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This is the text extract for Schedule Update - effective 1 July 2013, browse documents here.


Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 July 2013

Cumulative for May, June and July 2013


Contents

Summary of PHARMAC decisions effective 1 July 2013 ................................. 3 The new Hospital Medicines List (HML) ......................................................... 7 Anti-Infectives restriction amendments ......................................................... 8 Sensory Organs changes ............................................................................... 8 Funding of blood glucose and blood ketone testing products via PSO ......... 8 Ticagrelor subsidised for acute coronary syndrome ....................................... 9 Pegfilgrastim – new listing ............................................................................ 9 Risedronate – new listing .............................................................................. 9 Adalimumab new listing and extension to Special Authority criteria ............. 9 Phenobarbitone injection subsidised ............................................................. 9 m-Eslon 30 mg capsules out-of-stock............................................................ 9 Ursodeoxycholic acid – amendment to Special Authority criteria ................ 10 Prednisone 1 mg tablets – removal of Stat dispensing ................................ 10 New Pharmacode for Zyban ........................................................................ 10 Permax (pergolide) 0.25 mg stock shortage ................................................ 11 News in brief ............................................................................................... 11 Tender News ................................................................................................ 12 Looking Forward ......................................................................................... 12 Sole Subsidised Supply products cumulative to July 2013 ........................... 13 New Listings ................................................................................................ 22 Changes to Restrictions ............................................................................... 25 Changes to Subsidy and Manufacturer’s Price............................................. 46 Changes to General Rules............................................................................ 50 Changes to Brand Name ............................................................................. 53 Changes to Section I ................................................................................... 54 Changes to Section E .................................................................................. 55 Delisted Items ............................................................................................. 56 Items to be Delisted .................................................................................... 59 Index ........................................................................................................... 62

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Summary of PHARMAC decisions

EFFECTIVE 1 JULY 2013 New listings (page 22) • Ascorbic acid (Cvite) tab 100 mg • Vitamin B Complex (Bplex) tab, strong, BPC • Vitamins (Mvite) tab (BPC cap strength) • Ticagrelor (Brilinta) tab 90 mg – Special Authority – Retail pharmacy • Pegfilgrastim (Neulastim) inj 6 mg per 0.6 ml syringe – Special Authority – Retail pharmacy • Amiloride hydrochloride (Apo-Amiloride) tab 5 mg • Cetomacrogol with glycerol (Pharmacy Health Sorbolene with Glycerine) crm 90% with glycerol 10%, 500 g OP • Lidocaine [lignocaine] hydrochloride (Lidocaine-Claris) inj 1%, 5 ml and 20 ml ampoule • Phenobarbitone (Martindale) inj 200 mg per ml, 1 ml ampoule – Special Authority – Retail pharmacy – S29 • Adalimumab (Humira) inj 20 mg per 0.4 ml prefilled syringe – Special Authority – Retail pharmacy • Sodium hyaluronate (Hylo-Fresh) eye drops 1 mg per ml, 10 ml OP – Special Authority – Retail pharmacy – addition of note • Retinol palmitate (VitA-POS) eye oint 138 mcg per g, 5 g OP – Special Authority – Retail pharmacy • Pharmacy services (BSF Arrow-Quinapril) Brand switch fee – may only be claimed once per patient • Fat supplement (Liquigen) oil, 250 ml, 4 OP – Special Authority – Hospital pharmacy [HP3] • Renal oral feed 2 kcal/ml (Renilon 7.5) liquid (apricot), 125 ml, 4 OP and liquid (caramel), 125 ml, 4 OP – Special Authority – Hospital pharmacy [HP3] Changes to restrictions (pages 25-45) • Blood ketone diagnostic test meter (Freestyle Optium) – addition of 1 dev available on a PSO • Ketone blood beta-ketone electrodes (Freestyle Optium Ketone) – addition of up to 10 test available on a PSO • Blood glucose diagnostic test meter (CareSens) – addition of 1 dev available on a PSO, removal of Brand switch fee payable and addition of patient copayment. • Blood glucose diagnostic test strip (CareSens) – addition of up to 50 test available on a PSO • Ursodeoxycholic acid (Ursosan) – Special Authority amendment

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Summary of PHARMAC decisions – effective 1 July 2013 (continued) • Mucilaginous laxatives (Konsyl-D) – amendment of chemical name to ispaghula (psyllium) husk) • Protamine sulphate (Artex) inj 10 mg per ml, 5 ml – addition of S29 • Quinapril (Arrow-Quinapril 5, Arrow-Quinapril 10, Arrow-Quinapril 20) tab 5 mg , 10 mg and 20 mg – addition of Brand switch fee payable • Cyproterone acetate with ethinyloestradiol (Ginet 84) – addition of up to 84 tab available on a PSO • Solifenacin succinate (Vesicare) tab 5 mg and 10 mg – Special Authority amendment • Tolterodine (Arrow-Tolterodine) tab 1 mg and 2 mg – Special Authority amendment • Prednisone (Apo-Prednisone) tab 1 mg – removal of stat symbol • Propylthiouracil (PTU) – addition of prescribing note • Cabergoline (Dostinex) tab 0.5 mg – Special Authority amendment • Danazol (Azol) cap 100 mg and 200 mg – removal of Retail pharmacySpecialist • Cefazolin sodium (AFT) inj 500 mg and 1 g – amendment of endorsement restriction • Ceftriaxone sodium (Vercacol) inj 500 mg and 1 g (Aspen Ceftriazone) – amendment of endorsement restriction • Minocycline hydrochloride tab 50 mg – addition of Special Authority for higher subsidy • Gentamicin sulphate inj – amendment of endorsement restriction • Moxifloxacin (Avelox) tab 400 mg – Special Authority amendment • Vancomycin hydrochloride (Mylan) inj 500 mg – amendment of endorsement restriction • Fluconazole (Diflucan) powder for oral suspension 10 mg per ml – Special Authority amendment • Lamivudine (Zetlam) tab 100 mg and (Zeffix) oral liq 5 mg per ml – Special Authority amendment • Entecavir (Baraclude) tab 0.5 mg – Special Authority amendment • Tenofovir disoproxil fumarate (Viread) tab 300 mg – Special Authority amendment • Valaciclovir (Valtrex) tab 500 mg – Special Authority amendment • Antiretrovirals – Special Authority amendment • Guidelines for the use of interferon in the treatment of hepatitis C – amendment • Pegylated interferon alpha-2A – Special Authority amendment

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Summary of PHARMAC decisions – effective 1 July 2013 (continued) • Lidocaine [lignocaine] hydrochloride inj 1%, 5 ml ampoule – amendment to PSO quantity • Sumatriptan (Arrow-Sumatriptan) inj 12 mg per ml, 0.5 ml – addition of cartridge to presentation • Hyoscine (Scopolamine) patch 1.5 mg – Special Authority amendment • Adalimumab (Humira and HumiraPen) – Special Authority amendment • Bee venom allergy treatment – Special Authority amendment • Wasp venom allergy treatment – Special Authority amendment • Special Foods – Special Authority amendments to o Carbohydrate o Carbohydrate and Fat o Fat o Protein o Respiratory products o Fat modified products o High protein products o Paediatric products o Paediatric products for children with chronic renal failure o Renal products o Specialised and elemental products o Adult products high calorie o Extensively hydrolysed formula • Renal oral feed 1 kcal/ml (Suplena) liquid – chemical amended to 2 kcal/ml Decreased subsidy (pages 46-49) • Insulin lispro with insulin lispro protamine (Humalog Mix 25) and (Humalog Mix 50) • Ispaghula (psyllium) husk (Konsyl-D) powder for oral soln • Sodium citrate with sodium lauryl sulphoacetate (Micolette) enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml • Terazosin (Arrow) tab 1 mg, 2 mg and 5 mg • Cilazapril (Zapril) tab 0.5 mg, 2.5 mg and 5 mg • Clonidine hydrochloride (Dixarit) tab 25 mcg • Spironolactone (Spirotone) tab 25 mg and 100 mg • Ezetimibe (Ezetrol) tab 10 mg • Ezetimibe with simvastatin (Vytorin) tab 10 mg with simvastatin 10 mg, 10 mg with simvastatin 20 mg, 10 mg with simvastatin 40 mg and 10 mg with simvastatin 80 mg

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Summary of PHARMAC decisions – effective 1 July 2013 (continued) • Levonorgestrel (Next Choice) tab 750 mcg • Medroxyprogesterone acetate (Depo-Provera) inj 150 mg per ml, 1 ml syringe • Clindamycin (Dalacin C) inj phosphate 150 mg per ml, 4 ml • Aciclovir (Lovir) tab dispersible 200 mg, 400 mg and 800 mg • Tetrabenazine (Motetis) tab 25 mg • Lidocaine [lignocaine] hydrochloride (Xylocaine) inj 2%, 5 ml and 20 ml • Dihydrocodeine tartrate (DHC Continus) tab long-acting 60 mg • Morphine sulphate (Arrow-Morphine LA) tab long-acting 10 mg, 30 mg, 60 mg and 100 mg • Sertraline (Arrow-Sertraline) tab 50 mg and 100 mg • Venlafaxine (Arrow-Venlafaxine XR) tab 37.5 mg, 75 mg, 150 mg and 225 mg • Venlafaxine (Efexor XR) cap 37.5 mg, 75 mg and 150 mg • Sumatriptan (Arrow-Sumatriptan) tab 50 mg and 100 mg; and inj 12 mg per ml, 0.5 ml cartridge • Naltrexone hydrochloride (Naltraccord) tab 50 mg • Methotrexate (Hospira) inj 25 mg per ml, 2 ml and 20 ml • Docetaxel (Taxotere) inj 20 mg per ml, 1 ml and 4 ml • Docetaxel (Baxter) inj 1 mg for ECP • Temozolomide (Temaccord) cap 5 mg, 20 mg, 100 mg and 250 mg • Vincristine sulphate (Hospira) inj 1 mg per ml, 1ml and 2 ml • Vincristine sulphate (Baxter) inj 1 mg for ECP • Bacillus calmette-guerin (BCG) vaccine (OncoTICE) inj 2-8 x 100 million CFU • Ipratropium bromide (Univent) nebuliser soln, 250 mcg per ml, 1 ml and 2 ml Increased subsidy (pages 46-49) • Fusidic acid (Foban) oint 2%, 15 g OP • Morphine tartrate (Hospira) inj 80 mg per ml, 1.5 ml and 5 ml • Nitrazepam (Nitrados) tab 5 mg

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Pharmaceutical Schedule - Update News

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The new Hospital Medicines List (HML)

This month DHB hospitals start a transition to using a nationally-consistent list of funded hospital pharmaceuticals. The new Section H will be known as the HML (Hospital Medicines List) and will list all the medicines that all DHB hospitals need to provide for their patients. It includes both contracted products and non-contracted products. The introduction of the HML will mean more alignment between the funding of medicines in hospitals and in the community. Restrictions to reflect community restrictions The use of some medicines in DHB hospitals will be restricted by prescriber type or indication. Each restriction will generally reflect current community restrictions such as Special Authorities. Dispensing DHB prescriptions in the community For community based patients’ prescriptions originating from DHB hospitals, community pharmacies should dispense in accordance with the community Pharmaceutical Schedule listings. A hospital pharmacy must dispense according to HML rules, including when dispensing to community-based patients. Implementation/transition period There are likely to be new listings and changes to restrictions in the community Pharmaceutical Schedule as work continues developing the HML and on aligning it with the community Schedule.

Further HML information can be found on our website, including: • An electronic copy of the HML • Notifications by therapeutic group of what medicines are included in the HML • An alphabetical list of products that were considered for the HML If you have questions or feedback relating to the HML, email HML@pharmac.govt.nz or call 0800 66 00 50 (option 2) Please note that the changes to Section H that usually appear in this Update, are being reflected in a separate HML Update for the next few months.


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Pharmaceutical Schedule - Update News

Anti-Infectives restriction amendments

From 1 July 2013 there will be amendments to Special Authority criteria and endorsement criteria for a number of pharmaceuticals listed in the Infections Group. The changes are the result of a review of the pharmaceuticals in this group by the Anti-infective Subcommittee.

Sensory Organs changes

There will be a number of changes to the Sensory therapeutic group of products. These include: • Hylo-Fresh (sodium hyaluronate) eye drops 1 mg per ml will be listed fully funded and Sole Supply from 1 July 2013. Hylo-Fresh will be fully funded for patients with severe secretory dry eye who have a confirmed allergic reaction to eye drop preservative. Note that Hylo-Fresh eye drops have a six month expiry after opening. Only the prescribed dosage to the nearest OP may be claimed. Prescriptions will not be subsidised as one bottle per month as detailed in the Pharmacy Procedures Manual. • VitA-POS (retinol palmitate) eye oint 138 mcg per g, 5 g OP will be listed fully funded from 1 July 2013. • Systane Unit Dose (macrogol 400 0.4% with propylene glycol 0.3%) 0.4 ml eye drops will be listed fully funded and Sole Supply from 1 August 2013. • Poly-Gel (carbomer) 0.3% ophthalmic gel, 0.5 g will be listed fully funded and Sole Supply from 1 August 2013. • Special Authority criteria will apply to all Preservative Free Ocular Lubricants from 1 July 2013. • The listing for Poly-Tears (hypromellose 0.3% with dextran 0.1%) eye drops will be amended from 1 August 2013 to include dextran.

Funding of blood glucose and blood ketone testing products via PSO

From 1 July 2013 the following quantities of blood glucose and blood ketone testing products will be funded on a PSO (in addition to the current subsidy provisions): • Blood glucose diagnostic test meter – 1 meter • Blood glucose diagnostic test strip – up to 50 strips (1 OP) of CareSens or CareSens N brands only • Blood ketone diagnostic test meter – 1 meter • Ketone blood beta-ketone electrodes test strip – up to 10 strips (1 OP)


Pharmaceutical Schedule - Update News

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Ticagrelor subsidised for acute coronary syndrome

Ticagrelor (Brilinta) 90 mg tablets will be listed fully funded from 1 July 2013 subject to Special Authority criteria for acute coronary syndrome.

Pegfilgrastim – new listing

From 1 July 2013, pegfilgrastim (Neulastim) injection, 6 mg per 0.6 ml syringe, will be listed fully funded subject to Special Authority criteria for the prevention of neutropenia in patients undergoing high risk chemotherapy for cancer

Risedronate – new listing

From 1 September 2013, risedronate sodium (Risedronate Sandoz) 35 mg tablets will be listed fully funded.

Adalimumab new listing and extension to Special Authority criteria

From 1 July 2013, a 20 mg per 0.4 ml prefilled syringe of adalimumab (Humira) will be subsidised. The Special Authority criteria will also be amended from 1 July 2013 to include patients with juvenile idiopathic arthritis and fistulising Crohn’s disease.

Phenobarbitone injection subsidised

Phenobarbitone (Martindale) injection 200 mg per ml, 1 ml ampoule will be listed fully funded from 1 July 2013 subject to Special Authority criteria for the treatment of terminal agitation unresponsive to other agents. The Martindale brand is an unapproved medicine and must be supplied in accordance with section 29 of the Medicines Act 1981.

m-Eslon 30 mg capsules out-of-stock

Multichem has advised that m-Eslon (morphine sulphate) 30 mg long-acting capsules are outof-stock until mid-July. Pharmacists can dispense the equivalent dose of 10 mg long-acting capsules or contact the prescriber.


10 Pharmaceutical Schedule - Update News

Ursodeoxycholic acid – amendment to Special Authority criteria

The Special Authority criteria for ursodeoxycholic acid will be widened from 1 July 2013 to include patients with: • Alagille syndrome • Progressive familial intrahepatic cholestasis (PFIC) • Chronic severe drug induced cholestatic liver injury; and • Total parenteral nutrition induced cholestasis (TPN-IC) in paediatric patients The criteria will also be amended to specify the criteria for patients with cholestasis associated with pregnancy and for patients with cirrhosis, and to reduce the bilirubin level relating to decompensated cirrhosis from 170 μmol/L to 100 μmol/L.

Prednisone 1 mg tablets – removal of Stat dispensing

Due to limited supply of Apo-Prednisone 1 mg tablets, the requirement to dispense prednisone 1 mg tablets ‘stat’ will be removed from 1 July 2013 until further notice.

Protamine sulphate – addition of section 29

From 1 July 2013, the section 29 symbol will be added to the listing of the Artex brand of protamine sulphate. New supplies of stock are unapproved and must be supplied in accordance with section 29 of the Medicines Act 1981.

New Pharmacode for Zyban

From 1 August 2013, there is a price and subsidy reduction for bupropion hydrochloride (Zyban) modified release tablets. GSK have advised that there will be a new Pharmacode for the stock supplied at the new price and claims for the new Pharmacode cannot be made until it is listed from 1 August 2013.


Pharmaceutical Schedule - Update News

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Permax (pergolide) 0.25 mg stock shortage

Permax (Pergolide) 0.25 mg, supplied by Aspen Pharmacare, is temporarily out-of-stock due to manufacturing issues. Resupply is expected in September 2013 at the earliest. Some stock of Permax 1 mg is available, but this presentation is also expected to go out-of-stock. Patients should consult with their prescribers regarding alternative treatment options.

News in brief

• A Brand Switch Fee will apply to dispensings of Arrow-Quinapril from 1 July 2013 to 1 October 2013. • Lincocin (lincomycin) injection 300 mg per ml, 2 ml injection will be delisted 1 December 2013. • The description of Konsyl-D is changing from mucilaginous laxatives to ispaghula (psyllium) husk from 1 July 2013. • Please note due to the number of changes this month only the amended portion of the Special Authority criteria is shown. For the full text refer to the Pharmaceutical Schedule online at www.pharmac.govt.nz. • From 1 July 2013 pharmacist are no longer able to dispense and claim for blood glucose diagnostic test meters without a prescription.


Tender News

Sole Subsidised Supply changes – effective 1 August 2013

Chemical Name Amisulpride Amisulpride Amisulpride Amisulpride Codeine phosphate Codeine phosphate Codeine phosphate Presentation; Pack size Oral liq 100 mg per ml; 60 ml Tab 100 mg; 30 tab Tab 200 mg; 60 tab Tab 400 mg; 60 tab Tab 15 mg; 100 tab Tab 30 mg; 100 tab Tab 60 mg; 100 tab Sole Subsidised Supply brand (and supplier) Solian (Sanofi) Solian (Sanofi) Solian (Sanofi) Solian (Sanofi) PSM (PSM) PSM (PSM) PSM (PSM)

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 future implementation 1 August 2013 • Removal of Special Authority on Arrow-Venlafaxine brand of venlafaxine • Increase in price and subsidy for Marevan brand of warfarin • Oxydone BNM brand of oxycodone hydrochloride – new listing

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Sole Subsidised Supply Products – cumulative to July 2013

Generic Name

Abacavir sulphate Acarbose Acetazolamide Acetylcysteine Allopurinol Amantadine hydrochloride Aminophylline Amitriptyline Amlodipine Amoxycillin Amoxycillin clavulanate

Presentation

Oral liq 20 mg per ml Tab 300 mg Tab 50 mg and 100 mg Tab 250 mg Inj 200 mg per ml, 10 ml Tab 100 mg & 300 mg Cap 100 mg Inj 25 mg per ml, 10 ml Tab 10 mg Tab 25 mg & 50 mg Tab 2.5 mg Tab 5 mg & 10 mg Inj 250 mg, 500 mg & 1 g 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 500 mg with potassium clavulanate 125 mg Crm Tab 50 mg & 100 mg Tab 10 mg, 20 mg, 40 mg & 80 mg Inj 600 mcg, 1 ml Tab 500 mg Tab 10 mg Tab 2.5 mg & 5 mg Inj 1.2 mega u per 2.3 ml Inj 600 mg Eye drops 0.5% Eye drops 0.25% Tab 200 mg Tab long-acting 400 mg Tab 50 mg Meter with 50 lancets, a lancing device and 10 diagnostic test strips

Brand Name Expiry Date*

Ziagen Ziagen Accarb Diamox Martindale Acetylcysteine Apo-Allopurinol Symmetrel DBL Aminophylline Arrow-Amitriptyline Amitrip Apo-Amlodipine Apo-Amlodipine Ibiamox Augmentin Augmentin Curam Duo AFT Mylan Atenolol Zarator AstraZeneca Apo-Azithromycin Pacifen ArrowBendrofluazide Bicillin LA Sandoz Betoptic Betoptic S Bezalip Bezalip Retard Bicalaccord CareSens N CareSens N POP CareSens II 2014 2014 2015 2015 2015 2015 2016 2014 2015 2014 2014 2015 2014 2015 2014 2015 2014 2015 2014 2014 2014 2014 2014 2014 2015

Aqueous cream Atenolol Atorvastatin Atropine sulphate Azithromycin Baclofen Bendrofluazide Benzathine benzylpenicillin Benzylpenicillin sodium (Penicillin G) Betaxolol hydrochloride Bezafibrate Bicalutamide Blood glucose diagnostic test meter

*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.

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Sole Subsidised Supply Products – cumulative to July 2013

Generic Name

Blood glucose diagnostic test strip Brimonidine tartrate Cabergoline Calamine Calcitonin Calcium carbonate Calcium folinate Candesartan Cefazolin sodium Cefuroxime sodium Cetirizine hydrochloride Chloramphenicol Chlorhexidine gluconate

Presentation

Blood glucose test strips Eye drops 0.2% Tab 0.5 mg Lotn, BP Inj 100 iu per ml, 1 ml Tab 1.25 g (500 mg elemental) Tab eff 1.75 g (1 g elemental) Tab 15 mg Tab 4 mg, 8 mg, 16 mg & 32 mg Inj 500 mg & 1 g Inj 750 mg Oral liq 1 mg per ml Tab 10 mg Eye oint 1% Eye drops 0.5% Mouthwash 0.2% Handrub 1% with ethanol 70% Soln 4% Nail-soln 8% Tab 250 mg, 500 mg & 750 mg Tab 20 mg Tab 500 mg Tab 250 mg Tab 10 mg & 25 mg Tab 150 mcg Inj 150 mcg per ml, 1 ml Crm 1% Crm 10% Tab 50 mg Oral liq 100 mg per ml Tab 50 mg & 100 mg Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tabs Nasal spray 10 mcg per dose Tab 1 mg & 4 mg Eye oint 0.1%

Brand Name Expiry Date*

CareSens CareSens N Arrow-Brimonidine Dostinex PSM Miacalcic Arrow-Calcium Calsource DBL Leucovorin Calcium Candestar AFT Multichem Cetirizine - AFT Zetop Chlorsig Chlorafast healthE healthE Orion Apo-Ciclopirox Cipflox Arrow-Citalopram Apo-Clarithromycin Apo-Clarithromycin Apo-Clomipramine Catapres Clomazol Itch-Soothe Nausicalm Neoral Siterone Ginet 84 Desmopressin-PH&T Douglas Maxidex 2015 2014 2015 2015 2014 2014 2014 2015 2014 2014 2014 2015 2015 2014 2015 2014 2014 2014 2015 2015 2014 2015 2015 2015 2015 2014 2014 2015 2014

Ciclopirox olamine Ciprofloxacin Citalopram hydrobromide Clarithromycin Clomipramine hydrochloride Clonidine hydrochloride Clotrimazole Crotamiton Cyclizine hydrochloride Cyclosporin Cyproterone acetate Cyproterone acetate with ethinyloestradiol Desmopressin Dexamethasone

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*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 July 2013

Generic Name Presentation Brand Name Expiry Date*

Maxitrol Maxitrol 2014 Dexamethasone with neomycin Eye oint 0.1% with neomycin sulphate and polymyxin b sulphate 0.35% and polymyxin B sulphate 6,000 u per g Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml Dexamphetamine sulphate Dextrose Diclofenac sodium Tab 5 mg Inj 50%, 10 ml Tab EC 25 mg & 50 mg Tab long-acting 75 mg & 100 mg Inj 25 mg per ml, 3 ml Eye drops 1 mg per ml Suppos 12.5 mg, 25 mg, 50 mg & 100 mg Cap long-acting 120 mg, 180 mg & 240 mg Tab 30 mg & 60 mg Tab long-acting 150 mg Cap 50 mg Cap 120 mg Tab 10 mg Tab 2 mg & 4 mg Tab 100 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 Inj 500 mcg per ml, 1 ml Tab 200 mg Tab 10 mcg Tab 20 mcg with levonorgestrel 100 mcg & 7 inert tab Tab 30 mcg with levonorgestrel 150 mcg & 7 inert tab Tab 25 mg Tab long-acting 5 mg & 10 mg Tab long-acting 2.5 mg Inj 50 mcg per ml, 2 ml & 10 ml Inj 300 mcg per 0.5 ml Inj 480 mcg per 0.5 ml

PSM Biomed Apo-Diclo Diclax SR Voltaren Voltaren Ophtha Voltaren Apo-Diltiazem CD Dilzem Pytazen SR Laxofast 50 Laxofast 120 Prokinex Apo-Doxazosin Doxine AFT m-Enalapril Clexane Entapone DBL Ergometrine Arrow-Etidronate NZ Medical and Scientific Ava 20 ED Ava 30 ED Aromasin Plendil ER Plendil ER Boucher and Muir Zarzio Zarzio

2015 2014 2015 2014

Diltiazem hydrochloride

2015

Dipyridamole Docusate sodium Domperidone Doxazosin mesylate Doxycycline hydrochloride Emulsifying ointment Enalapril Enoxaparin sodium Entacapone Ergometrine maleate Etidronate disodium Ethinyloestradiol Ethinyloestradiol with levonorgestrel

2014 2014 2015 2014 2014 2014 2015 2015 2015 2014 2015 2015 2014

Exemestane Felodopine Fentanyl citrate Filgrastim

2014 2015 2015

31/12/15

*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.

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Sole Subsidised Supply Products – cumulative to July 2013

Generic Name

Finasteride Flucloxacillin sodium

Presentation

Tab 5 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Cap 250 mg & 500 mg Inj 250 mg, 500 mg & 1 g Cap 50 mg, 150 mg & 200 mg Eye drops 0.1% Crm 5% Metered aqueous nasal spray, 50 mcg per dose Tab 500 mg Tab 40 mg Inj 40 mg per ml, 2 ml Tab 80 mg Tab 5 mg Suppos 3.6 g Aerosol spray 400 mcg per dose TDDS 5 mg & 10 mg Tab 600 mcg Tab 5 mg & 20 mg Crm 1% Powder Rectal foam 10%, CFC-Free (14 applications) Lipocream 0.1% Milky emul 0.1% Oint 0.1% Scalp lotn 0.1% Lotn 1% with wool fat hydrous 3% and mineral oil Inj 1 mg per ml, 1 ml Tab 200 mg Inj 20 mg, 1 ml Tab 10 mg Tab 200 mg Tab long-acting 800 mg Crm 5% Inj 50 mg per ml, 2 ml Tab 100 mg

Brand Name Expiry Date*

Rex Medical AFT Staphlex Flucloxin Ozole Flucon Efudix Flixonase Hayfever & Allergy Urex Forte Diurin 40 Pfizer Apo-Gliclazide Minidiab PSM Glytrin Nitroderm TTS Lycinate Douglas Pharmacy Health ABM Colifoam Locoid Lipocream Locoid Crelo Locoid Locoid DP Lotn HC ABM Hydroxocobalamin Plaquenil Buscopan Gastrosoothe Arrowcare Brufen SR Aldara Ferrum H PSM 2014 2015 2014 2014 2015 2015 2015 2015 2015 2014 2015 2015 2014

Fluconazole Fluorometholone Fluorouracil sodium Fluticasone propionate Furosemide Gentamicin sulphate Gliclazide Glipizide Glycerol Glyceryl trinitrate

Hydrocortisone

2015 2014 2015 2015

Hydrocortisone acetate Hydrocortisone butyrate

Hydrocortisone with wool fat and mineral oil Hydroxocobalamin Hydroxychloroquine sulphate Hyoscine N-butylbromide Ibuprofen Imiquimod Iron polymaltose Isoniazid

2014 2015 2015 2014 2014 2014 2014 2015

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*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 July 2013

Generic Name

Isosorbide mononitrate Isotretinoin Ketoconazole Lamivudine Lansoprazole Latanoprost Letrozole Levonorgestrel Lignocaine hydrochloride Lisinopril Lithium carbonate Lodoxamide trometamol Losartan Losartan with hydrochlorothiazide Mask for spacer device Mebendazole Mebeverine hydrochloride Megestrol acetate Methylprednisolone Methylprednisolone acetate Methylprednisolone acetate with lignocaine Mesalazine Metformin hydrochloride Methadone hydrochloride

Presentation

Tab 20 mg Tab long-acting 40 mg Cap 10 mg & 20 mg Shampoo 2% Tab 100 mg Cap 15 mg & 30 mg Eye drops 50 mcg per ml Tab 2.5 mg Subdermal implant (2 x 75 mg rods) Viscous soln 2% Tab 5 mg, 10 mg & 20 mg Tab 250 mg & 400 mg Cap 250 mg Eye drops 0.1% Tab 12.5 mg, 25 mg, 50 mg & 100 mg Tab 50 mg with hydrochlorothiazide 12.5 mg Size 2 Tab 100 mg Tab 135 mg Tab 160 mg Tab 4 mg & 100 mg Inj 40 mg per ml Inj 40 mg per ml with lignocaine 1 ml Enema 1 g per 100 ml Suppos 500 mg Tab immediate-release 500 mg & 850 mg Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Inj 40 mg per ml, 1 ml; 62.5 mg per ml, 2 ml; 500 mg & 1 g

Brand Name Expiry Date*

Ismo 20 Corangin Oratane Sebizole Zetlam Solox Hysite Letraccord Jadelle Xylocaine Viscous Arrow-Lisinopril Lithicarb FC Douglas Lomide Lostaar Arrow-Losartan & Hydroclorothiazide EZ-fit Paediatric Mask De-Worm Colofac Apo-Megestrol Medrol Depo-Medrol Depo-Medrol with Lidocaine Pentasa Asacol Apotex Biodone Biodone Forte Biodone Extra Forte Solu-Medrol 2014 2015 2014 2014 2015 2015 2015 31/12/13 2014 2015 2015 2014 2014 2014 2014 2015 2014 2014 2015 2015 2015 2015 2015 2014 2015 2015

Methylprednisolone sodium succinate

2015

*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.

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Sole Subsidised Supply Products – cumulative to July 2013

Generic Name

Metoclopramide hydrochloride Metoprolol succinate Metoprolol tartrate

Presentation

Inj 5 mg per ml, 2 ml Tab 10 mg Tab long-acting 23.75 mg, 47.5 mg, 95 mg & 190 mg Inj 1 mg per ml, 5 ml Tab 50 mg & 100 mg Tab long-acting 200 mg Oral gel 20 mg per g Crm 2% Tab 30 mg & 45 mg Tab 150 mg & 300 mg Crm 0.1% Oint 0.1% Oral liq 1 mg per ml, 2 mg per ml, 5 mg per ml & 10 mg per ml Inj 5 mg per ml, 1 ml Inj 10 mg per ml, 1 ml Inj 15 mg per ml, 1 ml Inj 30 mg per ml, 1 ml

Brand Name Expiry Date*

Pfizer Metamide Metoprolol-AFT CR Lopresor Lopresor Slow-Lopresor Decozol Multichem Avanza Apo-Moclobemide m-Mometasone RA-Morph DBL Morphine Sulphate DBL Morphine Sulphate DBL Morphine Sulphate DBL Morphine Sulphate Naphcon Forte Apo-Nadolol Noflam 250 Noflam 500 AstraZeneca Nevirapine Alphapharm Habitrol Habitrol Habitrol Apo-Nicotinic Acid Noriday 28 Primolut N Arrow-Norfloxacin Norpress Nilstat 2014 2015 2014 2014 2016 2014 2014 2015 2015

Miconazole Miconazole nitrate Mirtazapine Moclobemide Mometasone furoate Morphine hydrochloride Morphine sulphate

2015 2014 2015 2015 2015 2015 2014

Naphazoline hydrochloride Nadolol Naproxen Neostigmine Nevirapine Nicotine

Eye drops 0.1% Tab 40 mg & 80 mg Tab 250 mg Tab 500 mg Inj 2.5 mg per ml, 1 ml Tab 200 mg Gum 2 mg & 4 mg (classic, fruit, mint) Lozenge 1 mg & 2 mg Patch 7 mg, 14 mg & 21 mg Tab 50 mg & 500 mg Tab 350 mcg Tab 5 mg Tab 400 mg Tab 10 mg & 25 mg Oral liq 100,000 u per ml

2014 2015 2015 2014 2015 2014

Nicotinic acid Norethisterone Norfloxacin Nortriptyline hydrochloride Nystatin

18

*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 July 2013

Generic Name

Octreotide (somatostatin analogue) Oil in water emulsion Omeprazole

Presentation

Inj 50 mcg per ml, 1 ml Inj 100 mcg per ml, 1 ml Inj 500 mcg per ml, 1 ml Crm Cap 10 mg, 20 mg & 40 mg Powder Inj 40 mg Tab 10 mg & 15 mg Oral liq 5 mg per ml Tab 5 mg Inj 50 mg per ml, 1 ml Inj 10 mg per ml, 1 ml & 2 ml Inj 5 iu with ergometrine maleate 500 mcg per ml, 1 ml Inj 3 mg per ml, 10 ml; 6 mg per ml, 10 ml & 9 mg per ml, 10 ml Inj 40 mg Suppos 500 mg 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 Low range & normal range Tab 0.25 mg & 1 mg Crm 5% Lotn 5% Tab 50 mg & 100 mg Inj 50 mg per ml, 1 ml Inj 50 mg per ml, 2 ml

Brand Name Expiry Date*

Octreotide Max Rx 2014

healthE Fatty Cream Omezol Relief Midwest Dr Reddy’s Omeprazole Ox-Pam Apo-Oxybutynin OxyNorm Oxycodone Orion Syntometrine Pamidronate BNM Pantocid IV Paracare Parafast Ethics Paracetamol Paracare Double Strength Paracetamol + Codeine (Relieve) Breath-Alert Permax Lyderm A-Scabies PSM DBL Pethidine Hydrochloride DBL Pethidine Hydrochloride PSM Pizaccord Sandomigran Coloxyl Span-K Cholvastin Cilicaine Allersoothe Allersoothe

2015 2014

Oxazepam Oxybutynin Oxycodone hydrochloride Oxytocin Pamidronate disodium Pantoprazole Paracetamol

2014 2016 2015 2015 2014 2014 2015 2014

Paracetamol with codeine Peak flow meter Pergolide Permethrin Pethidine hydrochloride

2014 2015 2014 2014 2015 2014

Phenobarbitone Pioglitazone Pizotifen Poloxamer Potassium chloride Pravastatin Procaine penicillin Promethazine hydrochloride

Tab 15 mg & 30 mg Tab 15 mg, 30 mg & 45 mg Tab 500 mcg Oral drops 10% Tab long-acting 600 mg Tab 20 mg & 40 mg Inj 1.5 mega u Oral liq 5 mg per 5 ml Tab 10 mg & 25 mg

2015 2015 2015 2014 2015 2014 2014 2015

*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.

19


Sole Subsidised Supply Products – cumulative to July 2013

Generic Name

Pyridostigmine bromide Pyridoxine hydrochloride Quinapril Quinapril with hydrochlorothiazide

Presentation

Tab 60 mg Tab 25 mg Tab 50 mg Tab 5 mg, 10 mg & 20 mg Tab 10 mg with hydrochlorothiazide 12.5 mg Tab 20 mg with hydrochlorothiazide 12.5 mg Oral liq 150 mg per 10 ml Tab 150 mg & 300 mg Tab 100 mg Tab orodispersible 10 mg Tab 150 mg & 300 mg Nebuliser soln, 1 mg per ml & 2 mg per ml, 2.5 ml Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml Tab 25 mg, 50 mg & 100 mg Tab 10 mg Tab 20 mg Tab 40 mg Tab 80 mg Eye drops 1 mg per ml, 10 ml OP 800 ml 230 ml (single patient) Tab 20 mg Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium, 500 ml & 1,000 ml Tab 10 mg Tab 250 mg Inj long-acting 100 mg per ml, 10 ml Cap 40 mg Inj 250 mcg Inj 1 mg per ml, 1 ml Eye drops 0.25% & 0.5% Eye drops 0.3% Eye oint 0.3% Inj 40 mg per ml, 2 ml

Brand Name Expiry Date*

Mestinon PyridoxADE Apo-Pyridoxine Arrow-Quinapril Accuretic 10 Accuretic 20 Peptisoothe Arrow-Ranitidine Norvir Rizamelt ArrowRoxithromycin Asthalin Duolin 2014 2015 2014 2015 2015 2015 2014 2014 2015 2015

Ranitidine hydrochloride Ritonavir Rizatriptan Roxithromycin Salbutamol Salbutamol with ipratropium bromide Sildenafil Simvastatin

Silagra Arrow-Simva 10mg Arrow-Simva 20mg Arrow-Simva 40mg Arrow-Simva 80mg Hylo-Fresh Volumatic Space Chamber Plus Genox Pinetarsol

2014 2014

Sodium hyaluronate Spacer device Tamoxifen citrate Tar with triethanolamine lauryl sulphate and fluorescein Temazepam Terbinafine Testosterone cypionate Testosterone undecanoate Tetracosactrin Timolol maleate Tobramycin

2016 2015 2014 2014

Normison Dr Reddy’s Terbinafine Depo-Testosterone Andriol Testocaps Synacthen Synacthen Depot Arrow-Timolol Tobrex Tobrex DBL Tobramycin

2014 2014 2014 2015 2014 2014 2014

20

*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 July 2013

Generic Name

Tolcapone Tramadol hydrochloride Triamcinolone acetonide

Presentation

Tab 100 mg Cap 50 mg Inj 10 mg per ml, 1 ml Inj 40 mg per ml, 1 ml Crm 0.02% Oint 0.02% 0.1% in Dental Paste USP Eye drops 0.5% & 1% Cap 250 mg Inj 500 mg Tab 40 mg & 80 mg Tab 300 mg with lamivudine 150 mg Oint BP Caps 137.4 mg (50 mg elemental)

Brand Name Expiry Date*

Tasmar Arrow-Tramadol Kenacort-A Kenacort-A40 Aristocort Aristocort Oracort Mydriacyl Ursosan Mylan Isoptin Alphapharm Multichem Zincaps 2014 2014 2014

Tropicamide Ursodeoxycholic acid Vancomycin hydrochloride Verapamil hydrochloride Zidovudine [AZT] with lamivudine Zinc and castor oil Zinc sulphate July changes are in bold type

2014 2014 2014 2014 2014 2014 2014

*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.

21


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings

Effective 1 July 2013

41 ASCORBIC ACID a) No more than 100 mg per dose b Only on a prescription ❋ Tab 100 mg ........................................................................... 13.80 VITAMIN B COMPLEX ❋ Tab, strong, BPC ....................................................................... 4.70 VITAMINS ❋ Tab (BPC cap strength) ............................................................ 8.00 TICAGRELOR – Special Authority see SA1382 – Retail pharmacy ❋ Tab 90 mg .............................................................................. 90.00

41 42 45

500 500 1,000 56

✔ Cvite ✔ Bplex ✔ Mvite ✔ Brilinta

➽ SA1382 Special Authority for Subsidy Initial application (acute coronary syndrome) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 Patient has recently been diagnosed with an ST-elevation or a non-ST-elevation acute coronary syndrome; and 2 Fibrinolytic therapy has not been given in the last 24 hours and is not planned. Renewal (subsequent acute coronary syndrome) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 Patient has recently been diagnosed with an ST-elevation or a non-ST-elevation acute coronary syndrome; and 2 Fibrinolytic therapy has not been given in the last 24 hours and is not planned. 48 PEGFILGRASTIM – Special Authority see SA1384 – Retail pharmacy Inj 6 mg per 0.6 ml syringe ................................................. 1,080.00 1 ✔ Neulastim

➽ SA1384 Special Authority for Subsidy Initial application only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notified where used for prevention of neutropenia in patients undergoing high risk chemotherapy for cancer (febrile neutropenia risk ≥ 20%*). *Febrile neutropenia risk ≥ 20% after taking into account other risk factors as defined by the European Organisation for Research and Treatment of Cancer (EORTC) guidelines. 58 69 AMILORIDE HYDROCHLORIDE ❋ Tab 5 mg ................................................................................ 17.50 CETOMACROGOL WITH GLYCEROL Crm 90% with glycerol 10% ....................................................... 4.50 100 500 g OP ✔ Apo-Amiloride ✔ Pharmacy Health Sorbolene with Glycerin ✔ Lidocaine-Claris ✔ Lidocaine-Claris

119

LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE Inj 1%, 5 ml ampoule – Up to 25 inj available on a PSO .............. 8.75 Inj 1%, 20 ml ampoule – Up to 5 inj available on a PSO .............. 2.40

25 1

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

22

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

New Listings - effective 1 July 2013 (continued)

140 PHENOBARBITONE SODIUM – Special Authority see SA1386 – Retail pharmacy Inj 200 mg per ml, 1 ml ampoule ............................................. 46.20 10 ✔ Martindale S29

➽ SA1386 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 For the treatment of terminal agitation that is unresponsive to other agents; and 2 The applicant is part of a multidisciplinary team working in palliative care. 166 185 ADALIMUMAB – Special Authority see SA1371 – Retail pharmacy Inj 20 mg per 0.4 ml prefilled syringe .................................. 1,799.92 2 ✔ Humira ✔ Hylo-Fresh

SODIUM HYALURONATE – Special Authority see SA1388 – Retail pharmacy Eye drops 1 mg per ml ............................................................ 22.00 10 ml OP

Note: Hylo-Fresh has a 6 month expiry after opening. The Pharmacy Handbook restriction allowing one bottle per month is not relevant and therefore only the prescribed dosage to the nearest OP may be claimed. 185 PRESERVATIVE FREE OCULAR LUBRICANTS ➽ SA1388 – Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 12 months for patients meeting the following criteria: Both: 1 Confirmed diagnosis by slit lamp of severe secretory dry eye; and 2 Either: 2.1 Patient is using eye drops more than four times daily on a regular basis; or 2.2 Patient has had a confirmed allergic reaction to preservative in eye drop. Renewal from any relevant practitioner. Approvals valid for 24 months where the patient continues to require lubricating eye drops and has benefited from treatment. 185 186 198 202 RETINOL PALMITATE Eye oint 138 mcg per g ............................................................. 3.80 PHARMACY SERVICES – May only be claimed once per patient. ❋ Brand switch fee ....................................................................... 4.33 The Pharmacode for BSF Arrow-Quinapril is 2441497. 5 g OP 1 fee ✔ VitA-POS ✔ BSF Arrow-Quinapril

FAT SUPPLEMENT – Special Authority see SA1374 – Hospital pharmacy [HP3] Oil, 250 ml ............................................................................ 114.92 4 OP

✔ Liquigen

RENAL ORAL FEED 2 KCAL/ML – Special Authority see SA1101 – Hospital pharmacy [HP3] Liquid (apricot), 125 ml ........................................................... 11.52 4 OP ✔ Renilon 7.5 Liquid (caramel), 125 ml ......................................................... 11.52 4 OP ✔ Renilon 7.5

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

23


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings - effective 1 June 2013

39 MACROGOL 3350 – Special Authority see SA0891 – Retail pharmacy Powder 13.125 g, sachets - Maximum of 60 sach per prescription ......................................................................... 18.14 BOSENTAN – Special Authority see SA0967 – Retail pharmacy Tab 62.5 mg ..................................................................... 2,000.00 Tab 125 mg ...................................................................... 2,000.00

30 60 60

✔ Movicol ✔ pms-Bosentan ✔ pms-Bosentan

62

211 213

AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA1108 – Hospital pharmacy [HP3] Powder (unflavoured), 29 g .................................................. 330.12 30 ✔ PKU Anamix Junior HIGH FAT LOW CARBOHYDRATE FORMULA – Special Authority see SA1197 – Retail pharmacy Powder (unflavoured) .............................................................. 35.50 300 g OP ✔ KetoCal 4:1

Effective 6 May 2013

72 MALATHION WITH PERMETHRIN AND PIPERONYL BUTOXIDE Spray 0.25% with permethrin 0.5% and piperonyl butoxide 2%......................................................................... 11.95

90 g OP

✔ Para Plus

Effective 1 May 2013

52 57 58 61 119 PERINDOPRIL ❋ Tab 2 mg ................................................................................. 3.75 ❋ Tab 4 mg ................................................................................. 4.80 CLONIDINE HYDROCHLORIDE ❋ Tab 25 mcg............................................................................. 15.09 METOLAZONE – Special Authority see SA1323 – Retail pharmacy Tab 5 mg ............................................................................. CBS 30 30 112 50 ✔ Apo-Perindopril ✔ Apo-Perindopril ✔ Clonidine BNM ✔ Zaroxolyn S29 ✔ Onelink S29 ✔ Lidocaine-Claris ✔ Lidocaine-Claris ✔ BSF Apo-Diltiazem CD

HYDRALAZINE HYDROCHLORIDE – Special Authority see SA1321 – Retail pharmacy ❋ Tab 25 mg ........................................................................... CBS 56 LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE Inj 2%, 5 ml – Up to 5 inj available on a PSO .............................. 6.90 Inj 2%, 20 ml – Up to 5 inj available on a PSO ............................ 2.40 PHARMACY SERVICES – May only be claimed once per patient Brand switch fee ....................................................................... 4.33 The Pharmacode for BSF Apo-Diltiazem CD is 2437775 25 1 1 fee

186

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

24

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 Restrictions

Effective 1 July 2013

29 BLOOD KETONE DIAGNOSTIC TEST METER a) Meter funded for the purposes of blood ketone diagnostics only. Patient has had one or more episodes of ketoacidosis and is at risk of future episodes. Only one meter per patient will be subsidised every 5 years. b) Up to 1 dev available on a PSO. Meter ..................................................................................... 40.00 1 ✔ Freestyle Optium KETONE BLOOD BETA-KETONE ELECTRODES a) Maximum of 20 strip per prescription. b) Up to 10 test available on a PSO. Test strip – Not on a BSO ........................................................ 15.50

29

10 strip OP ✔ Freestyle Optium Ketone

29

BLOOD GLUCOSE DIAGNOSTIC TEST METER – Subsidy by endorsement a) Maximum of 1 pack per prescription. b) Up to 1 dev available on a PSO. c) A diagnostic blood glucose test meter is subsidised for a patient who: i is receiving insulin or sulphonylurea therapy; or ii is pregnant and has diabetes; or iii is on home TPN at risk of hypoglycaemia or hyperglycaemia; or iv has a genetic or an acquired disorder of glucose homeostasis excluding type 1 or type 2 diabetes and metabolic syndrome. d) CareSens N brand: Brand switch fee payable (Pharmacode 2423138) - see page 186 for details e) CareSens N POP brand: Brand switch fee payable (Pharmacode 2423154) - see page 186 for details f) CareSens II brand: Brand switch fee payable (Pharmacode 2423146) - see page 186 for details g) No patient co-payment payable Only one CareSens meter per patient. No further prescriptions will be subsidised for patients who already have a CareSens meter. For the avoidance of doubt patients who have previously received a funded meter, other than CareSens, are eligible for a CareSens meter. The prescription must be endorsed accordingly. Pharmacists may annotate the prescription as endorsed where there exists a record of prior dispensing of insulin or sulphonylureas. Meter with 50 lancets, a lancing device and 10 diagnostic test strips – Note differing brand requirements ............................ 20.00 1 OP ✔ CareSens II ✔ CareSens N ✔ CareSens N POP Note: Only 1 meter available per PSO

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

25


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

30 BLOOD GLUCOSE DIAGNOSTIC TEST STRIP a) Up to 50 test available on a PSO. b) The number of test strips available on a prescription is restricted to 50 unless: 1) Prescribed with insulin or a sulphonylurea but are on a different prescription and endorsed accordingly; or 2) Prescribed on the same prescription as insulin or a sulphonylurea in which case the prescription is deemed to be endorsed; or 3) Prescribed for a pregnant woman with diabetes and endorsed accordingly; or 4) Prescribed for a patient on home TPN at risk of hypoglycaemia or hyperglycaemia and endorsed accordingly; or 5) Prescribed for a patient with a genetic or an acquired disorder of glucose homeostasis excluding type 1 or type 2 diabetes and metabolic syndrome and endorsed accordingly. Blood glucose test strips – Note differing brand requirements below ........................... 10.56 50 test OP ✔ CareSens ✔ CareSens N 28.75 ✔ Accu-Chek Performa ✔ Freestyle Optium a) Accu-Chek Performa brand: Special Authority see SA1294 – Retail pharmacy b) Freestyle Optium brand: Special Authority see SA1291 – Retail pharmacy Note: Accu-Chek Performa and Freestyle Optium are not available on a PSO URSODEOXYCHOLIC ACID – Special Authority see SA1383 1188 – Retail pharmacy Cap 250 mg – For ursodeoxycholic acid oral liquid formulation refer, page 188 .................................................. 71.50 100

38

✔ Ursosan

➽ SA1383 1188 Special Authority for Subsidy Initial application – (Alagille syndrome or progressive familial intrahepatic cholestasis) - from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1. Patient has been diagnosed with Alagille syndrome; or 2. Patient has progressive familial intrahepatic cholestasis. Initial application – (Chronic severe drug induced cholestatic liver injury) - from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1. Patient has chronic severe drug induced cholestatic liver injury; and 2. Cholestatic liver injury not due to Total Parenteral Nutrition (TPN) use in adults; and 3. Treatment with ursodeoxycholic acid may prevent hospital admission or reduce duration of stay. Initial application – (Cirrhosis) - from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1. Primary biliary cirrhosis confirmed by antimitochondrial antibody titre (AMA) > 1:80, and raised cholestatic liver enzymes with or without raised serum IgM or, if AMA is negative, by liver biopsy; and 2. Patient not requiring a liver transplant (bilirubin > 170 100 umol/l; decompensated cirrhosis). Initial application – (Pregnancy/Cirrhosis) - from any relevant practitioner. Approvals valid for 6 months where the Either: patient diagnosed with cholestasis of pregnancy.; or 1. Both: 1.1. Primary biliary cirrhosis confirmed by antimitochondrial antibody titre (AMA) > 1:80, and raised cholestatic liver enzymes with or without raised serum IgM or, if AMA is negative, by liver biopsy; and 1.2. Patient not requiring a liver transplant (bilirubin > 170 100 umol/l; decompensated cirrhosis) continued... Note: Liver biopsy is not usually required for diagnosis but is helpful to stage the disease. 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

26


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

continued... Initial application – (Haematological transplant) - from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1. Patient at risk of veno-occlusive disease or has hepatic impairment and is undergoing conditioning treatment prior to allogenic stem cell or bone marrow transplantation; and 2. Treatment for up to 13 weeks. Initial application – (Total parenteral nutrition induced cholestasis) from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1. Paediatric patient has developed abnormal liver function as indicated on testing which is likely to be induced by Total Parenteral Nutrition (TPN); and 2. Liver function has not improved with modifying the TPN composition. Renewal (Chronic severe drug induced cholestatic liver injury) from any relevant practitioner. Approvals valid for 6 months where the patient continues to benefit from treatment. Renewal – (Pregnancy/cirrhosis) - from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. Renewal - (Total parenteral nutrition induced cholestasis) from any relevant practitioner. Approvals valid for 6 months where a paediatric patient continues to require TPN and who is benefiting from treatment, defined as a sustained improvement in bilirubin levels. Note: Ursodeoxycholic acid is not an appropriate therapy for patients requiring a liver transplant (bilirubin > 170 100 µmol/l; decompensated cirrhosis). These patients should be referred to an appropriate transplant centre. Treatment failure – doubling of serum bilirubin levels, absence of a significant decrease in ALP or ALT and AST, development of varices, ascites or encephalopathy, marked worsening of pruritus or fatigue, histological progression by two stages, or to cirrhosis, need for transplantation. 38 47 MUCILAGINOUS LAXATIVES ISPAGHULA (PSYLLIUM) HUSK – Only on a prescription ❋ Dry Powder for oral soln........................................................... 5.51 500 g OP ✔ Konsyl-D PROTAMINE SULPHATE ❋ Inj 10 mg per ml, 5 ml ............................................................ 22.40 (101.61) QUINAPRIL – Brand switch fee payable (Pharmacode 2441497) ❋ Tab 5 mg ................................................................................. 3.44 ❋ Tab 10 mg ............................................................................... 4.64 ❋ Tab 20 mg ............................................................................... 6.34 CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL ❋ Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tabs – Up to 84 tab available on a PSO ........................................ 3.89 10 Artex S29 90 90 90 ✔ Arrow-Quinapril 5 ✔ Arrow-Quinapril 10 ✔ Arrow-Quinapril 20

52 78 80

84

✔ Ginet 84

SOLIFENACIN SUCCINATE – Special Authority see SA0998 – Retail pharmacy Tab 5 mg ............................................................................... 56.50 30 ✔ Vesicare Tab 10 mg .............................................................................. 56.50 30 ✔ Vesicare ➽ SA0998 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal, unless notified, where the patient has overactive bladder and a documented intolerance of, or is non-responsive to oxybutynin.

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

27


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

80 TOLTERODINE – Special Authority see SA1272 – Retail pharmacy Tab 1 mg ............................................................................... 14.56 Tab 2 mg ................................................................................ 14.56 56 56 ✔ Arrow-Tolterodine ✔ Arrow-Tolterodine

➽ SA1272 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal, unless notified, where the patient has overactive bladder and a documented intolerance of, or is non-responsive to oxybutynin. 82 85 PREDNISONE Tab 1 mg ............................................................................... 10.68 500 ✔ Apo-Prednisone Note: the removal of the stat symbol will be temporary due to a potential out of stock PROPYLTHIOURACIL – Special Authority see SA1199 – Retail pharmacy Tab 50 mg .............................................................................. 35.00 100 ✔ PTU S29 Note: Propylthiouracil is not recommended for patients under the age of 18 years unless the patient is pregnant and other treatments are contraindicated. CABERGOLINE Tab 0.5 mg – Maximum of 2 tab per prescription; can be waived by Special Authority see SA1370 1031 ........... 6.25 25.00 ➽ SA1370 1031 Special Authority for Waiver of Rule

86

2 8

✔ Dostinex ✔ Dostinex

Initial application only from an obstetrician, endocrinologist or any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria where the patient has: 1) pathological hyperprolactinemia; or 2) acromegaly*. Renewal (for patients who have previously been funded under Special Authority form SA1031) only from an obstetrician, endocrinologist or gynaecologist any relevant practitioner. Approvals valid without further renewal unless notified where the patient has previously held a Special Authority which has expired and the treatment remains appropriate and the patient is benefiting from treatment. Indication marked with * is an Unapproved Indication. 86 DANAZOL – Retail pharmacy-Specialist Cap 100 mg ........................................................................... 68.33 Cap 200 mg ........................................................................... 97.83 100 100 ✔ Azol ✔ Azol

88

CEFAZOLIN SODIUM – Subsidy by endorsement Only if prescribed for dialysis or cystic fibrosis patient cellulitis in accordance with a DHB approved protocol and the prescription is endorsed accordingly. Inj 500 mg ................................................................................ 3.99 5 ✔ AFT Inj 1 g ....................................................................................... 3.99 5 ✔ AFT 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 pelvic inflammatory disease, 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 Inj 1 g ..................................................................................... 10.49 5 ✔ Aspen Ceftriaxone

88

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

28

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 Restrictions - effective 1 July 2013 (continued)

91 MINOCYCLINE HYDROCHLORIDE ❋ Tab 50 mg – Additional subsidy by Special Authority see SA1355 – Retail pharmacy ................ 5.79 60 (12.05) Mino-tabs ➽ SA1355 Special Authority for Manufacturers Price Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has rosacea. GENTAMICIN SULPHATE Inj 10 mg per ml, 1 ml – Subsidy by endorsement ..................... 8.56 5 ✔ Mayne Only if prescribed for a dialysis or cystic fibrosis patient or for prophylaxis of endocarditis or complicated urinary tract infection, and the prescription is endorsed accordingly. Inj 10 mg per ml, 2 ml – Subsidy by endorsement ................ 175.10 25 ✔ APP Pharmaceuticals

S29

92

Only if prescribed for a dialysis or cystic fibrosis patient or for prophylaxis of endocarditis or complicated urinary tract infection, and the prescription is endorsed accordingly. Inj 40 mg per ml, 2 ml – Subsidy by endorsement ..................... 6.50 10 ✔ Pfizer Only if prescribed for a dialysis or cystic fibrosis patient or for prophylaxis of endocarditis or complicated urinary tract infection, and the prescription is endorsed accordingly. 92 MOXIFLOXACIN – Special Authority see SA1358 1065 – Retail pharmacy No patient co-payment payable Tab 400 mg ........................................................................... 52.00

5

✔ Avelox

➽ SA1358 1065 Special Authority for Subsidy Initial application - (Mycoplasma genitalium) from any relevant practitioner. Approvals valid for 1 month for applications meeting the following criteria: All of the following: 1. Has nucleic acid amplification test (NAAT) confirmed Mycoplasma genitalium*; and 2. Has tried and failed to clear infection using azithromycin; and 3. Treatment is only for 7 days. Initial application - (Penetrating eye injury) only from an ophthalmologist. Approvals valid for 1 month where the patient requires prophylaxis following a penetrating eye injury and treatment is for 5 days only. 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). 93 VANCOMYCIN HYDROCHLORIDE – Subsidy by endorsement Only if prescribed for a dialysis or cystic fibrosis patient or in the treatment of pseudomembranous colitis or for prophylaxis of endocarditis or for treatment of Clostridium difficile following metronidazole failure and the prescription is endorsed accordingly. Inj 500 mg ............................................................................... 3.58 1 ✔ Mylan FLUCONAZOLE Powder for oral suspension 10 mg per ml – Special Authority see SA1359 1148– Retail pharmacy ...... 34.56

94

35 ml

✔ Diflucan

➽ SA1359 1148 Special Authority for Subsidy Initial application – (Systemic candidiasis) from any relevant practitioner. Approvals valid for 6 weeks for applications meeting the following criteria: Both: 1. Patient requires prophylaxis for, or treatment of systemic candidiasis; 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

29


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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

continued... 2. Patient is unable to swallow capsules. Initial application – (Immunocompromised) from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1. Patient is immunocompromised; and 2. Patient is at moderate to high risk of invasive fungal infection; and 3. Patient is unable to swallow capsules. Renewal – (Systemic candidiasis) from any relevant practitioner. Approvals valid for 6 weeks for applications meeting the following criteria: Both: 1. Patient requires prophylaxis for, or treatment of systemic candidiasis; and 2. Patient is unable to swallow capsules. Renewal – (Immunocompromised) from any relevant practitioner. Approvals valid for 6 month for applications meeting the following criteria: All of the following: 1. Patient remains immunocompromised; and 2. Patient remains at moderate to high risk of invasive fungal infection; and 3. Patient is unable to swallow capsules. 98 LAMIVUDINE – Special Authority see SA1360 0832– Retail pharmacy Tab 100 mg ............................................................................ 32.50 Oral liq 5 mg per ml ................................................................ 90.00 28 240 ml ✔ Zetlam ✔ Zeffix

➽ SA1360 0832 Special Authority for Subsidy Initial application only from a gastroenterologist, infectious disease specialist, paediatrician or general physician or on the recommendation of a gastroenterologist, infectious disease specialist, paediatrician or general physician. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1.1 All of the following: 1.1.1 HBsAg positive for more than 6 months; and 1.1.2 HBeAg positive or HBV DNA positive defined as > 100,000 copies per ml by quantitative PCR at a reference laboratory; and 1.1.3 ALT greater than twice upper limit of normal or bridging fibrosis or cirrhosis (Metavir stage 3 or 4 or equivalent) on liver histology or clinical/radiological evidence of cirrhosis; or 21 HBV DNA positive cirrhosis prior to liver transplantation; or 32 HBsAg positive and have had a liver, kidney, heart, lung or bone marrow transplant; or 43 Hepatitis B virus naïve patient who has received a liver transplant from an anti-HBc (Hepatitis B core antibody) positive donor; or 4 Hepatitis B surface antigen (HbsAg) positive patient who is receiving chemotherapy for a malignancy, or high dose steroids (at least 20mg/day for at least 7 days) or who has received such treatment within the previous two months; or 5 Hepatitis B surface antigen positive patient who is receiving anti tumour necrosis factor treatment; or 6 Hepatitis B core antibody (anti-HBc) positive patient who is receiving rituximab plus high dose steroids (e.g. R-CHOP). 2. All of the following: 2.1. No continuing alcohol abuse or intravenous drug use; and 2.2. Not coinfected with HCV or HDV; and 2.3. Neither ALT nor AST greater than 10 times upper limit of normal; and 2.4. No history of hypersensitivity to lamivudine; and 2.5. No previous lamivudine therapy with genotypically proven lamivudine resistance. 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

30


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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

continued... Renewal only from a gastroenterologist, infectious disease specialist, paediatrician or general physician or on the recommendation of a gastroenterologist, infectious disease specialist. paediatrician or general physician. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: Renewal for patients who have maintained continuous treatment and response to lamivudine 1. All of the following: 1.1. Have maintained continuous treatment with lamivudine; and 1.2. Most recent test result shows continuing biochemical response (normal ALT); and 1.3. HBV DNA < 100,000 copies per ml by quantitative PCR at a reference laboratory. Renewal when given in combination with adefovir dipivoxil for patients with cirrhosis and resistance to lamivudine 2. All of the following 2.1. lamivudine to be used in combination with adefovir dipivoxil; and 2.2. patient is cirrhotic; and Documented resistance to lamivudine, defined as: 2.3. patient has raised serum ALT (> 1 x ULN); and 2.4. patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 2.5. detection of M204I or M204V mutation. Renewal when given in combination with adefovir dipivoxil for patients with resistance to adefovir dipivoxil 3. All of the following 3.1. lamivudine to be used in combination with adefovir dipivoxil; and Documented resistance to adefovir, defined as: 3.2. patient has raised serum ALT (> 1 x ULN); and 3.3. patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 3.4. detection of N236T or A181T/V mutation 98 ENTECAVIR – Special Authority see SA1361 0977 – Retail pharmacy Tab 0.5 mg ........................................................................... 400.00 30 ✔ Baraclude

➽ SA1361 0977 Special Authority for Subsidy Initial application only from a gastroenterologist or infectious disease specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 Patient is Hepatitis B nucleoside analogue treatment-naive; and 3 Entecavir dose 0.5 mg/day; and 4 Either: 4.1 ALT greater than upper limit of normal; or 4.2 Bridging fibrosis (Metavir stage 3 or greater or moderate fibrosis) or cirrhosis on liver histology; and 5 Either: 5.1 HBeAg positive; or 5.2 patient has ≥ 2,000 IU HBV DNA units per ml and fibrosis (Metavir stage 2 or greater) on liver histology; and 6 No continuing alcohol abuse or intravenous drug use; and 7 Not co-infected with HCV, HIV or HDV; and 8 Neither ALT nor AST greater than 10 times upper limit of normal; and 9 No history of hypersensitivity to entecavir; and 10 No previous documented lamivudine resistance (either clinical or genotypic). Notes: • Entecavir should be continued for 6 months following documentation of complete HBeAg seroconversion (defined as loss of HBeAg plus appearance of anti-HBe plus loss of serum HBV DNA) for patients who were HBeAg positive prior to commencing this agent. This period of consolidation therapy should be extended to 12 months in patients with advanced fibrosis (Metavir Stage F3 or F4). • Entecavir should be taken on an empty stomach to improve absorption

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

31


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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

100 TENOFOVIR DISOPROXIL FUMARATE – Subsidy by endorsement; can be waived by Special Authority see SA1362 1047 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 SA1364 1025 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 SA1364 1025. Tab 300 mg .......................................................................... 531.00 30 ✔ Viread ➽ SA1362 1047 Special Authority for Waiver of Rule Initial application - (Chronic Hepatitis B) 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 1.1. All of the following 1.1.1. Patient has had previous lamivudine, adefovir or entecavir therapy; and 1.1.2. HBV DNA greater than 20,000 IU/mL or increased = 10 fold over nadir; and 1.1.3. Any of the following: 1.1.3.1. Lamivudine resistance - detection of M204I/V mutation; or 1.1.3.2. Adefovir resistance - detection of A181T/V or N236T mutation; or 1.1.3.3. Entecavir resistance - detection of relevant mutations including I169T, L180M T184S/A/I/L/G/C/M, S202C/G/I, M204V or M250I/V mutation; or 2. Patient is either listed or has undergone liver transplantation for HBV; or 3. Patient has decompensated cirrhosis with a Mayo score >20. Initial application - (Pregnant, active hepatitis B) only from a gastroenterologist, infectious disease physician or general physician. Approvals valid for 12 months 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 - (Subsequent Pregnancy or breastfeeding, active hepatitis B) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 12 months 4 months for applications meeting the following criteria: Both: 1 Patient is HBsAg positive and pregnant or breastfeeding; 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. Initial application - (Pregnant, prevention of vertical transmission) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 6 months 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 20 million IU/mL and ALT normal. Renewal - (Subsequent pregnancy, prevention of vertical transmission) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 6 months 4 months for applications meeting the following criteria: 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

32


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

continued... 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 20 million IU/mL and ALT normal. 100 VALACICLOVIR – Special Authority see SA1363 0957 – Retail pharmacy Tab 500 mg ......................................................................... 102.72 ➽ SA1363 0957 Special Authority for Subsidy Initial application – (recurrent genital herpes) from any medical practitioner. Approvals valid for 12 months where the patient has genital herpes with 2 or more breakthrough episodes in any 6 month period while treated with aciclovir 400 mg twice daily. Renewal – (recurrent genital herpes) from any medical practitioner. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. Initial application – (ophthalmic zoster) from any medical practitioner. Approvals valid without further renewal unless notified where the patient has previous history of ophthalmic zoster and the patient is at risk of vision impairment. Initial application – (CMV prophylaxis) from any medical practitioner. Approvals valid for 3 months where the patient has undergone organ transplantation. Initial application – (immunocompromised patients) from any medical practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 Patients is immunocompromised; and 2 Patient has herpes zoster; and 3 Valaciclovir is to be given for a maximum of 7 days per course. 102 ANTIRETROVIRALS ➽ SA1364 1025 Special Authority for Subsidy Initial application – (Confirmed HIV/AIDS) only from a named specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Confirmed HIV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 Both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3; or 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 copies per ml; or 2.4 Both: 2.4.1 Patient aged 6 years and over; and 2.4.2 CD4 counts < 350500 cells/mm3. Notes: Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals. Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. continued...

30

✔ Valtrex

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

33


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

continued... Renewal — (Confirmed HIV/AIDS) only from a named specialist. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment. Initial application — (Prevention of maternal transmission) only from a named specialist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Notes: Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals. Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. Some antiretrovirals are unapproved or contraindicated for this indication. Practitioners prescribing these medications should exercise their own skill, judgement, expertise and discretion, and make their own prescribing decisions with respect to the use of a Pharmaceutical for an indication for which it is not approved or contraindicated. Initial application – (post-exposure prophylaxis following non-occupational exposure to HIV) only from a named specialist. Approvals valid for 4 weeks for applications meeting the following criteria: Both: 1 Treatment course to be initiated within 72 hours post exposure; and 2 Either: 2.1 Patient has had unprotected receptive anal intercourse with a known HIV positive person; or 2.2 Patient has shared intravenous injecting equipment with a known HIV positive person; or 2.3 Patient has had non-consensual intercourse and the clinician considers that the risk assessment indicates prophylaxis is required Notes: Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals. Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. Renewal – (second or subsequent post-exposure prophylaxis) only from a named specialist. Approvals valid for 4 weeks for applications meeting the following criteria: Both: 1 Treatment course to be initiated within 72 hours post exposure; and 2 Either: 2.1 Patient has had unprotected receptive anal intercourse with a known HIV positive person; or 2.2 Patient has shared intravenous injecting equipment with a known HIV positive person; or 2.3 Patient has had non-consensual intercourse and the clinician considers that the risk assessment indicates prophylaxis is required Initial application – (Percutaneous exposure) only from a named specialist. Approvals valid for 6 weeks where the patient has percutaneous exposure to blood known to be HIV positive. Notes: Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals. Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals. Renewal – (Second or subsequent percutaneous exposure) only from a named specialist. Approvals valid for 6 weeks where the patient has percutaneous exposure to blood known to be HIV positive.

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

34

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 July 2013 (continued)

105 Guidelines for the use of interferon in the treatment of hepatitis C: Physicians considering treatment of patients with hepatitis C should discuss cases with a gastroenterologist or an infectious disease physician. All subjects undergoing treatment require careful monitoring for side effects. Patients should be otherwise fit. Hepatocellular carcinoma should be excluded by ultrasound examination and alpha-fetoprotein level. Criteria for Treatment a) Diagnosis - Anti-HCV positive on at least two occasions with a positive PCR for HCV-RNA and preferably confirmed by a supplementary RIBA test; or - PCR-RNA positive for HCV on at least 2 occasions if antibody negative; or - Anti-HCV positive on at least two occasions with a positive supplementary RIBA test with a negative PCR for HCV RNA but with a liver biopsy consistent with 2(b) following. b) Establishing Active Chronic Liver Disease - Confirmed HCV infection and serum ALT/AST levels measured on at least three occasions over six months averaging > 1.5 x upper limit of normal. (ALT is the preferable enzyme); or - Liver biopsy showing significant inflammatory activity (active hepatitis) with or without cirrhosis. This is not a necessary requirement for those patients with coagulopathy. (Some patients have active disease on histology with normal transaminase enzymes). Exclusion Criteria a) Autoimmune liver disease. (Interferon may exacerbate autoimmune liver disease as well as other autoimmune diseases such as thyroid disease). b) Pregnancy. c) Neutropenia (<2.0 x 109) and/or thrombocytopenia. d) Continuing alcohol abuse and/or continuing intravenous drug users. Dosage The current recommended dosage is 3 million units of interferon alpha-2a or interferon alpha-2b administered subcutaneously three times a week for 52 weeks (twelve months). Exit Criteria The patient's response to interferon treatment should be reviewed at either three or four months. Interferon treatment should be discontinued in patients who do not show a substantial reduction (50%) in their mean pretreatment ALT level at this stage. 107 PEGYLATED INTERFERON ALPHA-2A – Special Authority see SA1365 1134 – Retail pharmacy See prescribing guideline Inj 135 mcg prefilled syringe ................................................. 362.00 1 ✔ Pegasys 1,448.00 4 ✔ Pegasys Inj 180 mcg prefilled syringe . ................................................ 450.00 1 ✔ Pegasys 1,800.00 4 ✔ Pegasys Inj 135 mcg prefilled syringe × 4 with ribavirin tab 200 mg × 112 ............................. 1,799.68 1 OP ✔ Pegasys RBV Combination Pack Inj 135 mcg prefilled syringe × 4 with ribavirin tab 200 mg × 168 .............................. 1,975.00 1 OP ✔ Pegasys RBV Combination Pack Inj 180 mcg prefilled syringe × 4 with ribavirin tab 200 mg × 112 .............................. 2,059.84 1 OP ✔ Pegasys RBV Combination Pack Inj 180 mcg prefilled syringe × 4 with ribavirin tab 200 mg × 168 ............................. 2,190.00 1 OP ✔ Pegasys RBV Combination Pack 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

35


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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

continued... ➽ SA1365 1134 Special Authority for Subsidy Initial application – (chronic hepatitis C - genotype 1, 4, 5 or 6 infection or co-infection with HIV or genotype 2 or 3 post liver transplant) from any specialist. Approvals valid for 18 months for applications meeting the following criteria: Both: 1 Any of the following: Either: 1.1 Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection; or 1.2 Patient has chronic hepatitis C and is co-infected with HIV; and or 1.3 Patient has chronic hepatitis C genotype 2 or 3 and has received a liver transplant; and 2 Maximum of 48 weeks therapy. Notes: • Consider stopping treatment if there is absence of a virological response (defined as at least a 2-log reduction in viral load) following 12 weeks of treatment since this is predictive of treatment failure. • Consider reducing treatment to 24 weeks if serum HCV RNA level at Week 4 is undetectable by sensitive PCR assay (less than 50 IU/ml) AND Baseline serum HCV RNA is less than 400,000 IU/ml Initial application – (chronic hepatitis C - genotype 2 or 3 infection without co-infection with HIV) from any specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 Patient has chronic hepatitis C, genotype 2 or 3 infection; and 2 Maximum of 6 months therapy. Initial application – (Hepatitis B) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 18 months for applications meeting the following criteria: All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 Patient is Hepatitis B treatment-naive; and 3 ALT > 2 times Upper Limit of Normal; and 4 HBV DNA < 10 log10 IU/ml; and 5 Either: 5.1 HBeAg positive; or 5.2 serum HBV DNA ≥ 2,000 units/ml and significant fibrosis (≥ Metavir Stage F2 or moderate fibrosis); and 6 Compensated liver disease; and 7 No continuing alcohol abuse or intravenous drug use; and 8 Not co-infected with HCV, HIV or HDV; and 9 Neither ALT nor AST > 10 times upper limit of normal; and 10 No history of hypersensitivity or contraindications to pegylated interferon; and 11 Maximum of 48 weeks therapy. Notes: • Approved dose is 180 mcg once weekly. • The recommended dose of Pegylated Interferon-alpha 2a is 180 mcg once weekly. • In patients with renal insufficiency (calculated creatinine clearance less than 50ml/min), Pegylated Interferon-alpha 2a dose should be reduced to 135 mcg once weekly. • In patients with neutropaenia and thrombocytopaenia, dose should be reduced in accordance with the datasheet guidelines. • Pegylated Interferon-alpha 2a is not approved for use in children.

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

36

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 July 2013 (continued)

119 LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE Inj 1%, 5 ml ampoule – Up to 25 inj available on a PSO ............ 35.60 6.90 SUMATRIPTAN Inj 12 mg per ml, 0.5 ml cartridge – Maximum of 10 inj per prescription ................................... 13.80 50 25 ✔ Xylocaine ✔ Lidocaine-Claris

130

2 OP

✔ Arrow-Sumatriptan

131

HYOSCINE (SCOPOLAMINE) – Special Authority see SA1387 0939 – Retail pharmacy Patch 1.5 mg ......................................................................... 11.95 2 ✔ Scopoderm TTS ➽ SA1387 0939 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: Either: 1 Control of intractable nausea, vomiting, or inability to swallow saliva in the treatment of malignancy or chronic disease where the patient cannot tolerate or does not adequately respond to oral anti-nausea agents; or and 2 Control of clozapine-induced hypersalivation where trials of at least two other alternative treatments have proven ineffective. 2 Patient cannot tolerate or does not adequately respond to oral anti-nausea agents; and 3 The applicant must specify the underlying malignancy or chronic disease. Renewal from any relevant practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment.

166

ADALIMUMAB – Special Authority see SA1371 1156 – Retail pharmacy Inj 20 mg per 0.4 ml prefilled syringe .................................. 1,799.92 2 Inj 40 mg per 0.8 ml prefilled pen ...................................... 1,799.92 2 Inj 40 mg per 0.8 ml prefilled syringe .................................. 1,799.92 2 Note: Only the new criteria is listed below existing criteria remains unchanged.

✔ Humira ✔ HumiraPen ✔ Humira

➽ SA1371 1156 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: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for juvenile idiopathic arthritis (JIA); 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 juvenile idiopathic arthritis; or 2 All of the following: 2.1 To be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.2 Patient diagnosed with JIA; and 2.3 Patient has had severe active polyarticular course JIA for 6 months duration or longer; and 2.4 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 either oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose) or a full trial of serial intra-articular corticosteroid injections; and 2.5 Both: continued... 2.5.1 Either:

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

37


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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

continued... Patient has persistent symptoms of poorly-controlled and active disease in at least 20 swollen, tender joints; or 2.5.1.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip; and 2.5.2 Physician's global assessment indicating severe disease. 2.5.1.1

Initial application – (fistulising Crohn’s disease) only from a gastroenterologist. Approvals valid for 6 months for applications meeting the following criteria: 1 Patient has confirmed Crohn’s disease; and 2 Either 2.1 Patient has one or more complex externally draining enterocutaneous fistula(e); or 2.2 Patient has one or more rectovaginal fistula(e); and 3 A Baseline Fistula Assessment has been completed and is no more than 1 month old at the time of application; and 4 The patient will be assessed for response to treatment after 4 months’ adalimumab treatment (see Note). Note: a maximum of 4 months’ adalimumab will be subsidised on an initial Special Authority approval for fistulising Crohn’s disease. Renewal – (juvenile idiopathic arthritis) only from a named specialist, 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 adalimumab 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 3 to 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 inactive joint count and continued improvement in physician's global assessment from baseline. Renewal – (fistulising Crohn’s disease) only from a gastroenterologist or Practitioner on the recommendation of a gastroenterologist. Approvals valid for 6 months meeting the following criteria: Both: 1 Either: 1.1 Applicant is a gastroenterologist; or 1.2 Applicant is a Practitioner and confirms that a gastroenterologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 The number of open draining fistulae have decreased from baseline by at least 50%; or 2.2 There has been a marked reduction in drainage of all fistula(e) from baseline as demonstrated by a reduction in the Fistula Assessment score, together with less induration and patient-reported pain.

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

38

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 July 2013 (continued)

175 BEE VENOM ALLERGY TREATMENT – Special Authority see SA1368 0053 – Retail pharmacy Maintenance kit - 6 vials 120 mcg freeze dried venom, 6 diluent 1.8 ml ................................................................ 285.00 1 OP ✔ Albay Treatment kit - Inj 1 vial 550 mcg freeze dried venom, 1 diluent 9 ml, 3 diluent 1.8 ml ........................................... 285.00 1 OP ✔ Albay ➽ SA1368 0053 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 RAST or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. 175 WASP VENOM ALLERGY TREATMENT – Special Authority see SA1367 0053 – Retail pharmacy Treatment kit (Paper wasp venom) - 1 vial 550 mcg freeze dried polister venom, 1 diluent 9 ml, 1 diluent 1.8 ml ..............285.00 1 OP ✔ Albay Treatment kit (Yellow jacket venom) - 1 vial 550 mcg freeze dried vespula venom, 1 diluent 9 ml, 1 diluent 1.8 ml ..............285.00 1 OP ✔ Albay ➽ SA1367 0053 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 RAST or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. 196 CARBOHYDRATE ➽ SA1373 1091 Special Authority for Subsidy nitial application – (Cystic fibrosis or kidney disease renal failure) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Either: 1 cystic fibrosis; or 2 chronic kidney disease renal failure or continuous ambulatory peritoneal dialysis (CAPD) patient Initial application – (Indications other than cystic fibrosis or renal failure) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1 cancer in children; or 2 cancers affecting alimentary tract where there are malabsorption problems in patients over the age of 20 years; or 3 faltering growth in an infant/child; or failure to thrive; or growth deficiency; or 4 bronchopulmonary dysplasia; or 5 premature and post premature infant; or 6 inborn errors of metabolism; or 7 for use as a component in a modular formula.

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

39


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 July 2013 (continued)

196 CARBOHYDRATE AND FAT ➽ SA1376 1091 Special Authority for Subsidy Initial application – (Cystic fibrosis) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 infant or child aged four years or under; and 2 cystic fibrosis. Initial application – (Indications other than cystic fibrosis) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Infant or child aged four years or under; and 2 Any of the following: 2.1 cancer in children; or 2.2 faltering growth; or failure to thrive; or growth deficiency; or 2.3 bronchopulmonary dysplasia; or 2.4 premature and post premature infants. 197 FAT ➽ SA1374 1092 Special Authority for Subsidy Initial application — (Indications other than inborn errors of metabolism) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1 faltering growth in an infant/child; or failure to thrive where other high calorie products are inappropriate or inadequate; or growth deficiency; or 2 bronchopulmonary dysplasia; or 3 fat malabsorption; or 4 lymphangiectasia; or 5 short bowel syndrome; or 6 infants with necrotising enterocolitis; or 7 biliary atresia; or 8 for use in a ketogenic diet; or 9 chyle leak; or 10 acites; or 11 for use as a component in a modular formula. PROTEIN ➽ SA1375 1093 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: Any of the following: 1 protein losing enteropathy; or 2 high protein needs (eg burns); or 3 for use as a component in a modular formula.

198

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

40

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 Restrictions - effective 1 July 2013 (continued)

198 RESPIRATORY PRODUCTS ➽ SA1094 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year where the patient has CORD and hypercapnia, defined as a CO2 value exceeding 55 mmHg. FAT MODIFIED PRODUCTS ➽ SA1381 1096 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: Any of the following: 1 Patient has metabolic disorders of fat metabolism; or 2 Patient has chylothorax a chyle leak; or 3 Modified as a modular feed for adults. HIGH PROTEIN PRODUCTS ➽ SA1378 1097 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Anorexia and weight loss; and 2 Either: 2.1 decompensating liver disease without encephalopathy; or 2.2 protein losing gastro-enteropathy Either: 1 decompensating liver disease without encephalopathy; or 2 protein losing gastro-enteropathy. PAEDIATRIC PRODUCTS ➽ SA1379 1224 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Child is aged one to ten years; and 2 Any of the following: 2.1 the child is being fed via a tube or a tube is to be inserted for the purposes of feeding; or 2.2 any condition causing malabsorption; or failure to thrive; or 2.3 faltering growth in an infant/child; or 2.4 increased nutritional requirements; or 2.5 the child is being transitioned from TPN or tube feeding to oral feeding. PAEDIATRIC PRODUCTS FOR CHILDREN WITH CHRONIC RENAL FAILURE ➽ SA1099 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years where the patient is a child (up to 18 years) with acute or chronic kidney disease renal failure. RENAL PRODUCTS ➽ SA1101 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years where the patient has acute or chronic renal failure kidney disease.

199

199

200

200

201

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

41


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2013 (continued)

202 SPECIALISED AND ELEMENTAL PRODUCTS ➽ SA1377 1102 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1 malabsorption; or 2 short bowel syndrome; or 3 enterocutaneous fistulas; or pancreatitis. 4 eosinophilic oesophagitis; or 5 inflammatory bowel disease; or 6 patients with multiple food allergies requiring enteral feeding. RENAL ORAL FEED 1 KCAL/ML 2 KCAL/ML – Special Authority see SA1101 – Hospital pharmacy [HP3] Liquid ........................................................................................ 3.80 237 ml OP ✔ Suplena ADULT PRODUCTS HIGH CALORIE ➽ SA1195 Special Authority for Subsidy Note: Only the criteria that have been amended are shown. Initial application — (Indications other than cystic fibrosis) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Any of the following: 1.1 any condition causing malabsorption; or failure to thrive; or 1.2 faltering growth in an infant/child; or 1.3 increased nutritional requirements; or 1.4 fluid restricted; and 2 other lower calorie products have been tried; and 3 patient has substantially increased metabolic requirements or is fluid restricted. EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1380 1220 – Hospital pharmacy [HP3] Powder ................................................................................... 15.21 450 g OP ✔ Pepti Junior Gold Karicare Aptamil ➽ SA1380 1220 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: Any of the following: 1 Both: 1.1 Cows milk formula is inappropriate due to severe intolerance or allergy to its protein content; and 1.2 Either: 1.2.1 Soy milk formula has been trialled without resolution of symptoms; or 1.2.2 Soy milk formula is considered clinically inappropriate or contraindicated; or 2 Severe malabsorption; or 3 Short bowel syndrome; or 4 Intractable diarrhea; or 5 Biliary atresia; or 6 Cholestatic liver diseases causing malsorption; or Chylous ascite; or Chylothorax; or 7 Cystic fibrosis; or 8 Proven fat malabsorption; or 9 Severe intestinal motility disorders causing significant malabsorption; or 10 Intestinal failure.

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

203 208

212

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

42


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 June 2013

29 ACARBOSE – Brand switch fee payable (Pharmacode 2433257) - see page 177 for details ❋ Tab 50 mg ................................................................................ 9.82 90 ✔ Accarb ❋ Tab 100 mg ............................................................................ 15.83 90 ✔ Accarb METOLAZONE – Special Authority see SA1323 – Retail pharmacy Tab 5 mg ............................................................................ CBS

58

50 1

➽ SA1323 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where used for applications meeting the following criteria: the treatment of patients with refractory heart failure who are intolerant or have not responded to loop diuretics and/or loop-thiazide combination therapy. Either: 1)For the treatment of heart failure in patients who are intolerant or have not responded to ACE inhibitors and/or angiotensin receptor blockers; or 2)For the treatment of heart failure, in patients in whom treatment with ACE inhibitors and/or angiotensin receptor blockers is not tolerated due to renal impairment. 72 ETHINYLOESTRADIOL WITH LEVONORGESTREL ❋ Tab 20 mcg with levonorgestrel 100 mcg and 7 inert tab – Up to 84 tab available on a PSO – Brand switch fee payable (Pharmacode 2427958) see page 177 for details ........................................................ 2.95 84

✔ Zaroxolyn S29 ✔ Metolazone S29

✔ Ava 20 ED

98

LAMIVUDINE – Special Authority see SA0832 – Retail pharmacy – Brand switch fee payable (Pharmacode 2433257) - see page 177 for details Tab 100 mg ............................................................................ 32.50 28 ✔ Zetlam ENTACAPONE – Brand switch fee payable (Pharmacode 2433249) - see page 177 for details s Tab 200 mg............................................................................ 47.92 100 ✔ Entapone METOCLOPRAMIDE HYDROCHLORIDE ❋ Tab 10 mg – For metoclopramide oral liquid formulation refer, page 188 .............................................................................. 3.95 CHLORAMPHENICOL Eye drops 0.5% ........................................................................ 1.20 Funded for use in the ear* Indications marked with* are Unapproved Indications.

118 131

100 10 ml OP

✔ Metamide ✔ Chlorafast

182

182

EYE PREPARATIONS Eye preparations are only funded for use in the eye, unless explicitly stated otherwise. The exception is pilocarpine eye drops 1%, 2% and 4% which are subsidised for oral use pursuant to the Standard Formulae. PILOCARPINE Eye drops 4% - Subsidised for oral use pursuant to the Standard Formulae .............................................................. 7.99

184

15 ml OP

✔ Isopto Carpine

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

43


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 May 2013

52 PERINDOPRIL Perindopril will be funded to the level of the ex-manufacturer price listed in the Schedule for patients who were taking these ACE inhibitors for the treatment of congestive heart failure prior to 1 June 1998. The prescription must be endorsed accordingly. We recommend that the words used to indicate eligibility are "certified condition" or an appropriate description of the patient such as "congestive heart failure", "CHF", "congestive cardiac failure" or "CCF". Definition of Congestive Heart Failure At the request of some prescribers the PTAC Cardiovascular subcommittee has provided a definition of congestive heart failure for the purposes of the funding of the manufacturer’s surcharge: "Clinicians should use their clinical judgement. Existing patients would be eligible for the funding of the surcharge if the patient shows signs and symptoms of congestive heart failure, and requires or has in the past required concomitant treatment with a diuretic. The definition could also be considered to include patients post myocardial infarction with an ejection fraction of less than 40%." ❋ Tab 2 mg – Higher subsidy of $18.50 per 30 tab with Endorsement .................................................................. 3.75 30 ✔ Apo-Perindopril (18.50) Coversyl ❋ Tab 4 mg – Higher subsidy of $25.00 per 30 tab with Endorsement .................................................................. 4.80 30 ✔ Apo-Perindopril (25.00) Coversyl TRANDOLAPRIL Higher subsidy by endorsement is available Trandolapril will be funded to the level of the ex-manufacturer price listed in the Schedule for patients who were taking these ACE inhibitors trandolapril for the treatment of congestive heart failure prior to 1 June 1998. The prescription must be endorsed accordingly. We recommend that the words used to indicate eligibility are "certified condition" or an appropriate description of the patient such as "congestive heart failure", "CHF", "congestive cardiac failure" or "CCF". Definition of Congestive Heart Failure At the request of some prescribers the PTAC Cardiovascular subcommittee has provided a definition of congestive heart failure for the purposes of the funding of the manufacturer's surcharge: "Clinicians should use their clinical judgement. Existing patients would be eligible for the funding of the surcharge if the patient shows signs and symptoms of congestive heart failure, and requires or has in the past required concomitant treatment with a diuretic. The definition could also be considered to include patients post myocardial infarction with an ejection fraction of less than 40%." For the purposes of this endorsement, congestive heart failure includes patients post myocardial infarction with an ejection fraction of less than 40%. Patients who started on trandolapril after 1 June 1998 are not eligible for full subsidy by endorsement. ❋ Cap 1 mg – Higher subsidy of $18.67 per 28 cap with Endorsement .................................................................. 3.06 28 (18.67) Gopten ❋ Cap 2 mg – Higher subsidy of $27.00 per 28 cap with Endorsement .................................................................. 4.43 28 (27.00) Gopten DILTIAZEM HYDROCHLORIDE ❋ Cap long-acting 120 mg – Brand switch fee payable (Pharmacode 2437775) .......... 31.83 ❋ Cap long-acting 180 mg – Brand switch fee payable (Pharmacode 2437775) .......... 47.67 ❋ Cap long-acting 240 mg – Brand switch fee payable (Pharmacode 2437775) .......... 63.58

52

57

500 500 500

✔ Apo-Diltiazem CD ✔ Apo-Diltiazem CD ✔ Apo-Diltiazem CD

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

44

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 Restrictions - effective 1 May 2013 (continued)

91 CIPROFLOXACIN – Subsidy by endorsement 1) Subsidised only if: a) Patient has: i) microbiologically confirmed and clinically significant pseudomonas infection; or ii) prostatitis; or iii) pyelonephritis; or iv) gonorrhoea; b) Prescription or PSO is written by, or on the recommendation of, an infectious disease physician or a clinical microbiologist; and 2) The prescription or PSO is endorsed accordingly. Recommended for patients with the any of the following: i) microbiologically confirmed and clinically significant pseudomonas infection; or ii) prostatitis; or iii) pyelonephritis; or iv) gonorrhoea; or Tab 250 mg – Up to 5 tab available on a PSO ............................ 2.20 28 ✔ Cipflox Tab 500 mg – Up to 5 tab available on a PSO ............................ 3.00 28 ✔ Cipflox 10.71 100 ✔ Cipflox Tab 750 mg .............................................................................. 5.15 28 ✔ Cipflox 5.52 30 ✔ Ciprofloxacin Rex CLINDAMYCIN Cap hydrochloride 150 mg – Maximum of 4 cap per prescription; can be waived by endorsement – Retail pharmacy-Specialist .... 9.90 16 ✔ Clindamycin ABM Specialist must be an infectious disease physician or a clinical microbiologist Inj phosphate 150 mg per ml, 4 ml – Retail pharmacy-Specialist...160.00 10 ✔ Dalacin C Prescriptions must be written by, or on the recommendation of, an infectious disease physician or a clinical microbiologist. ITRACONAZOLE Cap 100 mg – Subsidy by endorsement .................................... 4.25 15 ✔ Itrazole Funded for tinea vesicolor where topical treatment has not been successful and diagnosis has been confirmed by mycology, or for tinea unguium where terbinafine has not been successful in eradication or the patient is intolerant to terbinafine and diagnosis has been confirmed by mycology and the prescription is endorsed accordingly. Can be waived by endorsement - Retail pharmacy - Specialist. Specialist must be an infectious disease physician, clinical microbiologist, clinical immunologist or dermatologist. ISONIAZID – Retail pharmacy-Specialist a) No patient co-payment payable b) Prescriptions must be written by, or on the recommendation of, an internal medicine physician, paediatrician, clinical microbiologist, dermatologist or public health physician ❋ Tab 100 mg ........................................................................... 20.00 100 ✔ PSM ❋ Tab 100 mg with rifampicin 150 mg ....................................... 90.04 100 ✔ Rifinah ❋ Tab 150 mg with rifampicin 300 mg ..................................... 179.57 100 ✔ Rifinah LIGNOCAINE HYDROCHLORIDE LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE Viscous soln 2%...................................................................... 55.00 200 ml Inj 1%, 5 ml – Up to 5 inj available on a PSO ........................... 35.00 50 Inj 2%, 5 ml – Up to 5 inj available on a PSO ........................... 23.00 50 6.90 25 Inj 1%, 20 ml – Up to 5 inj available on a PSO .......................... 20.00 5 Inj 2%, 20 ml – Up to 5 inj available on a PSO .......................... 15.00 5 2.40 1 ✔ Xylocaine Viscous ✔ Xylocaine ✔ Xylocaine ✔ Lidocaine-Claris ✔ Xylocaine ✔ Xylocaine ✔ Lidocaine-Claris

92

94

96

119

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

45


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer’s Price

Effective 1 July 2013

28 INSULIN LISPRO WITH INSULIN LISPRO PROTAMINE ( subsidy) s Inj lispro 25% with insulin lispro protamine 75% 100 u per ml, 3 ml ............................................................... 42.66 s Inj lispro 50% with insulin lispro protamine 50% 100 u per ml, 3 ml ................................................................................... 42.66 ISPAGUHULA (PHYLLIUM) HUSK – Only on a prescription ( subsidy) ❋ Powder for oral soln .................................................................. 5.51

5 5 500 g OP

✔ Humalog Mix 25 ✔ Humalog Mix 50 ✔ Konsyl-D

38 39

SODIUM CITRATE WITH SODIUM LAURYL SULPHOACETATE – Only on a prescription ( subsidy) Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml ................................................................ 19.95 50 ✔ Micolette TERAZOSIN ( subsidy) ❋ Tab 1 mg .................................................................................. 0.50 ❋ Tab 2 mg .................................................................................. 0.45 ❋ Tab 5 mg .................................................................................. 0.68 CILAZAPRIL ( subsidy) ❋ Tab 0.5 mg ............................................................................... 2.00 ❋ Tab 2.5 mg ............................................................................... 4.31 ❋ Tab 5 mg .................................................................................. 6.98 CLONIDINE HYDROCHLORIDE ( subsidy) ❋ Tab 25 mcg ............................................................................ 13.47 SPIRONOLACTONE ( subsidy) ❋ Tab 25 mg ............................................................................... 3.65 ❋ Tab 100 mg ........................................................................... 11.80 EZETIMIBE – Special Authority see SA1045 – Retail pharmacy ( subsidy) Tab 10 mg ............................................................................. 34.43 28 28 28 90 90 90 100 100 100 30 ✔ Arrow ✔ Arrow ✔ Arrow ✔ Zapril ✔ Zapril ✔ Zapril ✔ Dixarit ✔ Spirotone ✔ Spirotone ✔ Ezetrol

51

51

57 58

60 60

EZETIMIBE WITH SIMVASTATIN – Special Authority see SA1046 – Retail pharmacy ( subsidy) Tab 10 mg with simvastatin 10 mg .......................................... 36.68 30 ✔ Vytorin Tab 10 mg with simvastatin 20 mg .......................................... 38.70 30 ✔ Vytorin Tab 10 mg with simvastatin 40 mg .......................................... 41.40 30 ✔ Vytorin Tab 10 mg with simvastatin 80 mg .......................................... 45.45 30 ✔ Vytorin FUSIDIC ACID ( subsidy) Oint 2% .................................................................................... 3.45 a) Maximum of 15 g per prescription b) Only on a prescription c) Not in combination LEVONORGESTREL ( subsidy) ❋ Tab 750 mcg............................................................................. 3.50 15 g OP ✔ Foban

65

78 78

2

✔ Next Choice

MEDROXYPROGESTERONE ACETATE ( subsidy) ❋ Inj 150 mg per ml, 1 ml syringe – Up to 5 inj available on a PSO ............................................. 7.00 1 ✔ Depo-Provera 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

46


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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 July 2013 (continued)

92 CLINDAMYCIN ( subsidy) Inj phosphate 150 mg per ml, 4 ml – Retail pharmacy-Specialist ............................................. 100.00 ACICLOVIR ( subsidy) ❋ Tab dispersible 200 mg ............................................................ 1.78 ❋ Tab dispersible 400 mg ............................................................. 5.98 ❋ Tab dispersible 800 mg ............................................................ 6.64 TETRABENAZINE ( subsidy) Tab 25 mg ........................................................................... 118.00 LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE ( subsidy) Inj 2%, 5 ml – Up to 5 inj available on a PSO ............................ 13.80 Inj 2%, 20 ml – Up to 5 inj available on a PSO .......................... 12.00 DIHYDROCODEINE TARTRATE ( subsidy) Tab long-acting 60 mg ........................................................... 13.64 MORPHINE SULPHATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency Tab long-acting 10 mg ............................................................ 1.95 Tab long-acting 30 mg .............................................................. 2.98 Tab long-acting 60 mg ............................................................. 5.75 Tab long-acting 100 mg ............................................................ 6.45 MORPHINE TARTRATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency Inj 80 mg per ml, 1.5 ml ......................................................... 35.60 Inj 80 mg per ml, 5 ml .......................................................... 107.67 SERTRALINE ( subsidy) ❋ Tab 50 mg ................................................................................ 3.64 ❋ Tab 100 mg ............................................................................. 6.28 VENLAFAXINE – Special Authority see SA1061 – Retail pharmacy ( subsidy) Tab 37.5 mg ............................................................................. 7.84 Tab 75 mg .............................................................................. 13.94 Tab 150 mg ............................................................................ 17.08 Tab 225 mg ............................................................................ 27.14 Cap 37.5 mg ............................................................................. 8.71 Cap 75 mg .............................................................................. 17.42 Cap 150 mg ............................................................................ 21.35

10 25 56 35 112 50 5 60

✔ Dalacin C ✔ Lovir ✔ Lovir ✔ Lovir ✔ Motetis ✔ Xylocaine ✔ Xylocaine ✔ DHC Continus

99

119 119

120 122

10 10 10 10

✔ Arrow-Morphine LA ✔ Arrow-Morphine LA ✔ Arrow-Morphine LA ✔ Arrow-Morphine LA

122

5 5 90 90 28 28 28 28 28 28 28

✔ Hospira ✔ Hospira ✔ Arrow-Sertraline ✔ Arrow-Sertraline ✔ Arrow-Venlafaxine XR ✔ Arrow-Venlafaxine XR ✔ Arrow-Venlafaxine XR ✔ Arrow-Venlafaxine XR ✔ Efexor XR ✔ Efexor XR ✔ Efexor XR

124

125

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

47


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 July 2013 (continued)

130 SUMATRIPTAN ( subsidy) Tab 50 mg ................................................................................ 1.19 29.80 Tab 100 mg .............................................................................. 1.10 54.80 Inj 12 mg per ml, 0.5 ml cartridge – Maximum of 10 inj per prescription ................................... 13.80 4 100 2 100 2 OP ✔ Arrow-Sumatriptan ✔ Arrow-Sumatriptan ✔ Arrow-Sumatriptan ✔ Arrow-Sumatriptan ✔ Arrow-Sumatriptan

140

NITRAZEPAM – Safety medicine; prescriber may determine dispensing frequency ( subsidy) Tab 5 mg ................................................................................. 4.98 100 ✔ Nitrados ‡ Safety cap for extemporaneously compounded oral liquid preparations. NALTREXONE HYDROCHLORIDE – Special Authority see SA0909 – Retail pharmacy ( subsidy) Tab 50 mg .............................................................................. 79.00 30 ✔ Naltraccord METHOTREXATE ( subsidy) ❋ Inj 25 mg per ml, 2 ml – PCT – Retail pharmacy-Specialist ...... 20.20 ❋ Inj 25 mg per ml, 20 ml – PCT – Retail pharmacy-Specialist .... 27.78 DOCETAXEL – PCT only – Specialist ( subsidy) Inj 20 mg per ml, 1 ml ............................................................ 48.75 Inj 20 mg per ml, 4 ml .......................................................... 195.00 Inj 1 mg for ECP ....................................................................... 2.63 5 1 1 1 1 mg ✔ Hospira ✔ Hospira ✔ Taxotere ✔ Taxotere ✔ Baxter ✔ Temaccord ✔ Temaccord ✔ Temaccord ✔ Temaccord

145 149 151

153

TEMOZOLOMIDE – Special Authority see SA1063 – Retail pharmacy ( subsidy) Cap 5 mg .................................................................................. 8.00 5 Cap 20 mg .............................................................................. 36.00 5 Cap 100 mg .......................................................................... 175.00 5 Cap 250 mg ......................................................................... 410.00 5 VINCRISTINE SULPHATE ( subsidy) Inj 1 mg per ml, 1 ml – PCT – Retail pharmacy-Specialist ................................................ 64.80 Inj 1 mg per ml, 2 ml – PCT – Retail pharmacy-Specialist ................................................ 69.60 Inj 1 mg for ECP – PCT only – Specialist .................................... 9.45

154

5 5 1 mg

✔ Hospira ✔ Hospira ✔ Baxter

166

BACILLUS CALMETTE-GUERIN (BCG) VACCINE – PCT only – Specialist ( subsidy) Subsidised only for bladder cancer. Inj 2-8 × 100 million CFU .................................................... 149.37 1 IPRATROPIUM BROMIDE ( subsidy) Nebuliser soln, 250 mcg per ml, 1 ml – Up to 40 neb available on a PSO ......................................... 3.26 Nebuliser soln, 250 mcg per ml, 2 ml – Up to 40 neb available on PSO ............................................ 3.37

✔ OncoTICE

178

20 20

✔ Univent ✔ Univent

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

48

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 Subsidy and Manufacturer's Price - effective 1 June 2013

53 AMIODARONE HYDROCHLORIDE ( subsidy) Inj 50 mg per ml, 3 ml ampoule – Up to 6 inj available on a PSO..................................................................................... 22.80

6

✔ Cordarone-X

72

MALATHION WITH PERMETHRIN AND PIPERONYL BUTOXIDE ( subsidy) Spray 0.25% with permethrin 0.5% and piperonyl butoxide 2%......................................................................... 11.15 90 g OP METYRAPONE ( subsidy) Cap 250 mg – Retail pharmacy-Specialist ............................. 520.00 PRAZIQUANTEL ( subsidy) Tab 600 mg ........................................................................... 68.00 METHYLCELLULOSE ( subsidy) Powder .................................................................................. 36.95 50 8 100 g

✔ Para Plus ✔ Metopirone ✔ Biltricide ✔ MidWest

87 88 193

Effective 1 May 2013

52 PERINDOPRIL ( subsidy) Tab 2 mg ................................................................................. 3.75 (18.50) Tab 4 mg .................................................................................. 4.80 (25.00) CALAMINE ( price) a) Only on a prescription b) Not in combination Crm, aqueous, BP .................................................................... 1.77 (3.80) LEVONORGESTREL ( subsidy) ❋ Tab 1.5 mg ............................................................................... 3.50 a) Maximum of 2 tab per prescription b) Up to 5 tab available on a PSO 30 Coversyl 30 Coversyl

66

100 g Home Essential 1 ✔ Postinor-1

78

120

CODEINE PHOSPHATE ( subsidy) – Safety medicine; prescriber may determine dispensing frequency Tab 15 mg ................................................................................ 4.75 100 ✔ PSM Tab 30 mg ................................................................................ 5.80 100 ✔ PSM Tab 60 mg .............................................................................. 12.50 100 ✔ PSM AMISULPRIDE ( subsidy) – Safety medicine; prescriber may determine dispensing frequency Tab 100 mg .............................................................................. 6.22 30 ✔ Solian Tab 200 mg ........................................................................... 21.92 60 ✔ Solian Tab 400 mg ........................................................................... 44.52 60 ✔ Solian Oral liq 100 mg per ml ............................................................ 52.50 60 ml ✔ Solian

132

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

49


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 July 2013

11 12 12 “Assessed Pharmaceuticals” means the list of Pharmaceuticals set out in Section H Part III of the Schedule, that have been or are being assessed by PHARMAC. “Optional Pharmaceuticals” means the list of National Contract Pharmaceuticals set out in Section H Part III of the Schedule. “Hospital Pharmaceuticals” means National Contract Pharmaceuticals, DV Pharmaceuticals, Discretionary Community Supply Pharmaceuticals and Assessed Pharmaceuticals. the list of Pharmaceuticals set out in Section H Part II of the Schedule which includes some National Contract Pharmaceuticals. “Community Pharmaceutical” means a Pharmaceutical listed in Section A to G and Section I of the Pharmaceutical Schedule that is subsidised by the Funder from the Pharmaceutical Budget for use in the community. “Discretionary Community Supply Pharmaceutical” means the list of Pharmaceuticals set out in Section H Part IV of the Schedule, which may be funded by a DHB Hospital from its own budget for use in the community. “Hospital Pharmaceuticals in the Community (HPC)” means the pathway under the Named Patient Pharmaceutical Assessment policy to allow District Health Board hospitals to fund a medicine for a patient in the community if this is more affordable for the DHB than paying for the treatment that would otherwise need to be provided. “Practitioner” means a Doctor, a Dentist, a Dietitian, a Midwife, a Nurse Prescriber or an Optometrist or a Pharmacist as those terms are defined in the Pharmaceutical Schedule. “Unlisted Pharmaceutical” means a Pharmaceutical that is within the scope of a Hospital Pharmaceutical, but is not listed in Section H Part II. 3.6 Pharmacists’ prescriptions The following apply to every prescription written by a Pharmacist: 3.6.1 Prescriptions written by a Pharmacist for a Community Pharmaceutical will only be subsidised where theyare for the CareSens, CareSens N and CareSens N POP blood glucose diagnostic meters and annotated appropriately. 3.6.2 The prescribing and dispensing of blood glucose diagnostic meters by Pharmacists must be in accordance with regulations 41 and 42 of the Medicines Regulations 1984.

12

12 12

14 16 19

Effective 1 May 2013

18 3.3 Original Packs, Certain Antibiotics and Unapproved Medicines 3.3.2 If a Community Pharmaceutical is either: a) the liquid oral form of an antibiotic to which a diluent must be added by the Contractor at the time of dispensing; or b) an unapproved medicine supplied under Section 29 of the Medicines Act 1981 excluding any medicine listed as Cost, Brand, Source of Supply, and it is prescribed or ordered by a Practitioner in an amount that does not coincide with the amount contained in one or more standard packs of that Community Pharmaceutical, Subsidy will be paid for the amount prescribed or ordered by the Practitioner in accordance with either clause 3.1 or clause 3.3 of the Schedule, and for the balance of any pack or packs from which the Community Pharmaceutical has been dispensed. At the time of dispensing the Contractor must keep a record of the quantity discarded. To ensure wastage is reduced, the Contractor should reduce the amount dispensed to make it equal to the quantity contained in a whole pack where: continued... 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

50


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 May 2013 (continued)

continued... a) b) the difference the amount dispensed and the amount prescribed by the Practitioner is less than 10% (eg; if a prescription is for 105 mls then a 100 ml pack would be dispensed); and in the reasonable opinion of the Contractor the difference would not affect the efficacy of the course of treatment prescribed by the Practitioner.

Note: For the purposes of audit and compliance it is an act of fraud to claim wastage and then use the wastage amount for any subsequent prescription.

Effective 1 April 2013

13 “Hospital Pharmacy-Specialist” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy to an Outpatient either: a) on a Prescription signed by a Specialist, or b) where the treatment with the Community Pharmaceutical has been recommended by a Specialist, on the Prescription of a practitioner which is either: i) endorsed with the words “recommended by [name of specialist and year of authorisation]” and signed by the Practitioner, or ii) endorsed with the word ‘protocol’ which means “initiated in accordance with DHB hospital approved protocol”, iii) annotated by the dispensing pharmacist, following verbal confirmation from the Practitioner of the name of the Specialist and date of recommendation, with the words “recommended by [name of specialist and date of authorisation], confirmed by [practitioner]”. Where the Contractor has an electronic record of such an Endorsement or Annotation from a previous prescription for the same Community Pharmaceutical written by a prescriber for the same patient, they may annotate the prescription accordingly. “As recommended by a Specialist” to be interpreted as either: 1) a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written; c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the specialist and the General Practitioner must keep a written record of the consultation; or 2) treatment with the Community Pharmaceutical has been initiated in accordance with a DHB hospital approved protocol 15 “Retail Pharmacy-Specialist” means that the Community Pharmaceutical is only eligible for Subsidy if it is either: a) supplied on a Prescription or Practitioner’s Supply Order signed by a Specialist, or, b) in the case of treatment recommended by a Specialist, supplied on a Prescription or Practitioner’s Supply Order and either: i) endorsed with the words “recommended by [name of Specialist and year of authorisation]” and signed by the Practitioner, or ii) endorsed with the word ‘protocol’ which means “initiated in accordance with DHB hospital approved protocol”, or iii) Annotated by the dispensing pharmacist, following verbal confirmation from the Practitioner of the name of the Specialist and date of recommendation, with the words “recommended by [name of specialist and year of authorisation], confirmed by [practitioner]”. Where the Contractor has an electronic record of such an Endorsement or Annotation from a previous prescription for the same Community Pharmaceutical written by a prescriber for the same patient, they may annotate the prescription accordingly. “As recommended by a Specialist” to be interpreted as either: 1) a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written;

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

51


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 May 2013 (continued)

continued... c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the Specialist and the General Practitioner must keep a written record of consultation; or 2) treatment with the Community Pharmaceutical has been initiated in accordance with a DHB hospital approved protocol.

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

52

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 Brand Name

Effective 1 July 2013

209 FOOD THICKENER – Special Authority see SA1106 – Hospital pharmacy [HP3] Powder ..................................................................................... 7.25 380 g OP ✔ Aptamil Feed Thickener Feed Thickener Karicare Aptamil

212

EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1380 – Hospital pharmacy [HP3] Powder ................................................................................... 15.21 450 g OP ✔ Gold Pepti Junior Pepti Junior Gold Karicare Aptamil

Effective 1 June 2013

209 FOOD THICKENER – Special Authority see SA1106 – Hospital pharmacy [HP3] Powder ..................................................................................... 7.25 380 g OP ✔ Karicare Food Thickener Aptamil Feed Thickener

212

EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1380 – Hospital pharmacy [HP3] Powder ................................................................................... 15.21 450 g OP ✔ Pepti Junior Gold Aptamil Gold Pepti Junior

Effective 1 May 2013

85 LEVOTHYROXINE Tab 50 mcg .............................................................................. 1.71 28 ✔ Goldshield Mercury Pharma ✔ Goldshield Mercury Pharma

‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 100 mcg............................................................................. 1.78 28 ‡ Safety cap for extemporaneously compounded oral liquid preparations.

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

53


Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Section I

Effective 1 May 2013

224 INFLUENZA VACCINE – Hospital pharmacy [Xpharm] Inj ........................................................................................... 90.00 A) ✔ Fluarix ✔ Fluvax is available each year for patients who meet the following criteria, as set by PHARMAC: a) all people 65 years of age and over; b) people under 65 years of age with who: i) have the following cardiovascular disease: 1) ischaemic heart disease, 2) congestive heart disease, 3) rheumatic heart disease, 4) congenital heart disease, or 5) cerebo-vascular disease; ii) have the following chronic respiratory disease: 1) asthma, if on a regular preventative therapy, or 2) other chronic respiratory disease with impaired lung function; iii)are children aged four and under who have been hospitalised for respiratory illness or have a history of significant respiratory illness. iii)iv) have diabetes; iv)v) have chronic renal disease; v)vi) have any cancer, excluding basal and squamous skin cancers if not invasive; vi)vii)have any of the following other conditions: a) autoimmune disease, b) immune suppression, c) HIV, d) transplant recipients, e) neuromuscular and CNS diseases, f) haemoglobinopathies, or g) are children on long term aspirin; or vii)h)are pregnancy pregnant. c) people under 18 years of age living within the boundaries of the Canterbury District Health Board d) are children aged four and under who have been hospitalised for respiratory illness or have a history of significant respiratory illness Unless meeting other the criteria above, the following conditions are excluded from funding: a) asthma not requiring regular preventative therapy, b) hypertension and/or dyslipidaemia without evidence of end-organ disease. Doctors are the only Contractors entitled to claim payment from the Funder for the supply of influenza vaccine to patients eligible under the above criteria for subsidised immunisation and they may only do so in respect of the influenza vaccine listed in the Pharmaceutical Schedule. Individual DHBs may fund patients over and above the above criteria. The claiming process for these additional patients should be determined between the DHB and Contractor. Stock of the seasonal influenza vaccine is typically available from February until late July with suppliers being required to ensure supply until at least 30 June. Exact start and end dates for each season will be notified each year. 10

B) C) D)

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

54

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 Section E

Effective 1 July 2013

214 214 214 214 216 216 BLOOD GLUCOSE DIAGNOSTIC TEST METER ✔ Meter ..................................1 BLOOD KETONE DIAGNOSTIC TEST METER ✔ Meter ..................................1 BLOOD GLUCOSE DIAGNOSTIC TEST STRIP ✔ Test strip .............................50 strip CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL ✔ Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tabs ................84 KETONE BLOOD BETA-KETONE ELECTRODES ✔ Test strip .............................10 strip LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE ✔ Inj 1%, 5 ml .........................25 5

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

55


Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items

Effective 1 July 2013

27 49 PANTOPRAZOLE ❋ Inj 40 mg .................................................................................. 6.50 DEXTROSE WITH ELECTROLYTES Soln with electrolytes................................................................. 6.60 6.75 QUINAPRIL ❋ Tab 5 mg .................................................................................. 1.15 ❋ Tab 10 mg ............................................................................... 1.55 ❋ Tab 20 mg ............................................................................... 2.11 PROPRANOLOL ❋ Tab 10 mg ............................................................................... 3.55 CALAMINE a) Only on a prescription b) Not in combination Crm, aqueous, BP .................................................................... 1.77 (3.80) METHYLPREDNISOLONE SODIUM SUCCINATE – Retail pharmacy-Specialist Inj 500 mg ............................................................................. 18.00 1 ✔ Pantocid IV

1,000 ml OP ✔ Pedialyte – Fruit ✔ Pedialyte – Plain 30 30 30 100 ✔ Accupril ✔ Accupril ✔ Accupril ✔ Cardinol

52 55 66

100 g Home Essential 1 ✔ Solu-Medrol

81 118 127

LEVODOPA WITH CARBIDOPA ❋ Tab 100 mg with carbidopa 25 mg – For levodopa with carbidopa oral liquid formulation refer, page 188 .................................. 20.00 100 ❋ Tab long-acting 200 mg with carbidopa 50 mg ........................ 47.50 100 ❋ Tab 250 mg with carbidopa 25 mg .......................................... 40.00 100 Note – new presentations of Sinement and Sinement CR were listed 1 January 2013.

✔ Sinemet ✔ Sinemet CR ✔ Sinemet

GABAPENTIN Cap 100 mg .............................................................................. 7.16 100 ✔ Nupentin Cap 300 mg ............................................................................ 11.50 100 ✔ Nupentin Note – the Nupentin capsules in the blister pack are delisted. The Nupentin capsules in bottles will remain listed as fully funded. PHARMACY SERVICES Brand switch fee........................................................................ 4.33 1 fee ✔ BSF Alphapharm ✔ BSF Nevirapine Alphapharm ✔ BSF Caresens II ✔ BSF Caresens N ✔ BSF Caresens N POP

186

212

AMINO ACID FORMULA – Special Authority see SA1219 below – Hospital pharmacy [HP3] Powder ................................................................................... 53.00 400 g OP ✔ Neocate

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

56

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 June 2013

53 AMIODARONE HYDROCHLORIDE Inj 50 mg per ml, 3 ml ampoule – Up to 6 inj available on a PSO..................................................................................... 60.84 BEZAFIBRATE ❋Tab 200 mg ............................................................................... 9.70 STAVUDINE [D4T] – Special Authority see SA1025 – Retail pharmacy Cap 30 mg ........................................................................... 377.80 DICLOFENAC SODIUM ❋Tab EC 25 mg ............................................................................ 1.63 ❋Tab EC 50 mg ........................................................................... 1.60 (2.13) DOMPERIDONE ❋Tab 10 mg – For domperidone oral liquid formulation refer, page 188 ............................................................................... 3.25 (11.99) PROMETHAZINE HYDROCHLORIDE ❋‡ Oral liq 5 mg per 5 ml ............................................................. 2.79 (3.10) PHARMACY SERVICES ❋Brand switch fee ........................................................................ 4.33

10 90 60 50 50

✔Cordarone-X ✔ Fibalip ✔ Zerit ✔ Diclofenac Sandoz Diclofenac Sandoz

59 104 109

130

100 Motilium 100 ml Promethazine Winthrop Elixir 1 fee ✔ BSF Accarb ✔ BSF Ava 20 ED ✔ BSF Entapone ✔ BSF Zetlam

176

186

Effective 1 May 2013

24 CALCIUM CARBONATE WITH AMINOACETIC ACID ❋ Tab 420 mg with aminoacetic acid 180 mg – Higher subsidy of $6.30 per 100 tab with Endorsement ......................................................................... 3.00 100 (6.30) Titralac Additional subsidy by endorsement is available for pregnant women. The prescription must be endorsed accordingly. MICONAZOLE Oral gel 20 mg per g ................................................................ 4.95 (8.70) RIVAROXABAN – Special Authority see SA1066 – Retail pharmacy Tab 10 mg ............................................................................ 306.00 40 g OP Daktarin 30 ✔ Xarelto

40

47

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

57


Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 May 2013 (continued)

57 DILTIAZEM HYDROCHLORIDE Cap long-acting 120 mg ............................................................ 1.91 (4.34) Cap long-acting 180 mg ........................................................... 2.86 (6.50) Cap long-acting 240 mg ........................................................... 3.81 (8.67) SILDENAFIL – Special Authority see SA1293 – Retail pharmacy Tab 25 mg ............................................................................. 39.00 Tab 50 mg ............................................................................. 43.50 Tab 100 mg – For sildenafil oral liquid formulation refer, page 179 ............................................................................. 47.00 CALCIPOTRIOL Oint 50 mcg per g .................................................................. 20.20 Soln 50 mcg per ml ................................................................ 33.79 4 4 4 30 g OP 60 ml OP

Cardizem CD Cardizem CD Cardizem CD ✔ Viagra ✔ Viagra ✔ Viagra ✔ Daivonex ✔ Daivonex

63

72

89

AZITHROMYCIN – Maximum of 5 days treatment per prescription; can be waived by endorsement For Endorsement, patient has either: i) Received a lung transplant and requires treatment or prophylaxis for bronchiolitis obliterans syndrome *; or ii) Cystic fibrosis and has chronic infection with Pseudomonas aeruginosa or Pseudomonas related gram negative organisms * Indications marked with * are Unapproved Indications Tab 500 mg – Up to 8 tab available on a PSO ............................ 1.25 2 OP ✔ Arrow-Azithromycin PAMIDRONATE DISODIUM Inj 3 mg per ml, 10 ml ............................................................ 16.00 (37.50) Inj 6 mg per ml, 10 ml ............................................................ 32.00 (75.00) Inj 9 mg per ml, 10 ml ............................................................ 48.00 (112.50) TYLOXAPOL ❋ Eye drops 0.25% ..................................................................... 8.63 1 Pamisol 1 Pamisol 1 Pamisol 15 ml OP ✔ Enuclene ✔ Neocate Advance

113

185 212

AMINO ACID FORMULA – Special Authority see SA1219 – Hospital pharmacy [HP3] Powder (tropical) .................................................................... 53.00 400 g OP

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

58

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 August 2013

178 SALBUTAMOL ‡ Oral liq 2 mg per 5 ml ................................................................ 1.20 1.99 PHARMACY SERVICES - May only be claimed once per patient ❋ Brand switch fee........................................................................ 4.33 90 ml 150 ml 1 fee ✔ Broncolin S29 ✔ Ventolin ✔ BSF Apo-Diltiazem CD

186

Effective 1 October 2013

45 SODIUM TETRADECYL SULPHATE ❋ Inj 0.5% 2 ml ...................................................................... 23.20 (51.00) ❋ Inj 1% 2 ml ......................................................................... 25.00 (55.00) CLONIDINE HYDROCHLORIDE ❋ Tab 25 mcg............................................................................. 13.47 LEVONORGESTREL ❋ Tab 750 mcg............................................................................. 3.50 5 Fibro-vein 5 Fibro-vein 100 2 ✔ Dixarit ✔ Next Choice

57 78 88

CEFOXITIN SODIUM – Retail pharmacy-Specialist – Subsidy by endorsement Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. Inj 1 g .................................................................................. 55.00 5 ✔ Mayne CEFUROXIME SODIUM Inj 250 mg – Maximum of 3 inj per prescription; can be waived by endorsement ....................................................... 20.97 10 ✔ Mayne Waiver by endorsement must state that the prescription is for dialysis or cystic fibrosis patient. Inj 1.5 g – Retail pharmacy-Specialist – Subsidy by endorsement ......................................................................... 2.65 1 ✔ Mylan 4.04 ✔ Zinacef Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. FUSIDIC ACID Inj 500 mg sodium fusidate per 10 ml – Retail pharmacySpecialist – Subsidy by endorsement ................................... 12.87 1 (17.80) Fucidin Only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. SUMATRIPTAN Tab 50 mg ................................................................................ 1.19 Tab 100 mg .............................................................................. 1.10 HOMATROPINE HYDROBROMIDE ❋ Eye drops 2% ............................................................................ 7.18 PHARMACY SERVICES ❋ Brand switch fee ....................................................................... 4.33 4 2 15 ml OP 1 fee ✔ Arrow-Sumatriptan ✔ Arrow-Sumatriptan ✔ Isopto Homatropine ✔ BSF Arrow-Quinapril

89

92

130

184 186

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

59


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 November 2013

181 211 SODIUM CROMOGLYCATE Nasal spray, 4% ..................................................................... 15.85 22 ml OP ✔ Rex

AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA1108 – Hospital pharmacy [HP3] Sachets (tropical) ................................................................. 324.00 30 ✔ Phlexy 10

Effective 1 December 2013

31 75 INSULIN SYRINGES, DISPOSABLE WITH ATTACHED NEEDLE – Maximum of 100 dev per prescription ❋ Syringe 0.3 ml with 31 g × 8 mm needle ................................ 13.00 100 ✔ ABM CONDOMS ❋ 53 mm extra strength – Up to 144 dev available on a PSO ......... 1.11 13.36 METHYLCELLULOSE Powder .................................................................................. 14.00 12 144 100 g ✔ Gold Knight ✔ Gold Knight

193

✔ ABM

Effective 1 January 2014

41 ASCORBIC ACID a) No more than 100 mg per dose b) Only on a prescription ❋ Tab 100 mg ........................................................................... 13.80 VITAMIN B COMPLEX ❋ Tab, strong, BPC ....................................................................... 4.70 VITAMINS ❋ Tab (BPC cap strength) ............................................................ 8.00 MAGNESIUM SULPHATE ❋ Paste ........................................................................................ 2.98 (4.90)

500 500 1,000 80 g

✔ Vitala-C ✔ B-PlexADE ✔ MultiADE

41 42 74 83

PSM

OESTROGENS – See prescribing guideline Conjugated, equine tab 300 mcg .............................................. 3.01 28 (11.48) Conjugated, equine tab 625 mcg .............................................. 4.12 28 (11.48) Note: The old Pharmacodes are being delisted; Pharmacodes 2427478 and 2427486 will remain fully funded. AMOXYCILLIN Drops 125 mg per 1.25 ml ....................................................... 4.00 30 ml OP

Premarin Premarin

90

✔ Ospamox Paediatric Drops

92

LINCOMYCIN – Retail pharmacy-Specialist Prescriptions must be written by, or on the recommendation of, an infectious disease physician or a clinical microbiologist Inj 300 mg per ml, 2 ml .......................................................... 80.00 5 ✔ Lincocin

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

60


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 2014 (continued)

126 GABAPENTIN – Special Authority see SA1071 – Retail pharmacy s Cap 400 mg ............................................................................ 14.75 100 ✔ Nupentin Note: This is the blister pack presentation only. The Nupentin capsules in the bottle will remain fully funded.

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

61


Index

Pharmaceuticals and brands A Acarbose ........................................................... 43 Accarb ............................................................... 43 Accu-Chek Performa .......................................... 26 Aciclovir ............................................................ 47 Adalimumab....................................................... 37 Adult products high calorie ................................. 42 Albay ................................................................. 39 Accupril ............................................................. 56 Adalimumab....................................................... 23 Amiloride hydrochloride...................................... 22 Amino acid formula ...................................... 56, 58 Aminoacid formula without phenylalanine ..... 24, 60 Amiodarone hydrochloride............................ 49, 57 Amisulpride........................................................ 49 Amoxycillin ........................................................ 60 Antiretrovirals ..................................................... 33 Apo-Amiloride .................................................... 22 Apo-Diltiazem CD ............................................... 44 Apo-Perindopril ............................................ 24, 44 Apo-Prednisone ................................................. 28 Aptamil Feed Thickener ...................................... 53 Aptamil Gold Pepti Junior ................................... 53 Arrow-Azithromycin ........................................... 58 Arrow-Morphine LA ............................................ 47 Arrow-Quinapril 5 ............................................... 27 Arrow-Quinapril 10 ............................................. 27 Arrow-Quinapril 20 ............................................. 27 Arrow-Sertraline ................................................. 47 Arrow-Sumatriptan ................................. 37, 48, 59 Arrow-Tolterodine .............................................. 28 Arrow-Venlafaxine XR......................................... 47 Artex .................................................................. 27 Ascorbic acid ............................................... 22, 60 Aspen Ceftriaxone .............................................. 28 Ava 20 ED.......................................................... 43 Avelox................................................................ 29 Azithromycin ...................................................... 58 Azol ................................................................... 28 B Bacillus calmette-guerin (BCG) vaccine .............. 48 Baraclude .......................................................... 31 Bee venom allergy treatment .............................. 39 Bezafibrate ......................................................... 57 Biltricide............................................................. 49 Blood glucose diagnostic test meter ............. 25, 55 Blood glucose diagnostic test strip ............... 26, 55 Blood ketone diagnostic test meter ............... 25, 55 Bosentan ........................................................... 24 Bplex ................................................................. 22 B-PlexADE ......................................................... 60 Brilinta ............................................................... 22 Broncolin ........................................................... 59 BSF Accarb ........................................................ 57 BSF Alphapharm ................................................ 56 BSF Apo-Diltiazem CD .................................. 24, 59 BSF Arrow-Quinapril ..................................... 23, 59 BSF Ava 20 ED................................................... 57 BSF Caresens II.................................................. 56 BSF Caresens N ................................................. 56 BSF Caresens N POP ......................................... 56 BSF Entapone .................................................... 57 BSF Nevirapine Alphapharm ............................... 56 BSF Zetlam ........................................................ 57 C Cabergoline........................................................ 28 Calamine...................................................... 49, 56 Calcipotriol......................................................... 58 Calcium carbonate with aminoacetic acid ........... 57 Carbohydrate ..................................................... 39 Carbohydrate and fat .......................................... 40 Cardinol ............................................................. 56 Cardizem CD ...................................................... 58 CareSens ........................................................... 26 CareSens II ........................................................ 25 CareSens N .................................................. 25, 26 CareSens N POP ................................................ 25 Cefazolin sodium ............................................... 28 Cefoxitin sodium ................................................ 59 Ceftriaxone sodium ............................................ 28 Cefuroxime sodium ............................................ 59 Cetomacrogol with glycerol ................................ 22 Chlorafast .......................................................... 43 Chloramphenicol ................................................ 43 Cilazapril ............................................................ 46 Cipflox ............................................................... 45 Ciprofloxacin ...................................................... 45 Ciprofloxacin Rex ............................................... 45 Clindamycin ................................................. 45, 47 Clindamycin ABM............................................... 45 Clonidine BNM ................................................... 24 Clonidine hydrochloride .......................... 24, 46, 59 Condoms ........................................................... 60 Cordarone-X ................................................ 49, 57 Codeine phosphate ............................................ 49 Coversyl ...................................................... 44, 49 Cvite .................................................................. 22 Cyproterone acetate with ethinyloestradiol .... 27, 55 D Daivonex ............................................................ 58 Daktarin ............................................................. 57 Dalacin C ..................................................... 45, 47

62


Index

Pharmaceuticals and brands Danazol.............................................................. 28 Depo-Provera ..................................................... 46 Dextrose with electrolytes................................... 56 DHC Continus .................................................... 47 Diclofenac Sandoz ............................................. 57 Diclofenac sodium ............................................. 57 Diltiazem hydrochloride ................................ 44, 58 Diflucan ............................................................. 29 Dihydrocodeine tartrate ...................................... 47 Dixarit .......................................................... 46, 59 Docetaxel ........................................................... 48 Domperidone ..................................................... 57 Dostinex ............................................................ 28 E Efexor XR ........................................................... 47 Entacapone ........................................................ 43 Entapone ........................................................... 43 Entecavir ............................................................ 31 Enuclene ............................................................ 58 Ethinyloestradiol with Levonorgestrel .................. 43 Extensively hydrolysed formula..................... 42, 53 Ezetimibe ........................................................... 46 Ezetimibe with simvastatin ................................. 46 Ezetrol ............................................................... 46 F Fat ..................................................................... 40 Fat modified products......................................... 41 Fat supplement .................................................. 23 Feed Thickener Karicare Aptamil ......................... 53 Fibalip ................................................................ 57 Fibro-vein........................................................... 59 Fluarix ................................................................ 54 Fluconazole ........................................................ 29 Fluvax ................................................................ 54 Foban ................................................................ 46 Food Thickener .................................................. 53 Freestyle Optium .......................................... 25, 26 Freestyle Optium Ketone ..................................... 25 Fucidin ............................................................... 59 Fusidic acid.................................................. 46, 59 G Gabapentin .................................................. 56, 61 Gentamicin sulphate ........................................... 29 Ginet 84 ............................................................. 27 Gold Knight ........................................................ 60 Gold Pepti Junior................................................ 53 Goldshield.......................................................... 53 Gopten ............................................................... 44 H High fat low carbohydrate formula ...................... 24 High protein products ......................................... 41 Homatropine hydrobromide ................................ 59 Home Essential ............................................ 49, 56 Humalog Mix 25................................................. 46 Humalog Mix 50................................................. 46 Humira......................................................... 23, 37 HumiraPen ......................................................... 37 Hydralazine hydrochloride .................................. 24 Hylo-Fresh ......................................................... 23 Hyoscine (scopolamine)..................................... 37 I Influenza vaccine................................................ 54 Insulin lispro with insulin lispro protamine ........... 46 Insulin syringes, disposable with attached needle ............................................... 60 Ipratropium bromide ........................................... 48 Isoniazid ............................................................ 45 Isopto carpine .................................................... 43 Isopto Homatropine ............................................ 59 Ispaghula (psyllium) husk............................. 27, 46 Itraconazole ....................................................... 45 Itrazole ............................................................... 45 K Karicare Food Thickener ..................................... 53 KetoCal 4:1 ........................................................ 24 Ketone blood beta-ketone electrodes ............ 25, 55 Konsyl-D...................................................... 27, 46 L Lamivudine .................................................. 30, 43 Levodopa with carbidopa ................................... 56 Levonorgestrel ....................................... 46, 49, 59 Levothyroxine .................................................... 53 Lidocaine-Claris ............................... 22, 24, 37, 45 Lidocaine [lignocaine] hydrochloride .................... 22, 24, 37, 45, 47, 55 Lignocaine hydrochloride ................................... 45 Lincocin ............................................................. 60 Lincomycin ........................................................ 60 Liquigen ............................................................. 23 Lovir .................................................................. 47 M Macrogol 3350 .................................................. 24 Magnesium sulphate .......................................... 60 Malathion with permethrin and piperonyl butoxide ..................................... 24, 49 Medroxyprogesterone acetate............................. 46 Mercury Pharma ................................................ 53 Methylcellulose ............................................ 49, 60 Metolazone .................................................. 24, 43 Metamide........................................................... 43 Methotrexate ...................................................... 48 Methylprednisolone sodium succinate ................ 56 Metoclopramide hydrochloride ........................... 43 Metopirone ........................................................ 49

63


Index

Pharmaceuticals and brands Metyrapone........................................................ 49 Micolette ............................................................ 46 Miconazole ........................................................ 57 Minocycline hydrochloride.................................. 29 Mino-tabs .......................................................... 29 Morphine sulphate.............................................. 47 Morphine tartrate ................................................ 47 Motetis .............................................................. 47 Motilium ............................................................ 57 Movicol.............................................................. 24 Moxifloxacin....................................................... 29 Mucilaginous laxatives ....................................... 27 MultiADE............................................................ 60 Mvite ................................................................. 22 N Naltraccord ........................................................ 48 Naltrexone hydrochloride .................................... 48 Neocate ............................................................. 56 Neocate Advance ............................................... 58 Neulastim .......................................................... 22 Next Choice ................................................. 46, 59 Nitrados ............................................................. 48 Nitrazepam......................................................... 48 Nupentin ...................................................... 56, 61 O Oestrogens ........................................................ 60 OncoTICE........................................................... 48 Ospamox Paediatric Drops ................................. 60 P Paediatric products ............................................ 41 Paediatric products for children with chronic renal failure ..................................................... 41 Pamidronate disodium ....................................... 58 Pamisol ............................................................. 58 Pantocid IV ........................................................ 56 Pantoprazole ...................................................... 56 Para Plus ..................................................... 24, 49 Pedialyte – Fruit ................................................. 56 Pedialyte – Plain................................................. 56 Pegfilgrastim ...................................................... 22 Pegasys............................................................. 35 Pegasys RBV Combination Pack ........................ 35 Pegylated interferon alpha-2a ............................. 35 Pepti Junior Gold................................................ 53 Pepti Junior Gold Karicare Aptamil ................ 42, 53 Perindopril ............................................. 24, 44, 49 Pharmacy Health Sorbolene with Glycerin ........... 22 Pharmacy services..................... 23, 24, 56, 57, 59 Phenobarbitone sodium...................................... 23 Phlexy 10........................................................... 60 Pilocarpine ......................................................... 43 PKU Anamix Junior ............................................ 24 pms-Bosentan ................................................... 24 Postinor-1.......................................................... 49 Praziquantel ....................................................... 49 Prednisone......................................................... 28 Premarin ............................................................ 60 Preservative free ocular lubricants ...................... 23 Promethazine winthrop elixir ............................... 57 Promethazine hydrochloride ............................... 57 Propranolol ........................................................ 56 Propylthiouracil .................................................. 28 Protamine sulphate ............................................ 27 Protein ............................................................... 40 PTU ................................................................... 28 Q Quinapril ...................................................... 27, 56 R Renal oral feed 1 kcal/ml .............................. 23, 42 Renal oral feed 2 kcal/ml .................................... 42 Renal products................................................... 41 Renilon 7.5 ........................................................ 23 Respiratory products .......................................... 41 Retinol palmitate ................................................ 23 Rifinah ............................................................... 45 Rivaroxaban ....................................................... 57 S Salbutamol......................................................... 59 Scopoderm TTS ................................................. 37 Sertraline ........................................................... 47 Sildenafil ............................................................ 58 Sinemet ............................................................. 56 Sinemet CR........................................................ 56 Sodium citrate with sodium lauryl sulphoacetate . 46 Sodium cromoglycate ........................................ 60 Sodium hyaluronate ........................................... 23 Sodium tetradecyl sulphate ................................ 59 Solian ................................................................ 49 Solifenacin succinate ......................................... 27 Solu-Medrol ....................................................... 56 Specialised and elemental products .................... 42 Spironolactone ................................................... 46 Spirotone ........................................................... 46 Stavudine [D4T] ................................................. 57 Sumatriptan ........................................... 37, 48, 59 Suplena ............................................................. 42 T Taxotere............................................................. 48 Temaccord ........................................................ 48 Temozolomide ................................................... 48 Tenofovir disoproxil fumarate ............................. 32 Terazosin ........................................................... 46 Tetrabenazine..................................................... 47 Ticagrelor .......................................................... 22

64


Index

Pharmaceuticals and brands Titralac .............................................................. Tolterodine ......................................................... Trandolapril ........................................................ Tyloxapol ........................................................... U Univent .............................................................. Ursodeoxycholic acid ......................................... Ursosan ............................................................. V Valaciclovir ........................................................ Valtrex ............................................................... Vancomycin hydrochloride ................................. Venlafaxine ........................................................ Ventolin ............................................................. Veracol .............................................................. Vesicare............................................................. Viagra ................................................................ Vincristine sulphate ............................................ Viread ................................................................ 57 28 44 58 48 26 26 33 33 29 47 59 28 27 58 48 32 Vitala-C .............................................................. 60 Vitamin B complex ....................................... 22, 60 Vitamins ...................................................... 22, 60 VitA-POS............................................................ 23 Vytorin ............................................................... 46 W Wasp venom allergy treatment ........................... 39 X Xarelto ............................................................... 57 Xylocaine ............................................... 37, 45, 47 Xylocaine Viscous .............................................. 45 Z Zapril ................................................................. 46 Zaroxolyn ..................................................... 24, 43 Zeffix.................................................................. 30 Zerit ................................................................... 57 Zetlam ......................................................... 30, 43 Zinacef ............................................................... 59

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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 July 2013

Abstract

Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 May 2013 Section H cumulative for April and May 2013 Contents Summary of PHARMAC decisions effective 1 May 2013 ….. 3 Amendment to restrictions for ciprofloxacin tablets and clindamycin …..…

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