cancer) from any medical practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal — (Endometriosis) from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Either: 1 Both: 1.1 There has been a satisfactory response to the ﬁrst 3 months treatment; and 1.2 Surgery is inappropriate; or 2 The ﬁrst three months of therapy did not follow surgery for infertility. continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

continued. . . Note: If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal — (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application. GOSERELIN ACETATE – Special Authority see SA0839 below – Hospital pharmacy [HP3] Inj 3.6 mg ........................................................................................221.60 1 Zoladex Inj 10.8 mg ......................................................................................554.70 1 Zoladex ¾SA0839 Special Authority for Subsidy Initial application — (Breast cancer) from any medical practitioner. Approvals valid for 1 year where the patient is a premenopausal woman with breast cancer. Initial application — (Prostate cancer) only from an oncologist, urologist or endocrinologist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Advanced prostatic cancer; or 2 Neoadjuvant or adjuvant treatment of locally advanced prostatic cancer. 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: G 3 months to assess whether surgery is appropriate G 3 months for infertile patients after surgery G 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 where the patient is affected by gonadotropin dependent precocious puberty. Renewal — (Breast or prostate cancer) from any medical practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal — (Endometriosis) from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Either: 1 Both: 1.1 There has been a satisfactory response to the ﬁrst 3 months treatment; and 1.2 Surgery is inappropriate; or 2 The ﬁrst three months of therapy did not follow surgery for infertility. Note: If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal — (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once LThree months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

LEUPRORELIN – Hospital pharmacy [HP3] Inj 3.75 mg preﬁlled syringe ...........................................................221.60 Inj 3.75 mg ......................................................................................221.60 Inj 7.5 mg ........................................................................................184.90 Inj 11.25 mg preﬁlled syringe .........................................................591.68 Inj 11.25 mg ....................................................................................591.68 Inj 22.5 mg ......................................................................................554.70 Inj 30 mg .........................................................................................739.60 Inj 30 mg preﬁlled syringe ...........................................................1,109.40 Inj 45 mg ......................................................................................1,109.40

1 1 1 1 1 1 1 1 1

Lucrin Depot PDS Lucrin Depot Eligard Lucrin Depot PDS Lucrin Depot Eligard Eligard Lucrin Depot PDS Eligard

Vasopressin Agonists

DESMOPRESSIN L Nasal drops 100 µg per ml – Retail pharmacy-Specialist.................39.03 L Nasal spray 10 µg per dose – Retail pharmacy-Specialist ...............29.94 Inj 4 µg per ml, 1 ml – Special Authority see SA0090 below – Hospital pharmacy [HP3]............................................................67.18 2.5 ml OP 6 ml OP

Minirin DesmopressinPH&T

Minirin

¾SA0090 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 2 years where the patient cannot use desmopressin nasal spray or nasal drops. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Other Endocrine Agents

CABERGOLINE Tab 0.5 mg – Maximum of 2 tab per prescription; can be waived by Special Authority see SA0175 below.........................26.26 105.03

2 8

Arrow-Cabergoline Arrow-Cabergoline Dostinex

¾SA0175 Special Authority for Waiver of Rule Initial application only from an obstetrician, endocrinologist or gynaecologist. Approvals valid for 2 years where the patient has pathological hyperprolactinemia. Renewal only from an obstetrician, endocrinologist or gynaecologist. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. CLOMIPHENE CITRATE – Retail pharmacy-Specialist Only a prescription for a female patient. Tab 50 mg ...........................................................................................2.50 5 Phenate DANAZOL – Retail pharmacy-Specialist Cap 100 mg .....................................................................................17.00 56.66 Cap 200 mg ......................................................................................25.00 (D-Zol Cap 100 mg to be delisted 1 October 2009) GESTRINONE – Retail pharmacy-Specialist Cap 2.5 mg .....................................................................................101.87 METYRAPONE Cap 250 mg – Hospital pharmacy [HP3]-Specialist .......................238.00 30 100 30

D-Zol Azol D-Zol

8 OP 50

Dimetriose Metopirone

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

Anthelmintics

MEBENDAZOLE – Only on a prescription Tab 100 mg .......................................................................................17.28 Oral liq 100 mg per 5 ml .....................................................................2.18 (7.17) 24 15 ml

De-Worm

Vermox

Antibacterials

a) For topical antibacterials, refer to DERMATOLOGICALS, page 58 b) For anti-infective eye preparations, refer to SENSORY ORGANS, page 157

Cephalosporins and Cephamycins

CEFACLOR MONOHYDRATE Cap 250 mg ......................................................................................28.90 Grans for oral liq 125 mg per 5 ml ......................................................3.92 100 100 ml

Ranbaxy-Cefaclor Ranbaxy-Cefaclor

CEFAZOLIN SODIUM – Hospital pharmacy [HP3] – Subsidy by endorsement Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. Inj 500 mg ...........................................................................................5.00 5 Hospira Inj 1 g ..................................................................................................8.00 5 Hospira CEFOXITIN SODIUM – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. Inj 1 g ................................................................................................55.00 5 Mayne CEFTRIAXONE SODIUM – Hospital pharmacy [HP3] – Subsidy by endorsement a) Up to 5 inj available on a PSO b) Subsidised only if prescribed for a dialysis or cystic ﬁbrosis patient, or the treatment of conﬁrmed ciproﬂoxacin-resistant gonorrhoea, or the treatment of suspected meningitis in patients who have a known allergy to penicillin, and the prescription or PSO is endorsed accordingly. Inj 500 mg ...........................................................................................3.99 1 AFT Inj 1 g ..................................................................................................5.40 1 AFT CEFUROXIME AXETIL – Subsidy by endorsement Only if prescribed for prophylaxis of endocarditis and the prescription is endorsed accordingly. Tab 250 mg .......................................................................................29.40 50 Zinnat CEFUROXIME SODIUM – Hospital pharmacy [HP3] Inj 250 mg – Maximum of 3 inj per prescription; can be waived by endorsement.......................................................................... 20.97 10 Mayne Inj 750 mg – Maximum of 1 inj per prescription; can be waived by endorsement.......................................................................... 10.71 5 Zinacef Inj 1.5 g – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement.................................................................................4.04 1 Zinacef Only if prescribed for a dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly.

Macrolides

AZITHROMYCIN – Subsidy by endorsement a) Maximum of 2 tab per prescription; can be waived by Special Authority see SA0964 on the next page b) Up to 4 tab available on a PSO c) 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 or PSO is endorsed accordingly. Tab 500 mg .........................................................................................5.95 2 OP Arrow-Azithromycin

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once LThree months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA0964 Special Authority for Waiver of Rule Initial application only from a respiratory specialist or paediatrician. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: All of the following: 1 The applicant is part of multidisciplinary team experienced in the management of cystic ﬁbrosis; and 2 The patient has been deﬁnitively diagnosed with cystic ﬁbrosis*; and 3 The patient has chronic infection with Pseudomonas aeruginosa or Pseudomonas related gram negative organisms as deﬁned by two positive respiratory tract cultures at least three months apart*; and 4 The patient has negative cultures for non-tuberculous mycobacteria. Notes: Caution is advised if using azithromycin as an antibiotic in the treatment of cystic ﬁbrosis patients with pneumonia. Testing for non-tuberculosis mycobacteria should occur annually. Indications marked with * are Unapproved Indications (refer to Section A: General Rules, Part I (Interpretations and Deﬁnitions) and Part IV (Miscellaneous Provisions) rule 4.6). CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA0657 below Tab 250 mg .........................................................................................7.75 14 Klamycin Grans for oral liquid 125 mg per 5 ml ...............................................23.12 70 ml Klacid ¾SA0657 Special Authority for Waiver of Rule 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: 1 Mycobacterium Avium Intracellulare Complex infections in patient with AIDS; or 2 Atypical and drug-resistant mycobacterial infection; or 3 All of the following: 3.1 Prophylaxis against disseminated Mycobacterium Avium Intracellulare Complex infection; and 3.2 HIV infection; and 3.3 CD4 count ≤ 50 cells/mm3 . Renewal — (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. ERYTHROMYCIN ETHYL SUCCINATE Tab 400 mg – Up to 30 tab available on a PSO................................16.95 100 E-Mycin Grans for oral liq 200 mg per 5 ml – Up to 200 ml available on a PSO...................................................................................... 4.35 100 ml E-Mycin Grans for oral liq 400 mg per 5 ml – Up to 200 ml available on a PSO...................................................................................... 5.85 100 ml E-Mycin ERYTHROMYCIN LACTOBIONATE Inj 1 g ................................................................................................10.93 ERYTHROMYCIN STEARATE Tab 250 mg – Up to 30 tab available on a PSO................................14.95 (22.29) Tab 500 mg .......................................................................................29.90 (44.58) 1 100 ERA 100 ERA

Erythrocin IV

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

ROXITHROMYCIN Tab 150 mg .........................................................................................8.98 Tab 300 mg .......................................................................................16.48

50 50

ArrowRoxithromycin

Penicillins

AMOXYCILLIN Cap 250 mg – Up to 30 cap available on a PSO..............................17.30 Cap 500 mg ......................................................................................27.25 Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................1.00 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................1.27 Drops 125 mg per 1.25 ml ..................................................................4.00 Inj 250 mg .........................................................................................12.42 Inj 500 mg .........................................................................................14.24 Inj 1 g – Up to 5 inj available on a PSO............................................21.62 AMOXYCILLIN CLAVULANATE Tab amoxycillin 500 mg with potassium clavulanate 125 mg – Up to 30 tab available on a PSO ............................................. 25.10 Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml – Up to 200 ml available on a PSO..............................................................................................2.75 Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml – Up to 200 ml available on a PSO..............................................................................................4.75 BENZATHINE BENZYLPENICILLIN Inj 1.2 mega u per 2.3 ml – Up to 5 inj available on a PSO............315.00 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 1 mega u – Up to 5 inj available on a PSO..................................10.49 DICLOXACILLIN Cap 250 mg .......................................................................................2.47 (4.35) Cap 500 mg .......................................................................................3.83 (8.65) (Diclocil Cap 250 mg to be delisted 1 September 2009) (Diclocil Cap 500 mg to be delisted 1 September 2009) FLUCLOXACILLIN SODIUM Cap 250 mg – Up to 30 cap available on a PSO..............................18.50 Cap 500 mg ......................................................................................57.90 Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................2.05 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................2.72 Inj 250 mg ...........................................................................................9.00 Inj 500 mg .........................................................................................10.40 Inj 1 g – Up to 5 inj available on a PSO............................................14.00

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

Apo-Amoxi Apo-Amoxi Ranbaxy Amoxicillin Ranbaxy Amoxicillin Ospamox Paediatric

Drops

Ibiamox Ibiamox Ibiamox

100

Synermox Augmentin Augmentin Bicillin LA Sandoz

100 ml

100 ml 10 10 24

Diclocil 24 Diclocil

250 500 100 ml 100 ml 10 10 10

Staphlex Staphlex AFT AFT Flucloxin Flucloxin Flucloxin 85

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

PHENOXYMETHYLPENICILLIN (PENICILLIN V) Cap potassium salt 250 mg – Up to 30 cap available on a PSO .........4.29 Cap potassium salt 500 mg ................................................................8.15 Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO...................................................................................... 1.68 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO...................................................................................... 1.82 PROCAINE PENICILLIN Inj 1.5 mega u – Up to 5 inj available on a PSO...............................50.86

50 50 100 ml 100 ml 5

Cilicaine VK Cilicaine VK AFT AFT Cilicaine

Tetracyclines

DOXYCYCLINE HYDROCHLORIDE F Tab 50 mg – Up to 30 tab available on a PSO....................................2.90 (6.00) F Tab 100 mg – Up to 30 tab available on a PSO..................................8.10 MINOCYCLINE HYDROCHLORIDE F Tab 50 mg ...........................................................................................5.79 (12.05) F Cap 100 mg ......................................................................................19.32 (52.04) 30 Doxy-50 250 60 Mino-tabs 100 Minomycin

Doxine

Other Antibiotics

For topical antibiotics, refer to DERMATOLOGICALS, page 58 CIPROFLOXACIN Tab 250 mg – Up to 5 tab available on a PSO....................................3.35 Tab 500 mg – Up to 5 tab available on a PSO....................................4.90 Tab 750 mg – Retail pharmacy-Specialist ..........................................7.54 CLINDAMYCIN Cap hydrochloride 150 mg – Maximum of 4 cap per prescription; can be waived by endorsement - Retail pharmacy Specialist ....................................................................................11.39 Inj phosphate 150 mg per ml, 4 ml – Retail pharmacySpecialist ....................................................................................19.45

30 30 30

Rex Medical Rex Medical Rex Medical

16 1

Dalacin C Dalacin C

CO-TRIMOXAZOLE F Tab trimethoprim 80 mg and sulphamethoxazole 400 mg – Up to 30 tab available on a PSO ................................................17.00 500 Trisul F Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml – Up to 200 ml available on a PSO.............................................................................................. 5.90 500 ml Trisul F Oral liq trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml – Up to 200 ml available on a PSO................................ 2.15 100 ml Deprim (Trisul Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml to be delisted 1 January 2010) COLISTIN SULPHOMETHATE – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. Inj 150 mg .........................................................................................65.00 1 Colistin-Link

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

FUSIDIC ACID Tab 250 mg – Hospital pharmacy [HP3]-Specialist ..........................34.50 12 Fucidin Inj 500 mg sodium fusidate per 10 ml – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement .............................. 12.87 1 (17.80) Fucidin Only if prescribed for a dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. GENTAMICIN SULPHATE Inj 10 mg per ml, 1 ml – Hospital pharmacy [HP3] – Subsidy by endorsement............................................................................8.56 5 Mayne Only if prescribed for a dialysis or cystic ﬁbrosis patient or for prophylaxis of endocarditis and the prescription is endorsed accordingly. Inj 40 mg per ml, 2 ml – Hospital pharmacy [HP3] – Subsidy by endorsement............................................................................4.56 10 Pﬁzer Only if prescribed for a dialysis or cystic ﬁbrosis patient or for prophylaxis of endocarditis and the prescription is endorsed accordingly. TOBRAMYCIN Inj 40 mg per ml, 2 ml – Hospital pharmacy [HP3] – Subsidy by endorsement.......................................................................... 34.50 5 Mayne Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. TRIMETHOPRIM F Tab 300 mg – Up to 30 tab available on a PSO..................................8.69 50 TMP VANCOMYCIN HYDROCHLORIDE – Hospital pharmacy [HP3] – Subsidy by endorsement Only if prescribed for a dialysis or cystic ﬁbrosis patient or in the treatment of pseudomembranous colitis or for prophylaxis of endocarditis and the prescription is endorsed accordingly. Inj 50 mg per ml, 10 ml .......................................................................5.04 1 Paciﬁc

Antifungals

a) For topical antifungals refer to DERMATOLOGICALS, page 59 b) For topical antifungals refer to GENITO URINARY, page 73 FLUCONAZOLE – Hospital pharmacy [HP3]-Specialist Cap 50 mg ..........................................................................................6.82 Cap 150 mg ........................................................................................1.30 Cap 200 mg ......................................................................................19.05 ITRACONAZOLE – Hospital pharmacy [HP3]-Specialist Cap 100 mg ......................................................................................23.70 KETOCONAZOLE Tab 200 mg – Retail pharmacy-Specialist ........................................38.12 NYSTATIN Tab 500,000 u .....................................................................................9.60 Cap 500,000 u ..................................................................................11.64 TERBINAFINE Tab 250 mg .......................................................................................25.50

28 1 28 15 30 50 50 100

Paciﬁc Paciﬁc Paciﬁc Sporanox Nizoral Nilstat S29 Nilstat Apo-Terbinaﬁne

Antimalarials

HYDROXYCHLOROQUINE SULPHATE F Tab 200 mg .......................................................................................22.50 100

Plaquenil

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

Antitrichomonal Agents

METRONIDAZOLE Tab 200 mg – Up to 30 tab available on a PSO..................................9.50 Tab 400 mg .......................................................................................17.50 Oral liq benzoate 200 mg per 5 ml ...................................................25.00 Suppos 500 mg ................................................................................24.48 ORNIDAZOLE Tab 500 mg .......................................................................................12.38 100 100 100 ml 10 10

Trichozole Trichozole Flagyl-S Flagyl Tiberal

Antituberculotics and Antileprotics

Note: There is no co-payment charge for all pharmaceuticals listed in the Antituberculotics and Antileprotics group regardless of immigration status. DAPSONE – No patient co-payment payable Tab 25 mg .........................................................................................95.00 100 Dapsone Tab 100 mg .....................................................................................110.00 100 Dapsone ETHAMBUTOL HYDROCHLORIDE – No patient co-payment payable Tab 400 mg .......................................................................................56.84 ISONIAZID – Retail pharmacy-Specialist No patient co-payment payable F Tab 100 mg .......................................................................................20.50 F Tab 100 mg with rifampicin 150 mg ..................................................90.04 F Tab 150 mg with rifampicin 300 mg ................................................179.57 PYRAZINAMIDE – Retail pharmacy-Specialist No patient co-payment payable F Tab 500 mg .......................................................................................59.00 RIFABUTIN – Hospital pharmacy [HP3]-Specialist No patient co-payment payable F Cap 150 mg ....................................................................................213.19 RIFAMPICIN – Retail pharmacy-Specialist No patient co-payment payable F Tab 600 mg .....................................................................................114.40 F Cap 150 mg ......................................................................................58.66 F Cap 300 mg ....................................................................................122.36 F Oral liq 100 mg per 5 ml ...................................................................12.66 56

Myambutol S29

100 100 100

PSM Riﬁnah Riﬁnah

100

AFT-Pyrazinamide

Mycobutin

30 100 100 60 ml

Rifadin Rifadin Rifadin Rifadin

Antivirals

For eye preparations refer to Eye Preparations, Anti-Infective Preparations, page 157

Hepatitis B Treatment

ADEFOVIR DIPIVOXIL – Special Authority see SA0829 on the next page – Retail pharmacy Tab 10 mg .......................................................................................670.00 30

Hepsera

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA0829 Special Authority for Subsidy Initial application only from a gastroenterologist or infectious disease specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Patient has conﬁrmed Hepatitis B infection (HBsAg+); and Documented resistance to lamivudine, deﬁned as: 2 Patient has raised serum ALT (> 1 × ULN); and 3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and 4 Detection of M204I or M204V mutation; and 5 Either: 5.1 Both: 5.1.1 Patient is cirrhotic; and 5.1.2 adefovir dipivoxil to be used in combination with lamivudine; or 5.2 Both: 5.2.1 Patient is not cirrhotic; and 5.2.2 adefovir dipivoxil to be used as monotherapy. Renewal only from a gastroenterologist or infectious disease specialist. Approvals valid for 2 years where in the opinion of the treating physician, treatment remains appropriate and patient is beneﬁting from treatment. Notes: Lamivudine should be added to adefovir dipivoxil if a patient develops documented resistance to adefovir dipivoxil, deﬁned as: i) raised serum ALT (> 1 × ULN); and ii) HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and iii) Detection of N236T or A181T/V mutation. Adefovir dipivoxil should be stopped 6 months following HBeAg seroconversion for patients who were HBeAg+ prior to commencing adefovir dipivoxil. The recommended dose of adefovir dipivoxil is no more than 10mg daily. In patients with renal insufﬁciency adefovir dipivoxil dose should be reduced in accordance with the datasheet guidelines. Adefovir dipivoxil should be avoided in pregnant women and children. ENTECAVIR – Special Authority see SA0977 below – Retail pharmacy Tab 0.5 mg ......................................................................................400.00 30 Baraclude ¾SA0977 Special Authority for Subsidy Initial application only from a gastroenterologist or infectious disease specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: All of the following: 1 Patient has conﬁrmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 Patient is Hepatitis B nucleoside analogue treatment-naive; and 3 Entecavir dose 0.5 mg/day; and 4 Either: 4.1 ALT greater than upper limit of normal; or 4.2 Bridging ﬁbrosis or cirrhosis (Metavir stage 3 or greater) on liver histology; and 5 Either: 5.1 HBeAg positive; or 5.2 patient has ≥ 2,000 IU HBV DNA units per ml and ﬁbrosis (Metavir stage 2 or greater) on liver histology; and 6 No continuing alcohol abuse or intravenous drug use; and 7 Not co-infected with HCV, HIV or HDV; and 8 Neither ALT nor AST greater than 10 times upper limit of normal; and 9 No history of hypersensitivity to entecavir; and 10 previous documented lamivudine resistance (either clinical or genotypic). Notes: continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . G Entecavir should be continued for 6 months following documentation of complete HBeAg seroconversion (deﬁned as loss of HBeAg plus appearance of anti-HBe plus loss of serum HBV DNA) for patients who were HBeAg positive prior to commencing this agent. This period of consolidation therapy should be extended to 12 months in patients with advanced ﬁbrosis (Metavir Stage F3 or F4). G Entecavir should be taken on an empty stomach to improve absorption. LAMIVUDINE – Special Authority see SA0832 below – Retail pharmacy Tab 100mg ......................................................................................143.00 28 Zefﬁx Oral liq 5 mg per ml ..........................................................................90.00 240 ml Zefﬁx ¾SA0832 Special Authority for Subsidy 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 > 100,000 copies per ml by quantitative PCR at a reference laboratory; and 1.1.3 ALT greater than twice upper limit of normal or bridging ﬁbrosis or cirrhosis (Metavir stage 3 or 4 or equivalent) 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; or 1.4 Hepatitis B surface antigen positive (HbsAg) patient who is receiving chemotherapy for a malignancy, or who has received such treatment within the previous two months; and 2 All of the following: 2.1 No continuing alcohol abuse or intravenous drug use; and 2.2 Not coinfected with HCV or HDV; and 2.3 Neither ALT nor AST greater than 10 times upper limit of normal; and 2.4 No history of hypersensitivity to lamivudine; and 2.5 No previous lamivudine therapy with genotypically proven lamivudine resistance. Renewal only from a gastroenterologist, infectious disease specialist, paediatrician or general physician. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: Renewal for patients who have maintained continuous treatment and response to lamivudine 1 All of the following: 1.1 Have maintained continuous treatment with lamivudine; and 1.2 Most recent test result shows continuing biochemical response (normal ALT); and 1.3 HBV DNA <100,00 copies per ml by quantitative PCR at a reference laboratory; or Renewal when given in combination with adefovir dipivoxil for patients with cirrhosis and resistance to lamivudine 2 All of the following: 2.1 Lamivudine to be used in combination with adefovir dipivoxil; and 2.2 Patient is cirrhotic; and Documented resistance to lamivudine, deﬁned as: 2.3 Patient has raised serum ALT (> 1 × ULN); and 2.4 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 2.5 Detection of M204I or M204V mutation; or Renewal when given in combination with adefovir dipivoxil for patients with resistance to adefovir dipivoxil 3 All of the following: 3.1 Lamivudine to be used in combination with adefovir dipivoxil; and continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . Documented resistance to adefovir, deﬁned as: 3.2 Patient has raised serum ALT (> 1 × ULN); and 3.3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 3.4 Detection of N236T or A181T/V mutation.

Herpesvirus Treatments

ACICLOVIR F Tab dispersible 200 mg .......................................................................1.98 F Tab dispersible 400 mg .......................................................................6.64 F Tab dispersible 800 mg .......................................................................7.38 VALACICLOVIR – Special Authority see SA0957 below – Retail pharmacy Tab 500 mg .....................................................................................102.72 25 56 35 30

Lovir Lovir Lovir Valtrex

¾SA0957 Special Authority for Subsidy Initial application — (recurrent genital herpes) from any medical practitioner. Approvals valid for 12 months where the patient has genital herpes with 2 or more breakthrough episodes in any 6 month period while treated with aciclovir 400 mg twice daily. Renewal — (recurrent genital herpes) from any medical practitioner. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Initial application — (ophthalmic zoster) from any medical practitioner. Approvals valid without further renewal unless notiﬁed where the patient has previous history of ophthalmic zoster and the patient is at risk of vision impairment. Initial application — (CMV prophylaxis) from any medical practitioner. Approvals valid for 3 months where the patient has undergone organ transplantation.

Antiretrovirals

¾SA0779 Special Authority for Subsidy Initial application — (Conﬁrmed HIV/AIDS) only from a named specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 Conﬁrmed HIV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3 ; or 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 copies per ml; or 2.4 Both: 2.4.1 Patient aged 6 years and over; and 2.4.2 CD4 counts < 350 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 or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals. Initial application — (Percutaneous exposure) only from a named specialist. Approvals valid for 6 weeks where the patient has percutaneous exposure to blood known to be HIV positive. continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . 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 or atazanavir 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 specialist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Notes: 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 or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals. Some antiretrovirals are unapproved or contraindicated for this indication. Practitioners prescribing these medications should exercise their own skill, judgement, expertise and discretion, and make their own prescribing decisions with respect to the use of a Pharmaceutical for an indication for which it is not approved or contraindicated. Renewal — (Conﬁrmed HIV/AIDS) only from a named specialist. Approvals valid without further renewal unless notiﬁed where the treatment remains appropriate and the patient is beneﬁting from treatment.

Non-nucleosides Reverse Transcriptase Inhibitors

EFAVIRENZ – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 50 mg .......................................................................................158.33 30 Tab 200 mg .....................................................................................474.99 90 Tab 600 mg .....................................................................................474.99 30 Cap 50 mg .....................................................................................158.33 30 Cap 200 mg ...................................................................................474.99 90 (Stocrin Cap 50 mg to be delisted 1 December 2009) (Stocrin Cap 200 mg to be delisted 1 December 2009)

Stocrin Stocrin Stocrin Stocrin Stocrin

NEVIRAPINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 200 mg .....................................................................................319.80 60 Viramune Oral suspension 10 mg per ml ........................................................134.55 240 ml Viramune Suspension

Nucleosides Reverse Transcriptase Inhibitors

ABACAVIR SULPHATE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 300 mg .....................................................................................458.00 60 Ziagen Oral liq 20 mg per ml ......................................................................100.00 240 ml OP Ziagen ABACAVIR SULPHATE WITH LAMIVUDINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Note: Kivexa counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority. Tab 600 mg with lamivudine 300 mg ..............................................630.00 30 Kivexa DIDANOSINE [DDI] – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 125 mg ....................................................................................115.05 30 Videx EC Cap 200 mg ....................................................................................184.08 30 Videx EC Cap 250 mg ....................................................................................230.10 30 Videx EC Cap 400 mg ....................................................................................368.16 30 Videx EC EMTRICITABINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 200 mg ....................................................................................307.20 30 Emtriva LAMIVUDINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 150 mg .....................................................................................307.20 60 3TC Oral liq 10 mg per ml ......................................................................100.00 240 ml OP 3TC

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

STAVUDINE [D4T] – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Cap 20 mg ......................................................................................317.10 60 Cap 30 mg ......................................................................................377.80 60 Cap 40 mg ......................................................................................503.80 60 Powder for oral soln 1 mg per ml ....................................................100.76 200 ml OP

Zerit Zerit Zerit Zerit

TENOFOVIR DISOPROXIL FUMARATE – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Tab 300 mg .....................................................................................531.00 30 Viread ZIDOVUDINE [AZT] – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Cap 100 mg ....................................................................................290.00 100 Oral liq 10 mg per ml ........................................................................58.00 200 ml OP

Retrovir Retrovir

ZIDOVUDINE [AZT] WITH LAMIVUDINE – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Combivir counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority. Tab 300 mg with lamivudine 150 mg ..............................................667.20 60 Combivir

Protease Inhibitors

ATAZANAVIR SULPHATE – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Cap 150 mg ....................................................................................568.34 60 Reyataz Cap 200 mg ....................................................................................757.79 60 Reyataz INDINAVIR – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Cap 200 mg ....................................................................................519.75 Cap 400 mg ....................................................................................519.75 360 180

Crixivan Crixivan

LOPINAVIR WITH RITONAVIR – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Tab 200 mg with ritonavir 50 mg .....................................................735.00 120 Kaletra Oral liq 80 mg with ritonavir 20 mg per ml ......................................735.00 300 ml OP Kaletra RITONAVIR – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Cap 100 mg ....................................................................................121.27 84 90 ml OP Oral liq 80 mg per ml ......................................................................103.98 SAQUINAVIR – Special Authority see SA0779 on page 91 – Hospital pharmacy [HP1] Tab 500 mg ....................................................................................556.59 120 (Invirase Tab 500 mg to be delisted 1 February 2010)

Norvir Norvir Invirase

Antiretrovirals - Additional Therapies HIV Fusion Inhibitors

ENFUVIRTIDE – Special Authority see SA0845 below – Hospital pharmacy [HP1] Powder for inj 90 mg per ml × 60 ................................................2,380.00 1

Fuzeon

¾SA0845 Special Authority for Subsidy Initial application only from a named specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Conﬁrmed HIV infection; and 2 Enfuvirtide to be given in combination with optimized background therapy (including at least 1 other antiretroviral drug that the patient has never previously been exposed to) for treatment failure; and 3 Either: 3.1 Patient has evidence of HIV replication, despite ongoing therapy; or 3.2 Patient has treatment-limiting toxicity to previous antiretroviral agents; and 4 Previous treatment with 3 different antiretroviral regimens has failed; and continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . 5 All of the following: 5.1 Previous treatment with a non-nucleoside reverse transcriptase inhibitor has failed; and 5.2 Previous treatment with a nucleoside reverse transcriptase inhibitor has failed; and 5.3 Previous treatment with a protease inhibitor has failed. Renewal only from a named specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Evidence of at least a 10 fold reduction in viral load at 12; and 2 The treatment remains appropriate and the patient is beneﬁting from treatment.

Immune Modulators

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. Criteria for Treatment 1) Diagnosis G Anti-HCV positive on at least two occasions with a positive PCR for HCV-RNA and preferably conﬁrmed by a supplementary RIBA test; or G PCR-RNA positive for HCV on at least 2 occasions if antibody negative; or G 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. 2) Establishing Active Chronic Liver Disease G Conﬁrmed HCV infection and serum ALT/AST levels measured on at least three occasions over six months averaging > 1.5 × upper limit of normal. (ALT is the preferable enzyme); or G 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 1) Autoimmune liver disease. (Interferon may exacerbate autoimmune liver disease as well as other autoimmune diseases such as thyroid disease). 2) Pregnancy. 3) Neutropenia (<2.0 × 109 ) and/or thrombocytopenia. 4) Continuing alcohol abuse and/or continuing intravenous drug users. Dosage The current recommended dosage is 3 million units of interferon alpha-2a or interferon aplha-2b administered subcutaneously 3 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. INTERFERON ALPHA-2A – PCT – Hospital pharmacy [HP3]-Specialist a) See prescribing guideline above b) Only one multidose cartridge starter pack to be prescribed and dispensed per patient. Inj 3 m iu preﬁlled syringe .................................................................31.32 1 Roferon-A 1 Roferon-A Inj 4.5 m iu preﬁlled syringe ..............................................................46.98 Inj 6 m iu preﬁlled syringe .................................................................62.64 1 Roferon-A Inj 9 m iu preﬁlled syringe .................................................................93.96 1 Roferon-A Inj 18 m iu multidose cartridge .......................................................187.92 1 Roferon-A Inj 18 m iu multidose cartridge × 2 starter pack .............................375.84 1 Roferon-A

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

INTERFERON ALPHA-2A WITH RIBAVIRIN – Special Authority see SA0784 below – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Inj 18 m iu multidose cartridge × 2 with ribavirin tab 200 mg × 168 ....................................................................................1,375.84 1 OP Roferon RBV Combination Pack Inj 18 m iu multidose cartridge × 2 with with pen and needles with ribavirin tab 200 mg × 168 ............................................1,375.84 1 OP Roferon RBV Combination Pack Starter Kit ¾SA0784 Special Authority for Subsidy Initial application from any specialist. Approvals valid for 12 months where patient has chronic hepatitis C (all genotypes). INTERFERON ALPHA-2B – PCT – Hospital pharmacy [HP3]-Specialist See prescribing guideline on the preceding page Inj 18 m iu, 1.2 ml multidose pen ....................................................187.92 1 Intron-A Inj 30 m iu, 1.2 ml multidose pen ....................................................313.20 1 Intron-A Inj 60 m iu, 1.2 ml multidose pen ....................................................626.40 1 Intron-A PEGYLATED INTERFERON ALPHA-2A – Special Authority see SA0952 below – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Inj 135 µg preﬁlled syringe .............................................................362.00 1 Pegasys Inj 180 µg preﬁlled syringe .............................................................450.00 1 Pegasys Inj 135 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 112 .......................................................................................1,799.68 1 OP Pegasys RBV Combination Pack Inj 135 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 168 .......................................................................................1,975.00 1 OP Pegasys RBV Combination Pack Inj 180 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 112 .......................................................................................2,059.84 1 OP Pegasys RBV Combination Pack Inj 180 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 168 .......................................................................................2,190.00 1 OP Pegasys RBV Combination Pack ¾SA0952 Special Authority for Subsidy Initial application — (chronic hepatitis C - genotype 1, 4, 5 or 6 infection or co-infection with HIV) from any specialist. Approvals valid for 48 weeks 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 and is co-infected with HIV. Notes: G Consider stopping treatment if there is absence of a virological response (deﬁned as at least a 2-log reduction in viral load) following 12 weeks of treatment since this is predictive of treatment failure. G Consider reducing treatment to 24 weeks if serum HCV RNA level at Week 4 is undetectable by sensitive PCR assay (less than 50IU/ml) AND Baseline serum HCV RNA is less than 400,000IU/ml Initial application — (chronic hepatitis C - genotype 2 or 3 infection without co-infection with HIV) from any specialist. Approvals valid for 6 months where patient has chronic hepatitis C, genotype 2 or 3 infection. Initial application — (Hepatitis B) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 48 weeks for applications meeting the following criteria: All of the following: continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once LThree months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . 1 Patient has conﬁrmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 Patient is Hepatitis B treatment-naive; and 3 ALT > 2 times Upper Limit of Normal; and 4 HBV DNA < 10 log10 IU/ml; and 5 Either: 5.1 HBeAg positive; or 5.2 serum HBV DNA ≥ 2,000 units/ml and signiﬁcant ﬁbrosis (≥ Metavir Stage F2); and 6 Compensated liver disease; and 7 No continuing alcohol abuse or intravenous drug use; and 8 Not co-infected with HCV, HIV or HDV; and 9 Neither ALT nor AST > 10 times upper limit of normal; and 10 No history of hypersensitivity or contraindications to pegylated interferon. Notes: G Approved dose is 180 µg once weekly. G The recommended dose of Pegylated Interferon-alpha 2a is 180 µg once weekly. G In patients with renal insufﬁciency (calculated creatinine clearance less than 50ml/min), Pegylated Interferon-alpha 2a dose should be reduced to 135 µg once weekly. G In patients with neutropaenia and thrombocytopaenia, dose should be reduced in accordance with the datasheet guidelines. G Pegylated Interferon-alpha 2a is not approved for use in children.

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

PEGYLATED INTERFERON ALPHA-2B WITH RIBAVIRIN – Special Authority see SA0953 below – Hospital pharmacy [HP3] See prescribing guideline on page 94 Inj 50 µg × 4 with ribavirin cap 200 mg × 112 ............................1,080.40 1 OP Pegatron Combination Therapy Inj 50 µg × 4 with ribavirin cap 200 mg × 84 .................................976.80 1 OP Pegatron Combination Therapy Inj 80 µg × 4 with ribavirin cap 200 mg × 140 ............................1,583.60 1 OP Pegatron Combination Therapy Inj 80 µg × 4 with ribavirin cap 200 mg × 168 ............................1,687.20 1 OP Pegatron Combination Therapy Inj 80 µg × 4 with ribavirin cap 200 mg × 84 ..............................1,376.40 1 OP Pegatron Combination Therapy Inj 100 µg × 4 with ribavirin cap 200 mg × 112 ..........................1,746.40 1 OP Pegatron Combination Therapy Inj 100 µg × 4 with ribavirin cap 200 mg × 84 ............................1,642.80 1 OP Pegatron Combination Therapy Inj 120 µg × 4 with ribavirin cap 200 mg × 140 ..........................2,116.40 1 OP Pegatron Combination Therapy Inj 120 µg × 4 with ribavirin cap 200 mg × 84 ............................1,909.20 1 OP Pegatron Combination Therapy Inj 150 µg × 4 with ribavirin cap 200 mg × 140 ..........................2,516.00 1 OP Pegatron Combination Therapy Inj 150 µg × 4 with ribavirin cap 200 mg × 168 ..........................2,619.60 1 OP Pegatron Combination Therapy Inj 150 µg × 4 with ribavirin cap 200 mg × 84 ............................2,308.80 1 OP Pegatron Combination Therapy ¾SA0953 Special Authority for Subsidy Initial application — (chronic hepatitis C - genotype 1, 4, 5 or 6 infection or co-infection with HIV) from any specialist. Approvals valid for 11 months where patient has an existing Special Authority. Note: Existing current approvals are still valid but no new applications will be accepted.

Urinary Tract Infections

HEXAMINE HIPPURATE F Tab 1 g ..............................................................................................18.40 (38.10) 100 Hiprex

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

NITROFURANTOIN F Tab 50 mg .........................................................................................17.90 F Tab 100 mg .......................................................................................30.25 NORFLOXACIN Tab 400 mg – Maximum of 6 tab per prescription; can be waived by endorsement - Retail pharmacy - Specialist..............22.50

100 100

Nifuran Nifuran

100

Arrow-Norﬂoxacin

Vaccines Inﬂuenza vaccine

INFLUENZA VACCINE – Hospital pharmacy [Xpharm] 1) Subsidy is available between 1 March and 30 September of each year. 2) Doctors are the only Contractors entitled to claim payment from the Funder for the supply of inﬂuenza vaccine to patients eligible under (1) above for subsidised immunisation and they may only do so in respect of the inﬂuenza vaccine listed in the Pharmaceutical Schedule. 3) 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 ........................................................................................................9.00 1 Fluvax Fluarix 90.00 10 Fluarix Vaxigrip

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

MUSCULOSKELETAL SYSTEM

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

Anticholinesterases

NEOSTIGMINE Inj 2.5 mg per ml, 1 ml ......................................................................20.30 PYRIDOSTIGMINE BROMIDE L Tab 60 mg .........................................................................................40.08 50 100

AstraZeneca Mestinon

Anti-inﬂammatory Non Steroidal Drugs (NSAIDs)

¾SA0291 Special Authority for Manufacturers Price 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 where the treatment remains appropriate and the patient is beneﬁting from treatment. DICLOFENAC SODIUM F Tab EC 25 mg .....................................................................................3.51 100 Apo-Diclo F Tab 50 mg dispersible – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy .............................1.50 20 (8.00) Voltaren D F Tab EC 50 mg ...................................................................................25.88 500 Apo-Diclo F Tab long-acting 75 mg ......................................................................22.78 500 Apo-Diclo SR F Tab long-acting 100 mg ....................................................................34.32 500 Apo-Diclo SR F Inj 25 mg per ml, 3 ml .......................................................................12.00 5 Voltaren Up to 5 inj available on a PSO F Suppos 12.5 mg .................................................................................1.85 10 Voltaren F Suppos 25 mg ....................................................................................2.22 10 Voltaren F Suppos 50 mg ....................................................................................3.84 10 Voltaren Up to 10 supp available on a PSO F Suppos 100 mg ..................................................................................6.36 10 Voltaren IBUPROFEN – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy F Tab 200 mg .......................................................................................16.00 1,000 F Tab 400 mg .........................................................................................1.07 30 (4.56) F Tab 600 mg .........................................................................................1.60 30 (6.84) F Tab long-acting 800 mg ......................................................................1.50 30 (9.12) 200 ml F‡ Oral liq 100 mg per 5 ml .....................................................................3.49 KETOPROFEN – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy F Cap long-acting 100 mg .....................................................................6.72 100 (21.56) F Cap long-acting 200 mg ...................................................................13.44 100 (43.12)

Ethics Ibuprofen

Brufen Brufen Brufen Retard

Fenpaed

Oruvail 100 Oruvail 200

MEFENAMIC ACID – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy F Cap 250 mg ........................................................................................2.50 100 (18.33) Ponstan

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

MUSCULOSKELETAL SYSTEM

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

NAPROXEN F Tab 250 mg .......................................................................................21.00 F Tab 500 mg .......................................................................................17.95 F Tab long-acting 750 mg ....................................................................18.00 F Tab long-acting 1,000 mg .................................................................21.00 NAPROXEN SODIUM F Tab 275 mg .........................................................................................6.00 F Tab 550 mg .......................................................................................12.80

500 250 90 90 120 100

Noﬂam 250 Noﬂam 500 Naprosyn SR 750 Naprosyn SR 1000 Sonaﬂam Synﬂex

SULINDAC – Additional subsidy by Special Authority see SA0291 on the preceding page – Retail pharmacy F Tab 100 mg .........................................................................................5.32 100 (12.00) Daclin F Tab 200 mg .........................................................................................6.72 100 (20.00) Daclin 3.36 50 (15.87) Clinoril TENOXICAM F Tab 20 mg .........................................................................................23.75 100

Tilcotil

TIAPROFENIC ACID – Additional subsidy by Special Authority see SA0291 on the preceding page – Retail pharmacy F Tab 300 mg .........................................................................................4.03 60 (19.26) Surgam

NSAIDs Other

INDOMETHACIN F Cap 25 mg .........................................................................................5.90 F Cap 50 mg .........................................................................................6.95 F Cap long-acting 75 mg .....................................................................13.30 F Suppos 100 mg ................................................................................14.50 (Rheumacin Cap 25 mg to be delisted 1 December 2009) (Rheumacin Cap 50 mg to be delisted 1 October 2009) PIROXICAM F Tab dispersible 10 mg .........................................................................3.25 F Tab dispersible 20 mg .........................................................................5.50 100 100 100 30

Rheumacin Rheumacin Rheumacin SR Arthrexin

50 100

Piram-D Piram-D

Antirheumatoid Agents

AURANOFIN Tab 3 mg ...........................................................................................68.99 LEFLUNOMIDE Tab 10 mg .........................................................................................55.00 79.27 Tab 20 mg .........................................................................................76.00 108.60 Tab 100 mg .......................................................................................54.44 PENICILLAMINE Tab 125 mg .......................................................................................61.93 Tab 250 mg .......................................................................................98.98 60 30 30 3 100 100

Ridaura AFT-Leﬂunomide Arava AFT-Leﬂunomide Arava Arava D-Penamine D-Penamine

100

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

MUSCULOSKELETAL SYSTEM

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

SODIUM AUROTHIOMALATE 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

Tumour Necrosis Factor (TNF) Inhibitors

ADALIMUMAB – Special Authority see SA0974 below – Retail pharmacy Inj 40 mg per 0.8 ml preﬁlled pen ................................................1,799.92 Inj 40 mg per 0.8 ml preﬁlled syringe ..........................................1,799.92 2 2

HumiraPen Humira

¾SA0974 Special Authority for Subsidy Initial application — (rheumatoid arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with at least two of the following (triple therapy): sulphasalazine, prednisone at a dose of at least 7.5 mg per day, azathioprine, intramuscular gold, or hydroxychloroquine sulphate (at maximum tolerated doses); and 5 Either: 5.1 Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of cyclosporin alone or in combination with another agent; or 5.2 Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of leﬂunomide alone or in combination with another agent; and 6 Either: 6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 7 Either: 7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Initial application — (Crohn’s disease) only from a gastroenterologist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient has severe active Crohn’s disease; and 2 Any of the following: 2.1 Patient has a Crohn’s Disease Activity Index (CDAI) score of greater than or equal to 300; or 2.2 Patient has extensive small intestine disease affecting more than 50 cm of the small intestine; or 2.3 Patient has evidence of short gut syndrome or would be at risk of short gut syndrome with further bowel resection; or 2.4 Patient has an ileostomy or colostomy, and has intestinal inﬂammation; and 3 Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses (unless contraindicated) and corticosteroids; and 4 Surgery (or further surgery) is considered to be clinically inappropriate. Initial application — (severe chronic plaque psoriasis) only from a dermatologist. Approvals valid for 4 months for applications meeting the following criteria: continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

101

MUSCULOSKELETAL SYSTEM

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

continued. . .

All of the following: 1 Either: 1.1 Patient has "whole body" severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and 3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 4 The most recent PASI assessment is no more than 1 month old at the time of application. Note: "Inadequate response" is deﬁned as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. Initial application — (ankylosing spondylitis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient has a conﬁrmed diagnosis of ankylosing spondylitis present for more than six months; and 2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 4 Patient’s ankylosing spondylitis has not responded adequately to treatment with two or more non-steroidal anti-inﬂammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regimen supervised by a physiotherapist; and 5 Either: 5.1 Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by a score of at least 1 on each of the lumbar ﬂexion and lumbar side ﬂexion measurements of the Bath Ankylosing Spondylitis Metrology Index (BASMI); or 5.2 Patient has limitation of chest expansion by at least 2.5 cm below the average normal values corrected for age and gender (see Notes); and 6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale; and 7 Either: 7.1 An elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 7.2 A C-reactive protein (CRP) level greater than 15 mg per litre. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI, ESR and CRP measures must be no more than 1 month old at the time of initial application. Average normal chest expansion corrected for age and gender: 18-24 years - Male: 7.0 cm; Female: 5.5 cm 25-34 years - Male: 7.5 cm; Female: 5.5 cm 35-44 years - Male: 6.5 cm; Female: 4.5 cm 45-54 years - Male: 6.0 cm; Female: 5.0 cm 55-64 years - Male: 5.5 cm; Female: 4.0 cm 65-74 years - Male: 4.0 cm; Female: 4.0 cm 75+ years - Male: 3.0 cm; Female: 2.5 cm continued. . .

102

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

MUSCULOSKELETAL SYSTEM

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

continued. . . Initial application — (psoriatic arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 3 Patient has tried and not responded to at least three months of sulphasalazine at a dose of at least 2 g per day or leﬂunomide at a dose of up to 20 mg daily (or maximum tolerated doses); and 4 Either: 4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 4.2 Patient has persistent symptoms of poorly controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 5 Any of the following: 5.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 5.3 ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Renewal — (rheumatoid arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and conﬁrms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Either: 3.1 Following 4 months initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically signiﬁcant response to treatment in the opinion of the physician; or 3.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically signiﬁcant response to treatment in the opinion of the physician. Renewal — (Crohn’s disease) only from a gastroenterologist or Practitioner on the recommendation of a gastroenterologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Either: 1.1 Applicant is a gastroenterologist; or 1.2 Applicant is a Practitioner and conﬁrms that a gastroenterologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 The treatment remains appropriate and the patient is beneﬁting from treatment. Renewal — (severe chronic plaque psoriasis) only from a dermatologist or Practitioner on the recommendation of a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Either: 1.1 Applicant is a dermatologist; or 1.2 Applicant is a Practitioner and conﬁrms that a dermatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Both: continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

103

MUSCULOSKELETAL SYSTEM

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

continued. . . 2.1.1 Patient has "whole body" severe chronic plaque psoriasis; and 2.1.2 Following each prior adalimumab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-adalimumab treatment baseline value; or 2.2 Both: 2.2.1 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot; and 2.2.2 Either: 2.2.2.1 Following each prior adalimumab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 2.2.2.2 Following each prior adalimumab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-adalimumab treatment baseline value. Note: An adalimumab treatment course is deﬁned as a minimum of 12 weeks adalimumab treatment. Renewal — (ankylosing spondylitis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and conﬁrms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Following 12 weeks of adalimumab treatment, BASDAI has improved by 4 or more points from pre-adalimumab baseline on a 10 point scale, or by 50%, whichever is less; and 3 ESR or CRP is within the normal range; and 4 Physician considers that the patient has beneﬁted from treatment and that continued treatment is appropriate. Renewal — (psoriatic arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and conﬁrms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Following 4 months initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically signiﬁcant response to treatment in the opinion of the treating physician; or 2.2 The patient demonstrates at least a continuing 50% improvement in active joint count from baseline and a clinically signiﬁcant response to prior adalimumab treatment in the opinion of the treating physician. ETANERCEPT – Retail pharmacy-Specialist prescription – Special Authority see SA0868 below Inj 25 mg .........................................................................................949.96 4 Enbrel

¾SA0868 Special Authority for Subsidy Initial application only from a named specialist or rheumatologist. 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 diagnosed with Juvenile Idiopathic Arthritis (JIA); and 3 Patient has had severe active polyarticular course JIA for 6 months duration or longer; and continued. . .

104

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

MUSCULOSKELETAL SYSTEM

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

continued. . . 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 or at the maximum tolerated dose) in combination with oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose); 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 or at the maximum tolerated dose) 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, swollen, 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. Note: A patient declaration form http://www.pharmac.govt.nz/special_authority_forms/SA0667-declaration.pdf must be signed by the legal guardian of the patient and the prescriber in the presence of a witness (over 18 years of age) Renewal only from a named specialist or rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 Following 4 months initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician’s global assessment from baseline; or 2.2 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.

Calcium Homeostasis Alendronate for Osteoporosis

¾SA0948 Special Authority for Subsidy Initial application — (Underlying cause – Osteoporosis) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Any of the following: 1 History of one signiﬁcant osteoporotic fracture demonstrated radiologically and documented bone mass density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5); or 2 History of one signiﬁcant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two signiﬁcant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0. Initial application — (Underlying cause – glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is receiving systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Either: 2.1 The patient has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5); or continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

105

MUSCULOSKELETAL SYSTEM

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

continued. . . 2.2 The patient has a history of one signiﬁcant osteoporotic fracture demonstrated radiologically. Renewal — (Underlying cause was, and remains, glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year where the patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents). Renewal — (Underlying cause was glucocorticosteroid therapy but patient now meets the ’Underlying cause - osteoporosis’ criteria) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Any of the following: 1 History of one signiﬁcant osteoporotic fracture demonstrated radiologically and documented bone mass density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5); or 2 History of one signiﬁcant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two signiﬁcant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0. Notes: a) Evidence used by National Institute for Health and Clinical Excellence (NICE) guidance indicates that patients aged 75 years and over who have a history of signiﬁcant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5, and therefore do not require BMD measurement for treatment with bisphosphonates. b) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be deﬁned using the WHO deﬁnitions of osteoporosis and fragility fracture. The WHO deﬁnes severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantiﬁed this as forces equivalent to a fall from a standing height or less. c) 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. ALENDRONATE SODIUM – Special Authority see SA0948 on the preceding page – Retail pharmacy Tab 70 mg .........................................................................................35.91 4 Fosamax ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA0948 on the preceding page – Retail pharmacy Tab 70 mg with cholecalciferol 2800 iu .............................................35.91 4 Fosamax Plus

Alendronate for Paget’s Disease

¾SA0949 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 6 months where the treatment remains appropriate and the patient is beneﬁting from treatment. ALENDRONATE SODIUM – Special Authority see SA0949 above – Retail pharmacy Tab 40 mg .......................................................................................133.00 30 Fosamax

106

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

MUSCULOSKELETAL SYSTEM

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

Other Treatments

CALCITONIN F Inj 100 iu per ml, 1 ml .....................................................................110.00 5

Miacalcic

ETIDRONATE DISODIUM F Tab 200 mg .......................................................................................22.80 60 Didronel 38.00 100 Etidrate Prescribing Guidelines 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. PAMIDRONATE DISODIUM – Hospital pharmacy [HP3] Inj 3 mg per ml, 5 ml .........................................................................18.75 1 Pamisol Inj 3 mg per ml, 10 ml .......................................................................37.50 1 Pamisol Inj 6 mg per ml, 10 ml .......................................................................75.00 1 Pamisol Inj 9 mg per ml, 10 ml .....................................................................112.50 1 Pamisol

Enzymes

HYALURONIDASE Inj 1,500 iu per ml .............................................................................18.32 (243.24) 10 Hyalase

Hyperuricaemia and Antigout

ALLOPURINOL F Tab 100 mg .........................................................................................5.44 F Tab 300 mg .........................................................................................4.03 COLCHICINE F Tab 500 µg ..........................................................................................9.60 PROBENECID F Tab 500 mg .......................................................................................55.00 250 100 100 100

Apo-Allopurinol Apo-Allopurinol Colgout AFT

Muscle Relaxants

BACLOFEN F Tab 10 mg ...........................................................................................3.75 DANTROLENE SODIUM F Cap 25 mg ........................................................................................32.96 F Cap 50 mg ........................................................................................51.70 ORPHENADRINE CITRATE Tab 100 mg .......................................................................................18.54 QUININE SULPHATE F Tab 200 mg .......................................................................................15.95 ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 300 mg .......................................................................................34.75 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 100 100 100 100 250 500

Pacifen Dantrium Dantrium Norﬂex Q 200 Q 300

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

107

NERVOUS SYSTEM

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

Anaesthetics Local

BUPIVACAINE HYDROCHLORIDE – Hospital pharmacy [HP3] Inj 0.5%, 4 ml ....................................................................................29.35 Inj 0.5%, 8% glucose, 4 ml ...............................................................24.50 5 5

Marcain Isobaric Marcain Heavy

LIGNOCAINE HYDROCHLORIDE Inj 0.5%, 5 ml – Up to 5 inj available on a PSO................................44.10 50 Xylocaine Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use. Inj 1%, 5 ml – Up to 5 inj available on a PSO...................................42.00 50 Xylocaine Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use. Inj 1%, 20 ml – Up to 5 inj available on a PSO.................................23.50 5 Xylocaine Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use. LIGNOCAINE WITH CHLORHEXIDINE Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringes ...............43.26 10 Pﬁzer LIGNOCAINE WITH PRILOCAINE – Special Authority see SA0906 below – Hospital pharmacy [HP3] Crm 2.5% with prilocaine 2.5% ........................................................41.00 30 g OP EMLA Crm 2.5% with prilocaine 2.5% (5 g tubes) ......................................41.00 5 EMLA ¾SA0906 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years where the patient is a child with a chronic medical condition requiring frequent injections or venepuncture. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Analgesics

For Anti-inﬂammatory NSAIDS refer to MUSCULOSKELETAL, page 99

Non-Opioid Analgesics

ASPIRIN F Tab EC 300 mg ...................................................................................2.15 (8.10) F Tab dispersible 300 mg – Up to 30 tab available on a PSO ...............2.15 NEFOPAM HYDROCHLORIDE Tab 30 mg .........................................................................................23.40 PARACETAMOL F Tab 500 mg – Up to 30 tab available on a PSO..................................9.60 F‡ Oral liq 120 mg per 5 ml .....................................................................6.80 a) Up to 200 ml available on a PSO b) Not in combination F‡ Oral liq 250 mg per 5 ml .....................................................................7.00 a) Up to 100 ml available on a PSO b) Not in combination F Suppos 125 mg ..................................................................................7.49 F Suppos 250 mg ................................................................................14.40 F Suppos 500 mg ................................................................................20.50 100 Aspec 300 100 90 1,000 1,000 ml

Ethics Aspirin Acupan Pharmacare Paracare Junior Paracare Double

Strength

1,000 ml

20 20 50

Panadol Panadol Paracare

108

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

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 ...........................................................................................5.50 Tab 30 mg ...........................................................................................8.50 Tab 60 mg .........................................................................................18.50 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 (33.14) DIHYDROCODEINE TARTRATE Tab long-acting 60 mg ......................................................................30.30 FENTANYL – Special Authority see SA0935 below – Retail pharmacy a) Only on a controlled drug form b) No patient co-payment payable Transdermal patch, matrix 25 µg per hour ........................................55.23 Transdermal patch, matrix 50 µg per hour ......................................100.52 Transdermal patch, matrix 75 µg per hour ......................................139.18 Transdermal patch, matrix 100 µg per hour ....................................171.22 5 Temgesic 100 100 100 500 Paradex 500 Capadex 60

PSM PSM PSM

DHC Continus

5 5 5 5

Durogesic Durogesic Durogesic Durogesic

¾SA0935 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 3 months where the treatment remains appropriate and the patient is beneﬁting from treatment. FENTANYL CITRATE a) Only on a controlled drug form b) No patient co-payment payable Inj 50 µg per ml, 2 ml ..........................................................................6.10 5 Hospira Inj 50 µg per ml, 10 ml ......................................................................15.65 5 Hospira METHADONE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable c) Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). d) For methadone hydrochloride oral liquid refer, page 166 Tab 5 mg .............................................................................................2.10 10 Methatabs ‡ Oral liq 2 mg per ml ............................................................................5.95 200 ml Biodone ‡ Oral liq 5 mg per ml ............................................................................5.55 200 ml Biodone Forte ‡ Oral liq 10 mg per ml ..........................................................................8.95 200 ml Biodone Extra Forte Inj 10 mg per ml, 1 ml .......................................................................61.00 10 AFT

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

109

NERVOUS SYSTEM

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

MORPHINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable ‡ Oral liq 1 mg per ml ............................................................................8.06 ‡ Oral liq 2 mg per ml ............................................................................8.56 ‡ Oral liq 5 mg per ml ............................................................................9.61 ‡ Oral liq 10 mg per ml ........................................................................12.56 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Tab immediate-release 10 mg ............................................................2.64 Tab long-acting 10 mg ........................................................................1.80 Tab immediate-release 20 mg ............................................................5.10 Tab long-acting 30 mg ........................................................................3.60 Tab long-acting 60 mg ........................................................................7.20 Tab long-acting 100 mg ......................................................................8.50 Cap long-acting 10 mg .......................................................................1.80 Cap long-acting 30 mg .......................................................................2.64 Cap long-acting 60 mg .......................................................................7.20 Cap long-acting 100 mg .....................................................................7.85 Cap long-acting 200 mg ...................................................................17.00 Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO .......................5.17 Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................4.50 Inj 15 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................4.70 Inj 30 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................4.98 MORPHINE TARTRATE a) Only on a controlled drug form b) No patient co-payment payable Inj 80 mg per ml, 1.5 ml ....................................................................20.20 Inj 80 mg per ml, 5 ml .......................................................................67.37

200 ml 200 ml 200 ml 200 ml

RA-Morph RA-Morph RA-Morph RA-Morph

10 10 10 10 10 10 10 10 10 10 10 5 5 5 5

Sevredol LA-Morph Sevredol LA-Morph LA-Morph LA-Morph m-Eslon m-Eslon m-Eslon m-Eslon m-Eslon Mayne Mayne Mayne Mayne

5 5

Mayne Mayne

OXYCODONE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable Tab controlled-release 5 mg ...............................................................7.51 20 OxyContin Tab controlled-release 10 mg ...........................................................11.14 20 OxyContin Tab controlled-release 20 mg ...........................................................18.93 20 OxyContin Tab controlled-release 40 mg ...........................................................33.29 20 OxyContin Tab controlled-release 80 mg ...........................................................58.03 20 OxyContin Cap 5 mg ............................................................................................2.83 20 OxyNorm Cap 10 mg ..........................................................................................5.58 20 OxyNorm Cap 20 mg ..........................................................................................9.77 20 OxyNorm ‡ Oral liq 5 mg per 5 ml .......................................................................11.20 250 ml OxyNorm Inj 10 mg per ml, 1 ml .......................................................................14.40 5 OxyNorm Inj 10 mg per ml, 2 ml .......................................................................28.80 5 OxyNorm Prescribing Guideline Prescribers should note that oxycodone is signiﬁcantly more expensive than long-acting morphine sulphate and clinical advice suggests that it is reasonable to consider this as a second-line agent to be used after morphine. PARACETAMOL WITH CODEINE F Tab paracetamol 500 mg with codeine phosphate 8 mg ....................3.24 100 Codalgin

110

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

PETHIDINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable Tab 50 mg ...........................................................................................3.00 Tab 100 mg .........................................................................................4.00 Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................5.20 Inj 50 mg per ml, 1.5 ml – Up to 5 inj available on a PSO ..................4.35 Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .....................5.50

10 10 5 5 5

PSM PSM Mayne Mayne Mayne

Antidepressants Cyclic and Related Agents

AMITRIPTYLINE Tab 10 mg ...........................................................................................2.77 Tab 25 mg ...........................................................................................3.40 Tab 50 mg ...........................................................................................5.20 CLOMIPRAMINE HYDROCHLORIDE Tab 10 mg .........................................................................................10.00 Tab 25 mg .........................................................................................26.00 DOTHIEPIN HYDROCHLORIDE Tab 75 mg ...........................................................................................8.75 Cap 25 mg ..........................................................................................4.75 DOXEPIN HYDROCHLORIDE Cap 10 mg ..........................................................................................5.24 Cap 25 mg ..........................................................................................5.46 Cap 50 mg ..........................................................................................7.34 IMIPRAMINE HYDROCHLORIDE Tab 10 mg ...........................................................................................5.48 Tab 25 mg ...........................................................................................8.80 MAPROTILINE HYDROCHLORIDE Tab 25 mg .........................................................................................25.06 Tab 75 mg .........................................................................................21.01 50 100 100 100 500 100 100 100 100 100 50 50 100 30

Amirol Amitrip Amitrip Clopress Clopress Dopress Dopress Anten Anten Anten Tofranil Tofranil Ludiomil Ludiomil Tolvon

MIANSERIN HYDROCHLORIDE – Special Authority see SA0864 below – Retail pharmacy Tab 30 mg .........................................................................................29.25 30

¾SA0864 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Depression; and 2 Either: 2.1 Co-existent bladder neck obstruction; or 2.2 Cardiovascular disease. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. NORTRIPTYLINE HYDROCHLORIDE Tab 10 mg ...........................................................................................5.94 100 Norpress Tab 25 mg .........................................................................................14.44 180 Norpress

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

111

NERVOUS SYSTEM

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

TRIMIPRAMINE MALEATE Cap 25 mg ..........................................................................................6.20 Cap 50 mg ........................................................................................11.20

100 100

Tripress Tripress

Monoamine-Oxidase Inhibitors (MAOIs) - Non Selective

PHENELZINE SULPHATE Tab 15 mg .........................................................................................95.00 TRANYLCYPROMINE SULPHATE Tab 10 mg .........................................................................................22.94 100 50

Nardil Parnate Parnate S29 S29

Monoamine-Oxidase Type A Inhibitors

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. Tab 150 mg .......................................................................................49.45 500 Apo-Moclobemide Tab 300 mg .......................................................................................26.11 100 Apo-Moclobemide

Selective Serotonin Reuptake Inhibitors

CITALOPRAM HYDROBROMIDE F Tab 20 mg ...........................................................................................3.78 84

Arrow-Citalopram

FLUOXETINE HYDROCHLORIDE F Tab dispersible 20 mg, scored – Subsidy by endorsement .................5.50 30 Fluox Subsidised by endorsement 1) When prescribed for a patient who cannot swallow whole tablets or capsules and the prescription is endorsed accordingly; or 2) When prescribed in a daily dose that is not a multiple of 20 mg in which case the prescription is deemed to be endorsed. Note: Tablets should be combined with capsules to facilitate incremental 10 mg doses. F Cap 20 mg ..........................................................................................4.39 90 Fluox PAROXETINE HYDROCHLORIDE Tab 20 mg ...........................................................................................5.90 30

Loxamine

Other Antidepressants

VENLAFAXINE – Special Authority see SA0789 below – Retail pharmacy Cap 37.5 mg .....................................................................................18.64 Cap 75 mg ........................................................................................37.27 Cap 150 mg ......................................................................................45.68 28 28 28

Efexor XR Efexor XR Efexor XR

¾SA0789 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. 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: continued. . .

112

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . 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 where the patient has a high risk of relapse (prescriber determined).

Antiepilepsy Drugs Agents for Control of Status Epilepticus

CLONAZEPAM Inj 1 mg per ml, 1 ml .........................................................................19.00 DIAZEPAM Inj 5 mg per ml, 2 ml – Subsidy by endorsement ...............................9.24 a) Up to 5 inj available on a PSO b) Only on a PSO c) PSO must be endorsed “not for anaesthetic procedures”. Rectal tubes 5 mg – Up to 5 tube available on a PSO .....................25.05 Rectal tubes 10 mg – Up to 5 tube available on a PSO ...................30.50 PARALDEHYDE F Inj 5 ml .........................................................................................1,500.00 PHENYTOIN SODIUM F Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................69.24 F Inj 50 mg per ml, 5 ml – Up to 5 inj available on a PSO ...................77.27 5 5

Rivotril Mayne

5 5 5 5 5

Stesolid Stesolid AFT Mayne Mayne

Control of Epilepsy

CARBAMAZEPINE F Tab 200 mg .......................................................................................14.53 F Tab long-acting 200 mg ....................................................................16.98 F Tab 400 mg .......................................................................................34.58 F Tab long-acting 400 mg ....................................................................39.17 F‡ Oral liq 100 mg per 5 ml ...................................................................26.37 CLOBAZAM Tab 10 mg ...........................................................................................9.12 ‡ Safety cap for extemporaneously compounded oral liquid preparations. CLONAZEPAM Tab 500 µg ..........................................................................................6.26 Tab 2 mg ...........................................................................................11.15 ‡ Oral drops 2.5 mg per ml ....................................................................7.38 ETHOSUXIMIDE F Cap 250 mg ......................................................................................32.90 F‡ Oral liq 250 mg per 5 ml ...................................................................11.96 GABAPENTIN – Special Authority see SA0936 on the next page – Retail pharmacy L Cap 100 mg ........................................................................................7.16 L Cap 300 mg ......................................................................................11.50 L Cap 400 mg ......................................................................................14.75 100 100 100 100 250 ml 50

Tegretol Tegretol CR Tegretol Tegretol CR Tegretol Frisium

100 100 10 ml OP 200 200 ml 100 100 100

Paxam Paxam Rivotril Zarontin Zarontin Nupentin Nupentin Nupentin

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

113

NERVOUS SYSTEM

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

¾SA0936 Special Authority for Subsidy Initial application — (Epilepsy - new patients) from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Either: 1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents. Note: “Optimal treatment with other antiepilepsy agents” is deﬁned as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given 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 — (Epilepsy - patient has had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life from gabapentin, topiramate, vigabatrin and/or lamotrigine. Note: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Initial application — (Neuropathic pain - new patients) from any relevant practitioner. Approvals valid for 3 months where the patient has tried and failed, or has been unable to tolerate, treatment with a tricyclic antidepressant. Initial application — (Neuropathic pain - patient has had an approval for gabapentin for neuropathic pain prior to 1 August 2007) from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 The patient has demonstrated a marked improvement in their control of pain (prescriber determined); or 2 The patient has previously demonstrated clinical responsiveness to gabapentin and has now developed neuropathic pain in a new site. Renewal — (Epilepsy) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life. Notes: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. If the patient had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Renewal — (Neuropathic pain) from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 The patient has demonstrated a marked improvement in their control of pain (prescriber determined); or 2 The patient has previously demonstrated clinical responsiveness to gabapentin and has now developed neuropathic pain in a new site. Note: If the patient had an approval for gabapentin for neuropathic pain prior to 1 August 2007 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. GABAPENTIN (NEURONTIN) – Special Authority see SA0973 below – Retail pharmacy L Tab 600 mg .......................................................................................79.79 100 Neurontin L Cap 100 mg ......................................................................................15.67 100 Neurontin L Cap 300 mg ......................................................................................47.00 100 Neurontin L Cap 400 mg ......................................................................................62.66 100 Neurontin ¾SA0973 Special Authority for Subsidy Notes: Subsidy for patients pre-approved by PHARMAC on 1 August 2009. Approvals valid without further renewal unless notiﬁed. No new approvals will be granted from 1 August 2009.

114

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

LAMOTRIGINE L Tab dispersible 2 mg ...........................................................................6.74 L Tab dispersible 5 mg ...........................................................................9.64 15.00 L Tab dispersible 25 mg .......................................................................19.38 20.40 29.09 L Tab dispersible 50 mg .......................................................................32.97 34.70 47.89 L Tab dispersible 100 mg .....................................................................56.91 59.90 79.16 L Tab dispersible 200 mg ...................................................................101.80 LEVETIRACETAM – Special Authority see SA0921 below – Retail pharmacy Tab ....................................................................................................CBS

30 30 56 56

Lamictal Lamictal Arrow-Lamotrigine Logem Arrow-Lamotrigine Mogine Lamictal Logem Arrow-Lamotrigine Mogine Lamictal Logem Arrow-Lamotrigine Mogine Lamictal Arrow-Lamotrigine Mogine Keppra

¾SA0921 Special Authority for Subsidy Subsidy by application to the Levetiracetam Special Access Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Coordinator, Levetiracetam Special Access Panel Phone: (04) 916-7553 PHARMAC, PO Box 10 254 Facsimile: (09) 929-3226 Wellington Email: lsacoordinator@pharmac.govt.nz PHENOBARBITONE For phenobarbitone oral liquid refer, page 166 F Tab 15 mg .........................................................................................23.68 F Tab 30 mg .........................................................................................24.59 PHENYTOIN SODIUM F Tab 50 mg .........................................................................................15.63 F Cap 30 mg ........................................................................................15.50 F Cap 100 mg ......................................................................................14.69 F‡ Oral liq 30 mg per 5 ml .....................................................................11.19 PRIMIDONE F Tab 250 mg .......................................................................................17.25 SODIUM VALPROATE F Tab 100 mg .......................................................................................13.65 F Tab 200 mg EC .................................................................................27.44 F Tab 500 mg EC .................................................................................52.24 F‡ Oral liq 200 mg per 5 ml ...................................................................20.48 F Inj 100 mg per ml, 4 ml .....................................................................41.50

500 500 200 200 200 500 ml 100 100 100 100 300 ml 1

PSM PSM Dilantin Infatab Dilantin Dilantin Dilantin Apo-Primidone Epilim Crushable Epilim Epilim Epilim S/F Liquid Epilim Syrup Epilim IV

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

115

NERVOUS SYSTEM

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

TOPIRAMATE L Tab 25 mg .........................................................................................26.04 L Tab 50 mg .........................................................................................44.26 L Tab 100 mg .......................................................................................75.25 L Tab 200 mg .....................................................................................129.85 L Sprinkle cap 15 mg ...........................................................................20.84 L Sprinkle cap 25 mg ...........................................................................26.04 VIGABATRIN – Special Authority see SA0937 below – Retail pharmacy L Tab 500 mg .....................................................................................119.30

60 60 60 60 60 60 100

Topamax Topamax Topamax Topamax Topamax Topamax Sabril

¾SA0937 Special Authority for Subsidy Initial application — (new patients) from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Both: 1 Either: 1.1 Patient has infantile spasms; or 1.2 Both: 1.2.1 Patient has epilepsy; and 1.2.2 Either: 1.2.2.1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 1.2.2.2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents; and 2 Either: 2.1 Patient is, or will be, receiving regular automated visual ﬁeld testing (ideally before starting therapy and on a 6-monthly basis thereafter); or 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. Notes: “Optimal treatment with other antiepilepsy agents” is deﬁned as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Vigabatrin is associated with a risk of irreversible visual ﬁeld defects, which may be asymptomatic in the early stages. Initial application — (patient has had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 Patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life from gabapentin, topiramate, vigabatrin and or lamotrigine; and 2 Either: 2.1 Patient is receiving regular automated visual ﬁeld testing (ideally every 6 months) on an ongoing basis for the duration of treatment with vigabatrin; or 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. Notes: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Vigabatrin is associated with a risk of irreversible visual ﬁeld defects, which may be asymptomatic in the early stages. Renewal from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 The patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life; and 2 Either: 2.1 Patient is receiving regular automated visual ﬁeld testing (ideally every 6 months) on an ongoing basis for duration of treatment with vigabatrin; or continued. . .

116

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. Notes: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Vigabatrin is associated with a risk of irreversible visual ﬁeld defects, which may be asymptomatic in the early stages. If the patient had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application.

Antimigraine Preparations

For Anti-inﬂammatory NSAIDS refer to MUSCULOSKELETAL, page 99

Acute Migraine Treatment

ERGOTAMINE TARTRATE WITH CAFFEINE Tab 1 mg with caffeine 100 mg .........................................................31.00 METOCLOPRAMIDE HYDROCHLORIDE WITH PARACETAMOL Tab 5 mg with paracetamol 500 mg ....................................................6.77 RIZATRIPTAN BENZOATE Wafer 10 mg .....................................................................................25.32 SUMATRIPTAN Tab 50 mg .........................................................................................12.00 22.00 Tab 100 mg .......................................................................................12.00 22.00 Inj 12 mg per ml, 0.5 ml – Hospital pharmacy [HP3]-Specialist .........80.00 Maximum of 10 inj per prescription 100 60 3 4

Cafergot Paramax Maxalt Melt Arrow-Sumatriptan Sumagran Imigran Arrow-Sumatriptan Sumagran Imigran Imigran

2 OP

Prophylaxis of Migraine

For Beta Adrenoceptor Blockers refer to CARDIOVASCULAR SYSTEM, page 51 CLONIDINE HYDROCHLORIDE F Tab 25 µg ..........................................................................................17.53 PIZOTIFEN F Tab 500 µg ........................................................................................21.10 (24.10)

100 100

Dixarit

Sandomigran

Antinausea and Vertigo Agents

For Antispasmodics refer to ALIMENTARY TRACT, page 27 BETAHISTINE DIHYDROCHLORIDE F Tab 16 mg ...........................................................................................7.56 CYCLIZINE HYDROCHLORIDE Tab 50 mg ...........................................................................................1.59 CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml .......................................................................14.95

84 10 5

Vergo 16 Nausicalm Valoid (AFT)

DOMPERIDONE – Additional subsidy by Special Authority see SA0938 on the next page – Retail pharmacy F Tab 10 mg ...........................................................................................3.90 100 (7.99) Motilium

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

117

NERVOUS SYSTEM

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

¾SA0938 Special Authority for Manufacturers Price Initial application from any relevant practitioner. Approvals valid for 6 months where the patient is terminally ill and requires control of nausea and vomiting. Renewal from any relevant practitioner. Approvals valid for 6 months where the treatment remains appropriate and the patient is beneﬁting from treatment. HYOSCINE (SCOPOLAMINE) – Special Authority see SA0939 below – Hospital pharmacy [HP3] Patches, 1.5 mg ................................................................................11.95 2 Scopoderm TTS ¾SA0939 Special Authority for Subsidy Initial application from any relevant 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. Renewal from any relevant practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is beneﬁting from treatment. HYOSCINE HYDROBROMIDE F Inj 400 µg per ml, 1 ml ........................................................................6.66 5 Mayne METOCLOPRAMIDE HYDROCHLORIDE F Tab 10 mg ...........................................................................................5.15 F Inj 5 mg per ml, 2 ml – Up to 5 inj available on a PSO .......................4.50 100 10

Metamide Pﬁzer

ONDANSETRON – Retail pharmacy-Specialist a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 below b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 below c) Not more than one prescription per month; can be waived by Special Authority see SA0887 below. d) The maximum of 6 tab per dispensing cannot be waived via Access Exemption Criteria. Tab 4 mg ...........................................................................................17.18 10 Zofran Tab disp 4 mg ...................................................................................17.18 10 Zofran Zydis Tab 8 mg ...........................................................................................33.89 20 Zofran Tab disp 8 mg ...................................................................................20.43 10 Zofran Zydis ¾SA0887 Special Authority for Waiver of Rule Initial application from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment of malignancy. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment of malignancy. PROCHLORPERAZINE F Tab 3 mg buccal .................................................................................5.97 50 (15.00) Buccastem F Tab 5 mg – Up to 30 tab available on a PSO....................................16.85 500 Antinaus F Inj 12.5 mg per ml, 1 ml – Up to 5 inj available on a PSO ................25.81 10 Stemetil F Suppos 25 mg ..................................................................................23.87 5 Stemetil PROMETHAZINE THEOCLATE F Tab 25 mg ...........................................................................................1.20 (6.24) TROPISETRON – Hospital pharmacy [HP3]-Specialist a) Maximum of 6 cap per prescription b) Maximum of 3 cap per dispensing c) Not more than one prescription per month. Cap 5 mg ..........................................................................................77.41 10 Avomine

Navoban

118

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

Antiparkinson Agents Dopamine Agonists and Related Agents

AMANTADINE HYDROCHLORIDE L Cap 100 mg ......................................................................................47.81 APOMORPHINE HYDROCHLORIDE L Inj 10 mg per ml, 2 ml ......................................................................50.43 L Inj 10 mg per ml, 1 ml ......................................................................50.43 (APO-go S29 Inj 10 mg per ml, 2 ml to be delisted 1 October 2009) (Mayne Inj 10 mg per ml, 1 ml to be delisted 1 October 2009) BROMOCRIPTINE MESYLATE F Tab 2.5 mg ........................................................................................32.08 F Tab 10 mg .......................................................................................120.86 ENTACAPONE L Tab 200 mg .....................................................................................116.00 LEVODOPA WITH BENSERAZIDE F Tab dispersible 50 mg with benserazide 12.5 mg .............................10.00 F F F F Cap 50 mg with benserazide 12.5 mg ................................................8.00 Cap 100 mg with benserazide 25 mg ...............................................12.50 Cap long-acting 100 mg with benserazide 25 mg ............................17.00 Cap 200 mg with benserazide 50 mg ...............................................25.00 60 5 5

Symmetrel APO-go S29 Apomine Mayne

100 100

AlphaBromocriptine

100 100 100 100 100 100 50 100 100 100 30 100 100

Comtan Madopar

Dispersible

Madopar 62.5 Madopar 125 Madopar HBS Madopar 250 Sindopa Sinemet Sinemet CR Sinemet Dopergin Permax Permax

LEVODOPA WITH CARBIDOPA F Tab 100 mg with carbidopa 25 mg ....................................................10.00 20.00 F Tab long-acting 200 mg with carbidopa 50 mg – Retail pharmacy-Specialist ................................................................... 70.00 F Tab 250 mg with carbidopa 25 mg ....................................................57.50 LISURIDE HYDROGEN MALEATE L Tab 200 µg ........................................................................................27.50 PERGOLIDE L Tab 0.25 mg ......................................................................................48.00 L Tab 1 mg .........................................................................................170.00

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

119

NERVOUS SYSTEM

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

ROPINIROLE HYDROCHLORIDE L Tab 0.25 mg ........................................................................................7.90 19.75 (31.50) L Tab 0.25 mg × 42, 0.5 mg × 42 and 1 mg × 21 .............................21.92 (35.70) L Tab 0.5 mg × 42, 1 mg × 42 and 2 mg × 63 ..................................73.60 (122.11)

84 210 105

Ropin

Requip Requip Starter Pack

147 Requip Follow-on Pack Ropin Requip Ropin Requip Ropin Requip

L Tab 1 mg ...........................................................................................40.32 84 (67.20) L Tab 2 mg ...........................................................................................60.72 84 (101.21) L Tab 5 mg ...........................................................................................90.00 84 (150.00) (Requip Tab 0.25 mg to be delisted 1 September 2009) (Requip Starter Pack Tab 0.25 mg × 42, 0.5 mg × 42 and 1 mg × 21 to be delisted 1 September 2009) (Requip Follow-on Pack Tab 0.5 mg × 42, 1 mg × 42 and 2 mg × 63 to be delisted 1 September 2009) (Requip Tab 1 mg to be delisted 1 September 2009) (Requip Tab 2 mg to be delisted 1 September 2009) (Requip Tab 5 mg to be delisted 1 September 2009) SELEGILINE HYDROCHLORIDE F Tab 5 mg ...........................................................................................16.06 TOLCAPONE – Retail pharmacy-Specialist prescription Specialist must be a neurologist, geriatrician or general physician. L Tab 100 mg .....................................................................................128.75 100

Apo-Selegiline

100

Tasmar

Anticholinergics

BENZTROPINE MESYLATE Tab 2 mg .............................................................................................7.99 Inj 1 mg per ml, 2 ml .........................................................................36.35 a) Up to 5 inj available on a PSO b) Only on a PSO ORPHENADRINE HYDROCHLORIDE Tab 50 mg .........................................................................................31.93 PROCYCLIDINE HYDROCHLORIDE Tab 5 mg .............................................................................................7.40 60 5

Benztrop Cogentin

250 100

Disipal Kemadrin

120

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

Antipsychotics

Guidelines for the use of atypical antipsychotic 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 antipsychotic therapy, physicians should consider whether the patient is likely to respond to and/or tolerate conventional antipsychotic therapy and, where appropriate, trial one or more conventional agent prior to use of an atypical agent.

General

AMISULPRIDE Tab 100 mg .......................................................................................22.52 Tab 200 mg .......................................................................................97.03 Tab 400 mg .....................................................................................185.44 Oral liq 100 mg per ml ......................................................................55.44 ARIPIPRAZOLE – Special Authority see SA0920 below – Retail pharmacy Tab 10 mg .......................................................................................123.54 Tab 15 mg .......................................................................................175.28 Tab 20 mg .......................................................................................213.42 Tab 30 mg .......................................................................................260.07 30 60 60 60 ml 30 30 30 30

Solian Solian Solian Solian Abilify Abilify Abilify Abilify

¾SA0920 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient is suffering from schizophrenia or related psychoses; and 2 Either: 2.1 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of unacceptable side effects; or 2.2 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of inadequate clinical response. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. CHLORPROMAZINE HYDROCHLORIDE Tab 10 mg – Up to 30 tab available on a PSO..................................12.36 100 Largactil Tab 25 mg – Up to 30 tab available on a PSO..................................13.02 100 Largactil Tab 100 mg – Up to 30 tab available on a PSO................................30.61 100 Largactil Inj 25 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................25.66 10 Largactil CLOZAPINE – Hospital pharmacy [HP4] Tab 25 mg .........................................................................................13.37 26.74 6.69 13.37 Tab 50 mg ...........................................................................................8.67 17.33 Tab 100 mg .......................................................................................34.65 69.30 17.33 34.65 Tab 200 mg .......................................................................................34.65 69.30 Suspension 50 mg per ml .................................................................17.33

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

50 100 50 100 50 100 50 100 50 100 50 100 100 ml

Clozaril Clozaril Clopine Clopine Clopine Clopine Clozaril Clozaril Clopine Clopine Clopine Clopine Clopine 121

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

NERVOUS SYSTEM

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

HALOPERIDOL Tab 500 µg – Up to 30 tab available on a PSO...................................4.93 Tab 1.5 mg – Up to 30 tab available on a PSO...................................7.45 Tab 5 mg – Up to 30 tab available on a PSO....................................23.49 Oral liq 2 mg per ml – Up to 200 ml available on a PSO ..................18.06 Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................17.04 LITHIUM CARBONATE Tab 250 mg .......................................................................................36.10 Tab 400 mg .......................................................................................13.50 Tab long-acting 400 mg ....................................................................16.05 Cap 250 mg ........................................................................................7.22 METHOTRIMEPRAZINE Tab 25 mg .........................................................................................16.93 Tab 100 mg .......................................................................................43.96 Inj 25 mg per ml, 1 ml .......................................................................73.68 OLANZAPINE – Special Authority see SA0741 below – Retail pharmacy Tab 2.5 mg ........................................................................................51.07 Tab 5 mg .........................................................................................101.21 Tab 10 mg .......................................................................................204.49

100 100 100 100 ml 10 500 100 100 100 100 100 10 28 28 28

Serenace Serenace Serenace Serenace Serenace Lithicarb Lithicarb Priadel Douglas Nozinan Nozinan Nozinan Zyprexa Zyprexa Zyprexa

¾SA0741 Special Authority for Subsidy Initial application only from a psychiatrist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 Patient presents with ﬁrst episode schizophrenia or related psychoses; or 2 Both: 2.1 Patient suffering from schizophrenia and related psychoses or acute mania in bipolar disorder who is likely to beneﬁt from antipsychotic treatment; and 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 4 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 2 years where 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 ........................................................................................12.49 100 Neulactil Tab 10 mg .........................................................................................44.45 100 Neulactil QUETIAPINE Tab 25 mg .........................................................................................20.62 46.20 Tab 100 mg .......................................................................................41.25 92.40 Tab 200 mg .......................................................................................70.88 158.76 Tab 300 mg .....................................................................................119.25 267.12 90 60 90 60 90 60 90 60

Quetapel Seroquel Quetapel Seroquel Quetapel Seroquel Quetapel Seroquel

122

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

RISPERIDONE Tab 0.5 mg ..........................................................................................5.20 15.60 5.20 Tab 1 mg ...........................................................................................30.77 Tab 2 mg ...........................................................................................61.53 Tab 3 mg ...........................................................................................92.32 Tab 4 mg .........................................................................................123.05 Oral liquid 1 mg per ml .....................................................................45.92 TRIFLUOPERAZINE HYDROCHLORIDE Tab 1 mg .............................................................................................9.83 Tab 2 mg ...........................................................................................14.64 Tab 5 mg ...........................................................................................16.66

20 60 20 60 60 60 60 30 ml 100 100 100

Ridal Ridal Risperdal Ridal Risperdal Ridal Risperdal Ridal Risperdal Ridal Risperdal Risperdal Stelazine S29 Stelazine S29 Stelazine S29

ZIPRASIDONE – Subsidy by endorsement Ziprasidone is subsidised for patients suffering from schizophrenia or related psychoses after a trial of an effective dose of risperidone or quetiapine that has been discontinued, or is in the process of being discontinued, because of unacceptable side effects or inadequate response, and the prescription is endorsed accordingly. Cap 20 mg ........................................................................................87.88 60 Zeldox Cap 40 mg ......................................................................................164.78 60 Zeldox Cap 60 mg ......................................................................................247.17 60 Zeldox Cap 80 mg ......................................................................................329.56 60 Zeldox

Depot Injections

FLUPENTHIXOL DECANOATE Inj 20 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................13.14 Inj 20 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................20.90 Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO .................40.87 FLUPHENAZINE DECANOATE Inj 12.5 mg per 0.5 ml, 0.5 ml – Up to 5 inj available on a PSO .........17.60 Inj 25 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................27.90 Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO ...............154.50 HALOPERIDOL DECANOATE Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................28.39 Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO .................55.90 PIPOTHIAZINE PALMITATE Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .................178.48 Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .................353.32 RISPERIDONE – Special Authority see SA0926 on the next page – Retail pharmacy Microspheres for injection 25 mg ....................................................175.00 Microspheres for injection 37.5 mg .................................................230.00 Microspheres for injection 50 mg ....................................................280.00 5 5 5 5 5 5 5 5 10 10 1 1 1

Fluanxol Fluanxol Fluanxol Modecate Modecate Modecate Haldol Haldol Concentrate Piportil Piportil Risperdal Consta Risperdal Consta Risperdal Consta

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

123

NERVOUS SYSTEM

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

¾SA0926 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient has schizophrenia or other psychotic disorder; and 2 Has tried but failed to comply with treatment using oral atypical antipsychotic agents; and 3 Has been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment for 30 days or more in last 12 months. Renewal from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had less than 12 months treatment with risperidone microspheres; and 1.2 There is no clinical reason to discontinue treatment; or 2 The initiation of risperidone microspheres has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of risperidone microspheres. Note: Risperidone microspheres should ideally be used as monotherapy (i.e. without concurrent use of any other antipsychotic medication). In some cases, it may be clinically appropriate to attempt to treat a patient with typical antipsychotic agents in depot injectable form before trialing risperidone microspheres. ZUCLOPENTHIXOL DECANOATE Inj 200 mg per ml, 1 ml – Up to 5 inj available on a PSO .................19.80 5 Clopixol

Orodispersible Antipsychotics

OLANZAPINE – Special Authority see SA0739 below – Retail pharmacy Wafer 5 mg .....................................................................................102.19 Wafer 10 mg ...................................................................................204.37 28 28

Zyprexa Zydis Zyprexa Zydis

¾SA0739 Special Authority for Subsidy 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 supervision for administration of medicine. Renewal only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; and 2 The patient is under direct 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. RISPERIDONE – Special Authority see SA0927 below – Retail pharmacy Orally-disintegrating tablets 0.5 mg ..................................................21.42 28 Risperdal Quicklet Orally-disintegrating tablets 1 mg .....................................................42.84 28 Risperdal Quicklet Orally-disintegrating tablets 2 mg .....................................................85.71 28 Risperdal Quicklet

¾SA0927 Special Authority for Subsidy Initial application — (Acute situations) from any relevant practitioner. Approvals valid for 6 weeks for applications meeting the following criteria: Both: 1 For a non-adherent patient on oral therapy with standard risperidone tablets or risperidone oral liquid; and 2 The patient is under direct supervision for administration of medicine. continued. . .

124

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . Initial application — (Chronic situations) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 2 The patient is under direct supervision for administration of medicine. Renewal from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 2 The patient is under direct supervision for administration of medicine. Note: Risperdal Quicklets cost signiﬁcantly more than risperidone tablets and should only be used where necessary.

Anxiolytics

ALPRAZOLAM – Month Restriction Tab 250 µg ..........................................................................................3.25 50 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 500 µg ..........................................................................................4.30 50 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 1 mg .............................................................................................7.85 50 ‡ Safety cap for extemporaneously compounded oral liquid preparations. BUSPIRONE HYDROCHLORIDE – Special Authority see SA0863 below – Retail pharmacy Month Restriction Tab 5 mg ...........................................................................................28.00 100 Tab 10 mg .........................................................................................17.00 100

Arrow-Alprazolam Arrow-Alprazolam Arrow-Alprazolam

Paciﬁc Buspirone Paciﬁc Buspirone

¾SA0863 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. DIAZEPAM Tab 2 mg – Month Restriction............................................................8.40 500 Pro-Pam 11.44 Arrow-Diazepam ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 5 mg – Month Restriction.............................................................5.00 250 Pro-Pam 13.71 500 Arrow-Diazepam ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 10 mg – Month Restriction...........................................................3.45 100 Pro-Pam ‡ Safety cap for extemporaneously compounded oral liquid preparations. (Pro-Pam Tab 2 mg to be delisted 1 February 2010) LORAZEPAM – Month Restriction Tab 1 mg .............................................................................................6.28 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 2.5 mg ..........................................................................................4.12 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 250 100

Ativan Ativan

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

125

NERVOUS SYSTEM

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

OXAZEPAM – Month Restriction Tab 10 mg ...........................................................................................1.98 (5.50) ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 15 mg ...........................................................................................2.45 (7.60) ‡ Safety cap for extemporaneously compounded oral liquid preparations.

100 Ox-Pam 100 Ox-Pam

Multiple Sclerosis Treatments

¾SA0855 Special Authority for Subsidy Special Authority approved by the Multiple Sclerosis Treatment Committee Notes: Budget managed by appointed clinicians on the Multiple Sclerosis Treatment Assessments Committee (MSTAC). Applications will be considered by MSTAC at its regular meetings and approved subject to eligibility according to the Entry and Stopping criteria (below). Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The coordinator Phone: 04 460 4990 Multiple Sclerosis Treatment Assessment Committee Facsimile: 04 916 7571 PHARMAC PO Box 10 254 Email: mstaccoordinator@pharmac.govt.nz Wellington Completed application forms must be sent to the coordinator for MSTAC and will be considered by MSTAC at the next practicable opportunity. Notiﬁcation of MSTAC’s decision will be sent to the patient, the applying clinician and the patient’s GP (if speciﬁed). 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. Prescribers must send quarterly prescriptions for approved patients to the MSTAC coordinator. 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, or 20 mg glatiramer acetate daily will be subsidised. Appeals against MSTAC’s decision and/or the processing of any application may be lodged with the MSTAC coordinator. Concerns that cannot be or have not been adequately addressed by MSTAC will be forwarded to a separate Appeal Committee if necessary. Switching between treatments is permitted within the 12 month approval period without reapproval by MSTAC. The MSTAC coordinator should be notiﬁed of the change and a new prescription provided. Entry Criteria 1) 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 2) patients must have active relapsing MS (conﬁrmed by MR scan where necessary) with or without underlying progression; and 3) patients must have either: a) EDSS score 2.5 - 5.5 with 2+ relapses: G experienced at least 2 signiﬁcant relapses of MS in the previous 12 months, and G an EDSS score of between 2.5 and 5.5 inclusive; or b) EDSS score 2.0 with 3+ relapses: G experienced at least 3 signiﬁcant relapses of MS in the previous 12 months, and G an EDSS score of 2.0; and 4) Each relapse must: a) be conﬁrmed by a neurologist or general physician (the patient may not necessarily have been seen during the relapse but the neurologist/physician must be satisﬁed that the clinical features were characteristic and met the speciﬁed criteria); continued. . .

126

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . b) be associated with characteristic new symptom(s)/sign(s) or substantial worsening of previously experienced symptom(s)/sign(s); c) last at least one week; d) follow a period of stability of at least one month; e) be severe enough to change either the EDSS or at least one of the Kurtzke functional systems scores by at least 1 point; f) be distinguishable from the effects of general fatigue; and g) not be associated with a fever (T>37.5◦ C); and 5) applications must be made at least four weeks after the date of the onset of the last known relapse; and 6) patients must have no previous history of lack of response to beta-interferon or glatiramer acetate (see criteria for stopping). 7) applications must be submitted to the Multiple Sclerosis Treatment Assessment Committee (MSTAC) by the patient’s neurologist or a general physician; and 8) 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 9) patients must agree to allow clinical data to be collected and reviewed by MSTAC annually for each year in which they receive funding for beta-interferon or glatiramer acetate. Stopping Criteria 1) 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 an increase of 1 EDSS point from the starting EDSS or an increase in EDSS score to 6.0 or more; or 2) stable or increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment); or 3) pregnancy and/or lactation; or 4) within the 12 month approval year, intolerance to interferon beta-1-alpha, and/or interferon beta-1-beta and/or glatiramer acetate; or 5) non-compliance with treatment, including refusal to undergo annual assessment or refusal to allow the results of the assessment to be submitted to MSTAC; or 6) 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 or glatiramer acetate. GLATIRAMER ACETATE – Special Authority see SA0855 on the preceding page Inj 20 mg preﬁlled syringe ...........................................................1,089.25 28 Copaxone INTERFERON BETA-1-ALPHA – Special Authority see SA0855 on the preceding page Inj 6 million iu preﬁlled syringe ....................................................1,329.65 4 Inj 6 million iu per vial ..................................................................1,329.65 4 INTERFERON BETA-1-BETA – Special Authority see SA0855 on the preceding page Inj 8 million iu per 1 ml .................................................................1,436.79 15

Avonex Avonex Betaferon

Sedatives and Hypnotics

LORMETAZEPAM – Month Restriction Tab 1 mg .............................................................................................3.11 (23.50) ‡ Safety cap for extemporaneously compounded oral liquid preparations. 30 Noctamid

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

127

NERVOUS SYSTEM

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

MIDAZOLAM Tab 7.5 mg – Month Restriction........................................................10.38 (25.00) ‡ Safety cap for extemporaneously compounded oral liquid preparations. Inj 1 mg per ml, 5 ml .........................................................................10.75 (14.73) Inj 5 mg per ml, 3 ml .........................................................................11.90 (19.64) NITRAZEPAM – Month Restriction Tab 5 mg .............................................................................................2.00 (4.65) ‡ Safety cap for extemporaneously compounded oral liquid preparations. TEMAZEPAM – Month Restriction Tab 10 mg ...........................................................................................0.83 ‡ Safety cap for extemporaneously compounded oral liquid preparations. TRIAZOLAM – Month Restriction Tab 125 µg ..........................................................................................5.10 (6.50) ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 250 µg ..........................................................................................4.10 (7.20) ‡ Safety cap for extemporaneously compounded oral liquid preparations. ZOPICLONE – Month Restriction Tab 7.5 mg ........................................................................................21.02

100 Hypnovel 10 5

Hypnovel

Pﬁzer

Hypnovel

Pﬁzer

100 Nitrados

Normison

100 Hypam 100 Hypam

500

Apo-Zopiclone

Other CNS Agents

ATOMOXETINE – Special Authority see SA0951 below – Retail pharmacy Cap 10 mg ......................................................................................107.03 Cap 18 mg ......................................................................................107.03 Cap 25 mg ......................................................................................107.03 Cap 40 mg ......................................................................................107.03 Cap 60 mg ......................................................................................107.03 Cap 80 mg ......................................................................................139.11 Cap 100 mg ....................................................................................139.11 28 28 28 28 28 28 28

Strattera Strattera Strattera Strattera Strattera Strattera Strattera

¾SA0951 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient has ADHD (Attention Deﬁcit and Hyperactivity Disorder) diagnosed according to DSM-IV or ICD 10 criteria; and 2 Once-daily dosing; and 3 Any of the following: 3.1 Treatment with a subsidised formulation of a stimulant has resulted in the development or worsening of serious adverse reactions or where the combination of subsidised stimulant treatment with another agent would pose an unacceptable medical risk; or 3.2 Treatment with a subsidised formulation of a stimulant has resulted in worsening of co-morbid substance abuse or there is a signiﬁcant risk of diversion with subsidised stimulant therapy; or 3.3 An effective dose of a subsidised formulation of a stimulant has been trialled and has been discontinued because of inadequate clinical response; and continued. . .

128

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . 4 The patient will not be receiving treatment with atomoxetine in combination with a subsidised formulation of a stimulant, except for the purposes of transitioning from subsidised stimulant therapy to atomoxetine. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: A "subsidised formulation of a stimulant" refers to currently subsidised methylphenidate hydrochloride tablet formulations (immediate-release, sustained-release and extended-release) or dexamphetamine sulphate tablets. BUPROPION HYDROCHLORIDE Tab modiﬁed-release 150 mg ...........................................................65.00 30 Zyban DEXAMPHETAMINE SULPHATE – Special Authority see SA0907 below – Retail pharmacy Only on a controlled drug form Tab 5 mg ...........................................................................................17.00 100

PSM

¾SA0907 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over – new patients) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant 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 paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients 5 or over - patient has had an approval for dexamphetamine for ADHD prior to 1 April 2008) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients under 5 – new patients) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deﬁcit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (ADHD in patients under 5 - patient has had an approval for dexamphetamine for ADHD in patients under 5 prior to 1 April 2008) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Initial application — (Narcolepsy – new patients) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Initial application — (Narcolepsy - patient has had an approval for dexamphetamine for narcolepsy prior to 1 April 2008) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is beneﬁting from treatment.. continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

129

NERVOUS SYSTEM

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

continued. . . Renewal — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Note: If the patient had an approval for dexamphetamine for ADHD prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone the Contact Centre on 0800 243 666 for clariﬁcation if needed. Renewal — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If the patient had an approval for dexamphetamine for ADHD in patients under 5 prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone the Contact Centre on 0800 243 666 for clariﬁcation if needed. Renewal — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If the patient had an approval for dexamphetamine for narcolepsy prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone the Contact Centre on 0800 243 666 for clariﬁcation if needed. DISULFIRAM Tab 200 mg .......................................................................................24.30 100 Antabuse METHYLPHENIDATE HYDROCHLORIDE – Special Authority see SA0908 below – Retail pharmacy Only on a controlled drug form Tab immediate-release 5 mg ..............................................................3.20 30 Rubifen Tab immediate-release 10 mg ............................................................3.00 30 Ritalin Rubifen Tab immediate-release 20 mg ............................................................7.85 30 Rubifen Tab sustained-release 20 mg ...........................................................10.95 30 Rubifen SR 50.00 100 Ritalin SR ¾SA0908 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over – new patients) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant 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 paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients 5 or over - patient has had an approval for methylphenidate for ADHD prior to 1 April 2008) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: continued. . .

130

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients under 5 – new patients) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deﬁcit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (ADHD in patients under 5 - patient has had an approval for methylphenidate for ADHD in patients under 5 prior to 1 April 2008) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Initial application — (Narcolepsy – new patients) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Initial application — (Narcolepsy - patient has had an approval for methylphenidate for narcolepsy prior to 1 April 2008) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is beneﬁting from treatment.. Renewal — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Note: If the patient had an approval for methylphenidate for ADHD prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone the Contact Centre on 0800 243 666 for clariﬁcation if needed. Renewal — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If the patient had an approval for methylphenidate for ADHD in patients under 5 prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone the Contact Centre on 0800 243 666 for clariﬁcation if needed. Renewal — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If the patient had an approval for methylphenidate for narcolepsy prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone the Contact Centre on 0800 243 666 for clariﬁcation if needed.

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

131

NERVOUS SYSTEM

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

METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE – Special Authority see SA0924 below – Retail pharmacy Only on a controlled drug form Tab extended-release 18 mg ............................................................58.96 30 Concerta Tab extended-release 27 mg ............................................................65.44 30 Concerta Tab extended-release 36 mg ............................................................71.93 30 Concerta Tab extended-release 54 mg ............................................................86.24 30 Concerta 30 Ritalin LA Cap modiﬁed-release 20 mg ............................................................25.50 Cap modiﬁed-release 30 mg ............................................................31.90 30 Ritalin LA Cap modiﬁed-release 40 mg ............................................................38.25 30 Ritalin LA ¾SA0924 Special Authority for Subsidy Initial application only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deﬁcit and Hyperactivity Disorder); and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist; and 4 Either: 4.1 Patient is taking a currently subsidised formulation of methylphenidate hydrochloride (immediate-release or sustainedrelease) which has not been effective due to signiﬁcant administration and/or compliance difﬁculties; or 4.2 There is signiﬁcant concern regarding the risk of diversion or abuse of immediate-release methylphenidate hydrochloride. Renewal only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. NALTREXONE HYDROCHLORIDE – Special Authority see SA0909 below – Retail pharmacy Tab 50 mg .......................................................................................180.00 30 ReVia ¾SA0909 Special Authority for Subsidy Initial application from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Patient is currently enrolled in a recognised comprehensive treatment programme for alcohol dependence; and 2 Applicant works in a community Alcohol and Drug Service contracted to one of the 21 District Health Boards or accredited against the New Zealand Alcohol and Other Drug Sector Standard or the National Mental Health Sector Standard. Renewal from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Compliance with the medication (prescriber determined); and 2 Any of the following: continued. . .

132

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . 2.1 Patient is still unstable and requires further treatment; or 2.2 Patient achieved signiﬁcant improvement but requires further treatment; or 2.3 Patient is well controlled but requires maintenance therapy. The patient may not have had more than 1 prior approval in the last 12 months. TETRABENAZINE Tab 25 mg .......................................................................................243.00 112

Xenazine 25

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

133

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

Chemotherapeutic Agents Alkylating Agents

BUSULPHAN – PCT – Retail pharmacy-Specialist Tab 2 mg ...........................................................................................47.89 CARBOPLATIN – PCT only – Specialist Inj 10 mg per ml, 5 ml .......................................................................12.00 Inj 10 mg per ml, 15 ml .....................................................................18.70 Inj 10 mg per ml, 45 ml .....................................................................55.50 Inj 10 mg per ml, 100 ml .................................................................135.65 Inj 1 mg for ECP .................................................................................0.13 CARMUSTINE – PCT only – Specialist Inj 100 mg .......................................................................................204.13 Inj 100 mg for ECP .........................................................................204.13 CHLORAMBUCIL – PCT – Retail pharmacy-Specialist Tab 2 mg ...........................................................................................22.35 CISPLATIN – PCT only – Specialist Inj 1 mg per ml, 50 ml .......................................................................19.00 Inj 1 mg per ml, 100 ml .....................................................................38.00 Inj 1 mg for ECP .................................................................................0.46 CYCLOPHOSPHAMIDE Tab 50 mg – PCT – Retail pharmacy-Specialist..............................25.71 Inj 1 g – PCT – Retail pharmacy-Specialist.....................................23.65 127.80 Inj 2 g – PCT only – Specialist.........................................................47.30 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.03 IFOSFAMIDE – PCT only – Specialist Inj 1 g ................................................................................................96.00 Inj 2 g ..............................................................................................180.00 Inj 1 mg for ECP .................................................................................0.10 LOMUSTINE – PCT only – Specialist Cap 10 mg ......................................................................................132.59 Cap 40 mg ......................................................................................399.15 MELPHALAN Tab 2 mg – PCT – Retail pharmacy-Specialist................................31.31 Inj 50 mg – PCT only – Specialist....................................................52.15 100 1 1 1 1 1 mg 1 100 mg OP 25 1 1 1 mg 50 1 6 1 1 mg 1 1 1 mg 20 20 25 1

Myleran Carboplatin Ebewe Carboplatin Ebewe Carboplatin Ebewe Carboplatin Ebewe Baxter BiCNU Baxter Leukeran FC Cisplatin Ebewe Mayne Cisplatin Ebewe Mayne Baxter Cycloblastin Endoxan Cytoxan Endoxan Baxter Holoxan Holoxan Baxter CeeNU CeeNU Alkeran Alkeran Eloxatin Eloxatin Baxter

OXALIPLATIN – PCT only – Specialist – Special Authority see SA0900 on the next page Inj 50 mg .........................................................................................200.00 1 Inj 100 mg .......................................................................................400.00 1 Inj 1 mg for ECP .................................................................................4.36 1 mg

134

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA0900 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has metastatic colorectal cancer; and 1.2 To be used for ﬁrst or second line use as part of a combination chemotherapy regimen; or 2 Both: 2.1 The patient has stage III (Duke’s C) colorectal* cancer; and 2.2 Adjuvant oxaliplatin to be given in combination with a ﬂuoropyrimidine (ﬂuorouracil or capecitabine). Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. Note: Indications marked with * are Unapproved Indications, oxaliplatin is indicated for adjuvant treatment of stage III (Duke’s C) colon cancer after complete resection of the primary tumour. THIOTEPA – PCT only – Specialist Inj 15 mg ...........................................................................................CBS 1 Bedford S29

Antimetabolites

CALCIUM FOLINATE Tab 15 mg – PCT – Hospital pharmacy [HP3]-Specialist ................63.89 Inj 3 mg per ml, 1 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................... 17.10 Inj 50 mg – PCT – Hospital pharmacy [HP1]-Specialist ..................24.50 Inj 100 mg – PCT only – Specialist....................................................9.75 Inj 300 mg – PCT only – Specialist..................................................30.00 Inj 1 g – PCT only – Specialist.......................................................100.00 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.10 10 5 5 1 1 1 1 mg

Mayne Mayne Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Baxter Xeloda Xeloda

CAPECITABINE – Hospital pharmacy [HP1]-Specialist – Special Authority see SA0869 below Tab 150 mg .....................................................................................115.00 60 Tab 500 mg .....................................................................................705.00 120

¾SA0869 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 The patient has advanced gastrointestinal malignancy; or 2 The patient has metastatic breast cancer*; or 3 The patient has stage III (Duke’s stage C) colorectal*# cancer and undergone surgery; or 4 Both: 4.1 The patient has poor venous access or needle phobia*; and 4.2 The patient requires a substitute for single agent ﬂuoropyrimidine*. Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

135

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. Note: Indications marked with * are Unapproved Indications, # capecitabine is approved for stage III (Duke’s stage C) colon cancer. CLADRIBINE – PCT only – Specialist Inj 2 mg per ml, 5 ml .......................................................................873.00 1 Litak S29 Inj 1 mg per ml, 10 ml ..................................................................5,249.72 7 Leustatin Inj 10 mg for ECP ...........................................................................749.96 10 mg OP Baxter CYTARABINE Inj 100 mg – PCT – Retail pharmacy-Specialist..............................80.00 Inj 100 mg per ml, 5 ml – PCT – Retail pharmacy-Specialist ..........95.36 Inj 100 mg per ml, 10 ml – PCT – Retail pharmacy-Specialist .........42.65 Inj 100 mg per ml, 20 ml – PCT only – Specialist............................34.47 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.03 Inj 100 mg intrathecal syringe for ECP – PCT only – Specialist .........16.00 FLUDARABINE PHOSPHATE – PCT only – Specialist Tab 10 mg .......................................................................................650.25 867.00 Inj 50 mg ......................................................................................1,430.00 Inj 50 mg for ECP ...........................................................................286.00 FLUOROURACIL SODIUM Inj 50 mg per ml, 10 ml – PCT only – Specialist................................4.95 Inj 50 mg per ml, 20 ml – PCT only – Specialist................................8.60 Inj 25 mg per ml, 100 ml – PCT only – Specialist............................13.55 Inj 50 mg per ml, 50 ml – PCT only – Specialist..............................21.50 Inj 50 mg per ml, 100 ml – PCT only – Specialist............................43.00 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.01 5 5 1 1 1 mg 100 mg OP 15 20 5 50 mg OP 1 1 1 1 1 1 mg

Mayne Pharmacia Mayne Mayne Mayne Baxter Baxter Fludara Fludara Oral Fludara Baxter Fluorouracil Ebewe Fluorouracil Ebewe Mayne Fluorouracil Ebewe Fluorouracil Ebewe Baxter

GEMCITABINE HYDROCHLORIDE – PCT only – Specialist – Special Authority see SA0877 below Inj 1 g ..............................................................................................245.00 1 Gemcitabine Ebewe 349.20 Gemzar Inj 200 mg .........................................................................................49.00 1 Gemcitabine Ebewe 78.00 Gemzar Inj 1 mg for ECP .................................................................................0.26 1 mg Baxter ¾SA0877 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 The patient has non small cell lung carcinoma (stage IIIa, or above); or 2 The patient has advanced malignant mesothelioma*; or 3 The patient has advanced pancreatic carcinoma; or 4 The patient has ovarian, fallopian tube* or primary peritoneal carcinoma*; or 5 The patient has advanced transitional cell carcinoma of the urothelial tract (locally advanced or metastatic). Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. Note: Indications marked with a * are Unapproved Indications.

136

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

IRINOTECAN – PCT only – Specialist – Special Authority see SA0878 below Inj 20 mg per ml, 2 ml .....................................................................124.00 Inj 20 mg per ml, 5 ml .....................................................................310.00 Inj 1 mg for ECP .................................................................................3.19

1 1 1 mg

Camptosar Camptosar Baxter

¾SA0878 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic colorectal cancer; and 2 Either: 2.1 To be used for ﬁrst or second line use as part of a combination chemotherapy regimen; or 2.2 As single agent chemotherapy in ﬂuropyrimidine-relapsed disease. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. MERCAPTOPURINE – PCT – Retail pharmacy-Specialist Tab 50 mg .........................................................................................47.06 25 Purinethol METHOTREXATE F Tab 2.5 mg – PCT – Hospital pharmacy [HP3]-Specialist .................5.22 F Tab 10 mg – PCT – Hospital pharmacy [HP3]-Specialist ................40.93 F Inj 2.5 mg per ml, 2 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................... 23.65 F Inj 25 mg per ml, 2 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................... 46.10 F Inj 25 mg per ml, 20 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................... 80.25 F Inj 100 mg per ml, 10 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................... 27.50 F Inj 100 mg per ml, 50 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................. 135.00 F Inj 1 mg for ECP – PCT only – Specialist ..........................................0.09 F Inj 5 mg intrathecal syringe for ECP – PCT only – Specialist............4.73 THIOGUANINE – PCT – Hospital pharmacy [HP3]-Specialist Tab 40 mg .........................................................................................97.16 30 50 5 5 1 1 1 1 mg 5 mg OP 25

Methoblastin Methoblastin Mayne Mayne Mayne Methotrexate Ebewe Methotrexate Ebewe Baxter Baxter Lanvis

Other Cytotoxic Agents

AMSACRINE – PCT only – Specialist Inj 75 mg ...........................................................................................CBS 6

Amsidyl S29

ANAGRELIDE HYDROCHLORIDE – PCT only – Specialist – Special Authority see SA0879 on the next page Cap 0.5 mg .......................................................................................CBS 100 Agrylin S29 Teva S29

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

137

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA0879 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has primary thrombocythaemia; and 2 Either: 2.1 is at high risk (previous thromboembolic disease, bleeding or platelet count >1500/ml); or 2.2 is intolerant or refractory to hydroxyurea or interferon. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: It is recommended that treatment with anagrelide be initiated only on the recommendation of a haematologist. ARSENIC TRIOXIDE – PCT only – Specialist Inj 10 mg ......................................................................................4,817.00 10 AFT S29 BLEOMYCIN SULPHATE – PCT only – Specialist Inj 15,000 iu ....................................................................................680.00 Inj 1,000 iu for ECP ............................................................................5.26 COLASPASE (L-ASPARAGINASE) – PCT only – Specialist Inj 10,000 iu ....................................................................................102.32 Inj 10,000 iu for ECP ......................................................................102.32 DACARBAZINE – PCT only – Specialist Inj 200 mg .........................................................................................43.86 Inj 200 mg for ECP ...........................................................................43.86 DACTINOMYCIN (ACTINOMYCIN D) – PCT only – Specialist Inj 0.5 mg ..........................................................................................13.52 Inj 0.5 mg for ECP ............................................................................13.52 DAUNORUBICIN – PCT only – Specialist Inj 2 mg per ml, 10 ml .......................................................................99.00 Inj 5 mg per ml, 4 ml .........................................................................99.00 Inj 20 mg for ECP .............................................................................99.00 DOCETAXEL – PCT only – Specialist – Special Authority see SA0880 below Inj 20 mg .........................................................................................460.00 Inj 80 mg ......................................................................................1,650.00 Inj 1 mg for ECP ...............................................................................23.81 10 1,000 iu 1 10,000 iu OP 1 200 mg OP 1 0.5 mg OP 1 1 20 mg OP 1 1 1 mg

Blenoxane Baxter Leunase Baxter Mayne Baxter Cosmegen Baxter Pﬁzer S29 Mayne Baxter Taxotere Taxotere Baxter

¾SA0880 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 Both: 1.1 The patient has ovarian*, fallopian* or primary peritoneal cancer*; and 1.2 Either: 1.2.1 Has not received prior chemotherapy; or 1.2.2 Has received prior chemotherapy but has not previously been treated with taxanes; or 2 The patient has metastatic breast cancer; or 3 Both: 3.1 The patient has early breast cancer; and 3.2 Docetaxel is to be given concurrently with trastuzumab; or 4 Both: continued. . .

138

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 4.1 The patient has non small-cell lung cancer; and 4.2 Either: 4.2.1 Has advanced disease (stage IIIa or above); or 4.2.2 Is receiving combined chemotherapy and radiotherapy; or 5 Both: 5.1 The patient has small-cell lung cancer*; and 5.2 Docetaxel is to be used as second-line therapy. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic breast cancer, non small-cell lung cancer, or small-cell lung cancer*; and 2 Either: 2.1 The patient requires continued therapy; or 2.2 The tumour has relapsed and requires re-treatment. Note: indications marked with * are Unapproved Indications. DOXORUBICIN – PCT only – Specialist Inj 10 mg .............................................................................................8.80 1 Doxorubicin Ebewe Inj 50 mg ...........................................................................................39.40 1 Doxorubicin Ebewe Inj 100 mg .........................................................................................81.00 1 Doxorubicin Ebewe Inj 200 mg .......................................................................................162.00 1 Doxorubicin Ebewe Inj 1 mg for ECP .................................................................................0.87 1 mg Baxter EPIRUBICIN – PCT only – Specialist Inj 2 mg per ml, 5 ml .........................................................................25.00 Inj 2 mg per ml, 25 ml .......................................................................87.50 Inj 2 mg per ml, 50 ml .....................................................................155.00 Inj 2 mg per ml, 100 ml ...................................................................310.00 Inj 1 mg for ECP .................................................................................1.90 ETOPOSIDE Cap 50 mg – PCT – Hospital pharmacy [HP3]-Specialist .............340.73 Cap 100 mg – PCT – Hospital pharmacy [HP3]-Specialist ...........340.73 Inj 20 mg per ml, 5 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................... 25.00 612.20 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.30 ETOPOSIDE PHOSPHATE – PCT only – Specialist Inj 100 mg (of etoposide base) .........................................................40.00 Inj 1 mg (of etoposide base) for ECP .................................................0.47 HYDROXYUREA – PCT – Retail pharmacy-Specialist Cap 500 mg ......................................................................................31.76 IDARUBICIN HYDROCHLORIDE – PCT only – Specialist Cap 5 mg ..........................................................................................80.75 Cap 10 mg ......................................................................................144.50 Inj 5 mg ...........................................................................................170.00 Inj 10 mg .........................................................................................340.00 Inj 1 mg for ECP ...............................................................................37.74 1 1 1 1 1 mg 20 10 1 10 1 mg 1 1 mg 100 1 1 1 1 1 mg

Epirubicin Ebewe Epirubicin Ebewe Epirubicin Ebewe Epirubicin Ebewe Baxter Vepesid Vepesid Mayne Vepesid Baxter Etopophos Baxter Hydrea Zavedos Zavedos Zavedos Zavedos Baxter

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

139

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

MESNA – PCT only – Specialist Tab 400 mg .....................................................................................168.30 Tab 600 mg .....................................................................................251.35 Inj 100 mg per ml, 4 ml ...................................................................109.63 Inj 100 mg per ml, 10 ml .................................................................251.73 Inj 1 mg for ECP .................................................................................0.02 MITOMYCIN C – PCT only – Specialist Inj 2 mg ...........................................................................................283.00 Inj 10 mg .........................................................................................531.30 Inj 1 mg for ECP ...............................................................................11.85 MITOZANTRONE – PCT only – Specialist Inj 2 mg per ml, 5 ml .......................................................................110.00 Inj 2 mg per ml, 10ml ......................................................................220.00 Inj 2 mg per ml, 12.5 ml ..................................................................407.50 Inj 1 mg for ECP ...............................................................................12.43 PACLITAXEL – PCT only – Specialist Inj 30 mg ...........................................................................................37.95 189.75 Inj 100 mg .......................................................................................125.35 Inj 150 mg .......................................................................................188.03 Inj 300 mg .......................................................................................376.05 Inj 600 mg .......................................................................................724.50 Inj 1 mg for ECP .................................................................................1.32 PENTOSTATIN (DEOXYCOFORMYCIN) – PCT only – Specialist Inj 10 mg ...........................................................................................CBS PROCARBAZINE HYDROCHLORIDE – PCT only – Specialist Cap 50 mg ......................................................................................225.00 TEMOZOLOMIDE – Special Authority see SA0831 below – Hospital pharmacy [HP3] Cap 5 mg ..........................................................................................50.00 Cap 20 mg ......................................................................................170.00 Cap 100 mg ....................................................................................840.00 Cap 250 mg .................................................................................2,100.00

50 50 15 15 1 mg 10 5 1 mg 1 1 1 1 mg 1 5 1 1 1 1 1 mg 1 50 5 5 5 5

Uromitexan Uromitexan Uromitexan Uromitexan Baxter Mitomycin-C S29 Mitomycin-C S29 Baxter Mitozantrone Ebewe Mitozantrone Ebewe Onkotrone Baxter Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Baxter Nipent S29 Natulan S29 Temodal Temodal Temodal Temodal

¾SA0831 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 10 months for applications meeting the following criteria: All of the following: 1 Patient has newly diagnosed glioblastoma multiforme; and 2 Temozolomide is to be (or has been) given concomitantly with radiotherapy; and 3 Following concomitant treatment temozolomide is to be used for a maximum of six cycles of 5 days treatment, at a maximum dose of 200 mg/m2 . Notes: Temozolomide is not subsidised for the treatment of relapsed glioblastoma multiforme. Reapplications will not be approved. Studies of temozolomide show that its beneﬁt is predominantly in those patients with a good performance status (WHO grade 0 or 1 or Karnofsky score >80), and in patients who have had at least a partial resection of the tumour. TENIPOSIDE – PCT only – Specialist Inj 10 mg per ml, 5 ml .....................................................................845.11 10 Vumon Inj 50 mg for ECP .............................................................................84.51 50 mg OP Baxter THALIDOMIDE – PCT only – Specialist – Special Authority see SA0882 on the next page Only on a controlled drug form Cap 50 mg ......................................................................................490.00 28

Thalidomide

Pharmion

140

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA0882 Special Authority for Subsidy Initial application — (for new patients) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has refractory, progressive or relapsed multiple myeloma; and 2 The patient has received prior chemotherapy. Initial application — (for patients receiving thalidomide prior to 1 January 2006) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notiﬁed where the patient was receiving treatment with thalidomide for multiple myeloma on or before 31 December 2005. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notiﬁed where the patient has obtained a response from treatment during the initial approval period. Notes: Prescription must be written by a registered prescriber in the thalidomide risk management programme operated by the supplier. Maximum dose of 400 mg daily as monotherapy or in a combination therapy regimen. TRETINOIN – PCT only – Specialist Cap 10 mg ......................................................................................435.90 100 Vesanoid VINBLASTINE SULPHATE Inj 10 mg – PCT – Retail pharmacy-Specialist..............................137.50 Inj 1 mg for ECP – PCT only – Specialist ..........................................3.05 VINCRISTINE SULPHATE Inj 1 mg per ml, 1 ml – PCT – Retail pharmacy-Specialist ..............99.00 Inj 1 mg per ml, 2 ml – PCT – Retail pharmacy-Specialist ............199.00 Inj 1 mg for ECP – PCT only – Specialist ........................................21.46 VINORELBINE – PCT only – Specialist – Special Authority see SA0901 below Inj 10 mg per ml, 1 ml .......................................................................24.00 42.00 Inj 10 mg per ml, 5 ml .....................................................................120.00 210.00 Inj 1 mg for ECP .................................................................................4.75 5 1 mg 5 5 1 mg 1 1 1 mg

Mayne Baxter Mayne Mayne Baxter Navelbine Vinorelbine Ebewe Navelbine Vinorelbine Ebewe Baxter

¾SA0901 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 The patient has metastatic breast cancer; or 2 The patient has non-small cell lung cancer (stage IIIa, or above); or 3 All of the following: 3.1 The patient has stage IB-IIIA non-small cell lung cancer; and 3.2 Vinorelbine is to be given as adjuvant treatment in combination with cisplatin; and 3.3 The patient has good performance status (WHO/ECOG grade 0-1). Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment.

Protein-tyrosine Kinase Inhibitors

DASATINIB – Special Authority see SA0976 on the next page Tab 20 mg ....................................................................................3,774.06 Tab 50 mg ....................................................................................6,214.20 Tab 70 mg ....................................................................................7,692.58

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

60 60 60

Sprycel Sprycel Sprycel

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

141

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA0976 Special Authority for Subsidy Special Authority approved by the CML/GIST Co-ordinator Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz, and prescriptions should be sent to: The CML/GIST Co-ordinator Phone: (04) 460 4990 PHARMAC Facsimile: (04) 916 7571 PO Box 10 254 Email: mary.chesterﬁeld@pharmac.govt.nz 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 140 mg/day for accelerated or blast phase, and 100 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 reapplication (after seven months) should provide details of the haematological response. The third reapplication should provide details of the cytogenetic response after 14-18 months from initiating therapy. All other reapplications 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. Note: Dasatinib is indicated for the treatment of adults with chronic, accelerated or blast phase CML with resistance or intolerance to prior therapy including imatinib. 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: 1) complete haematologic response (as characterised by an absolute neutrophil count (ANC) > 1.5 × 109 /L, platelets > 100 × 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 2) no evidence of leukaemia (as characterised by an absolute neutrophil count (ANC) > 1.0 × 109 /L, platelets > 20 × 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 3) 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. IMATINIB MESYLATE – Special Authority see SA0643 below Tab 100 mg ..................................................................................2,400.00 60 Glivec ¾SA0643 Special Authority for Subsidy Special Authority approved by the CML/GIST Co-ordinator Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz, and prescriptions should be sent to: The CML/GIST Co-ordinator Phone: (04) 460 4990 PHARMAC Facsimile: (04) 916 7571 PO Box 10 254 Email: mary.chesterﬁeld@pharmac.govt.nz 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. continued. . .

142

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . d) Initial approvals valid seven months. e) Subsequent approval(s) are granted on application and are valid for six months. The ﬁrst reapplication (after seven months) should provide details of the haematological response. The third reapplication should provide details of the cytogenetic response after 14-18 months from initiating therapy. All other reapplications 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. 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: 1) complete haematologic response (as characterised by an absolute neutrophil count (ANC) > 1.5 × 109 /L, platelets > 100 × 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 2) no evidence of leukaemia (as characterised by an absolute neutrophil count (ANC) > 1.0 × 109 /L, platelets > 20 × 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 3) 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: 1) with a diagnosis (conﬁrmed by an oncologist) of unresectable and/or metastatic malignant gastrointestinal stromal tumour (GIST); and 2) 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

For GnRH ANALOGUES – refer to HORMONE PREPARATIONS, Trophic Hormones, page 79 ANASTROZOLE Tab 1 mg .........................................................................................146.46 30

Arimidex

ANASTROZOLE-DP – Subsidy by endorsement Subsidised only for patients with hormone receptor positive advanced breast cancer and the prescription is endorsed accordingly. Tab 1 mg ...........................................................................................29.50 30 DP-Anastrozole BICALUTAMIDE – Special Authority see SA0941 below – Retail pharmacy Tab 50 mg .........................................................................................27.10 30

Bicalox

¾SA0941 Special Authority for Subsidy Initial application from any medical practitioner. Approvals valid without further renewal unless notiﬁed where the patient has advanced prostate cancer. EXEMESTANE Tab 25 mg .......................................................................................175.00 30 Aromasin FLUTAMIDE – Hospital pharmacy [HP3]-Specialist Tab 250 mg .......................................................................................39.50 100

Flutamin

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

143

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

LETROZOLE Tab 2.5 mg – Higher subsidy of $200.00 per 30 with Special Authority see SA0943 below .................................................... 146.46 (200.00)

30 Femara

¾SA0943 Special Authority for Alternate Subsidy Initial application — (New patients) only from a relevant specialist. Approvals valid for 5 years for applications meeting the following criteria: All of the following: 1 Patient is a postmenopausal woman; and 2 Patient has hormone receptor positive early breast cancer; and 3 Either: 3.1 The patient has a very clear history of intolerance to tamoxifen; or 3.2 The use of tamoxifen is contraindicated due to a history of thromboembolic disease. Initial application — (Patient has had a Special Authority approval for letrozole prior to 1 December 2008) only from a relevant specialist. Approvals valid without further renewal unless notiﬁed where the treatment remains appropriate and the patient is beneﬁting from treatment. Renewal only from a relevant specialist. Approvals valid without further renewal unless notiﬁed where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: If the patient had an approval for letrozole prior to 1 December 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone Ministry of Health Sector Services on 0800 243 666 for clariﬁcation if needed. MEGESTROL ACETATE – Retail pharmacy-Specialist Tab 160 mg .......................................................................................74.25 30 Megace OCTREOTIDE (SOMATOSTATIN ANALOGUE) – Special Authority see SA0563 below – Hospital pharmacy [HP3] Inj 50 µg per ml, 1 ml ........................................................................25.65 5 Hospira 43.50 Sandostatin Inj 100 µg per ml, 1 ml ......................................................................48.50 5 Hospira 81.00 Sandostatin Inj 500 µg per ml, 1 ml ....................................................................175.00 5 Hospira 399.00 Sandostatin LAR 10 mg preﬁlled syringe ........................................................1,772.50 1 Sandostatin LAR LAR 20 mg preﬁlled syringe ........................................................2,358.75 1 Sandostatin LAR LAR 30 mg preﬁlled syringe ........................................................2,951.25 1 Sandostatin LAR ¾SA0563 Special Authority for Subsidy 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 continued. . .

144

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 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 octreotide 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 where the treatment remains appropriate and the patient is beneﬁting from treatment. TAMOXIFEN CITRATE F Tab 10 mg .........................................................................................10.80 100 Genox F Tab 20 mg ...........................................................................................6.66 60 Tamoxifen Sandoz 11.10 100 Genox

Immunosuppressants Cytotoxic Immunosuppressants

AZATHIOPRINE – Retail pharmacy-Specialist F Tab 50 mg .........................................................................................25.00 (34.90) F Inj 50 mg ...........................................................................................46.33 (47.72) (Thioprine Tab 50 mg to be delisted 1 October 2009) 100

Azamun Thioprine

Imuran Imuran

MYCOPHENOLATE MOFETIL – Special Authority see SA0960 below – Hospital pharmacy [HP3] Tab 500 mg .....................................................................................206.66 50 Cellcept Cap 250 mg ....................................................................................206.66 100 Cellcept Powder for oral liq 1 g per 5 ml – Subsidy by endorsement ............285.00 165 ml OP Cellcept Mycophenolate powder for oral liquid is subsidised only for patients unable to swallow tablets and capsules, and when the prescription is endorsed accordingly. ¾SA0960 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Any of the following: 1 Renal transplant recipient; or 2 Heart transplant recipient; or 3 Liver transplant recipient; or 4 Patient has an organ transplant and has severe tophaceous gout making azathioprine unsuitable.

Immune Modulators

ANTITHYMOCYTE GLOBULIN (EQUINE) – PCT only – Specialist Inj 50 mg per ml, 5 ml ..................................................................2,137.50 5

ATGAM Mabthera Mabthera Baxter

RITUXIMAB – PCT only – Specialist – Special Authority see SA0961 on the next page Inj 100 mg per 10 ml vial .............................................................1,195.00 2 Inj 500 mg per 50 ml vial .............................................................2,987.00 1 Inj 1 mg for ECP .................................................................................6.27 1 mg

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

145

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA0961 Special Authority for Subsidy Initial application — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has B-cell post-transplant lymphoproliferative disorder*; and 2 To be used for a maximum of 8 treatment cycles. Initial application — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has indolent low grade NHL with relapsed disease following prior chemotherapy; and 1.2 To be used for a maximum of 4 treatment cycles; or 2 Both: 2.1 The patient has indolent, low grade lymphoma requiring ﬁrst-line systemic chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/Waldenstrom macroglobulinaemia. Rituximab is not funded for Chronic lymphocytic leukaemia/small lymphocytic lymphoma. Initial application — (Aggressive CD20 positive NHL) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has treatment-naive aggressive CD20 positive NHL; and 2 To be used with a multi-agent chemotherapy regimen given with curative intent; and 3 To be used for a maximum of 8 treatment cycles. Note: ’Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia Renewal — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has indolent, low-grade NHL with relapsed disease following prior chemotherapy; and 3 To be used for no more than 4 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/Waldenstrom macroglobulinaemia. Rituximab is not funded for Chronic lymphocytic leukaemia/small lymphocytic lymphoma. Renewal — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has B-cell post-transplant lymphoproliferative disorder*; and 3 To be used for no more than 6 treatment cycles. Note: Indications marked with * are Unapproved Indications. TRASTUZUMAB – PCT only – Specialist – Special Authority see SA0885 on the next page Inj 150 mg vial .............................................................................1,350.00 1 Herceptin Inj 440 mg vial .............................................................................3,875.00 1 Herceptin Inj 1 mg for ECP .................................................................................9.36 1 mg Baxter

146

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA0885 Special Authority for Subsidy Initial application — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months where the patient has metastatic breast cancer expressing HER-2 IHC 3+ or FISH+. Renewal — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic breast cancer; and 2 The cancer has not progressed. Initial application — (early breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 The patient has early breast cancer expressing HER 2 IHC 3+ or FISH +; and 2 Maximum cumulative dose of 20mg/kg (9 weeks treatment)*; and 3 Trastuzumab is to be given concurrently with adjuvant taxane chemotherapy*; and 4 Trastuzumab is not to be given concurrently with anthracycline chemotherapy. Notes: indications marked with * are Unapproved Indications. It is recommended that for early breast cancer trastuzumab be administered concurrently with docetaxel prior to anthracyclines as per the FinHer regimen (Joensuu H, Kellokumpu-Lehtinen P, Bono P, et al. Adjuvant docetaxel or vinorelbine with or without trastuzumab for breast cancer. N Engl J Med 2006;354(8):809-20).

Other Immunosuppressants

CYCLOSPORIN A – Special Authority see SA0470 below – Hospital pharmacy [HP3] Cap 25 mg ........................................................................................85.00 50 Cap 50 mg ......................................................................................169.34 50 Cap 100 mg ....................................................................................338.69 50 Oral liq 100 mg per ml ....................................................................377.38 50 ml OP

Neoral Neoral Neoral Neoral

¾SA0470 Special Authority for Subsidy Initial application — (Organ transplant) only from a relevant specialist. Approvals valid without further renewal unless notiﬁed where the patient is an organ transplant recipient. 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: 1 Psoriasis; and 2 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: 1 Severe atopic dermatitis; and 2 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: 1 Nephrotic Syndrome; and continued. . .

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

147

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 2 Corticosteroid dependent patients who have failed on cytotoxic therapy. Initial application — (Endogenous uveitis) only from a relevant specialist. Approvals valid for 2 years where the patient suffers from 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: 1 Severe rheumatoid arthritis; and 2 The patient must be either unresponsive to or unable to tolerate, both sulphasalazine and methotrexate; and 3 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 where 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 where the treatment remains appropriate and the patient is beneﬁting from treatment. Guidelines for use of cyclosporin A in rheumatoid arthritis Monitoring: All patients require frequent monitoring for creatinine levels and blood pressure: G fortnightly, in the ﬁrst three months of therapy and then monthly, if results are stable; G if dose is increased or there is a rise in serum creatinine or blood pressure, then more frequent monitoring is required. Contraindications: Cyclosporin A is contraindicated in patients with the following conditions: G current or past malignancy; G uncontrolled hypertension; G renal dysfunction (abnormal serum creatinine for age and sex); G immunodeﬁciency and neutropenia; G abnormally low white blood cell count or platelet count; or G liver function tests more than twice the upper limit of normal. Caution in use: G age above 65 years; G controlled hypertension; G use of anti-epileptic medications; G use of ketoconazole, ﬂuconazole, trimethoprim, erythromycin, verapamil, and diltiazem; G concurrent or previous use of alkylating agents such as cyclophosphamide; G use of any experimental drug within the past three months; G premalignant conditions such as leukoplakia, monoclonal paraproteinaemia, myelodysplastic syndrome and dysplastic naevi; G active infection may necessitate temporary discontinuation; G 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. SIROLIMUS – Special Authority see SA0866 on the next page – Hospital pharmacy [HP3] Tab 1 mg .........................................................................................813.00 100 Rapamune Tab 2 mg ......................................................................................1,626.00 100 Rapamune Oral liq 1 mg per ml ........................................................................487.80 60 ml OP Rapamune

148

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA0866 Special Authority for Subsidy Initial application from any medical practitioner. Approvals valid without further renewal unless notiﬁed where the drug is to be used for rescue therapy for an organ transplant recipient. Notes: Rescue therapy deﬁned as unresponsive to calcineurin inhibitor treatment as deﬁned by refractory rejection; or intolerant to calcineurin inhibitor treatment due to any of the following: G GFR<30 ml/min; or G Rapidly progressive transplant vasculopathy; or G Rapidly progressive obstructive bronchiolitis; or G HUS or TTP; or G Leukoencepthalopathy; or G Signiﬁcant malignant disease TACROLIMUS – Special Authority see SA0669 below – Hospital pharmacy [HP3] Cap 0.5 mg .....................................................................................214.00 100 Prograf Cap 1 mg ........................................................................................428.00 100 Prograf Cap 5 mg .....................................................................................1,070.00 50 Prograf ¾SA0669 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid without further renewal unless notiﬁed where the patient is an organ transplant recipient. Note: Subsidy applies for either primary or rescue therapy.

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

149

RESPIRATORY SYSTEM AND ALLERGIES

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

Antiallergy Preparations

BEE VENOM ALLERGY TREATMENT – Special Authority see SA0053 below – Hospital pharmacy [HP3] Maintenance kit - 6 vials 120 µg freeze dried venom, 6 diluent 1.8 ml ....................................................................................... 285.00 1 OP Albay Treatment kit - 1 vial 550 µg freeze dried venom, 1 diluent 9 ml, 3 diluent 1.8 ml ............................................................... 285.00 1 OP Albay ¾SA0053 Special Authority for Subsidy 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 where the treatment remains appropriate and the patient is beneﬁting from treatment. WASP VENOM ALLERGY TREATMENT – Special Authority see SA0053 below – Hospital pharmacy [HP3] Treatment kit (Paper wasp venom) - 1 vial 550 µg freeze dried polister venom, 1 diluent 9 ml, 1 diluent 1.8 ml ....................... 285.00 1 OP Albay Treatment kit (Yellow jacket venom) - 1 vial 550 µg freeze dried vespula venom, 1 diluent 9 ml, 1 diluent 1.8 ml .............. 285.00 1 OP Albay ¾SA0053 Special Authority for Subsidy 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 where the treatment remains appropriate and the patient is beneﬁting from treatment.

Antihistamines

AZATADINE MALEATE F Tab 1 mg ............................................................................................6.94 (16.90) (Zadine Tab 1 mg to be delisted 1 February 2010) CETIRIZINE HYDROCHLORIDE F Tab 10 mg ...........................................................................................2.21 F‡ Oral liq 1 mg per ml ............................................................................3.50 CHLORPHENIRAMINE MALEATE F‡ Oral liq 2 mg per 5 ml .........................................................................8.06 CYPROHEPTADINE HYDROCHLORIDE F Tab 4 mg .............................................................................................6.27 50 Zadine

100 200 ml 500 ml 100

Zetop Cetirizine - AFT Histafen Periactin

150

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

RESPIRATORY SYSTEM AND ALLERGIES

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

DEXTROCHLORPHENIRAMINE MALEATE F Tab 2 mg .............................................................................................2.52 (9.99) F Tab long-acting 6 mg ..........................................................................5.40 (12.56)

50 Polaramine 40 Polaramine Colour-Free Repetab Polaramine Repetab 100 ml Polaramine

(12.56) F‡ Oral liq 2 mg per 5 ml .........................................................................1.77 (10.29) (Polaramine Repetab Tab long-acting 6 mg to be delisted 1 January 2010) FEXOFENADINE HYDROCHLORIDE F Tab 60 mg ...........................................................................................4.34 (11.53) F Tab 120 mg .......................................................................................14.22 (29.81) LORATADINE F Tab 10 mg ...........................................................................................3.58 F Oral liq 1 mg per ml ............................................................................3.65 PROMETHAZINE HYDROCHLORIDE F Tab 10 mg ...........................................................................................2.72 F Tab 25 mg ...........................................................................................4.44 F‡ Oral liq 5 mg per 5 ml .........................................................................3.53 (8.51) F Inj 25 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................11.00 TRIMEPRAZINE TARTRATE ‡ Oral liq 30 mg per 5 ml .......................................................................2.79 (8.06)

20 Telfast 30 Telfast 100 100 ml 50 50 100 ml 5 100 ml OP Vallergan Forte

Loraclear Hayfever

Relief

Lorapaed Allersoothe Allersoothe

Phenergan

Mayne

Inhaled Corticosteroids

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 100 µg per dose CFC-free ......................................12.50 Aerosol inhaler, 250 µg per dose CFC-free ......................................22.67 Aerosol inhaler, 50 µg per dose CFC-free ..........................................8.54 Aerosol inhaler, 50 µg per dose .........................................................8.54 Aerosol inhaler, 100 µg per dose .....................................................12.50 Aerosol inhaler, 250 µg per dose .....................................................22.67 (Beclazone 50 Aerosol inhaler, 50 µg per dose to be delisted 1 February 2010) (Beclazone 100 Aerosol inhaler, 100 µg per dose to be delisted 1 February 2010) (Beclazone 250 Aerosol inhaler, 250 µg per dose to be delisted 1 February 2010) BUDESONIDE Powder for inhalation, 100 µg per dose ............................................17.00 Powder for inhalation, 200 µg per dose ............................................19.00 Powder for inhalation, 400 µg per dose ............................................32.00 200 dose OP 200 dose OP 200 dose OP 200 dose OP 200 dose OP 200 dose OP

Beclazone 100 Beclazone 250 Beclazone 50 Beclazone 50 Beclazone 100 Beclazone 250

200 dose OP 200 dose OP 200 dose OP

Pulmicort

Turbuhaler

Pulmicort

Turbuhaler

Pulmicort

Turbuhaler

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

151

RESPIRATORY SYSTEM AND ALLERGIES

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

FLUTICASONE Aerosol inhaler, 50 µg per dose CFC-free ..........................................7.50 Powder for inhalation, 50 µg per dose ................................................5.10 (8.67) Powder for inhalation, 100 µg per dose ..............................................7.50 (13.87) Aerosol inhaler, 125 µg per dose CFC-free ......................................13.60 Aerosol inhaler, 250 µg per dose CFC-free ......................................27.20 Powder for inhalation, 250 µg per dose ............................................13.60 (24.51)

120 dose OP 60 dose OP 60 dose OP

Flixotide

Flixotide Accuhaler Flixotide Accuhaler

120 dose OP 120 dose OP 60 dose OP

Flixotide Flixotide

Flixotide Accuhaler

Inhaled Long-acting Beta-adrenoceptor Agonists

Prescribing Guideline for Inhaled Long-Acting Beta-Adrenoceptor Agonists The addition of inhaled long-acting beta-adrenoceptor agonists (LABAs) to inhaled corticosteroids is recommended: G For younger children (aged under 12 years) where asthma is poorly controlled despite using inhaled corticosteroids for at least three months at total daily doses of 200 µg beclomethasone or budesonide (or 100 µg ﬂuticasone). G For adults and older children (aged 12 years and over) where asthma is poorly controlled despite using inhaled corticosteroids for at least three months at total daily doses of 400 µg beclomethasone or budesonide (or 200 µg ﬂuticasone). Note: Further information on the place of inhaled corticosteroids and inhaled LABAs in the management of asthma can be found in the New Zealand guidelines for asthma in adults (www.nzgg.org.nz) and in the New Zealand guidelines for asthma in children aged 1-15 (www.paediatrics.org.nz). EFORMOTEROL FUMARATE – See prescribing guideline above Powder for inhalation, 6 µg per dose, breath activated .....................16.90 60 dose OP Oxis Turbuhaler Powder for inhalation, 12 µg per dose, and monodose device .........35.80 60 dose Foradil SALMETEROL – See prescribing guideline above Aerosol inhaler CFC-free, 25 µg per dose ........................................26.46 Powder for inhalation, 50 µg per dose, breath activated ...................26.46 120 dose OP 60 dose OP

Serevent Serevent Accuhaler

Inhaled Corticosteroids with Long-Acting Beta-Adrenoceptor Agonists

¾SA0958 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 All of the following: 1.1 Patient is a child under the age of 12; and 1.2 All of the following: Has, for 3 months of more, been treated with: 1.2.1 An inhaled long-acting beta adrenoceptor agonist; and 1.2.2 Inhaled corticosteroids at a dose of at least 400 µg per day beclomethasone or budesonide, or 200 µg per day ﬂuticasone; and 1.3 The prescriber considers that the patient would receive additional clinical beneﬁt from switching to a combination product; or 2 All of the following: 2.1 Patient is over the age of 12; and 2.2 All of the following: Has, for 3 months of more, been treated with: 2.2.1 An inhaled long-acting beta adrenoceptor agonist; and continued. . .

152

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

RESPIRATORY SYSTEM AND ALLERGIES

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

continued. . . 2.2.2 Inhaled corticosteroids at a dose of at least 800 µg per day beclomethasone or budesonide, or 500 µg per day ﬂuticasone; and 2.3 The prescriber considers that the patient would receive additional clinical beneﬁt from switching to a combination product. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. BUDESONIDE WITH EFORMOTEROL – Special Authority see SA0958 on the preceding page – Retail pharmacy Aerosol inhaler 100 µg with eformoterol fumarate 6 µg ....................55.00 120 dose OP Vannair Powder for inhalation 100 µg with eformoterol fumarate 6 µg ..........55.00 120 dose OP Symbicort Turbuhaler 100/6 Aerosol inhaler 200 µg with eformoterol fumarate 6 µg ....................60.00 120 dose OP Vannair Powder for inhalation 200 µg with eformoterol fumarate 6 µg ..........60.00 120 dose OP Symbicort Turbuhaler 200/6 Powder for inhalation 400 µg with eformoterol fumarate 12 µg – No more than 2 dose per day .................................................. 60.00 60 dose OP Symbicort Turbuhaler 400/12 FLUTICASONE WITH SALMETEROL – Special Authority see SA0958 on the preceding page – Retail pharmacy Aerosol inhaler 50 µg with salmeterol 25 µg .....................................37.48 120 dose OP Seretide Aerosol inhaler 125 µg with salmeterol 25 µg ...................................49.69 120 dose OP Seretide Powder for inhalation 100 µg with salmeterol 50 µg – No more than 2 dose per day.................................................................... 37.48 60 dose OP Seretide Accuhaler Powder for inhalation 250 µg with salmeterol 50 µg – No more than 2 dose per day.................................................................... 49.69 60 dose OP Seretide Accuhaler

Beta-Adrenoceptor Agonists

SALBUTAMOL ‡ Oral liq 2 mg per 5 ml .........................................................................2.25 Infusion 1 mg per ml, 5 ml ..............................................................118.38 (130.21) Inj 500 µg per ml, 1 ml – Up to 5 inj available on a PSO ..................12.90 150 ml 10 5

Salapin

Ventolin

Inhaled Beta-Adrenoceptor Agonists

SALBUTAMOL Aerosol inhaler, 100 µg per dose CFC free – Up to 1000 dose available on a PSO.......................................................................3.80 (6.00) Nebuliser soln, 1 mg per ml, 2.5 ml – Up to 30 neb available on a PSO......................................................................................3.52 Nebuliser soln, 2 mg per ml, 2.5 ml – Up to 30 neb available on a PSO......................................................................................3.70 TERBUTALINE SULPHATE Powder for inhalation, 250 µg per dose, breath activated .................18.20

200 dose OP

Respigen Salamol

Ventolin

20 20 200 dose OP

Asthalin Asthalin Bricanyl Turbuhaler

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

153

RESPIRATORY SYSTEM AND ALLERGIES

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

Inhaled Anticholinergic agents

IPRATROPIUM BROMIDE Aerosol inhaler, 20 µg per dose CFC-free ........................................16.20 Nebuliser soln, 250 µg per ml, 1 ml – Up to 40 neb available on a PSO...................................................................................... 4.30 Nebuliser soln, 250 µg per ml, 2 ml – Up to 40 neb available on a PSO...................................................................................... 5.25 200 dose OP 20

Atrovent Ipratropium

Steri-Neb

Ipratropium

Steri-Neb

TIOTROPIUM BROMIDE – Special Authority see SA0872 below – Retail pharmacy Powder for inhalation, 18 µg per dose ..............................................70.00 30 dose

Spiriva

¾SA0872 Special Authority for Subsidy 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 µg ipratropium q.i.d for one month; and 3 Any of the following: The patient’s breathlessness according to the Medical Research Council (UK) dyspnoea scale is: 3.1 Grade 4 (stops for breath after walking about 100 meters or after a few minutes on the level); or 3.2 Grade 5 (too breathless to leave the house, or breathless when dressing or undressing); and 4 Actual FEV1 (litres) < 0.6 × predicted (litres); and 5 Either: 5.1 Patient is not a smoker (for reporting purposes only); or 5.2 Patient is a smoker and has been offered smoking cessation counselling; and 6 The patient has been offered annual inﬂuenza immunisation. Renewal only from a general practitioner or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Patient is compliant with the medication; and 2 Patient has experienced improved COPD symptom control (prescriber determined); and 3 Applicant must state recent measurement of FEV1 (% of predicted).

Inhaled Beta-Adrenoceptor Agonists with Anticholinergic Agents

SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 µg with ipratropium bromide, 20 µg per dose ...........................................................................................13.50 Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml – Up to 20 neb available on a PSO ........................... 4.29

200 dose OP 20

Combivent Duolin

Mast cell stabilisers

NEDOCROMIL Aerosol inhaler, 2 mg per dose CFC-free .........................................23.20 (28.07) SODIUM CROMOGLYCATE Powder for inhalation, 20 mg per dose .............................................16.31 (17.94) Aerosol inhaler, 5 mg per dose CFC-free .........................................23.20 (28.07)

fully subsidised [HP1], [HP3], [HP4] refer page 8

112 dose OP Tilade 50 dose Intal Spincaps 112 dose OP Vicrom

154

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

RESPIRATORY SYSTEM AND ALLERGIES

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

Methylxanthines

AMINOPHYLLINE F Inj 25 mg per ml, 10 ml – Up to 5 inj available on a PSO .................12.84 THEOPHYLLINE F Tab long-acting 250 mg ....................................................................21.51 F‡ Oral liq 80 mg per 15 ml .....................................................................4.06 (15.50) 5 100 500 ml

Mayne Nuelin-SR

Nuelin

Cystic Fibrosis

DORNASE ALFA – Special Authority see SA0611 below – Hospital pharmacy [HP1] Nebuliser soln, 2.5 mg per 2.5 ml ampoule ....................................294.30 6

Pulmozyme

¾SA0611 Special Authority for Subsidy Special Authority approved by the Cystic Fibrosis Advisory Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Co-ordinator, Cystic Fibrosis Advisory Panel Phone: (04) 460 4990 PHARMAC, PO Box 10 254 Facsimile: (04) 916 7571 Wellington Email: CFPanel@pharmac.govt.nz Prescriptions for patients approved for treatment must be written by respiratory physicians or paediatricians who have experience and expertise in treating cystic ﬁbrosis.

Nasal Preparations Allergy Prophylactics

BECLOMETHASONE DIPROPIONATE Metered aqueous nasal spray, 50 µg per dose ...................................2.35 Metered aqueous nasal spray, 100 µg per dose .................................2.46 BUDESONIDE Metered aqueous nasal spray, 50 µg per dose ...................................2.35 (2.95) Metered aqueous nasal spray, 100 µg per dose .................................2.61 (3.30) IPRATROPIUM BROMIDE Aqueous nasal spray, 0.03% ............................................................12.66 SODIUM CROMOGLYCATE Nasal spray, 4% ................................................................................13.50 200 dose OP 200 dose OP 200 dose OP Butacort Aqueous 200 dose OP Butacort Aqueous 30 ml OP 22 ml OP

Alanase Alanase

Apo-Ipravent Rex

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

155

RESPIRATORY SYSTEM AND ALLERGIES

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

Respiratory Devices

MASK FOR SPACER DEVICE a) Maximum of 20 dev per WSO b) Only on a WSO c) 1) 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. 2) Only available for children aged six years and under. 3) 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. 4) 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 Size 2 ..................................................................................................3.28 1 Foremount Child’s Silicone Mask PEAK FLOW METER a) Maximum of 10 dev per WSO b) Only on a WSO Low range .........................................................................................13.75 1 Breath-Alert Normal range ....................................................................................13.75 1 Breath-Alert SPACER DEVICE a) Maximum of 20 dev per WSO b) Only on a WSO c) 1) 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. 2) 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. Space Chamber distributed by Airﬂow Products. Forward orders to: Airﬂow Products - PO Box 1485, Wellington Telephone: 04 499 1240 or 0800 AIR FLOW, Facsimile: 04 499 1245 or 0800 323 270 Volumatic Distributed by GlaxoSmithKline. Forward orders to: Telephone: 0800 877 789 Facsimile: 0800 877 785 230 ml (autoclavable) – Subsidy by endorsement.............................11.60 1 Space Chamber Available where the prescriber requires a spacer device that is capable of sterilisation in an autoclave and the WSO is endorsed accoringly. 230 ml (single patient) ........................................................................8.38 1 Space Chamber 800 ml .................................................................................................8.50 1 Volumatic

156

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SENSORY ORGANS

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

Ear Preparations

ACETIC ACID WITH 1, 2- PROPANEDIOL DIACETATE AND BENZETHONIUM For Vosol ear drops with hydrocortisone powder refer, page 166 Ear drops 2% with 1, 2-Propanediol diacetate 3% and benzethonium chloride 0.02 % ....................................................6.97 CHLORAMPHENICOL Ear drops 0.5% ...................................................................................1.87 FLUMETASONE PIVALATE Ear drops 0.02% with clioquinol 1% ...................................................4.46

35 ml OP 5 ml OP 7.5 ml OP

Vosol Chloromycetin Locorten-Vioform

TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN Ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g ............................................3.35 7.5 ml OP

Kenacomb

Ear/Eye Preparations

DEXAMETHASONE WITH FRAMYCETIN AND GRAMICIDIN Ear/Eye drops 500 µg with framycetin sulphate 5 mg and gramicidin 50 µg per ml ...............................................................4.50 (9.27) FRAMYCETIN SULPHATE Ear/Eye drops 0.5% ............................................................................4.13 (8.65)

8 ml OP Sofradex 8 ml OP Soframycin

Eye Preparations Anti-Infective Preparations

ACICLOVIR F Eye oint 3% ......................................................................................37.53 CHLORAMPHENICOL Eye oint 1% ........................................................................................2.37 Eye drops 0.5% ..................................................................................1.40 4.5 g OP 4 g OP 10 ml OP

Zovirax Chlorsig Chlorsig

CIPROFLOXACIN Eye Drops 0.3% ................................................................................12.43 5 ml OP Ciloxan For treatment of bacterial keratitis or severe bacterial conjunctivitis resistant to chloramphenicol. FUSIDIC ACID Eye drops 1% .....................................................................................4.50 5 g OP (10.68) Fucithalmic GENTAMICIN SULPHATE Eye drops 0.3% ................................................................................11.40 PROPAMIDINE ISETHIONATE F Eye drops 0.1 % .................................................................................2.97 (7.99) SULPHACETAMIDE SODIUM F Eye drops 10% ...................................................................................4.41 TOBRAMYCIN Eye oint 0.3% ...................................................................................10.45 Eye drops 0.3% ................................................................................11.48

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

5 ml OP 10 ml OP

Genoptic

Brolene 15 ml OP 3.5 g OP 5 ml OP

Bleph 10 Tobrex Tobrex

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

157

SENSORY ORGANS

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

Corticosteroids and Other Anti-Inﬂammatory Preparations

DEXAMETHASONE F Eye oint 0.1% .....................................................................................5.86 F Eye drops 0.1 % .................................................................................4.50 DEXAMETHASONE WITH NEOMYCIN AND POLYMYXIN B SULPHATE F Eye oint 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per g ............................................................. 5.39 F Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml ...................................................... 4.50 DICLOFENAC SODIUM F Eye drops 1 mg per ml .....................................................................13.80 FLUOROMETHOLONE F Eye drops 0.1% ..................................................................................4.05 4.30 LEVOCABASTINE Eye drops 0.5 mg per ml ....................................................................8.71 (10.34) LODOXAMIDE TROMETAMOL Eye drops 0.1% ..................................................................................8.71 PREDNISOLONE ACETATE F Eye drops 0.12% ................................................................................4.50 (7.53) F Eye drops 1% .....................................................................................4.50 (9.44) SODIUM CROMOGLYCATE Eye drops 2% .....................................................................................3.95 3.5 g OP 5 ml OP

Maxidex Maxidex

3.5 g OP 5 ml OP 5 ml OP 5 ml OP

Maxitrol Maxitrol Voltaren Ophtha FML Flucon

4 ml OP Livostin 10 ml OP 5 ml OP Pred Mild 5 ml OP Pred Forte 10 ml OP

Lomide

Cromolux

Glaucoma Preparations - Beta Blockers

BETAXOLOL HYDROCHLORIDE F Eye drops 0.25% ..............................................................................11.80 F Eye drops 0.5% ..................................................................................7.50 LEVOBUNOLOL F Eye drops 0.25% ................................................................................7.00 F Eye drops 0.5 % .................................................................................7.00 TIMOLOL MALEATE F Eye drops 0.25% ................................................................................2.37 F Eye drops 0.25%, gel forming ............................................................3.30 F Eye drops 0.5% ..................................................................................2.29 F Eye drops 0.5%, gel forming ..............................................................3.78 5 ml OP 5 ml OP 5 ml OP 5 ml OP 5 ml OP 2.5 ml OP 5 ml OP 2.5 ml OP

Betoptic S Betoptic Betagan Betagan Apo-Timop Timoptol XE Apo-Timop Timoptol XE

158

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SENSORY ORGANS

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

Glaucoma Preparations - Carbonic Anhydrase Inhibitors

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: 1) that person has previously trialled all other such subsidised agents (except brimonidine tartrate); and 2) those trials have indicated that that person does not respond adequately to treatment with those other agents. ACETAZOLAMIDE F Tab 250 mg .......................................................................................10.40 100 Diamox BRINZOLAMIDE L Eye Drops 1% .....................................................................................9.77 DORZOLAMIDE HYDROCHLORIDE F Eye drops 2% .....................................................................................9.77 (13.95) DORZOLAMIDE HYDROCHLORIDE WITH TIMOLOL MALEATE F Eye drops 2% with timolol maleate 0.5% .........................................18.50 5 ml OP 5 ml OP Trusopt 5 ml OP

Azopt

Cosopt

Glaucoma Preparations - Prostaglandin Analogues

Prescribing Guideline Bimatoprost, lantanoprost and travoprost are subsidised for use in the treatment of glaucoma as either monotherapy or as an adjunctive agent for patients in whom prostaglandin analogue monotherapy has been ineffective in controlling intraocular pressure. Bimatoprost, lantanoprost and travoprost should not be prescribed for a person in whom less expensive ﬁrst line agents for the treatment of glaucoma are not contraindicated unless: 1) That person has previously trialled all other such subsidised agents (beta-blockers, pilocarpine, carbonic anhydrase inhibitors); and 2) Those trials have indicated that that person does not respond adequately to treatment with those other agents. BIMATOPROST – Retail pharmacy-Specialist See prescribing guideline above 3 ml OP Lumigan L Eye Drops 0.03% ..............................................................................19.50 LATANOPROST – Retail pharmacy-Specialist See prescribing guideline above L Eye drops 50 µg per ml, 2.5ml ..........................................................19.50 TRAVOPROST – Retail pharmacy-Specialist See prescribing guideline above L Eye drops 0.004% ............................................................................19.50

2.5 ml OP

Xalatan

2.5 ml OP

Travatan

Glaucoma Preparations - Other

BRIMONIDINE TARTRATE F Eye Drops 0.2% ..................................................................................7.93 5 ml OP AFT Prescribing Guidelines Brimonidine tartrate is subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Brimonidine tartrate should not be prescribed for a person in whom less expensive ﬁrst line agents for the treatment of glaucoma are not contraindicated unless: G that person has previously trialled all other such subsidised agents (except dorzolamide hydrochloride); and G those trials have indicated that that person does not respond adequately to or does not tolerate treatment with those other agents. BRIMONIDINE TARTRATE WITH TIMOLOL MALEATE L Eye drops 0.2% with timolol maleate 0.5% ......................................18.50 5 ml OP Combigan

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once LThree months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

159

SENSORY ORGANS

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

Prescribing Guidelines Combigan is subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Combigan should only be prescribed when: 1) less expensive ﬁrst line agents for the treatment of glaucoma are contraindicated; or 2) the response to such subsidised agents is inadequate; or 3) the patient cannot tolerate such subsidised agents. PILOCARPINE F Eye drops 0.5% .................................................................................3.19 15 ml OP Pilopt F Eye drops 1% .....................................................................................3.24 15 ml OP Pilopt 4.26 Isopto Carpine S29 F Eye drops 2% ....................................................................................4.32 15 ml OP Pilopt 5.35 Isopto Carpine S29 F Eye drops 4% .....................................................................................6.57 15 ml OP Pilopt 7.99 Isopto Carpine S29 F Eye drops 6% ....................................................................................8.56 15 ml OP Pilopt F Eye drops 2% single dose – Special Authority see SA0895 below – Hospital pharmacy [HP3] ..............................................31.95 20 dose (32.72) Minims (Pilopt Eye drops 0.5% to be delisted 1 December 2009) (Pilopt Eye drops 2% to be delisted 1 January 2010) (Pilopt Eye drops 6% to be delisted 1 February 2010) ¾SA0895 Special Authority for Subsidy Initial application from any relevant 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 relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Mydriatics and Cycloplegics

ATROPINE SULPHATE F Eye drops 1% .....................................................................................4.40 CYCLOPENTOLATE HYDROCHLORIDE F Eye drops 1% .....................................................................................8.76 HOMATROPINE HYDROBROMIDE F Eye drops 2% .....................................................................................7.18 TROPICAMIDE F Eye drops 0.5% ..................................................................................7.15 F Eye drops 1% .....................................................................................8.66 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP

Atropt Cyclogyl Isopto Homatropine Mydriacyl Mydriacyl

Preparations for Tear Deﬁciency

For acetylcysteine eye drops refer, page 166 HYPROMELLOSE F Eye drops 0.3% ..................................................................................2.62 F Eye drops 0.5% ..................................................................................2.00 POLYVINYL ALCOHOL F Eye drops 1.4% ..................................................................................2.68 F Eye drops 3% .....................................................................................3.75

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

Poly-Tears Methopt Vistil Vistil Forte

160

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SENSORY ORGANS

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

TYLOXAPOL F Eye drops 0.25% ................................................................................8.63

15 ml OP

Enuclene

Other Eye Preparations

NAPHAZOLINE HYDROCHLORIDE F Eye drops 0.1% ..................................................................................4.15 PARAFFIN LIQUID WITH SOFT WHITE PARAFFIN F Eye oint with soft white parafﬁn ..........................................................3.63 PARAFFIN LIQUID WITH WOOL FAT LIQUID F Eye oint 3% with wool fat liq 3% .........................................................3.63 PHENYLEPHRINE HYDROCHLORIDE F Eye drops 0.12% ................................................................................4.47 PHENYLEPHRINE HYDROCHLORIDE WITH ZINC SULPHATE F 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 15 ml OP

Naphcon Forte Lacri-Lube Poly-Visc Prefrin Zincfrin

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once

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

161

VARIOUS

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

Agents Used in the Treatment of Poisonings

See also to MUSCULOSKELETAL, Anticholinesterases, page 99 CHARCOAL F Tab 300 mg .........................................................................................7.13 F Oral liq 50 g per 250 ml ....................................................................43.50 a) Up to 250 ml available on a PSO b) Only on a PSO DESFERRIOXAMINE MESYLATE – Hospital pharmacy [HP3] F Inj 500 mg .........................................................................................99.00 IPECACUANHA F Tincture .............................................................................................41.20 (43.40) NALOXONE HYDROCHLORIDE a) Up to 5 inj available on a PSO b) Only on a PSO F Inj 400 µg per ml, 1 ml ......................................................................33.00 SODIUM CALCIUM EDETATE F Inj 200 mg per ml, 5 ml .....................................................................53.31 (156.71)

100 250 ml OP

Red Seal Carbosorb-X

10 500 ml

Mayne

PSM

5 6

Mayne

Calcium Disodium Versenate

Detection of Substances in Urine

ORTHO-TOLIDINE F Compound diagnostic sticks ...............................................................7.50 (8.25) TETRABROMOPHENOL F Blue diagnostic strips .........................................................................7.02 (13.92) 50 test OP Hemastix 100 test OP Albustix

162

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SECTION C: EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS

INTRODUCTION

The following extemporaneously compounded products are eligible for subsidy:

G G G G

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 a) One or more subsidised dermatological galenical(s) in a subsidised dermatological base. b) Dilution of proprietary Topical Corticosteroid-Plain preparations with a dermatological base (Retail pharmacy-specialist). c) Menthol crystals only in the following bases: Aqueous cream Urea cream 10% Wool fat with mineral oil lotion Hydrocortisone 1% with wool fat and mineral oil lotion Glycerol, parafﬁn and cetyl alcohol lotion.

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:

G G G G G G G G G G G G G G

Aqueous cream Cetomacrogol cream BP Collodion ﬂexible 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

Dermatological galenical: Dermatological galenicals will only be subsidised when added to a dermatological base. More than one dermatological galenical can be added to a dermatological base. The following are dermatological galenicals:

G G G G

Coal tar solution BP - up to 10% Hydrocortisone powder - up to 5% Salicylic acid powder Sulphur precipitated powder

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

163

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: qs Solid dose form qs Preservative Suspending agent qs Water to 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: G Mixing one or more proprietary oral liquids (eg an antihistamine with pholcodine linctus). G Extemporaneously compounding an oral liquid with more than one solid dose chemical. G Mixing more than one extemporaneously compounded oral liquid mixture. G Mixing one or more extemporaneously compounded oral liquid mixtures with one or more proprietary oral liquids. G The addition of a chemical/powder/agent/solution to a proprietary oral liquid or extemporaneously compounded oral mixture. Standard formulae 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 163) 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 165 may assist you in deciding whether or not a dermatological ECP is subsidised.

164

EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS

Dermatological ECPs

Is it subsidised?

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? Yes Is the second base a proprietary topical corticosteroid-plain? No Is prescription written by a specialist or on the recommendation of a specialist? Entire product is NSS

Yes

Entire product is NSS

This part of the product is subsidised

Yes

Has a non-subsidised ingredient been added: e.g. glycerol?

Has a dermatological galenical or other non-subsidised ingredient been added? Yes

Yes

The non-subsidised ingredient is not subsidised but the rest is

The dermatological galenicals & non-subsidised ingredients are NSS

165

EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS

Standard Formulae

ACETYLCYSTEINE EYE DROPS Acetylcysteine inj 200 mg per ml, 10 ml qs Suitable eye drop base qs ASPIRIN AND 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 Calcium folinate 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 qs qs to 100 ml

METHYL HYDROXYBENZOATE 10% SOLUTION Methyl hydroxybenzoate 10 g Propylene glycol to 100 ml (Use 1 ml of the 10% solution per 100 ml of oral liquid mixture) OMEPRAZOLE SUSPENSION Omeprazole capules Sodium bicarbonate powder BP Water PHENOBARBITONE ORAL LIQUID Phenobarbitone Sodium Glycerol BP Water

qs 8.4 g to 100 ml 1g 70 ml to 100 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.) SALIVA SUBSTITUTE FORMULA Methylcellulose 5g Preservative qs Water to 500 ml (Preservative should be used if quantity 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

166

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS

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

Extemporaneously Compounded Preparations and Galenicals

ACETYLCYSTEINE – Hospital pharmacy [HP1]-Specialist Inj 200 mg per ml, 10 ml .................................................................137.06 (219.75) (255.35) BENZOIN Tincture compound BP .....................................................................24.42 (38.00) CHLOROFORM – Only in combination Only in aspirin and chloroform application. Chloroform BP ..................................................................................25.50 500 ml PSM 10 Martindale Acetylcysteine Hospira

500 ml

PSM

CODEINE PHOSPHATE Powder – Only in combination .........................................................63.09 25 g (84.20) Douglas a) Only in extemporaneously compounded codeine linctus diabetic or codeine linctus paediatric. b) ‡ Safety cap for extemporaneously compounded oral liquid preparations. COLLODION FLEXIBLE Collodion ﬂexible ..............................................................................19.30 100 ml PSM COMPOUND HYDROXYBENZOATE – Only in combination Only in extemporaneously compounded oral mixtures. Soln ..................................................................................................34.18 GLYCEROL F Liquid – Only in combination ...........................................................19.80 24.75 19.80 (24.75) Only in extemporaneously compounded oral liquid preparations. MAGNESIUM HYDROXIDE Paste ................................................................................................22.61

100 ml 2,000 ml

David Craig ABM PSM

MidWest

500 g

PSM

METHADONE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable c) Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). Powder ................................................................................................7.84 1g AFT ‡ Safety cap for extemporaneously compounded oral liquid preparations. METHYL HYDROXYBENZOATE Powder ..............................................................................................10.00 25 g ABM (18.45) PSM METHYLCELLULOSE Powder ..............................................................................................14.00 (17.72) PHENOBARBITONE SODIUM Powder – Only in combination .......................................................325.00 a) Only in children up to 12 years b) ‡ Safety cap for extemporaneously compounded oral liquid preparations.

fully subsidised

100 g

ABM

MidWest

100 g

MidWest

[HP1], [HP3], [HP4] refer page 8

167

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS

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

PROPYLENE GLYCOL Only in extemporaneously compounded methyl hydroxybenzoate 10% solution. Liq .....................................................................................................12.00 500 ml 17.70 SODIUM BICARBONATE Powder BP – Only in combination .....................................................9.80 (11.99) (29.50) Only in extemporaneously compounded omeprazole suspension. SYRUP (PHARMACEUTICAL GRADE) – Only in combination Only in extemporaneously compounded oral liquid preparations. Liq .....................................................................................................21.75 WATER Tap – Only in combination .................................................................0.00 500 g

ABM PSM ABM

Biomed David Craig

2,000 ml 1 ml

Midwest Tap water

168

fully subsidised

[HP1], [HP3], [HP4] refer page 8

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. Who can apply for Special Authority? Only Specialists 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: Ministry of Health Sector Services Private Bag 3015 WHANGANUI 4540 Freefax 0800 100 131 Initial Applications: Reapplications: Subsidies and manufacturer’s surcharges 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. Where are special foods available from? 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. Deﬁnitions 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

169

SPECIAL FOODS

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

Nutrient Modules Carbohydrate

¾SA0912 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis or renal failure) only from a 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) only from a 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; or 7 inborn errors of metabolism. Renewal — (Cystic ﬁbrosis or renal failure) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0912 above – Hospital pharmacy [HP3] Powder ..............................................................................................36.50 5,000 g Morrex Maltodextrin 1.30 400 g OP (5.29) Polycal 1.14 350 g OP (7.85) Polycose 1.30 368 g OP (12.00) Moducal (Polycose Powder to be delisted 1 October 2009)

Carbohydrate And Fat

¾SA0581 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis) only from a 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) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: continued. . .

170

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

continued. . . 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0581 on the preceding page – Hospital pharmacy [HP3] Powder (neutral) ...............................................................................60.31 400 g OP Duocal Super Soluble Powder

Fat

¾SA0899 Special Authority for Subsidy Initial application — (Inborn errors of metabolism) only from a relevant specialist. Approvals valid for 3 years where the patient has inborn errors of metabolism. Initial application — (Indications other than inborn errors of metabolism) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1 failure to thrive where other high calorie products are inappropriate or inadequate; 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

fully subsidised

[HP1], [HP3], [HP4] refer page 8

171

SPECIAL FOODS

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

FAT SUPPLEMENT – Special Authority see SA0899 on the preceding page – Hospital pharmacy [HP3] Emulsion (neutral) ............................................................................12.30 200 ml OP Calogen 30.75 500 ml OP Calogen Emulsion (strawberry) .......................................................................12.30 200 ml OP Calogen Oil .....................................................................................................28.73 250 ml OP Liquigen 30.00 500 ml OP MCT oil (Nutricia)

Protein

¾SA0582 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0582 above – Hospital pharmacy [HP3] Powder ................................................................................................7.90 225 g OP Protifar 90 Powder (vanilla) ................................................................................12.90 275 g OP 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. ¾SA0583 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis) only from a relevant specialist. Approvals valid for 3 years where the patient has cystic ﬁbrosis. Initial application — (Indications other than cystic ﬁbrosis) only from a 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

172

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

ORAL SUPPLEMENT 1KCAL/ML – Special Authority see SA0583 on the preceding page – Hospital pharmacy [HP3] Powder (chocolate) .............................................................................9.22 900 g OP Sustagen Hospital Formula 4.75 400 g OP (7.22) Ensure Powder (strawberry) ...........................................................................4.75 400 g OP (7.22) Ensure Powder (vanilla) ..................................................................................9.22 900 g OP Sustagen Hospital Formula 4.75 400 g OP (7.22) Ensure

Oral Supplements/Complete Diet (Nasogastric/Gastrostomy Tube Feed) Respiratory Products

¾SA0588 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0588 above – Hospital pharmacy [HP3] Liquid ..................................................................................................1.66 237 ml OP Pulmocare

Diabetic Products

¾SA0594 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

fully subsidised

[HP1], [HP3], [HP4] refer page 8

173

SPECIAL FOODS

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

DIABETIC ENTERAL FEED 1KCAL/ML – Special Authority see SA0594 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................7.50 1,000 ml OP Diason RTH Glucerna Select RTH Resource Diabetic TF RTH (Resource Diabetic TF RTH Liquid to be delisted 1 September 2009) ORAL FEED 1KCAL/ML – Special Authority see SA0594 on the preceding page – Hospital pharmacy [HP3] Liquid (strawberry) ..............................................................................1.50 200 ml OP Diasip 1.78 237 ml OP Resource Diabetic Liquid (vanilla) ....................................................................................1.50 200 ml OP Diasip 1.78 237 ml OP Resource Diabetic 1.88 250 ml OP Glucerna Select

Fat Modiﬁed Products

¾SA0615 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0615 above – Hospital pharmacy [HP3] Powder ..............................................................................................60.48 400 g OP Monogen

High Protein Products

¾SA0589 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

174

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

ORAL FEED 1KCAL/ML – Special Authority see SA0589 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................1.50 200 ml OP Fortimel

Paediatric Products For Children Awaiting Liver Transplant

¾SA0607 Special Authority for Subsidy Initial application only from a 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 only from a 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 – Special Authority see SA0607 above – Hospital pharmacy [HP3] Powder ..............................................................................................78.97 400 g OP Generaid Plus

Paediatric Products For Children With Chronic Renal Failure

¾SA0606 Special Authority for Subsidy Initial application only from a 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 only from a 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 – Special Authority see SA0606 above – Hospital pharmacy [HP3] Liquid ................................................................................................54.00 400 g OP Kindergen

Paediatric Products

¾SA0896 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 infant aged one to eight 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 continued. . .

fully subsidised

[HP1], [HP3], [HP4] refer page 8

175

SPECIAL FOODS

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

continued. . . 3.2 The product is to be used as a complete diet. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0896 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................1.60 200 ml OP Nutrini Energy RTH 6.00 500 ml OP Nutrini Energy RTH PAEDIATRIC ENTERAL FEED 1KCAL/ML – Special Authority see SA0896 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................1.07 200 ml OP Nutrini RTH 2.68 500 ml OP Nutrini RTH Pediasure RTH PAEDIATRIC ORAL FEED 1.5KCAL/ML – Special Authority see SA0896 on the preceding page – Hospital pharmacy [HP3] 200 ml OP Fortini Liquid (strawberry) .............................................................................1.60 NutriniDrink Liquid (vanilla) ...................................................................................1.60 200 ml OP Fortini NutriniDrink (Fortini Liquid (strawberry) to be delisted 1 November 2009) (Fortini Liquid (vanilla) to be delisted 1 November 2009) PAEDIATRIC ORAL FEED 1KCAL/ML – Special Authority see SA0896 on the preceding page – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.07 200 ml OP Pediasure Liquid (strawberry) ..............................................................................1.07 200 ml OP Pediasure Liquid (vanilla) ....................................................................................1.27 237 ml OP Pediasure PAEDIATRIC ORAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA0896 on the preceding page – Hospital pharmacy [HP3] Liquid (chocolate) ..............................................................................1.60 200 ml OP Fortini Multiﬁbre NutriniDrink Multiﬁbre Liquid (strawberry) .............................................................................1.60 200 ml OP Fortini Multiﬁbre NutriniDrink Multiﬁbre Liquid (vanilla) ...................................................................................1.60 200 ml OP Fortini Multiﬁbre NutriniDrink Multiﬁbre (Fortini Multiﬁbre Liquid (chocolate) to be delisted 1 November 2009) (Fortini Multiﬁbre Liquid (strawberry) to be delisted 1 November 2009) (Fortini Multiﬁbre Liquid (vanilla) to be delisted 1 November 2009)

176

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

Renal Products

¾SA0587 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0587 above – Hospital pharmacy [HP3] Liquid ..................................................................................................6.08 500 ml OP Nutrison Concentrated RENAL ORAL FEED 2KCAL/ML – Special Authority see SA0587 above – Hospital pharmacy [HP3] Liquid ..................................................................................................2.43 200 ml OP Nepro (vanilla) 2.88 237 ml OP NovaSource Renal Liquid (apricot) ....................................................................................2.88 125 ml OP Renilon 7.5 Liquid (caramel) ..................................................................................2.88 125 ml OP Renilon 7.5

Specialised And Elemental Products

¾SA0592 Special Authority for Subsidy Initial application only from a 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. Notes: 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

fully subsidised

[HP1], [HP3], [HP4] refer page 8

177

SPECIAL FOODS

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

ENTERAL/ORAL ELEMENTAL FEED 1KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Powder ................................................................................................4.40 79 g OP Vital HN 7.50 76 g OP Alitraq ORAL ELEMENTAL FEED 0.8KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Liquid (grapefruit) ...............................................................................9.50 250 ml OP Elemental 028 Extra Liquid (pineapple & orange) ...............................................................9.50 250 ml OP Elemental 028 Extra Liquid (summer fruit) ..........................................................................9.50 250 ml OP Elemental 028 Extra ORAL ELEMENTAL FEED 1KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Powder (unﬂavoured) .........................................................................4.00 80.4 g OP Vivonex TEN SEMI-ELEMENTAL ENTERAL FEED 1KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................6.02 500 ml OP Peptisorb 12.04 1,000 ml OP Peptisorb

Undyalised End Stage Renal Failure

¾SA0586 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0586 above – Hospital pharmacy [HP3] Liquid ..................................................................................................3.80 237 ml OP Suplena

Adult Products Standard

¾SA0702 Special Authority for Subsidy Initial application — (Oral feed for cystic ﬁbrosis patient) only from a 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) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: continued. . .

178

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

continued. . . 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. Renewal — (Oral feed cystic ﬁbrosis patient) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Initial application — (Enteral feed) only from a 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 — (Enteral feed or Oral feed for indications other than cystic ﬁbrosis) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Notes: 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.

fully subsidised

[HP1], [HP3], [HP4] refer page 8

179

SPECIAL FOODS

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

ENTERAL FEED 1KCAL/ML – Special Authority see SA0702 on page 178 – Hospital pharmacy [HP3] Liquid ..................................................................................................1.24 250 ml OP Isosource HN Isosource Standard 2.65 500 ml OP Nutrison Standard RTH 5.29 1,000 ml OP Nutrison Standard RTH Isosource HN RTH Isosource Standard RTH Osmolite RTH ENTERAL FEED WITH FIBRE 1 KCAL/ML – Special Authority see SA0702 on page 178 – Hospital pharmacy [HP3] Liquid .................................................................................................1.24 250 ml OP Fibersource Fibersource HN 2.65 500 ml OP Nutrison Multi Fibre 5.29 1,000 ml OP Nutrison Multi Fibre Fibersource HN RTH Fibersource RTH Jevity RTH (Fibersource Liquid to be delisted 1 December 2009) (Fibersource RTH Liquid to be delisted 1 December 2009) ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA0702 on page 178 – Hospital pharmacy [HP3] Liquid ..................................................................................................7.00 1,000 ml OP Ensure Plus RTH 1.75 250 ml OP Isosource 1.5 7.00 1,000 ml OP Isosource 1.5 Nutrison Energy Multi Fibre ORAL FEED 1.5KCAL/ML – Special Authority see SA0702 on page 178 – Hospital pharmacy [HP3] Liquid (banana) ...................................................................................1.12 200 ml OP Fortisip (1.45) Ensure Plus Liquid (chocolate) ...............................................................................1.12 200 ml OP Fortisip 1.33 237 ml OP Resource Plus 1.12 200 ml OP (1.45) Ensure Plus 1.33 237 ml OP Ensure Plus Liquid (coffee) .....................................................................................1.33 237 ml OP Ensure Plus Liquid (fruit of the forest) .....................................................................1.12 200 ml OP (1.45) Ensure Plus Liquid (strawberry) ..............................................................................1.12 200 ml OP Fortisip 1.33 237 ml OP Resource Plus 1.12 200 ml OP (1.45) Ensure Plus 1.33 237 ml OP Ensure Plus Liquid (toffee) ......................................................................................1.12 200 ml OP Fortisip Liquid (tropical fruit) ............................................................................1.12 200 ml OP Fortisip Liquid (vanilla) ....................................................................................1.12 200 ml OP Fortisip 1.33 237 ml OP Resource Plus 1.12 200 ml OP (1.45) Ensure Plus 1.33 237 ml OP Ensure Plus

180

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

ORAL FEED WITH FIBRE 1.5 KCAL/ML – Special Authority see SA0702 on page 178 – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.12 200 ml OP Fortisip Multi Fibre Liquid (strawberry) ..............................................................................1.12 200 ml OP Fortisip Multi Fibre Liquid (vanilla) ....................................................................................1.12 200 ml OP Fortisip Multi Fibre

Adult Products High Calorie

¾SA0585 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis) only from a 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) only from a 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. Renewal — (Cystic ﬁbrosis) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Notes: 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 – Special Authority see SA0585 above – Hospital pharmacy [HP3] Liquid (vanilla) ....................................................................................2.25 237 ml OP Two Cal HN

fully subsidised

[HP1], [HP3], [HP4] refer page 8

181

SPECIAL FOODS

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

Food Thickeners

¾SA0595 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year where the patient has motor neurone disease with swallowing disorder. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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. FOOD THICKENER – Special Authority see SA0595 above – Hospital pharmacy [HP3] Powder ................................................................................................3.80 250 g OP Resource Thicken Up 4.56 380 g (7.25) Karicare Food Thickener

Gluten Free Foods

¾SA0722 Special Authority for Subsidy Initial application only from a 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 – Special Authority see SA0722 above – Hospital pharmacy [HP3] Powder ................................................................................................2.81 1,000 g OP (5.15) Healtheries Simple Baking Mix GLUTEN FREE BREAD MIX – Special Authority see SA0722 above – Hospital pharmacy [HP3] Powder ................................................................................................3.93 1,000 g OP (6.88) 4.77 (8.57) 3.51 (10.51) GLUTEN FREE FLOUR – Special Authority see SA0722 above – Hospital pharmacy [HP3] Powder ................................................................................................5.62 2,000 g OP (17.42)

NZB Low Gluten Bread Mix Bakels Gluten Free Health Bread Mix Horleys Bread Mix

Horleys Flour

182

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

GLUTEN FREE PASTA – Special Authority see SA0722 on the preceding page – Hospital pharmacy [HP3] Buckwheat Spirals ..............................................................................2.00 250 g OP (3.11) Orgran Corn and Spinach Rigatini ..................................................................2.00 250 g OP (2.92) Orgran Corn and Vegetable Shells .................................................................2.00 250 g OP (2.92) Orgran Corn and Vegetable Spirals ................................................................2.00 250 g OP (2.92) Orgran Garlic and Parsley Shells ...................................................................2.00 250 g OP (2.92) Orgran Rice and Corn Garden Herb Pasta .....................................................2.00 250 g OP (2.92) Orgran Rice and Corn Lasagne Sheets .........................................................1.60 200 g OP (3.82) Orgran Rice and Corn Macaroni .....................................................................2.00 250 g OP (2.92) Orgran Rice and Corn Penne .........................................................................2.00 250 g OP (2.92) Orgran Rice and Maize Pasta Spirals .............................................................2.00 250 g OP (2.92) Orgran Rice and Millet Spirals ........................................................................2.00 250 g OP (3.11) Orgran Rice and corn spaghetti noodles ........................................................2.00 375 g OP (2.92) Orgran Vegetable and Rice Spirals ................................................................2.00 250 g OP (2.92) Orgran Italian long style spaghetti ..................................................................2.00 220 g OP (3.11) Orgran

Foods And Supplements For Inborn Errors Of Metabolism - Other

¾SA0732 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Prescribing Guideline 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.

fully subsidised

[HP1], [HP3], [HP4] refer page 8

183

SPECIAL FOODS

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

Supplements For Homocystinuria

AMINOACID FORMULA WITHOUT METHIONINE – Special Authority see SA0732 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Powder ............................................................................................461.94 500 g OP XMET Maxamum

Supplements For MSUD

AMINOACID FORMULA WITHOUT VALINE, LEUCINE AND ISOLEUCINE – Special Authority see SA0732 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Powder ............................................................................................300.54 500 g OP MSUD Maxamaid 437.22 MSUD Maxamum

Foods And Supplements For Inborn Errors Of Metabolism - PKU

Prescribing Guideline 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

¾SA0733 Special Authority for Subsidy Initial application — (Patient aged over 16) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 dietary management of PKU; and 2 The patient’s blood phenylalanine level is < 900 mmol/litre (average of tests over last 12 months). Initial application — (Patient aged 16 or under) only from a relevant specialist. Approvals valid for 3 years where the patient requires dietary management of PKU. Renewal — (Patient aged over 16) only from a relevant specialist. Approvals valid for 1 year where blood phenylalanine level < 900 mmol/litre (average of tests over last 12 months). Renewal — (Patient aged 16 or under) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. PHENYL FREE BAKING MIX – Special Authority see SA0733 above – Hospital pharmacy [HP3] See prescribing guideline above Powder ................................................................................................6.70 500 g OP (8.22) Loproﬁn Mix

184

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

PHENYL FREE PASTA – Special Authority see SA0733 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Animal shapes ..................................................................................10.65 500 g OP (11.91) Loproﬁn Lasagne ..............................................................................................5.32 250 g OP (5.95) Loproﬁn 500 g OP Low protein rice pasta ......................................................................10.65 (11.91) Loproﬁn Macaroni .............................................................................................5.32 250 g OP (5.95) Loproﬁn Penne ...............................................................................................10.65 500 g OP (11.91) Loproﬁn Spaghetti ..........................................................................................10.65 500 g OP (11.91) Loproﬁn Spirals ...............................................................................................10.65 500 g OP (11.91) Loproﬁn

Supplements For PKU

fully subsidised

[HP1], [HP3], [HP4] refer page 8

185

SPECIAL FOODS

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

AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA0733 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on page 184 Tabs ..................................................................................................99.00 75 OP Phlexy 10 Sachets (pineapple/vanilla) 29 g ....................................................330.10 30 OP Minaphlex Sachets (tropical) ............................................................................324.00 30 Phlexy 10 400 g OP XP Analog LCP Infant formula ..................................................................................174.72 Powder (orange) .............................................................................221.00 500 g OP XP Maxamaid 320.00 XP Maxamum Powder (unﬂavoured) .....................................................................221.00 500 g OP XP Maxamaid 320.00 XP Maxamum Liquid (berry) ....................................................................................15.65 62.5 ml OP Lophlex LQ 31.20 125 ml OP Lophlex LQ Liquid (citrus) ....................................................................................15.65 62.5 ml OP Lophlex LQ 31.20 125 ml OP Lophlex LQ Liquid (forest berries) ........................................................................30.00 250 ml OP Easiphen Liquid Liquid (orange) .................................................................................15.65 62.5 ml OP Lophlex LQ 31.20 125 ml OP Lophlex LQ Liquid (tropical) .................................................................................30.00 250 ml OP Easiphen

Multivitamin And Mineral Supplements

¾SA0962 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Dietary management of phenylketonuria (PKU); or 2 For use as a supplement to the ketogenic diet in patients diagnosed with epilepsy. AMINOACID FORMULA WITH MINERALS WITHOUT PHENYLALANINE – Special Authority see SA0962 above – Retail pharmacy See prescribing guideline on page 184 Powder ..............................................................................................58.44 250 g OP Metabolic Mineral Mixture

Infant Formulae For Premature Infants

¾SA0602 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 6 months where the patient is infant weighing less than 1.5 kg at birth. PREMATURE BIRTH FORMULA – Special Authority see SA0602 above – Hospital pharmacy [HP3] Liquid ..................................................................................................0.75 100 ml OP S26LBW Gold RTF

For Williams Syndrome

¾SA0601 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year where the patient is an infant suffering from Williams Syndrome and associated hypercalcaemia. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

186

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

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

LOW CALCIUM INFANT FORMULA – Special Authority see SA0601 on the preceding page – Hospital pharmacy [HP3] Powder ..............................................................................................44.40 400 g OP Locasol

For Gastrointestinal And Other Malabsorptive Problems

¾SA0603 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year where the patient is infant suffering from malabsorption and other gastrointestinal problems. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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. 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. ELEMENTAL FORMULA – Special Authority see SA0603 above – Hospital pharmacy [HP3] Powder ..............................................................................................15.52 450 g OP (19.01) Pepti Junior 63.97 400 g OP (67.08) Neocate (67.08) Neocate LCP 5.62 48.5 g OP (6.00) Vivonex Pediatric Powder (tropical) ...............................................................................52.90 400 g OP (56.00) Neocate Advance Powder (unﬂavoured) .......................................................................52.90 400 g OP (56.00) Neocate Advance

For Milk Intolerance

¾SA0604 Special Authority for Subsidy Initial application — (Lactase deﬁciency or disaccharide intolerance) only from a 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. Notes: 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) only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 intolerant to cows’ milk; and continued. . .

fully subsidised

[HP1], [HP3], [HP4] refer page 8

187

SPECIAL FOODS

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

continued. . . 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) only from a 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 – Special Authority see SA0604 on the preceding page – Retail pharmacy Powder ................................................................................................9.42 900 g OP (22.75) Karicare Goats Milk Infant Formula LACTOSE FREE INFANT FORMULA – Special Authority see SA0604 on the preceding page – Retail pharmacy Powder ................................................................................................5.66 900 g OP (17.95) Delact SOYA INFANT FORMULA – Special Authority see SA0604 on the preceding page – Retail pharmacy Powder ................................................................................................6.34 900 g OP (19.57) S26 Soy

Infant Formulae - Lactose Intolerance and Cows’ Milk Protein Intolerance

¾SA0757 Special Authority for Subsidy 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 SOY FORMULA – Special Authority see SA0757 above – Retail pharmacy Powder ................................................................................................7.27 900 g (16.35) Karicare Soy All Ages

188

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SECTION E PART I PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS Pharmaceuticals and quantities that may be obtained on a Practitioner’s Supply Order

ADRENALINE Inj 1 in 1,000, 1 ml ...................................................... 5 Inj 1 in 10,000, 10 ml .................................................. 5 AMINOPHYLLINE Inj 25 mg per ml, 10 ml ............................................... 5 AMIODARONE HYDROCHLORIDE Inj 50 mg per ml, 3 ml ................................................. 5 AMOXYCILLIN Cap 250 mg .............................................................. 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 200 ml Inj 1 g.......................................................................... 5 AMOXYCILLIN CLAVULANATE Tab amoxycillin 500 mg with potassium clavulanate 125 mg ..............................................30 Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml................................................................ 200 ml Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml................................................................ 200 ml APPLICATOR Applicator – See note on page 69 .............................. 1 ASPIRIN Tab dispersible 300 mg............................................. 30 ATROPINE SULPHATE Inj 600 µg, 1 ml ........................................................... 5 Inj 1200 µg, 1 ml ......................................................... 5 AZITHROMYCIN Tab 500 mg – Subsidy by endorsement – See note on page 83 ..............................................4 BENDROFLUAZIDE Tab 2.5 mg – See note on page 55......................... 150 BENZATHINE BENZYLPENICILLIN Inj 1.2 mega u per 2.3 ml ............................................ 5 BENZTROPINE MESYLATE Inj 1 mg per ml, 2 ml ................................................... 5 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 1 mega u ................................................................ 5 CEFTRIAXONE SODIUM Inj 500 mg – Hospital pharmacy [HP3] – Subsidy by endorsement – See note on page 83 ..................................................................5 Inj 1 g – Hospital pharmacy [HP3] – Subsidy by endorsement – See note on page 83 ................5 CHARCOAL Oral liq 50 g per 250 ml ..................................... 250 ml CHLORPROMAZINE HYDROCHLORIDE Tab 10 mg ................................................................. 30 Tab 25 mg ................................................................. 30 Tab 100 mg ............................................................... 30 Inj 25 mg per ml, 2 ml ................................................. 5 CIPROFLOXACIN Tab 250 mg ................................................................. 5 Tab 500 mg ................................................................. 5 CO-TRIMOXAZOLE Tab trimethoprim 80 mg and sulphamethoxazole 400 mg..................................30 Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml................................................................ 200 ml Oral liq trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml................................................................ 200 ml COMPOUND ELECTROLYTES Powder for soln for oral use 5 g ................................ 10 CONDOMS 49 mm..................................................................... 144 52 mm..................................................................... 144 52 mm extra strength.............................................. 144 53 mm..................................................................... 144 53 mm (chocolate) .................................................. 144 53 mm (strawberry)................................................. 144 53 mm extra strength.............................................. 144 54 mm, shaped ....................................................... 144 55 mm..................................................................... 144 56 mm..................................................................... 144 56 mm extra strength.............................................. 144 56 mm, shaped ....................................................... 144 60 mm..................................................................... 144 DEXAMETHASONE Tab 1 mg – Retail pharmacy-Specialist .................... 30 Tab 4 mg – Retail pharmacy-Specialist .................... 30 DEXAMETHASONE SODIUM PHOSPHATE Inj 4 mg per ml, 1 ml ................................................... 5 Inj 4 mg per ml, 2 ml ................................................... 5 DEXTROSE Inj 50%, 10 ml ............................................................. 5 Inj 50%, 90 ml ............................................................. 5 continued. . .

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

189

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

(continued) DIAPHRAGM Diaphragm – See note on page 69............................. 1 DIAZEPAM Inj 5 mg per ml, 2 ml – Subsidy by endorsement – See note on page 113 ...................5 Rectal tubes 5 mg....................................................... 5 Rectal tubes 10 mg..................................................... 5 DICLOFENAC SODIUM Inj 25 mg per ml, 3 ml ................................................. 5 Suppos 50 mg........................................................... 10 DIGOXIN Tab 62.5 µg ............................................................... 30 Tab 250 µg ................................................................ 30 DOXYCYCLINE HYDROCHLORIDE Tab 50 mg ................................................................. 30 Tab 100 mg ............................................................... 30 ERGOMETRINE MALEATE Inj 500 µg per ml, 1 ml ................................................ 5 ERYTHROMYCIN ETHYL SUCCINATE Tab 400 mg ............................................................... 30 Grans for oral liq 200 mg per 5 ml ..................... 200 ml Grans for oral liq 400 mg per 5 ml ..................... 200 ml ERYTHROMYCIN STEARATE Tab 250 mg ............................................................... 30 ETHINYLOESTRADIOL WITH DESOGESTREL Tab 20 µg with desogestrel 150 µg ........................... 63 Tab 20 µg with desogestrel 150 µg and 7 inert tab ................................................................84 Tab 30 µg with desogestrel 150 µg ........................... 63 Tab 30 µg with desogestrel 150 µg and 7 inert tab ................................................................84 ETHINYLOESTRADIOL WITH GESTODENE Tab 30 µg with gestodene 75 µg and 7 inert tab ........................................................................84 ETHINYLOESTRADIOL WITH LEVONORGESTREL Tab ethinyloestradiol 30 µg with levonorgestrel 50 µg (6) and tab ethinyloestradiol 40 µg with levonorgestrel 75 µg (5), and tab ethinyloestradiol 30 µg with levonorgestrel 125 µg (10) and 7 inert tab ................................................................84 Tab 50 µg with levonorgestrel 125 µg and 7 inert tab ................................................................84 Tab 30 µg with levonorgestrel 150 µg ....................... 63 Tab 30 µg with levonorgestrel 150 µg and 7 inert tab ................................................................84 Tab 20 µg with levonorgestrel 100 µg and 7 inert tab ................................................................84 ETHINYLOESTRADIOL WITH NORETHISTERONE Tab 35 µg with norethisterone 1 mg.......................... 63 Tab 35 µg with norethisterone 1 mg and 7 inert tab ................................................................84 Tab 35 µg with norethisterone 500 µg....................... 63 Tab 35 µg with norethisterone 500 µg and 7 inert tab ................................................................84 FLUCLOXACILLIN SODIUM Cap 250 mg .............................................................. 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 200 ml Inj 1 g.......................................................................... 5 FLUPENTHIXOL DECANOATE Inj 20 mg per ml, 1 ml ................................................. 5 Inj 20 mg per ml, 2 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 FLUPHENAZINE DECANOATE Inj 12.5 mg per 0.5 ml, 0.5 ml ..................................... 5 Inj 25 mg per ml, 1 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 FUROSEMIDE Tab 40 mg ................................................................. 30 Inj 10 mg per ml, 2 ml ................................................. 5 GLUCAGON HYDROCHLORIDE Inj 1 mg syringe kit...................................................... 5 GLYCERYL TRINITRATE Tab 600 µg .............................................................. 100 Oral pump spray 400 µg per dose ................. 250 dose HALOPERIDOL Tab 500 µg ................................................................ 30 Tab 1.5 mg ................................................................ 30 Tab 5 mg ................................................................... 30 Oral liq 2 mg per ml ........................................... 200 ml Inj 5 mg per ml, 1 ml ................................................... 5 HALOPERIDOL DECANOATE Inj 50 mg per ml, 1 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 HYDROCORTISONE Inj 50 mg per ml, 2 ml ................................................. 5 HYDROXOCOBALAMIN Inj 1 mg per ml, 1 ml ................................................... 6 HYOSCINE N-BUTYLBROMIDE Inj 20 mg, 1 ml ............................................................ 5 continued. . .

190

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

(continued) IPRATROPIUM BROMIDE Nebuliser soln, 250 µg per ml, 1 ml .......................... 40 Nebuliser soln, 250 µg per ml, 2 ml .......................... 40 LEVONORGESTREL Tab 30 µg .................................................................. 84 Tab 1.5 mg .................................................................. 5 LIGNOCAINE HYDROCHLORIDE Inj 0.5%, 5 ml – See note on page 108....................... 5 Inj 1%, 5 ml – See note on page 108.......................... 5 Inj 1%, 20 ml – See note on page 108........................ 5 LOPERAMIDE HYDROCHLORIDE Tab 2 mg ................................................................... 30 MEDROXYPROGESTERONE ACETATE Inj 150 mg per ml, 1 ml ............................................... 5 Inj 150 mg per ml, 1 ml syringe................................... 5 METHYLERGOMETRINE Inj 200 µg per ml, 1 ml .............................................. 10 METOCLOPRAMIDE HYDROCHLORIDE Inj 5 mg per ml, 2 ml ................................................... 5 METRONIDAZOLE Tab 200 mg ............................................................... 30 MORPHINE SULPHATE Inj 5 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 10 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 15 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 30 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 NALOXONE HYDROCHLORIDE Inj 400 µg per ml, 1 ml ................................................ 5 NONOXYNOL-9 Jelly 2% ............................................................... 108 g NORETHISTERONE Tab 350 µg ................................................................ 84 Tab 5 mg ................................................................... 30 NORETHISTERONE WITH MESTRANOL Tab 1 mg with mestranol 50 µg and 7 inert tab......... 84 OXYTOCIN Inj 5 iu per ml, 1 ml ..................................................... 5 Inj 10 iu per ml, 1 ml ................................................... 5 Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml...................................................................5 PARACETAMOL Tab 500 mg ............................................................... 30 Oral liq 120 mg per 5 ml .................................... 200 ml Oral liq 250 mg per 5 ml .................................... 100 ml PETHIDINE HYDROCHLORIDE Inj 50 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 50 mg per ml, 1.5 ml – Only on a controlled drug form ...............................................5 Inj 50 mg per ml, 2 ml – Only on a controlled drug form ................................................................5 PHENOXYMETHYLPENICILLIN (PENICILLIN V) Cap potassium salt 250 mg ...................................... 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 200 ml PHENYTOIN SODIUM Inj 50 mg per ml, 2 ml ................................................. 5 Inj 50 mg per ml, 5 ml ................................................. 5 PHYTOMENADIONE Inj 2 mg per 0.2 ml ...................................................... 5 Inj 10 mg per ml, 1 ml ................................................. 5 PIPOTHIAZINE PALMITATE Inj 50 mg per ml, 1 ml ................................................. 5 Inj 50 mg per ml, 2 ml ................................................. 5 PREDNISOLONE SODIUM PHOSPHATE Oral liq 5 mg per ml – See note on page 75 ........................................................... 30 ml PREDNISONE Tab 5 mg ................................................................... 30 PROCAINE PENICILLIN Inj 1.5 mega u ............................................................. 5 PROCHLORPERAZINE Tab 5 mg ................................................................... 30 Inj 12.5 mg per ml, 1 ml .............................................. 5 PROMETHAZINE HYDROCHLORIDE Inj 25 mg per ml, 2 ml ................................................. 5 SALBUTAMOL Inj 500 µg per ml, 1 ml ................................................ 5 Aerosol inhaler, 100 µg per dose CFC free .......................................................... 1000 dose Nebuliser soln, 1 mg per ml, 2.5 ml .......................... 30 Nebuliser soln, 2 mg per ml, 2.5 ml .......................... 30 SALBUTAMOL WITH IPRATROPIUM BROMIDE Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml ............................20 continued. . .

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

191

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

(continued) SILVER SULPHADIAZINE Crm 1% with chlorhexidine digluconate 0.2% ................................................................500 g SODIUM BICARBONATE Inj 8.4%, 50ml ............................................................. 5 Inj 8.4%, 100 ml .......................................................... 5 SODIUM CHLORIDE Inf 0.9% – See note on page 43 ...................... 2000 ml Inj 0.9%, 5 ml .............................................................. 5 Inj 0.9%, 10 ml ............................................................ 5 TRIMETHOPRIM Tab 300 mg ............................................................... 30 VERAPAMIL HYDROCHLORIDE Inj 2.5 mg per ml, 2 ml ................................................ 5 WATER Puriﬁed for inj 5 ml – See note on page 43................. 5 Puriﬁed for inj 10 ml – See note on page 43............... 5 Puriﬁed for inj 20 ml – See note on page 43............... 5 ZUCLOPENTHIXOL DECANOATE Inj 200 mg per ml, 1 ml ............................................... 5

Pharmaceuticals that may be obtained on a Wholesale Supply Order

INTRA-UTERINE DEVICE IUD MASK FOR SPACER DEVICE Size 2 PEAK FLOW METER Low range Normal range PREGNANCY TESTS - HCG URINE Cassette SPACER DEVICE 230 ml (autoclavable) 230 ml (single patient) 800 ml

192

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

SECTION E PART II: RURAL AREAS

Rural Areas for Practitioner’s Supply Orders

NORTH ISLAND Northland DHB Dargaville Hikurangi Kaeo 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 Tikitiki Tokomaru Bay 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 Levin Otaki Pahiatua Shannon Woodville Wairarapa DHB Carteron Featherston Greytown Martinborough SOUTH ISLAND Nelson/Marlborough DHB Havelock Mapua Motueka Murchison Picton Takaka Wakeﬁeld West Coast DHB Dobson Greymouth Hokitika Karamea Reefton South Westland Westport Whataroa Canterbury DHB Akaroa Amberley Amuri Cheviot Darﬁeld Diamond Harbour Hanmer Springs Kaikoura Leeston Lincoln Methven Oxford Rakaia Rolleston Rotherham Templeton Waikari

South Canterbury DHB Fairlie Geraldine Pleasant Point Temuka Twizel Waimate

Otago DHB Alexandra Balclutha Cromwell Kurow Lawrence Milton Oamaru Outram Owaka Palmerston Ranfurly Roxburgh Tapanui Wanaka

Southland DHB Gore Lumsden Mataura Oban Otautau Queenstown Riverton Te Anau Tokonui Tuatapere Winton

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

193

SECTION F: COMMUNITY PHARMACEUTICALS DISPENSING PERIOD EXEMPTIONS SECTION F: PART I

A Community Pharmaceutical identiﬁed with a F 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 F 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 F 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 L 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”. 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 L 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.

194

SECTION F: PART II

ALIMENTARY TRACT AND METABOLISM INSULIN ASPART INSULIN GLARGINE INSULIN ISOPHANE INSULIN ISOPHANE WITH INSULIN NEUTRAL INSULIN LISPRO INSULIN LISPRO WITH INSULIN LISPRO PROTAMINE INSULIN NEUTRAL

MUSCULOSKELETAL SYSTEM PYRIDOSTIGMINE BROMIDE

NERVOUS SYSTEM AMANTADINE HYDROCHLORIDE APOMORPHINE HYDROCHLORIDE ENTACAPONE GABAPENTIN GABAPENTIN (NEURONTIN)

CARDIOVASCULAR SYSTEM AMIODARONE HYDROCHLORIDE Tab 100 mg Cordarone-X Tab 200 mg Cordarone-X DISOPYRAMIDE PHOSPHATE FLECAINIDE ACETATE Tab 50 mg Tab 100 mg Cap long-acting 100 mg Cap long-acting 200 mg Tambocor Tambocor Tambocor CR Tambocor CR

LAMOTRIGINE LISURIDE HYDROGEN MALEATE PERGOLIDE ROPINIROLE HYDROCHLORIDE TOLCAPONE TOPIRAMATE VIGABATRIN

MEXILETINE HYDROCHLORIDE PROPAFENONE HYDROCHLORIDE SENSORY ORGANS BIMATOPROST HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES DESMOPRESSIN Nasal drops 100 µg per Minirin ml Nasal spray 10 µg per Desmopressin-PH&T dose BRIMONIDINE TARTRATE WITH TIMOLOL MALEATE BRINZOLAMIDE LATANOPROST TRAVOPROST

195

SECTION G: SAFETY CAP MEDICINES

Pharmacists are required, under the Code of Ethics of the Pharmacy Council of New Zealand, to endeavour 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: G 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 G 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 G 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 Practitioner’s 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 24 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

196

SAFETY CAP MEDICINES

ALIMENTARY TRACT AND METABOLISM FERROUS SULPHATE Oral liq 150 mg per 5 ml Ferodan CARDIOVASCULAR SYSTEM AMILORIDE Oral liq 1 mg per ml Biomed CAPTOPRIL Oral liq 5 mg per ml CHLOROTHIAZIDE Oral liq 50 mg per ml DIGOXIN Oral liq 50 µg per ml FUROSEMIDE Oral liq 10 mg per ml SPIRONOLACTONE Oral liq 5 mg per ml Capoten Biomed Lanoxin Lasix Biomed CLOBAZAM Tab 10 mg Frisium (Extemporaneously compounded oral liquid preparations) CLONAZEPAM Oral drops 2.5 mg per ml DIAZEPAM Tab 2 mg

Rivotril

Pro-Pam Arrow-Diazepam Tab 5 mg Pro-Pam Arrow-Diazepam Tab 10 mg Pro-Pam (Extemporaneously compounded oral liquid preparations) ETHOSUXIMIDE Oral liq 250 mg per 5 ml

Zarontin

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES LEVOTHYROXINE Tab 50 µg Eltroxin Goldshield Synthroid Tab 100 µg Eltroxin Goldshield Synthroid Tab 25 µg Synthroid (Extemporaneously compounded oral liquid preparations) MUSCULOSKELETAL SYSTEM IBUPROFEN Oral liq 100 mg per 5 ml Fenpaed QUININE SULPHATE Tab 200 mg Q 200 Tab 300 mg Q 300 (Extemporaneously compounded oral liquid preparations) NERVOUS SYSTEM ALPRAZOLAM Tab 250 µg Arrow-Alprazolam Tab 500 µg Arrow-Alprazolam Tab 1 mg Arrow-Alprazolam (Extemporaneously compounded oral liquid preparations) CARBAMAZEPINE Oral liq 100 mg per 5 ml

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 2 mg per ml Biodone Oral liq 5 mg per ml Biodone Forte Oral liq 10 mg per ml Biodone Extra Forte MIDAZOLAM Tab 7.5 mg Hypnovel (Extemporaneously compounded oral liquid preparations) MORPHINE HYDROCHLORIDE Oral liq 1 mg per ml RA-Morph Oral liq 2 mg per ml RA-Morph Oral liq 5 mg per ml RA-Morph Oral liq 10 mg per ml RA-Morph NITRAZEPAM Tab 5 mg Nitrados (Extemporaneously compounded oral liquid preparations) OXAZEPAM Tab 10 mg Ox-Pam Tab 15 mg Ox-Pam (Extemporaneously compounded oral liquid preparations)

Tegretol

197

SAFETY CAP MEDICINES

OXYCODONE HYDROCHLORIDE Oral liq 5 mg per 5 ml OxyNorm PARACETAMOL Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml PHENYTOIN SODIUM Oral liq 30 mg per 5 ml SODIUM VALPROATE Oral liq 200 mg per 5 ml Paracare Junior Paracare Double Strength Dilantin Epilim S/F Liquid Epilim Syrup 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 THEOPHYLLINE Oral liq 80 mg per 15 ml Salapin Nuelin

TRIMEPRAZINE TARTRATE Oral liq 30 mg per 5 ml Vallergan Forte 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)

TEMAZEPAM Tab 10 mg Normison (Extemporaneously compounded oral liquid preparations) TRIAZOLAM Tab 125 µg Hypam Tab 250 µg Hypam (Extemporaneously compounded oral liquid preparations) RESPIRATORY SYSTEM AND ALLERGIES CETIRIZINE HYDROCHLORIDE Oral liq 1 mg per ml Cetirizine - AFT CHLORPHENIRAMINE MALEATE Oral liq 2 mg per 5 ml Histafen

198

INDEX Generic Chemicals and Brands

- Symbols 3TC .................................................92 -AA-Lices ............................................64 Abacavir sulphate ...........................92 Abacavir sulphate with lamivudine ................................. 92 Abilify ............................................121 Acarbose ........................................29 ACB ................................................51 Accu-Chek Performa ................31, 32 Accupril ...........................................49 Accuretic 10 ....................................49 Accuretic 20 ....................................49 Acebutolol .......................................51 Acetazolamide ..............................159 Acetic acid with 1, 2- propanediol diacetate and benzethonium .......................... 157 Acetic acid with hydroxyquinoline and ricinoleic acid ...................... 73 Acetylcysteine ...............................167 Aci-Jel .............................................73 Aciclovir Infection ......................................91 Sensory ....................................157 Acidex .............................................25 Acipimox .........................................44 Acitretin ...........................................65 Actigall ............................................33 Actos ...............................................30 Actrapid ..........................................28 Actrapid Penﬁll ................................28 Acupan .........................................108 Adalat 10 ........................................53 Adalat Oros .....................................53 Adalimumab ..................................101 Adeﬁn XL ........................................53 Adefovir dipivoxil .............................88 Adrenaline ......................................55 Advantan ........................................62 AFT-Pyrazinamide ..........................88 Agents Affecting the Renin-Angiotensin System .........48 Agents Used in the Treatment of Poisonings ............................... 162 Agrylin ..........................................137 Alanase .........................................155 Albay .............................................150 Albustix .........................................162 Aldara .............................................67 Alendronate sodium ......................106 Alendronate sodium with cholecalciferol .......................... 106 Alfacalcidol .....................................36 Alginic acid .....................................25 Alitraq ...........................................178 Alkeran .........................................134 Allersoothe ....................................151 Allopurinol .....................................107 Alpha Adrenoceptor Blockers .........48 Alpha tocopheryl acetate ................37 Alpha-Bromocriptine .....................119 Alpha-Keri Lotion ............................64 Alprazolam ....................................125 Alu-Tab ...........................................25 Aluminium hydroxide ......................25 Amantadine hydrochloride ............119 Amiloride ........................................54 Amiloride with frusemide ................55 Amiloride with hydrochlorothiazide ................... 55 Aminophylline ...............................155 Amiodarone hydrochloride ..............50 Amirol ...........................................111 Amisulpride ...................................121 Amitrip ..........................................111 Amitriptyline ..................................111 Amizide ...........................................55 Amlodipine ......................................53 Amorolﬁne ......................................59 Amoxycillin ......................................85 Amoxycillin clavulanate ..................85 Amphotericin B ...............................35 Amsacrine ....................................137 Amsidyl .........................................137 Amyl nitrite ......................................56 Anabolic Agents ..............................75 Anaesthetics .................................108 Anagrelide hydrochloride ..............137 Analgesics ....................................108 Anastrozole ...................................143 Anastrozole-DP ............................143 Androderm ......................................76 Antabuse ......................................130 Antacids and Antiﬂatulants .............25 Anten ............................................111 Anthelmintics ..................................83 Anti-inﬂammatory Non Steroidal Drugs (NSAIDs) ......................... 99 Antiacne Preparations ....................58 Antiallergy Preparations ...............150 Antianaemics ..................................39 Antiandrogen Oral Contraceptives ........................... 72 Antiarrhythmics ...............................50 Antibacterials ..................................83 Antibacterials Topical ......................58 Anticholinesterases ........................99 Antidepressants ............................111 Antidiarrhoeals ................................25 Antiepilepsy Drugs .......................113 Antiﬁbrinolytics, Haemostatics and Local Sclerosants ............... 40 Antifungals ......................................87 Antifungals Topical ..........................59 Antihaemorrhoidals .........................26 Antihistamines ..............................150 Antihypotensives .............................51 Antimalarials ...................................87 Antimigraine Preparations ............117 Antinaus ........................................118 Antinausea and Vertigo Agents ..................................... 117 Antiparkinson Agents ...................119 Antipruritic Preparations .................60 Antipsychotics ...............................121 Antiretrovirals ..................................91 Antiretrovirals - Additional Therapies ................................... 93 Antirheumatoid Agents .................100 Antispasmodics and Other Agents Altering Gut Motility ....................................... 27 Antithrombotic Agents ....................40 Antithymocyte globulin (equine) ................................... 145 Antitrichomonal Agents ..................88 Antituberculotics and Antileprotics ............................... 88 Antiulcerants ...................................27 Antivirals .........................................88 Anusol .............................................26 Anxiolytics .....................................125 API ..................................................60 Apo-Allopurinol .............................107 Apo-Amlodipine ..............................53 Apo-Amoxi ......................................85 Apo-Ascorbic Acid ..........................36 Apo-B-Complex ..............................36 Apo-Captopril .................................48 Apo-Cimetidine ...............................27 Apo-Clopidogrel ..............................40 Apo-Diclo ........................................99 Apo-Diclo SR ..................................99 Apo-Doxazosin ...............................48

199

INDEX Generic Chemicals and Brands

Apo-Folic Acid ................................39 Apo-Gliclazide ................................30 APO-go .........................................119 Apo-Ipravent .................................155 Apo-Moclobemide .........................112 Apo-Nadolol ....................................52 Apo-Nicotinic Acid ..........................44 Apo-Oxybutynin ..............................74 Apo-Prazo .......................................48 Apo-Prednisone ..............................76 Apo-Primidone ..............................115 Apo-Pyridoxine ...............................36 Apo-Selegiline ..............................120 Apo-Terazosin .................................48 Apo-Terbinaﬁne ..............................87 Apo-Thiamine .................................36 Apo-Timol .......................................53 Apo-Timop ....................................158 Apo-Zopiclone ..............................128 Apomine .......................................119 Apomorphine hydrochloride .........119 Applicator ........................................69 Apresoline .......................................56 Aquasun 30+ ..................................67 Aquasun Oil Free Faces SPF30+ ..................................... 67 Aquasun Sensitive SPF 30+ ...........67 Aqueous cream ..............................63 Aratac .............................................50 Arava ............................................100 Arimidex ........................................143 Aripiprazole ...................................121 Aristocort ........................................62 Aromasin ......................................143 Arrow-Alprazolam .........................125 Arrow-Azithromycin ........................83 Arrow-Cabergoline ..........................82 Arrow-Citalopram ..........................112 Arrow-Diazepam ...........................125 Arrow-Lamotrigine ........................115 Arrow-Lisinopril ...............................49 Arrow-Metformin .............................30 Arrow-Nifedipine XR .......................53 Arrow-Norﬂoxacin ...........................98 Arrow-Ranitidine .............................27 Arrow-Roxithromycin ......................85 Arrow-Simva 10mg .........................46 Arrow-Simva 20mg .........................46 Arrow-Simva 40mg .........................46 Arrow-Simva 80mg .........................46 Arrow-Sumatriptan ........................117 Arsenic trioxide .............................138 Arthrexin .......................................100 Asacol .............................................26 Ascorbic acid ..................................36 Aspec 300 .....................................108 Aspen Adrenaline ...........................55 Aspirin Blood ..........................................40 Nervous ....................................108 Asthalin .........................................153 Atacand ..........................................49 Atazanavir sulphate ........................93 Atenolol ...........................................51 ATGAM .........................................145 Ativan ............................................125 Atomoxetine ..................................128 Atorvastatin ....................................45 Atropine sulphate Alimentary ..................................27 Sensory ....................................160 Atropt ............................................160 Atrovent ........................................154 Augmentin ......................................85 Auranoﬁn ......................................100 Avomine ........................................118 Avonex ..........................................127 Azamun ........................................145 Azatadine maleate ........................150 Azathioprine .................................145 Azithromycin ...................................83 Azol .................................................82 Azopt ............................................159 AZT .................................................93 -BB-D Micro-Fine ...............................32 B-D Ultra Fine .................................32 B-D Ultra Fine II ..............................32 Baclofen ........................................107 Bactroban .......................................59 Bakels Gluten Free Health Bread Mix ........................................... 182 Baraclude .......................................89 Barrier Creams and Emollients .................................. 63 Batrafen ..........................................59 Beclazone 100 ..............................151 Beclazone 250 ..............................151 Beclazone 50 ................................151 Beclomethasone dipropionate ..................... 151, 155 Bedford .........................................135 Bee venom allergy treatment ................................. 150 Bendroﬂuazide ................................55 Benhex ...........................................64 Benzathine benzylpenicillin ............85 Benzoin .........................................167 Benztrop .......................................120 Benztropine mesylate ...................120 Benzydamine hydrochloride ...........35 Benzylpenicillin sodium (penicillin G) ............................................... 85 Beta Adrenoceptor Blockers ...........51 Beta Cream ....................................61 Beta Ointment .................................61 Beta Scalp ......................................66 Beta-Adrenoceptor Agonists .........153 Betadine .........................................64 Betadine Skin Prep .........................64 Betaferon ......................................127 Betagan ........................................158 Betahistine dihydrochloride ..........117 Betaloc ............................................52 Betaloc CR .....................................52 Betamethasone dipropionate ..........61 Betamethasone sodium phosphate with betamethasone acetate ............. 75 Betamethasone valerate ...........61, 66 Betamethasone valerate with clioquinol .................................... 62 Betamethasone valerate with fusidic acid ................................. 62 Betaxolol hydrochloride ................158 Betnovate .......................................61 Betnovate-C ....................................62 Betoptic .........................................158 Betoptic S .....................................158 Bezaﬁbrate .....................................44 Bezalip Retard ................................44 Bicalox ..........................................143 Bicalutamide .................................143 Bicillin LA ........................................85 BiCNU ...........................................134 Bimatoprost ..................................159 Biodone ........................................109 Biodone Extra Forte ......................109 Biodone Forte ...............................109 Bisacodyl ........................................34 BK Lotion ........................................64 Blenoxane .....................................138 Bleomycin sulphate ......................138 Bleph 10 .......................................157 Blood glucose diagnostic test meter ......................................... 31 Blood glucose diagnostic test strip ............................................ 32 Bonjela ............................................35

200

INDEX Generic Chemicals and Brands

Bosentan ........................................56 Breath-Alert ..................................156 Brevinor 1/21 ..................................71 Brevinor 1/28 ..................................71 Brevinor 21 .....................................71 Bricanyl Turbuhaler .......................153 Brimonidine tartrate ......................159 Brimonidine tartrate with timolol maleate .................................... 159 Brinzolamide .................................159 Brolene .........................................157 Bromocriptine mesylate ................119 Brufen .............................................99 Brufen Retard .................................99 Buccastem ....................................118 Budesonide Alimentary ..................................25 Respiratory .......................151, 155 Budesonide with eformoterol .............................. 153 Bumetanide ....................................54 Bupivacaine hydrochloride ...........108 Buprenorphine hydrochloride ........................... 109 Bupropion hydrochloride ...............129 Burinex ...........................................54 Buscopan ........................................27 Buserelin acetate ............................80 Buspirone hydrochloride ...............125 Busulphan .....................................134 Butacort Aqueous .........................155 -CCabergoline ....................................82 Cafergot ........................................117 Cal-d-Forte .....................................36 Calamine ........................................60 Calci-Tab 500 ..................................37 Calci-Tab 600 ..................................37 Calcipotriol ......................................65 Calcitonin ......................................107 Calcitriol ..........................................36 Calcitriol-AFT ..................................36 Calcium ...........................................37 Calcium carbonate ..........................37 Calcium carbonate with aminoacetic acid ........................ 25 Calcium Channel Blockers .............53 Calcium Disodium Versenate ................................ 162 Calcium folinate ............................135 Calcium Folinate Ebewe ...............135 Calcium gluconate ..........................37 Calcium Homeostasis ...................105 Calcium polystyrene sulphonate ................................. 43 Calcium Resonium .........................43 Calogen ........................................172 Calsource .......................................37 Camptosar ....................................137 Candesartan ...................................49 Canesten ........................................59 Capadex .......................................109 Capecitabine .................................135 Capoten ..........................................48 Capsaicin ........................................68 Captopril .........................................48 Carafate ..........................................28 Carbamazepine ............................113 Carbimazole ...................................79 Carboplatin ...................................134 Carboplatin Ebewe .......................134 Carbosorb-X .................................162 Cardinol ..........................................53 Cardinol LA .....................................53 Cardizem CD ..................................53 Carmustine ...................................134 Carvedilol .......................................51 Catapres .........................................54 Catapres-TTS-1 ..............................54 Catapres-TTS-2 ..............................54 Catapres-TTS-3 ..............................54 CeeNU ..........................................134 Cefaclor monohydrate ....................83 Cefazolin sodium ............................83 Cefoxitin sodium .............................83 Ceftriaxone sodium ........................83 Cefuroxime axetil ............................83 Cefuroxime sodium .........................83 Celestone Chronodose ...................75 Celiprolol .........................................51 Cellcept .........................................145 Celol ...............................................51 Cerezyme .......................................35 Cetirizine - AFT ............................150 Cetirizine hydrochloride ................150 Cetomacrogol .................................63 Charcoal .......................................162 Chemotherapeutic Agents ............134 Chlorambucil .................................134 Chloramphenicol ...........................157 Chlorhexidine gluconate Alimentary ..................................35 Dermatological ...........................63 Chloroform ....................................167 Chloromycetin ...............................157 Chlorothiazide .................................55 Chlorpheniramine maleate ...........150 Chlorpromazine hydrochloride ........................... 121 Chlorsig ........................................157 Chlorthalidone ................................55 Chlorvescent ..................................44 Cholecalciferol ................................36 Cholestyramine with aspartame ................................. 44 Choline salicylate with cetalkonium chloride .................. 35 Ciclopiroxolamine ...........................59 Cilazapril .........................................48 Cilazapril with hydrochlorothiazide ................... 49 Cilicaine ..........................................86 Cilicaine VK ....................................86 Ciloxan ..........................................157 Cimetidine .......................................27 Ciproﬂoxacin Infection ......................................86 Sensory ....................................157 Cisplatin ........................................134 Cisplatin Ebewe ............................134 Citalopram hydrobromide .............112 Cladribine .....................................136 Clarithromycin .................................84 Clexane ..........................................41 Climara 100 ....................................77 Climara 50 ......................................77 Clindamycin ....................................86 Clinistix ...........................................31 Clinitest ...........................................30 Clinoril ..........................................100 Clobazam .....................................113 Clobetasol propionate ...............61, 66 Clobetasone butyrate .....................61 Clomazol Dermatological ...........................59 Genito-Urinary ............................73 Clomiphene citrate ..........................82 Clomipramine hydrochloride .........111 Clonazepam .................................113 Clonidine .........................................54 Clonidine hydrochloride Cardiovascular ...........................54 Nervous ....................................117 Clopidogrel .....................................40 Clopine .........................................121 Clopixol .........................................124 Clopress .......................................111 Clotrimazole Dermatological ...........................59

201

INDEX Generic Chemicals and Brands

Genito-Urinary ............................73 Clozapine ......................................121 Clozaril .........................................121 Co-Renitec ......................................49 Co-trimoxazole ...............................86 Coal tar ...........................................66 Coal tar with allantoin, menthol, phenol and sulphur .................... 66 Coal tar with salicylic acid and sulphur ....................................... 66 Coco-Scalp .....................................66 Codalgin .......................................110 Codeine phosphate Extemporaneous ......................167 Nervous ....................................109 Cogentin .......................................120 Colaspase (L-asparaginase) .........138 Colchicine .....................................107 Colestid ...........................................44 Colestipol hydrochloride .................44 Colgout .........................................107 Colifoam .........................................26 Colistin sulphomethate ...................86 Colistin-Link ....................................86 Collodion ﬂexible ..........................167 Colofac ...........................................27 Coloxyl ............................................34 Combigan .....................................159 Combivent ....................................154 Combivir .........................................93 Compound electrolytes ...................43 Compound hydroxybenzoate ..................... 167 Comtan .........................................119 Concerta .......................................132 Condoms ........................................69 Condyline ........................................67 Contraceptives - Hormonal .............70 Contraceptives Non-hormonal ............................ 69 Copaxone .....................................127 Copper ............................................30 Corangin .........................................55 Cordarone-X ...................................50 Corticosteroids and Related Agents for Systemic Use ........... 75 Corticosteroids Topical ...................61 Cosmegen ....................................138 Cosopt ..........................................159 Cotazym ECS .................................33 Coumadin .......................................42 Coversyl ..........................................49 Cozaar ............................................50 Creon 10000 ...................................33 Creon Forte ....................................33 Crixivan ...........................................93 Cromolux ......................................158 Crotamiton ......................................60 Crystacide ......................................59 Cyclizine hydrochloride .................117 Cyclizine lactate ............................117 Cycloblastin ..................................134 Cyclogyl ........................................160 Cyclopentolate hydrochloride ........................... 160 Cyclophosphamide .......................134 Cyclosporin A ...............................147 Cyklokapron ....................................40 Cyproheptadine hydrochloride ........................... 150 Cyproterone acetate .......................76 Cyproterone acetate with ethinyloestradiol ......................... 72 Cystic Fibrosis ..............................155 Cytarabine ....................................136 Cytotec ...........................................27 Cytoxan ........................................134 -DD-Penamine ..................................100 D-Zol ...............................................82 d4T .................................................92 Dacarbazine .................................138 Daclin ............................................100 Dactinomycin (actinomycin D) ............................................. 138 Daivonex .........................................65 Daktarin Alimentary ..................................35 Dermatological ...........................60 Dalacin C ........................................86 Danazol ..........................................82 Dantrium .......................................107 Dantrolene sodium .......................107 Daonil .............................................30 Dapsone .........................................88 Dasatinib .......................................141 Daunorubicin ................................138 DDI .................................................92 De-Worm ........................................83 Deca-Durabolin Orgaject ................75 Delact ...........................................188 Depo-Medrol ...................................75 Depo-Medrol with lidocaine ............75 Depo-Provera .................................72 Depo-Testosterone .........................76 Deprim ............................................86 Derbac-M ........................................64 Dermol ......................................61, 66 Desferrioxamine mesylate ............162 Desmopressin .................................82 Desmopressin-PH&T ......................82 Detection of Substances in Urine ........................................ 162 Dexamethasone Hormone ....................................75 Sensory ....................................158 Dexamethasone sodium phosphate .................................. 75 Dexamethasone with framycetin and gramicidin ......................... 157 Dexamethasone with neomycin and polymyxin b sulphate .........158 Dexamphetamine sulphate ...........129 Dextrochlorpheniramine maleate .................................... 151 Dextropropoxyphene with paracetamol ............................. 109 Dextrose .........................................43 Dextrose with electrolytes ...............44 DHC Continus ...............................109 Diabetes .........................................28 Diabetes Management ...................30 Diabur 5000 ....................................31 Diamox .........................................159 Diaphragm ......................................69 Diasip ............................................174 Diason RTH ..................................174 Diastix .............................................31 Diastop ...........................................25 Diazepam .............................113, 125 Dibenyline .......................................48 Diclocil ............................................85 Diclofenac sodium Musculoskeletal System .............99 Sensory ....................................158 Dicloxacillin .....................................85 Didanosine [DDI] ............................92 Didronel ........................................107 Difﬂam ............................................35 Diﬂucortolone valerate ....................61 Digestives Including Enzymes .................................... 33 Digoxin ............................................50 Dihydrocodeine tartrate ................109 Dilantin ..........................................115 Dilantin Infatab ..............................115 Dilatrend .........................................51 Diltiazem hydrochloride ..................53

202

INDEX Generic Chemicals and Brands

Dilzem .............................................53 Dimetriose ......................................82 Dipentum ........................................26 Diphemanil methylsulphate ............63 Diphenoxylate hydrochloride with atropine sulphate ....................... 25 Diprosone .......................................61 Diprosone OV .................................61 Dipyridamole ...................................41 Disinfecting and Cleansing Agents ....................................... 63 Disipal ...........................................120 Disopyramide phosphate ................50 Disulﬁram ......................................130 Dithranol .........................................66 Diuretics ..........................................54 Diurin 40 .........................................54 Diurin 500 .......................................54 Dixarit ...........................................117 Docetaxel ......................................138 Docusate sodium ............................34 Docusate sodium with sennosides ................................ 34 Domperidone ................................117 Dopergin .......................................119 Dopress ........................................111 Dornase alfa .................................155 Dorzolamide hydrochloride ...........159 Dorzolamide hydrochloride with timolol maleate ........................ 159 Dostinex ..........................................82 Dothiepin hydrochloride ................111 Doxazosin mesylate .......................48 Doxepin hydrochloride ..................111 Doxine ............................................86 Doxorubicin ...................................139 Doxorubicin Ebewe .......................139 Doxy-50 ..........................................86 Doxycycline hydrochloride ..............86 DP Lotion ........................................64 DP Lotn HC ....................................62 DP-Anastrozole ............................143 Dr Reddy’s Omeprazole .................28 Dr Reddy’s Pantoprazole ................28 Dulcolax ..........................................34 Duocal Super Soluble Powder ..................................... 171 Duolin ...........................................154 Duphalac ........................................34 Duphaston ......................................78 Durex Conﬁdence ...........................69 Durex Extra Safe ............................69 Durex Select Flavours ....................69 Duride .............................................55 Durogesic .....................................109 Dusting Powders .............................63 Dydrogesterone ..............................78 Dynacirc-SRO .................................53 -EE-Mycin ...........................................84 Ear Preparations ...........................157 Ear/Eye Preparations ...................157 Easiphen .......................................186 Easiphen Liquid ............................186 Econazole nitrate ............................59 Efavirenz .........................................92 Efexor XR .....................................112 Eformoterol fumarate ....................152 Efudix ..............................................68 Egopsoryl TA ..................................66 Elemental 028 Extra .....................178 Eligard ............................................82 Elocon .............................................62 Eloxatin .........................................134 Eltroxin ............................................79 EMLA ............................................108 Emtricitabine ...................................92 Emtriva ...........................................92 Emulsifying ointment ......................63 Enalapril .........................................49 Enalapril with hydrochlorothiazide ................... 49 Enbrel ...........................................104 Endocrine Therapy .......................143 Endoxan .......................................134 Enerlyte ..........................................43 Enfuvirtide ......................................93 Enoxaparin sodium .........................41 Ensure ..........................................173 Ensure Plus ..................................180 Ensure Plus RTH ..........................180 Entacapone ..................................119 Entecavir .........................................89 Entocort CIR ...................................25 Enuclene .......................................161 Enzymes .......................................107 Epilim ............................................115 Epilim Crushable ..........................115 Epilim IV .......................................115 Epilim S/F Liquid ...........................115 Epilim Syrup .................................115 Epirubicin ......................................139 Epirubicin Ebewe ..........................139 Eprex ..............................................39 ERA ................................................84 Ergometrine maleate ......................73 Ergotamine tartrate with caffeine .................................... 117 Erythrocin IV ...................................84 Erythromycin ethyl succinate ..........84 Erythromycin lactobionate ..............84 Erythromycin stearate ....................84 Erythropoietin alpha .......................39 Erythropoietin beta .........................39 Estelle 35-ED ..................................72 Estraderm TTS 100 ........................77 Estraderm TTS 25 ..........................77 Estraderm TTS 50 ..........................77 Estrofem .........................................77 Etanercept ....................................104 Ethambutol hydrochloride ...............88 Ethics Aspirin ................................108 Ethics Aspirin EC ............................40 Ethics Ibuprofen ..............................99 Ethinyloestradiol .............................78 Ethinyloestradiol with desogestrel ................................ 70 Ethinyloestradiol with gestodene .................................. 70 Ethinyloestradiol with levonorgestrel ............................ 71 Ethinyloestradiol with norethisterone ............................ 71 Ethosuximide ................................113 Etidrate .........................................107 Etidronate disodium ......................107 Etopophos ....................................139 Etoposide ......................................139 Etoposide phosphate ....................139 Eumovate .......................................61 Eurax ..............................................60 Exemestane ..................................143 Extemporaneously Compounded Preparations and Galenicals ................................ 167 Eye Preparations ..........................157 Ezetimibe ........................................46 Ezetimibe with simvastatin .............47 Ezetrol ............................................46 -FFamotidine ......................................27 Famox .............................................27 Felo 10 ER ......................................53 Felo 5 ER ........................................53 Felodipine .......................................53 Femara .........................................144 Femodene 28 .................................70 Femtran 100 ...................................77

203

INDEX Generic Chemicals and Brands

Femtran 50 .....................................77 Fenpaed .........................................99 Fentanyl ........................................109 Fentanyl citrate .............................109 Ferodan ..........................................38 Ferro-F-Tabs ...................................38 Ferro-Gradumet ..............................38 Ferro-tab .........................................38 Ferrograd-Folic ...............................38 Ferrous fumarate ............................38 Ferrous fumarate with folic acid ............................................ 38 Ferrous gluconate with ascorbic acid ............................................ 38 Ferrous sulphate .............................38 Ferrous sulphate with folic acid ............................................ 38 Ferrum H ........................................38 Fexofenadine hydrochloride .........151 Fibalip .............................................44 Fibersource ...................................180 Fibersource HN ............................180 Fibersource HN RTH ....................180 Fibersource RTH ..........................180 Fibro-vein ........................................40 Finasteride ......................................73 Fintral ..............................................73 Flagyl ..............................................88 Flagyl-S ..........................................88 Flecainide acetate ..........................51 Fleet ................................................34 Fleet Glycerin Suppositories ..........34 Fleet Phosphate Enema .................34 Flixotide ........................................152 Flixotide Accuhaler .......................152 Florinef ...........................................75 Fluanxol ........................................123 Fluarix .............................................98 Flucloxacillin sodium .......................85 Flucloxin .........................................85 Flucon ...........................................158 Fluconazole ....................................87 Fludara .........................................136 Fludara Oral ..................................136 Fludarabine phosphate .................136 Fludrocortisone acetate ..................75 Fluids and Electrolytes ...................43 Flumetasone pivalate ...................157 Fluocortolone caproate with ﬂuocortolone pivalate and cinchocaine ................................ 26 Fluorometholone ...........................158 Fluorouracil Ebewe .......................136 Fluorouracil sodium Dermatological ...........................68 Oncology ..................................136 Fluox .............................................112 Fluoxetine hydrochloride ...............112 Flupenthixol decanoate ................123 Fluphenazine decanoate ..............123 Flutamide ......................................143 Flutamin ........................................143 Fluticasone ...................................152 Fluticasone with salmeterol ..........153 Fluvax .............................................98 FML ..............................................158 Foban .............................................58 Folic acid ........................................39 Food Thickeners ...........................182 Foods And Supplements For Inborn Errors Of Metabolism Other ........................................ 183 Foods And Supplements For Inborn Errors Of Metabolism PKU ......................................... 184 Foradil ...........................................152 Foremount Child’s Silicone Mask ........................................ 156 Fortimel ........................................175 Fortini ...........................................176 Fortini Multiﬁbre ............................176 Fortisip ..........................................180 Fortisip Multi Fibre ........................181 Fosamax .......................................106 Fosamax Plus ...............................106 Framycetin sulphate .....................157 FreeStyle Lite ...........................31, 32 Frisium ..........................................113 Frumil ..............................................55 Fucicort ...........................................62 Fucidin ............................................87 Fucithalmic ...................................157 Fungilin ...........................................35 Furosemide .....................................54 Fusidic acid Dermatological ...........................58 Infection ......................................87 Sensory ....................................157 Fuzeon ............................................93 -GGabapentin ...................................113 Gabapentin (Neurontin) ................114 Gamma benzene hexachloride .............................. 64 Gastrosoothe ..................................27 Gaviscon .........................................25 Gaviscon Double Strength ..............25 Gaviscon Infant ...............................25 Gemcitabine Ebewe .....................136 Gemcitabine hydrochloride ...........136 Gemzar .........................................136 Generaid Plus ...............................175 Genoptic .......................................157 Genotropin ......................................80 Genox ...........................................145 Gentamicin sulphate Infection ......................................87 Sensory ....................................157 Gestrinone ......................................82 Glatiramer acetate ........................127 Gliben .............................................30 Glibenclamide .................................30 Gliclazide ........................................30 Glipizide ..........................................30 Glivec ............................................142 Glucagen Hypokit ...........................28 Glucagon hydrochloride ..................28 Glucerna Select ............................174 Glucerna Select RTH ....................174 Glucobay ........................................29 Glucose oxidase .............................31 Gluten Free Foods ........................182 Glycerol Alimentary ..................................34 Extemporaneous ......................167 Glycerol with parafﬁn and cetyl alcohol ....................................... 63 Glyceryl trinitrate ............................55 Gold Knight .....................................69 Goldshield .......................................79 Gopten ............................................49 Goserelin acetate ...........................81 Growth hormone biosynthetic human ........................................ 80 Gutron .............................................51 Gynaecological Anti-infectives ............................ 73 Gynol II ...........................................69 -HHabitrol ...........................................57 Haldol ...........................................123 Haldol Concentrate .......................123 Haloperidol ...................................122 Haloperidol decanoate .................123 Hamilton Sunscreen .......................67 healthE ...........................................60 healthE Fatty Cream .......................63 Healtheries Iron with Vitamin C ................................................ 38

204

INDEX Generic Chemicals and Brands

Healtheries Multi-vitamin tablets ........................................ 37 Healtheries Simple Baking Mix ........................................... 182 Hemastix .......................................162 Heparin sodium ..............................42 Heparinised saline ..........................42 Hepsera ..........................................88 Herceptin ......................................146 Hexamine hippurate .......................97 Hiprex .............................................97 Histafen ........................................150 Holoxan ........................................134 Homatropine hydrobromide ..........160 Horleys Bread Mix ........................182 Horleys Flour ................................182 Hormone Replacement Therapy Systemic .................................... 76 Humalog .........................................29 Humalog Mix 25 ..............................29 Humalog Mix 50 ..............................29 Humira ..........................................101 HumiraPen ....................................101 Humulin 30/70 ................................28 Humulin NPH ..................................28 Humulin R .......................................28 Hyalase .........................................107 Hyaluronidase ...............................107 Hybloc .............................................52 Hydralazine .....................................56 Hydrea ..........................................139 Hydrocortisone Dermatological ...........................61 Hormone ....................................75 Hydrocortisone acetate ..................26 Hydrocortisone butyrate ...........62, 66 Hydrocortisone butyrate with chlorquinaldol ............................ 62 Hydrocortisone with miconazole ................................ 62 Hydrocortisone with natamycin and neomycin ............................ 62 Hydrocortisone with wool fat and mineral oil .................................. 62 Hydroderm Lotion ...........................64 Hydrogen peroxide Alimentary ..................................36 Dermatological .....................59, 68 Hydroxocobalamin ..........................36 Hydroxychloroquine sulphate .........87 Hydroxyurea .................................139 Hygroton .........................................55 Hyoscine (scopolamine) ...............118 Hyoscine hydrobromide ................118 Hyoscine N-butylbromide ...............27 Hypam ..........................................128 Hyperuricaemia and Antigout ................................... 107 Hypnovel .......................................128 Hypromellose ................................160 Hytrin ..............................................48 Hytrin Starter Pack .........................48 Hyzaar ............................................50 -IIbiamox ...........................................85 Ibuprofen ........................................99 Idarubicin hydrochloride ...............139 Ifosfamide .....................................134 Iloprost ............................................56 Imatinib mesylate ..........................142 Imiglucerase ...................................35 Imigran ..........................................117 Imipramine hydrochloride .............111 Imiquimod .......................................67 Immune Modulators ........................94 Immunosuppressants ...................145 Imuran ..........................................145 Indapamide .....................................55 Indinavir ..........................................93 Indomethacin ................................100 Infant Formulae ............................186 Inﬂuenza vaccine ............................98 Inhaled Anticholinergic agents ...................................... 154 Inhaled Corticosteroids .................151 Inhaled Long-acting Beta-adrenoceptor Agonists ................................... 152 Inhibace ..........................................48 Inhibace Plus ..................................49 Insulin aspart ..................................29 Insulin glargine ...............................29 Insulin isophane ..............................28 Insulin isophane with insulin neutral ........................................ 28 Insulin lispro ....................................29 Insulin lispro with insulin lispro protamine ................................... 29 Insulin neutral .................................28 Insulin pen needles .........................32 Insulin syringes, disposable with attached needle ......................... 32 Intal Spincaps ...............................154 Interferon alpha-2a .........................94 Interferon alpha-2a with ribavirin ...................................... 95 Interferon alpha-2b .........................95 Interferon beta-1-alpha .................127 Interferon beta-1-beta ...................127 Intra-uterine device .........................69 Intron-A ...........................................95 Invirase ...........................................93 Ipecacuanha .................................162 Ipratropium bromide .............154–155 Ipratropium Steri-Neb ...................154 Irinotecan ......................................137 Iron polymaltose .............................38 Ismo 20 ...........................................55 Isogel ..............................................33 Isoniazid .........................................88 Isoprenaline hydrochloride .............55 Isoptin .............................................54 Isopto Carpine ..............................160 Isopto Homatropine ......................160 Isosorbide mononitrate ...................55 Isosource 1.5 ................................180 Isosource HN ................................180 Isosource HN RTH .......................180 Isosource Standard ......................180 Isosource Standard RTH ..............180 Isotane 10 .......................................58 Isotane 20 .......................................58 Isotretinoin ......................................58 Isradipine ........................................53 Isuprel .............................................55 Itraconazole ....................................87 -JJanola .............................................63 Jevity RTH ....................................180 -KKaletra ............................................93 Karicare Food Thickener ..............182 Karicare Goats Milk Infant Formula ................................... 188 Karicare Soy All Ages ...................188 Kemadrin ......................................120 Kenacomb Dermatological ...........................62 Sensory ....................................157 Kenacort-A ......................................76 Kenacort-A40 ..................................76 Keppra ..........................................115 Keto-Diabur 5000 ............................31 Keto-Diastix ....................................31 Ketoconazole Dermatological .....................59, 66 Infection ......................................87 Ketone blood beta-ketone

205

INDEX Generic Chemicals and Brands

electrodes .................................. 31 Ketoprofen ......................................99 Ketostix ...........................................31 Ketovite ...........................................37 Ketovite Liquid ................................37 Ketur-Test .......................................31 Kindergen .....................................175 Kivexa .............................................92 Klacid ..............................................84 Klamycin .........................................84 Kliogest ...........................................78 Kliovance ........................................78 Konakion .........................................40 Konakion MM ..................................40 Konsyl-D .........................................33 -LLA-Morph ......................................110 Labetalol .........................................52 Lacri-Lube ....................................161 Lactulose ........................................34 Lamictal ........................................115 Lamivudine ...............................90, 92 Lamotrigine ...................................115 Lanoxin ...........................................50 Lanoxin PG .....................................50 Lansoprazole ..................................27 Lantus .............................................29 Lantus SoloStar ..............................29 Lanvis ...........................................137 Largactil ........................................121 Lasix ...............................................54 Latanoprost ...................................159 Lax-Tabs .........................................34 Laxatives ........................................33 Laxsol .............................................34 Leﬂunomide ..................................100 Lemnis Fatty Cream .......................63 Lemnis Fatty Cream HC .................61 Letrozole .......................................144 Leukeran FC .................................134 Leunase ........................................138 Leuprorelin ......................................82 Leustatin .......................................136 Levetiracetam ...............................115 Levlen ED .......................................71 Levobunolol ..................................158 Levocabastine ..............................158 Levodopa with benserazide ..........119 Levodopa with carbidopa ..............119 Levonorgestrel Genito-Urinary ............................72 Hormone ....................................78 Levothyroxine ..................................79 Lifestyles Flared .............................69 Lignocaine hydrochloride ..............108 Lignocaine with chlorhexidine ........................... 108 Lignocaine with prilocaine ............108 Lipid Modifying Agents ...................44 Lipitor ..............................................45 Liquigen ........................................172 Lisinopril .........................................49 Lisuride hydrogen maleate ...........119 Litak ..............................................136 Lithicarb ........................................122 Lithium carbonate .........................122 Livostin .........................................158 Locasol .........................................187 Loceryl ............................................59 Locoid .......................................62, 66 Locoid C .........................................62 Locoid Crelo ...................................62 Locoid Lipocream ...........................62 Locorten-Vioform ..........................157 Lodoxamide trometamol ...............158 Loette .............................................71 Logem ...........................................115 Lomide ..........................................158 Lomustine .....................................134 Loperamide hydrochloride ..............25 Lophlex LQ ...................................186 Lopinavir with ritonavir ....................93 Lopresor .........................................52 Lopressor ........................................52 Loproﬁn .........................................185 Loproﬁn Mix ..................................184 Loraclear Hayfever Relief .............151 Lorapaed ......................................151 Loratadine .....................................151 Lorazepam ....................................125 Lormetazepam .............................127 Losartan .........................................50 Losec Hp7 OAC ..............................27 Lovir ................................................91 Loxamine ......................................112 Lucrin Depot ...................................82 Lucrin Depot PDS ...........................82 Ludiomil ........................................111 Lumigan ........................................159 Lycinate ..........................................55 Lyderm ............................................65 -Mm-Enalapril .....................................49 m-Eslon ........................................110 m-Hydrocortisone ...........................61 Mabthera ......................................145 Macrogol 3350 ................................34 Madopar 125 ................................119 Madopar 250 ................................119 Madopar 62.5 ...............................119 Madopar Dispersible .....................119 Madopar HBS ...............................119 Magnesium hydroxide ...................167 Magnesium sulphate Alimentary ..................................38 Dermatological ...........................68 Malathion ........................................64 Maprotiline hydrochloride .............111 Marcain Heavy ..............................108 Marcain Isobaric ...........................108 Marevan ..........................................42 Marine Blue Lotion SPF 30+ ..........67 Marquis Black .................................69 Marquis Conforma ..........................69 Marquis Protecta ............................69 Marquis Selecta ..............................69 Marquis Sensolite ...........................69 Marquis Supalite .............................69 Marquis Titillata ..............................69 MarquisTantiliza ..............................69 Marvelon 21 ....................................70 Marvelon 28 ....................................70 Mask for spacer device .................156 Mast cell stabilisers ......................154 Maxalt Melt ...................................117 Maxidex ........................................158 Maxitrol .........................................158 MCT oil (Nutricia) .........................172 MDS Quick Card .............................73 Mebendazole ..................................83 Mebeverine hydrochloride ..............27 Medrol .............................................75 Medroxyprogesterone acetate Genito-Urinary ............................72 Hormone ..............................77, 79 Mefenamic acid ..............................99 Megace .........................................144 Megestrol acetate .........................144 Melphalan .....................................134 Menthol ...........................................60 Mercaptopurine ............................137 Mercilon 21 .....................................70 Mercilon 28 .....................................70 Mesalazine .....................................26 Mesna ...........................................140 Mestinon .........................................99 Metabolic Disorder Agents .............35

206

INDEX Generic Chemicals and Brands

Metabolic Mineral Mixture .............186 Metamide ......................................118 Metamucil .......................................33 Metformin hydrochloride .................30 Methadone hydrochloride Extemporaneous ......................167 Nervous ....................................109 Methatabs .....................................109 Methoblastin .................................137 Methopt .........................................160 Methotrexate .................................137 Methotrexate Ebewe .....................137 Methotrimeprazine ........................122 Methyl hydroxybenzoate ...............167 Methylcellulose .............................167 Methyldopa .....................................54 Methylergometrine ..........................73 Methylphenidate hydrochloride ........................... 130 Methylphenidate hydrochloride extended-release ..................... 132 Methylprednisolone ........................75 Methylprednisolone aceponate .................................. 62 Methylprednisolone acetate ............75 Methylprednisolone acetate with lignocaine .................................. 75 Methylprednisolone sodium succinate ................................... 75 Methylxanthines ............................155 Metoclopramide hydrochloride ........................... 118 Metoclopramide hydrochloride with paracetamol ..................... 117 Metopirone ......................................82 Metoprolol - AFT CR .......................52 Metoprolol succinate .......................52 Metoprolol tartrate ..........................52 Metronidazole .................................88 Metyrapone .....................................82 Mexiletine hydrochloride .................51 Mexitil .............................................51 Miacalcic .......................................107 Mianserin hydrochloride ...............111 Micanol ...........................................66 Micelle E .........................................37 Miconazole .....................................35 Miconazole nitrate Dermatological ...........................60 Genito-Urinary ............................73 Micreme ..........................................73 Micreme H ......................................62 Microgynon 20 ED ..........................71 Microgynon 30 ................................71 Microgynon 30 ED ..........................71 Microgynon 50 ED ..........................71 Microlax ..........................................34 Microlut ...........................................72 Midazolam ....................................128 Midodrine ........................................51 Minaphlex .....................................186 Minerals ..........................................37 Minidiab ..........................................30 Minirin .............................................82 Mino-tabs ........................................86 Minocycline hydrochloride ..............86 Minomycin ......................................86 Minor Skin Infections ......................64 Minulet 28 .......................................70 Mirena .............................................78 Misoprostol .....................................27 Mitomycin C ..................................140 Mitomycin-C ..................................140 Mitozantrone .................................140 Mitozantrone Ebewe .....................140 Mixtard 30 .......................................28 Moclobemide ................................112 Modecate ......................................123 Moducal ........................................170 Mogine ..........................................115 Mometasone furoate .......................62 Monofeme .......................................71 Monogen .......................................174 Morphine hydrochloride ................110 Morphine sulphate ........................110 Morphine tartrate ..........................110 Morrex Maltodextrin ......................170 Motilium ........................................117 Mouth and Throat ...........................35 Movicol ...........................................34 MSUD Maxamaid .........................184 MSUD Maxamum .........................184 Mucilaginous laxatives ....................33 Mucilaginous laxatives with stimulants .................................. 34 Mucilax ...........................................33 Multiload Cu 375 .............................69 Multiload Cu 375 SL .......................69 Multiparin ........................................42 Multiple Sclerosis Treatments ............................... 126 Multivitamins ...................................37 Mupirocin ........................................59 Muscle Relaxants .........................107 Myambutol ......................................88 Mycobutin .......................................88 Mycophenolate mofetil ..................145 Mycostatin ......................................60 Mydriacyl ......................................160 Mylan ..............................................53 Mylanta P ........................................25 Myleran .........................................134 Myocrisin ......................................101 Myometrial and Vaginal Hormone Preparations .............................. 73 -NNadolol ...........................................52 Nalcrom ..........................................26 Naloxone hydrochloride ................162 Naltrexone hydrochloride ..............132 Nandrolone decanoate ...................75 Napamide .......................................55 Naphazoline hydrochloride ...........161 Naphcon Forte ..............................161 Naprosyn SR 1000 .......................100 Naprosyn SR 750 .........................100 Naproxen ......................................100 Naproxen sodium ..........................100 Nardil ............................................112 Nasal Preparations .......................155 Natulan .........................................140 Nausicalm .....................................117 Navelbine ......................................141 Navoban .......................................118 Nedocromil ...................................154 Nefopam hydrochloride ................108 Neo-B12 .........................................36 Neo-Mercazole ...............................79 Neo-Naclex .....................................55 Neocate ........................................187 Neocate Advance .........................187 Neocate LCP ................................187 Neoral ...........................................147 NeoRecormon ................................39 Neostigmine ....................................99 Neotigason .....................................65 Nepro (vanilla) ..............................177 Nerisone .........................................61 Neulactil ........................................122 Neurontin ......................................114 Nevirapine ......................................92 Nicotine ...........................................57 Nicotinell .........................................57 Nicotinic acid ..................................44 Nifedipine ........................................53 Nifuran ............................................98 Nilstat Alimentary ..................................35

207

INDEX Generic Chemicals and Brands

Genito-Urinary ............................73 Infection ......................................87 Nipent ...........................................140 Nitrados ........................................128 Nitrates ...........................................55 Nitrazepam ...................................128 Nitroderm TTS ................................55 Nitrofurantoin ..................................98 Nitrolingual Pumpspray ..................55 Nizoral Dermatological ...........................59 Infection ......................................87 Noctamid ......................................127 Nodia ..............................................25 Noﬂam 250 ...................................100 Noﬂam 500 ...................................100 Nonoxynol-9 ...................................69 Nordette 28 .....................................71 Norditropin SimpleXx 10mg ............80 Norditropin SimpleXx 15mg ............80 Norditropin SimpleXx 5mg ..............80 Norethisterone Genito-Urinary ............................72 Hormone ....................................79 Norethisterone with mestranol ................................... 71 Norﬂex ..........................................107 Norﬂoxacin ......................................98 Noriday 28 ......................................72 Norimin ...........................................71 Norinyl-1/28 ....................................71 Normacol ........................................33 Normacol Plus ................................34 Normison ......................................128 Norpress .......................................111 Nortriptyline hydrochloride ............111 Norvir ..............................................93 Noten ..............................................51 NovaSource Renal .......................177 NovoFine ........................................32 NovoRapid ......................................29 NovoRapid Penﬁll ...........................29 Nozinan ........................................122 Nuelin ...........................................155 Nuelin-SR .....................................155 Nupentin .......................................113 Nutraplus ........................................63 Nutrient Modules ..........................170 Nutrini Energy RTH ......................176 Nutrini RTH ...................................176 NutriniDrink ...................................176 NutriniDrink Multiﬁbre ...................176 Nutrison Concentrated .................177 Nutrison Energy Multi Fibre ..........180 Nutrison Multi Fibre ......................180 Nutrison Standard RTH ................180 Nuvelle ............................................78 Nyefax Retard .................................53 Nystatin Alimentary ..................................35 Dermatological ...........................60 Genito-Urinary ............................73 Infection ......................................87 NZB Low Gluten Bread Mix ..........182 -OOctreotide (somatostatin analogue) ................................. 144 Oestradiol .......................................77 Oestradiol valerate .........................77 Oestradiol with levonorgestrel .........78 Oestradiol with norethisterone ............................ 78 Oestriol Genito-Urinary ............................73 Hormone ....................................78 Oestrogens .....................................77 Oestrogens with medroxyprogesterone ................ 78 Oil in water emulsion ......................63 Oily cream ......................................63 Olanzapine ...........................122, 124 Olbetam ..........................................44 Olsalazine .......................................26 Omeprazole ....................................28 Omeprazole, amoxycillin and clarithromycin ............................ 27 Ondansetron .................................118 One-Alpha ......................................36 Onkotrone .....................................140 Optium 10 second test ....................32 Optium 5 second test ......................32 Optium Blood Ketone Test Strips ......................................... 31 Optium Xceed .................................31 Orabase ..........................................35 Oracort ...........................................35 Oral Supplements .........................172 Oral Supplements/Complete Diet (Nasogastric/Gastrostomy Tube Feed) .............................. 173 Orgran ..........................................183 Ornidazole ......................................88 Orphenadrine citrate .....................107 Orphenadrine hydrochloride .........120 Ortho ..............................................69 Ortho All-ﬂex ...................................69 Ortho Coil .......................................69 Ortho-tolidine ................................162 Oruvail 100 .....................................99 Oruvail 200 .....................................99 Osmolite RTH ...............................180 Ospamox Paediatric Drops .............85 Other CNS Agents ........................128 Other Endocrine Agents .................82 Other Oestrogen Preparations .............................. 78 Other Progestogen Preparations .............................. 78 Other Skin Preparations .................68 Ovestin Genito-Urinary ............................73 Hormone ....................................78 Ox-Pam ........................................126 Oxaliplatin .....................................134 Oxazepam ....................................126 Oxis Turbuhaler ............................152 Oxybutynin ......................................74 Oxycodone hydrochloride .............110 OxyContin .....................................110 OxyNorm ......................................110 Oxypentifylline ................................56 Oxytocin ..........................................73 -PPacifen ..........................................107 Paciﬁc Buspirone ..........................125 Paclitaxel ......................................140 Paclitaxel Ebewe ..........................140 Paediatric Seravit ...........................37 Pamidronate disodium ..................107 Pamisol .........................................107 Panadol ........................................108 Pancreatic enzyme .........................33 Pancrex V .......................................33 Pancrex V Forte ..............................33 Panteston .......................................76 Pantocid IV .....................................28 Pantoprazole ...................................28 Panzytrat ........................................33 Papaverine hydrochloride ...............56 Paracare .......................................108 Paracare Double Strength ............108 Paracare Junior ............................108 Paracetamol .................................108 Paracetamol with codeine ............110 Paradex ........................................109 Parafﬁn ...........................................64 Parafﬁn liquid with soft white parafﬁn ..................................... 161

208

INDEX Generic Chemicals and Brands

Parafﬁn liquid with wool fat liquid ........................................ 161 Paraldehyde ..................................113 Paramax .......................................117 Parasiticidal Preparations ...............64 Parnate .........................................112 Parnate S29 ..................................112 Paroxetine hydrochloride ..............112 Paxam ..........................................113 Peak ﬂow meter ............................156 Pedialyte - Bubblegum ....................44 Pedialyte - Fruit ...............................44 Pedialyte - Plain ..............................44 Pediasure .....................................176 Pediasure RTH .............................176 Pegasys ..........................................95 Pegasys RBV Combination Pack ........................................... 95 Pegatron Combination Therapy ..................................... 97 Pegylated interferon alpha-2a .........95 Pegylated interferon alpha-2b with ribavirin .............................. 97 Penicillamine ................................100 PenMix 30 .......................................28 PenMix 40 .......................................28 PenMix 50 .......................................28 Pentasa ..........................................26 Pentostatin (deoxycoformycin) ................... 140 Pepti Junior ...................................187 Peptisoothe .....................................27 Peptisorb ......................................178 Pergolide ......................................119 Perhexiline maleate ........................53 Periactin ........................................150 Pericyazine ...................................122 Perindopril ......................................49 Permax .........................................119 Permethrin ......................................65 Persantin ........................................41 Pethidine hydrochloride ................111 Pevaryl ............................................59 Pexsig .............................................53 Pharmacare ..................................108 Phenate ..........................................82 Phenelzine sulphate .....................112 Phenergan ....................................151 Phenobarbitone ............................115 Phenobarbitone sodium ................167 Phenoxybenzamine hydrochloride ............................. 48 Phenoxymethylpenicillin (Penicillin V) ............................... 86 Phentolamine mesylate ..................48 Phenylephrine hydrochloride ........................... 161 Phenylephrine hydrochloride with zinc sulphate ............................ 161 Phenytoin sodium .................113, 115 Phlexy 10 ......................................186 Phosphate-Sandoz .........................44 Phytomenadione .............................40 Pilocarpine ....................................160 Pilopt .............................................160 Pimafucort ......................................62 Pindol ..............................................52 Pindolol ...........................................52 Pinetarsol ........................................66 Pioglitazone ....................................30 Piportil ..........................................123 Pipothiazine palmitate ..................123 Piram-D ........................................100 Piroxicam ......................................100 Pizaccord ........................................30 Pizotifen ........................................117 Plaquenil .........................................87 Plavix ..............................................40 Plendil ER .......................................53 Podophyllotoxin ..............................67 Polaramine ....................................151 Polaramine Colour-Free Repetab ................................... 151 Polaramine Repetab .....................151 Poloxamer .......................................34 Poly-Tears .....................................160 Poly-Visc .......................................161 Polycal ..........................................170 Polycose .......................................170 Polytar Emollient .............................66 Polyvinyl alcohol ...........................160 Ponstan ..........................................99 Postinor-1 .......................................72 Potassium bicarbonate ...................44 Potassium chloride ...................43–44 Povidone iodine ..............................64 Prantal ............................................63 Pravachol ........................................45 Pravastatin ......................................45 Prazosin hydrochloride ...................48 Pred Forte ....................................158 Pred Mild ......................................158 Prednisolone acetate ....................158 Prednisolone sodium phosphate .................................. 75 Prednisone .....................................76 Prefrin ...........................................161 Pregnancy tests - HCG urine .........73 Premarin .........................................77 Premia 2.5 Continuous ...................78 Premia 5 Continuous ......................78 Priadel ..........................................122 Primidone .....................................115 Primolut N .......................................79 Pro-Pam .......................................125 Probenecid ...................................107 Procaine penicillin ...........................86 Procarbazine hydrochloride ..........140 Prochlorperazine ..........................118 Procyclidine hydrochloride ............120 Prodopa ..........................................54 Prograf ..........................................149 Progynova ......................................77 Promethazine hydrochloride .........151 Promethazine theoclate ................118 Promod .........................................172 Propafenone hydrochloride ............51 Propamidine isethionate ...............157 Propranolol .....................................53 Propylene glycol ...........................168 Protamine sulphate .........................42 Protaphane .....................................28 Protaphane Penﬁll ..........................28 Protifar 90 .....................................172 Provera .....................................77, 79 PSO ......................................189–192 Psoriasis and Eczema Preparations .............................. 65 Pulmicort Turbuhaler ....................151 Pulmocare ....................................173 Pulmozyme ...................................155 Purinethol .....................................137 Pyrazinamide ..................................88 Pyridostigmine bromide ..................99 Pyridoxine hydrochloride ................36 Pytazen SR .....................................41 -QQ 200 ............................................107 Q 300 ............................................107 Questran-Lite ..................................44 Quetapel .......................................122 Quetiapine ....................................122 Quinapril .........................................49 Quinapril with hydrochlorothiazide ................... 49 Quinine sulphate ...........................107 QV ..................................................63

209

INDEX Generic Chemicals and Brands

-RRA-Morph .....................................110 Ranbaxy Amoxicillin .......................85 Ranbaxy-Cefaclor ...........................83 Ranitidine hydrochloride .................27 Rapamune ....................................148 Recombinant human growth hormone .................................... 80 Redipred .........................................75 Regitine ..........................................48 Renilon 7.5 ...................................177 Requip ..........................................120 Requip Follow-on Pack .................120 Requip Starter Pack .....................120 Resonium-A ....................................44 Resource Diabetic ........................174 Resource Diabetic TF RTH ..........174 Resource Plus ..............................180 Resource Thicken Up ...................182 Respigen ......................................153 Respiratory Devices .....................156 Retrovir ...........................................93 ReVia ............................................132 Reyataz ..........................................93 Rheumacin ...................................100 Rheumacin SR .............................100 Ridal .............................................123 Ridaura .........................................100 Rifabutin .........................................88 Rifadin ............................................88 Rifampicin .......................................88 Riﬁnah ............................................88 Riodine ...........................................64 Risperdal ......................................123 Risperdal Consta ..........................123 Risperdal Quicklet ........................124 Risperidone ..........................123–124 Ritalin ............................................130 Ritalin LA ......................................132 Ritalin SR ......................................130 Ritonavir .........................................93 Rituximab ......................................145 Rivotril ...........................................113 Rizatriptan benzoate .....................117 Rocaltrol solution ............................36 Roferon RBV Combination Pack ........................................... 95 Roferon RBV Combination Pack Starter Kit .................................. 95 Roferon-A .......................................94 Ropin ............................................120 Ropinirole hydrochloride ...............120 Roxithromycin .................................85 Rubifen .........................................130 Rubifen SR ...................................130 Rythmodan .....................................50 Rytmonorm .....................................51 -SS26 Soy ........................................188 S26LBW Gold RTF .......................186 Sabril ............................................116 Salamol .........................................153 Salapin ..........................................153 Salazopyrin .....................................26 Salazopyrin EN ...............................26 Salbutamol ....................................153 Salbutamol with ipratropium bromide .................................... 154 Salicylic acid ...................................66 Salmeterol ....................................152 Sandomigran ................................117 Sandostatin ...................................144 Sandostatin LAR ...........................144 Sandoz ...........................................85 Saquinavir .......................................93 Scalp Preparations .........................66 Scopoderm TTS ...........................118 Sebizole ..........................................66 Sedatives and Hypnotics ..............127 Selegiline hydrochloride ...............120 Senna .............................................35 Senokot ..........................................35 SensoCard ......................................32 Serenace ......................................122 Seretide ........................................153 Seretide Accuhaler .......................153 Serevent .......................................152 Serevent Accuhaler ......................152 Seroquel .......................................122 Sevredol .......................................110 Sex Hormones Non Contraceptive ............................ 76 Shield 49 .........................................69 Shield Blue .....................................69 Shield XL ........................................69 Sildenaﬁl .........................................56 Silvazine .........................................59 Silver sulphadiazine ........................59 Simethicone ....................................25 Simvastatin .....................................46 Sindopa ........................................119 Sinemet ........................................119 Sinemet CR ..................................119 Sirolimus .......................................148 Siterone ..........................................76 Slow-Lopressor ...............................52 Smoking Cessation .........................57 Sodium acid phosphate ..................34 Sodium alginate ..............................25 Sodium aurothiomalate .................101 Sodium bicarbonate Blood ..........................................43 Extemporaneous ......................168 Sodium calcium edetate ...............162 Sodium carboxymethylcellulose .............. 35 Sodium chloride ..............................43 Sodium citrate with sodium lauryl sulphoacetate ............................ 34 Sodium citro-tartrate .......................74 Sodium cromoglycate Alimentary ..................................26 Respiratory .......................154–155 Sensory ....................................158 Sodium ﬂuoride ..............................37 Sodium hypochlorite .......................63 Sodium nitroprusside ......................31 Sodium polystyrene sulphonate ................................. 44 Sodium tetradecyl sulphate ............40 Sodium valproate ..........................115 Sofradex .......................................157 Soframycin ....................................157 Solian ............................................121 Solox ...............................................27 Solu-Cortef .....................................75 Solu-Medrol ....................................75 Sonaﬂam ......................................100 Sotacor ...........................................53 Sotalol .............................................53 Space Chamber ............................156 Spacer device ...............................156 Span-K ............................................44 Spiriva ...........................................154 Spironolactone ................................54 Spirotone ........................................54 Sporanox ........................................87 Sprycel .........................................141 Staphlex ..........................................85 Stavudine [d4T] ..............................93 Stelazine .......................................123 Stemetil .........................................118 Stesolid .........................................113 Stocrin ............................................92 Stomahesive ...................................35 Strattera ........................................128 Sucralfate .......................................28 Sulindac ........................................100

210

INDEX Generic Chemicals and Brands

Sulphacetamide sodium ...............157 Sulphasalazine ...............................26 Sulphur ...........................................66 Sumagran .....................................117 Sumatriptan ..................................117 Sunscreens .....................................67 Sunscreens, proprietary .................67 Suplena ........................................178 Suprefact ........................................80 Surgam .........................................100 Sustagen Hospital Formula ..........173 Sustanon Ampoules .......................76 Symbicort Turbuhaler 100/6 .........153 Symbicort Turbuhaler 200/6 .........153 Symbicort Turbuhaler 400/12 ..................................... 153 Symmetrel ....................................119 Sympathomimetics .........................55 Synacthen .......................................76 Synacthen Depot ............................76 Synermox .......................................85 Synﬂex ..........................................100 Synthroid ........................................79 Syntocinon ......................................73 Syntometrine ..................................73 Syrup (pharmaceutical grade) ...................................... 168 -TTacrolimus ....................................149 Tambocor ........................................51 Tambocor CR ..................................51 Tamoxifen citrate ...........................145 Tamoxifen Sandoz ........................145 Tap water ......................................168 Tar with cade oil ..............................66 Tar with triethanolamine lauryl sulphate and ﬂuorescein ............ 66 Tasmar ..........................................120 Taxotere ........................................138 Tegretol .........................................113 Tegretol CR ...................................113 Telfast ...........................................151 Temazepam ..................................128 Temgesic ......................................109 Temodal ........................................140 Temozolomide ..............................140 Teniposide ....................................140 Tenofovir disoproxil fumarate ..........93 Tenoxicam ....................................100 Terazosin hydrochloride ..................48 Terbinaﬁne ......................................87 Terbutaline sulphate .....................153 Testosterone ...................................76 Testosterone cypionate ...................76 Testosterone esters ........................76 Testosterone undecanoate .............76 Tetrabenazine ...............................133 Tetrabromophenol .........................162 Tetracosactrin .................................76 Teva ..............................................137 Thalidomide ..................................140 Thalidomide Pharmion .................140 Theophylline .................................155 Thiamine hydrochloride ..................36 Thioguanine ..................................137 Thioprine ......................................145 Thiotepa ........................................135 Thymol glycerin ..............................36 Thyroid and Antithyroid Agents ....................................... 79 Tiaprofenic acid ............................100 Tiberal .............................................88 Tilade ............................................154 Tilcotil ...........................................100 Timolol maleate Cardiovascular ...........................53 Sensory ....................................158 Timoptol XE ..................................158 Tiotropium bromide .......................154 Titralac ............................................25 TMP ................................................87 Tobramycin Infection ......................................87 Sensory ....................................157 Tobrex ...........................................157 Tofranil ..........................................111 Tolcapone .....................................120 Tolvon ...........................................111 Topamax .......................................116 Topiramate ....................................116 Total parenteral nutrition (TPN) ......................................... 43 TPN ................................................43 Tracleer ...........................................56 Trandate ..........................................52 Trandolapril .....................................49 Tranexamic acid ..............................40 Tranylcypromine sulphate .............112 Trastuzumab .................................146 Travatan ........................................159 Travoprost .....................................159 Trental 400 ......................................56 Tretinoin ........................................141 Triamcinolone acetonide Alimentary ..................................35 Dermatological ...........................62 Hormone ....................................76 Triamcinolone acetonide with gramicidin, neomycin and nystatin Dermatological ...........................62 Sensory ....................................157 Triamizide .......................................55 Triamterene with hydrochlorothiazide ................... 55 Triazolam ......................................128 Trichozole .......................................88 Trifeme ............................................71 Triﬂuoperazine hydrochloride ........................... 123 Trimeprazine tartrate ....................151 Trimethoprim ...................................87 Trimipramine maleate ...................112 Triphasil 28 .....................................71 Tripress .........................................112 Triquilar ED .....................................71 Trisequens ......................................78 Trisul ...............................................86 Trophic Hormones ..........................79 Tropicamide ..................................160 Tropisetron ....................................118 Trusopt ..........................................159 Two Cal HN ...................................181 Tyloxapol .......................................161 -UUltraproct ........................................26 Ural .................................................74 Urea ................................................63 Urinary Agents ................................73 Urinary Tract Infections ...................97 Uromitexan ...................................140 Ursodeoxycholic acid ......................33 -VVaccines .........................................98 Valaciclovir ......................................91 Vallergan Forte .............................151 Valoid (AFT) ..................................117 Valtrex .............................................91 Vancomycin hydrochloride ..............87 Vannair .........................................153 Vasodilators ....................................56 Vasopressin Agonists .....................82 Vaxigrip ...........................................98 Venlafaxine ...................................112 Ventavis ..........................................56 Ventolin .........................................153 Vepesid .........................................139 Verapamil hydrochloride .................54 Vergo 16 .......................................117

211

INDEX Generic Chemicals and Brands

Vermox ...........................................83 Verpamil SR ...................................54 Vesanoid .......................................141 Viaderm KC ....................................62 Viagra .............................................56 Vicrom ..........................................154 Videx EC .........................................92 Vigabatrin .....................................116 Vinblastine sulphate .....................141 Vincristine sulphate ......................141 Vinorelbine ....................................141 Vinorelbine Ebewe ........................141 Viramune ........................................92 Viramune Suspension ....................92 Viread .............................................93 Vistil ..............................................160 Vistil Forte ....................................160 Vitadol C .........................................36 Vital HN ........................................178 Vitamin A with vitamins D and C ................................................ 36 Vitamin B complex ..........................36 Vitamins ....................................36–37 Vivonex Pediatric ..........................187 Vivonex TEN .................................178 Voltaren ..........................................99 Voltaren D .......................................99 Voltaren Ophtha ............................158 Volumatic ......................................156 Vosol .............................................157 Vumon ..........................................140 Vytorin ............................................47 -WWarfarin sodium ..............................42 Wart Preparations ...........................67 Wasp venom allergy treatment ................................. 150 Water Blood ..........................................43 Extemporaneous ......................168 Wholesale Supply Order ...............192 Wool fat with mineral oil ..................64 -XXalatan .........................................159 Xeloda ..........................................135 Xenazine 25 ..................................133 XMET Maxamum ..........................184 XP Analog LCP .............................186 XP Maxamaid ...............................186 XP Maxamum ...............................186 Xylocaine ......................................108 -ZZadine ...........................................150 Zantac .............................................27 Zarontin ........................................113 Zavedos ........................................139 Zefﬁx ...............................................90 Zeldox ...........................................123 Zerit ................................................93 Zetop ............................................150 Ziagen .............................................92 Zidovudine [AZT] ............................93 Zidovudine [AZT] with lamivudine ................................. 93 Zinacef ............................................83 Zinc .................................................63 Zinc and castor oil ..........................63 Zinc oxide .......................................26 Zinc sulphate ..................................38 Zincaps ...........................................38 Zincfrin ..........................................161 Zinnat ..............................................83 Ziprasidone ...................................123 Zofran ...........................................118 Zofran Zydis ..................................118 Zoladex ...........................................81 Zopiclone ......................................128 Zostrix HP .......................................68 Zovirax ..........................................157 Zuclopenthixol decanoate .............124 Zyban ............................................129 Zyprexa .........................................122 Zyprexa Zydis ...............................124

212

AUTHORITY TO SUBSTITUTE

Dear Pharmacist Where I refer in a prescription to a medicine by its trade mark or trade name (brand), or by the name of its manufacturer, I give authority to substitute an alternative brand of the same medicine in the following situations: Sole Supply Products Where PHARMAC has entered into sole supply arrangement for the medicine 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. Other subsidised products Where PHARMAC has listed one or more brands of the medicine on the Pharmaceutical Schedule (and the brand that I have prescribed is not listed or has a Manufacturer’s Price that is greater than the Subsidy) you may substitute with a listed 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 pharmaceuticals which I may have provided previously. This authority to substitute is valid unless I have indicated on the prescription an instruction not to substitute. This authority is valid whether or not there is a ﬁnancial implication for the Funder. Please inform my patient that I have authorised substitution.

Name:

NZMC:

Signature:

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.

NOTES

AUTHORITY TO SUBSTITUTE

Name:

NZMC:

Signature:

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.

NOTES

AUTHORITY TO SUBSTITUTE

Name:

NZMC:

Signature:

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.

NOTES

AUTHORITY TO SUBSTITUTE

Name:

NZMC:

Signature:

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.

NOTES

AUTHORITY TO SUBSTITUTE

Name:

NZMC:

Signature:

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.

NOTES

AUTHORITY TO SUBSTITUTE

Name:

NZMC:

Signature:

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.

NOTES

Pharmaceutical Management Agency Level 9, Cigna House, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Phone: 64 4 460 4990 - Fax: 64 4 460 4995 - www.pharmac.govt.nz Freephone Information line (9am-5pm weekdays) 0800 66 00 50

PHARMAC is the Government agency responsible for deciding which medicines are subsidised for New Zealanders. It manages spending on pharmaceuticals for the District Health Boards, and ensures that a comprehensive list of medicines (the Pharmaceutical Schedule) is subsidised for New Zealanders, and that the list of medicines continues to grow to meet the needs of patients.

Metadata

Title

Pharmaceutical Schedule - effective 1 August 2009

Abstract

Pharmaceutical Management Agency August 2009 New Zealand Pharmaceutical Schedule Introducing PHARMAC 2 August 2009 Volume 16 Number 2 Editors Kaye Wilson & Scott Brydon email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 9, Cigna House…

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.