Pharmaceutical Schedule - effective 1 April 2010 (text extract)

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Pharmaceutical Management Agency

April 2010

New Zealand Pharmaceutical Schedule

April 2010

Volume 17 Number 1

Editors Kaye Wilson & Scott Brydon email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 9, 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. See www.pharmac.govt.nz/schedule/archive/ for the XML version of this Schedule. Programmers Anrik Drenth & John Geering email: texschedule@pharmac.govt.nz c Pharmaceutical Management Agency ISSN 1179-3686 pdf ISSN 1172-9376 print This work is licensed under the Creative Commons Attribution 3.0 New Zealand licence. In essence, you are free to copy, distribute and adapt it, as long as you attribute the work to PHARMAC and abide by the other licence terms. To view a copy of this licence, visit: creativecommons.org/licenses/by/3.0/nz/. Attribution to PHARMAC should be in written form and not by reproduction of the PHARMAC logo. 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 there from.

Introducing PHARMAC

Section A Section B

General Rules 12 Alimentary Tract & Metabolism 25

Blood & Blood Forming Organs 40 Cardiovascular System 49 Dermatologicals 59 Genito Urinary System 70 Hormone Preparations – Systemic 76 Infections – Agents For Systemic Use 84 Musculoskeletal System 100 Nervous System 109 Oncology Agents & Immunosuppressants 136 Respiratory System & Allergies 151 Sensory Organs 158

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

Special Foods 169 Supply Orders (PSO & WSO) 188 Rural Areas 192

Section F Section G

Dispensing Period Exemptions 193 Safety Cap Medicines 195 Index 198

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 Stuart McLaughlan 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); a G the particular health needs of M¯ ori and Paciﬁc peoples; 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 Marianne Empson Ian Hosford Sisira Jayathissa George Laking Jim Lello Graham Mills Peter Pillans Mark Weatherall Howard Wilson MBChB, MD, MRCP (UK), FRACP, FRCP, physician/clinical pharmacologist, Chair BHB, MBChB, MMed(ClinEpi), FRACP, FRCPA, immunologist MBChB, FRANZCP, psychiatrist MMedSc (Clin Epi), MMBS, MD, MRCP (UK), FRCP (Edin), FRACP, FAFPHM, Dip Clin Epi, Dip OHP, Dip HSM, MBS PhD, MB, B.Med.Sci, MD, FRACP BHB, MBChB, DCH, FRNZCGP, general practitioner MBChB, MTropHlth, MD, FRACP, infectious disease specialist and general physician MBBCh, MD, FCP, FRACP, clinical pharmacologist BA, MBChB, MApplStats, FRACP BSc, PhD, MB, BS, Dip Obst, FRNZCGP, FRACGP, general practitioner, Deputy Chair

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 Adam McRae Team Leader, Access & Optimal Lauren Abernethy Funding and Procurement Use Assistant Scott Metcalfe Chief Advisor Population Kate Adams Health Economist Medicine / Public Health Paul Alexander Health Economist Physician Jason Arnold Senior Analyst Peter Moodie Medical Director Diana Beswethrick HR Contractor Christina Newman Executive Assistant to Chief Mike Bignall Therapeutic Group Manager Executive/Ofﬁce Manager Stephen Boxall Creative Director Leigh Parish PA to Medical Director Scott Brydon Schedule Analyst Marama Parore Manager, Access & Optimal Davina Carpenter Records Manager Use & M¯ ori Health a Christine Chapman Therapeutic Group Manager Chris Peck Analyst Yvonne Chen Tender Analyst Sharon Ponniah Access and Optimal Use Mary Chesterﬁeld High Cost Medicines Manager Co-ordinator Matthew Poynton Analyst/Health Economist Steffan Crausaz Manager, Funding and Rachel Pratt Hospital Exceptional Procurement Circumstances Panel Andrew Davies Procurement Initiatives Co-ordinator Manager Rosanna Price Receptionist Rachelle Davies Senior Receptionist Jan Quin Team Leader, Medical Team Jessica Dougherty Corporate Team Assistant Dilky Rasiah Deputy Medical Director Sean Dougherty Therapeutic Group Manager Kyle Reid High Cost Medicines Panel Anrik Drenth Database Analyst Co-ordinator / Growth Hormone Kim Ellis Access & Optimal Use Awhimai Reynolds M¯ ori Health Manager a Co-ordinator Brian Roulston Contract Manager Simon England Communications Manager Fiona Rutherford Senior Policy Analyst Andy Erceg Senior Network and System Rico Schoeler Manager, Analysis and Administrator Assessment Jackie Evans Therapeutic Group Manager Merryn Simmons PHARMAC Seminar Series John Geering Systems Architect Co-ordinator Rachel Grocott Health Economist / Team Liz Skelley Finance Manager Leader Assessment Jude Urlich Manager, Corporate and Susan Haniel Advisory Committee Manager External Relations David Harland Health Economist Jayne Watkins Community Exceptional Ben Healey Analyst Circumstances Panel Karen Jacobs Access & Optimal Use Manager Co-ordinator Cherie Jacobson One Heart Many Lives Bryce Wigodsky Communications Advisor Programme Co-ordinator Greg Williams Therapeutic Group Manager Helen Knight Accounts Payable Co-ordinator Lisa Williams Legal Counsel Geoff Lawn Applications Developer Kaye Wilson Schedule Analyst Geraldine MacGibbon Therapeutic Group Manager Stephen Woodruffe Therapeutic Group Manager Janet Mackay Access & Optimal Use Manager Sue Anne Yee Therapeutic Group Manager Rachel Mackay Manager, Schedule and Michael Young Analyst Contracts Trish Mahoney Contract Manager

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 April 2010 and is to be referred to as the Pharmaceutical Schedule Volume 17 Number 1, 2010. Distribution will be from 20 April 2010. This Schedule comes into force on 1 April 2010.

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) initialed 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 tab 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) .................................23.00 21.1 g OP Colifoam MESALAZINE Tab 400 mg .......................................................................................49.50 Tab EC 500 mg .................................................................................49.50 Tab long-acting 500 mg ....................................................................59.05 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 .......................................................................................11.68 F Tab EC 500 mg .................................................................................12.89 100 100 100 7 20 28 100 100 100 100 100

Asacol Asamax 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 .............................52.00 F Inj 1200 µg, 1 ml – Up to 5 inj available on a PSO ..........................32.00 (AstraZeneca Inj 1200 µg, 1 ml to be delisted 1 June 2010) 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

AstraZeneca AstraZeneca

20 5 90

Gastrosoothe Buscopan Colofac

Antiulcerants Antisecretory and Cytoprotective

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

Cytotec

Helicobacter Pylori Eradication

CLARITHROMYCIN Tab 500 mg – Subsidy by endorsement ............................................23.30 14 Klamycin a) Maximum of 14 tab per prescription b) Subsidised only if prescribed for helicobacter pylori eradication and prescription is endorsed accordingly. Note: the prescription is considered endorsed if clarithromycin is prescribed in conjunction with a proton pump inhibitor and either amoxycillin or metronidazole. 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 ..........................................................................................3.50 F Cap 30 mg ..........................................................................................4.65 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 5 mg .............................................................................................5.00 GLICLAZIDE F Tab 80 mg .........................................................................................22.24 GLIPIZIDE F Tab 5 mg .............................................................................................3.50 METFORMIN HYDROCHLORIDE F Tab immediate-release 500 mg ..........................................................8.09 F Tab immediate-release 850 mg ..........................................................6.67 (Arrow-Metformin Tab immediate-release 500 mg to be delisted 1 May 2010) (Arrow-Metformin Tab immediate-release 850 mg to be delisted 1 May 2010) PIOGLITAZONE – Special Authority see SA0959 below – Retail pharmacy Tab 15 mg ...........................................................................................2.61 Tab 30 mg ...........................................................................................5.23 Tab 45 mg ...........................................................................................7.80 28 28 28 100 500 100 500 250

Daonil Apo-Gliclazide Minidiab Apotex Arrow-Metformin Apotex Arrow-Metformin

Pizaccord Pizaccord Pizaccord

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) (Clinitest Tab, diagnostic to be delisted 1 September 2010) 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) (Diabur 5000 Urine diagnostic test to be delisted 1 September 2010) (Diastix Urine diagnostic test with peroxidase to be delisted 1 September 2010) (Clinistix Urine diagnostic test with peroxidase to be delisted 1 September 2010)

50 strip OP Diabur 5000 50 strip OP Diastix Clinistix

Ketone Testing

KETONE BLOOD BETA-KETONE ELECTRODES – Subsidy by endorsement 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. The prescription must be endorsed accordingly. 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 20 strip OP

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 ..................................................................................................6.00 1 CareSens POP 9.00 CareSens II FreeStyle Lite On Call Advanced 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 × 50 and lancets × 5 ...............................19.10 1 OP On Call Advanced 19.60 CareSens Blood glucose test strips ..................................................................21.65 50 test OP Accu-Chek Performa FreeStyle Lite Optium 5 second test 26.20 SensoCard

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 11.75 SC Proﬁ-Fine F 31 g × 5 mm .....................................................................................11.75 100 B-D Micro-Fine SC Proﬁ-Fine F 31 g × 6 mm .....................................................................................10.50 100 ABM 11.75 Fine Ject 10.50 (26.00) NovoFine F 31 g × 8 mm .....................................................................................10.50 100 ABM B-D Micro-Fine 11.75 SC Proﬁ-Fine

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 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 DM Ject F Syringe 0.3 ml with 31 g × 8 mm needle .........................................13.00 100 ABM B-D Ultra Fine II DM Ject F Syringe 0.5 ml with 29 g × 12.7 mm needle ....................................13.00 100 ABM B-D Ultra Fine DM Ject F Syringe 0.5 ml with 31 g × 8 mm needle .........................................13.00 100 ABM B-D Ultra Fine II DM Ject F Syringe 1 ml with 29 g × 12.7 mm needle .......................................13.00 100 ABM B-D Ultra Fine DM Ject F Syringe 1 ml with 31 g × 8 mm needle ............................................13.00 100 ABM B-D Ultra Fine II DM Ject

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 SA1003 below – Retail pharmacy Cap 300 mg ....................................................................................179.00 100

¾SA1003 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Patient diagnosed with cholestasis of pregnancy; or 2 Both: 2.1 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 2.2 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. 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.

ALIMENTARY TRACT AND METABOLISM

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

continued. . . Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. Note: Ursodeoxycholic acid 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) MUCILAGINOUS LAXATIVES WITH STIMULANTS F Dry ......................................................................................................3.52 (7.69) 8.80 (16.49) 325 g OP 380 g OP 450 g OP 500 g OP Normacol 336 g OP Metamucil 275 g OP Mucilax 200 g OP Normacol Plus 500 g OP Normacol Plus

Konsyl-D Mucilax

Isogel

Faecal Softeners

DOCUSATE SODIUM – Only on a prescription F Tab 50 mg ...........................................................................................3.95 4.89 F Tab 120 mg .........................................................................................5.49 6.73 F Enema conc 18% ...............................................................................5.40 DOCUSATE SODIUM WITH SENNOSIDES F Tab 50 mg with total sennosides 8 mg ...............................................6.38 POLOXAMER – Only on a prescription F Oral drops 10% ...................................................................................3.78 100 100 100 ml OP 200 30 ml OP

Laxofast 50 Coloxyl Laxofast 120 Coloxyl Coloxyl Laxsol Coloxyl

Osmotic Laxatives

GLYCEROL F Suppos 3.6 g – Only on a prescription ...............................................6.00 LACTULOSE – Only on a prescription F Oral liq 10 g per 15 ml ........................................................................6.65 20 1,000 ml

PSM Duphalac

MACROGOL 3350 – Special Authority see SA0891 on the next page – Retail pharmacy Powder 13.125 g, sachets – Maximum of 60 sach per prescription ......................................................................................18.14 30

Movicol

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

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 ......................................................................................3.00 F Suppos 10 mg ....................................................................................3.00 3.96 (Fleet Suppos 10 mg to be delisted 1 August 2010) SENNA – Only on a prescription F Tab, standardised ...............................................................................2.17 (6.16) 200 6 6 12

Lax-Tabs Dulcolax Dulcolax Fleet

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) 500 ml Difﬂam 200 ml OP 15 g OP Bonjela

Orion

‡ 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

SODIUM CARBOXYMETHYLCELLULOSE With pectin and gelatin paste ...........................................................17.20 4.55 (7.90) With pectin and gelatin powder ..........................................................8.48 (10.95) TRIAMCINOLONE ACETONIDE 0.1% in Dental Paste USP ..................................................................4.38

56 g OP 15 g OP 28 g OP

Stomahesive

Orabase Stomahesive

5 g OP

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

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 ................................................................................ 4.50

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 .......................6.15 (10.84) (Neo-B12 Inj 1 mg per ml, 1 ml to be delisted 1 July 2010) 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

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

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 ........................................................................................3.03 10.10 F Cap 0.5 µg ..........................................................................................5.62 18.73 F Oral liq 1 µg per ml ...........................................................................39.40 (Calcitriol-AFT Cap 0.25 µg to be delisted 1 May 2010) (Calcitriol-AFT Cap 0.5 µg to be delisted 1 May 2010) CHOLECALCIFEROL F Tab 1.25 mg (50,000 iu) – Maximum of 12 tab per prescription .........7.76 100 100 20 ml OP 30 100 30 100 10 ml OP

One-Alpha One-Alpha One-Alpha Airﬂow Calcitriol-AFT Airﬂow Calcitriol-AFT Rocaltrol solution

Cal-d-Forte

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 on the next page – Retail pharmacy Tab ...................................................................................................19.65 100 Powder ..............................................................................................36.00 100 g OP Oral liq .............................................................................................13.50 150 ml OP (Ketovite Tab to be delisted 1 September 2010) (Ketovite Liquid Oral liq to be delisted 1 September 2010)

Ketovite Paediatric Seravit Ketovite Liquid

‡ 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

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. Renewal from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where patient has had a previous approval for multivitamins. 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 F Cap (fat soluble vitamins A, D, E, K) – Special Authority see SA1002 below – Retail pharmacy .............................................23.40 60 Vitabdeck ¾SA1002 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 Patient has cystic ﬁbrosis with pancreatic insufﬁciency; or 2 Patient is an infant or child with liver disease or short gut syndrome.

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

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 .............................................12.04 100 60 500

Ferro-tab Ferro-F-Tabs Healtheries Iron

with Vitamin C

(Healtheries Iron with Vitamin C Tab 170 mg with ascorbic acid 40 mg to be delisted 1 August 2010)

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

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

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%, 5 ml ..................................................................................26.60

Mayne

Zinc

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

Zincaps

Agents Used in the Treatment of Poisonings

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 IPECACUANHA F Tincture .............................................................................................41.20 (43.40) SODIUM CALCIUM EDETATE F Inj 200 mg per ml, 5 ml .....................................................................53.31 (156.71) 100 250 ml OP

Red Seal Carbosorb-X

500 ml PSM 6 Calcium Disodium Versenate

‡ 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

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 ........................................................................................19.80 F Tab 5 mg ...........................................................................................10.21 Oral liq 50 µg per ml .........................................................................21.05 1,000 500 25 ml OP

Apo-Folic Acid Apo-Folic Acid Biomed

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

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 .......................................................................................32.92 5 Fibro-vein 5 Fibro-vein 5 Fibro-vein 100

Cyklokapron

Vitamin K

PHYTOMENADIONE Inj 2 mg per 0.2 ml – Up to 5 inj available on a PSO..........................8.00 May be administered orally. Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................9.21 May be administered orally. 5 5

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 .........................................................................................25.00 (73.38) 990 28

Ethics Aspirin EC Apo-Clopidogrel Arrow-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: 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.

BLOOD AND BLOOD FORMING ORGANS

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

continued. . . 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. 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

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

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 ....................................................................11.44 10 Pﬁzer 46.30 50 Pﬁzer 66.80 Mayne Inj 1,000 iu per ml, 35 ml ..................................................................16.00 1 Mayne Inj 5,000 iu per ml, 1 ml ....................................................................14.20 5 Mayne Inj 5,000 iu per ml, 5 ml ....................................................................43.67 10 Multiparin 118.50 50 Pﬁzer Inj 25,000 iu per ml, 0.2 ml .................................................................9.50 5 Mayne HEPARINISED SALINE F Inj 10 iu per ml, 5 ml .........................................................................32.50 PROTAMINE SULPHATE F Inj 10 mg per ml, 5 ml .......................................................................22.40 (86.54) 50 10 Artex

Pﬁzer

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

‡ 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

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 (AstraZeneca Inj 150 mg per ml, 10 ml to be delisted 1 June 2010) 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 WATER 1) On a prescription or Practitioner’s Supply Order only when on the same form 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 10.51 Puriﬁed for inj, 10 ml – Up to 5 inj available on a PSO .....................10.38 11.32 Puriﬁed for inj, 20 ml – Up to 5 inj available on a PSO .......................5.04 1 OP

TPN

as an injection listed in the Pharmaceutical

50 50 20

Multichem AstraZeneca Multichem AstraZeneca 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

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

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 ......................................................................7.00 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.

‡ 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

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

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

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 45 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.

‡ 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

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.

Iron Overload

DESFERRIOXAMINE MESYLATE – Hospital pharmacy [HP3] F Inj 500 mg .........................................................................................99.00 10

Mayne

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

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 ...........................................................................................23.30 F Tab 5 mg ...........................................................................................29.00 500 500 30 5 Regitine 100 100 100 28 14 OP 500 500

Apo-Doxazosin Apo-Doxazosin Dibenyline S29

Apo-Prazo Apo-Prazo Apo-Prazo Apo-Terazosin Hytrin Starter Pack Apo-Terazosin 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 ENALAPRIL F Tab 5 mg .............................................................................................2.19 F Tab 10 mg ...........................................................................................2.76 F Tab 20 mg ...........................................................................................3.68 500 500 500 95 ml OP

Apo-Captopril Apo-Captopril Apo-Captopril Capoten

30 28 28 90 90 90

Inhibace Inhibace Inhibace m-Enalapril m-Enalapril m-Enalapril

‡ 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

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 tab with Endorsement..................................................................................... 3.00 (18.50) F Tab 4 mg – Higher subsidy of $25.00 per 30 tab 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 cap with Endorsement..................................................................................... 3.06 (18.67) F Cap 2 mg – Higher subsidy of $27.00 per 28 cap with Endorsement..................................................................................... 4.43 (27.00)

30 30 30

Arrow-Lisinopril Arrow-Lisinopril Arrow-Lisinopril

30 Coversyl 30 Coversyl 30 30 30

Accupril Accupril Accupril

28 Gopten 28 Gopten

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. . .

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

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 109 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

‡ 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

FLECAINIDE ACETATE – Retail pharmacy-Specialist L Tab 50 mg .........................................................................................45.82 L Tab 100 mg .......................................................................................80.92 L Cap long-acting 100 mg ...................................................................45.82 L Cap long-acting 200 mg ...................................................................80.92 Inj 10 mg per ml, 15 ml .....................................................................52.45 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 200 mg .....................................................................................15.94 (ACB Cap 200 mg to be delisted 1 October 2010) ATENOLOL F Tab 50 mg ..........................................................................................0.39 6.18 F Tab 100 mg .......................................................................................10.73 (Noten S29 Tab 50 mg to be delisted 1 June 2010) 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

ACB

30 500 500

Noten S29 Paciﬁc Atenolol Paciﬁc Atenolol

30 30 30 180

Dilatrend Dilatrend Dilatrend Celol

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

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, 20 ml .......................................................................59.06 (88.60) METOPROLOL SUCCINATE F Tab long-acting 23.75 mg ...................................................................2.73 F Tab long-acting 47.5 mg .....................................................................3.41 F Tab long-acting 95 mg ........................................................................5.88 F Tab long-acting 190 mg ....................................................................10.63 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 5.40 F Tab 10 mg ..........................................................................................8.35 9.19 F Tab 15 mg ........................................................................................12.00 13.80 (Pindol Tab 5 mg to be delisted 1 June 2010) (Pindol Tab 10 mg to be delisted 1 June 2010) (Pindol Tab 15 mg to be delisted 1 June 2010) 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

100 100 100 100 5

Hybloc Hybloc Hybloc Hybloc

Trandate

30 30 30 30

Betaloc CR Metoprolol - AFT CR Betaloc CR Metoprolol - AFT CR Betaloc CR Metoprolol - AFT CR Betaloc CR Metoprolol - AFT CR Lopresor Lopressor Slow-Lopressor

Betaloc

100 60 28 5

100 100 100 100 100

Apo-Nadolol Apo-Nadolol Pindol Apo-Pindolol Pindol Apo-Pindolol Pindol Apo-Pindolol

100 100 100 500 100 5 100

Cardinol Cardinol Cardinol LA Mylan Mylan Sotacor Apo-Timol

‡ 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

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 .....................................................................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 Pexsig

PERHEXILINE MALEATE – Special Authority see SA0256 below – Hospital pharmacy [HP3] F Tab 100 mg .......................................................................................62.90 100

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 F Inj 2.5 mg per ml, 2 ml – Up to 5 inj available on a PSO ....................7.54 5 Isoptin

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

Centrally Acting Agents

CLONIDINE F TDDS 2.5 mg, 100 µg per day – Only on a prescription...................23.30 F TDDS 5 mg, 200 µg per day – Only on a prescription......................32.80 F TDDS 7.5 mg, 300 µg per day – Only on a prescription...................41.20 CLONIDINE HYDROCHLORIDE F Tab 150 µg ........................................................................................33.00 F Inj 150 µg per ml, 1 ml ......................................................................15.45 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 50.00 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 50 30 ml OP 5 50

Burinex Burinex Diurin 40 Diurin 500 Urex Forte S29 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

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

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 ...........................................................................................21.50 500 500

Neo-Naclex Neo-Naclex

‡ 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

CHLOROTHIAZIDE ‡ Oral liq 50 mg per ml ........................................................................22.60 CHLORTHALIDONE F Tab 25 mg ...........................................................................................8.00 INDAPAMIDE F Tab 2.5 mg ..........................................................................................4.00

25 ml OP 50 100

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

Smoking Cessation Nicotine Gum

NICOTINE a) Maximum of 768 piece per prescription b) Maximum of 384 piece per dispensing c) For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks. d) The maximum of 384 piece per dispensing cannot be waived via Access Exemption Criteria. Gum 2 mg (Fruit) ..............................................................................14.97 96 OP Habitrol 23.41 Nicotinell Gum 2 mg (Mint) ...............................................................................14.97 96 OP Habitrol 23.41 Nicotinell Gum 4 mg (Fruit) ..............................................................................20.02 96 OP Habitrol 23.41 Nicotinell Gum 4 mg (Mint) ...............................................................................20.02 96 OP Habitrol 23.41 Nicotinell

Nicotine Lozenge

NICOTINE a) Maximum of 432 loz per prescription b) Maximum of 216 loz per dispensing c) For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks. d) The maximum of 216 loz per dispensing cannot be waived via Access Exemption Criteria. Lozenge 1 mg ...................................................................................11.08 36 OP Habitrol Lozenge 2 mg ...................................................................................11.08 36 OP Habitrol

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

Nicotine Patch

NICOTINE a) Maximum of 56 patch per prescription b) Maximum of 28 patch per dispensing c) For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks. d) The maximum of 28 patch per dispensing cannot be waived via Access Exemption Criteria. Patch 7 mg .......................................................................................10.53 7 OP Habitrol Patch 14 mg .....................................................................................11.63 7 OP Habitrol Patch 21 mg .....................................................................................12.32 7 OP Habitrol

Other Agents

BUPROPION HYDROCHLORIDE Tab modiﬁed-release 150 mg ...........................................................65.00 30

Zyban

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

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 AMBRISENTAN – Special Authority see SA0967 above – Hospital pharmacy [HP1] Tab 5 mg ......................................................................................4,585.00 Tab 10 mg ....................................................................................4,585.00 30 30

Volibris Volibris

‡ 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

BOSENTAN – Special Authority see SA0967 on the preceding page – Hospital pharmacy [HP1] Tab 62.5 mg .................................................................................4,585.00 60 Tracleer Tab 125 mg ..................................................................................4,585.00 60 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 .........................................................................................52.00 Tab 50 mg .........................................................................................59.50 Tab 100 mg .......................................................................................68.00 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

DERMATOLOGICALS

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

Antiacne Preparations

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 84 ISOTRETINOIN – Special Authority see SA0955 below – Retail pharmacy Cap 10 mg ........................................................................................48.48 Cap 20 mg ........................................................................................69.70

180 180

Oratane Oratane

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 84 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

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

15 g OP

Foban

15 g OP

Foban

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

HYDROGEN PEROXIDE F Crm 1% ..............................................................................................8.56

10 g OP

Crystacide

MUPIROCIN Oint 2% ...............................................................................................6.60 15 g OP (9.26) a) Only on a prescription b) Not in combination SILVER SULPHADIAZINE Crm 1% ............................................................................................12.30 50 g OP a) Up to 250 g available on a PSO b) Not in combination Crm 1% with chlorhexidine digluconate 0.2% .................................15.04 100 g OP a) Up to 500 g available on a PSO b) Not in combination (Silvazine Crm 1% with chlorhexidine digluconate 0.2% to be delisted 1 July 2010)

Bactroban

Flamazine Silvazine

Antifungals Topical

For systemic antifungals, refer to INFECTIONS, Antifungals, page 88 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

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

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

KETOCONAZOLE Crm 2% ..............................................................................................1.00 (9.50) a) Only on a prescription b) Not in combination 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 Nizoral

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 Lotn, BP ............................................................................................16.70 CROTAMITON a) Only on a prescription b) Not in combination Crm 10% ............................................................................................3.79 4.26 (4.45)

100 g 2,000 ml

healthE API

20 g OP

Itch-Soothe

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

‡ 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

Corticosteroids Topical

For systemic corticosteroids, refer to CORTICOSTEROIDS AND RELATED AGENTS, page 76

Corticosteroids - Plain

BETAMETHASONE DIPROPIONATE Crm 0.05% .........................................................................................8.97 (18.36) Crm 0.05% in propylene glycol base ..................................................4.33 (13.83) Oint 0.05% ..........................................................................................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% .........................................................................................3.48 F Oint 0.05% ..........................................................................................3.48 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 50 g OP Diprosone 30 g OP Diprosone OV 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

3.75 12.20 500 g F Powder – Only in combination .........................................................33.00 25 g Up to 5% in a dermatological base (not proprietary Topical Corticosteriod – Plain) with galenicals. Refer, page 163 HYDROCORTISONE BUTYRATE Lipocream 0.1% ..................................................................................2.30 30 g OP 6.85 100 g OP Oint 0.1% ............................................................................................6.85 100 g OP Milky emul 0.1% .................................................................................6.85 100 ml OP HYDROCORTISONE WITH WOOL FAT AND MINERAL OIL Lotn 1% with wool fat hydrous 3% and mineral oil – Only on a prescription................................................................................ 9.95

Pharmacy Health PSM ABM

or without other dermatological

Locoid Lipocream Locoid Lipocream Locoid Locoid Crelo

250 ml

DP Lotn HC

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

METHYLPREDNISOLONE ACEPONATE Crm 0.1% ...........................................................................................4.95 Oint 0.1% ............................................................................................4.95 MOMETASONE FUROATE Crm 0.1% ...........................................................................................2.38 4.55 Oint 0.1% ............................................................................................2.38 4.55 Lotn 0.1% ...........................................................................................4.80 TRIAMCINOLONE ACETONIDE Crm 0.02% .........................................................................................6.63 Oint 0.02% ..........................................................................................6.69

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

Advantan Advantan m-Mometasone m-Mometasone m-Mometasone m-Mometasone 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% ................2.79 15 g OP Oint 1% with natamycin 1% and neomycin sulphate 0.5% .................2.79 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

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% ...........................................................4.60 500 ml 5.40 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

healthE Orion Orion

Janola

‡ 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

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 (12.00) 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 OILY CREAM F Crm BP ...............................................................................................2.80 (13.60) (15.40) UREA F Crm 10% ............................................................................................2.52 (3.07) 500 g 500 g 500 g 250 ml QV 500 g 500 g David Craig PSM 100 g OP Nutraplus

AFT PSM AFT

healthE Fatty Cream

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

WOOL FAT WITH MINERAL OIL – Only on a prescription F Lotn hydrous 3% with mineral oil ........................................................1.40 (3.50) 5.60 (10.90) 1.40 (3.50) 5.60 (9.54) (20.53) 1.40 (7.73) 5.60 (23.91)

250 ml OP DP Lotion 1,000 ml DP Lotion 250 ml OP Hydroderm Lotion 1,000 ml Hydroderm Lotion Alpha-Keri Lotion 250 ml OP BK Lotion 1,000 ml 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 ................10.00 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 PERMETHRIN Crm 5% .............................................................................................3.65 (4.20) Lotn 5% ..............................................................................................3.65 (Lyderm Crm 5% to be delisted 1 May 2010) 50 g OP 200 ml 30 ml OP 30 g OP Lyderm 30 ml OP

Benhex Derbac-M A-Lices

A-Scabies

‡ 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

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 ...............................................................................20.20 30 g OP Daivonex 56.32 100 g OP Daivonex Oint 50 µg per g ................................................................................20.20 30 g OP Daivonex 56.32 100 g OP Daivonex Soln 50 µg per ml .............................................................................20.22 30 ml OP Daivonex 33.79 60 ml OP Daivonex 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 30 g OP allantoin crm 2.5% ....................................................................... 3.43 (4.35) Egopsoryl TA COAL TAR WITH SALICYLIC ACID AND SULPHUR Soln 12% with salicylic acid 2% and sulphur 4% oint .........................7.95 40 g OP

Coco-Scalp

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

DITHRANOL Crm 1% ...........................................................................................27.50 (Micanol Crm 1% to be delisted 1 July 2010)

50 g OP

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% ..................................................................................7.22 CLOBETASOL PROPIONATE F Scalp app 0.05% ................................................................................6.36 HYDROCORTISONE BUTYRATE Scalp lotn 0.1% ...................................................................................3.65 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

‡ 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

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 (5.50) 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 (6.94) Aquasun 30+ (8.82) Aquasun Sensitive SPF 30+ (Aquasun Sensitive SPF 30+ Lotn to be delisted 1 May 2010)

Wart Preparations

For salicylic acid preparations refer to PSORIASIS AND ECZEMA PREPARATIONS, page 66 IMIQUIMOD – Special Authority see SA0923 below – Retail pharmacy Crm 5% ..........................................................................................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: Every effort should be made to biopsy the lesion to conﬁrm that it is a superﬁcial basal cell carcinoma. PODOPHYLLOTOXIN Soln 0.5% .........................................................................................33.60 3.5 ml OP Condyline a) Maximum of 3.5 ml per prescription b) Only on a prescription

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

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

‡ 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 - 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

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 - 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 tab 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 tab 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 tab 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 tab 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 (16.50) Femodene 28 a) Higher subsidy of $14.49 per 84 tab with Special Authority see SA0500 above b) Up to 84 tab available on a PSO (Femodene 28 Tab 30 µg with gestodene 75 µg and 7 inert tab to be delisted 1 June 2010)

‡ 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

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 – Up to 84 tab available on a PSO............... 6.62 84 Trifeme 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 tab 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 tab with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO 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 tab 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

Progestogen-only Contraceptives

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

continued. . . 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 tab with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO MEDROXYPROGESTERONE ACETATE F Inj 150 mg per ml, 1 ml syringe – Up to 5 inj available on a PSO .........7.15 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 ......................4.91 84 Ginet 84

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 (24.00) CLOTRIMAZOLE F Vaginal crm 1% with applicator(s) ......................................................1.45 F Vaginal crm 2% with applicators .........................................................2.75

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

100 g OP Aci-Jel 35 g OP 20 g OP

Clomazol Clomazol

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

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

40 g OP Micreme 75 g OP

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 .............................................................................5.94 Inj 10 iu per ml, 1 ml ...........................................................................7.48 Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml ......................10.12 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 a) Up to 200 test available on a PSO b) Only on a PSO Cassette ...........................................................................................19.00 22.80

25 test OP 40 test OP

MDS Quick Card Innovacon hCG One

Step Pregnancy Test

Urinary Agents

For urinary tract Infections refer to INFECTIONS, Antibacterials, page 96

5-Alpha Reductase Inhibitors

FINASTERIDE – Special Authority see SA0928 below – Retail pharmacy Tab 5 mg ...........................................................................................19.20 30

Fintral

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

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

500 473 ml OP

Apo-Oxybutynin Apo-Oxybutynin

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

GENITO-URINARY SYSTEM

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

SODIUM CITRO-TARTRATE F Grans eff 4 g sachets .........................................................................2.75

Ural Vesicare Vesicare

SOLIFENACIN SUCCINATE – Special Authority see SA0998 below – Retail pharmacy Tab 5 mg ...........................................................................................56.50 30 Tab 10 mg .........................................................................................56.50 30

¾SA0998 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has overactive bladder and a documented intolerance of oxybutynin.

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

‡ 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

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 .............................................................................................8.35 F Tab 20 mg .........................................................................................20.95 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 .........................................................................................20.80 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

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

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 40 mg per ml, 1 ml .......................................................................28.09

500 500 500 500 10 1 5 5

Apo-Prednisone Apo-Prednisone Apo-Prednisone Apo-Prednisone Synacthen Synacthen Depot 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 Andriol Testocaps 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”.

‡ 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

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 patch 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 patch 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 patch 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 patch 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 patch 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 ..........................................................................................3.09 30 F Tab 5 mg ...........................................................................................13.06 100 F Tab 10 mg ...........................................................................................6.85 30

Provera Provera Provera

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

Progestogen and Oestrogen Combined Preparations

OESTRADIOL WITH NORETHISTERONE – See prescribing guideline on page 77 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 77 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. 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: 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.

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

continued. . . 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 ........................................96.50 100 Provera F Tab 200 mg – Retail pharmacy-Specialist ........................................70.50 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

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

SOMATROPIN – Special Authority see SA0755 on the preceding page F Inj 5 mg ..........................................................................................300.00 F Inj 10 mg ........................................................................................600.00 F Inj 15 mg ........................................................................................900.00 F Inj cartridge 16 iu (5.3 mg) .............................................................160.00 F Inj cartridge 36 iu (12 mg) ..............................................................360.00 (Norditropin SimpleXx 5mg Inj 5 mg to be delisted 1 July 2010) (Norditropin SimpleXx 10mg Inj 10 mg to be delisted 1 July 2010) (Norditropin SimpleXx 15mg Inj 15 mg to be delisted 1 July 2010)

1 1 1 1 1

Norditropin

SimpleXx 5mg

Norditropin

SimpleXx 10mg

Norditropin

SimpleXx 15mg

Genotropin Genotropin

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. . .

‡ 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

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 – Hospital pharmacy [HP3] Inj 3.6 mg ........................................................................................200.00 1 Zoladex Inj 10.8 mg ......................................................................................500.00 1 Zoladex LEUPRORELIN – Hospital pharmacy [HP3] Inj 3.75 mg ......................................................................................221.60 Inj 3.75 mg preﬁlled syringe ...........................................................221.60 Inj 7.5 mg ........................................................................................166.20 Inj 11.25 mg ....................................................................................591.68 Inj 11.25 mg preﬁlled syringe .........................................................591.68 Inj 22.5 mg ......................................................................................443.76 Inj 30 mg .........................................................................................591.68 Inj 30 mg preﬁlled syringe ...........................................................1,109.40 Inj 45 mg .........................................................................................832.05 1 1 1 1 1 1 1 1 1

Lucrin Depot Lucrin Depot PDS Eligard Lucrin Depot Lucrin Depot PDS 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.........................66.00 26.26 105.03

8 2 8

Dostinex Arrow-Cabergoline Arrow-Cabergoline

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

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

DANAZOL – Retail pharmacy-Specialist Cap 100 mg ......................................................................................68.33 Cap 200 mg ......................................................................................29.35 97.83 GESTRINONE – Retail pharmacy-Specialist Cap 2.5 mg .....................................................................................101.87 METYRAPONE Cap 250 mg – Hospital pharmacy [HP3]-Specialist .......................238.00

100 30 100 8 OP 50

Azol D-Zol Azol Dimetriose Metopirone

‡ 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

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 59 b) For anti-infective eye preparations, refer to SENSORY ORGANS, page 158

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. CEPHALEXIN MONOHYDRATE – Hospital pharmacy [HP3] Grans for oral liq 125 mg per 5 ml ......................................................8.50 100 ml Cefalexin Sandoz Grans for oral liq 250 mg per 5 ml ....................................................11.50 100 ml Cefalexin Sandoz

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

Macrolides

AZITHROMYCIN – Subsidy by endorsement; can be waived by Special Authority see SA0964 below a) Maximum of 2 tab per prescription; can be waived by Special Authority see SA0964 below 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; can be waived by Special Authority see SA0964. Tab 500 mg .........................................................................................5.95 2 OP Arrow-Azithromycin 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 SA0988 below Tab 250 mg .........................................................................................7.75 14 Klamycin Grans for oral liq 125 mg per 5 ml ....................................................23.12 70 ml Klacid ¾SA0988 Special Authority for Waiver of Rule 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 1

Erythrocin 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.

INFECTIONS - AGENTS FOR SYSTEMIC USE

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

ERYTHROMYCIN STEARATE Tab 250 mg – Up to 30 tab available on a PSO................................14.95 (22.29) Tab 500 mg .......................................................................................29.90 (44.58) ROXITHROMYCIN Tab 150 mg .........................................................................................8.98 Tab 300 mg .......................................................................................16.48

100 ERA 100 ERA 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 1.55 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO...................................................................................... 1.10 1.27 Drops 125 mg per 1.25 ml ..................................................................4.00 500 500 100 ml

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

Drops

100 ml 30 ml OP

Inj 250 mg .........................................................................................12.42 10 Inj 500 mg .........................................................................................14.24 10 Inj 1 g – Up to 5 inj available on a PSO............................................21.62 10 (Ranbaxy Amoxicillin Grans for oral liq 125 mg per 5 ml to be delisted 1 September 2010) (Ranbaxy Amoxicillin Grans for oral liq 250 mg per 5 ml to be delisted 1 May 2010) 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.............................................................................................. 2.20 Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml – Up to 200 ml available on a PSO.............................................................................................. 3.85 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

Ibiamox Ibiamox Ibiamox

100

Synermox Curam Curam Bicillin LA Sandoz

100 ml

100 ml 10 10

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

FLUCLOXACILLIN SODIUM Cap 250 mg – Up to 30 cap available on a PSO.............................18.50 32.00 Cap 500 mg .....................................................................................57.90 110.00 Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................3.12 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................3.55 Inj 250 mg ...........................................................................................9.00 Inj 500 mg .........................................................................................10.40 Inj 1 g – Up to 5 inj available on a PSO............................................14.00 (Staphlex Cap 250 mg to be delisted 1 June 2010) (Staphlex Cap 500 mg to be delisted 1 June 2010) 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

250 500

Staphlex AFT Staphlex AFT AFT AFT Flucloxin Flucloxin Flucloxin

100 ml 100 ml 10 10 10

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 59 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 .................................................................................... 16.00

30 30 30

Rex Medical Rex Medical Rex Medical

16 1

Dalacin C Dalacin C

‡ 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

CO-TRIMOXAZOLE F Tab trimethoprim 80 mg and sulphamethoxazole 400 mg – Up to 30 tab available on a PSO ................................................17.00 F Oral liq trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml – Up to 200 ml available on a PSO................................ 2.15

500 100 ml

Trisul Deprim

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 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............................................................................ 9.00 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 60 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

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

28 1 28 15 30 50 50

Paciﬁc Paciﬁc Paciﬁc Sporanox Nizoral Nilstat Nilstat

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

TERBINAFINE Tab 250 mg .......................................................................................25.50

100

Apo-Terbinaﬁne

Antimalarials

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

Plaquenil

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 100 mg .......................................................................................57.81 Tab 400 mg .......................................................................................56.84 ISONIAZID – Retail pharmacy-Specialist No patient co-payment payable F Tab 100 mg .......................................................................................20.00 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 56

Myambutol S29 Myambutol S29

100 100 100

PSM Riﬁnah Riﬁnah

100

AFT-Pyrazinamide

Mycobutin

30 100 100 60 ml

Rifadin Rifadin Rifadin Rifadin

‡ 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

Antivirals

For eye preparations refer to Eye Preparations, Anti-Infective Preparations, page 158

Hepatitis B Treatment

ADEFOVIR DIPIVOXIL – Special Authority see SA0829 below – Retail pharmacy Tab 10 mg .......................................................................................670.00 30

Hepsera

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: 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. . . 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 No previous documented lamivudine resistance (either clinical or genotypic). Notes: 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 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. . . 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 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.

Hepatitis B/ HIV/AIDS Treatment

TENOFOVIR DISOPROXIL FUMARATE – Subsidy by endorsement; can be waived by Special Authority see SA0997 on the next page Endorsement for treatment of HIV/AIDS: Prescription is deemed to be endorsed if tenofovir disoproxil fumarate is co-prescribed with another anti-retroviral subsidised under Special Authority SA0779 and the prescription is annotated accordingly by the Pharmacist or endorsed by the prescriber. Note: G Tenofovir disoproxil fumarate prescribed under endorsement for the treatment of HIV/AIDS is included in the count of up to 3 subsidised antiretrovirals for the purposes of Special Authority SA0779, page 93 G Subsidy for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. Tab 300 mg .....................................................................................531.00 30 Viread

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

¾SA0997 Special Authority for Waiver of Rule Initial application — (Drug-Resistant Chronic Hepatitis B) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 1 year 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 has had previous lamivudine, adefovir or entecavir therapy; and 3 All of the following: Documented drug resistance, deﬁned as both: 3.1 ALT greater than upper limit of normal; or ≥ Metavir Stage F3; and 3.2 HBV DNA greater than 20,000 IU/mL or increased ≥ 10 fold over nadir; and 4 Any of the following: 4.1 Hepatitis B virus resistant to lamivudine with detection of M204I/V mutation; or 4.2 Hepatitis B virus resistant to adefovir with detection of A181T/V or N236T mutation; or 4.3 Hepatitis B virus resistant to entecavir with detection of I169T, L180M T184S/A/I/L/G/C/M, S202C/G/I, M204V or M250I/V mutation. Renewal — (Drug-Resistant Chronic Hepatitis B) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. Notes: G Tenofovir disoproxil fumarate should be stopped 6 months following HBeAg seroconversion for patients who were HBeAg positive prior to commencing Tenofovir disoproxil fumarate. G The recommended dose of Tenofovir disoproxil fumarate for the treatment of hepatitis B is 300 mg once daily. G In patients with renal insufﬁciency (calculated creatinine clearance less than 50ml/min), Tenofovir disoproxil fumarate dose should be reduced in accordance with the approved Medsafe datasheet guidelines. G Tenofovir disoproxil fumarate is not approved for use in children.

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 . Notes: Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 3 subsidised antiretrovirals. Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. 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. . . 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. Notes: Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 3 subsidised antiretrovirals. Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. 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: Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 3 subsidised antiretrovirals. Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. 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 Stocrin Tab 200 mg .....................................................................................474.99 90 Stocrin Tab 600 mg .....................................................................................474.99 30 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

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

LAMIVUDINE – Special Authority see SA0779 on page 93 – Hospital pharmacy [HP1] Tab 150 mg .....................................................................................307.20 60 Oral liq 10 mg per ml ......................................................................100.00 240 ml OP STAVUDINE [D4T] – Special Authority see SA0779 on page 93 – 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 ZIDOVUDINE [AZT] – Special Authority see SA0779 on page 93 – Hospital pharmacy [HP1] Cap 100 mg ....................................................................................145.00 100 Oral liq 10 mg per ml ........................................................................29.00 200 ml OP

3TC 3TC Zerit Zerit Zerit Zerit Retrovir Retrovir

ZIDOVUDINE [AZT] WITH LAMIVUDINE – Special Authority see SA0779 on page 93 – 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 93 – Hospital pharmacy [HP1] Cap 150 mg ....................................................................................568.34 60 Reyataz Cap 200 mg ....................................................................................757.79 60 Reyataz INDINAVIR – Special Authority see SA0779 on page 93 – 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 93 – 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 93 – Hospital pharmacy [HP1] Cap 100 mg ....................................................................................121.27 84 Oral liq 80 mg per ml ......................................................................103.98 90 ml OP

Norvir Norvir

Strand Transfer Inhibitors

RALTEGRAVIR POTASSIUM – Special Authority see SA0779 on page 93 – Hospital pharmacy [HP1] Tab 400 mg ..................................................................................1,350.00 60 Isentress

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 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. . . 3.2 Patient has treatment-limiting toxicity to previous antiretroviral agents; and 4 Previous treatment with 3 different antiretroviral regimens has failed; and 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.

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 – PCT – Hospital pharmacy [HP3]-Specialist a) See prescribing guideline on the preceding page b) Only one multidose cartridge starter pack to be prescribed and dispensed per patient. Inj 3 m iu preﬁlled syringe .................................................................31.32 1 Inj 4.5 m iu preﬁlled syringe .............................................................46.98 1 Inj 6 m iu preﬁlled syringe .................................................................62.64 1 Inj 9 m iu preﬁlled syringe .................................................................93.96 1 Inj 18 m iu multidose cartridge ......................................................187.92 1 Inj 18 m iu multidose cartridge × 2 starter pack ............................375.84 1 (Roferon-A Inj 4.5 m iu preﬁlled syringe to be delisted 1 August 2010) (Roferon-A Inj 18 m iu multidose cartridge to be delisted 1 August 2010) (Roferon-A Inj 18 m iu multidose cartridge × 2 starter pack to be delisted 1 August 2010)

Roferon-A Roferon-A Roferon-A Roferon-A Roferon-A Roferon-A

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 (Roferon RBV Combination Pack Inj 18 m iu multidose cartridge × 2 with ribavirin tab 200 mg × 168 to be delisted 1 August 2010) (Roferon RBV Combination Pack Starter Kit Inj 18 m iu multidose cartridge × 2 with with pen and needles with ribavirin tab 200 mg × 168 to be delisted 1 August 2010) 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 on the next page – 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

‡ 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

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: 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.

Urinary Tract Infections

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

Nifuran Nifuran

100

Arrow-Norﬂoxacin

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

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INFECTIONS - AGENTS FOR SYSTEMIC USE

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

Vaccines Inﬂuenza vaccine

INFLUENZA VACCINE – Hospital pharmacy [Xpharm] A) is available between 1 March and 30 June each year for patients who meet the following criteria, as set by the Ministry of Health: a) all people 65 years of age and over; b) people under 65 years of age with: i) the following cardiovascular disease: 1) ischaemic heart disease, 2) congestive heart disease, 3) rheumatic heart disease, 4) congenital heart disease, or 5) cerebo-vascular disease; ii) the following chronic respiratory disease: 1) asthma, if on a regular preventative therapy, or 2) other chronic respiratory disease with impaired lung function; iii) diabetes; iv) chronic renal disease; v) any cancer, excluding basal and squamous skin cancers if not invasive; vi) the following other conditions: a) autoimmune disease, b) immune suppression, c) HIV, d) transplant recipients, e) neuromuscular and CNS diseases, f) haemoglobinopathies, or g) children on long term aspirin. c) people under 65 years of age who are: i) pregnant; or ii) morbidly obsese d) children aged over 6 months and under 5 years who are from high deprivation backgrounds The following conditions are excluded from funding: a) asthma not requiring regular preventative therapy, b) hypertension and/or dyslipidaemia without evidence of end-organ disease, B) Doctors are the only Contractors entitled to claim payment from the Funder for the supply of inﬂuenza vaccine to patients eligible under the above criteria for subsidised immunisation and they may only do so in respect of the inﬂuenza vaccine listed in the Pharmaceutical Schedule. C) Individual DHBs may fund patients over and above the above criteria. The claiming process for these additional patients should be determined between the DHB and Contractor. D) 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 90.00 10 Inﬂuvac Vaxigrip

‡ 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

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 .....................................................................................1.63 50 Diclohexal 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 .....................................................................................2.13 50 Diclohexal F Tab long-acting 75 mg ........................................................................3.10 30 Diclax SR 32.80 500 Diclax SR 19.60 100 Voltaren SR 22.78 500 Apo-Diclo SR F Tab long-acting 100 mg ....................................................................34.32 500 Apo-Diclo SR 63.22 Diclax 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 (Voltaren SR Tab long-acting 75 mg to be delisted 1 June 2010) 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) F‡ Oral liq 100 mg per 5 ml .....................................................................3.49 200 ml 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

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

MEFENAMIC ACID – Additional subsidy by Special Authority see SA0291 on the preceding page – Retail pharmacy F Cap 250 mg ........................................................................................2.50 100 (18.33) Ponstan NAPROXEN F Tab 250 mg .......................................................................................23.70 F Tab 500 mg .......................................................................................24.88 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 long-acting 75 mg .....................................................................13.30 F Suppos 100 mg ................................................................................14.50 PIROXICAM F Tab dispersible 10 mg .........................................................................3.25 F Tab dispersible 20 mg .........................................................................5.50 100 30 50 100

Rheumacin SR Arthrexin 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 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

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

60 30 30 3 100 100 10 10 10

Ridaura AFT-Leﬂunomide Arava AFT-Leﬂunomide Arava Arava D-Penamine D-Penamine Myocrisin Myocrisin Myocrisin 101

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

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: All of the following: 1 Either: continued. . .

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

continued. . . 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 Initial application — (psoriatic arthritis) only from a rheumatologist. Approvals valid for 6 months 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.

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continued. . .

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: 2.1.1 Patient has "whole body" severe chronic plaque psoriasis; and continued. . .

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

continued. . . 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 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 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.

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continued. . . 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

¾SA0990 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 mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); 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 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Dubbo) which incorporates BMD measurements (see Note). 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) (see Note); or 2.2 The patient has a history of one signiﬁcant osteoporotic fracture demonstrated radiologically. continued. . .

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

continued. . . 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 mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); 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 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Dubbo) which incorporates BMD measurements (see Note). Notes: a) T-Score must be derived using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) 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. c) 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. d) 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 SA0990 on the preceding page – Retail pharmacy Tab 70 mg .........................................................................................35.91 4 Fosamax ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA0990 on the preceding page – Retail pharmacy Tab 70 mg with cholecalciferol 5,600 iu ............................................35.91 4 Fosamax Plus Tab 70 mg with cholecalciferol 2,800 iu ...........................................35.91 4 Fosamax Plus (Fosamax Plus Tab 70 mg with cholecalciferol 2,800 iu to be delisted 1 September 2010)

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.

‡ 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.

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

ALENDRONATE SODIUM – Special Authority see SA0949 on the preceding page – Retail pharmacy Tab 40 mg .......................................................................................133.00 30 Fosamax

Other Treatments

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

Miacalcic

ETIDRONATE DISODIUM F Tab 200 mg .......................................................................................23.95 100 Arrow-Etidronate 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 ...........................................................................................4.75 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 (17.20) ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 300 mg .......................................................................................54.06 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 100 100 100 100 250 Q 200 500

Pacifen Dantrium Dantrium Norﬂex

Q 300

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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 100

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

‡ 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.

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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 ...........................................................................................5.39 Tab 30 mg ...........................................................................................8.25 Tab 60 mg .........................................................................................17.76 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 ......................................................................27.27 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

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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 ............................................................................8.84 ‡ Oral liq 2 mg per ml ..........................................................................11.62 ‡ Oral liq 5 mg per ml ..........................................................................14.65 ‡ Oral liq 10 mg per ml ........................................................................21.55 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Tab immediate-release 10 mg ............................................................2.80 Tab long-acting 10 mg ........................................................................1.80 Tab immediate-release 20 mg ............................................................5.52 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.

‡ 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

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

PARACETAMOL WITH CODEINE F Tab paracetamol 500 mg with codeine phosphate 8 mg ....................2.45 100 (3.24) (Codalgin Tab paracetamol 500 mg with codeine phosphate 8 mg to be delisted 1 June 2010) PETHIDINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable Tab 50 mg ...........................................................................................3.20 Tab 100 mg .........................................................................................4.20 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

ParaCode

Codalgin

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 12.60 Tab 25 mg ...........................................................................................8.68 26.00 (Clopress Tab 10 mg to be delisted 1 June 2010) 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 50 100 100 100 100 500

Amirol Amitrip Amitrip Clopress Apo-Clomipramine Apo-Clomipramine Clopress

100 100 100 100 100 50 50 100 30

Dopress Dopress Anten Anten Anten Tofranil Tofranil Ludiomil Ludiomil

MIANSERIN HYDROCHLORIDE – Special Authority see SA0864 on the next page – Retail pharmacy 30 Tolvon Tab 30 mg .........................................................................................29.25

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

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 TRIMIPRAMINE MALEATE Cap 50 mg .......................................................................................11.20 (Tripress Cap 50 mg to be delisted 1 August 2010) 100

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

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 .........................................................................................8.31 60 GenRx Moclobemide 69.23 500 Apo-Moclobemide Tab 300 mg .......................................................................................18.80 60 GenRx Moclobemide 31.33 100 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

‡ 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.

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

Other Antidepressants

MIRTAZAPINE – Special Authority see SA0994 below – Retail pharmacy Tab 30 mg .........................................................................................22.00 Tab 45 mg .........................................................................................35.00 30 30

Avanza Avanza

¾SA0994 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 The patient has a severe major depressive episode; and 2 Either: 2.1 The patient must have had a trial of two different antidepressants and was unable to tolerate the treatments or failed to respond to an adequate dose over an adequate period of time (usually at least four weeks); or 2.2 Both: 2.2.1 The patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2 The patient must have had a trial of one other antidepressant and either could not tolerate it or failed to respond to an adequate dose over an adequate period of time. Renewal from any relevant practitioner. Approvals valid for 2 years where the patient has a high risk of relapse (prescriber determined). VENLAFAXINE – Special Authority see SA0789 below – Retail pharmacy Cap 37.5 mg .....................................................................................18.64 28 Efexor XR Cap 75 mg ........................................................................................37.27 28 Efexor XR Cap 150 mg ......................................................................................45.68 28 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: 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 5 5

Rivotril Mayne

5 5

Stesolid Stesolid

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

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 5

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 SA1009 below – 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

¾SA1009 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 for applications meeting the following criteria: Either: 1 Patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and/or quality of life from gabapentin; or 2 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents, or seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents. 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.

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

continued. . . 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. 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.

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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 (Arrow-Lamotrigine Tab dispersible 200 mg to be delisted 1 May 2010) 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

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 .........................................................................................25.00 F Tab 30 mg .........................................................................................26.00 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.

117

NERVOUS SYSTEM

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

TOPIRAMATE L Tab 25 mg .........................................................................................11.07 26.04 L Tab 50 mg .........................................................................................18.81 44.26 L Tab 100 mg .......................................................................................31.99 75.25 L Tab 200 mg .......................................................................................55.19 129.85 L Sprinkle cap 15 mg ...........................................................................20.84 L Sprinkle cap 25 mg ...........................................................................26.04 VIGABATRIN – Special Authority see SA1010 below – Retail pharmacy L Tab 500 mg .....................................................................................119.30

60 60 60 60 60 60 100

Arrow-Topiramate Topamax Arrow-Topiramate Topamax Arrow-Topiramate Topamax Arrow-Topiramate Topamax Topamax Topamax Sabril

¾SA1010 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: Either: 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 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. Note: 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 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. continued. . .

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NERVOUS SYSTEM

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

continued. . . 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 100

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 .........................................................................................38.83 1.55 (12.00) (22.00) Tab 100 mg .......................................................................................77.66 1.55 (12.00) (22.00) Inj 12 mg per ml, 0.5 ml – Hospital pharmacy [HP3]-Specialist .........80.00 Maximum of 10 inj per prescription (Sumagran Tab 50 mg to be delisted 1 May 2010) (Imigran Tab 50 mg to be delisted 1 May 2010) (Sumagran Tab 100 mg to be delisted 1 May 2010) (Imigran Tab 100 mg to be delisted 1 May 2010) 100 60 3 100 4

Cafergot Paramax Maxalt Melt Arrow-Sumatriptan

Sumagran Imigran Arrow-Sumatriptan Sumagran Imigran Imigran

100 2

2 OP

Prophylaxis of Migraine

For Beta Adrenoceptor Blockers refer to CARDIOVASCULAR SYSTEM, page 52 CLONIDINE HYDROCHLORIDE F Tab 25 µg ..........................................................................................19.25 PIZOTIFEN F Tab 500 µg ........................................................................................21.10

100 100

Dixarit Sandomigran

Antinausea and Vertigo Agents

For Antispasmodics refer to ALIMENTARY TRACT, page 27 APREPITANT – Special Authority see SA0987 on the next page – Retail pharmacy Cap 2 × 80 mg and 1 × 125 mg ....................................................116.00

3 OP

Emend Tri-Pack

‡ 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

¾SA0987 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing highly emetogenic chemotherapy and/or anthracycline-based chemotherapy for the treatment of malignancy. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing highly emetogenic chemotherapy and/or anthracycline-based chemotherapy for the treatment of malignancy. BETAHISTINE DIHYDROCHLORIDE F Tab 16 mg ...........................................................................................9.26 84 Vergo 16 CYCLIZINE HYDROCHLORIDE Tab 50 mg ...........................................................................................1.59 CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml .......................................................................14.95 10 5

Nausicalm Valoid (AFT)

DOMPERIDONE – Additional subsidy by Special Authority see SA0938 below – Retail pharmacy F Tab 10 mg ...........................................................................................3.90 100 (7.99)

Motilium

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] Patch 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.

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NERVOUS SYSTEM

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

PROCHLORPERAZINE F Tab 3 mg buccal .................................................................................5.97 (15.00) F Tab 5 mg – Up to 30 tab available on a PSO....................................16.85 F Inj 12.5 mg per ml, 1 ml – Up to 5 inj available on a PSO ................25.81 F Suppos 25 mg ..................................................................................23.87 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

50 Buccastem 500 10 5 10 Avomine

Antinaus Stemetil Stemetil

Navoban

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 .....................................................................110.00 BROMOCRIPTINE MESYLATE F Tab 2.5 mg .......................................................................................32.08 60 5 100

Symmetrel Apomine AlphaBromocriptine

F Cap 5 mg ..........................................................................................60.43 (Alpha-Bromocriptine Tab 2.5 mg to be delisted 1 June 2010) 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

100

Apo-Bromocriptine ApoBromocriptine S29

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 121

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 .................................47.50 F Tab 250 mg with carbidopa 25 mg ....................................................40.00 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.

NERVOUS SYSTEM

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

ROPINIROLE HYDROCHLORIDE L Tab 0.25 mg ........................................................................................7.90 L Tab 1 mg ...........................................................................................40.32 L Tab 2 mg ...........................................................................................60.72 L Tab 5 mg ...........................................................................................90.00 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

84 84 84 84 100

Ropin Ropin Ropin Ropin 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

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 on the next page – 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

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S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

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 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 ....................................................................17.65 Cap 250 mg ........................................................................................7.73 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 on the next page – Retail pharmacy Tab 2.5 mg ........................................................................................51.07 Tab 5 mg .........................................................................................101.21 Tab 10 mg .......................................................................................204.49 50 100 50 100 50 100 50 100 50 100 50 100 100 ml 100 100 100 100 ml 10 500 100 100 100 100 100 10 28 28 28

Clozaril Clozaril Clopine Clopine Clopine Clopine Clozaril Clozaril Clopine Clopine Clopine Clopine Clopine Serenace Serenace Serenace Serenace Serenace Lithicarb Lithicarb Priadel Douglas Nozinan Nozinan Nozinan Zyprexa Zyprexa Zyprexa

‡ 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

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 .........................................................................................16.78 46.20 Tab 100 mg .......................................................................................32.59 92.40 Tab 200 mg .......................................................................................56.70 158.76 Tab 300 mg .......................................................................................95.40 267.12 90 60 90 60 90 60 90 60

Quetapel Seroquel Quetapel Seroquel Quetapel Seroquel Quetapel Seroquel

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

RISPERIDONE Tab 0.5 mg ..........................................................................................3.51 5.20 15.60 5.20 Tab 1 mg .............................................................................................6.00

60 20 60 20 60

Apo-Risperidone Ridal Ridal Risperdal Apo-Risperidone Dr Reddy’s

Risperidone

30.77 Tab 2 mg ...........................................................................................11.00 60

Ridal Risperdal Apo-Risperidone Dr Reddy’s

Risperidone

61.53 Tab 3 mg ...........................................................................................15.00 60

Ridal Risperdal Apo-Risperidone Dr Reddy’s

Risperidone

92.32 Tab 4 mg ...........................................................................................20.00 60

Ridal Risperdal Apo-Risperidone Dr Reddy’s

Risperidone

123.05 Oral liq 1 mg per ml ..........................................................................18.35 45.92 TRIFLUOPERAZINE HYDROCHLORIDE Tab 1 mg .............................................................................................9.83 Tab 2 mg ...........................................................................................14.64 Tab 5 mg ...........................................................................................16.66 100 100 100 30 ml

Ridal Risperdal Apo-Risperidone Risperon Risperdal Stelazine Stelazine Stelazine

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 ZUCLOPENTHIXOL HYDROCHLORIDE Tab 10 mg .........................................................................................31.45 100

Clopixol

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 5 5 5

Fluanxol Fluanxol Fluanxol

‡ 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

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 below – 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 10 10 1 1 1

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

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: continued. . .

126

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S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

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

continued. . . 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. 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 ..........................................................................................3.15 50 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 500 µg ..........................................................................................4.10 50 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 1 mg .............................................................................................7.25 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.

‡ 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

DIAZEPAM Tab 2 mg – Month Restriction...........................................................11.44 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 5 mg – Month Restriction...........................................................13.71 ‡ Safety cap for extemporaneously compounded oral liquid preparations. LORAZEPAM – Month Restriction Tab 1 mg ...........................................................................................16.42 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 2.5 mg ........................................................................................11.17 ‡ Safety cap for extemporaneously compounded oral liquid preparations. OXAZEPAM – Month Restriction Tab 10 mg ...........................................................................................1.98 (5.89) ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 15 mg ...........................................................................................2.45 (8.13) ‡ Safety cap for extemporaneously compounded oral liquid preparations.

500 500

Arrow-Diazepam Arrow-Diazepam

250 100

Ativan Ativan

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: 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. . . experienced at least 2 signiﬁcant relapses of MS in the previous 12 months, and 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); 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

G G

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

‡ 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

Sedatives and Hypnotics

LORMETAZEPAM – Month Restriction Tab 1 mg .............................................................................................3.11 30 (23.50) Noctamid ‡ Safety cap for extemporaneously compounded oral liquid preparations. MIDAZOLAM Note: Midazolam injection will be funded if prescribed for intranasal administration for use in palliative care. Note that only the Hypnovel brand is currently indicated for intranasal administration. Tab 7.5 mg – Month Restriction........................................................10.38 100 (25.00) Hypnovel ‡ Safety cap for extemporaneously compounded oral liquid preparations. Inj 1 mg per ml, 5 ml .........................................................................10.75 10 Hypnovel (14.73) Pﬁzer Inj 5 mg per ml, 3 ml .........................................................................11.90 5 Hypnovel (19.64) Pﬁzer NITRAZEPAM – Month Restriction Tab 5 mg .............................................................................................2.00 (4.98) ‡ 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 Nitrados

Normison

100 Hypam 100 Hypam

500

Apo-Zopiclone

Other CNS Agents

ATOMOXETINE – Special Authority see SA0951 on the next page – 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

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

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 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. DEXAMPHETAMINE SULPHATE – Special Authority see SA0907 below – Retail pharmacy Only on a controlled drug form Tab 5 mg ...........................................................................................16.50 100 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 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.

131

NERVOUS SYSTEM

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

continued. . . 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.. 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 on the next page – 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

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

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: 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. 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.

133

NERVOUS SYSTEM

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

continued. . . 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. 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 Cap modiﬁed-release 10 mg ............................................................19.50 30 Ritalin LA Cap modiﬁed-release 20 mg ............................................................25.50 30 Ritalin LA 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.

134

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

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

Mayne ReVia

NALTREXONE HYDROCHLORIDE – Special Authority see SA0909 below – Retail pharmacy Tab 50 mg .......................................................................................180.00 30

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: 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.

135

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 .......................................................................20.00 Inj 10 mg per ml, 15 ml .....................................................................22.50 Inj 10 mg per ml, 45 ml .....................................................................55.00 Inj 10 mg per ml, 100 ml .................................................................120.00 Inj 1 mg for ECP .................................................................................0.15 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 Oxaliplatin Ebewe Eloxatin Oxaliplatin Ebewe Eloxatin Baxter

OXALIPLATIN – PCT only – Specialist – Special Authority see SA0900 on the next page Inj 50 mg ...........................................................................................65.00 1 200.00 Inj 100 mg .......................................................................................130.00 1 400.00 1 mg Inj 1 mg for ECP .................................................................................1.42

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

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.

137

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 (Fludara Tab 10 mg to be delisted 1 July 2010) 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

Mayne Pharmacia Mayne Mayne Mayne Baxter Baxter Fludara Fludara Oral Fludara Baxter

1 1 1 1 1 1 mg

Fluorouracil Ebewe Fluorouracil Ebewe Mayne Fluorouracil Ebewe Fluorouracil Ebewe Baxter

GEMCITABINE HYDROCHLORIDE – PCT only – Specialist – Special Authority see SA0877 on the next page 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

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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

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. IRINOTECAN – PCT only – Specialist – Special Authority see SA0878 below Inj 20 mg per ml, 2 ml .....................................................................124.00 1 Camptosar Inj 20 mg per ml, 5 ml .....................................................................310.00 1 Camptosar Inj 1 mg for ECP .................................................................................3.19 1 mg 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 30 50 5 5 1 1 1 1 mg 5 mg OP

Methoblastin Methoblastin Mayne Mayne Mayne Methotrexate Ebewe Methotrexate Ebewe Baxter 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.

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

THIOGUANINE – PCT – Hospital pharmacy [HP3]-Specialist Tab 40 mg .........................................................................................97.16

Lanvis

Other Cytotoxic Agents

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

Amsidine S29

ANAGRELIDE HYDROCHLORIDE – PCT only – Specialist – Special Authority see SA0879 below Cap 0.5 mg .......................................................................................CBS 100 Agrylin S29 Teva S29 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 ....................................................................................120.00 680.00 Inj 1,000 iu for ECP ............................................................................9.28 (Blenoxane Inj 15,000 iu to be delisted 1 June 2010) 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 1 10 1,000 iu

DBL Bleomycin

Sulfate

Blenoxane Baxter

1 10,000 iu OP 1 200 mg OP 1 0.5 mg OP 1 1 20 mg OP

Leunase Baxter Mayne Baxter Cosmegen Baxter Pﬁzer S29 Mayne Baxter Docetaxel Ebewe Taxotere Docetaxel Ebewe Taxotere Baxter

DOCETAXEL – PCT only – Specialist – Special Authority see SA0880 on the next page Inj 20 mg .........................................................................................325.00 1 460.00 Inj 80 mg ......................................................................................1,300.00 1 1,650.00 Inj 1 mg for ECP ...............................................................................23.81 1 mg

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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

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: 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 1 1 1 1 1 mg 20 10 1 10 1 mg

Epirubicin Ebewe Epirubicin Ebewe Epirubicin Ebewe Epirubicin Ebewe Baxter Vepesid Vepesid Mayne Vepesid 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.

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

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 ........................................................................................115.00 Cap 10 mg ......................................................................................144.50 Inj 5 mg ...........................................................................................170.00 Inj 10 mg .........................................................................................340.00 Inj 1 mg for ECP ...............................................................................37.74 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 .........................................................................................808.00 Inj 1 mg for ECP ...............................................................................16.13 MITOZANTRONE – PCT only – Specialist Inj 2 mg per ml, 5 ml .......................................................................110.00 Inj 2 mg per ml, 10 ml .....................................................................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 .........................................................................................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

1 1 mg 100 1 1 1 1 1 mg 50 50 15 15 1 mg 10 5 1 mg 1 1 1 1 mg 5 1 1 1 1 1 mg 1 50

Etopophos Baxter Hydrea Zavedos Zavedos Zavedos Zavedos Baxter 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 Baxter Nipent S29 Natulan S29 Temodal Temodal Temodal Temodal

TEMOZOLOMIDE – Special Authority see SA0831 on the next page – Hospital pharmacy [HP3] Cap 5 mg ..........................................................................................50.00 5 Cap 20 mg ......................................................................................170.00 5 Cap 100 mg ....................................................................................840.00 5 Cap 250 mg .................................................................................2,100.00 5

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ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

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 (Vumon Inj 10 mg per ml, 5 ml to be delisted 1 May 2010) (Baxter Inj 50 mg for ECP to be delisted 1 May 2010) THALIDOMIDE – PCT only – Specialist – Special Authority see SA0882 below Only on a controlled drug form Cap 50 mg ......................................................................................490.00

Thalidomide

Pharmion

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 5 1 mg 5 5 1 mg

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

VINORELBINE – PCT only – Specialist – Special Authority see SA0901 on the next page Inj 10 mg per ml, 1 ml .......................................................................24.00 1 42.00 Inj 10 mg per ml, 5 ml .....................................................................120.00 1 210.00 Inj 1 mg for ECP .................................................................................2.71 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.

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

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 below Tab 20 mg ....................................................................................3,774.06 Tab 50 mg ....................................................................................6,214.20 Tab 70 mg ....................................................................................7,692.58 Tab 100 mg ..................................................................................6,214.20 60 60 60 30

Sprycel Sprycel Sprycel Sprycel

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 continued. . .

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ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 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. 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).

‡ 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.

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

Aromatase Inhibitors

ANASTROZOLE Tab 1 mg ...........................................................................................26.55 29.50 30

Arimidex DP-Anastrozole

EXEMESTANE – Additional subsidy by Special Authority see SA1000 below – Retail pharmacy Note: Repeat dispensings for Aromasin will be fully subsidised where the initial dispensing was before 1 February 2010 Tab 25 mg .........................................................................................26.55 30 (175.00) Aromasin ¾SA1000 Special Authority for Alternate Subsidy Initial application from any relevant practitioner. 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 breast cancer; and 3 Any of the following: 3.1 The patient was receiving funded exemestane prior to 1 February 2010; or 3.2 The patient has advanced breast cancer and a very clear history of intolerance to anastrozole or letrozole; or 3.3 The patient has advanced breast cancer and disease has progressed following treatment with anastrozole or letrozole. Renewal from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the treatment remains appropriate and the patient is beneﬁtting from treatment. LETROZOLE Tab 2.5 mg ........................................................................................26.55 30 Letara (146.46) Femara (Femara Tab 2.5 mg to be delisted 1 July 2010)

Endocrine Therapy

For GnRH ANALOGUES – refer to HORMONE PREPARATIONS, Trophic Hormones, page 80 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. FLUTAMIDE – Hospital pharmacy [HP3]-Specialist Tab 250 mg .......................................................................................48.30 100 Flutamin MEGESTROL ACETATE – Retail pharmacy-Specialist Tab 160 mg .......................................................................................57.92 74.25 30

Apo-Megestrol Megace

OCTREOTIDE (SOMATOSTATIN ANALOGUE) – Special Authority see SA0563 on the next page – Hospital pharmacy [HP3] 5 Hospira Inj 50 µg per ml, 1 ml ........................................................................25.65 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 Inj LAR 10 mg preﬁlled syringe ...................................................1,772.50 1 Sandostatin LAR Inj LAR 20 mg preﬁlled syringe ...................................................2,358.75 1 Sandostatin LAR Inj LAR 30 mg preﬁlled syringe ...................................................2,951.25 1 Sandostatin LAR

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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

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 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 .........................................................................................26.75 25.00 (34.90) F Inj 50 mg .....................................................................