Schedule Update - effective 1 December 2010 (text extract)

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Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 December 2010

Cumulative for September, October, November and December 2010 Section H for December 2010

Contents

Summary of PHARMAC decisions effective 1 December 2010 ....................... 3 Rivaroxaban – new listing.............................................................................. 5 Moxifloxacin – new listing ............................................................................. 5 Multiple sclerosis treatments – widening of access ....................................... 5 Temozolamide – widening of access .............................................................. 6 New fibrate lipid modifying agent subsidised ............................................... 6 Two new selective serotonin reuptake inhibitors (SSRI) antidepressants subsidised ............................................................................ 6 New bases for extemporaneously compounded oral liquids ......................... 7 Varenicline (Champix) Special Authority clarification..................................... 7 Tracking medicine funding applications ........................................................ 8 Tender News .................................................................................................. 9 Looking Forward ........................................................................................... 9 Sole Subsidised Supply products cumulative to December 2010 ................. 11 New Listings ................................................................................................ 20 Changes to Restrictions ............................................................................... 30 Changes to Subsidy and Manufacturer’s Price............................................. 61 Changes to General Rules............................................................................ 69 Changes to Brand Name ............................................................................. 69 Changes to Section E Part I ......................................................................... 70 Changes to Sole Subsidised Supply ............................................................. 70 Delisted Items ............................................................................................. 71 Items to be Delisted .................................................................................... 75 Section H changes to Part II ........................................................................ 79 Index ........................................................................................................... 82

Summary of PharmaC decisions

effeCtive 1 DeCemBer 2010 New listings (pages 20-21) • Rivaroxaban (Xarelto) tab 10 mg – Special Authority – Retail pharmacy • Gemfibrozil (Lipazil) tab 600 mg • Menthol (Midwest) crystals, 25 g – Only in combination • Sulphur (Midwest) precipitated 100 g – Only in combination • Moxifloxacin (Avelox) tab 400 mg – Special Authority – Retail pharmacy • Itraconazole (Itrazole) cap 100 mg – Retail pharmacy-Specialist • Escitalopram (Loxalate) tab 10 mg and 20 mg • Sertraline (Arrow-Sertraline) tab 50 mg and 100 mg • Glycerin with sucrose (Ora-Sweet) suspension – Only in combination with OraPlus • Glycerin with sodium saccharin (Ora-Sweet SF) suspension – Only in combination with Ora-Plus • Methyl hydroxybenzoate (Midwest) powder, 25 g • Methylcellulose with glycerin and sucrose (Ora-Blend) suspension – Only in combination • Methylcellulose with glycerin and sodium saccharin (Ora-Blend SF) suspension – Only in combination • Methylcellulose (Ora-Plus) suspension – Only in combination • Propylene glycol (Midwest) liq, 500 ml – Only in extemporaneously compounded methyl hydroxybenzoate 10% solution • Sodium bicarbonate (Midwest) powder BP, 500 g – Only in extemporaneously compounded omeprazole suspension Changes to restrictions (pages 30-33) • Levomepromazine – chemical name change from methotrimeprazine • Multiple Sclerosis Treatments – amended stopping criteria • Temozolomide (Temodal) cap 5 mg, 20 mg, 100 mg and 250 mg – amended Special Authority criteria Decreased subsidy (pages 61-62) • Loperamide hydrochloride (Nodia) tab 2 mg • Cilazapril (Inhibace) tab 0.5 mg, 2.5 mg and 5 mg • Labetalol (Hybloc) tab 50 mg, 100 mg and 200 mg • Propranolol (Cardinol LA) cap long-acting 160 mg • Nifedipine (Adefin XL) tab long-acting 30 mg and 60 mg • Isosorbide mononitrate (Duride) tab long-acting 60 mg • Menthol (PSM) crystals, 25 g

Summary of PharmaC decisions – effective 1 December 2010 (continued) • Amoxycillin (Apo-Amoxi) cap 250 mg and 500 mg • Naproxen sodium tab 275 mg (Sonaflam) and tab 550 mg (Synflex) • Interferon beta-1-beta (Betaferon) inj 8 million iu per 1 ml • Carboplatin (Carboplatin Ebewe) inj 10 mg per ml, 45 ml and 100 ml • Oxaliplatin inj 50 mg and 100 mg (Oxaliplatin Ebewe) and inj 1 mg for ECP (Baxter) • Calcium folinate (Calcium Folinate Ebewe) inj 1 g • Methotrexate inj 100 mg per ml, 10 ml and 50 ml (Methotrexate Ebewe) and inj 1 mg for ECP (Baxter) • Doxorubicin (Doxorubicin Ebewe) inj 100 mg and 200 mg • Epirubicin inj 2 mg per ml, 50 ml and 100 ml (Epirubicin Ebewe) and inj 1 mg for ECP (Baxter) • Paclitaxel inj 30 mg, 100 mg, 150 mg, 300 mg and 600 mg (Paclitaxel Ebewe) and inj 1 mg for ECP (Baxter) • Chloramphenicol (Chlorsig) eye drops 0.5% • Methyl hydroxybenzoate (PSM) powder, 25 g • Propylene glycol (PSM) liq, 500 ml increased subsidy (pages 61-62) • Chlorhexidine gluconate (Rivacol) mouthwash 0.2% • Doxorubicin inj 10 mg and 50 mg (Doxorubicin Ebewe) and inj 1 mg for ECP (Baxter)

Pharmaceutical Schedule - Update News

Rivaroxaban – new listing

The Xarelto brand of rivaroxaban 10 mg tablets will be fully subsidised from 1 December 2010. Rivaroxaban is an oral anticoagulant and will be subsidised subject to Special Authority criteria for the prophylaxis of venous thromboembolism following major orthopaedic surgery. Rivaroxaban will be subsidised for up to 5 weeks therapy for prophylaxis of venous thromboembolism following a total hip replacement and up to 2 weeks therapy for prophylaxis of venous

thromboembolism following a total knee replacement.

Moxifloxacin – new listing

Moxifloxacin 400 mg tablets (Avelox) will be listed fully subsidised from 1 December 2010 for use in treatment-resistant mycobacterial infections including tuberculosis. Special Authority criteria apply, see page 20 of this Update for full details.

Multiple sclerosis treatments – widening of access

The Stopping Criteria that apply to prescribing and dispensing of funded multiple sclerosis treatments (glatiramer acetate, interferon beta-1-alpha and interferon beta1-beta) have been amended to include options for patients meeting certain criteria to stay on treatment for longer or to switch to a second class of treatment following an increase in relapse rate from the first class of treatment. See page 30 of this Update.

Pharmaceutical Schedule - Update News

Temozolamide – widening of access

From 1 December 2010 funded access to temozolomide capsules (5 mg, 20 mg, 100 mg and 250 mg) will be widened to include patients with newly diagnosed anaplastic astrocytoma. We note that temozolomide is not approved by Medsafe for the treatment of patients with newly diagnosed anaplastic astrocytoma. Therefore, in this setting clinicians are required to prescribe temozolomide in accordance with Section 25 of the Medicines Act. This is not an unusual situation for cancer treatments. See page 31 of this Update for the full Special Authority criteria.

New fibrate lipid modifying agent subsidised

Lipazil (gemfibrozil) 600 mg tablets will be fully subsidised without restriction from 1 December 2010. Gemfibrozil is a fibrate lipid modifying agent.

Two new selective serotonin reuptake inhibitors (SSRI) antidepressants subsidised

Two further SSRI antidepressants will be subsidised from 1 December 2010. Escitalopram (Loxalate) 10 mg and 20 mg tablets and sertraline (Arrow-Sertraline) 50 mg and 100 mg tablets will be fully subsidised without restriction.

Pharmaceutical Schedule - Update News

New bases for extemporaneously compounded oral liquids

A range of liquid bases for use in extemporaneously compounded oral mixtures will be subsidised from 1 December 2010. Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet and Ora-Sweet SF, supplied by Midwest Pharmaceuticals, will be listed with the “Only in Combination” restriction. This means that they will be able to used as a suspending base in the preparation of oral liquid mixtures where compounding is appropriate. PHARMAC encourages pharmacists to use the evidence based information provided on the Emixt website (http://www. pharminfotech.co.nz/manual/Formulation/ mixtures/index.htm). The Emixt website also provides stability and expiry data for compounded products. For the majority of products compounded with Ora-Blend, OraBlend SF, Ora-Plus, Ora-Sweet or Ora-Sweet SF a four week expiry is appropriate. Where a Standard Formula exists in the Pharmaceutical Schedule for a solid dose form, compounding the solid dose form with one of the Ora products will not be subsidised.

Varenicline (Champix) Special Authority clarification

Champix tablets were listed fully subsidised as a smoking cessation treatment, subject to Special Authority criteria, from 1 November 2010. One of the Special Authority criteria refers to patients not having used varenicline in the last 12 months (criterion 4). We would like to clarify that this means patients must not have used subsidised varenicline in the last 12 months. This criterion has already been amended on the Special Authority form.

Pharmaceutical Schedule - Update News

Tracking medicine funding applications

PHARMAC has launched a new online tool that will give people a look inside PHARMAC’s evaluation of medicine funding applications. The Application Tracker, available on the PHARMAC website (www.pharmac.govt.nz) conveniently brings together information on the medicines PHARMAC is considering for funding. The information included in the Tracker is all information that is currently published and publically available. The Tracker enables people to search for medicines by brand name, pharmaceutical name or condition, or the name of the applicant. It provides information on when the application was received, what condition the funding request was for, the status of the application (e.g. referred to committee, approved) when PHARMAC had completed sufficient assessment, when it was considered by Pharmacology Therapeutics Advisory Committee (PTAC) and the relevant PTAC sub-

committee and the recommendation of PTAC or the sub-committee, when any consultation was done and the date of notification. It also provides links to documents like PTAC minutes, or consultation letters relevant to the application. At present the Tracker contains data dating back to 2008 however older information will be included in future. PHARMAC welcomes feedback on ways to further develop this tool.

tender News

Sole Subsidised Supply changes – effective 1 January 2011

Chemical Name Aciclovir Aciclovir Aciclovir Ascorbic acid Azathioprine Ceftriaxone sodium Indapamide Ipratropium bromide Ipratropium bromide Lorazepam Lorazepam Malathion Mercaptopurine Sodium citrate with sodium lauryl sulphoacetate Terazosin hydrochloride Terazosin hydrochloride Terazosin hydrochloride Presentation; Pack size Tab dispersible 200 mg; 25 tab Tab dispersible 400 mg; 56 tab Tab dispersible 800 mg; 35 tab Tab 100 mg; 500 tab Tab 50 mg; 100 tab Inj 1 g; 5 inj Tab 2.5 mg; 90 tab Nebuliser soln, 250 µg per ml, 1 ml; 20 neb Nebuliser soln, 250 µg per ml, 2 ml; 20 neb Tab 1 mg; 250 tab Tab 2.5 mg; 250 tab Liq 0.5%; 200 ml OP Tab 50 mg; 25 tab Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml; 50 enema Tab 1 mg; 28 tab Tab 2 mg; 28 tab Tab 5 mg; 28 tab Sole Subsidised Supply brand (and supplier) Lovir (Douglas) Lovir (Douglas) Lovir (Douglas) Vitala-C (Boucher and Muir) Imuprine (Mylan) Aspen Ceftriaxone (Aspen) Dapa-Tabs (Mylan) Univent (Rex) Univent (Rex) Ativan (Sigma) Ativan (Sigma) A-Lices (AFT) Purinethol (Aspen) Micolette (AFT) Arrow (Arrow) Arrow (Arrow) Arrow (Arrow)

Looking forward

This section is designed to alert both pharmacists and prescribers to possible future changes to the Pharmaceutical Schedule. It may also assist pharmacists, distributors and wholesalers to manage stock levels. Possible decisions for implementation 1 January 2011 • Brand Switch Fees – azathioprine tab, indapamide tab, ipratropium bromide neb, and terazosin hydrochloride tab • Dermatological bases list in Section C – remove oily cream and zinc cream BP as these are being delisted • Elemental formula (Neocate and Neocate LCP) 400 g OP – subsidy decrease • Influenza vaccine (Fluvax, Fluarix) inj, 10 inj packs – new listing under current criteria • Nicotine (Habitrol) loz 1 mg and 2 mg, 216 piece packs – new listing • Nicotine (Habitrol) loz 1 mg and 2 mg, 36 piece packs – to be delisted from 1 April 2011

Possible decisions for implementation 1 January 2011 (continued) • Nicotine (Habitrol) patch 7 mg, 14 mg, 21 mg, 28 patch packs – new listing • Nicotine (Habitrol) patch 7 mg, 14 mg, 21 mg, 7 patch packs – to be delisted from 1 April 2011 • Nicotine (Habitrol) gum (classic) 2 mg and 4 mg, 96 piece packs – new listing • Nicotine – all presentations – remove original pack (OP) • Nicotine – all presentations – remove all dispensing rules that currently apply (with the exception of the rule that Nicotine will not be funded Close Control in amounts less than 4 weeks, which will be retained) • Raltegravir potassium (Isentress) tab 400 mg – price and subsidy decrease • Sildenafil (Viagra) tab 25 mg, 50 mg and 100 mg – amended Special Authority criteria • Sodium chloride (Multichem) inj 0.9%, 5 ml and 10 ml – new listing

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Acarbose Acetazolamide Allopurinol Amantadine hydrochloride Amoxycillin

Presentation

Tab 50 mg & 100 mg Tab 250 mg Tab 100 mg & 300 mg Cap 100 mg Grans for oral liq 250 mg per 5 ml Drops 125 mg per 1.25 ml Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml Tab amoxycillin 500 mg with potassium clavulanate 125 mg Crm 500 g Tab 100 mg Tab dispersible 300 mg Tab 50 mg & 100 mg Inj 600 µg, 1 ml Inj 50 mg Tab 500 mg Tab 10 mg Tab 2.5 mg & 5 mg Inj 1 mega u Scalp app 0.1% Tab 200 mg Tab 50 mg Tab 5 mg Eye drops 0.2% Crm, aqueous, BP Lotn, BP Inj 100 iu per ml, 1 ml Cap 0.25 µg & 0.5 µg Tab 1.25 g (500 mg elemental) Tab 1.5 g (600 mg elemental) Tab eff 1.7 g (1 g elemental) Inj 50 mg

Brand Name Expiry Date*

Glucobay Diamox Apo-Allopurinol Symmetrel Ospamox Ospamox Paediatric Drops Curam Curam Synermox AFT Ethics Aspirin EC Ethics Aspirin Atenolol Tablet USP AstraZeneca Imuran Arrow-Azithromycin Pacifen ArrowBendrofluazide Sandoz Beta Scalp Fibalip Bicalox Lax-Tab AFT healthE API Miacalcic Airflow Calci-Tab 500 Calci-Tab 600 Calsource Calcium Folinate Ebewe 2011 2011 2013 2012 2012 2013 2012 2012 2011 2011 2012 2011 2011 2013 2011 2012 2011 2012 2011 2012 2011 2011 2011 2012 2011 2012

Amoxycillin clavulanate

Aqueous cream Aspirin Atenolol Atropine sulphate Azathioprine Azithromycin Baclofen Bendrofluazide Benzylpenicillin sodium (Penicillin G) Betamethasone valerate Bezafibrate Bicalutamide Bisacodyl Brimonidine tartrate Calamine Calcitonin Calcitriol Calcium carbonate

Calcium folinate

2011

*Expiry date of the Sole Subsidised Supply period is 30 June of the year indicated unless otherwise stated. Please note that Sole Subsidised Supply may have been awarded for a wider scope than just those presentation(s) listed in the above table.

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Captopril Cefaclor monohydrate Cefazolin sodium Cefuroxime sodium Cephalexin monohydrate Cetirizine hydrochloride Cetomacrogol Chloramphenicol Chlorhexidine gluconate Ciclopiroxolamine Cilazapril with hydrochlorothiazide Ciprofloxacin Citalopram Clobetasol propionate

Presentation

Oral liq 5 mg per ml Grans for oral liq 125 mg per 5 ml Inj 500 mg & 1 g Inj 750 mg & 1.5 g Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Tab 10 mg Oral liq 1 mg per ml Crm BP Eye oint 1% Handrub 1% with ethanol 70% Soln 4% Nail soln 8% Tab 5 mg with hydrochlorothiazide 12.5 mg Tab 250 mg, 500 mg & 750 mg Tab 20 mg Crm 0.05% Oint 0.05% Scalp app 0.05% Tab 500 µg & 2 mg TDDS 2.5 mg, 100 µg per day TDDS 5 mg, 200 µg per day TDDS 7.5 mg, 300 µg per day Inj 150 µg per ml, 1 ml Tab 25 µg Tab 150 µg Vaginal crm 1% with applicator Vaginal crm 2% with applicator Crm 1% Soln BP Tab 500 µg Crm 10% Tab 50 mg Tab 50 mg Tab 50 mg & 100 mg Tab 2 mg with ethinyloestradiol 35 µg and 7 inert tabs Nasal spray 10 µg per dose Eye drops 0.1%

Brand Name Expiry Date*

Capoten Ranbaxy-Cefaclor Hospira Zinacef Cefalexin Sandoz Cefalexin Sandoz Zetop Cetirizine-AFT PSM Chlorsig healthE Orion Batrafen Inhibace Plus Rex Medical Arrow-Citalopram Dermol Dermol Dermol Paxam Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Catapres Dixarit Catapres Clomazol Clomazol Clomazol Midwest Colgout Itch-Soothe Nausicalm Cycloblastin Siterone Ginet 84 Desmopressin-PH&T Maxidex 2013 2013 2011 2011 2012 2011 2013 2012 2012 2011 2012 2013 2011 2011 2012

Clonazepam Clonidine

2011 2012

Clonidine hydrochloride

2012

Clotrimazole

2013 2011 2013 2013 2012 2012 2013 2012 2011 2011 2013

Coal tar Colchicine Crotamiton Cyclizine hydrochloride Cyclophosphamide Cyproterone acetate Cyproterone acetate with ethinyloestradiol Desmopressin Dexamethasone

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Dexamethasone sodium phosphate Dextrose Dextrose with electrolytes

Presentation

Inj 4 mg per ml, 1 ml & 2 ml Inj 50%, 10 ml Soln with electrolytes

Brand Name Expiry Date*

Hospira Biomed Pedialyte – Fruit Pedialyte – Bubblegum Pedialyte – Plain Diclofenac Sandoz Voltaren Ophtha Voltaren Voltaren DHC Continus Dilzem Cardizem CD Pytazen SR Laxofast 50 Laxofast 120 Laxsol Donepezil-Rex AFT Arrow-Enalapril Clexane Comtan E-Mycin E-Mycin E-Mycin NZ Medical and Scientific Arrow-Etidronate Felo 5 ER Felo 10 ER Ferodan Fintral AFT AFT AFT Flucloxin Pacific 2013 2011 2013

Diclofenac sodium

Tab EC 25 mg & 50 mg Eye drops 1 mg per ml Inj 25 mg per ml, 3 ml Suppos 12.5 mg, 25 mg, 50 mg & 100 mg Tab long-acting 60 mg Tab 30 mg & 60 mg Cap long-acting 120 mg, 180 mg & 240 mg Tab long-acting 150 mg Cap 50 mg Cap 120 mg Tab 50 mg with total sennosides 8 mg Tab 5 mg & 10 mg Oint BP Tab 5 mg, 10 mg & 20 mg Inj 20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg & 150 mg Tab 200 mg Tab 400 mg Grans for oral liq 200 mg per 5 ml Grans for oral liq 400 mg per 5 ml Tab 10 µg Tab 200 mg Tab long-acting 5 mg Tab long-acting 10 mg Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml) Tab 5 mg Cap 250 mg & 500 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Inj 250 mg, 500 mg & 1 g Cap 50 mg, 150 mg & 200 mg

2012 2011

Dihydrocodeine tartrate Diltiazem hydrochloride

2013 31/12/11

Dipyridamole Docusate sodium Docusate sodium with sennosides Donepezil hydrochloride Emulsifying ointment Enalapril Enoxaparin sodium (low molecular weight heparin) Entacapone Erythromycin ethyl succinate

2011 2011 2013 2012 2011 2012 2012 2012 2012 2011 2012 2012 2012 2013 2011 2012 2011 2011

Ethinyloestradiol Etidronate disodium Felodipine Ferrous sulphate Finasteride Flucloxacillin sodium

Fluconazole

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Fludarabine phosphate Fluorometholone Fluoxetine hydrochloride Flutamide Fluticasone propionate Furosemide Fusidic acid Gabapentin Gentamicin sulphate Gliclazide Glipizide Glycerol Glyceryl trinitrate

Presentation

Inj 50 mg Tab 10 mg Eye drops 0.1% Cap 20 mg Tab dispersible 20 mg, scored Tab 250 mg Metered aqueous nasal spray, 50 µg per dose Tab 40 mg Crm 2% Oint 2% Cap 100 mg, 300 mg & 400 mg Inj 40 mg per ml, 2 ml Tab 80 mg Tab 5 mg Liquid Tab 600 µg Oral pump spray 400 µg per dose TDDS 5 mg & 10 mg

Brand Name Expiry Date*

Fludara Fludara Oral FML Fluox Fluox Flutamin Flixonase Hayfever & Allergy Diurin 40 Foban Foban Nupentin Pfizer Apo-Gliclazide Minidiab healthE Lycinate Nitrolingual Pumpspray Nitroderm TTS Serenace Serenace Serenace Solu-Cortef Douglas ABM PSM Colifoam Micreme H DP Lotn HC ABM Hydroxocobalamin Plaquenil Methopt Buscopan Gastrosoothe Fenpaed Ethics Ibuprofen 2011 2012 2013 2013 31/1/13 2012 2013 31/7/12 2012 2011 2011 2013 2011

Haloperidol

Inj 5 mg per ml, 1 ml Oral liq 2 mg per ml Tab 500 µg, 1.5 mg & 5 mg Inj 50 mg per ml, 1 ml Tab 5 mg & 20 mg Powder Crm 1% Rectal foam 10%, CFC-free (14 applications) Crm 1% with miconazole nitrate 2% Lotn 1% with wool fat hydrous 3% and mineral oil Inj 1 mg per ml, 1 ml Tab 200 mg Eye drops 0.5% Inj 20 mg, 1 ml Tab 20 mg Oral liq 100 mg per 5 ml Tab 200 mg

2013

Hydrocortisone

2013 2012 2011 2012 2013 2011 2012 2012 2011 2011 2013 2012

Hydrocortisone acetate Hydrocortisone with miconazole Hydrocortisone with wool fat and mineral oil Hydroxocobalamin Hydroxychloroquine sulphate Hypromellose Hysocine N-butylbromide Ibuprofen

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Iron polymaltose Isotretinoin Ketoconazole Lamivudine Latanoprost Letrozole Levonorgestrel Lignocaine hydrochloride Lignocaine with prilocaine

Presentation

Inj 50 mg per ml, 2 ml Cap 10 mg & 20 mg Shampoo 2% Oral liq 10 mg per ml Tab 150 mg Eye drops 50 µg per ml Tab 2.5 mg Subdermal implant (2 x 75 mg rods) Inj 1%, 5 ml & 20 ml Crm 2.5% with prilocaine 2.5% (5 g tubes) Crm 2.5% with prilocaine 2.5%; 30 g OP Tab 5 mg, 10 mg & 20 mg Oral liq 1 mg per ml Tab 10 mg Shampoo 1% Device Tab 100 mg Tab 135 mg Tab 160 mg Enema 1 g per 100 ml Tab immediate-release 500 mg & 850 mg Tab 5 mg Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Inj 25 mg per ml, 2 ml & 20 ml Tab 2.5 mg & 10 mg Inj 100 mg per ml, 10 ml Inj 100 mg per ml, 50 ml Tab 125 mg, 250 mg & 500 mg Tab 4 mg & 100 mg Inj 40 mg per ml, 1 ml Inj 40 mg per ml with lignocaine 1 ml

Brand Name Expiry Date*

Ferrum H Oratane Sebizole 3TC 3TC Hysite Letara Jadelle Xylocaine EMLA EMLA Arrow-Lisinopril Lorapaed Loraclear Hayfever Relief A-Lices Foremount Child’s Silicone Mask De-Worm Colofac Apo-Megestrol Pentasa Apotex Methatabs Biodone Biodone Forte Biodone Extra Forte Hospira Methoblastin Methotrexate Ebewe Methotrexate Ebewe Prodopa Medrol Depo-Medrol Depo-Medrol with Lidocaine 2012 2013 2011 2012 2011 2013 2012 2012 31/12/13 2013 2013

Lisinopril Loratadine

Malathion Mask for Spacer Device Mebendazole Mebeverine hydrochloride Megestrol acetate Mesalazine Metformin hydrochloride Methadone hydrochloride

2013 30/9/11 2011 2011 2012 2012 2012 2013 2012

Methotrexate

2013 2012 2011 2011 2012 2011 2011

Methyldopa Methylprednisolone Methylprednisolone acetate Methylprednisolone acetate with lignocaine

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Methylprednisolone sodium succinate

Presentation

Inj 40 mg per ml, 1 ml Inj 62.5 mg per ml, 2 ml Inj 500 mg Inj 1 g Inj 5 mg per ml, 2 ml Crm 2% Tab 150 mg & 300 mg Crm 0.1% Oint 0.1% Oral liq 1 mg per ml Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Cap long-acting 10 mg, 30 mg, 60 mg & 100 mg Tab immediate release 10 mg & 20 mg Inj 10 mg per ml, 1 ml Inj 30 mg per ml, 1 ml Inj 80 mg per ml, 1.5 ml & 5 ml Tab 250 mg Tab 500 mg Oral suspension 10 mg per ml Tab 200 mg

Brand Name Expiry Date*

Solu-Medrol Solu-Medrol Solu-Medrol Solu-Medrol Pfizer Multichem Apo-Moclobemide m-Mometasone m-Mometasone RA-Morph RA-Morph RA-Morph RA-Morph m-Elson Sevredol Mayne Mayne Hospira Noflam 250 Noflam 500 Viramune Suspension Viramune Noriday 28 Primolut N Norpress Nilstat Nilstat Nilstat Dr Reddy’s Omeprazole Dr Reddy’s Omeprazole Syntocinon Syntocinon Syntometrine Pamisol Pamisol Pamisol Dr Reddy’s Pantoprazole 2012

Metoclopramide hydrochloride Miconazole nitrate Moclobemide Mometasone furoate Morphine hydrochloride

2011 2011 2012 2012 2012

Morphine sulphate

2013 2012 2011 2013 2012 2012

Morphine tartrate Naproxen Nevirapine

Norethisterone Nortriptyline hydrochloride Nystatin

Tab 350 µg Tab 5 mg Tab 10 mg & 25 mg Cap 500,000 u Tab 500,000 u Oral liq 100,000 u per ml, 24 ml OP Cap 10 mg, 20 mg & 40 mg Inj 40 mg

2012 2011 2011 2013 2011 2011

Omeprazole

Oxytocin

Inj 5 iu per ml, 1 ml Inj 10 iu per ml, 1 ml Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml Inj 3 mg per ml, 5 ml Inj 3 mg per ml, 10 ml Inj 6 mg per ml, 10 ml Tab 20 mg & 40 mg

2012

Pamidronate disodium

2011

Pantoprazole

2013

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Paracetamol

Presentation

Tab 500 mg Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml Tab paracetamol 500 mg with codeine phosphate 8 mg Eye oint with soft white paraffin Tab 20 mg Low range and Normal range Inj 135 µg prefilled syringe Inj 180 µg prefilled syringe Inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 Inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 Inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 Inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 Tab 0.25 mg & 1 mg Lotn 5% Cap potassium salt 250 mg & 500 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Tab 5 mg, 10 mg & 15 mg Tab 15 mg, 30 mg & 45 mg Tab 500 µg Oral drops 10% Eye drops 1.4% Eye drops 3% Tab long-acting 600 mg Tab 1 mg, 2.5 mg, 5 mg & 20 mg Oral liq 5 mg per ml Cassette Inj 1.5 mega u Oral liq 5 mg per 5 ml Tab 10 mg & 25 mg

Brand Name Expiry Date*

Pharmacare Paracare Junior Paracare Double Strength ParaCode Lacri-Lube Loxamine Breath-Alert Pegasys Pegasys Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Permax A-Scabies Cilicaine VK AFT AFT Apo-Pindolol Pizaccord Sandomigran Coloxyl Vistil Vistil Forte Span-K Apo-Prednisone Redipred Innovacon hCG One Step Pregnancy Test Cilicaine Promethazine Winthrop Elixir Allersoothe Accupril 2012 2012 2012 2011 2011 2012 2011 2012 2012 2011 2012 2011 2011 2011

Paracetamol with codeine Paraffin liquid with soft white paraffin Paroxetine hydrochloride Peak Flow Meter Pegylated interferon alpha-2A

2011 2013 2013 30/9/11 31/12/12

Pergolide Permethrin Phenoxymethylpenicillin (Pencillin V)

2011 2011 2013

Pindolol Pioglitazone Pizotifen Poloxamer Polyvinyl alcohol Potassium chloride Prednisone Prednisone sodium phosphate Pregnancy tests – hCG urine Procaine penicillin Promethazine hydrochloride

Quinapril

Tab 5 mg, 10 mg & 20 mg

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Quinapril with hydrochlorothiazide

Presentation

Tab 10 mg with hydrochlorothiazide 12.5 mg Tab 20 mg with hydrochlorothiazide 12.5 mg Tab 300 mg Cap 150 mg Tab 0.25 mg, 1 mg, 2 mg & 5 mg Tab 150 mg & 300 mg Oral liq 2 mg per 5 ml Nebuliser soln, 1 mg per ml, 2.5 ml Nebuliser soln, 2 mg per ml, 2.5 ml Nebuliser soln, 2.5 mg with ipratopium bromide 0.5 mg per vial, 2.5 ml Tab 5 mg Tab 10 mg Tab 20 mg Tab 40 mg Tab 80 mg Inj 23.4%, 20 ml Grans effervescent 4 g sachets Nasal spray, 4% Inj cartridge 16 iu (5.3 mg) Inj cartridge 36 iu (12 mg) Tab 80 mg & 160 mg 230 ml Tab 25 mg & 100 mg Tab 50 mg & 100 mg Cap 400 µg Soln 2.3% Tab 10 mg Tab 250 mg Inj long-acting 100 mg per ml, 10 ml Cap 40 mg Inj 250 µg Inj 1 mg per ml, 1 ml Tab 10 mg Eye drops 0.25% & 0.5% Cap 50 mg

Brand Name Expiry Date*

Accuretic 10 Accuretic 20 Q 300 Mycobutin Ropin ArrowRoxithromycin Salapin Asthalin Asthalin Duolin 2012 2013 2013 2012 2013 2012 2012 2011

Quinine sulphate Rifabutin Ropinirole hydrochloride Roxithromycin Salbutamol

Salbutamol with ipratropium bromide Selegiline hydrochloride Simvastatin

Apo-Selegiline Arrow-Simva 10 mg Arrow-Simva 20 mg Arrow-Simva 40 mg Arrow-Simva 80 mg Biomed Ural Rex Genotropin Genotropin Mylan Space Chamber Spirotone Arrow-Sumatriptan Tamsulosin-Rex Pinetarsol Normison Apo-Terbinafine Depo-Testosterone Arrow-Testosterone Synacthen Synacthen Depot Apo-Timol Apo-Timop Arrow-Tramadol

2012 2011

Sodium chloride Sodium citro-tartrate Sodium cromoglycate Somatropin Sotalol Spacer Device Spironolactone Sumatriptan Tamsulosin hydrochloride Tar with triethanolamine lauryl sulphate and fluorescein Temazepam Terbinafine Testosterone cypionate Testosterone undecanoate Tetracosactrin Timolol maleate Tramadol hydrochloride

2013 2013 2012 31/12/12 2012 30/9/11 2013 2013 2013 2011 2011 2011 2011 2012 2011 2012 2011 2011

Sole Subsidised Supply Products – cumulative to December 2010

Generic Name

Tranexamic acid Triamcinolone acetonide

Presentation

Tab 500 mg Crm 0.02% Oint 0.02% Inj 40 mg per ml, 1 ml 0.1% in Dental Paste USP Tab 300 mg Cap 5 mg Cap 300 mg Inj 50 mg per ml, 10 ml Cap 100 mg Oral liq 10 mg per ml Oint BP Cap 137.4 mg (50 mg elemental) Tab 7.5 mg

Brand Name Expiry Date*

Cycklokapron Aristocort Aristocort Kenacort-A40 Oracort TMP Navoban Actigall Pacific Retrovir Retrovir PSM Zincaps Apo-Zopiclone 2013 2011

Trimethoprim Tropisetron Ursodeoxycholic acid Vancomycin hydrochloride Zidovudine [AZT] Zinc and castor oil Zinc sulphate Zopiclone December changes in bold

2011 2012 2011 2011 2013 2011 2011 2011

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings

Effective 1 December 2010

43 RIVAROXABAN – Special Authority see SA1066 – Retail pharmacy Tab 10 mg ............................................................................ 153.00 15 ✔ Xarelto 306.00 30 ✔ Xarelto ➽ SA1066 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 5 weeks for applications meeting the following criteria: Either: 1 For the prophylaxis of venous thromboembolism following a total hip replacement; or 2 For the prophylaxis of venous thromboembolism following a total knee replacement. Renewal from any relevant practitioner. Approvals valid for 5 weeks where prophylaxis for venous thromboembolism is required for patients following a subsequent total hip or knee replacement. Note: Rivaroxaban is only currently indicated and subsidised for up to 5 weeks therapy for prophylaxis of venous thromboembolism following a total hip replacement and up to 2 weeks therapy for prophylaxis of venous thromboembolism following a total knee replacement. 45 61 GEMFIBROZIL Tab 600 mg ........................................................................... 14.00 60 ✔ Lipazil

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 .................................................................................... 6.92 25 g ✔ Midwest SULPHUR Precipitated – Only in combination ............................................ 6.35 100 g ✔ Midwest 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, 2) With or without other dermatological galenicals. MOXIFLOXACIN – Special Authority see SA1065 – Retail pharmacy Tab 400 mg ............................................................................ 52.00 5 ✔ Avelox ➽ SA1065 Special Authority for Subsidy Initial application only from a respiratory specialist or infectious disease specialist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Both: 1.1 Active tuberculosis*; and 1.2 Any of the following: 1.2.1 Documented resistance to one or more first-line medications; or 1.2.2 Suspected resistance to one or more first-line medications (tuberculosis assumed to be contracted in an area with known resistance), as part of regimen containing other second-line agents; or 1.2.3 Impaired visual acuity (considered to preclude ethambutol use); or 1.2.4 Significant pre-existing liver disease or hepatotoxicity from tuberculosis medications; or 1.2.5 Significant documented intolerance and/or side effects following a reasonable trial of first-line medications; or 2 Mycobacterium avium-intracellulare complex not responding to other therapy or where such therapy is contraindicated.*

continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 December 2010 (continued)

continued... Renewal only from a respiratory specialist or infectious disease specialist. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. Note: 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).

89 116

ITRACONAZOLE – Retail pharmacy-Specialist Cap 100 mg ............................................................................. 4.25 ESCITALOPRAM Tab 10 mg ................................................................................ 2.65 Tab 20 mg ................................................................................ 4.20 SERTRALINE Tab 50 mg ................................................................................ 5.40 Tab 100 mg .............................................................................. 9.60 GLYCERIN WITH SUCROSE – Only in combination Suspension ............................................................................. 38.00 Only in combination with Ora-Plus GLYCERIN WITH SODIUM SACCHARIN – Only in combination Suspension ............................................................................. 38.00 Only in combination with Ora-Plus METHYL HYDROXYBENZOATE Powder .................................................................................... 8.98

15 28 28 90 90 473 ml

✔ Itrazole ✔ Loxalate ✔ Loxalate ✔ Arrow-Sertraline ✔ Arrow-Sertraline ✔ Ora-Sweet

116

171

473 ml

✔ Ora-Sweet SF

172 172 172 172 172

25 g

✔ Midwest ✔ Ora-Blend

METHYLCELLULOSE WITH GLYCERIN AND SUCROSE – Only in combination Suspension ............................................................................. 38.00 473 ml

METHYLCELLULOSE WITH GLYCERIN AND SODIUM SACCHARIN – Only in combination Suspension ............................................................................. 38.00 473 ml ✔ Ora-Blend SF METHYLCELLULOSE Suspension – Only in combination ........................................... 38.00 473 ml ✔ Ora-Plus

PROPYLENE GLYCOL Only in extemporaneously compounded methyl hydroxybenzoate 10% solution. Liq ......................................................................................... 11.25 500 ml SODIUM BICARBONATE Powder BP – Only in combination ............................................. 8.95 Only in extemporaneously compounded omeprazole suspension. 500 g

✔ Midwest ✔ Midwest

172

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

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Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 November 2010

32 49 95 96 INSULIN PEN NEEDLES – Maximum of 100 dev per prescription ❋ 32 g × 4 mm ......................................................................... 10.50 CAPTOPRIL ❋ Tab 12.5 mg ............................................................................ 2.00 ❋ Tab 25 mg ............................................................................... 2.40 ❋ Tab 50 mg ............................................................................... 3.50 ETRAVIRINE – Special Authority see SA1025 – Retail pharmacy Tab 100 mg ......................................................................... 770.00 DARUNAVIR – Special Authority see SA1025 – Retail pharmacy Tab 300 mg ...................................................................... 1,190.00 Tab 400 mg ......................................................................... 837.50 ETANERCEPT – Special Authority see SA1060 – Retail pharmacy Inj 50 mg autoinjector ........................................................ 1,899.92 LEVETIRACETAM Tab 250 mg ........................................................................... 24.03 Tab 500 mg ........................................................................... 28.71 Tab 750 mg ........................................................................... 45.23 100 100 100 100 120 120 60 4 60 60 60 ✔ B-D Micro-Fine ✔ m-Captopril ✔ m-Captopril ✔ m-Captopril ✔ Intelence ✔ Prezista ✔ Prezista ✔ Enbrel ✔ Levetiracetam-Rex ✔ Levetiracetam-Rex ✔ Levetiracetam-Rex

107 119

123 136 137

SELEGILINE HYDROCHLORIDE ❋ Tab 5 mg ............................................................................... 16.06 100 ✔Apo-Selegiline S29 S29 Note – This unregistered pack of Apo-Selegiline tab 5 mg is a temporary listing to cover a potential out-of-stock. DONEPEZIL HYDROCHLORIDE ❋ Tab 5 mg .................................................................................. 7.71 ❋ Tab 10 mg .............................................................................. 14.06 90 90 ✔ Donepezil-Rex ✔ Donepezil-Rex

VARENICLINE TARTRATE – Special Authority see SA1054 – Retail pharmacy Tab 0.5 mg x 11 and 1 mg x 14 ............................................... 60.48 1 OP ✔ Champix Tab 1 mg ................................................................................ 67.74 28 ✔ Champix Tab 1 mg .............................................................................. 135.48 56 ✔ Champix ➽ SA1054 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 Either: 3.1 The patient has tried but failed to quit smoking after at least two separate trials of nicotine replacement therapy, at least one of which included the patient receiving comprehensive advice on the optimal use of nicotine replacement therapy; or 3.2 The patient has tried but failed to quit smoking using bupropion or nortriptyline; and 4 The patient has not used funded varenicline in the last 12 months; and 5 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and continued...

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

continued... 6 The patient is not pregnant.

New listings - effective 1 November 2010 (continued)

Renewal from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 The patient has not used funded varenicline in the last 12 months; and 4 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and 5 The patient is not pregnant. The patient may not have had more than 1 prior approval in the past 12 months. 149 SUNITINIB – Special Authority see SA1055 – Retail pharmacy Cap 12.5 mg ...................................................................... 2,315.38 Cap 25 mg ......................................................................... 4,630.77 Cap 50 mg ......................................................................... 9,261.54 28 28 28 ✔ Sutent ✔ Sutent ✔ Sutent

➽ SA1055 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 The patient has metastatic renal cell carcinoma; and 2 Either 2.1 The patient is sunitinib treatment naive; or 2.2 The patient received sunitinib prior to 1 November 2010 and disease has not progressed; and 3 The patient has good performance status (WHO/ECOG grade 0-1); and 4 The disease is of predominant clear cell histology; and 5 The patient has intermediate or poor prognosis based on the NCCN clinical practice guidelines for kidney cancer; and 6 Sunitinib to be used for a maximum of 2 cycles. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 No evidence of disease progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Notes: Sunitinib treatment should be stopped if disease progresses. NCCN clinical practice guidelines for kidney cancer are available at http://www.nccn.org/professionals/ physician_gls/f_guidelines.asp 151 BACILLUS CALMETTE-GUERIN (BCG) VACCINE – PCT only – Specialist Subsidised only for bladder cancer Inj 2-8 x 100 million CFU ....................................................... 187.37 PHARMACY SERVICES – No patient co-payment payable ❋ Brand switch fee........................................................................ 0.01 (BSF Arrow-Enalapril to be delisted 1 February 2011) ACETYLCYSTEINE – Retail pharmacy-Specialist Inj 200 mg per ml, 30 ml ...................................................... 219.00

1 1 fee

✔ OncoTICE ✔ BSF Arrow-Enalapril

167

171

✔ Acetadote

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 October 2010

25 35 44 LOPERAMIDE HYDROCHLORIDE – Up to 30 cap available on a PSO ❋ Cap 2 mg .................................................................................. 8.95 IMIGLUCERASE – Special Authority see SA0473 – Retail pharmacy Inj 40 iu per ml, 400 iu vial ................................................ 2,144.00 SODIUM CHLORIDE Inj 0.9%, 5 ml – Up to 5 inj available on a PSO ......................... 15.50 Inj 0.9%, 10 ml – Up to 5 inj available on a PSO ....................... 15.50 400 1 50 50 ✔ Diamide Relief ✔ Cerezyme S29 ✔ Pfizer ✔ Pfizer

DEFERIPRONE – Special Authority see SA1042 – Retail pharmacy Tab 500 mg .......................................................................... 533.17 100 ✔ Ferriprox Oral liq 100 mg per 1 ml ........................................................ 266.59 250 ml OP ✔ Ferriprox ➽ SA1042 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid without further renewal unless notified where the patient has been diagnosed with chronic transfusional iron overload due to congenital inherited anaemia. Note: For the purposes of this Special Authority, a relevant specialist is defined as a haematologist. CILAZAPRIL ❋ Tab 0.5 mg .............................................................................. 0.95 ❋ Tab 2.5 mg ............................................................................... 2.06 ❋ Tab 5 mg ................................................................................. 3.28 ADAPALENE a) Maximum of 30 g per prescription b) Only on a prescription Crm 0.1% ................................................................................ 22.89 Gel 0.1% ................................................................................. 22.89 AMOXYCILLIN Cap 250 mg – Up to 30 cap available on a PSO ....................... 16.18 Cap 500 mg ........................................................................... 26.50 30 30 30 ✔ Zapril ✔ Zapril ✔ Zapril

30 g OP 30 g OP 500 500

✔ Differin ✔ Differin ✔ Alphamox ✔ Alphamox

86 122

CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA0988 Tab 250 mg ............................................................................. 5.53 10 ✔ Klacid ONDANSETRON a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 c) Not more than one prescription per month; can be waived by Special Authority see SA0887 d) The maximum of 6 tab per dispensing cannot be waived via Access Exemption Criteria. Tab 4 mg .................................................................................. 5.10 30 ✔ Dr Reddy’s Ondansetron Tab 8 mg .................................................................................. 1.70 10 ✔ Dr Reddy’s Ondansetron ERLOTINIB HYDROCHLORIDE – Retail pharmacy–Specialist – Special Authority see SA1044 Tab 100 mg ....................................................................... 3,100.00 30 ✔ Tarceva Tab 150 mg ....................................................................... 3,950.00 30 ✔ Tarceva ➽ SA1044 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 4 months for applications meeting the following criteria: All of the following: continued...

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

148

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

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Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 October 2010 (continued)

continued... 1. Patient has advanced, unresectable, Non Small Cell Lung Cancer (NSCLC); and 2. Patient has documented disease progression following treatment with first line platinum based chemotherapy; and 3. Erlotinib is to be given for a maximum of 3 months. Renewal application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 6 months where radiological assessment (preferably including CT scan) indicates NSCLC has not progressed. 150 151 ANASTROZOLE Tab 1 mg ................................................................................ 26.55 30 ✔ Aremed ✔ Myaccord ✔ Myaccord

MYCOPHENOLATE MOFETIL – Special Authority see SA1041 – Retail pharmacy Tab 500 mg ............................................................................ 85.00 50 Cap 250 mg ............................................................................ 85.00 100 BUDESONIDE Powder for inhalation, 200 µg per dose ................................... 19.00 Powder for inhalation, 400 µg per dose ................................... 32.00 CHLORAMPHENICOL Eye drops 0.5% ......................................................................... 1.28 STANDARD FORMULAE Phenobarbitone Sodium Paediatric Oral Liquid (10 mg per ml) Phenobarbitone sodium powder 400 mg Glycerol BP 4 ml Water to 40 ml

156

200 dose OP ✔ Budenocort 200 dose OP ✔ Budenocort 10 ml OP ✔ Chlorafast

162 170

178

ORAL SUPPLEMENT 1KCAL/ML – Special Authority see SA0583 – Hospital pharmacy [HP3] Powder (chocolate) ................................................................... 9.50 900 g OP ✔ Ensure Powder (vanilla) ........................................................................ 9.50 900 g OP ✔ Ensure PAEDIATRIC ORAL FEED 1KCAL/ML – Special Authority see SA0896 – Hospital pharmacy [HP3] Liquid (vanilla) .......................................................................... 1.07 200 ml OP ✔ Pediasure RENAL ORAL FEED 2KCAL/ML – Special Authority see SA0587– Hospital pharmacy [HP3] Liquid ....................................................................................... 2.43 200 ml OP ✔ Nepro (strawberry) ENTERAL FEED WITH FIBRE 1KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.32 237 ml OP ✔ Jevity 2.65 500 ml OP ✔ Jevity RTH ENTERAL FEED 1KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.24 250 ml OP ✔ Osmolite 2.65 500 ml OP ✔ Osmolite RTH ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.75 250 ml OP ✔ Ensure Plus HN

181 182 184

184

185

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

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Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 October 2010 (continued)

191 ELEMENTAL FORMULA – Special Authority see SA0603 – Hospital pharmacy [HP3] Powder (vanilla) ...................................................................... 52.90 400 g OP (56.00) Powder (unflavoured) .............................................................. 52.90 400 g OP (56.00)

Elecare Elecare Elecare LCP

Effective 1 September 2010

29 33 36 41 45 55 85 INSULIN GLULISINE ▲ Inj 100 u per ml, 3 ml .............................................................. 46.07 MUCILAGINOUS LAXATIVES – Only on a prescription ❋ Dry ........................................................................................... 6.02 VITAMIN B COMPLEX ❋ Tab, strong, BPC ...................................................................... 4.70 CLOPIDOGREL Tab 75 mg ............................................................................. 16.25 SODIUM BICARBONATE Cap 840 mg .............................................................................. 8.52 FUROSEMIDE ❋ Inj 10 mg per ml, 2 ml – Up to 5 inj available on a PSO .............. 1.30 5 500 g OP 500 90 100 5 ✔ Apidra ✔ Konsyl-D ✔ B-PlexADE ✔ Apo-Clopidogrel ✔ Sodibic ✔ Frusemide-Claris

CEFTRIAXONE SODIUM – 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 ................................................................................ 2.70 1 ✔ Veracol CEPHALEXIN MONOHYDRATE Cap 500 mg .............................................................................. 8.90 20 ✔ Cephalexin ABM

85 102

MELOXICAM – Special Authority see SA1034 – Retail pharmacy Tab 7.5 mg ............................................................................. 11.50 30 ✔ Arrow-Meloxicam ➽ SA1034 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 The patient has moderate to severe haemophilia with less than or equal to 5% of normal circulating functional clotting factor; and 2 The patient has haemophilic arthropathy; and 3 Pain and inflammation associated with haemophilic arthropathy is inadequately controlled by alternative funded treatment options, or alternative funded treatment options are contraindicated. TENOXICAM ❋ Inj 20 mg .................................................................................. 9.95 1 ✔ AFT

102

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 September 2010 (continued)

109 ZOLEDRONIC ACID – Special Authority see SA1035 – Retail pharmacy Soln for infusion 5 mg in 100 ml ............................................ 600.00 100 ml ✔ Aclasta ➽ SA1035 Special Authority for Subsidy Initial application – (Paget’s disease) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 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; or 2.5 Preparation for orthopaedic surgery; and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Initial application – (Underlying cause - Osteoporosis) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Any of the following: 1.1 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 1.2 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 1.3 History of two significant osteoporotic fractures demonstrated radiologically; or 1.4 Documented T-Score ≤ -3.0 (see Note); or 1.5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 1.6 Patient has had a Special Authority approval for alendronate (Underlying cause – Osteoporosis); and 2 The patient will not be prescribed more than one infusion in a 12-month period. Initial application – (Underlying cause - glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 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 Any of the following: 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; or 2.3 The patient has had a Special Authority approval for alendronate (Underlying cause – glucocorticosteroid therapy); and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Renewal – (Paget’s disease) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Any of the following: 1.1 The patient has relapsed (based on increases in serum alkaline phosphatase); or 1.2 The patient’s serum alkaline phosphatase has not normalised following previous treatment with zoledronic acid; or 1.3 Symptomatic disease (prescriber determined); and continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 September 2010 (continued)

continued... 2 The patient will not be prescribed more than one infusion in the 12-month approval period. The patient may not have had a prior approval for Paget’s disease within the last 12 months. Renewal – (Underlying cause was, and remains, glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents); and 2 The patient will not be prescribed more than one infusion in the 12-month approval period. The patient may not have had a prior approval for 'Underlying cause glucocorticosteroid therapy' within the last 12 months. 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: Both: 1 Any of the following: 1.1 History of one significant osteoporotic fracture demonstrated radiologically and documented BMD ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 1.2 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 1.3 History of two significant osteoporotic fractures demonstrated radiologically; or 1.4 Documented T-Score ≤ -3.0 (see Note); or 1.5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 1.6 Patient has had a Special Authority approval for alendronate (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause – Osteoporosis’ criteria); and 2 The patient will not be prescribed more than one infusion in a 12-month period. Notes: a) BMD (including BMD used to derive T-Score) must be measured 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 has quantified this as forces equivalent to a fall from a standing height or less. d) 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. 111 LIGNOCAINE HYDROCHLORIDE Inj 2%, 5 ml – Up to 5 inj available on a PSO ............................ 23.00 Inj 2%, 20 ml – Up to 5 inj available on a PSO .......................... 15.00 Viscous solution 2% ................................................................ 55.00 CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml ............................................................. 14.95 50 5 200 ml 5 ✔ Xylocaine ✔ Xylocaine ✔ Xylocaine Viscous ✔ Nausicalm

121

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 September 2010 (continued)

141 145 163 FLUOROURACIL SODIUM Inj 1 mg for ECP – PCT only – Specialist .................................... 0.77 MESNA – PCT only – Specialist Inj 1 mg for ECP ........................................................................ 2.29 SODIUM CROMOGLYCATE Eye drops 2% ............................................................................ 1.18 100 mg 100 mg 5 ml OP ✔ Baxter ✔ Baxter ✔ Rexacrom

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions

Effective 1 December 2010

125 LEVOMEPROMAZINE METHOTRIMEPRAZINE Tab 25 mg ............................................................................. 16.93 Tab 100 mg ........................................................................... 43.96 Inj 25 mg per ml, 1 ml ............................................................ 73.68 Chemical name change to International Non-proprietary name 100 100 10 ✔ Nozinan ✔ Nozinan ✔ Nozinan

130

MULTIPLE SCLEROSIS TREATMENTS ➽ SA1062 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: Phone: 04 460 4990 The Coordinator Multiple Sclerosis Treatment Assessment Committee Facsimile: 04 916 7571 PHARMAC, PO Box 10 254 Email: lsacoordinator@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: • 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: • experienced at least 3 significant relapses of MS in the previous 12 months, and • an EDSS score of 2.0; and 4) Each relapse must: a) be confirmed by a neurologist or general physician (the patient may not necessarily have been seen during the relapse but the neurologist/physician must be satisfied that the clinical features were characteristic and met the specified criteria); continued...

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

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Changes to Restrictions - effective 1 December 2010 (continued)

continued... b) be associated with characteristic new symptom(s)/sign(s) or substantial worsening of previously experienced symptom(s)/sign(s); c) last at least one week; d) follow a period of stability of at least one month; e) be severe enough to change either the EDSS or at least one of the Kurtzke functional systems scores by at least 1 point; f) be distinguishable from the effects of general fatigue; and g) not be associated with a fever (T>37.5°C); and applications must be made at least four weeks after the date of the onset of the last known relapse; and patients must have no previous history of lack of response to beta-interferon or glatiramer acetate (see criteria for stopping). applications must be submitted to the Multiple Sclerosis Treatment Assessment Committee (MSTAC) by the patient’s neurologist or a general physician; and patients must agree (via informed consent) to co-operate if as a result of their meeting the stopping criteria, funding is withdrawn. Patients must agree to the collection of clinical data relating to their MS and use of those data by PHARMAC; and patients must agree to allow clinical data to be collected and reviewed by MSTAC annually for each year in which they receive funding for beta-interferon or glatiramer acetate.

5) 6) 7) 8) 9)

Stopping Criteria 1) Confirmed progression of disability that is sustained for three six months after during a minimum of one year of treatment. Progression of disability is defined as either any of: (a) an increase of 2 EDSS points where starting EDSS was 2.0; or (b) an increase of 1.5 EDSS points where starting EDSS was 2.5 or 3.0; or (c) an increase of 1 EDSS point from the where starting EDSS was 3.5 or greater; or (d) 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) (see Note); 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. Note: Patients who have a stable or increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment) and who do not meet any of the other Stopping Criteria at annual review may switch to a different class of funded treatment (i.e. patients may switch from either of the betainterferons [interferon beta-1-beta or interferon beta-1-alpha] to glatiramer acetate or vice versa). Patients may switch classes of treatment for this reason only once, after which they will be required to stop funded treatment if they meet any of the Stopping Criteria at annual review (including the criterion relating to stable or increasing relapse rate over 12 months of treatment). 145 TEMOZOLOMIDE – Special Authority see SA1063 0831 – Retail pharmacy Cap 5 mg ............................................................................... 50.00 5 ✔ Temodal Cap 20 mg ........................................................................... 170.00 5 ✔ Temodal Cap 100 mg ......................................................................... 840.00 5 ✔ Temodal Cap 250 mg ...................................................................... 2,100.00 5 ✔ Temodal ➽ SA1063 0831 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 Either: continued... ❋ Three months or six months, as applicable, dispensed all-at-once

▲

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

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Changes to Restrictions - effective 1 December 2010 (continued)

continued... 1.1 Patient has newly diagnosed glioblastoma multiforme; or 1.2 Patient has newly diagnosed anaplastic astrocytoma*; 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: Indication marked with a * is an Unapproved Indication. 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. 167 SECTION C – GLOSSARY Dermatological galenical: Dermatological galenicals will only be subsidised when added to a dermatological base. More than one dermatological galenical can be added to a dermatological base. The following are dermatological galenicals: • Coal tar solution BP - up to 10% • Hydrocortisone powder - up to 5% • Menthol crystals • Salicylic acid powder • Sulphur precipitated powder SECTION C – EXPLANATORY NOTES Oral liquid mixtures Oral liquid mixtures are subsidised for patients unable to swallow subsidised solid oral dose forms where no suitable alternative proprietary formulation is subsidised. Suitable alternatives include dispersible and sublingual formulations, oral liquid formulations or rectal formulations. Before extemporaneously compounding an oral liquid mixture, other alternatives such as dispersing the solid dose form (if appropriate) or crushing the solid dose form in jam, honey or soft foods such as yoghurt should be explored. The Emixt website (http://www.pharminfotech.co.nz/manual/Formulation/mixtures/index.htm) has evidencebased formulations which are intended to standardise compounded oral liquids within New Zealand. PHARMAC endorses the recommendations of the Emixt website and encourages New Zealand pharmacists to use these formulations when compounding is appropriate. The Emixt website also provides stability and expiry data for compounded products. For the majority of products compounded with Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet or Ora-Sweet SF a four week expiry is appropriate. Subsidy for extemporaneously compounded oral liquid mixtures is based on: Solid dose form qs Preservative qs Suspending agent qs Water to 100% Solid dose form qs Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet and/or Ora-Sweet SF to 100%

168

Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients such as flavouring and colouring agents, but these extra ingredients will not be reimbursed. The subsidised ingredients in the formula will be reimbursed and a compounding fee paid. The majority of extemporaneously compounded oral liquid mixtures should contain a preservative and suspending agent. • Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet and Ora-Sweet SF when used correctly are an appropriate preservative and suspending agent. • Methylcellulose 3% is considered a suitable suspending agent and compound hydroxybenzoate solution or methyl hydroxybenzoate 10% solution are considered to be suitable preservatives. Usually 1 ml of these preservative solutions is added to 100 ml of oral liquid mixture.

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 December 2010 (continued)

continued... Some solid oral dose forms are not appropriate for compounding into oral liquid mixtures and should therefore not be used/considered for extemporaneously compounded oral liquid mixtures. This includes long-acting solid dose formulations, enteric coated tablets or capsules, sugar coated tablets, hard gelatin capsules and chemotherapeutic agents. The following practices will not be subsidised: • Where a Standard Formula exists in the Pharmaceutical Schedule for a solid dose form, compounding the solid dose form in Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet and/or Ora-Sweet SF. • Mixing one or more proprietary oral liquids (eg an antihistamine with pholcodine linctus). • Extemporaneously compounding an oral liquid with more than one solid dose chemical. • Mixing more than one extemporaneously compounded oral liquid mixture. • Mixing one or more extemporaneously compounded oral liquid mixtures with one or more proprietary oral liquids. • The addition of a chemical/powder/agent/solution to a proprietary oral liquid or extemporaneously compounded oral mixture.

Effective 1 November 2010

44 SODIUM CHLORIDE Inj 0.9%, 20 ml – Up to 5 inj available on a PSO ........................ 4.72 11.79 8.41 6 30 20 ✔ Pharmacia ✔ Pharmacia ✔ Multichem

50 103

ENALAPRIL A Brand Switch Fee may be claimed from 1 November 2010 until 31 January 2011. ❋ Tab 5 mg ................................................................................. 1.98 90 ✔ Arrow-Enalapril ❋ Tab 10 mg ............................................................................... 2.44 90 ✔ Arrow-Enalapril ❋ Tab 20 mg ............................................................................... 3.24 90 ✔ Arrow-Enalapril ADALIMUMAB – Special Authority see SA1059 1026 – 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

➽ SA1059 1026 Special Authority for Subsidy Initial application — (rheumatoid arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 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 continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

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Changes to Restrictions - effective 1 November 2010 (continued)

continued... 2.4 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 2.5 Either: 2.5.1 Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of cyclosporine alone or in combination with another agent; or 2.5.2 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 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 2.6.2 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 2.7 Either: 2.7.1 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 2.7.2 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: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for severe chronic plaque psoriasis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for severe chronic plaque psoriasis; or 2 All of the following: 2.1 Either: 2.1.1 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 2.1.2 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 continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... 2.2 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 2.3 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 2.4 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: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for ankylosing spondylitis; or 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 Patient’s ankylosing spondylitis has not responded adequately to treatment with two or more nonsteroidal anti-inflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist; and 2.5 Either: 2.5.1 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 2.5.2 Patient has limitation of chest expansion by at least 2.5 cm below the following average normal values corrected for age and gender (see Notes); and 2.6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale;. and 7 Either: 7.1 An elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 7.2 A C-reactive protein (CRP) level greater than 15 mg per litre. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI, ESR and CRP measures must be no more than 1 month old at the time of initial application. Average normal chest expansion corrected for age and gender: 18-24 years - Male: 7.0 cm; Female: 5.5 cm 25-34 years - Male: 7.5 cm; Female: 5.5 cm 35-44 years - Male: 6.5 cm; Female: 4.5 cm 45-54 years - Male: 6.0 cm; Female: 5.0 cm 55-64 years - Male: 5.5 cm; Female: 4.0 cm 65-74 years - Male: 4.0 cm; Female: 4.0 cm 75+ years - Male: 3.0 cm; Female: 2.5 cm continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... Initial application — (psoriatic arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for psoriatic arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 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 2.3 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 2.4 Either: 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 2.4.2 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 2.5 Any of the following: 2.5.1 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 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 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; and 4 Either: 4.1 Adalimumab to be administered at doses no greater than 40 mg every 14 days; or 4.2 Patient cannot take concomitant methotrexate and requires doses of adalimumab higher than 40 mg every 14 days to maintain an adequate response. 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: All of the following: 1 Either: 1.1 Applicant is a gastroenterologist; or continued...

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

Check your Schedule for full details Schedule page ref

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Changes to Restrictions - effective 1 November 2010 (continued)

continued... 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 Either: 2.1 Either: 2.1.1 CDAI score has reduced by 100 points from the CDAI score when the patient was initiated on adalimumab; or 2.1.2 CDAI score is 150 or less; or 2.2 Both: 2.2.1 The patient has demonstrated an adequate response to treatment but CDAI score cannot be assessed; and 2.2.2 Applicant to indicate the reason that CDAI score cannot be assessed; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days.

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: All of the following: 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 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; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Note: A 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 preadalimumab baseline on a 10 point scale, or by 50%, whichever is less; and 3 ESR or CRP is within the normal range; and 3 4 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 4 5 Adalimumab to be administered at doses no greater than 40 mg every 14 days.

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... 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: 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 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 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; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. 107 ETANERCEPT – Retail pharmacy-Specialist prescription – Special Authority see SA1060 0868 – Retail pharmacy Inj 25 mg ............................................................................. 949.96 4 ✔ Enbrel Inj 50 mg autoinjector ........................................................ 1,899.92 4 ✔ Enbrel ➽ SA1060 0868 Special Authority for Subsidy Initial application – (juvenile idiopathic arthritis) 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 10-20 mg/m2 weekly or at the maximum tolerated dose) in combination with oral corticosteroids (prednisone 0.25 mg/kg or at maximum tolerated dose); and 5 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-15 mg/m2 weekly or at the maximum tolerated dose) in combination with one other diseasemodifying 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. Initial application - (rheumatoid arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... 2.3 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 2.4 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 2.5 Either: 2.5.1 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 2.5.2 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 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 2.6.2 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 2.7 Either: 2.7.1 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 2.7.2 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 - (severe chronic plaque psoriasis) only from a dermatologist. Approvals valid for 4 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for severe chronic plaque psoriasis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for severe chronic plaque psoriasis; or 2 All of the following: 2.1 Either: 2.1.1 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 2.1.2 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 2.2 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 2.3 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 2.4 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.continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... Initial application - (ankylosing spondylitis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for ankylosing spondylitis; or 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis present for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 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 2.5 Either: 2.5.1 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 2.5.2 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 2.6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI 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: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for psoriatic arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 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 2.3 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 2.4 Either: continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 2.4.2 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 2.5 Any of the following: 2.5.1 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 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 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 - (juvenile idiopathic arthritis) only from a named specialist or rheumatologist or Practitioner on the recommendation of a named specialist or rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a named specialist or rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a named specialist or rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Subsidised 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 and an improvement in physician's global assessment from baseline; or 3.2 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. 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 etanercept 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; and 4 Etanercept to be administered at doses no greater than 50 mg every 7 days. 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: All of the following: 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 etanercept treatment; and 2 Either: 2.1 Both: continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... 2.1.1 Patient has "whole body" severe chronic plaque psoriasis; and 2.1.2 Following each prior etanercept 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-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 etanercept 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 etanercept 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-treatment baseline value; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. Note: An etanercept treatment course is defined as a minimum of 12 weeks of etanercept 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 etanercept treatment; and 2 Following 12 weeks of etanercept treatment, BASDAI has improved by 4 or more points from pretreatment baseline on a 10 point scale, or by 50%, whichever is less; and 3 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 4 Etanercept to be administered at doses no greater than 50 mg every 7 days. 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: 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 etanercept 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 etanercept treatment in the opinion of the treating physician; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. Initial application only from a named specialist or rheumatologist. Approvals valid for 4 months for applications meeting the following criteria: All of the following: 1 To be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Patient diagnosed with Juvenile Idiopathic Arthritis (JIA); and 3 Patient has had severe active polyarticular course JIA for 6 months duration or longer; and continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

continued... 4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-20mg/m2 weekly or at the maximum tolerated dose) in combination with oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose); and 5 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-15mg/m2 weekly or at the maximum tolerated dose) in combination with one other disease-modifying agent; and 6 Both: 6.1 Either: 6.1.1 Patient has persistent symptoms of poorly-controlled and active disease in at least 20 active, swollen, tender joints; or 6.1.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip; and 6.2 Physician’s global assessment indicating severe disease; and 7 The patient or their legal guardian consents to details of their treatment being held on a central registry and has signed a consent form outlining conditions of ongoing treatment. Note: A patient declaration form http://www.pharmac.govt.nz/special_authority_forms/SA0667-declaration.pdf must be signed by the legal guardian of the patient and the prescriber in the presence of a witness (over 18 years of age) Renewal only from a named specialist or rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 Following 4 months initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician’s global assessment from baseline; or 2.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count and continued improvement in physician’s global assessment from baseline. VENLAFAXINE – Special Authority see SA1061 0789 – Retail pharmacy Cap 37.5 mg .......................................................................... 18.64 Cap 75 mg ............................................................................. 37.27 Cap 150 mg ........................................................................... 45.68 28 28 28 ✔ Efexor XR ✔ Efexor XR ✔ Efexor XR

116

➽ SA1061 0789 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 have had an inadequate response from 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 have had an inadequate response from 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).

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 November 2010 (continued)

119 LEVETIRACETAM – Special Authority see SA0921 – Retail pharmacy Tab 250 mg ........................................................................... 24.03 60 ✔ Levetiracetam-Rex Tab 500 mg ........................................................................... 28.71 60 ✔ Levetiracetam-Rex Tab 750 mg ........................................................................... 45.23 60 ✔ Levetiracetam-Rex ➽ SA0921 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 Note – Keppra tablets to be delisted 1 November 2010. PILOCARPINE ❋ Eye drops 1% ........................................................................... 4.26 ❋ Eye drops 2% ........................................................................... 5.35 ❋ Eye drops 4% ........................................................................... 7.99 15 ml OP 15 ml OP 15 ml OP ✔ Isopto Carpine

S29

165

✔ Isopto Carpine

S29

✔ Isopto Carpine

S29

Effective 1 October 2010

44 SODIUM CHLORIDE Inj 0.9%, 20 ml – Up to 5 inj available on a PSO ...................... 4.72 11.79 8.41 6 30 20 ✔ Pharmacia ✔ Pharmacia ✔ Multichem

EZETIMIBE – Special Authority see SA1045 0796 – Retail pharmacy Tab 10 mg ............................................................................. 57.60 30 ✔ Ezetrol ➽ SA1045 0796 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 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years; and 2 Patient’s LDL cholesterol is 2.0 mmol/litre or greater; and 3 Any of the following: 3.1 The patient has rhabdomyolysis (defined as muscle aches and creatine kinase more than 10 x normal) when treated with one statin; or 3.2 The patient is intolerant to both simvastatin and atorvastatin; or 3.3 The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin. Note: A patient who has failed to reduce their LDL cholesterol to < 2.0 mmol/litre with the use of a less potent statin should use a more potent statin prior to consideration being given to the use of non-statin therapies. Other treatment options including fibrates, resins and nicotinic acid should be considered after failure of statin therapy. If a patient’s LDL cholesterol cannot be calculated because the triglyceride level is too high then a repeat test should be performed and if the LDL cholesterol again cannot be calculated then it can be considered that the LDL cholesterol is greater than 2.0 mmol/litre.

Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains continued... appropriate and the patient is benefiting from treatment. Patients pay a manufacturer’s surcharge when S29 Unapproved medicine supplied under Section 29 the Manufacturer’s Price is greater than the Subsidy ‡ safety cap reimbursed Sole Subsidised Supply

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Subsidy (Mnfr’s price) $

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 October 2010 (continued)

continued... 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. 48 EZETIMIBE WITH SIMVASTATIN – Special Authority see SA1046 0826 – Retail pharmacy Tab 10 mg with simvastatin 10 mg ......................................... 69.00 30 ✔ Vytorin Tab 10 mg with simvastatin 20 mg ......................................... 75.00 30 ✔ Vytorin Tab 10 mg with simvastatin 40 mg ....................................... 103.50 30 ✔ Vytorin Tab 10 mg with simvastatin 80 mg ....................................... 123.00 30 ✔ Vytorin ➽ SA1046 0826 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for two years for applications meeting the following criteria: All of the following: 1 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years; and 2 Patient’s LDL cholesterol is 2.0 mmol/litre or greater; and 3 The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin. continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 October 2010 (continued)

continued... Note: A patient who has failed to reduce their LDL cholesterol to < 2.0 mmol/litre with the use of a less potent statin should use a more potent statin prior to consideration being given to the use of non-statin therapies. Other treatment options including fibrates, resins and nicotinic acid should be considered after failure of statin therapy. If a patient’s LDL cholesterol cannot be calculated because the triglyceride level is too high then a repeat test should be performed and if the LDL cholesterol again cannot be calculated then it can be considered that the LDL cholesterol is greater than 2.0 mmol/litre. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. 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. 93 TENOFOVIR DISOPROXIL FUMARATE – Subsidy by endorsement; can be waived by Special Authority see SA1047 0997 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 SA1025 and the prescription is annotated accordingly by the Pharmacist or endorsed by the prescriber. Note: Tenofovir disoproxil fumarate prescribed under endorsement for the treatment of HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals for the purposes of Special Authority SA1025. Tab 300 mg ......................................................................... 531.00 30 ✔ Viread ➽ SA1047 0997 Special Authority for Waiver of Rule Initial application — (Drug-Resistant Chronic Hepatitis B) Only only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid without further renewal, unless notified, for applications meeting the following criteria Approvals valid for 1 year for applications meeting the following criteria: Any All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and continued...

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 October 2010 (continued)

continued... 2 All of the following 2.1 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 2.2 3.2 HBV DNA greater than 20,000 IU/mL or increased ≥ 10 fold over nadir; and 2.3 4 Any of the following: 2.3.1 4.1 Hepatitis B virus resistant to lamivudine with detection of M204I/V mutation; or 2.3.2 4.2 Hepatitis B virus resistant to adefovir with detection of A181T/V or N236T mutation; or 2.3.3 4.3 Hepatitis B virus resistant to entecavir with detection of I169T, L180M T184S/A/I/L/GC/M, S202C/G/I, M204V or M250I/V mutation; or. 3 Patient is either listed or has undergone liver transplantation for HBV; Initial application - (Pregnant) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 4 months for applications meeting the following criteria: Both: 1 Patient is HBsAg positive and pregnant; and 2 Either: 2.1 HBV DNA > 20,000 IU/ml and ALT > ULN; or 2.2 HBV DNA > 100 million IU/ml and ALT normal. Renewal - (Confirmed Hepatitis B following funded tenofovir treatment for pregnancy within the previous two years) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 All of the following: 2.1 Patient has had previous lamivudine, adefovir or entecavir therapy; and 2.2 HBV DNA greater than 20,000 IU/mL or increased ≥ 10 fold over nadir; and 2.3 Any of the following: 2.3.1 Lamivudine resistance - detection of M204I/V mutation; or 2.3.2 Adefovir resistance - detection of A181T/V or N236T mutation; or 2.3.3 Entecavir resistance - detection of relevant mutations including I169T, L180M T184S/A/I/L/GC/M, S202C/G/I, M204V or M250I/V mutation; or 3 Patient is either listed or has undergone liver transplantation for HBV. Renewal - (Subsequent pregnancy) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 4 months for applications meeting the following criteria: Both: 1 Patient is HBsAg positive and pregnant; and 2 Either: 2.1 HBV DNA > 20,000 IU/mL and ALT > ULN; or 2.2 HBV DNA > 100 million IU/mL and ALT normal. 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: • Tenofovir disoproxil fumarate should be stopped 6 months following HBeAg seroconversion for patients who were HBeAg positive prior to commencing Tenofovir disoproxil fumarate this agent and 6 months following HBsAg seroconversion for patients who were HBeAg negative prior to commencing this agent. • The recommended dose of Tenofovir disoproxil fumarate for the treatment of hepatitis B is 300 mg once daily. • 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. • Tenofovir disoproxil fumarate is not approved for use in children.

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 October 2010 (continued)

115 MIANSERIN HYDROCHLORIDE – Special Authority see SA1048 0864 – Retail pharmacy Tab 30 mg ............................................................................. 24.86 30 ✔ Tolvon ➽ SA1048 0864 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either 1 Both: 1.1 Depression; and 1.2 Either: 1.2.1 Co-existent bladder neck obstruction; or 1.2.2 Cardiovascular disease.; or 2 Both: 2.1 The patient has a severe major depressive episode; and 2.2 Either: 2.2.1 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 2.2.2 Both: 2.2.2.1 The patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2.2 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 treatment remains appropriate and the patient is benefiting from treatment. CAPECITABINE – Retail pharmacy-Specialist – Special Authority see SA1049 1040 Tab 150 mg ......................................................................... 115.00 60 ✔ Xeloda Tab 500 mg ......................................................................... 705.00 120 ✔ Xeloda ➽ SA1049 1040 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 advanced gastrointestinal malignancy; or 2 The patient has metastatic breast cancer; or 3 The patient has stage III (Dukes’ stage C) colorectal*# cancer and has undergone surgery; or 4 All of the following: 4.1 The patient has stage II (Dukes' stage B) colorectal* cancer and has undergone surgery; and 4.2 Any of the following: 4.2.1 the patient has stage T4 disease; or 4.2.2 the patient has vascular invasion; or 4.2.3 Fewer than 10 lymph nodes were examined at resection; or 5 All of the following: 5.1 The patient has locally advanced (clinically or radiologically staged T3/T4: N0,1,2) rectal cancer; and 5.2 Surgery is planned; and 5.3 Capecitabine to be given prior to surgery (neoadjuvant); and 5.4 Capecitabine to be given at a maximum dose of 825 mg/m2 twice daily in combination with radiation therapy for a maximum of 6 weeks; or 6 Both: 6.1 The patient has poor venous access or needle phobia*; and 6.2 The patient requires a substitute for single agent fluoropyrimidine*. 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: continued...

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

140

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

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Changes to Restrictions - effective 1 October 2010 (continued)

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 (Dukes' stage C) colon cancer. 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 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 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, # capecitabine is approved for stage III (Duke’s stage C) colon cancer. 151 MYCOPHENOLATE MOFETIL – Special Authority see SA1041 0960 – Retail pharmacy Note: Dispensing pharmacy should check which brand to dispense with the prescriber if prescribed generically. Tab 500 mg ........................................................................... 70.00 50 ✔ Cellcept 85.00 ✔ Myaccord Cap 250 mg ........................................................................... 70.00 100 ✔ Cellcept 85.00 ✔ Myaccord Powder for oral liq 1 g per 5 ml – Subsidy by endorsement ... 285.00 165 ml OP ✔ Cellcept Mycophenolate powder for oral liquid is subsidised only for patients unable to swallow tablets and capsules, and when the prescription is endorsed accordingly. ➽ SA1041 0960 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 Transplant recipient; or 2 Both: Patients with diseases where 2.1 Steroids and azathioprine have been trialled and discontinued because of unacceptable side effects or inadequate clinical response; and 2.2 Either: Patients with diseases where 2.2.1 Cyclophosphamide has been trialled and discontinued because of unacceptable side effects or inadequate clinical response; or 2.2.2 Cyclophosphamide treatment is contraindicated. Initial application only from a relevant specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 Renal transplant recipient; or 2 Heart transplant recipient; or 3 Liver transplant recipient; or 4 Patient has an organ transplant and has severe tophaceous gout making azathioprine unsuitable. ❋ Three months or six months, as applicable, dispensed all-at-once

▲

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

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 October 2010 (continued)

151 RITUXIMAB – PCT only – Specialist – Special Authority see SA1050 0961 Inj 100 mg per 10 ml vial ................................................... 1,195.00 2 ✔ Mabthera Inj 500 mg per 50 ml vial ................................................... 2,987.00 1 ✔ Mabthera Inj 1 mg for ECP ....................................................................... 6.27 1 mg ✔ Baxter ➽ SA1050 0961 Special Authority for Subsidy Initial application — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has B-cell post-transplant lymphoproliferative disorder*; and 2 To be used for a maximum of 8 treatment cycles. Initial application — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has indolent low grade NHL with relapsed disease following prior chemotherapy; and 1.2 To be used for a maximum of 6 treatment cycles; or 2 Both: 2.1 The patient has indolent, low grade lymphoma requiring first-line systemic chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/ Waldenstrom macroglobulinaemia. Rituximab is not funded for chronic lymphocytic leukaemia/small lymphocytic lymphoma. Initial application — (Aggressive CD20 positive NHL) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either 1 All of the following: 1.1 The patient has treatment-naive aggressive CD20 positive NHL; and 1.2 To be used with a multi-agent chemotherapy regimen given with curative intent; and 1.3 To be used for a maximum of 8 treatment cycles; or 2 Both: 2.1 The patient has aggressive CD20 positive NHL with relapsed disease following prior chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ’Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia Renewal — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has B-cell post-transplant lymphoproliferative disorder*; and 3 To be used for no more than 6 treatment cycles. Renewal — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has indolent, low-grade NHL with relapsed disease following prior chemotherapy; and 3 To be used for no more than 6 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/ Waldenstrom macroglobulinaemia. continued...

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Changes to Restrictions - effective 1 October 2010 (continued)

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

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 October 2010 (continued)

continued... 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has B-cell post-transplant lymphoproliferative disorder*; and 3 To be used for no more than 6 treatment cycles. Note: Indications marked with * are Unapproved Indications. 164 TRAVOPROST – Retail pharmacy-Specialist a) See prescribing guideline above b) Additional subsidy by endorsement is available for patients who were being prescribed travoprost prior to 1 April 2010. Note additional subsidy valid until 30 September 2010. Pharmacists may annotate prescriptions for patients who were being prescribed travoprost prior to 1 April 2010 in which case the prescription is deemed to be endorsed. The pharmacist must be able to show a clear documented dispensing history for the patient. The prescription must be endorsed accordingly. ▲ Eye drops 0.004% – Higher subsidy of $19.50 per 2.5 ml with Endorsement .............................................. 19.50 2.5 ml OP ✔ Travatan

Effective 1 September 2010

29 ACARBOSE – Special Authority see SA0925 on the next page – Retail pharmacy ❋ Tab 50 mg ............................................................................. 16.50 90 ✔ Glucobay ❋ Tab 100 mg ........................................................................... 26.70 90 ✔ Glucobay ➽ SA0925 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. PIOGLITAZONE – Special Authority see SA0959 below – Retail pharmacy Tab 15 mg ............................................................................... 2.61 28 ✔ Pizaccord Tab 30 mg ............................................................................... 5.23 28 ✔ Pizaccord Tab 45 mg ............................................................................... 7.80 28 ✔ Pizaccord ➽ SA0959 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. MULTIVITAMINS – Special Authority see SA1036 0963 – Retail pharmacy Powder .................................................................................. 72.00 200 g OP ✔ Paediatric Seravit ➽ SA1036 0963 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: where the patient has inborn errors of metabolism. 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.

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

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Changes to Restrictions - effective 1 September 2010 (continued)

41 CLOPIDOGREL – Special Authority see SA0867 below – Retail pharmacy Tab 75 mg ............................................................................. 16.25 90 ✔ Apo-Clopidogrel 5.05 28 ✔ Apo-Clopidogrel 25.00 28 ✔ Arrow-Clopidogrel (73.38) Plavix ➽ SA0867 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 specialistconsultation. Note: Aspirin allergy is defined as a history of anaphylaxis, urticaria or asthma within 4 hours of ingestion of aspirin, other salicylates or NSAIDs. Initial application — (aspirin tolerant patients and aspirin naive patients) from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: Any of the following: The patient has: 1 experienced an acute myocardial infarction; or 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. continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2010 (continued)

continued... 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. 46 ATORVASTATIN – Additional subsidy by Special Authority see SA0788 – Retail pharmacy See prescribing guideline ❋ Tab 10 mg ............................................................................. 18.32 30 ✔ Lipitor ❋ Tab 20 mg ............................................................................. 26.70 30 ✔ Lipitor ❋ Tab 40 mg ............................................................................. 37.02 30 ✔ Lipitor ❋ Tab 80 mg ........................................................................... 110.50 30 ✔ Lipitor ➽ SA0788 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: • Constipation, flatulence (may occur in >1% of patients) • Asthenia, abdominal pain, headache (may occur in >1% of patients) • Myopathy, rhabdomyolysis (may occur in <3% of patients) • Elevated serum transaminase levels (may occur in <1% of patients) Statins have been shown to be generally well tolerated in clinical studies, with the rate of discontinuation due to adverse reactions being less than 5%, and similar to the discontinuation rate for patients taking a placebo. AMILORIDE WITH HYDROCHLOROTHIAZIDE ❋ Tab 5 mg with hydrochlorothiazide 50 mg ................................. 5.00 50 ✔ Moduretic S29

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2010 (continued)

59 ISOTRETINOIN – Special Authority see SA0955 – Retail pharmacy Cap 10 mg ............................................................................. 48.48 180 ✔ Oratane Cap 20 mg ............................................................................. 69.70 180 ✔ Oratane ➽ SA0955 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 received an inadequate response from 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 received an inadequate response from 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. TRICLOSAN – Subsidy by endorsement a) Maximum of 500 ml per prescription b) a) Only if prescribed for a patient identified with Methicillin-resistant Staphylococcus aureus (MRSA) prior to elective surgery in hospital and the prescription is endorsed accordingly; or b) Only if prescribed for a patient with recurrent Staphylococcus aureus infection and the prescription is endorsed accordingly Soln 1% ................................................................................... 5.90 500 ml OP ✔ healthE MALATHION Liq 0.5% ................................................................................... 3.79 200 ml OP ✔ A-Lices

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2010 (continued)

86 AZITHROMYCIN – Subsidy by endorsement; can be waived by Special Authority see SA0964 a) Maximum of 2 tab per prescription; can be waived by Special Authority see SA0964 b) Up to 8 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 ETHAMBUTOL HYDROCHLORIDE – No patient co-payment payable Tab 100 mg ........................................................................... 48.01 Tab 400 mg ........................................................................... 49.34 97 56 56 ✔ Myambutol S29 ✔ Myambutol S29

INTERFERON ALPHA-2A – PCT – Retail pharmacy-Specialist a) See prescribing guideline b) Only one multidose cartridge starter pack to be prescribed and dispensed per patient. Inj 3 m iu prefilled syringe ....................................................... 31.32 1 ✔ Roferon-A Inj 6 m iu prefilled syringe ....................................................... 62.64 1 ✔ Roferon-A Inj 9 m iu prefilled syringe ....................................................... 93.96 1 ✔ Roferon-A ANTI-INFLAMMATORY NON STEROIDAL DRUGS (NSAIDS) ➽ SA1038 0291 Special Authority for Manufacturers Price Notes: Subsidy for patients with existing approvals prior to 1 September 2010. Approvals valid without further renewal unless notified. No new approvals will be granted from 1 September 2010. 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. ALENDRONATE SODIUM – Special Authority see SA1039 0990 – Retail pharmacy Tab 70 mg ............................................................................. 35.91 4 ✔ Fosamax

101

108

ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA1039 0990 – Retail pharmacy Tab 70 mg with cholecalciferol 5,600 iu .................................. 35.91 4 ✔ Fosamax Plus ➽ SA1039 0990 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 Garvan) which incorporates BMD measurements (see Note); or continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2010 (continued)

continued... 6 Patient has had a Special Authority approval for zoledronic acid (Underlying cause – Osteoporosis). 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 Any of the following: 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; or 2.3 The patient has had a Special Authority approval for zoledronic acid (Underlying cause – glucocorticosteroid therapy). 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 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 Garvan) which incorporates BMD measurements (see Note); or 6 Patient has had a Special Authority approval for zoledronic acid (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause – Osteoporosis’ criteria). Notes: a) BMD (including BMD used to derive T-Score) must be measured 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. 111 LIGNOCAINE Gel 2%, 10 ml urethral syringe – Up to 5 each available on a PSO .................................... 43.26

✔ Pfizer

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2010 (continued)

111 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 ............................ 35.00 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 .......................... 20.00 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 – Up to 5 each available on a PSO ..................................... 43.26

111

✔ Pfizer

122

ONDANSETRON – Retail pharmacy-Specialist a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 c) Not more than one prescription per month; can be waived by Special Authority see SA0887. 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 TROPISETRON – Retail pharmacy-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 ALPRAZOLAM – Month Restriction Tab 250 µg .............................................................................. 3.15 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 500 µg .............................................................................. 4.10 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 1 mg ................................................................................. 7.25 ‡ Safety cap for extemporaneously compounded oral liquid preparations.

122

5 50 50 50

✔ Navoban ✔ Arrow-Alprazolam ✔ Arrow-Alprazolam ✔ Arrow-Alprazolam

129

BUSPIRONE HYDROCHLORIDE – Special Authority see SA0863 – Retail pharmacy Month Restriction Tab 5 mg ............................................................................... 28.00 100 Tab 10 mg ............................................................................. 17.00 100 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. 500 500

✔ Pacific Buspirone ✔ Pacific Buspirone ✔ Arrow-Diazepam ✔ Arrow-Diazepam

130

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2010 (continued)

130 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. LORMETAZEPAM – Month Restriction Tab 1 mg ................................................................................. 3.11 (23.50) ‡ Safety cap for extemporaneously compounded oral liquid preparations. MIDAZOLAM Tab 7.5 mg – Month Restriction............................................... 10.38 (25.00) ‡ Safety cap for extemporaneously compounded oral liquid preparations. 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 ............................................................................ 21.02 250 100 ✔ Ativan ✔ Ativan

130

100 Ox-Pam 100 Ox-Pam

132

30 Noctamid

132

100 Hypnovel

132

100 Nitrados

132

✔ Normison

132

100 Hypam 100 Hypam

132

500

✔ Apo-Zopiclone

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2010 (continued)

140 CAPECITABINE – Retail pharmacy-Specialist – Special Authority see SA1040 0869 Tab 150 mg ......................................................................... 115.00 60 ✔ Xeloda Tab 500 mg ......................................................................... 705.00 120 ✔ Xeloda ➽ SA1040 0869 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 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 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, # capecitabine is approved for stage III (Duke’s stage C) colon cancer.

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer’s Price

Effective 1 December 2010

25 35 49 53 53 54 56 61 LOPERAMIDE HYDROCHLORIDE – Up to 30 tab available on a PSO ( subsidy) ❋ Tab 2 mg ................................................................................. 8.95 400 CHLORHEXIDINE GLUCONATE ( subsidy) Mouthwash 0.2% ..................................................................... 3.87 CILAZAPRIL ( subsidy) ❋ Tab 0.5 mg .............................................................................. 0.95 (2.20) ❋ Tab 2.5 mg .............................................................................. 1.92 (4.10) ❋ Tab 5 mg ................................................................................. 3.06 (6.01) LABETALOL ( subsidy) ❋ Tab 50 mg ............................................................................... 8.23 ❋ Tab 100 mg ........................................................................... 10.06 ❋ Tab 200 mg ........................................................................... 17.55 PROPRANOLOL ( subsidy) ❋ Cap long-acting 160 mg ......................................................... 16.06 NIFEDIPINE ( subsidy) ❋ Tab long-acting 30 mg ............................................................. 8.56 ❋ Tab long-acting 60 mg ........................................................... 12.28 ISOSORBIDE MONONITRATE ( subsidy) ❋ Tab long-acting 60 mg ............................................................. 3.94 ✔ Nodia

200 ml OP ✔ Rivacol 30 Inhibace 28 Inhibace 28 Inhibace 100 100 100 100 30 30 90 ✔ Hybloc ✔ Hybloc ✔ Hybloc ✔ Cardinol LA ✔ Adefin XL ✔ Adefin XL ✔ Duride

MENTHOL – Only in combination ( subsidy) 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 .................................................................................... 6.50 25 g ✔ PSM AMOXYCILLIN ( subsidy) Cap 250 mg – Up to 30 cap available on a PSO ....................... 16.18 (17.30) Cap 500 mg ........................................................................... 26.50 (27.25) NAPROXEN SODIUM ( subsidy) ❋ Tab 275 mg ............................................................................. 5.69 ❋ Tab 550 mg ............................................................................. 9.95 INTERFERON BETA-1-BETA – Special Authority see SA1062 ( subsidy) Inj 8 million iu per 1 ml ...................................................... 1,322.89 CARBOPLATIN – PCT only – Specialist ( subsidy) Inj 10 mg per ml, 45 ml .......................................................... 50.00 Inj 10 mg per ml, 100 ml ...................................................... 105.00 500 Apo-Amoxi 500 Apo-Amoxi 120 100 15 1 1 ✔ Sonaflam ✔ Synflex ✔ Betaferon ✔ Carboplatin Ebewe ✔ Carboplatin Ebewe

102 131 139

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 December 2010 (continued)

139 OXALIPLATIN – PCT only – Specialist – Special Authority see SA0900 ( subsidy) Inj 50 mg ............................................................................... 55.00 1 Inj 100 mg ........................................................................... 110.00 1 Inj 1 mg for ECP ....................................................................... 1.20 1 mg CALCIUM FOLINATE ( subsidy) Inj 1 g – PCT only – Specialist ................................................. 90.00 METHOTREXATE ( subsidy) ❋ Inj 100 mg per ml, 10 ml – PCT – Retail pharmacy-Specialist ........................................................... 25.00 ❋ Inj 100 mg per ml, 50 ml – PCT – Retail pharmacy-Specialist ......................................................... 125.00 ❋ Inj 1 mg for ECP – PCT only – Specialist ................................... 0.09 DOXORUBICIN – PCT only – Specialist Inj 10 mg ( subsidy) .............................................................. 10.00 Inj 50 mg ( subsidy) .............................................................. 40.00 Inj 100 mg ( subsidy) ............................................................ 80.00 Inj 200 mg ( subsidy) .......................................................... 150.00 Inj 1 mg for ECP ( subsidy) ...................................................... 0.88 EPIRUBICIN – PCT only – Specialist ( subsidy) Inj 2 mg per ml, 50 ml .......................................................... 125.00 Inj 2 mg per ml, 100 ml ........................................................ 210.00 Inj 1 mg for ECP ....................................................................... 1.80 PACLITAXEL – PCT only – Specialist ( subsidy) Inj 30 mg ............................................................................. 137.50 Inj 100 mg ............................................................................. 91.67 Inj 150 mg ........................................................................... 137.50 Inj 300 mg ........................................................................... 275.00 Inj 600 mg ........................................................................... 550.00 Inj 1 mg for ECP ....................................................................... 1.02 CHLORAMPHENICOL ( subsidy) Eye drops 0.5% ........................................................................ 1.28 (2.40) METHYL HYDROXYBENZOATE ( subsidy) Powder .................................................................................... 8.00 1 ✔ Oxaliplatin Ebewe ✔ Oxaliplatin Ebewe ✔ Baxter ✔ Calcium Folinate Ebewe

140

142 144

1 1 1 mg 1 1 1 1 1 mg 1 1 1 mg 5 1 1 1 1 1 mg 10 ml OP

✔ Methotrexate Ebewe ✔ Methotrexate Ebewe ✔ Baxter ✔ Doxorubicin Ebewe ✔ Doxorubicin Ebewe ✔ Doxorubicin Ebewe ✔ Doxorubicin Ebewe ✔ Baxter ✔ Epirubicin Ebewe ✔ Epirubicin Ebewe ✔ Baxter ✔ Paclitaxel Ebewe ✔ Paclitaxel Ebewe ✔ Paclitaxel Ebewe ✔ Paclitaxel Ebewe ✔ Paclitaxel Ebewe ✔ Baxter

144

145

162

Chlorsig 25 g ✔ PSM

172 172

PROPYLENE GLYCOL ( subsidy) Only in extemporaneously compounded methyl hydroxybenzoate 10% solution. Liq ......................................................................................... 10.50 500 ml

✔ PSM

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 November 2010

33 MUCILAGINOUS LAXATIVES – Only on a prescription ( subsidy) ❋ Dry ........................................................................................... 3.91 (5.72) 4.58 (6.69) 5.42 (12.71) 6.02 (16.49) ❋ Dry-original flavour, regular texture only .................................... 4.05 (12.38) ❋ Sugar Free ................................................................................ 3.31 (10.60) MUCILAGINOUS LAXATIVES WITH STIMULANTS ( subsidy) ❋ Dry ........................................................................................... 2.41 (7.69) 6.02 (16.49) VITAMIN B COMPLEX ( subsidy) ❋ Tab, strong, BPC ...................................................................... 4.70 (12.10) VITAMINS ( subsidy) ❋ Tab (BPC cap strength) ............................................................ 8.00 CLOPIDOGREL ( subsidy) Tab 75 mg ............................................................................... 5.06 (73.38) FUROSEMIDE ( subsidy) ❋ Inj 10 mg per ml, 2 ml – Up to 5 inj available on a PSO ............................................................... 13.00 (29.50) 325 g OP Konsyl-D 380 g OP Mucilax 450 g OP Isogel 500 g OP Normacol 336 g OP Metamucil 275 g OP Mucilax 200 g OP Normacol Plus 500 g OP Normacol Plus 500 Apo-B-Complex 1,000 28 ✔ MultiADE ✔ Arrow-Clopidogrel Plavix

36 38 41

50 Mayne

CEFTRIAXONE SODIUM – Subsidy by endorsement ( subsidy) 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 ............................................................................... 2.57 1 (3.99) AFT DAUNORUBICIN – PCT only – Specialist ( subsidy) Inj 2 mg per ml, 10 ml .......................................................... 118.72 Inj 20 mg for ECP ................................................................. 118.72 TERBUTALINE SULPHATE ( subsidy) Powder for inhalation, 250 µg per dose, breath activated ......... 22.00 1 ✔ Pfizer S29 20 mg OP ✔ Baxter 200 dose OP ✔ Bricanyl Turbuhaler

143

158

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 November 2010 (continued)

163 SODIUM CROMOGLYCATE ( subsidy) Eye drops 2% ........................................................................... 2.36 (3.95) 10 ml OP Cromolux

Effective 1 October 2010

34 SODIUM CITRATE WITH SODIUM LAURYL SULPHOACETATE – Only on a prescription ( subsidy) Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml ................................................................. 6.00 12 (7.30) Microlax IMIGLUCERASE – Special Authority see SA0473 – Retail pharmacy (removal of CBS) Inj 40 iu per ml, 200 iu vial ................................................. 1072.00 1 ASCORBIC ACID ( subsidy) a) No more than 100 mg per dose b) Only on a prescription ❋ Tab 100 mg ........................................................................... 13.80 (17.25) SODIUM CHLORIDE ( subsidy) Inj 0.9%, 20 ml – Up to 5 inj available on a PSO ......................... 8.41 ✔ Cerezyme

35 37

44 44

500 Apo-Ascorbic Acid 20 ✔ Multichem

WATER ( subsidy) 1) On a prescription or Practitioner’s Supply Order only when on the same form as an injection listed in the Pharmaceutical Schedule requiring a solvent or diluent; or 2) On a bulk supply order; or 3) When used in the extemporaneous compounding of eye drops. Purified for inj, 5 ml – Up to 5 inj available on a PSO .................. 9.20 50 ✔ Multichem Purified for inj, 10 ml – Up to 5 inj available on a PSO .............. 10.20 50 ✔ Multichem Purified for inj, 20 ml – Up to 5 inj available on a PSO ................ 5.00 20 ✔ Multichem CHOLESTYRAMINE WITH ASPARTAME ( price) Sachets 4 g with aspartame .................................................... 19.25 (52.68) TERAZOSIN HYDROCHLORIDE ( subsidy) ❋ Tab 1 mg ................................................................................. 1.50 (2.50) ❋ Tab 2 mg ............................................................................... 14.29 (23.30) ❋ Tab 5 mg ............................................................................... 17.86 (29.00) INDAPAMIDE ( subsidy) ❋ Tab 2.5 mg .............................................................................. 3.25 NYSTATIN ( price) Crm 100,000 u per g ................................................................ 1.00 (7.90) a) Only on a prescription b) Not in combination 50 Questran-Lite 28 Apo-Terazosin 500 Apo-Terazosin 500 Apo-Terazosin 100 15 g OP Mycostatin ✔ Napamide

49 56 61

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 October 2010 (continued)

65 66 UREA ( subsidy) ❋ Crm 10% .................................................................................. 3.07 MALATHION ( subsidy) Liq 0.5% ................................................................................... 3.79 (4.99) OESTRIOL ( subsidy) ❋ Crm 1 mg per g with applicator ................................................. 6.30 ❋ Pessaries 500 µg ..................................................................... 6.53 100 g OP 200 ml OP Derbac-M 15 g OP 15 ✔ Ovestin ✔ Ovestin ✔ Nutraplus

74 85

CEFTRIAXONE SODIUM – Subsidy by endorsement ( subsidy) 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 1 g ...................................................................................... 2.10 1 (5.40) AFT NITROFURANTOIN ( subsidy) ❋ Tab 50 mg ............................................................................. 22.20 ❋ Tab 100 mg ........................................................................... 37.50 100 100 ✔ Nifuran ✔ Nifuran

99 115 126

MIANSERIN HYDROCHLORIDE – Special Authority see SA1048 – Retail pharmacy ( subsidy) Tab 30 mg ............................................................................. 24.86 30 ✔ Tolvon QUETIAPINE ( subsidy) Tab 25 mg ............................................................................... 7.00 Tab 100 mg ........................................................................... 14.00 Tab 200 mg ........................................................................... 24.00 Tab 300 mg ........................................................................... 40.00 AZATHIOPRINE – Retail pharmacy-Specialist ( subsidy) ❋ Tab 50 mg ............................................................................. 18.45 (34.90) 60 60 60 60 100 ✔ Seroquel ✔ Seroquel ✔ Seroquel ✔ Seroquel ✔ Azamun Imuran

151 151

MYCOPHENOLATE MOFETIL – Special Authority see SA1041– Retail pharmacy ( subsidy) Note: Dispensing pharmacy should check which brand to dispense with the prescriber if prescribed generically. Tab 500 mg ........................................................................... 70.00 50 ✔ Cellcept Cap 250 mg ........................................................................... 70.00 100 ✔ Cellcept IPRATROPIUM BROMIDE ( subsidy) Nebuliser soln, 250 µg per ml, 1 ml – Up to 40 neb available on a PSO ............................................................................... 3.79 Nebuliser soln, 250 µg per ml, 2 ml – Up to 40 neb available on a PSO ............................................................................... 4.06

159

20 20

✔ Ipratropium Steri-Neb ✔ Ipratropium Steri-Neb

164

▲

TRAVOPROST – Retail pharmacy-Specialist ( subsidy) See prescribing guideline ▲ Eye drops 0.004% ................................................................... 19.50

2.5 ml OP ✔ Travatan

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 October 2010 (continued)

178 ORAL SUPPLEMENT 1KCAL/ML – Special Authority see SA0583 – Hospital pharmacy [HP3] ( subsidy) Powder (chocolate) .................................................................. 4.22 400 g OP ✔ Ensure Powder (strawberry) ................................................................. 4.22 400 g OP ✔ Ensure Powder (vanilla) ....................................................................... 4.22 400 g OP ✔ Ensure

Effective 1 September 2010

35 41 44 46 49 56 67 CHOLINE SALICYLATE WITH CETALKONIUM CHLORIDE ( price) ❋ Adhesive gel 8.7% with cetalkonium chloride 0.01% ................. 2.06 (5.62) CLOPIDOGREL ( subsidy) Tab 75 mg ............................................................................... 5.05 SODIUM CHLORIDE ( subsidy) Inj 23.4%, 20 ml ..................................................................... 31.25 ATORVASTATIN ( subsidy) See prescribing guideline ❋ Tab 10 mg ............................................................................. 18.32 ❋ Tab 20 mg ............................................................................. 26.70 ❋ Tab 40 mg ............................................................................. 37.02 ❋ Tab 80 mg ........................................................................... 110.50 CAPTOPRIL ( subsidy) ❋‡ Oral liq 5 mg per ml .............................................................. 94.99 Oral liquid restricted to children under 12 years of age. AMILORIDE WITH HYDROCHLOROTHIAZIDE ( subsidy) ❋ Tab 5 mg with hydrochlorothiazide 50 mg ................................. 5.00 15 g OP Bonjela 28 5 ✔ Apo-Clopidogrel ✔ Biomed

30 30 30 30 95 ml OP

✔ Lipitor ✔ Lipitor ✔ Lipitor ✔ Lipitor ✔ Capoten

✔ Moduretic

COAL TAR ( subsidy) Soln BP – Only in combination ................................................ 12.95 200 ml ✔ David Craig Up to 10 % Only in combination with a dermatological base or proprietary Topical Corticosteriod – Plain With or without other dermatological galenicals. SODIUM CITRO-TARTRATE ( subsidy) ❋ Grans eff 4 g sachets ............................................................... 2.71 HYDROCORTISONE ( subsidy) ❋ Inj 50 mg per ml, 2 ml .............................................................. 3.99 a) Up to 5 inj available on a PSO b) Only on a PSO PHENOXYMETHYLPENICILLIN (PENICILLIN V) ( subsidy) Cap potassium salt 250 mg – Up to 30 cap available on a PSO ................................................................. 9.71 Cap potassium salt 500 mg .................................................... 11.70 NYSTATIN ( subsidy) Tab 500,000 u ....................................................................... 14.16 Cap 500,000 u ....................................................................... 12.81 28 1 ✔ Ural ✔ Solu-Cortef

75 77

50 50 50 50

✔ Cilicaine VK ✔ Cilicaine VK ✔ Nilstat ✔ Nilstat

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 September 2010 (continued)

90 ETHAMBUTOL HYDROCHLORIDE – No patient co-payment payable ( subsidy) Tab 100 mg ........................................................................... 48.01 56 Tab 400 mg ........................................................................... 49.34 56 IBUPROFEN ( subsidy) ❋ Tab long-acting 800 mg ........................................................... 9.12 LIGNOCAINE HYDROCHLORIDE ( subsidy) Inj 1%, 5 ml – Up to 5 inj available on a PSO ............................ 35.00 Inj 1%, 20 ml – Up to 5 inj available on a PSO .......................... 20.00 30 50 5 ✔ Myambutol ✔ Myambutol ✔ Brufen Retard ✔ Xylocaine ✔ Xylocaine

101 111

111

LIGNOCAINE WITH PRILOCAINE – Special Authority see SA0906 – Retail pharmacy ( subsidy) Crm 2.5% with prilocaine 2.5% ............................................... 45.00 30 g OP ✔ EMLA Crm 2.5% with prilocaine 2.5% (5 g tubes) ............................. 45.00 5 ✔ EMLA MORPHINE SULPHATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable Cap long-acting 10 mg ............................................................. 2.22 Cap long-acting 30 mg ............................................................. 3.20 Cap long-acting 100 mg ........................................................... 8.05 MORPHINE SULPHATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable Cap long-acting 60 mg ............................................................. 6.90 MORPHINE TARTRATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable Inj 80 mg per ml, 1.5 ml ......................................................... 30.00 Inj 80 mg per ml, 5 ml ............................................................ 75.00

113

10 10 10

✔ m-Eslon ✔ m-Eslon ✔m-Eslon

113

✔ m-Eslon

113

5 5

✔ Hospira ✔ Hospira

118 125

GABAPENTIN (NEURONTIN) – Special Authority see SA0973 – Retail pharmacy ( subsidy) ▲ Tab 600 mg ........................................................................... 67.50 100 ✔ Neurontin ▲ Cap 100 mg ........................................................................... 13.26 100 ✔ Neurontin ▲ Cap 300 mg ........................................................................... 39.76 100 ✔ Neurontin ▲ Cap 400 mg ........................................................................... 53.01 100 ✔ Neurontin HALOPERIDOL ( subsidy) Tab 500 µg – Up to 30 tab available on a PSO ........................... 5.42 Tab 1.5 mg – Up to 30 tab available on a PSO ........................... 8.20 Tab 5 mg – Up to 30 tab available on a PSO ............................ 25.84 Oral liq 2 mg per ml – Up to 200 ml available on a PSO ............ 19.87 Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 18.74 FLUOROURACIL SODIUM ( subsidy) Inj 50 mg per ml, 10 ml – PCT only – Specialist ....................... 26.25 100 100 100 100 ml 10 5 ✔ Serenace ✔ Serenace ✔ Serenace ✔ Serenace ✔ Serenace ✔ Fluorouracil Ebewe

141

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 September 2010 (continued)

141 FLUOROURACIL SODIUM ( subsidy) Inj 50 mg per ml, 20 ml – PCT only – Specialist ......................... 7.50 Inj 50 mg per ml, 50 ml – PCT only – Specialist ....................... 18.00 Inj 50 mg per ml, 100 ml – PCT only – Specialist ..................... 34.50 METHOTREXATE ( subsidy) ❋ Inj 25 mg per ml, 2 ml – PCT – Retail pharmacy-Specialist ..... 48.00 ❋ Inj 25 mg per ml, 20 ml – PCT – Retail pharmacy-Specialist ... 90.00 ❋ Inj 1 mg for ECP – PCT only – Specialist ................................... 0.10 DACARBAZINE – PCT only – Specialist ( subsidy) Inj 200 mg ............................................................................. 48.00 Inj 200 mg for ECP ................................................................. 48.00 MESNA – PCT only – Specialist ( subsidy) Tab 400 mg ......................................................................... 210.65 Tab 600 mg ......................................................................... 314.40 Inj 100 mg per ml, 4 ml ........................................................ 137.04 Inj 100 mg per ml, 10 ml ...................................................... 314.66 FLUTAMIDE – Retail pharmacy-Specialist ( subsidy) Tab 250 mg ........................................................................... 55.00 NEDOCROMIL ( subsidy) Aerosol inhaler, 2 mg per dose CFC-free ................................. 28.07 SODIUM CROMOGLYCATE ( subsidy) Powder for inhalation, 20 mg per dose .................................... 17.94 Aerosol inhaler, 5 mg per dose CFC-free ................................. 28.07 THEOPHYLLINE ( subsidy) ❋‡ Oral liq 80 mg per 15 ml ....................................................... 15.50 GLYCEROL ( subsidy) ❋ Liquid – Only in combination ................................................... 17.86 (19.80) (24.75) 0.89 (3.00) 1.79 (4.90) 4.47 (10.00) Only in extemporaneously compounded oral liquid preparations. 1 1 1 5 1 1 mg ✔ Fluorouracil Ebewe ✔ Fluorouracil Ebewe ✔ Fluorouracil Ebewe ✔ Hospira ✔ Hospira ✔ Baxter

142 143

1 ✔ Hospira 200 mg OP ✔ Baxter 50 50 15 15 100 ✔ Uromitexan ✔ Uromitexan ✔ Uromitexan ✔ Uromitexan ✔ Flutamin

145

149 160 160

112 dose OP ✔ Tilade 50 dose ✔ Intal Spincaps 112 dose OP ✔ Vicrom 500 ml 2,000 ml ABM MidWest 100 ml PSM 200 ml PSM 500 ml PSM ✔ Nuelin

160 171

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to General Rules

Effective 1 September 2010

15 “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.

Changes to Brand Name

Effective 1 October 2010

35 BISACODYL – Only on a prescription ❋ Tab 5 mg ................................................................................. 4.99 200 ✔ Lax-Tab Lax-Tabs

Effective 1 September 2010

113 MORPHINE TARTRATE a) Only on a controlled drug form b) No patient co-payment payable Inj 80 mg per ml, 1.5 ml ......................................................... 30.00 Inj 80 mg per ml, 5 ml ............................................................ 75.00 METHOTREXATE ❋ Inj 25 mg per ml, 2 ml – PCT – Retail pharmacy-Specialist ..... 48.00 ❋ Inj 25 mg per ml, 20 ml – PCT – Retail pharmacy-Specialist ... 90.00 DACARBAZINE – PCT only – Specialist Inj 200 mg ............................................................................. 48.00

5 5 5 1 1

✔ Hospira Mayne ✔ Hospira Mayne ✔ Hospira Mayne ✔ Hospira Mayne ✔ Hospira Mayne

142 143

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Section E Part I

Effective 1 November 2010

196 SODIUM CHLORIDE ✔ Inj 0.9%, 20 ml ......................................................................... 5

Effective 1 October 2010

196 SODIUM CHLORIDE ✔ Inj 0.9%, 20 ml ........................................................................ 5

Effective 1 September 2010

193 AZITHROMYCIN ✔ Tab 500 mg – Subsidy by endorsement – See note on page 86 ........................................................... 8 4 LIGNOCAINE ✔ Gel 2%, 10 ml urethral syringe................................................. 5 LIGNOCAINE WITH CHLORHEXIDINE ✔ Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringes .................................................................. 5

195 195

Changes to Sole Subsidised Supply

Effective 1 December 2010

For the list of new Sole Subsidised Supply products effective 1 December 2010 refer to the bold entries in the cumulative Sole Subsidised Supply table pages 11-19.

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items

Effective 1 December 2010

27 OMEPRAZOLE, AMOXYCILLIN AND CLARITHROMYCIN Omeprazole cap 20 mg × 14, amoxycillin cap 500 mg × 28 and clarithromycin tab 500 mg × 14 .................................. 55.00 HEPARIN SODIUM Inj 5,000 iu per ml, 5 ml ......................................................... 43.67 KETOCONAZOLE Crm 2% .................................................................................... 1.00 (9.50) a) Only on a prescription b) Not in combination

1 OP 10 15 g OP

✔ Losec Hp7 OAC ✔ Multiparin

43 61

Nizoral

COAL TAR Soln BP – Only in combination ................................................ 32.37 500 ml ✔ PSM 12.95 200 ml ✔ David Craig Up to 10 % Only in combination with a dermatological base or proprietary Topical Corticosteriod – Plain With or without other dermatological galenicals. FLUOXETINE HYDROCHLORIDE ❋ Cap 20 mg ............................................................................... 2.89 Note – Fluox cap 20 mg 84 cap pack remains subsidised. GLYCEROL ❋ Liquid – Only in combination ................................................... 17.86 (19.80) (24.75) 0.89 (3.00) 1.79 (4.90) 4.47 (10.00) Only in extemporaneously compounded oral liquid preparations. 90 ✔ Fluox

116 171

2,000 ml 100 ml

✔ PSM ABM MidWest PSM

200 ml PSM 500 ml PSM

184

ENTERAL FEED 1KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.24 250 ml OP ✔ Isosource HN 5.29 1,000 ml OP ✔ Isosource HN RTH ENTERAL FEED WITH FIBRE 1 KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.24 250 ml OP ✔ Fibersource HN 5.29 1,000 ml OP ✔ Fibersource HN RTH ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 7.00 1,000 ml OP ✔ Isosource 1.5 ORAL FEED 1.5KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid (vanilla) .......................................................................... 1.33 237 ml OP ✔ Resource Plus

184

185 185

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 December 2010 (continued)

186 FOOD THICKENER – Special Authority see SA0595 – Hospital pharmacy [HP3] Powder .................................................................................... 3.80 250 g OP ✔ Resource Thicken Up

Effective 1 November 2010

50 55 62 72 ENALAPRIL ❋ Tab 5 mg ................................................................................. 1.98 ❋ Tab 10 mg ............................................................................... 2.44 (2.76) ❋ Tab 20 mg ............................................................................... 3.24 (3.68) FUROSEMIDE ❋ Tab 500 mg ........................................................................... 12.00 HYDROCORTISONE ❋ Crm 1% – Only on a prescription .............................................. 2.44 ETHINYLOESTRADIOL WITH LEVONORGESTREL ❋ Tab ethinyloestradiol 30 µg with levonorgestrel 50 µg (6) and tab ethinyloestradiol 40 µg with levonorgestrel 75 µg (5), and tab ethinyloestradiol 30 µg with levonorgestrel 125 µg (10) and 7 inert tab – Up to 84 tab available on a PSO ............ 6.62 DYDROGESTERONE Tab 10 mg ............................................................................. 27.50 (29.90) Note – Duphaston tab 10 mg, 28 tab pack remains listed DANAZOL – Retail pharmacy-Specialist Cap 200 mg ........................................................................... 29.35 DICLOFENAC SODIUM ❋ Tab EC 25 mg .......................................................................... 1.63 ❋ Tab EC 50 mg .......................................................................... 2.13 ❋ Tab long-acting 75 mg ........................................................... 22.78 ❋ Tab long-acting 100 mg ......................................................... 34.32 CLOMIPRAMINE HYDROCHLORIDE Tab 25 mg ............................................................................. 26.00 90 90 90 m-Enalapril 100 100 g ✔ Diurin 500 ✔ Lemnis Fatty Cream HC ✔ m-Enalapril m-Enalapril

84 50

✔ Trifeme

Duphaston

83 101 114 115

30 50 50 500 500 500

✔ D-Zol ✔ Diclohexal ✔ Diclohexal ✔ Apo-Diclo SR ✔ Apo-Diclo SR ✔ Clopress

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 Tab 300 mg ........................................................................... 18.80 60 ✔ GenRx Moclobemide LEVETIRACETAM – Special Authority see SA0921 – Retail pharmacy Tab ..................................................................................... CBS 60 ✔ Keppra

119

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 November 2010 (continued)

141 FLUOROURACIL SODIUM Inj 50 mg per ml, 10 ml – PCT only – Specialist ......................... 4.95 1 Note – Fluorouracil Ebewe inj 50 mg per ml, 10 ml, 5 injection pack remains listed. ✔ Fluorouracil Ebewe

Effective 1 October 2010

28 OMEPRAZOLE ❋ Cap 20 mg ................................................................................ 2.85 Note: Dr Reddy's Omeprazole cap 20 mg, 30 capsule pack, remains listed 49 53 ACEBUTOLOL ❋ Cap 200 mg ............................................................................ 15.94 BENDROFLUAZIDE ❋ Tab 2.5 mg – Up to 150 tab available on a PSO ......................... 7.58 (13.50) May be supplied on a PSO for reasons other than emergency. ❋ Tab 5 mg ................................................................................ 11.75 (21.50) 100 500 Neo-Naclex 500 Neo-Naclex ✔ ACB 28 ✔ Dr Reddy’s Omeprazole

AMLODIPINE 30 ✔ Norvasc ❋ Tab 5 mg ............................................................................... 22.82 ❋ Tab 10 mg ............................................................................. 34.85 30 ✔ Norvasc Note – Norvasc tab 5 mg and 10 mg was a temporary listing to cover the out-of-stock of Apo-Amlodipine which is now back in stock. TESTOSTERONE UNDECANOATE – Retail pharmacy-Specialist Cap 40 mg .............................................................................. 47.95 (60.71) 60 ✔ Andriol Testocaps Panteston

Effective 1 September 2010

30 COPPER ❋ Tab, diagnostic – Not on a BSO ................................................. 5.02 (31.80) 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) DOCUSATE SODIUM – Only on a prescription ❋ Tab 50 mg ................................................................................ 3.95 (4.89) ❋ Tab 120 mg .............................................................................. 5.49 (6.73) 36 OP Clinitest 50 strip OP Diabur 5000 50 strip OP Diastix Clinistix 100 Coloxyl 100 Coloxyl

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 September 2010 (continued)

37 MULTIVITAMINS – Special Authority see SA0963 – Retail pharmacy Tab ......................................................................................... 19.65 Oral liq .................................................................................... 13.50 ATORVASTATIN ❋ Tab 10 mg ............................................................................... 1.77 ❋ Tab 20 mg ............................................................................... 2.60 ❋ Tab 40 mg ............................................................................... 4.38 ❋ Tab 80 mg ............................................................................... 7.73 BUSERELIN ACETATE Inj 1 mg per ml, 5.5 ml .......................................................... 195.00 (272.53) AMOXYCILLIN Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO ................................................................. 1.00 100 ✔ Ketovite 150 ml OP ✔ Ketovite Liquid 30 30 30 30 2 Suprefact ✔ Lorstat 10 ✔ Lorstat 20 ✔ Lorstat 40 ✔ Lorstat 80

46 82

100 ml

✔ Ranbaxy Amoxicillin

109 111

ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA1039 – Retail pharmacy Tab 70 mg with cholecalciferol 2,800 iu................................... 35.91 4 ✔ Fosamax Plus BUPIVACAINE HYDROCHLORIDE Inj 0.5%, 4 ml ......................................................................... 29.35 Inj 0.5%, 8% glucose, 4 ml ..................................................... 24.50 5 5 ✔ Marcain Isobaric ✔ Marcain Heavy

141

FLUOROURACIL SODIUM Inj 1 mg for ECP – PCT only – Specialist ................................... 0.01 1 mg ✔ Baxter Note – This product has been replaced with a 100 mg pack size listed 1 September 2010. MESNA – PCT only – Specialist Inj 1 mg for ECP ....................................................................... 0.02 1 mg ✔ Baxter Note – This product has been replaced with a 100 mg pack size listed 1 September 2010. CYPROHEPTADINE HYDROCHLORIDE ❋ Tab 4 mg ................................................................................. 6.27 PHENYLEPHRINE HYDROCHLORIDE WITH ZINC SULPHATE ❋ Eye drops 0.12% with zinc sulphate 0.25% ................................ 4.51 100 15 ml OP ✔ Periactin ✔ Zincfrin

145

155 166

S29

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be Delisted

Effective 1 January 2011

34 SODIUM CITRATE WITH SODIUM LAURYL SULPHOACETATE – Only on a prescription Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml ..................................................................................... 6.00 12 (7.30) ASCORBIC ACID a) No more than 100 mg per dose b) Only on a prescription ❋ Tab 100 mg ........................................................................... 13.80 (17.25) TERAZOSIN HYDROCHLORIDE ❋ Tab 1 mg ................................................................................. 1.50 (2.50) ❋ Tab 7 × 1 mg and 7 × 2 mg ................................................... 0.74 ❋ Tab 2 mg ............................................................................... 14.29 (23.30) ❋ Tab 5 mg ............................................................................... 17.86 (29.00) INDAPAMIDE ❋ Tab 2.5 mg .............................................................................. 3.25 MALATHION Liq 0.5% ................................................................................... 3.79 (4.99)

Microlax

49 56 66

500 Apo-Ascorbic Acid 28 14 OP 500 500 Apo-Terazosin 100 200 ml OP Derbac-M ✔ Napamide Apo-Terazosin ✔ Hytrin Starter Pack Apo-Terazosin

CEFTRIAXONE SODIUM – 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 1 g ...................................................................................... 2.10 1 (5.40) AFT INFLUENZA VACCINE – Hospital pharmacy [Xpharm] Inj ............................................................................................ 9.00 90.00 1 10 ✔ Fluvax ✔ Influvac ✔ Vaxigrip

100

137

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) .................................................................... 23.41 96 OP ✔ Nicotinell Gum 2 mg (Mint) .................................................................... 23.41 96 OP ✔ Nicotinell Gum 4 mg (Fruit) .................................................................... 23.41 96 OP ✔ Nicotinell Gum 4 mg (Mint) .................................................................... 23.41 96 OP ✔ Nicotinell

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be Delisted - effective 1 January 2011 (continued)

151 159 AZATHIOPRINE – Retail pharmacy-Specialist ❋ Tab 50 mg ............................................................................. 18.45 (34.90) IPRATROPIUM BROMIDE Nebuliser soln, 250 µg per ml, 1 ml – Up to 40 neb available on a PSO ............................................................................... 3.79 Nebuliser soln, 250 µg per ml, 2 ml – Up to 40 neb available on a PSO ............................................................................... 4.06 100 ✔ Azamun Imuran

20 20

✔ Ipratropium Steri-Neb ✔ Ipratropium Steri-Neb

Effective 1 February 2011

33 MUCILAGINOUS LAXATIVES – Only on a prescription ❋ Dry ........................................................................................... 3.91 (5.72) 4.58 (6.69) 5.42 (12.71) 6.02 (16.49) ❋ Dry-original flavour, regular texture only .................................... 4.05 (12.38) Note – Konsyl-D 500 g pack remains fully subsidised VITAMIN B COMPLEX ❋ Tab, strong, BPC ...................................................................... 4.70 (12.10) CLOPIDOGREL Tab 75 mg ................................................................................ 5.06 (73.38) Note – Apo-Clopidogrel tab 75 mg, 90 tab pack, remains fully subsidised. 55 FUROSEMIDE ❋ Inj 10 mg per ml, 2 ml – Up to 5 inj available on a PSO ............ 13.00 (29.50) 50 Mayne 325 g OP Konsyl-D 380 g OP Mucilax 450 g OP Isogel 500 g OP Normacol 336 g OP Metamucil

500 Apo-B-Complex 28

✔ Apo-Clopidogrel ✔ Arrow-Clopidogrel Plavix

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be Delisted - effective 1 February 2011 (continued)

163 SODIUM CROMOGLYCATE Eye drops 2% ............................................................................ 2.36 (3.95) 10 ml OP Cromolux

Effective 1 March 2011

49 63 74 87 CILAZAPRIL ❋ Tab 0.5 mg .............................................................................. 0.95 (2.20) ❋ Tab 2.5 mg .............................................................................. 1.92 (4.10) ❋ Tab 5 mg ................................................................................. 3.06 (6.01) 30 Inhibace 28 Inhibace 28 Inhibace ✔ Locoid C ✔ Hospira S29

HYDROCORTISONE BUTYRATE WITH CHLORQUINALDOL – Only on a prescription Crm 0.1% with chlorquinaldol 3% ............................................. 3.49 15 g OP METHYLERGOMETRINE Inj 200 µg per ml, 1 ml – Up to 10 inj available on a PSO ........... 9.28 AMOXYCILLIN Cap 250 mg – Up to 30 cap available on a PSO ....................... 16.18 (17.30) Cap 500 mg ........................................................................... 26.50 (27.25) CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml ............................................................. 14.95 CHLORAMPHENICOL Eye drops 0.5% ........................................................................ 1.28 (2.40) 10 500

Apo-Amoxi 500 Apo-Amoxi 5 10 ml OP Chlorsig ✔ Valoid (AFT)

121 162

Effective 1 April 2011

44 SODIUM CHLORIDE Inj 0.9%, 5 ml – Up to 5 inj available on a PSO ......................... 11.50 Inj 0.9%, 10 ml – Up to 5 inj available on a PSO ....................... 11.50 50 50 ✔ AstraZeneca ✔ AstraZeneca

WATER 1) On a prescription or Practitioner’s Supply Order only when on the same form as an injection listed in the Pharmaceutical Schedule requiring a solvent or diluent; or 2) On a bulk supply order; or 3) When used in the extemporaneous compounding of eye drops. Purified for inj, 5 ml – Up to 5 inj available on a PSO ................ 10.51 50 ✔ AstraZeneca Purified for inj, 10 ml – Up to 5 inj available on a PSO ............. 11.32 50 ✔ AstraZeneca AMILORIDE WITH HYDROCHLOROTHIAZIDE ❋ Tab 5 mg with hydrochlorothiazide 50 mg ............................... 13.00 500 ✔ Amizide

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be Delisted - effective 1 April 2011 (continued)

102 PIROXICAM ❋ Tab dispersible 10 mg .............................................................. 3.25 ❋ Tab dispersible 20 mg .............................................................. 5.50 50 100 ✔ Piram-D ✔ Piram-D

Effective 1 May 2011

33 PANCREATIC ENZYME Cap 8,000 USP u lipase, 30,000 USP u amylase, 30,000 USP u protease ........................................................ 85.00 RISPERIDONE Tab 0.5 mg ............................................................................... 1.17 Note – Ridal tab 0.5 mg, 60 tab pack, remains subsidised.

250 20

✔ Cotazym ECS ✔ Ridal

127

Effective 1 June 2011

37 53 80 ALPHA TOCOPHERYL ACETATE – Special Authority see SA0915 – Retail pharmacy Water solubilised soln 156 iu/ml, with calibrated dropper ......... 18.30 50 ml OP LABETALOL ❋ Tab 400 mg ........................................................................... 34.44 DYDROGESTERONE Tab 10 mg ............................................................................. 15.40 (16.75) 100 28 Duphaston

✔ Micelle E ✔ Hybloc

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes to Part II

Effective 1 December 2010

21 CALCIUM FOLINATE (extension of HSS) Inj 50 mg – 1% DV Sep-08 to 2014 ....................................... 24.50 Inj 100 mg – 1% DV Sep-08 to 2014 ....................................... 9.75 Inj 300 mg – 1% DV Sep-08 to 2014 ..................................... 30.00 Inj 1 g – 1% DV Sep-08 to 2014 ( price)................................ 90.00 22 CARBOPLATIN ( price) Inj 10 mg per ml, 45 ml – 1% DV Dec-09 to 2012 ................... 50.00 Inj 10 mg per ml, 100 ml – 1% DV Dec-09 to 2012 ............... 105.00 5 1 1 1 Calcium Folinate Ebewe Calcium Folinate Ebewe Calcium Folinate Ebewe Calcium Folinate Ebewe Carboplatin Ebewe Carboplatin Ebewe

1 1

DOPAMINE HYDROCHLORIDE Inj 40 mg per ml, 5 ml – 1% Feb-11 to 2012 ........................... 82.08 10 Max Health Note – Mayne’s brand of dopamine hydrochloride inj 40 mg per ml, 5 ml to be delisted 1 February 2011. DOXORUBICIN (addition of HSS) Inj 10 mg – 1% Feb-11 to 2012 ( price) ................................ 10.00 Inj 50 mg – 1% Feb-11 to 2012 ( price) ................................ 40.00 Inj 100 mg – 1% Feb-11 to 2012 ( price) .............................. 80.00 Inj 200 mg – 1% Feb-11 to 2012 ( price) ............................ 150.00 EPIRUBICIN ( price) Inj 2 mg per ml, 50 ml – 1% DV Oct-09 to 2012 .................... 125.00 Inj 2 mg per ml, 100 ml – 1% DV Oct-09 to 2012 .................. 210.00 ESCITALOPRAM Tab 10 mg – 1% Feb-11 to 2013 .............................................. 2.65 Tab 20 mg – 1% Feb-11 to 2013 .............................................. 4.20 GEMFIBROZIL Tab 600 mg – 1% Feb-11 to 2013 .......................................... 14.00 GLYCERIN WITH SUCROSE Suspension ............................................................................. 38.00 GLYCERIN WITH SODIUM SACCHARIN Suspension ............................................................................. 38.00 ITRACONAZOLE Cap 100 mg – 1% Feb-11 to 2013 ............................................ 4.25 Note – Sporanox cap 100 mg to be delisted 1 February 2011. 1 1 1 1 1 1 28 28 60 473 ml 473 ml 15 Doxorubicin Ebewe Doxorubicin Ebewe Doxorubicin Ebewe Doxorubicin Ebewe Epirubicin Ebewe Epirubicin Ebewe Loxalate Loxalate Lipazil Ora-Sweet Ora-Sweet SF Itrazole

33 34 34 38

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes Part II - effective 1 December 2010 (continued)

38 39 ISOSORBIDE MONONITRATE ( price) Tab long-acting 60 mg ............................................................. 3.94 LABETALOL ( price) Tab 50 mg ............................................................................... 8.23 Tab 100 mg ........................................................................... 10.06 Tab 200 mg ........................................................................... 17.55 LABETALOL Tab 400 mg ........................................................................... 34.44 Note – Hybloc tab 400 mg to be delisted 1 February 2011. METHOTREXATE ( price and extension of HSS) Inj 100 mg per ml, 10 ml – 1% DV Nov-08 to 2014 ................. 25.00 Inj 100 mg per ml, 50 ml – 1% DV Nov-08 to 2014 ............... 125.00 METHYLCELLULOSE Suspension ............................................................................. 38.00 METHYLCELLULOSE WITH GLYCERIN AND SUCROSE Suspension ............................................................................. 38.00 METHYLCELLULOSE WITH GLYCERIN AND SODIUM SACCHARIN Suspension ............................................................................. 38.00 MOXIFLOXACIN Tab 400 mg ............................................................................ 52.00 Soln for inf 1.6 mg per ml, 250 ml ........................................... 70.00 NIFEDIPINE ( price) Tab long-acting 30 mg ............................................................. 8.56 Tab long-acting 60 mg ........................................................... 12.28 OXALIPLATIN ( price) Inj 50 mg – 1% DV Jan-10 to 2012 ......................................... 55.00 Inj 100 mg – 1% DV Jan-10 to 2012 ..................................... 110.00 PACLITAXEL ( price and extension of HSS) Inj 30 mg – 1% DV Oct-08 to 2014 ...................................... 137.50 Inj 100 mg – 1% DV Oct-08 to 2014 ....................................... 91.67 Inj 150 mg – 1% DV Oct-08 to 2014 ..................................... 137.50 Inj 300 mg – 1% DV Oct-08 to 2014 ..................................... 275.00 Inj 600 mg – 1% DV Oct-08 to 2014 ..................................... 550.00 PROPRANOLOL ( price) Cap long-acting 160 mg ......................................................... 16.06 RIVAROXABAN Tab 10 mg ............................................................................ 153.00 306.00 90 100 100 100 100 Duride Hybloc Hybloc Hybloc Hybloc

1 1 473 ml 473 ml 473 ml 5 1 30 30 1 1 5 1 1 1 1 100 15 30

Methotrexate Ebewe Methotrexate Ebewe Ora-Plus Ora-Blend Ora-Blend SF Avelox Avelox IV 400 Adefin XL Adefin XL Oxaliplatin Ebewe Oxaliplatin Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Cardinol LA Xarelto Xarelto

43 43 43 45

51 53

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes Part II - effective 1 December 2010 (continued)

54 SERTRALINE Tab 50 mg – 1% Feb-11 to 2013 .............................................. 5.40 Tab 100 mg – 1% Feb-11 to 2013 ............................................ 9.60 SODIUM CHLORIDE Inf 0.9% ................................................................................... 1.70 1.71 VERAPAMIL HYDROCHLORIDE Tab long-acting 120 mg ......................................................... 15.20 90 90 500 ml 1,000 ml 250 Arrow-Sertraline Arrow-Sertraline Freeflex Freeflex Verpamil SR

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

Index

Pharmaceuticals and brands A A-Lices .............................................................. 55 Acarbose ........................................................... 52 ACB ................................................................... 73 Acetadote .......................................................... 23 Aclasta .............................................................. 27 Acebutolol.......................................................... 73 Acetylcysteine.................................................... 23 Adalimumab....................................................... 33 Adapalene .......................................................... 24 Adefin XL ..................................................... 61, 80 Alendronate sodium ........................................... 56 Alendronate sodium with cholecalciferol ....... 56, 74 Alphamox .......................................................... 24 Alpha tocopheryl acetate .................................... 78 Alprazolam ......................................................... 58 Amiloride with hydrochlorothiazide ......... 54, 66, 77 Amizide.............................................................. 77 Amlodipine......................................................... 73 Amoxycillin ...................................... 24, 61, 74, 77 Anastrozole ........................................................ 25 Andriol Testocaps .............................................. 73 Apidra ................................................................ 26 Apo-Amoxi ................................................... 61, 77 Apo-Ascorbic Acid ....................................... 64, 75 Apo-B-Complex ........................................... 63, 76 Apo-Clopidogrel ............................... 26, 53, 66, 76 Apo-Diclo SR ..................................................... 72 Apo-Selegiline S29 ........................................... 22 Apo-Terazosin.............................................. 64, 75 Apo-Zopiclone.................................................... 59 Aremed .............................................................. 25 Arrow-Alprazolam .............................................. 58 Arrow-Azithromycin ........................................... 56 Arrow-Clopidogrel .................................. 53, 63, 76 Arrow-Diazepam ................................................ 58 Arrow-Enalapril .................................................. 33 Arrow-Meloxicam............................................... 26 Arrow-Sertraline ........................................... 21, 81 Ascorbic acid ............................................... 64, 75 Ativan ................................................................ 59 Atorvastatin............................................ 54, 66, 74 Avelox.......................................................... 20, 80 Avelox IV 400..................................................... 80 Azamun ....................................................... 65, 76 Azathioprine ................................................. 65, 76 Azithromycin ................................................ 56, 70 B B-D Micro-Fine................................................... 22 B-PlexADE ......................................................... 26 Bacillus calmette-guerin (bcg) vaccine ............... 23 Bendrofluazide ................................................... 73 Betaferon ........................................................... 61 Bisacodyl ........................................................... 69 Bonjela .............................................................. 66 Bricanyl Turbuhaler ............................................ 63 Brufen Retard ..................................................... 67 BSF Arrow-Enalapril ........................................... 23 Budenocort ........................................................ 25 Budesonide ........................................................ 25 Bupivacaine hydrochloride.................................. 74 Buserelin acetate ................................................ 74 Buspirone hydrochloride..................................... 58 C Calcium folinate ........................................... 62, 79 Calcium Folinate Ebewe................................ 62, 79 Capecitabine ................................................ 48, 60 Capoten ............................................................. 66 Captopril ...................................................... 22, 66 Carboplatin .................................................. 61, 79 Carboplatin Ebewe ....................................... 61, 79 Cardinol LA .................................................. 61, 80 Ceftriaxone sodium .................... 26, 63, 65, 75, 76 Cellcept ....................................................... 49, 65 Cephalexin ABM ................................................. 26 Cephalexin monohydrate .................................... 26 Cerezyme..................................................... 24, 64 Champix ............................................................ 22 Chlorafast .......................................................... 25 Chloramphenicol .................................... 25, 62, 77 Chlorhexidine gluconate ..................................... 61 Chlorsig ....................................................... 62, 77 Cholestyramine with aspartame .......................... 64 Choline salicylate with cetalkonium chloride........ 66 Cilazapril ................................................ 24, 61, 77 Cilicaine VK........................................................ 66 Clarithromycin.................................................... 24 Clinistix .............................................................. 73 Clinitest.............................................................. 73 Clomipramine hydrochloride ............................... 72 Clopidogrel ................................ 26, 53, 63, 66, 76 Clopress ............................................................ 72 Cotazym ECS ..................................................... 78 Coal tar ........................................................ 66, 71 Coloxyl .............................................................. 73 Copper............................................................... 73 Cromolux ..................................................... 64, 77 Cyclizine lactate ........................................... 28, 77 Cyproheptadine hydrochloride ............................ 74 D D-Zol ................................................................. 72 Dacarbazine ................................................. 68, 69 Danazol.............................................................. 72 Darunavir ........................................................... 22

Index

Pharmaceuticals and brands Daunorubicin ..................................................... 63 Deferiprone ........................................................ 24 Derbac-M .................................................... 65, 75 Diabur 5000 ....................................................... 73 Diamide Relief .................................................... 24 Diastix ............................................................... 73 Diazepam........................................................... 58 Diclofenac sodium ............................................. 72 Diclohexal .......................................................... 72 Differin ............................................................... 24 Diurin 500 .......................................................... 72 Docusate sodium ............................................... 73 Donepezil hydrochloride ..................................... 22 Donepezil-Rex .................................................... 22 Dopamine hydrochloride .................................... 79 Doxorubicin ................................................. 62, 79 Doxorubicin Ebewe ...................................... 62, 79 Dr Reddy’s Omeprazole...................................... 73 Dr Reddy’s Ondansetron .................................... 24 Duphaston ................................................... 72, 78 Duride .......................................................... 61, 80 Dydrogesterone............................................ 72, 78 E Elecare .............................................................. 26 Elecare LCP ....................................................... 26 Elemental formula .............................................. 26 Efexor XR ........................................................... 43 EMLA................................................................. 67 Enalapril ....................................................... 33, 72 Enbrel .......................................................... 22, 38 Ensure ......................................................... 25, 66 Ensure Plus HN .................................................. 25 Enteral feed 1kcal/ml .................................... 25, 71 Enteral feed with fibre 1.5kcal/ml .................. 25, 71 Enteral feed with fibre 1 kcal/ml .................... 25, 71 Epirubicin..................................................... 62, 79 Epirubicin Ebewe.......................................... 62, 79 Erlotinib hydrochloride........................................ 24 Escitalopram ................................................ 21, 79 Etanercept.................................................... 22, 38 Ethambutol hydrochloride ............................. 56, 67 Ethinyloestradiol with levonorgestrel ................... 72 Etravirine............................................................ 22 Ezetimibe ........................................................... 44 Ezetimibe with simvastatin ................................. 45 Ezetrol ............................................................... 44 F Ferriprox ............................................................ 24 Fibersource HN .................................................. 71 Fibersource HN RTH........................................... 71 Fluorouracil Ebewe ................................. 67, 68, 73 Fluorouracil sodium.................... 29, 67, 68, 73, 74 Fluox.................................................................. 71 Fluoxetine hydrochloride ..................................... 71 Flutamide ........................................................... 68 Flutamin ............................................................. 68 Fluvax ................................................................ 75 Food thickener ................................................... 72 Fosamax ............................................................ 56 Fosamax Plus .............................................. 56, 74 Freeflex .............................................................. 81 Frusemide-Claris ................................................ 26 Furosemide ...................................... 26, 63, 72, 76 G Gabapentin (neurontin) ....................................... 67 Gemfibrozil .................................................. 20, 79 GenRx Moclobemide .......................................... 72 Glucobay ........................................................... 52 Glucose oxidase................................................. 73 Glycerin with sodium saccharin .................... 21, 79 Glycerin with sucrose ................................... 21, 79 Glycerol ....................................................... 68, 71 H Haloperidol ........................................................ 67 Heparin sodium.................................................. 71 Humira............................................................... 33 HumiraPen ......................................................... 33 Hybloc ................................................... 61, 78, 80 Hydrocortisone ............................................ 66, 72 Hydrocortisone butyrate with chlorquinaldol........ 77 Hypam ............................................................... 59 Hypnovel ........................................................... 59 Hytrin Starter Pack ............................................. 75 I Ibuprofen ........................................................... 67 Imiglucerase ................................................ 24, 64 Imuran ......................................................... 65, 76 Influenza vaccine................................................ 75 Influvac .............................................................. 75 Insulin glulisine .................................................. 26 Insulin pen needles............................................. 22 Intal Spincaps .................................................... 68 Intelence ............................................................ 22 Interferon alpha-2a ............................................. 56 Indapamide .................................................. 64, 75 Inhibace ....................................................... 61, 77 Interferon beta-1-beta......................................... 61 Ipratropium bromide ..................................... 65, 76 Ipratropium Steri-Neb ................................... 65, 76 Isogel........................................................... 63, 76 Isopto Carpine.................................................... 44 Isosorbide mononitrate................................. 61, 80 Isosource 1.5..................................................... 71 Isosource HN ..................................................... 71

Index

Pharmaceuticals and brands Isosource HN RTH ............................................. 71 Isotretinoin ......................................................... 55 Itraconazole ................................................. 21, 79 Itrazole ......................................................... 21, 79 J Jevity ................................................................. 25 Jevity RTH ......................................................... 25 K Keppra ............................................................... 72 Ketoconazole ..................................................... 71 Ketovite ............................................................. 74 Ketovite Liquid ................................................... 74 Klacid ................................................................ 24 Konsyl-D................................................ 26, 63, 76 L Labetalol ................................................ 61, 78, 80 Lax-Tab ............................................................. 69 Lax-Tabs............................................................ 69 Lemnis Fatty Cream HC...................................... 72 Levetiracetam ........................................ 22, 44, 72 Levetiracetam-Rex ....................................... 22, 44 Levomepromazine .............................................. 30 Lignocaine ................................................... 57, 70 Lignocaine hydrochloride ....................... 28, 58, 67 Lignocaine with chlorhexidine ....................... 58, 70 Lignocaine with prilocaine .................................. 67 Lipazil .......................................................... 20, 79 Lipitor .......................................................... 54, 66 Locoid C ............................................................ 77 Loperamide hydrochloride ............................ 24, 61 Lorazepam ......................................................... 59 Lormetazepam ................................................... 59 Lorstat 10 .......................................................... 74 Lorstat 20 .......................................................... 74 Lorstat 40 .......................................................... 74 Lorstat 80 .......................................................... 74 Losec Hp7 OAC ................................................. 71 Loxalate ....................................................... 21, 79 M m-Captopril ........................................................ 22 m-Enalapril ........................................................ 72 m-Eslon ............................................................. 67 Mabthera ........................................................... 50 Malathion ............................................... 55, 65, 75 Marcain Heavy ................................................... 74 Marcain Isobaric ................................................ 74 Meloxicam ......................................................... 26 Menthol ....................................................... 20, 61 Mesna ................................................... 29, 68, 74 Metamucil .................................................... 63, 76 Methotrexate .................................... 62, 68, 69, 80 Methotrexate Ebewe ..................................... 62, 80 Methotrimeprazine.............................................. 30 Methylcellulose ............................................ 21, 80 Methylcellulose with glycerin and sodium saccharin...................................... 21, 80 Methylcellulose with glycerin and sucrose .... 21, 80 Methylergometrine ............................................. 77 Methyl hydroxybenzoate ............................... 21, 62 Mianserin hydrochloride ............................... 48, 65 Micelle E ............................................................ 78 Microlax ....................................................... 64, 75 Midazolam ......................................................... 59 Moclobemide ..................................................... 72 Moduretic .................................................... 54, 66 Morphine sulphate.............................................. 67 Morphine tartrate .......................................... 67, 69 Moxifloxacin................................................. 20, 80 Mucilaginous laxatives ........................... 26, 63, 76 Mucilaginous laxatives with stimulants ............... 63 Mucilax ........................................................ 63, 76 MultiADE............................................................ 63 Multiparin........................................................... 71 Multiple sclerosis treatments .............................. 30 Multivitamins ............................................... 52, 74 Myaccord .................................................... 25, 49 Myambutol................................................... 56, 67 Mycophenolate mofetil ........................... 25, 49, 65 Mycostatin ......................................................... 64 N Napamide .................................................... 64, 75 Naproxen sodium ............................................... 61 Nausicalm.......................................................... 28 Navoban ............................................................ 58 Nedocromil ........................................................ 68 Neo-Naclex ........................................................ 73 Nepro (strawberry) ............................................. 25 Neurontin ........................................................... 67 Nicotine ............................................................. 75 Nicotinell ............................................................ 75 Nifedipine..................................................... 61, 80 Nifuran ............................................................... 65 Nilstat ................................................................ 66 Nitrados ............................................................. 59 Nitrazepam......................................................... 59 Nitrofurantoin ..................................................... 65 Nizoral ............................................................... 71 Noctamid ........................................................... 59 Nodia ................................................................. 61 Normacol ..................................................... 63, 76 Normacol Plus ................................................... 63 Normison ........................................................... 59 Norvasc ............................................................. 73 Nozinan ............................................................. 30

Index

Pharmaceuticals and brands Nuelin ................................................................ 68 Nutraplus ........................................................... 65 Nystatin ....................................................... 64, 66 O Oestriol .............................................................. 65 Omeprazole........................................................ 73 Omeprazole, amoxycillin and clarithromycin ....... 71 OncoTICE........................................................... 23 Ondansetron ................................................ 24, 58 Ora-Blend .................................................... 21, 80 Ora-Blend SF................................................ 21, 80 Ora-Plus ...................................................... 21, 80 Ora-Sweet.................................................... 21, 79 Ora-Sweet SF ............................................... 21, 79 Oral feed 1.5kcal/ml ........................................... 71 Oral supplement 1kcal/ml ............................. 25, 66 Oratane .............................................................. 55 Osmolite ............................................................ 25 Osmolite RTH..................................................... 25 Ovestin .............................................................. 65 Oxaliplatin Ebewe ......................................... 62, 80 Ox-Pam ............................................................. 59 Oxaliplatin .................................................... 62, 80 Oxazepam .......................................................... 59 P Pacific Buspirone ............................................... 58 Paclitaxel ..................................................... 62, 80 Paclitaxel Ebewe .......................................... 62, 80 Paediatric oral feed 1kcal/ml............................... 25 Paediatric Seravit ............................................... 52 Pancreatic enzyme ............................................. 78 Panteston .......................................................... 73 Pediasure........................................................... 25 Periactin ............................................................ 74 Pharmacy services............................................. 23 Phenobarbitone Sodium Paediatric Oral Liquid .... 25 Phenoxymethylpenicillin (penicillin v) .................. 66 Phenylephrine hydrochloride with zinc sulphate .. 74 Pilocarpine ......................................................... 44 Pioglitazone ....................................................... 52 Piram-D ............................................................. 78 Piroxicam........................................................... 78 Pizaccord........................................................... 52 Plavix ..................................................... 53, 63, 76 Prezista.............................................................. 22 Propranolol .................................................. 61, 80 Propylene glycol .......................................... 21, 62 Q Questran-Lite ..................................................... 64 Quetiapine.......................................................... 65 R Ranbaxy Amoxicillin ........................................... 74 Renal oral feed 2kcal/ml ..................................... 25 Resource Plus.................................................... 71 Resource Thicken Up ......................................... 72 Rexacrom .......................................................... 29 Ridal .................................................................. 78 Risperidone........................................................ 78 Ritaxumab ......................................................... 50 Rivacol .............................................................. 61 Rivaroxaban ................................................. 20, 80 Roferon-A .......................................................... 56 S Section C - Explanatory Notes ............................ 32 Section C - Glossary .......................................... 32 Selegiline hydrochloride ..................................... 22 Serenace ........................................................... 67 Seroquel ............................................................ 65 Sertraline ..................................................... 21, 81 Sodibic .............................................................. 26 Sodium bicarbonate ..................................... 21, 26 Sodium chloride ....... 24, 33, 44, 64, 66, 70, 77, 81 Sodium citrate with sodium lauryl sulphoacetate .................................. 64, 75 Sodium citro-tartrate .......................................... 66 Sodium cromoglycate ...................... 29, 64, 68, 77 Solu-Cortef ........................................................ 66 Sonaflam ........................................................... 61 Standard formulae .............................................. 25 Sulphur .............................................................. 20 Sunitinib ............................................................ 23 Suprefact ........................................................... 74 Sutent ................................................................ 23 Synflex............................................................... 61 T Tarceva.............................................................. 24 Temazepam ....................................................... 59 Temodal ............................................................ 31 Temozolomide ................................................... 31 Tenofovir disoproxil fumarate ............................. 46 Tenoxicam ......................................................... 26 Terazosin hydrochloride ............................... 64, 75 Terbutaline sulphate ........................................... 63 Testosterone undecanoate.................................. 73 Theophylline ...................................................... 68 Tilade................................................................. 68 Tolvon ......................................................... 48, 65 Travatan....................................................... 52, 65 Travoprost ................................................... 52, 65 Triazolam ........................................................... 59 Triclosan............................................................ 55 Trifeme .............................................................. 72 Tropisetron ........................................................ 58

Index

Pharmaceuticals and brands U Ural.................................................................... 66 Urea................................................................... 65 Uromitexan ........................................................ 68 V Valoid (AFT) ....................................................... 77 Varenicline tartrate ............................................. 22 Vaxigrip ............................................................. 75 Venlafaxine ........................................................ 43 Veracol .............................................................. 26 Verapamil hydrochloride ..................................... 81 Verpamil SR ....................................................... 81 Vicrom ............................................................... 68 Viread ................................................................ 46 Vitamin B complex ................................. 26, 63, 76 Vitamins ............................................................ 63 Vytorin ............................................................... 45 W Water ........................................................... 64, 77 X Xarelto ......................................................... 20, 80 Xeloda ......................................................... 48, 60 Xylocaine ............................................... 28, 58, 67 Xylocaine Viscous .............................................. 28 Z Zapril ................................................................. 24 Zincfrin .............................................................. 74 Zofran ................................................................ 58 Zofran Zydis ....................................................... 58 Zoledronic acid .................................................. 27 Zopiclone ........................................................... 59

Pharmaceutical Management Agency Level 9, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Phone: 64 4 460 4990 - Fax: 64 4 460 4995 - www.pharmac.govt.nz Freephone Information line (9am-5pm weekdays) 0800 66 00 50 ISSN 1172-9376 (Print) ISSN 1179-3686 (Online)

While care has been taken in compiling this Update, Pharmaceutical Management Agency takes no responsibility for any errors or omissions and shall not be liable to any person for any damages or loss arising out of reliance by that person for any purpose on any of the contents of this Update. Errors and omissions brought to the attention of Pharmaceutical Management Agency will be corrected if necessary by an erratum or otherwise in the next edition of the Update.

If Undelivered, Return To: PO Box 10-254, Wellington 6143, New Zealand

Metadata

Title

Schedule Update - effective 1 December 2010

Abstract

Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 December 2010 Cumulative for September, October, November and December 2010 Section H for December 2010 Contents Summary of PHARMAC decisions effective 1 December 2010 ….. 3 Rivaroxaban – new listing……

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