Pills

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


Pharmaceutical Management Agency

December 2013

New Zealand Pharmaceutical Schedule


December 2013

Volume 20 Number 3

Editors: Kaye Wilson, Donna Jennings & Sarah Le Leu email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 9, 40 Mercer Street PO Box 10 254 Wellington Freephone Information Line 0800 66 00 50 (9am – 5pm weekdays) Circulation Published each April, August and December. Changes to the contents are published in monthly updates. Accessible in an electronic format at no cost from the Health Professionals section of the PHARMAC website www.pharmac.govt.nz You can register to have an electronic version of the Pharmaceutical Schedule (link to PDF copy) emailed to your nominated email address each month. Alternatively there is a nominal charge for an annual subscription to the printed Schedule publications. To access either of these subscriptions visit our subscription website www.schedule.co.nz. Production Typeset automatically from XML and TEX. XML version of the Schedule available from www.pharmac.govt.nz/schedule/archive/ Programmers Anrik Drenth & John Geering email: texschedule@pharmac.govt.nz c Pharmaceutical Management Agency ISSN 1179-3686 pdf ISSN 1172-9376 print This work is licensed under the Creative Commons Attribution 3.0 New Zealand licence. In essence, you are free to copy, distribute and adapt it, as long as you attribute the work to PHARMAC and abide by the other licence terms. To view a copy of this licence, visit: creativecommons.org/licenses/by/3.0/nz/. Attribution to PHARMAC should be in written form and not by reproduction of the PHARMAC logo. While care has been taken in compiling this Schedule, PHARMAC takes no responsibility for any errors or omissions, and shall not be liable for any consequences arising there from.

Introducing PHARMAC

2

Section A Section B

General Rules 10 Alimentary Tract & Metabolism 24 Blood & Blood Forming Organs 44 Cardiovascular System 52 Dermatologicals 65 Genito Urinary System 76 Hormone Preparations – Systemic 82 Infections – Agents For Systemic Use 90 Musculoskeletal System 114 Nervous System 122

Oncology Agents & Immunosuppressants 151 Respiratory System & Allergies 181 Sensory Organs 188 Various 192

Section C Extemporaneous Compounds (ECPs) 193 Section D Section E

Special Foods 200 Practitioner’s Supply Orders 220 Rural Areas 224

Section F Section G Section I

Dispensing Period Exemptions 225 Safety Cap Medicines 227 National Immunisation Schedule 230 Index 233


Introducing PHARMAC

PHARMAC, the Pharmaceutical Management Agency, is a Crown entity established pursuant to the New Zealand Public Health and Disability Act 2000 (The Act). The primary objective of PHARMAC is to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided. The PHARMAC Board consists of up to six members appointed by the Minister of Health. All decisions relating to PHARMAC’s operation are made by or under the authority of the Board. The functions of PHARMAC are to perform, within the amount of funding provided to it in the Pharmaceutical Budget or to DHBs from their own budgets for the use of pharmaceuticals within their hospitals, as applicable, and in accordance with its statement of intent and any directions given by the Minister (Section 103 of the Crown Entities Act). Members of the PHARMAC Board Stuart McLauchlan Kura Denness David Kerr Jens Mueller Jan White Decisions taken by the PHARMAC Board members, or made under the authority of the Board, incorporate a balanced view of the needs of prescribers and patients. The aim is to achieve long-term gains and efficient ways of making pharmaceuticals available to the community and for DHB Hospitals to purchase them. The following attend PHARMAC’s Board meetings as observers G Murray Georgel, CE MidCentral DHB G Kate Russell, Chair Consumer Advisory Committee G Sisira Jayathissa, Chair Pharmacology and Therapeutics Advisory Committee (PTAC) The functions of PHARMAC are to perform the following, within the amount of funding provided to it in the Pharmaceutical Budget or to DHBs from their own budgets for the use of pharmaceuticals in their hospitals, as applicable, and in accordance with its annual plan and any directions given by the Minister (Section 103 of the Crown Entities Act): a) to maintain and manage a pharmaceutical schedule that applies consistently throughout New Zealand, including determining eligibility and criteria for the provision of subsidies; b) to manage incidental matters arising out of (a), including in exceptional circumstances providing for subsidies for the supply of pharmaceuticals not on the pharmaceutical schedule; c) to engage as it sees fit, but within its operational budget, in research to meet its objectives as set out in Section 47(a) of the Act; d) to promote the responsible use of pharmaceuticals; e) to manage the purchasing of any or all pharmaceuticals, whether used either in a hospital or outside it, on behalf of DHBs; f) any other functions given to PHARMAC by or under any enactment or authorised by the Minister. The policies and criteria set out in the Pharmaceutical Schedule and PHARMAC’s Operating Policies and Procedures arise out of, and are designed to help PHARMAC achieve and perform, PHARMAC’s objective and functions under the Act. However PHARMAC may, having regard to its public law obligations, depart from the strict application of those policies and criteria in certain exceptional cases where it considers this necessary or appropriate in the proper exercise of its statutory discretion and to give effect to its objective and functions, particularly with respect to: G Determining eligibility and criteria for the provision of subsidies; and G In exceptional circumstances providing for subsidies for the supply of pharmaceuticals not on the Pharmaceutical Schedule. Decision Criteria PHARMAC updates the Pharmaceutical Schedule at regular intervals to notify prescribers, pharmacists, hospital managers and patients of changes to Community Pharmaceutical subsidies and the prices for Hospital Pharmaceuticals. In making decisions about amendments to the Pharmaceutical Schedule, PHARMAC is guided by its Operating Policies and Procedures, as amended or supplemented from time to time. PHARMAC takes into account the following criteria when making decisions about Community Pharmaceuticals: G the health needs of all eligible people within New Zealand (eligible defined by the Government’s then current rules of eligibility); G the particular health needs of M¯ ori and Pacific peoples; a G the availability and suitability of existing medicines, therapeutic medical devices and related products and related things; G the clinical benefits and risks of pharmaceuticals; G the cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health and disability support services; G the budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Pharmaceutical Schedule; G the direct cost to health service users;

2


the Government’s priorities for health funding, as set out in any objectives notified by the Crown to PHARMAC, or in PHARMAC’s Funding Agreement, or elsewhere; and G such other criteria as PHARMAC thinks fit. PHARMAC will carry out appropriate consultation when it intends to take any such “other criteria” into account. The Operating Policies and Procedures, including any supplements, also describe the way in which PHARMAC determines the level of subsidy or purchase price payable for each Community Pharmaceutical or Hospital Pharmaceutical, respectively. The decision criteria for Hospital Pharmaceuticals are set out in the hospital supplement to the Operating Policies and Procedures and in the introductory part of Section H of the Pharmaceutical Schedule. Copies of PHARMAC’s Operating Policies and Procedures and of any applicable supplements are available on the PHARMAC website (www.pharmac.govt.nz), or on request.

G

PHARMAC’s clinical advisors Pharmacology and Therapeutics Advisory Committee (PTAC) PHARMAC works closely with the Pharmacology and Therapeutics Advisory Committee (PTAC), an expert medical committee which provides independent advice to PHARMAC on health needs and the clinical benefits of particular pharmaceuticals for use in the community and/or in DHB Hospitals. The committee members are all senior, practising clinicians. The chair of PTAC sits with the PHARMAC Board in an advisory capacity. PTAC helps decide which community pharmaceuticals are to be subsidised from public monies by making recommendations to PHARMAC. Part of the role of PTAC is to review whether Community Pharmaceuticals already listed on the Schedule should continue to receive Government funds. The resources freed up can be used to subsidise other community pharmaceuticals with a greater therapeutic worth. PHARMAC may obtain clinical advice from PTAC in relation to national purchasing strategies for Hospital Pharmaceuticals. There may be additional specialist hospital representatives on PTAC subcommittees, or additional PTAC subcommittees, where PHARMAC considers this necessary. PTAC members are: Sisira Jayathissa Melissa Copland Stuart Dalziel Ian Hosford George Laking Graham Mills Marius Rademaker Jane Thomas Mark Weatherall Sean Hanna MMBS, MMedSc (Clin Epi), MD, FRCP (Lon, Edin), FRACP, FAFPHM, FNZCPHM, Dip Clin Epi, Dip OHP, DipHSM, MBS, Chair PhD, BPharm(Hons), RegPharmNZ, FNZCP MBChB, PhD, FRACP MBChB, FRANZCP, psychiatrist PhD, MD, FRACP MBChB, MTropHlth, MD, FRACP, infectious disease specialist and general physician BM (Soton), FRCP (Edn), FRACP DM MBChB, FANZGL BA, MBChB, MApplStats, FRACP MB ChB, FRNZCGP, FRACGP, PGDipGP, PGCertClinEd

Contact PTAC C/- PTAC Secretary, Pharmaceutical Management Agency, PO Box 10 254, WELLINGTON, Email: PTAC@pharmac.govt.nz PHARMAC’s consumer advisors Consumer Advisory Committee (CAC) The Consumer Advisory Committee is an advisory committee to the PHARMAC Board. It provides written reports to the Board, and its Chair attends Board meetings as an observer to report on the activities and findings of the Committee, and to comment on consumer issues. While accountable to the Board, the Committee’s general working relationship is with the staff of PHARMAC. The Committee is made up of people from a range of backgrounds and interests including the health of M¯ ori people, Pacific a peoples, older people, women and mental health. For current membership of the Consumer Advisory Committee, visit our website. The Consumer Advisory Committee can be contacted by email: CAC@pharmac.govt.nz, or you can write to the Consumer Advisory Committee at PHARMAC’s postal address.

3


Purpose of the Pharmaceutical Schedule

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

Finding Information in the Pharmaceutical Schedule

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

Hospital Pharmaceuticals

Section H lists Pharmaceuticals that can be used in DHB Hospitals, and is split into the following parts: G Part I lists the rules in relation to use of Pharmaceuticals by DHB Hospitals. G Part II lists Hospital Pharmaceuticals that are funded for use in DHB Hospitals. These are classified based on the Anatomical Therapeutic Chemical (ATC) system used for Community Pharmaceuticals. It also provides information on any national contracts that exist, and an indication of which products have Hospital Supply Status (HSS). G Part III lists Optional Pharmaceuticals for which national contracts exist, and DHB Hospitals may choose to fund. These are listed alphabetically by generic chemical entity name and line item, the relevant Price negotiated by PHARMAC and, if applicable, an indication of whether it has Hospital Supply Status (HSS) and any associated Discretionary Variance Limit (DV Limit). The index located at the back of the Section H can be used to find page numbers for generic chemical entities, or product brand names, for Hospital Pharmaceuticals. The listings are displayed alphabetically (where practical) within each level of the classification system. Each anatomical section contains a series of therapeutic headings, some of which may contain a further classificationlevel. Community Pharmaceuticals are listed in a separate publication with Sections A to I (excluding Section H).

4


Explaining drug entries

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

5


Glossary

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

Abbreviations Ampoule ...................................... Amp Suppository ................................ Supp Granules ......................................Gran Capsule ........................................ Cap Tablet .............................................Tab Infusion............................................Inf Cream...........................................Crm Tincture.........................................Tinc Injection ...........................................Inj Device........................................... Dev Trans Dermal Delivery Linctus .......................................... Linc Dispersible................................... Disp System.................................. TDDS Liquid..............................................Liq Effervescent.................................... Eff Long Acting..................................... LA Emulsion..................................... Emul Ointment....................................... Oint Enteric Coated................................EC Sachet ........................................ Sach Gelatinous ..................................... Gel Solution........................................ Soln BSO Bulk Supply Order. CBS Cost Brand Source. There is no set manufacturer’s price, and the Government subsidises the product at the price it is obtained by the pharmacy. CE Compounded Extemporaneously. CPD Cost Per Dose. The Funder (as defined in Part I of the General Rules) cost of a standard dose, without mark-ups or fees and excluding GST. ECP Extemporaneously Compounded Preparation. HSS Hospital Supply Status, the status of being the brand of the relevant Hospital Pharmaceutical listed in Section H Part II as HSS, that DHBs are obliged to purchase subject to any DV Limit for that Hospital Pharmaceutical for the period of hospital supply, as awarded under an agreement between PHARMAC and the relevant pharmaceutical supplier. OP Original Pack – subsidy is rounded up to a multiple at whole packs. PSO Practitioner’s Supply Order. Sole Subsidised Supplier Only brand of this medicine subsidised. XPharm Pharmacies cannot claim subsidy because PHARMAC has made alternative distribution arrangements. L Three months supply may be dispensed at one time if the exempted medicine is endorsed ‘certified exemption’ by the practitioner or pharmacist. F Three months dispensed all-at-once or, in the case of oral contraceptives, six months dispensed all-at-once, unless the medicine meets the Dispensing Frequency Rule criteria. ‡ Safety cap required for oral liquid formulations, including extemporaneously compounded preparations. Fully subsidised brand of a given medicine. Brands without the tick are not fully subsidised and may cost the patient a manufacturer’s surcharge. This medicine is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Practitioners prescribing this medication should: a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984; b) be aware of and comply with their obligations under the Health and disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and c) exercise their own skill, judgement, expertise and discretions, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an indication for which it is not approved. Note: Where medicines supplied under Section 29 that are used for emergency situations, patient details required under Section 29 of the Medicines Act may be retrospectively provided to the supplier.

6


Abbrev. [HP3]

[HP4]

Definitions Pharmacy Services Agreement Subsidised when dispensed from pharmacies that have a Special Foods Service appended to their Pharmacy Services Agreement by their DHB. Subsidised when dispensed from pharmacies that have the Monitored Therapy Variation (for Clozapine Services)

All other Pharmacy Agreements Available from selected pharmacies that have an exclusive contract to dispense Special Foods. Avaliable from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP4] pharmaceuticals.

Patient costs

Community Pharmaceutical costs met by the Government Most of the cost of a subsidised prescription Community Pharmaceutical is met by the Government through the Pharmaceutical Budget. The Government pays a subsidy for the Community Pharmaceutical to Contractors, and a fee covering distribution and pharmacy dispensing services. The subsidy paid to Contractors does not necessarily represent the final cost to Government of subsidising a particular Community Pharmaceutical. The final cost will depend on the nature of PHARMAC’s contractual arrangements with the supplier. Fully subsidised medicines are identified with a in the product’s Schedule listing.

Pharmaceutical Co-Payments Some Community Pharmaceutical costs are met by the patient. Generally a patient pays a prescription charge. In addition a patient will sometimes pay a manufacturer’s surcharge, after hours service fee and any special packaging fee. PRESCRIPTION CHARGE From 1 January 2013, everyone who is eligible for publicly funded health and disability services should in most circumstances pay only $5 for subsidised medicines. All prescriptions from a public hospital, a midwife and a Family Planning Clinic are covered for $5 co-payments. Prescriptions from the following providers are approved for $5 co-payments on subsidised medicines if they meet the specified criteria: G After Hours Accident and Medical Services with a DHB or a PHO contract. G Youth Health Clinics with a DHB or a PHO contract. G Dentists who write a prescription that relates to a service being provided under a DHB contract. G Private specialists (for example, ophthalmologists and orthopaedics) who write a prescription for a patient receiving a publicly funded service contracted by the DHB. G General practitioners who write a prescription during normal business hours to a person who is not enrolled in the general practice provided the person is eligible for publicly funded health and disability services and the general practice is part of a PHO. G Hospices that have a contract with a DHB. Patients can check whether they are eligible for publicly funded health and disability services by referring to the Eligibility Direction on the Ministry of Health’s website. To check if a medicine is fully subsidised, refer to the Pharmaceutical Schedule on PHARMAC’s website or ask your pharmacist or general practitioner. DHBs have a list of eligible providers in their respective regions. Any provider/prescriber not specifically listed by a DHB as an approved provider/prescriber should be regarded as not approved. NOTE: Information sourced from Ministry of Health Website, for more information please visit www.moh.govt.nz MANUFACTURER’S SURCHARGE Not all Community Pharmaceuticals are fully subsidised. Although PHARMAC endeavours to fully subsidise at least one Community Pharmaceutical in each therapeutic group, and has contracts with some suppliers to maintain the price of a particular product, manufacturers are able to set their own price to pharmacies. When these prices exceed the subsidy, the pharmacist may recoup the difference from the patient. To estimate the amount a patient will pay on top of the prescription charge, take the difference between the manufacturer’s price and the subsidy, and multiply this by 1.86. The 1.86 factor represents the pharmacy mark-up on the surcharge plus other costs such as GST. Pharmacies charge different mark-ups so this may vary.

7


For example, a Community Pharmaceutical with a supplier (ex-manufacturer) cost of $11.00 per pack with a $10.00 subsidy will cost the patient a surcharge of $1.86 on top of the prescription charge. The most a patient should pay is therefore $16.86 - being $15.00 maximum prescription charge, plus $1.86. Hospital Pharmaceutical and Pharmaceutical Cancer Treatment Costs The cost of purchasing Hospital Pharmaceuticals (for use in DHB hospitals and/or in association with Outpatient services provided in DHB hospitals) is met by the relevant DHB hospital Funder from its own budget. Pharmaceutical Cancer Treatments (for use in DHB hospitals and/or in association with Outpatient services provided in DHB hospitals) are funded through the Combined Pharmaceutical Budget. As required by section 23(7) of the Act, in performing any of their functions in relation to the supply of Pharmaceuticals including Pharmaceutical Cancer Treatments, DHBs must not act inconsistently with the Pharmaceutical Schedule. PHARMAC web site PHARMAC has set up an interactive Schedule on the Internet. Other information about PHARMAC is also available on our website. This includes copies of the Annual Review, Annual Report and Annual Plan, as well as information such as the Pharmaceutical Schedule, Pharmaceutical Schedule Updates, National Hospital Pharmaceutical Strategy, other publications and recent press releases.

Special Authority Applications

Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular person. Applications must be submitted to the Ministry of Health by the prescriber for the request to be processed. Subsidy Once approved, the presciber will be provided a Special Authority number which must appear on the prescription. Specialists who make an application must communicate the valid authority number to the prescriber who will be writing the prescriptions. The authority number can provide access to subsidy, increased subsidy, or waive certain restrictions otherwise present on the Community Pharmaceutical. Some approvals are dependent on the availability of funding from the Pharmaceutical Budget. Criteria The criteria for approval of Special Authority applications are included below each Community Pharmaceutical listing, and on the application forms available on PHARMAC’s website. For some Special Authority Community Pharmaceuticals, not all indications that have been approved by Medsafe are subsidised. Criteria for each Special Authority Community Pharmaceutical are updated regularly, based on the decision criteria of PHARMAC. The appropriateness of the listing of a Community Pharmaceutical in the Special Authority category will also be regularly reviewed. Applications for inclusion of further Community Pharmaceuticals in the Special Authority category will generally be made by a pharmaceutical supplier. Special Authority Applications Application forms can be found at www.pharmac.govt.nz. Requests for fax copies should be made to PHARMAC, phone 04 460 4990. Applications are processed by the Ministry of Health, and should be sent to: Ministry of Health Sector Services, Fax: (06) 349 1983 or free fax 0800 100 131 Private Bag 3015, WANGANUI 4540 For enquiries, phone the Ministry of Health Sector Services Call Centre, free phone 0800 243 666 Note: The Ministry of Health can only provide information on Special Authority applications to prescribers and pharmacists. Each application must: G Include the patients name, date of birth and NHI number (codes for AIDS patients’ applications) G Include the practitioner’s name, address and registration number G Clearly indicate that the relevant criteria, have been met. G Be signed by the practitioner.

8


Named Patient Pharmaceutical Assessment policy

The Named Patient Pharmaceutical Assessment (NPPA) Policy is PHARMAC’s process for considering applications about named patients seeking funding for treatments not listed on the Schedule, either at all or for the named patient’s clinical circumstances. For PHARMAC to perform its legislative function of maintaining and managing a Schedule that applies consistently throughout New Zealand, the NPPA Policy will, and must, operate in a way that does not undermine the Schedule decision making process. Together, the Schedule process and the NPPA Policy, ensure there is a pathway for consideration of an individual’s clinical circumstances. If an individual has a set of clinical circumstances not covered by the NPPA Policy, the Schedule decision making process is available. It is not the purpose of the NPPA Policy to provide access to every treatment not listed on the Schedule. There are two main pathways by which named patients can be considered for funding under the NPPA Policy. PHARMAC will exercise its discretion to determine the most appropriate pathway for an application under the NPPA Policy based on the information that is provided. Information concerning NPPA in hospital use can be forund at http://www.pharmac.health.nz/tools-resources/forms/named-patientpharmaceutical-assessment-nppa-forms. PHARMAC will assess applications that meet the prerequisites described below according to its Decision Criteria before deciding whether to approve applications for funding. The Decision Criteria will be used to assess both the individual clinical circumstances of each NPPA applicant, and the implications of each NPPA funding decision on PHARMAC’s ability to carry out its legislative functions. For more information on NPPA, or to apply, visit the PHARMAC website at http://www.pharmac.govt.nz/nppa, or call the Panel Coordinators at 0800 60 00 50 option 3. Unusual Clinical Circumstance (UCC) The purpose of the Unusual Clinical Circumstances (UCC) pathway is to provide a process for consideration for funding for named patients whose clinical circumstances are so unusual that PHARMAC is unlikely, for administrative reasons, to consider listing treatments for these circumstances on the Schedule. The prerequisite requirements for UCC consideration are: G The patient has reasonably tried and failed all alternative funded treatments (or alternative treatments have been contraindicated, or there are no other treatments available), or the patient has experienced such serious side effects with all other relevant funded treatments that treatment has been ceased or cannot reasonably be continued; and G The patient is experiencing an indication or set of clinical circumstances that are so unusual that PHARMAC is unlikely to consider listing treatments for these on the Schedule; and G Generally, PHARMAC has not already considered/is not considering, through the Schedule decision making process, the treatment for the patient’s clinical circumstances, or has not considered the treatment at all. Urgent Assessment (UA) The purpose of the Urgent Assessment (UA) pathway is to provide a process for PHARMAC to consider funding treatments for named patients where PHARMAC is also considering or is likely to consider the treatment for Schedule listing, but the patient’s clinical circumstances justify urgent assessment, prior to a decision on Schedule listing. The prerequisite requirements for UA are: G The patient has reasonably tried and failed all alternative funded treatments (or alternative treatments have been contraindicated, or there are no other treatments available), or the patient has experienced such serious side effects with all other relevant funded treatments that treatment has been ceased or cannot reasonably be continued; and G The patient is experiencing an indication or set of clinical circumstances that may be experienced by a population group (either currently or over time); and G The patient has serious clinical circumstances and not receiving the treatment within six to 12 months would lead to either a significant deterioration in a serious clinical condition or the patient would miss the opportunity for significant improvement in clinical outcome (length or quality of life); and G The treatment has either not been prioritised by PHARMAC, or if it has, PHARMAC has funded the treatment under the NPPA Policy for the same clinical circumstances prior to prioritisation. G PHARMAC has not declined to list, on the Schedule, this treatment for these clinical circumstances.

9


SECTION A: GENERAL RULES

INTRODUCTION

Section A contains the restrictions and other general rules that apply to Subsidies on Community Pharmaceuticals. The amounts payable by the Funder to Contractors are currently determined by: G the quantities, forms, and strengths, of subsidised Community Pharmaceuticals dispensed under valid prescription by each Contractor; G the amount of the Subsidy on the Manufacturer’s Price payable for each unit of the Community Pharmaceuticals dispensed by each Contractor and; G the contractual arrangements between the Contractor and the Funder for the payment of the Contractor’s dispensing services. The Pharmaceutical Schedule shows the level of subsidy payable in respect of each Community Pharmaceutical so that the amount payable by the Government to Contractors, for each Community Pharmaceutical, can be calculated. The Pharmaceutical Schedule also shows the standard price (exclusive of GST) at which a Community Pharmaceutical is supplied ex-manufacturer to wholesalers if it differs from the subsidy. The manufacturer’s surcharge to patients can be estimated using the subsidy and the standard manufacturer’s price as set out in this Schedule. The cost to Government of subsidising each Community Pharmaceutical and the manufacturer’s prices may vary, in that suppliers may provide rebates to other stakeholders in the primary health care sector, including dispensers, wholesalers, and the Government. Rebates are not specified in the Pharmaceutical Schedule. This Schedule is dated 1 December 2013 and is to be referred to as the Pharmaceutical Schedule Volume 20 Number 3, 2013. Distribution will be from 20 December 2013. This Schedule comes into force on 1 December 2013.

PART I INTERPRETATIONS AND DEFINITIONS

1.1 In this Schedule, unless the context otherwise requires: “90 Day Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 90 consecutive days’ treatment; “180 Day Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 180 consecutive days’ treatment; “Access Exemption Criteria” means the criteria under which patients may receive greater than one Month’s supply of a Community Pharmaceutical covered by Section F Part II (b) subsidised in one Lot. The specifics of these criteria are conveyed in the Ministry of Health guidelines, which are issued from time to time. The criteria the patient must meet are that they: a) have limited physical mobility; b) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; c) are relocating to another area; d) are travelling extensively and will be out of town when the repeat prescriptions are due. “Act” means the New Zealand Public Health and Disability Act 2000. “Advisory Committee” means the Pharmaceutical Services Advisory Committee convened by the Ministry of Health under the terms of the Advice Notice issued to Contractors pursuant to Section 88 of the Act. “Alternate Subsidy” means a higher level of subsidy that the Government will pay contractors for a particular community Pharmaceutical dispensed to a person who has either been granted a Special Authority for that pharmaceutical, or where the prescription is endorsed in accordance with the requirements of this Pharmaceutical Schedule. “Annotation” means written annotation of a prescription by a dispensing pharmacist in the pharmacist’s own handwriting following confirmation from the Prescriber if required, and “Annotated” has a corresponding meaning. The Annotation must include the details specified in the Schedule, including the date the prescriber was contacted (if applicable) and be initialled by the dispensing pharmacist. “Authority to Substitute” means an authority for the dispensing pharmacist to change a prescribed medicine in accordance with regulation 42(4) of the Medicines Regulations 1984. An authority to substitute letter, which may be used by Practitioners, is available on the final page of the Schedule. “Bulk Supply Order” means a written order, on a form supplied by the Ministry of Health, or approved by the Ministry of Health, made by the licensee or manager of an institution certified to provide hospital care under the Health and Disability Services (Safety) Act 2001 for the supply of such Community Pharmaceuticals as are expected to be required for the treatment of persons who are under the medical or dental supervision of such a Private Hospital or institution.

10


SECTION A: GENERAL RULES

“Class B Controlled Drug” means a Class B controlled drug within the meaning of the Misuse of Drugs Act 1975. “Community Pharmaceutical” means a Pharmaceutical listed in Sections 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. “Contractor” means a person who is entitled to receive a payment from the Crown or a DHB under a notice issued by the Crown or a DHB under Section 88 of the Act or under a contract with the Ministry of Health or a DHB for the supply of Community Pharmaceuticals. “Controlled Drug” means a controlled drug within the meaning of the Misuse of Drugs Act 1975 (other than a controlled drug specified in Part VI of the Third Schedule to that Act). “Cost, Brand, Source of Supply” means that the Community Pharmaceutical is eligible for Subsidy on the basis of the Contractor’s annotated purchase price, brand, and source of supply. Alternatively a copy of the invoice for the purchase of the Pharmaceutical may be attached to the prescription, in the place of an annotation, in order to be eligible for Subsidy. “Dentist” means a person registered with the Dental Council, and who holds a current annual practising certificate, under the HPCA Act 2003. “Diabetes Nurse Prescriber” means a registered nurse practising in diabetes health who has authority to prescribe specified diabetes medicines in accordance with regulations made under the Medicines Act 1981, and who is practicing in an approved DHB demonstration site. “Dietitian” means a person registered as a dietitian with the Dietitians Board, and who holds a current annual practicing certificate under the HPCA Act 2003. “DHB” means an organisation established as a District Health Board by or under Section 19 of the Act. “DHB Hospital” means a DHB, including its hospital or associated provider unit that the DHB purchases Hospital Pharmaceuticals for. “Dispensing Frequency Rule” means the rule in Part IV, Section A of the Pharmaceutical Schedule that defines patient groups or medicines eligible for more frequent dispensing periods. “Doctor” means a medical Practitioner registered with the Medical Council of New Zealand and, who holds a current annual practising certificate under the HPCA Act 2003. “DV Limit” means, for a particular Hospital Pharmaceutical with HSS, the National DV Limit or the Individual DV Limit. “DV Pharmaceutical” means a discretionary variance Pharmaceutical, that does not have HSS and which: a) is either listed in Section H Part II of the Schedule as being a DV Pharmaceutical in association with the relevant Hospital Pharmaceutical with HSS; or b) is the same chemical entity, at the same strength, and in the same or a similar presentation or form, as the relevant Hospital Pharmaceutical with HSS, but which is not yet listed as being a DV Pharmaceutical. “Endorsements” - unless otherwise specified, endorsements should be either handwritten or computer generated by the practitioner prescribing the medication. The endorsement can be written as “certified condition”, or state the condition of the patient, where that condition is specified for the Community Pharmaceutical in Section B of the Pharmaceutical Schedule. Where the practitioner writes “certified condition” as the endorsement, he/she is making a declaration that the patient meets the criteria as set out in Section B of the Pharmaceutical Schedule. “Funder” means the body or bodies responsible, pursuant to the Act, for the funding of pharmaceuticals listed on the Schedule (which may be one or more DHBs and/or the Ministry of Health) and their successors. “GST” means goods and services tax under the Goods and Services Tax Act 1985. “Hospital Care Operator” means a person for the time being in charge of providing hospital care, in accordance with the Health and Disability Services (Safety) Act 2001. “Hospital Pharmaceuticals” means the list of pharmaceuticals set out in Section H part II of the Schedule which includes some National Contract Pharmaceuticals. “Hospital Pharmacy” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy to an person on the Prescription of a Practitioner. “Hospital Pharmacy-Specialist” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy 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”,

11


SECTION A: GENERAL RULES

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: a) i) follows a substantive consultation with an appropriate Specialist; ii) the consultation to relate to the Patient for whom the Prescription is written; iii) consultation to mean communication by referral, telephone, letter, facsimile or email; iv) except in emergencies consultation to precede annotation of the Prescription; and v) both the specialist and the General Practitioner must keep a written record of the consultation; or b) treatment with the Community Pharmaceutical has been initiated in accordance with a DHB hospital approved protocol. For the purposes of the definition it makes no difference whether or not the Specialist is employed by a hospital. “Hospital Pharmacy-Specialist Prescription” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy: a) to an Outpatient; and b) on a Prescription signed by a Specialist. For the purposes of this definition, a “specialist” means a doctor who holds a current annual practicing certificate and who satisfies the criteria set out in paragraphs (a) or (b) or (c) of the definitions of Specialist below. “HSS” means hospital supply status, the status of being the brand of the relevant Hospital Pharmaceutical listed in Section H Part II as HSS, that DHBs are obliged to purchase subject to any DV Limit for that Hospital Pharmaceutical for the period of hospital supply, as awarded under an agreement between PHARMAC and the relevant pharmaceutical supplier. “In Combination” means that the Community Pharmaceutical is only subsidised when prescribed in combination with another subsidised pharmaceutical as specified in Section B or C of the Pharmaceutical Schedule. “Individual DV Limit” means, for a particular Hospital Pharmaceutical with HSS and a particular DHB Hospital, the discretionary variance limit, being the specified percentage of that DHB Hospital’s Total Market Volume up to which that DHB Hospital may purchase DV Pharmaceuticals of that Hospital Pharmaceutical. “Licensed Hospital” means a place or institution that is certified to provide hospital care within the meaning of the Health and Disability Services (Safety) Act 2001. “Lot” means a quantity of a Community Pharmaceutical supplied in one dispensing. “Manufacturer’s Price” means the standard price at which a Community Pharmaceutical is supplied to wholesalers (excluding GST), as notified to PHARMAC by the supplier. “Maternity hospital” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied pursuant to a Bulk Supply Order to a maternity hospital certified under the Health and Disability Services (Safety) Act 2001. “Midwife” means a person registered as a midwife with the Midwifery Council, and who holds a current annual practising certificate under the HPCA Act 2003. “Month” means a period of 30 consecutive days. “Monthly Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 30 consecutive days’ treatment; “Named Patient Pharmaceutical Assessment Advisory Panel” means the panel of clinicians, appointed by the PHARMAC Board, that is responsible for advising, within its Terms of Reference, on Named Patient Pharmaceutical Assessment applications and Exceptional Circumstances renewal applications submitted after 1 March 2012 (EC renewal application form located at http://www.pharmac.govt.nz/healthpros/EC/ECForms) “National Contract Pharmaceutical” means a Hospital Pharmaceutical for which PHARMAC has negotiated a national contract and the Price. “National DV Limit” means, for a particular Hospital Pharmaceutical with HSS, the discretionary variance limit, being the specified percentage of the Total Market Volume up to which all DHB Hospitals may collectively purchase DV Pharmaceuticals of that Hospital Pharmaceutical. “National Immunisation Schedule” means Section I of the Pharmaceutical Schedule, which is a schedule administered by PHARMAC, being a schedule specifying a programme of vaccinations to promote immunity against the diseases specified in the schedule. “Not In Combination” means that no Subsidy is available for any Prescription containing the Community Pharmaceutical

12


SECTION A: GENERAL RULES

in combination with other ingredients unless the particular combination of ingredients is separately specified in Section B or C of the Schedule, and then only to the extent specified. “Nurse Precriber” means a nurse registered with the Nursing Council and who holds a current annual practicing certificate under the HPCA Act 2003 and who is approved by the Nursing Council to prescribe specified prescription medicines relating to his/her scope of practice including, for the avoidance of doubt, a Diabetes Nurse Prescriber. “Optional Pharmaceuticals” means the list of National Contract Pharmaceuticals set out in Section H Part II of the Schedule “Optometrist” means a person registered as an optometrist with the Optometrists and Dispensing Opticians Board, who holds a current annual practising certificate under the HPCA Act 2003, and who is approved by the Optometrists and Dispensing Opticians Board (in accordance with the Medicines (Designated Prescriber: Optometrists) Regulations 2005) to prescribe specified prescription medicines relating to his/her scope of practice. “Outpatient” , in relation to a Community Pharmaceutical, means a person who, as part of treatment at a hospital or other institution under the control of a DHB, is prescribed the Community Pharmaceutical for consumption or use in the person’s home. “PCT” means Pharmaceutical Cancer Treatment in respect of which DHB hospital pharmacies and other Contractors can claim Subsidies. “PCT only” means Pharmaceutical Cancer Treatment in respect of which only DHB hospital pharmacies can claim Subsidies. “Penal Institution” means a penal institution, as that term is defined in The Penal Institutions Act 1954; “PHARMAC” means the Pharmaceutical Management Agency established by Section 46 of the Act (PHARMAC). “Pharmaceutical” means a medicine, therapeutic medical device, or related product or related thing listed in Sections B to I of the Schedule. “Pharmaceutical Benefits” means the right of: a) a person; and b) any member under 16 years of age of that person’s family, to have made by the Government on his or her behalf, subject to any conditions for the time being specified in the Schedule, such payment in respect of any Community Pharmaceutical supplied to that person or family member under the order of a Practitioner in the course of his or her practice. “Pharmaceutical Budget” means the pharmaceutical budget set for PHARMAC by the Crown for the subsidised supply of Community Pharmaceuticals and Pharmaceutical Cancer Treatments including for named patients in exceptional circumstances. “Pharmaceutical Cancer Treatment” means Pharmaceuticals for the treatment of cancer, listed in Sections A to G of the Schedule and identified therein as a “PCT” or “PCT only” Pharmaceutical that DHBs must provide access to, for use in their hospitals, and/or in association with Outpatient services provided in their DHB Hospitals, in relation to the treatment of cancers. “Pharmacist Prescriber” means a person registered with the Pharmacy Council of New Zealand, who holds a current annual practising certificate under the HPCA Act 2003, and is approved by the Pharmacy Council of New Zealand to prescribe specified prescription medicines relating to his/her scope of practice. “Pharmacist” means a person registered with the Pharmacy Council of New Zealand and who holds a current annual practicing certificate under the HPCA Act 2003. “Practitioner” means a Doctor, a Dentist, a Dietitian, a Midwife, a Nurse Prescriber, an Optometrist, or a Pharmacist Prescriber as those terms are defined in the Pharmaceutical Schedule. “Practitioner’s Supply Order” means a written order made by a Practitioner on a form supplied by the Ministry of Health, or approved by the Ministry of Health, for the supply of Community Pharmaceuticals to the Practitioner, which the Practitioner requires to ensure medical supplies are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where individual prescription is not practicable. “Prescription” means a quantity of a Community Pharmaceutical prescribed for a named person on a document signed by a Practitioner. “Prescription Medicine” means any Pharmaceutical listed in Part I of Schedule 1 of the Medicines Regulations 1984. “Private Hospital” means a hospital certified under the Health and Disability Services (Safety) Act 2001 that is not owned or operated by a DHB. “Residential Disability Care Institution” means premises used to provide residential disability care in accordance with the Health and Disability Services (Safety) Act 2001. “Rest Home” means premises used to provide rest home care in accordance with the Health and Disability Services (Safety)

13


SECTION A: GENERAL RULES

Act 2001. “Restricted Medicine” means any Pharmaceutical listed in Part II of Schedule 1 of the Medicines Regulations 1984. “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: a) i) follows a substantive consultation with an appropriate Specialist; ii) the consultation to relate to the Patient for whom the Prescription is written; iii) consultation to mean communication by referral, telephone, letter, facsimile or email; iv) except in emergencies consultation to precede annotation of the Prescription; and v) both the Specialist and the General Practitioner must keep a written record of consultation; or b) treatment with the Community Pharmaceutical has been initiated in accordance with a DHB hospital approved protocol. “Retail Pharmacy-Specialist Prescription” means that the Community Pharmaceutical is only eligible for Subsidy if it is supplied on a Prescription, or Practitioner’s Supply Order, signed by a Specialist. For the purposes of this definition, a “specialist” means a doctor who holds a current annual practicing certificate and who satisfies the criteria set out in paragraphs (a) or (b) or (c) of the definitions of Specialist below. “Schedule” means this Pharmaceutical Schedule and all its sections and appendices. “Special Authority” means that the Community Pharmaceutical or Pharmaceutical Cancer Treatment is only eligible for Subsidy or additional Subsidy for a particular person if an application meeting the criteria specified in the Schedule has been approved, and the valid Special Authority number is present on the prescription. “Specialist”, in relation to a Prescription, means a doctor who holds a current annual practising certificate and who satisfies the criteria set out in paragraphs (a) or (b) or (c) or (d) below: a) the doctor is vocationally registered in accordance with the criteria set out by the Medical Council of New Zealand and the HPCA Act 2003 and who has written the Prescription in the course of practising in that area of medicine; or b) the doctor is recognised by the Ministry of Health as a specialist for the purposes of this Schedule and receives remuneration from a DHB at a level which that DHB considers appropriate for specialists and who has written that prescription in the course of practising in that area of competency; or c) the doctor is recognised by the Ministry of Health as a specialist in relation to a particular area of medicine for the purpose of writing Prescriptions and who has written the Prescription in the course of practising in that area of competency; or d) the doctor writes the prescription on DHB stationery and is appropriately authorised by the relevant DHB to do so. “Subsidy” means the maximum amount that the Government will pay Contractors for a Community Pharmaceutical dispensed to a person eligible for Pharmaceutical Benefits and is different from the cost to Government of subsidising that Community Pharmaceutical. For the purposes of a DHB hospital pharmacy claiming for Pharmaceutical Cancer Treatments, Subsidy refers to any payment made to the DHB hospital pharmacy or service provider to which that pharmacy serves, and does not relate to a specific payment that might be made on submission of a claim. “Supply Order” means a Bulk Supply Order or a Practitioner’s Supply Order. “Unapproved Indication” means, for a Pharmaceutical, an indication for which it is not approved under the Medicines Act 1981. Practitioners prescribing Pharmaceuticals for Unapproved Indications should be aware of, and comply with, their obligations under Section 25 and/or Section 29 of the Medicines Act 1981 and as set out in Section A: General Rules, Part

14


SECTION A: GENERAL RULES

IV (Miscellaneous Provisions) rule 5.5. “Unlisted Pharmaceutical” means a Pharmaceutical that is within the scope of a Hospital Pharmaceutical but is not listed in Section H part II “Unusual Clinical Circumstances (UCC)” means the pathway under the Named Patient Pharmaceutical Assessment policy for funding consideration for named patients whose clinical circumstances are so unusual that PHARMAC is unlikely, for administrative reasons, to consider listing treatments for these circumstances on the Schedule. “Urgent Assessment (UA)” means the pathway under the Named Patient P harmaceutical Assessment policy for funding consideration for treatments for named patients where PHARMAC is also considering or is likely to consider the treatment for Schedule listing, but the patient’s clinical circumstances justify urgent assessment, prior to a decision on Schedule listing. 1.2 In addition to the above interpretations and definitions, unless the content requires otherwise, a reference in the Schedule to: a) the singular includes the plural; and b) any legislation includes a modification and re-enactment of, legislation enacted in substitution for, and a regulation, Order in Council, and other instrument from time to time issued or made under that legislation, where that legislation, regulation, Order in Council or other instrument has an effect on the prescribing, dispensing or subsidising of Community Pharmaceuticals.

PART II COMMUNITY PHARMACEUTICALS SUBSIDY

2.1 Community Pharmaceuticals eligible for Subsidy include every medicine, therapeutic medical device or related product, or related thing listed in Sections B to G and I of the Schedule subject to: 2.1.1 clauses 2.2 of the Schedule; and 2.1.2 clauses 3.1 to 5.4 of the Schedule; and 2.1.3 the conditions (if any) specified in Sections B to G and I of the Schedule; 2.2 No claim by a Contractor for payment in respect of the supply of Community Pharmaceuticals will be allowed unless the Community Pharmaceuticals so supplied: 2.2.1 comply with the appropriate standards prescribed by regulations for the time being in force under the Medicines Act 1981; or 2.2.2 in the absence of any such standards, comply with the appropriate standards for the time being prescribed by the British Pharmacopoeia; or 2.2.3 in the absence of the standards prescribed in clauses 2.3.1 and 2.3.2, comply with the appropriate standards for the time being prescribed by the British Pharmaceutical Codex; or 2.2.4 in the absence of the standards prescribed in clauses 2.3.1, 2.3.2 and 2.3.3, are of a grade and quality not lower than those usually applicable to Community Pharmaceuticals intended to be used for medical purposes.

PART III PERIOD AND QUANTITY OF SUPPLY

3.1 Doctors’, Dentists’, Dietitians’, Midwives’, Nurse Prescribers’, Optometrists and Pharmacist Prescribers’ Prescriptions (other than oral contraceptives) The following provisions apply to all Prescriptions, other than those for an oral contraceptive, written by a Doctor, Dentist, Dietitian, Midwife, Nurse Prescriber, an Optometrist, or a Pharmacist Prescriber unless specifically excluded: 3.1.1 For a Community Pharmaceutical other than a Class B Controlled Drug, only a quantity suffcient to provide treatment for a period not exceeding three Months will be subsidised. 3.1.2 For methylphenidate hydrochloride and dexamphetamine sulphate (except for Dentist prescriptions), only a quantity sufficient to provide treatment for a period not exceeding one Month will be subsidised. 3.1.3 For a Class B Controlled Drug: a) other than Dentist prescriptions and methylphenidate hydrochloride and dexamphetamine sulphate, only a quantity: i) sufficient to provide treatment for a period not exceeding 10 days; and ii) which has been dispensed pursuant to a Prescription sufficient to provide treatment for a period not exceeding one Month, will be subsidised. b) for a Dentist prescription only such quantity as is necessary to provide treatment for a period not exceeding five days will be subsidised.

15


SECTION A: GENERAL RULES

3.1.4 Subject to clauses 3.1.3 and 3.1.7, for a Doctor, Dentist, Dietitian, Midwife or Nurse Prescriber and 3.1.7 for an Optometrist, where a practitioner has prescribed a quantity of a Community Pharmaceutical sufficient to provide treatment for: a) one Month or less than one Month, but dispensed by the Contractor in quantities smaller than the quantity prescribed, the Community Pharmaceutical will only be subsidised as if that Community Pharmaceutical had been dispensed in a Monthly Lot; b) more than one Month, the Community Pharmaceutical will be subsidised only if it is dispensed: i) in a 90 Day Lot, where the Community Pharmaceutical is a Pharmaceutical covered by Section F Part I of the Pharmaceutical Schedule; or ii) if the Community Pharmaceutical is not a Pharmaceutical referred to in Section F Part I of the Pharmaceutical Schedule, in Monthly Lots, unless: A) the eligible person or his/her nominated representative endorses the back of the Prescription form with a statement identifying which Access Exemption Criterion (Criteria) applies and signs that statement to this effect; or B) both: 1) the Practitioner endorses the Community Pharmaceutical on the Prescription with the words “certified exemption” written in the Practitioner’s own handwriting, or signed or initialled by the Practitioner; and 2) every Community Pharmaceutical endorsed as “certified exemption” is covered by Section F Part II of the Pharmaceutical Schedule. 3.1.5 A Community Pharmaceutical is only eligible for Subsidy if the Prescription under which it has been dispensed was presented to the Contractor: a) for a Class B Controlled Drug, within eight days of the date on which the Prescription was written; or b) for any other Community Pharmaceutical, within three Months of the date on which the Prescription was written. 3.1.6 No subsidy will be paid for any Prescription, or part thereof, that is not fulfilled within: a) in the case of a Prescription for a total supply of from one to three Months, three Months from the date the Community Pharmaceutical was first dispensed; or b) in any other case, one Month from the date the Community Pharmaceutical was first dispensed. Only that part of any Prescription that is dispensed within the time frames specified above is eligible for Subsidy. 3.1.7 If a Community Pharmaceutical: a) is stable for a limited period only, and the Practitioner has endorsed the Prescription with the words “unstable medicine” and has specified the maximum quantity that may be dispensed at any one time; or b) is stable for a limited period only, and the Contractor has endorsed the Prescription with the words “unstable medicine” and has specified the maximum quantity that should be dispensed at any one time in all the circumstances of the particular case; or c) is under the Dispensing Frequency Rule, The actual quantity dispensed will be subsidised in accordance with any such specification. 3.2 Oral Contraceptives The following provisions apply to all Prescriptions written by a Doctor, Midwife, Nurse Prescriber or a Pharmacist Prescriber for an oral contraceptive: 3.2.1 The prescribing Doctor, Midwife, Nurse Prescriber or a Pharmacist Prescriber must specify on the Prescription the period of treatment for which the Community Pharmaceutical is to be supplied. This period must not exceed six Months. 3.2.2 Where the period of treatment specified in the Prescription does not exceed six Months, the Community Pharmaceutical is to be dispensed: a) in Lots as specified in the Prescription if the Community Pharmaceutical is under the Dispensing Frequency Rule; or b) where no Lots are specified, in one Lot sufficient to provide treatment for the period prescribed. 3.2.3 An oral contraceptive is only eligible for Subsidy if the Prescription under which it has been dispensed was presented to the Contractor within three Months of the date on which it was written. 3.2.4 Where a Community Pharmaceutical on a Prescription is under the Dispensing Frequency Rule and a repeat on the Prescription remains unfulfilled after six Months from the date the Community Pharmaceutical was first

16


SECTION A: GENERAL RULES

dispensed only the actual quantity supplied by the Contractor within this time limit will be eligible for Subsidy. 3.3 Original Packs, Certain Antibiotics and Unapproved Medicines 3.3.1 Notwithstanding clauses 3.1 and 3.3 of the Schedule, if a Practitioner prescribes or orders a Community Pharmaceutical that is identified as an Original Pack (OP) on the Pharmaceutical Schedule and is packed in a container from which it is not practicable to dispense lesser amounts, every reference in those clauses to an amount or quantity eligible for Subsidy, is deemed to be a reference: a) where an amount by weight or volume of the Community Pharmaceutical is specified in the Prescription, to the smallest container of the Community Pharmaceutical, or the smallest number of containers of the Community Pharmaceutical, sufficient to provide that amount; and b) in every other case, to the amount contained in the smallest container of the Community Pharmaceutical that is manufactured in, or imported into, New Zealand. 3.3.2 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, but excluding any medicine listed as Cost, Brand, Source of Supply, or c) any other pharmaceutical that PHARMAC determines, from time to time and notes in the Pharmaceutical Schedule and it is prescribed or ordered by a Practitioner in an amount that does not coincide with the amount contained in one or more standard packs of that Community Pharmaceutical, Subsidy will be paid for the amount prescribed or ordered by the Practitioner in accordance with either clause 3.1 or clause 3.3 of the Schedule, and for the balance of any pack or packs from which the Community Pharmaceutical has been dispensed. At the time of dispensing the Contractor must keep a record of the quantity discarded. To ensure wastage is reduced, the Contractor should reduce the amount dispensed to make it equal to the quantity contained in a whole pack where: a) the difference between the amount dispensed and the amount prescribed by the Practitioner is less than 10% (eg; if a prescription is for 105 mls then a 100ml pack would be dispensed); and b) in the reasonable opinion of the Contractor the difference would not affect the efficacy of the course of treatment prescribed by the Practitioner. Note: For the purposes of audit and compliance it is an act of fraud to claim wastage and then use the wastage amount for any subsequent prescription. 3.4 Pharmacist Prescribers’ Prescriptions The following apply to every prescription written by a Pharmacist Prescriber 3.4.1 Prescriptions written by a Pharmacist Prescriber for a Community Pharmaceutical will only be subsidised where they are for either: a) a Community Pharmaceutical classified as a Prescription Medicine and which a Pharmacist Prescriber is permitted under regulations to prescribe; or b) any other Community Pharmaceutical that is a Restricted Medicine (Pharmacist Only Medicine), a Pharmacy Only Medicine or a General Sales Medicine. 3.4.2 Any Pharmacist Prescribers’ prescriptions for a medication requiring a Special Authority will only be subsidised if it is for a repeat prescription (ie after the initial prescription with Special Authority approval was dispensed). 3.5 Dietitians’ Prescriptions The following provisions apply to every Prescription written by a Dietitian: 3.5.1 Prescriptions written by a Dietitian for a Community Pharmaceutical will only be subsidised where they are for either: a) special foods, as listed in Section D; or b) any other Pharmaceutical that has been identified in Section D of the Pharmaceutical Schedule as being able to be prescribed by a Dietitian, providing that the products being prescribed are not classified as Prescription Medicines or Restricted Medicines. 3.5.2 For the purposes of Dietitians prescribing pursuant to this clause 3.5, the prescribing and dispensing of these products is required to be in accordance with regulations 41 and 42 of the Medicines Regulations 1984. 3.6 Diabetes Nurse Prescribers’ Prescriptions The following provisions apply to every Prescription written by a Diabetes Nurse Prescriber: 3.6.1 Prescriptions written by a Diabetes Nurse Prescriber for a Community Pharmaceutical will only be subsidised

17


SECTION A: GENERAL RULES

where they are for either: a) a Community Pharmaceutical classified as a Prescription Medicine or a Restricted Medicine and which a Diabetes Nurse Prescribers is permitted under regulations to prescribe; or b) any other Community Pharmaceutical listed below: aspirin, blood glucose diagnostic test meter, blood glucose diagnostic test strip, blood ketone diagnostic test meter, glucagon hydrochloride inj 1 mg syringe kit, insulin pen needles, insulin syringes disposable with attached needle, insulin pump accessories, insulin pump infusion set, insulin pump reservoir, ketone blood beta-ketone electrodes test strip, nicotine, sodium nitroprusside test strip, 3.6.2 Any Diabetes Nurse Prescribers’ prescription for a medication requiring a Special Authority will only be subsidised if it is for a repeat prescription (ie after the initial prescription with Special Authority approval was dispensed). Note: A list of Diabetes Nurse Prescribers will be published periodically in the Update of the Pharmaceutical Schedule for the duration of an initial pilot scheme. After this period there will be no approved DHB demonstration sites and hence no Diabetes Nurse Prescribers.

PART IV DISPENSING FREQUENCY RULE

The Pharmaceutical Schedule specifies, for community patients, a default period of supply for each Community Pharmaceutical (a Monthly Lot, 90 Day Lot or for oral contraceptives 180 Day Lot). This Dispensing Frequency rule defines patient groups or medicines eligible for more frequent dispensing periods; and the conditions that must be met to enable any claim for payment of handling fees for the additional dispensings made. “Frequent Dispensing” means: G for a Community Pharmaceutical referred to in Section F Part I, dispensing in quantities less than one 90 Day Lot (or for oral contraceptives, less than one 180 Day Lot); or G for any other Community Pharmaceutical, where any of 4.1, 4.2 or 4.3 of Part IV apply, dispensing in quantities less than a Monthly Lot NOTE patients who have had more frequent dispensings due to being "intellectually impaired, frail, infirm or unable to manage their medicines" will continue to receive the same frequency of dispensings until they are assessed to see if they are eligible for additional support under the Long-Term Condition (LTC) service. The structure of the remainder fee payment provides funding for pharmacy to continue to provide more frequent dispensings for patients until they are assessed. 4.1 Frequent Dispensings for persons in residential care 4.1.1 Pharmaceuticals can be dispensed in quantities of not less than 28 days to: G any person whose placement in a Residential Disability Care Institution is funded by the Ministry of Health or a DHB; or G a person assessed as requiring long term residential care services and residing in an age related residential care facility; on the request of the person, their agent or caregiver or community residential service provider, provided the following conditions are met: a) the quantity or period of supply to be dispensed at any one time is not less than 28 days’ supply (except under conditions outlined in 4.2.2 below); and b) the prescribing Practitioner or dispensing pharmacist has i) included the name of the patient’s residential placement or facility on the Prescription; and ii) included the patient’s NHI number on the Prescription; and iii) specified the maximum quantity or period of supply to be dispensed at any one time. 4.1.2 Any person meeting the criteria above who is being initiated onto a new medicine or having their dose changed is able to have their medicine dispensed in accordance with 4.2.2 below. 4.2 Frequent Dispensings for trial periods or safety medicines 4.2.1 If a Pharmacist considers more frequent dispensing is required, this can occur as follows: G For Long Term Condition (LTC) patients dispensing frequency can occur as often as the dispensing pharmacist deems appropriate to meet the patients compliance and adherence needs; G For non-LTC patients the dispensing frequency should be no more often than monthly. If Frequent Dispensing more often than monthly is necessary for non-LTC patients, prescriber approval is required.

18


SECTION A: GENERAL RULES

Verbal approval is acceptable, provided that it is annotated by the pharmacist on the Prescription and dated. NOTE this rule does not override alternative dispensing frequencies as expressly stated in the Medicines Act, Medicines Regulations, Pharmacy Services Agreement, Pharmaceutical Schedule or under rule 4.2.2 Trial Periods or rule 4.2.3 safety and co-prescribed medicines below. Pharmacy would claim handling fees only on repeats under the above scenarios. Prescribers can request, and pharmacists may dispense a higher frequency of dispensing in the following circumstances: 4.2.2 Trial Periods The Community Pharmaceutical has been prescribed for a patient who requires close monitoring due to recent initiation onto, or dose change for, the Community Pharmaceutical (applicable to the patient’s first changed Prescription only); and the prescribing Practitioner has: G endorsed each Community Pharmaceutical on the Prescription clearly with the words “Trial Period”, or “Trial”; and G specified the maximum quantity or period of supply to be dispensed for each Community Pharmaceutical at any one time. Patients who reside in Penal Institutions are not eligible for Trial Periods. 4.2.3 Safety and co-prescribed medicines a) The Community Pharmaceutical is any of the following: i) a tri-cyclic antidepressant; or ii) an antipsychotic; or iii) a benzodiazepine; or iv) a Class B Controlled Drug; or v) codeine (includes combination products) vi) buprenorphine with naloxone All of the following conditions must be met: The Community Pharmaceutical has been prescribed for a patient who is not a resident in a Penal Institution, or one of the residential placements or facilities referenced in 4.1 above. The prescribing Practitioner has: G Assessed clinical risk and determined the patient requires Frequent Dispensing; and G Specified the maximum quantity or period of supply to be dispensed for each Community Pharmaceutical at any one time. b) The Community Pharmaceutical is co-prescribed with one of the Community Pharmaceuticals listed in 4.2.3(a) above and has been prescribed for a patient who is not a resident in a Penal Institution, or one of the residential placements or facilities referenced in 4.1 above. The dispensing pharmacist has: G Assessed clinical risk and determined the patient requires Frequent Dispensing; G Annotated the Prescription with the amended dispensing quantity and frequency. 4.3 Frequent Dispensing for Pharmaceutical Supply Management 4.3.1 Frequent Dispensing may be required from time to time to manage stock supply issues or emergency situations. Pharmacists may dispense more frequently than the Schedule would otherwise allow when all of the following conditions are met: a) PHARMAC has approved and notified pharmacists to annotate Prescriptions for a specified Community Pharmaceutical(s) “out of stock” without prescriber endorsement for a specified time; and b) the dispensing pharmacist has: i) clearly annotated each of the approved Community Pharmaceuticals that appear on the Prescription with the words “out of stock” or “OOS”; and ii) initialled the annotation in their own handwriting; and iii) has complied with maximum quantity or period of supply to be dispensed at any one time, as specified by PHARMAC at the time of notification. Note – no claim shall be made to any DHB for subsidised dispensing where dispensing occurs more frequently than specified by PHARMAC to manage the supply management issue.

19


SECTION A: GENERAL RULES

PART V MISCELLANEOUS PROVISIONS

5.1 Bulk Supply Orders The following provisions apply to the supply of Community Pharmaceuticals under Bulk Supply Orders: 5.1.1 No Community Pharmaceutical supplied under a Bulk Supply Order will be subsidised unless all the requirements in Section B, C or D of the Schedule applicable to that pharmaceutical are met. 5.1.2 The person who placed the Bulk Supply Order may be called upon by the Ministry of Health to justify the amount ordered. 5.1.3 Class B Controlled Drugs will be subsidised only if supplied under Bulk Supply Orders placed by an institution certified to provide hospital care under the Health and Disability Services (Safety) Act 2001. 5.1.4 Any order for a Class B Controlled Drug or for buprenorphine hydrochloride must be written on a Special Bulk Supply Order Controlled Drug Form supplied by the Ministry of Health. 5.1.5 Community Pharmaceuticals listed in Part I of the First Schedule to the Medicines Regulations 1984 will be subsidised only if supplied under a Bulk Supply Order placed by an institution certified to provide hospital care under the Health and Disability Services (Safety) Act 2001 and: a) that institution employs a registered general nurse, registered with the Nursing Council and who holds a current annual practicing certificate under the HPCA Act 2003; and b) the Bulk Supply Order is supported by a written requisition signed by a Hospital Care Operator. 5.1.6 No Subsidy will be paid for any quantity of a Community Pharmaceutical supplied under a Bulk Supply Order in excess of what is a reasonable monthly allocation for the particular institution, after taking into account stock on hand. 5.1.7 The Ministry of Health may, at any time, by public notification, declare that any approved institution within its particular region, is not entitled to obtain supplies of Community Pharmaceuticals under Bulk Supply Orders with effect from the date specified in that declaration. Any such notice may in like manner be revoked by the Ministry of Health at any time. 5.2 Practitioner’s Supply Orders The following provisions apply to the supply of Community Pharmaceuticals to Practitioners under a Practitioner’s Supply Order: 5.2.1 Subject to clause 5.2.3 and 5.2.6, a Practitioner may only order under a Practitioner’s Supply Order those Community Pharmaceuticals listed in Section E Part I and only in such quantities as set out in Section E Part I that the Practitioner requires to ensure medical supplies are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where individual prescription is not practicable. 5.2.2 Any order for a Class B Controlled Drug or for buprenorphine hydrochloride must be written on a Special Practitioner’s Supply Order Controlled Drug Form supplied by the Ministry of Health. 5.2.3 A Practitioner may order such Community Pharmaceuticals as he or she expects to be required for personal administration to patients under the Practitioner’s care if: a) the Practitioner’s normal practice is in the specified areas listed in Section E Part II of the Schedule, or if the Practitioner is a locum for a Practitioner whose normal practice is in such an area. b) the quantities ordered are reasonable for up to one Month’s supply under the conditions normally existing in the practice. (The Practitioner may be called on by the Ministry of Health to justify the amounts of Community Pharmaceuticals ordered.) 5.2.4 No Community Pharmaceutical ordered under a Practitioner’s Supply order will be eligible for Subsidy unless: a) the Practitioner’s Supply Order is made on a form supplied for that purpose by the Ministry of Health, or approved by the Ministry of Health and which: i) is personally signed and dated by the Practitioner; and ii) sets out the Practitioner’s address; and iii) sets out the Community Pharmaceuticals and quantities, and; b) all the requirements of Sections B and C of the Schedule applicable to that pharmaceutical are met. 5.2.5 The Ministry of Health may, at any time, on the recommendation of an Advisory Committee appointed by the Ministry of Health for that purpose, by public notification, declare that a Practitioner specified in such a notice is not entitled to obtain supplies of Community Pharmaceuticals under Practitioner’s Supply Orders until such time as the Ministry of Health notifies otherwise.

20


SECTION A: GENERAL RULES

5.2.6 A Practitioner working in the Rheumatic Fever Prevention Programme (RFPP) may order under a Practitioner’s Supply Order such Community Pharmaceuticals (identified below) as he or she requires to ensure medical supplies are available for patients with suspected or confirmed Group A Streptococcal throat infections for the purposes of the RFPP in the following circumstances: a) the RFPP provider name is written on the Practitioner’s Supply Order; and b) the total quantity ordered does not exceed a multiple of: i) ten times the Practitioner’s Supply Order current maximum listed in Section E Part I for amoxycillin grans for oral liq 250 mg per 5 ml, amoxycillin cap 250 mg and amoxycillin cap 500 mg; or ii) two times the Practitioner’s Supply Order current maximum listed in Section E Part I for phenoxymethyl penicillin grans for oral liquid 250 mg per 5 ml, phenoxymethyl penicillin cap 500 mg, erythromycin ethyl succinate grans for oral liq 200 mg per 5 ml and erythromycin ethyl succinate tab 400 mg; and c) the practitioner must specify the order quantity in course-specific amounts on the Practitioner’s Supply Order (e.g. 10 x 300 ml amoxycillin grans for oral liq 250 mg per 5 ml). This will enable the pharmacy to dispense each course separately and claim multiple service fees as per the Community Pharmacy Services Agreement. 5.3 Retail Pharmacy and Hospital Pharmacy-Specialist Restriction The following provisions apply to Prescriptions for Community Pharmaceuticals eligible to be subsidised as “Retail Pharmacy-Specialist” and “Hospital Pharmacy-Specialist”: 5.3.1 Record Keeping It is expected that a record will be kept by both the General Practitioner and the Specialist of the fact of consultation and enough of the clinical details to justify the recommendation. This means referral by telephone will need to be followed up by written consultation. 5.3.2 Expiry The recommendation expires at the end of two years and can be renewed by a further consultation. 5.3.3 The circulation by Specialists of the circumstances under which they are prepared to recommend a particular Community Pharmaceutical is acceptable as a guide. It must however be followed up by the procedure in subclauses 5.3.1 and 5.3.2, for the individual Patient. 5.3.4 The use of preprinted forms and named lists of Specialists (as circulated by some pharmaceutical companies) is regarded as inappropriate. 5.3.5 The Rules for Retail Pharmacy-Specialist and Hospital Pharmacy-Specialist will be audited as part of the Ministry of Health’s routine auditing procedures. 5.4 Pharmaceutical Cancer Treatments 5.4.1 DHBs must provide access to Pharmaceutical Cancer Treatments for the treatment of cancers in their DHB hospitals, and/or in association with Outpatient services provided in their DHB hospitals. 5.4.2 DHBs must only provide access to Pharmaceuticals for the treatment of cancer that are listed as Pharmaceutical Cancer Treatments in Sections A to G of the Schedule, provided that DHBs may provide access to an unlisted pharmaceutical for the treatment of cancer where that unlisted pharmaceutical: a) has Named Patient Pharmaceutical Assessment (NPPA) approval; b) is being used as part of a bona fide clinical trial which has Ethics Committee approval; c) is being used and funded as part of a paediatric oncology service; or d) was being used to treat the patient in question prior to 1 July 2005. 5.4.3 A DHB hospital pharmacy that holds a claiming agreement for Pharmaceutical Cancer Treatements with the Funder may claim a Subsidy for a Pharmaceutical Cancer Treatment marked as “PCT” or “PCT only” in Sections A to G of this Schedule subject to that Pharmaceutical Cancer Treatment being dispensed in accordance with: a) Part 1; b) clauses 2.1 to 2.3; c) clauses 3.1 to 3.4; and d) clause 5.4, of Section A of the Schedule 5.4.4 A Contractor (other than a DHB hospital pharmacy) may only claim a Subsidy for a Pharmaceutical Cancer Treatment marked as “PCT” in Sections A to G of the Schedule subject to that Pharmaceutical Cancer

21


SECTION A: GENERAL RULES

Treatment being dispensed in accordance with the rules applying to Sections A to G of the Schedule. 5.4.5 Some indications for Pharmaceutical Cancer Treatments listed in the Schedule are Unapproved Indications. Some of these formed part of the October 2001 decision by the Minister of Health as to pharmaceuticals and indications for which DHBs must provide access. As far as reasonably practicable, these Unapproved Indications are marked in the Schedule. However, PHARMAC makes no representation and gives no guarantee as to the accuracy of this information. Practitioners prescribing Pharmaceutical Cancer Treatments for such Unapproved Indications should: a) be aware of and comply with their obligations under sections 25 and 29 of the Medicines Act 1981, as applicable, and otherwise under that act and the Medicines Regulations 1984; b) be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and c) exercise their own skill, judgement, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical Cancer Treatment or a Pharmaceutical Cancer Treatment for an Unapproved Indication. 5.4.6 Applications to add pharmaceuticals, and add or amend indications for Pharmaceutical Cancer Treatments, may be made in writing by pharmaceutical suppliers and/or clinicians to PHARMAC. Applications should follow the Guidelines for Funding Applications to PHARMAC 2010 and Recommended methods to derive clinical inputs for proposals to PHARMAC, copies of which are available from PHARMAC or PHARMAC’s website. 5.5 Practitioners prescribing unapproved Pharmaceuticals Practitioners should, where possible, prescribe Pharmaceuticals that are approved under the Medicines Act 1981. However, the access criteria under which a Pharmaceutical is listed on the Pharmaceutical Schedule may: a) in some case, explicitly permit Government funded access to a Pharmaceutical that is not approved under the Medicines Act 1981 or for an Unapproved Indication; or b) not explicitly preclude Government funded access to a Pharmaceutical when it is used for an Unapproved Indication; Accordingly, if Practitioners are planning on prescribing an unapproved Pharmaceutical or a Pharmaceutical for an Unapproved Indication, Practitioners should: a) be aware of and comply with their obligations under sections 25 and 29 of the Medicines Act 1981, as applicable, and otherwise under that Act and the Medicines Regulations 1984; b) be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an Unapproved Indication. Practitioners should be aware that simply by listing a Pharmaceutical on the Pharmaceutical Schedule PHARMAC makes no representations about whether that Pharmaceutical has any form of approval or consent under, or whether the supply or use of the Pharmaceutical otherwise complies with, the Medicines Act 1981. Further, the Pharmaceutical Schedule does not constitute an advertisement, advertising material or a medical advertisement as defined in the Medicines Act or otherwise. 5.6 Substitution Where a Practitioner has prescribed a brand of a Community Pharmaceutical that has no Subsidy or has a Manufacturer’s Price that is greater than the Subsidy and there is an alternative fully subsidised Community Pharmaceutical available, a Contractor may dispense the fully subsidised Community Pharmaceutical, unless either or both of the following circumstances apply: a) there is a clinical reason why substitution should not occur; or b) the prescriber has marked the prescription with a statement such as ‘no brand substitution permitted’ Such an Authority to Substitute is valid whether or not there is a financial implication for the Pharmaceutical Budget. When dispensing a subsidised alternative brand, the Contractor must annotate and sign the prescription and inform the patient of the brand change. 5.7 Alteration to Presentation of Pharmaceutical Dispensed A Contractor, when dispensing a subsidised Community Pharmaceutical, may alter the presentation of a Pharmaceutical dispensed to another subsidised presentation but may not alter the dose, frequency and/or total daily dose. This may only occur when it is not practicable for the contractor to dispense the requested presentation. If the change will

22


SECTION A: GENERAL RULES

result in additional cost to the DHBs, then annotation of the prescription by the dispensing pharmacist must occur stating the reason for the change, and the Contractor must initial the change for the purposes of Audit. 5.8 Conflict in Provisions If any rules in Sections B-G and Section I of this Schedule conflict with the rules in Section A, the rules in Sections B-G and Section I apply.

23


SECTION B: ALIMENTARY TRACT AND METABOLISM

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

Antacids and Antiflatulants Antacids and Reflux Barrier Agents

ALGINIC ACID Sodium alginate 225 mg and magnesium alginate 87.5 mg per sachet .................................................................................... 4.50 SIMETHICONE F Oral liq aluminium hydroxide 200 mg with magnesium hydroxide 200 mg and activated simethicone 20 mg per 5 ml ............... 1.50 (4.26) SODIUM ALGINATE F Tab 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg - peppermint flavour ....................................... 1.80 (8.60) F Oral liq 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg per 10 ml ........................................................ 1.50 (4.95)

30

Gaviscon Infant

500 ml Mylanta P

60 Gaviscon Double Strength 500 ml Acidex

Phosphate Binding Agents

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

Alu-Tab

CALCIUM CARBONATE Oral liq 1,250 mg per 5 ml (500 mg elemental per 5 ml) – Subsidy by endorsement ............................................................ 39.00 500 ml Roxane Only when prescribed for children under 12 years of age for use as a phosphate binding agent and the prescription is endorsed accordingly.

Antidiarrhoeals Agents Which Reduce Motility

DIPHENOXYLATE HYDROCHLORIDE WITH ATROPINE SULPHATE F Tab 2.5 mg with atropine sulphate 25 mcg ........................................3.90 (Diastop Tab 2.5 mg with atropine sulphate 25 mcg to be delisted 1 February 2014) LOPERAMIDE HYDROCHLORIDE – Up to 30 cap available on a PSO F Tab 2 mg .............................................................................................8.95 F Cap 2 mg ............................................................................................8.95 100

Diastop Nodia Diamide Relief

400 400

Rectal and Colonic Anti-inflammatories

BUDESONIDE Cap 3 mg – Special Authority see SA1155 on the next page – Retail pharmacy ................................................................... 166.50

90

Entocort CIR

24

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

¾SA1155 Special Authority for Subsidy Initial application — (Crohn’s disease) from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Mild to moderate ileal, ileocaecal or proximal Crohn’s disease; and 2 Any of the following: 2.1 Diabetes; or 2.2 Cushingoid habitus; or 2.3 Osteoporosis where there is significant risk of fracture; or 2.4 Severe acne following treatment with conventional corticosteroid therapy; or 2.5 History of severe psychiatric problems associated with corticosteroid treatment; or 2.6 History of major mental illness (such as bipolar affective disorder) where the risk of conventional corticosteroid treatment causing relapse is considered to be high; or 2.7 Relapse during pregnancy (where conventional corticosteroids are considered to be contraindicated). Initial application — (collagenous and lymphocytic colitis (microscopic colitis)) from any relevant practitioner. Approvals valid for 6 months where patient has a diagnosis of microscopic colitis (collagenous or lymphocytic colitis) by colonoscopy with biopsies. Initial application — (gut Graft versus Host disease) from any relevant practitioner. Approvals valid for 6 months where patient has a gut Graft versus Host disease following allogenic bone marrow transplantation*. Note: Indication marked with * is an Unapproved Indication. Renewal from any relevant practitioner. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefiting from treatment. Note: Clinical trials for Entocort CIR use beyond three months demonstrated no improvement in relapse rate. HYDROCORTISONE ACETATE Rectal foam 10%, CFC-Free (14 applications) .................................25.30 21.1 g OP Colifoam MESALAZINE Tab 400 mg .......................................................................................49.50 Tab EC 500 mg .................................................................................49.50 Tab long-acting 500 mg ....................................................................59.05 Modified release granules, 1 g .......................................................141.72 Enema 1 g per 100 ml ......................................................................44.12 Suppos 500 mg ................................................................................22.80 Suppos 1 g .......................................................................................50.96 54.60 OLSALAZINE Tab 500 mg .......................................................................................59.86 Cap 250 mg ......................................................................................31.51 SODIUM CROMOGLYCATE Cap 100 mg ......................................................................................89.21 SULPHASALAZINE F Tab 500 mg – For sulphasalazine oral liquid formulation refer, page 194 .................................................................................... 11.68 F Tab EC 500 mg .................................................................................12.89 100 100 100 120 OP 7 20 28 30 100 100 100

Asacol Asamax Pentasa Pentasa Pentasa Asacol Pentasa Pentasa Dipentum Dipentum Nalcrom

100 100

Salazopyrin Salazopyrin EN

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

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

25


ALIMENTARY TRACT AND METABOLISM

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

Local preparations for Anal and Rectal Disorders Antihaemorrhoidal Preparations

FLUOCORTOLONE CAPROATE WITH FLUOCORTOLONE PIVALATE AND CINCHOCAINE Oint 950 mcg, with fluocortolone pivalate 920 mcg, and cinchocaine hydrochloride 5 mg per g ............................................. 6.35 30 g OP Suppos 630 mcg, with fluocortolone pivalate 610 mcg, and cinchocaine hydrochloride 1 mg .................................................. 2.66 12 HYDROCORTISONE WITH CINCHOCAINE Oint 5 mg with cinchocaine hydrochloride 5 mg per g ......................15.00 Suppos 5 mg with cinchocaine hydrochloride 5 mg per g ..................9.90 30 g OP 12

Ultraproct Ultraproct Proctosedyl Proctosedyl

Management of Anal Fissures

GLYCERYL TRINITRATE – Special Authority see SA1329 below – Retail pharmacy F Oint 0.2% ..........................................................................................22.00 30 g OP

Rectogesic

¾SA1329 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has a chronic anal fissure that has persisted for longer than three weeks.

Antispasmodics and Other Agents Altering Gut Motility

HYOSCINE N-BUTYLBROMIDE F Tab 10 mg ...........................................................................................1.48 F Inj 20 mg, 1 ml – Up to 5 inj available on a PSO ................................9.57 MEBEVERINE HYDROCHLORIDE F Tab 135 mg .......................................................................................18.00 20 5 90

Gastrosoothe Buscopan Colofac

Antiulcerants Antisecretory and Cytoprotective

MISOPROSTOL F Tab 200 mcg .....................................................................................52.70 120

Cytotec

Helicobacter Pylori Eradication

CLARITHROMYCIN Tab 500 mg – Subsidy by endorsement ............................................10.95 14 Apo-Clarithromycin a) Maximum of 14 tab per prescription b) Subsidised only if prescribed for helicobacter pylori eradication and prescription is endorsed accordingly. Note: the prescription is considered endorsed if clarithromycin is prescribed in conjunction with a proton pump inhibitor and either amoxycillin or metronidazole.

H2 Antagonists

CIMETIDINE – Only on a prescription F Tab 200 mg .........................................................................................5.00 (7.50) F Tab 400 mg .......................................................................................10.00 (12.00) 100 Apo-Cimetidine 100 Apo-Cimetidine

26

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

RANITIDINE HYDROCHLORIDE – Only on a prescription F Tab 150 mg .........................................................................................6.79 F Tab 300 mg .........................................................................................9.34 F Oral liq 150 mg per 10 ml ...................................................................5.92 F Inj 25 mg per ml, 2 ml .........................................................................8.75

250 250 300 ml 5

Arrow-Ranitidine Arrow-Ranitidine Peptisoothe Zantac

Proton Pump Inhibitors

LANSOPRAZOLE F Cap 15 mg ..........................................................................................2.00 F Cap 30 mg ..........................................................................................2.32 OMEPRAZOLE For omeprazole suspension refer, page 197 F Cap 10 mg ..........................................................................................2.91 F Cap 20 mg ..........................................................................................3.78 F Cap 40 mg ..........................................................................................5.57 F Powder – Only in combination .........................................................42.50 Only in extemporaneously compounded omeprazole suspension. F Inj 40 mg ...........................................................................................28.65 PANTOPRAZOLE F Tab 20 mg ...........................................................................................1.23 F Tab 40 mg ...........................................................................................1.54 28 28

Solox Solox Omezol Relief Omezol Relief Omezol Relief Midwest Dr Reddy’s

Omeprazole

90 90 90 5g 5

28 28

Dr Reddy’s

Pantoprazole

Dr Reddy’s

Pantoprazole

Site Protective Agents

BISMUTH TRIOXIDE Tab 120 mg .......................................................................................32.50 SUCRALFATE Tab 1 g ..............................................................................................35.50 (48.28) 112 120 Carafate

De Nol

Diabetes Hyperglycaemic Agents

DIAZOXIDE – Special Authority see SA1320 below – Retail pharmacy Cap 25 mg – For diazoxide oral liquid formulation refer, page 194 ........................................................................................... 110.00 Cap 100 mg ....................................................................................280.00

100 100

Proglicem Proglicem

¾SA1320 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 12 months where used for the treatment of confirmed hypoglycaemia caused by hyperinsulinism. Renewal from any relevant practitioner. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment. GLUCAGON HYDROCHLORIDE Inj 1 mg syringe kit – Up to 5 kit available on a PSO........................32.00 1 Glucagen Hypokit

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

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

27


ALIMENTARY TRACT AND METABOLISM

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

Insulin - Short-acting Preparations

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

Actrapid Humulin R Actrapid Penfill Humulin R

Insulin - Intermediate-acting Preparations

INSULIN ASPART WITH INSULIN ASPART PROTAMINE L Inj 100 iu per ml, 3 ml prefilled pen ...................................................52.15 INSULIN ISOPHANE L Inj human 100 u per ml .....................................................................17.68 L Inj human 100 u per ml, 3 ml ............................................................29.86 INSULIN ISOPHANE WITH INSULIN NEUTRAL L Inj human with neutral insulin 100 u per ml ......................................25.26 L Inj human with neutral insulin 100 u per ml, 3 ml .............................42.66 5 10 ml OP 5

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

10 ml OP 5

INSULIN LISPRO WITH INSULIN LISPRO PROTAMINE L Inj lispro 25% with insulin lispro protamine 75% 100 u per ml, 3 ml ............................................................................................ 42.66 L Inj lispro 50% with insulin lispro protamine 50% 100 u per ml, 3 ml ............................................................................................ 42.66

5 5

Humalog Mix 25 Humalog Mix 50

Insulin - Long-acting Preparations

INSULIN GLARGINE L Inj 100 u per ml, 10 ml ......................................................................63.00 L Inj 100 u per ml, 3 ml ........................................................................94.50 L Inj 100 u per ml, 3 ml disposable pen ...............................................94.50 1 5 5

Lantus Lantus Lantus SoloStar

Insulin - Rapid Acting Preparations

INSULIN ASPART L Inj 100 u per ml, 3 ml ........................................................................51.19 L Inj 100 u per ml, 10 ml ......................................................................30.03 INSULIN GLULISINE L Inj 100 u per ml, 10 ml ......................................................................27.03 L Inj 100 u per ml, 3 ml ........................................................................46.07 L Inj 100 u per ml, 3 ml disposable pen ...............................................46.07 INSULIN LISPRO L Inj 100 u per ml, 10 ml ......................................................................34.92 L Inj 100 u per ml, 3 ml ........................................................................59.52 5 1 1 5 5 10 ml OP 5

NovoRapid Penfill NovoRapid Apidra Apidra Apidra SoloStar Humalog Humalog

28

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

Alpha Glucosidase Inhibitors

ACARBOSE F Tab 50 mg ...........................................................................................9.82 F Tab 100 mg .......................................................................................15.83 90 90

Accarb Accarb

Oral Hypoglycaemic Agents

GLIBENCLAMIDE F Tab 5 mg .............................................................................................5.00 GLICLAZIDE F Tab 80 mg .........................................................................................17.60 GLIPIZIDE F Tab 5 mg .............................................................................................3.00 METFORMIN HYDROCHLORIDE F Tab immediate-release 500 mg ........................................................12.30 F Tab immediate-release 850 mg ........................................................10.10 PIOGLITAZONE F Tab 15 mg ...........................................................................................1.50 F Tab 30 mg ...........................................................................................2.50 F Tab 45 mg ...........................................................................................3.50 100 500 100 1,000 500 28 28 28

Daonil Apo-Gliclazide Minidiab Apotex Apotex Pizaccord Pizaccord Pizaccord

Diabetes Management Ketone Testing

BLOOD KETONE DIAGNOSTIC TEST METER – Up to 1 meter available on a PSO 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. Meter ................................................................................................40.00 1 Freestyle Optium KETONE BLOOD BETA-KETONE ELECTRODES a) Maximum of 20 strip per prescription b) Up to 10 strip available on a PSO Test strip – Not on a BSO.................................................................15.50 SODIUM NITROPRUSSIDE – Maximum of 50 strip per prescription F Test strip – Not on a BSO...................................................................6.00 14.14

10 strip OP

Freestyle Optium

Ketone

50 strip OP

Accu-Chek

Ketur-Test

Ketostix

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

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

29


ALIMENTARY TRACT AND METABOLISM

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

Blood Glucose Testing

BLOOD GLUCOSE DIAGNOSTIC TEST METER – Subsidy by endorsement a) Up to 1 pack available on a PSO b) Maximum of 1 pack per prescription c) A diagnostic blood glucose test meter is subsidised for a patient who: 1) is receiving insulin or sulphonylurea therapy; or 2) is pregnant with diabetes; or 3) is on home TPN at risk of hypoglycaemia or hyperglycaemia; or 4) has a genetic or an acquired disorder of glucose homeostasis excluding type 1 or type 2 diabetes and metabolic syndrome. 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 .......................................................................................... 20.00 1 OP CareSens II CareSens N CareSens N POP Note: Only 1 meter available per PSO BLOOD GLUCOSE DIAGNOSTIC TEST STRIP – Up to 50 test available on a PSO 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 below – Retail pharmacy b) Freestyle Optium brand: Special Authority see SA1291 below – Retail pharmacy c) Note: Accu-Chek Performa and Freestyle Optium are not available on a PSO ¾SA1294 Special Authority for Subsidy Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz and can be sent to: PHARMAC PO Box 10 254 Facsimile: (04) 974 4788 Wellington Email: bgstrips@pharmac.govt.nz ¾SA1291 Special Authority for Subsidy Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz and can be sent to: PHARMAC PO Box 10 254 Facsimile: (04) 974 4788 Wellington Email: bgstrips@pharmac.govt.nz

30

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

BLOOD GLUCOSE TEST STRIPS (VISUALLY IMPAIRED) 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. SensoCard blood glucose test strips are subsidised only if prescribed for a patient who is severely visually impaired and is using a SensoCard Plus Talking Blood Glucose Monitor. Blood glucose test strips ..................................................................26.20 50 test OP SensoCard

Insulin Syringes and Needles

Subsidy is available for disposable insulin syringes, needles, and pen needles if prescribed on the same form as the one used for the supply of insulin or when prescribed for an insulin patient and the prescription is endorsed accordingly. INSULIN PEN NEEDLES – Maximum of 100 dev per prescription F 29 g × 12.7 mm ..................................................................................3.15 30 B-D Micro-Fine 10.50 100 B-D Micro-Fine F 31 g × 5 mm .....................................................................................11.75 100 B-D Micro-Fine F 31 g × 6 mm .....................................................................................10.50 100 ABM (26.00) NovoFine F 31 g × 8 mm .......................................................................................3.15 30 B-D Micro-Fine 10.50 100 B-D Micro-Fine ABM F 32 g × 4 mm .....................................................................................10.50 100 B-D Micro-Fine (NovoFine 31 g × 6 mm to be delisted 1 June 2014) INSULIN SYRINGES, DISPOSABLE WITH ATTACHED NEEDLE – Maximum of 100 dev per prescription F Syringe 0.3 ml with 29 g × 12.7 mm needle ......................................1.30 10 (1.99) B-D Ultra Fine 13.00 100 B-D Ultra Fine F Syringe 0.3 ml with 31 g × 8 mm needle ...........................................1.30 10 (1.99) B-D Ultra Fine II 13.00 100 B-D Ultra Fine II F Syringe 0.5 ml with 29 g × 12.7 mm needle ......................................1.30 10 (1.99) B-D Ultra Fine 13.00 100 B-D Ultra Fine F Syringe 0.5 ml with 31 g × 8 mm needle ...........................................1.30 10 (1.99) B-D Ultra Fine II 13.00 100 B-D Ultra Fine II F Syringe 1 ml with 29 g × 12.7 mm needle .......................................13.00 100 ABM 1.30 10 (1.99) B-D Ultra Fine 13.00 100 B-D Ultra Fine F Syringe 1 ml with 31 g × 8 mm needle ............................................13.00 100 ABM 1.30 10 (1.99) B-D Ultra Fine II 13.00 100 B-D Ultra Fine II

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

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

31


ALIMENTARY TRACT AND METABOLISM

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

Insulin Pumps

INSULIN PUMP – Special Authority see SA1237 below – Retail pharmacy a) Maximum of 1 dev per prescription b) Only on a prescription c) Maximum of 1 insulin pump per patient each four year period. Min basal rate 0.025 U/h; black colour ........................................4,500.00 Min basal rate 0.025 U/h; blue colour ..........................................4,500.00 Min basal rate 0.025 U/h; green colour .......................................4,500.00 Min basal rate 0.025 U/h; pink colour ..........................................4,500.00 Min basal rate 0.025 U/h; silver colour ........................................4,500.00 Min basal rate 0.05 U/h; blue colour ............................................4,400.00 Min basal rate 0.05 U/h; clear colour ...........................................4,400.00 Min basal rate 0.05 U/h; pink colour ............................................4,400.00 Min basal rate 0.05 U/h; purple colour ........................................4,400.00 Min basal rate 0.05 U/h; smoke colour ........................................4,400.00

1 1 1 1 1 1 1 1 1 1

Animas Vibe Animas Vibe Animas Vibe Animas Vibe Animas Vibe Paradigm 522 Paradigm 722 Paradigm 522 Paradigm 722 Paradigm 522 Paradigm 722 Paradigm 522 Paradigm 722 Paradigm 522 Paradigm 722

¾SA1237 Special Authority for Subsidy Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The IPP Co-ordinator Phone: (04) 460 4990 PHARMAC Facsimile: (04) 974 7806 PO Box 10 254 Email: ipp@pharmac.govt.nz Wellington

Insulin Pump Consumables

¾SA1240 Special Authority for Subsidy Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The IPP Co-ordinator Phone: (04) 460 4990 PHARMAC Facsimile: (04) 974 7806 PO Box 10 254 Email: ipp@pharmac.govt.nz Wellington INSULIN PUMP ACCESSORIES – Special Authority see SA1240 above – Retail pharmacy a) Maximum of 1 cap per prescription b) Only on a prescription c) Maximum of 1 prescription per 180 days. Battery cap .......................................................................................32.00 1

Animas Battery Cap

32

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

INSULIN PUMP INFUSION SET (STEEL CANNULA) – Special Authority see SA1240 on the previous page – Retail pharmacy a) Maximum of 3 sets per prescription b) Only on a prescription c) Maximum of 13 infusion sets will be funded per year. 10 mm steel needle; 29 G; manual insertion; 60 cm tubing × 10 with 10 needles ................................................................... 130.00 1 OP Paradigm Sure-T MMT-884 10 mm steel needle; 29 G; manual insertion; 60 cm tubing × 10 with 10 needles; luer lock ................................................... 130.00 1 OP Sure-T MMT-883 10 mm steel needle; 29 G; manual insertion; 80 cm tubing × 10 with 10 needles ................................................................... 130.00 1 OP Paradigm Sure-T MMT-886 10 mm steel needle; 29 G; manual insertion; 80 cm tubing × 10 with 10 needles; luer lock ................................................... 130.00 1 OP Sure-T MMT-885 6 mm steel cannula; straight insertion; 60 cm grey line × 10 with 10 needles ........................................................................ 130.00 1 OP Contact-D 6 mm steel needle; 29 G; manual insertion; 60 cm tubing × 10 with 10 needles ................................................................... 130.00 1 OP Paradigm Sure-T MMT-864 6 mm steel needle; 29 G; manual insertion; 60 cm tubing × 10 with 10 needles; luer lock ................................................... 130.00 1 OP Sure-T MMT-863 6 mm steel needle; 29 G; manual insertion; 80 cm tubing × 10 with 10 needles ................................................................... 130.00 1 OP Paradigm Sure-T MMT-866 6 mm steel needle; 29 G; manual insertion; 80 cm tubing × 10 with 10 needles; luer lock ................................................... 130.00 1 OP Sure-T MMT-865 8 mm steel cannula; straight insertion; 110 cm grey line × 10 with 10 needles ........................................................................ 130.00 1 OP Contact-D 8 mm steel cannula; straight insertion; 60 cm grey line × 10 with 10 needles ........................................................................ 130.00 1 OP Contact-D 8 mm steel needle; 29 G; manual insertion; 60 cm tubing × 10 with 10 needles ................................................................... 130.00 1 OP Paradigm Sure-T MMT-874 8 mm steel needle; 29 G; manual insertion; 60 cm tubing × 10 with 10 needles; luer lock ................................................... 130.00 1 OP Sure-T MMT-873 8 mm steel needle; 29 G; manual insertion; 80 cm tubing × 10 with 10 needles ................................................................... 130.00 1 OP Paradigm Sure-T MMT-876 8 mm steel needle; 29 G; manual insertion; 80 cm tubing × 10 with 10 needles; luer lock ................................................... 130.00 1 OP Sure-T MMT-875

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

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

33


ALIMENTARY TRACT AND METABOLISM

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

INSULIN PUMP INFUSION SET (TEFLON CANNULA, ANGLE INSERTION WITH INSERTION DEVICE) – Special Authority see SA1240 on page 32 – Retail pharmacy a) Maximum of 3 sets per prescription b) Only on a prescription c) Maximum of 13 infusion sets will be funded per year. 13 mm teflon cannula; angle insertion; insertion device; 110 cm grey line × 10 with 10 needles .......................................... 140.00 1 OP Inset 30 13 mm teflon cannula; angle insertion; insertion device; 60 cm blue line × 10 with 10 needles ........................................... 140.00 1 OP Inset 30 13 mm teflon cannula; angle insertion; insertion device; 60 cm grey line × 10 with 10 needles .......................................... 140.00 1 OP Inset 30 13 mm teflon cannula; angle insertion; insertion device; 60 cm pink line × 10 with 10 needles ........................................... 140.00 1 OP Inset 30 INSULIN PUMP INFUSION SET (TEFLON CANNULA, ANGLE INSERTION) – Special Authority see SA1240 on page 32 – Retail pharmacy a) Maximum of 3 sets per prescription b) Only on a prescription c) Maximum of 13 infusion sets will be funded per year. 13 mm teflon cannula; angel insertion; 60 cm grey line × 5 with 10 needles ........................................................................ 120.00 1 OP Comfort Short 13 mm teflon cannula; angle insertion; 120 cm line × 10 with 10 needles ............................................................................... 130.00 1 OP Paradigm Silhouette MMT-382 13 mm teflon cannula; angle insertion; 45 cm line × 10 with 10 needles ............................................................................... 130.00 1 OP Paradigm Silhouette MMT-368 13 mm teflon cannula; angle insertion; 60 cm line × 10 with 10 needles ............................................................................... 130.00 1 OP Paradigm Silhouette MMT-381 13 mm teflon cannula; angle insertion; 80 cm line × 10 with 10 needles ............................................................................... 130.00 1 OP Paradigm Silhouette MMT-383 17 mm teflon cannula; angle insertion; 110 cm grey line × 5 with 10 needles ........................................................................ 120.00 1 OP Comfort 17 mm teflon cannula; angle insertion; 110 cm line × 10 with 10 needles ............................................................................... 130.00 1 OP Paradigm Silhouette MMT-377 17 mm teflon cannula; angle insertion; 110 cm line × 10 with 10 needles; luer lock ................................................................ 130.00 1 OP Silhouette MMT-371 17 mm teflon cannula; angle insertion; 60 cm grey line × 5 with 10 needles ........................................................................ 120.00 1 OP Comfort 17 mm teflon cannula; angle insertion; 60 cm line × 10 with 10 needles ............................................................................... 130.00 1 OP Paradigm Silhouette MMT-378 17 mm teflon cannula; angle insertion; 60 cm line × 10 with 10 needles; luer lock ................................................................ 130.00 1 OP Silhouette MMT-373 17 mm teflon cannula; angle insertion; 80 cm line × 10 with 10 needles ............................................................................... 130.00 1 OP Paradigm Silhouette MMT-384

34

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

INSULIN PUMP INFUSION SET (TEFLON CANNULA, STRAIGHT INSERTION WITH INSERTION DEVICE) – Special Authority see SA1240 on page 32 – Retail pharmacy a) Maximum of 3 sets per prescription b) Only on a prescription c) Maximum of 13 infusion sets will be funded per year. 6 mm teflon cannula; straight insertion; insertion device; 110 cm grey line × 10 with 10 needles .......................................... 140.00 1 OP Inset II 6 mm teflon cannula; straight insertion; insertion device; 45 cm blue tubing × 10 with 10 needles ...................................... 130.00 1 OP Paradigm Mio MMT-941 6 mm teflon cannula; straight insertion; insertion device; 45 cm pink tubing × 10 with 10 needles ....................................... 130.00 1 OP Paradigm Mio MMT-921 6 mm teflon cannula; straight insertion; insertion device; 60 cm blue tubing × 10 with 10 needles ...................................... 130.00 1 OP Paradigm Mio MMT-943 6 mm teflon cannula; straight insertion; insertion device; 60 cm pink tubing × 10 with 10 needles ....................................... 130.00 1 OP Paradigm Mio MMT-923 6 mm teflon cannula; straight insertion; insertion device; 80 cm blue tubing × 10 with 10 needles ...................................... 130.00 1 OP Paradigm Mio MMT-945 6 mm teflon cannula; straight insertion; insertion device; 80 cm clear tubing × 10 with 10 needles ..................................... 130.00 1 OP Paradigm Mio MMT-965 6 mm teflon cannula; straight insertion; insertion device; 80 cm pink tubing × 10 with 10 needles ....................................... 130.00 1 OP Paradigm Mio MMT-925 6 mm teflon cannula; straight insertionl insertion device; 60 cm blue line × 10 with 10 needles ........................................... 140.00 1 OP Inset II 6 mm teflon cannula; straight insertionl insertion device; 60 cm grey line × 10 with 10 needles .......................................... 140.00 1 OP Inset II 6 mm teflon cannula; straight insertionl insertion device; 60 cm pink line × 10 with 10 needles ........................................... 140.00 1 OP Inset II 9 mm teflon cannula; straight insertion; insertion device; 60 cm blue line × 10 with 10 needles ........................................... 140.00 1 OP Inset II 9 mm teflon cannula; straight insertion; insertion device; 60 cm grey line × 10 with 10 needles .......................................... 140.00 1 OP Inset II 9 mm teflon cannula; straight insertion; insertion device; 60 cm pink line × 10 with 10 needles ........................................... 140.00 1 OP Inset II 9 mm teflon cannula; straight insertion; insertion device; 80 cm clear tubing × 10 with 10 needles ..................................... 130.00 1 OP Paradigm Mio MMT-975 9 mm teflon cannula; straight insertionl insertion device; 110 cm grey line × 10 with 10 needles .......................................... 140.00 1 OP Inset II

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

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

35


ALIMENTARY TRACT AND METABOLISM

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

INSULIN PUMP INFUSION SET (TEFLON CANNULA, STRAIGHT INSERTION) – Special Authority see SA1240 on page 32 – Retail pharmacy a) Maximum of 3 sets per prescription b) Only on a prescription c) Maximum of 13 infusion sets will be funded per year. 6 mm teflon cannula; straight insertion; 110 cm tubing × 10 with 10 needles ........................................................................ 130.00 1 OP Paradigm Quick-Set MMT-398 6 mm teflon cannula; straight insertion; 110 cm tubing × 10 with 10 needles; luer lock ........................................................ 130.00 1 OP Quick-Set MMT-391 6 mm teflon cannula; straight insertion; 60 cm tubing × 10 with 10 needles ........................................................................ 130.00 1 OP Paradigm Quick-Set MMT-399 6 mm teflon cannula; straight insertion; 60 cm tubing × 10 with 10 needles; luer lock ........................................................ 130.00 1 OP Quick-Set MMT-393 6 mm teflon cannula; straight insertion; 80 cm tubing × 10 with 10 needles ........................................................................ 130.00 1 OP Paradigm Quick-Set MMT-387 9 mm teflon cannula; straight insertion; 106 cm tubing × 10 with 10 needles ........................................................................ 130.00 1 OP Paradigm Quick-Set MMT-396 9 mm teflon cannula; straight insertion; 110 cm tubing × 10 with 10 needles; luer lock ........................................................ 130.00 1 OP Quick-Set MMT-390 9 mm teflon cannula; straight insertion; 60 cm tubing × 10 with 10 needles ........................................................................ 130.00 1 OP Paradigm Quick-Set MMT-397 9 mm teflon cannula; straight insertion; 60 cm tubing × 10 with 10 needles; luer lock ........................................................ 130.00 1 OP Quick-Set MMT-392 9 mm teflon cannula; straight insertion; 80 cm tubing × 10 with 10 needles ........................................................................ 130.00 1 OP Paradigm Quick-Set MMT-386 INSULIN PUMP RESERVOIR – Special Authority see SA1240 on page 32 – Retail pharmacy a) Maximum of 3 sets per prescription b) Only on a prescription c) Maximum of 13 packs of reservoir sets will be funded per year. 10 × luer lock conversion cartridges 1.8 ml for Paradigm pumps ........................................................................................ 50.00 1 OP 10 × luer lock conversion cartridges 3.0 ml for Paradigm pumps ........................................................................................ 50.00 1 OP Cartridge 200 U, luer lock × 10 ........................................................50.00 1 OP Cartridge for 5 and 7 series pump; 1.8 ml × 10 ...............................50.00 1 OP Cartridge for 7 series pump; 3.0 ml × 10 .........................................50.00 Syringe and cartridge for 50X pump, 3.0 ml × 10 ............................50.00 1 OP 1 OP

ADR Cartridge 1.8 ADR Cartridge 3.0 Animas Cartridge Paradigm 1.8

Reservoir

Paradigm 3.0

Reservoir

50X 3.0 Reservoir

36

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

Digestives Including Enzymes

PANCREATIC ENZYME Cap EC 10,000 BP u lipase, 9,000 BP u amylase and 210 BP u protease ..................................................................... 34.93 Cap EC 25,000 BP u lipase, 18,000 BP u amylase, 1,000 BP u protease .................................................................. 94.38 Cap EC 25,000 BP u lipase, 22,500 BP u amylase, 1,250 BP u protease .................................................................. 94.40

100 100 100

Creon 10000 Creon Forte Panzytrat

URSODEOXYCHOLIC ACID – Special Authority see SA1383 below – Retail pharmacy Cap 250 mg – For ursodeoxycholic acid oral liquid formulation refer, page 194..................................................................... 71.50 100

Ursosan

¾SA1383 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 > 100 umol/l; decompensated cirrhosis). Initial application — (Pregnancy) from any relevant practitioner. Approvals valid for 6 months where the patient diagnosed with cholestasis of pregnancy. 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. continued. . .

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

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

37


ALIMENTARY TRACT AND METABOLISM

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

continued. . . Renewal — (Total parenteral nutrition induced cholestasis) from any relevant practitioner. Approvals valid for 6 months where the 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 > 100 micromol/l; decompensated cirrhosis). These patients should be referred to an appropriate transplant centre. Treatment failure – doubling of serum bilirubin levels, absence of a significant decrease in ALP or ALT and AST, development of varices, ascites or encephalopathy, marked worsening of pruritus or fatigue, histological progression by two stages, or to cirrhosis, need for transplantation.

Laxatives Bulk-forming Agents

ISPAGHULA (PSYLLIUM) HUSK – Only on a prescription F Powder for oral soln ............................................................................5.51 MUCILAGINOUS LAXATIVES WITH STIMULANTS F Dry ......................................................................................................2.41 (8.72) 6.02 (17.32) 500 g OP 200 g OP Normacol Plus 500 g OP Normacol Plus

Konsyl-D

Faecal Softeners

DOCUSATE SODIUM – Only on a prescription F Cap 50 mg ..........................................................................................2.57 F Cap 120 mg ........................................................................................3.48 F Enema conc 18% ...............................................................................5.40 DOCUSATE SODIUM WITH SENNOSIDES F Tab 50 mg with total sennosides 8 mg ...............................................6.38 POLOXAMER – Only on a prescription Not funded for use in the ear. F Oral drops 10% ...................................................................................3.78 100 100 100 ml OP 200

Laxofast 50 Laxofast 120 Coloxyl Laxsol Coloxyl

30 ml OP

Osmotic Laxatives

GLYCEROL F Suppos 3.6 g – Only on a prescription ...............................................6.50 LACTULOSE – Only on a prescription F Oral liq 10 g per 15 ml ........................................................................3.84 7.68 MACROGOL 3350 – Special Authority see SA0891 below – Retail pharmacy Powder 13.125 g, sachets – Maximum of 60 sach per prescription ...................................................................................... 10.00 20 500 ml 1,000 ml

PSM Laevolac Laevolac

30

Lax-Sachets

¾SA0891 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months where the patient has problematic constipation requiring intervention with a per rectal preparation despite an adequate trial of other oral pharmacotherapies including lactulose where lactulose is not contraindicated. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is compliant and is continuing to gain benefit from treatment.

38

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

SODIUM ACID PHOSPHATE – Only on a prescription Enema 16% with sodium phosphate 8% ............................................2.50

1

Fleet Phosphate

Enema

SODIUM CITRATE WITH SODIUM LAURYL SULPHOACETATE – Only on a prescription Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml ............................................................................................ 19.95 50

Micolette

Stimulant Laxatives

BISACODYL – Only on a prescription F Tab 5 mg .............................................................................................4.99 F Suppos 5 mg ......................................................................................3.00 F Suppos 10 mg ....................................................................................3.00 DANTHRON WITH POLOXAMER – Only on a prescription Note: Only for the prevention or treatment of constipation in the terminally ill. Oral liq 25 mg with poloxamer 200 mg per 5 ml ...............................21.30 Oral liq 75 mg with poloxamer 1 g per 5 ml ......................................43.60 SENNA – Only on a prescription F Tab, standardised ...............................................................................0.43 (1.72) 2.17 (6.16) 200 6 6

Lax-Tab Dulcolax Dulcolax Pinorax Pinorax Forte

300 ml 300 ml 20

Senokot 100 Senokot

Metabolic Disorder Agents Gaucher’s Disease

IMIGLUCERASE – Special Authority see SA0473 below – Retail pharmacy Inj 40 iu per ml, 200 iu vial ...........................................................1,072.00 Inj 40 iu per ml, 400 iu vial ...........................................................2,144.00 1 1

Cerezyme Cerezyme

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

Mouth and Throat Agents Used in Mouth Ulceration

BENZYDAMINE HYDROCHLORIDE Soln 0.15% .........................................................................................3.60 (8.50) 9.00 (17.01) CHLORHEXIDINE GLUCONATE Mouthwash 0.2% ................................................................................2.68 200 ml Difflam 500 ml Difflam 200 ml OP

healthE

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

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

39


ALIMENTARY TRACT AND METABOLISM

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

CHOLINE SALICYLATE WITH CETALKONIUM CHLORIDE F Adhesive gel 8.7% with cetalkonium chloride 0.01% .........................2.06 (5.62) SODIUM CARBOXYMETHYLCELLULOSE With pectin and gelatin paste ...........................................................17.20 1.52 (3.60) 4.55 (7.90) With pectin and gelatin powder ..........................................................8.48 (10.95) TRIAMCINOLONE ACETONIDE 0.1% in Dental Paste USP ..................................................................4.34

15 g OP Bonjela 56 g OP 5 g OP 15 g OP Orabase 28 g OP Stomahesive 5 g OP

Stomahesive

Orabase

Oracort

Oropharyngeal Anti-infectives

AMPHOTERICIN B Lozenges 10 mg .................................................................................5.86 MICONAZOLE Oral gel 20 mg per g ...........................................................................4.95 NYSTATIN Oral liq 100,000 u per ml ....................................................................3.19 20 40 g OP 24 ml OP

Fungilin Decozol Nilstat

Other Oral Agents

For folinic mouthwash, pilocarpine oral liquid or saliva substitute formula refer, page 197 HYDROGEN PEROXIDE F Soln 10 vol – Maximum of 200 ml per prescription.............................1.28 100 ml THYMOL GLYCERIN F Compound, BPC .................................................................................9.15 500 ml

PSM PSM

Vitamins

Alpha tocopheryl acetate is available fully subsidised for specific patients at the Medical Director of PHARMAC’s discretion. Refer to PHARMAC website www.pharmac.govt.nz for the “Alpha tocopheryl acetate information sheet and application form”.

Vitamin A

VITAMIN A WITH VITAMINS D AND C F Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops ................................................................................ 4.50

10 ml OP

Vitadol C

Vitamin B

HYDROXOCOBALAMIN F Inj 1 mg per ml, 1 ml – Up to 6 inj available on a PSO .......................5.10 PYRIDOXINE HYDROCHLORIDE a) No more than 100 mg per dose b) Only on a prescription F Tab 25 mg – No patient co-payment payable .....................................2.20 F Tab 50 mg .........................................................................................12.16 3

ABM

Hydroxocobalamin

90 500

PyridoxADE Apo-Pyridoxine

40

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

THIAMINE HYDROCHLORIDE – Only on a prescription F Tab 50 mg ...........................................................................................5.62 VITAMIN B COMPLEX F Tab, strong, BPC ...............................................................................4.30 (B-PlexADE Tab, strong, BPC to be delisted 1 January 2014)

100 500

Apo-Thiamine B-PlexADE Bplex

Vitamin C

ASCORBIC ACID a) No more than 100 mg per dose b) Only on a prescription F Tab 100 mg .........................................................................................7.00 (Vitala-C Tab 100 mg to be delisted 1 January 2014)

500

Cvite Vitala-C

Vitamin D

ALFACALCIDOL F Cap 0.25 mcg ...................................................................................26.32 F Cap 1 mcg ........................................................................................87.98 F Oral drops 2 mcg per ml ...................................................................60.68 CALCITRIOL F Cap 0.25 mcg .....................................................................................3.03 10.10 F Cap 0.5 mcg .......................................................................................5.62 18.73 F Oral liq 1 mcg per ml .......................................................................39.40 (Rocaltrol solution Oral liq 1 mcg per ml to be delisted 1 February 2014) CHOLECALCIFEROL F Tab 1.25 mg (50,000 iu) – Maximum of 12 tab per prescription .........7.76 100 100 20 ml OP 30 100 30 100 10 ml OP

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

12

Multivitamin Preparations

MULTIVITAMINS – Special Authority see SA1036 below – Retail pharmacy F Powder ..............................................................................................72.00 200 g OP

Paediatric Seravit

¾SA1036 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has inborn errors of metabolism. Renewal from any relevant practitioner. Approvals valid without further renewal unless notified where patient has had a previous approval for multivitamins. VITAMINS F Tab (BPC cap strength) .....................................................................7.60 1,000 MultiADE Mvite F Cap (fat soluble vitamins A, D, E, K) – Special Authority see SA1002 on the next page – Retail pharmacy ............................ 23.40 60 Vitabdeck (MultiADE Tab (BPC cap strength) to be delisted 1 January 2014)

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

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

41


ALIMENTARY TRACT AND METABOLISM

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

¾SA1002 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 Patient has cystic fibrosis with pancreatic insufficiency; or 2 Patient is an infant or child with liver disease or short gut syndrome.

Minerals Calcium

CALCIUM CARBONATE F Tab eff 1.75 g (1 g elemental) .............................................................6.21 F Tab 1.25 g (500 mg elemental) ...........................................................6.38 CALCIUM GLUCONATE F Inj 10%, 10 ml ...................................................................................21.40 30 250 10

Calsource Arrow-Calcium Hospira

Fluoride

SODIUM FLUORIDE F Tab 1.1 mg (0.5 mg elemental) ...........................................................5.00 100

PSM

Iodine

POTASSIUM IODATE F Tab 256 mcg (150 mcg elemental iodine) ...........................................6.53 90

NeuroKare

Iron

FERROUS FUMARATE F Tab 200 mg (65 mg elemental) ...........................................................4.35 FERROUS FUMARATE WITH FOLIC ACID F Tab 310 mg (100 mg elemental) with folic acid 350 mcg ....................4.75 FERROUS SULPHATE F Tab long-acting 325 mg (105 mg elemental) ......................................1.01 (4.26) 5.06 (15.58) F‡ Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml) ...........................10.30 FERROUS SULPHATE WITH FOLIC ACID F Tab long-acting 325 mg (105 mg elemental) with folic acid 350 mcg ....................................................................................... 1.80 (4.29) IRON POLYMALTOSE F Inj 50 mg per ml, 2 ml .......................................................................19.90 100 60 30 Ferrograd 150 Ferrograd 500 ml

Ferro-tab Ferro-F-Tabs

Ferodan

30 Ferrograd F 5

Ferrum H

Magnesium

For magnesium hydroxide mixture refer, page 197 MAGNESIUM SULPHATE F Inj 2 mmol per ml, 5 ml .....................................................................18.35 26.60

10

Martindale Hospira

42

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ALIMENTARY TRACT AND METABOLISM

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

Zinc

ZINC SULPHATE F Cap 137.4 mg (50 mg elemental) .....................................................11.00 100

Zincaps

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

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

43


BLOOD AND BLOOD FORMING ORGANS

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

Antianaemics Hypoplastic and Haemolytic

¾SA0922 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Both: 1.1 patient in chronic renal failure; and 1.2 Haemoglobin ≤ 100g/L; and 2 Any of the following: 2.1 Both: 2.1.1 patient is not diabetic; and 2.1.2 glomerular filtration rate ≤ 30ml/min; or 2.2 Both: 2.2.1 patient is diabetic; and 2.2.2 glomerular filtration rate ≤ 45ml/min; or 2.3 patient is on haemodialysis or peritoneal dialysis. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. Notes: Erythropoietin beta is indicated in the treatment of anaemia associated with chronic renal failure (CRF) where no cause for anaemia other than CRF is detected and there is adequate monitoring of iron stores and iron replacement therapy. The Cockroft-Gault Formula may be used to estimate glomerular filtration rate (GFR) in persons 18 years and over: GFR (ml/min) (male) = (140 - age) × Ideal Body Weight (kg) / 814 × serum creatinine (mmol/l) GFR (ml/min) (female) = Estimated GFR (male) × 0.85 ERYTHROPOIETIN ALPHA – Special Authority see SA0922 above – Retail pharmacy Inj human recombinant 1,000 iu prefilled syringe .............................48.68 6 Eprex Inj human recombinant 2,000 iu, prefilled syringe ..........................120.18 6 Eprex Inj human recombinant 3,000 iu, prefilled syringe ..........................166.87 6 Eprex Inj human recombinant 4,000 iu, prefilled syringe ..........................193.13 6 Eprex Inj human recombinant 5,000 iu, prefilled syringe ..........................243.26 6 Eprex Inj human recombinant 6,000 iu, prefilled syringe ..........................291.92 6 Eprex Inj human recombinant 10,000 iu, prefilled syringe ........................395.18 6 Eprex ERYTHROPOIETIN BETA – Special Authority see SA0922 above – Retail pharmacy Inj 2,000 iu, prefilled syringe ...........................................................120.18 Inj 3,000 iu, prefilled syringe ...........................................................166.87 Inj 4,000 iu, prefilled syringe ...........................................................193.13 Inj 5,000 iu, prefilled syringe ...........................................................243.26 Inj 6,000 iu, prefilled syringe ...........................................................291.29 Inj 10,000 iu, prefilled syringe .........................................................395.18 6 6 6 6 6 6

NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon

Megaloblastic

FOLIC ACID F Tab 0.8 mg ........................................................................................19.80 F Tab 5 mg ...........................................................................................10.21 Oral liq 50 mcg per ml ......................................................................24.00 1,000 500 25 ml OP

Apo-Folic Acid Apo-Folic Acid Biomed

44

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


BLOOD AND BLOOD FORMING ORGANS

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

Antifibrinolytics, Haemostatics and Local Sclerosants

EPTACOG ALFA [RECOMBINANT FACTOR VIIA] – [Xpharm] For patients with haemophilia, whose treatment is managed by the Haemophilia Treaters Group in conjunction with the National Haemophilia Management Group. Inj 1 mg syringe ...........................................................................1,163.75 1 NovoSeven RT Inj 2 mg syringe ...........................................................................2,327.50 1 Novoseven RT Inj 5 mg syringe ...........................................................................5,818.75 1 Novoseven RT Inj 8 mg syringe ...........................................................................9,310.00 1 Novoseven RT FACTOR EIGHT INHIBITORS BYPASSING AGENT – [Xpharm] For patients with haemophilia, whose treatment is managed by the Haemophilia Treaters Group in conjunction with the National Haemophilia Management Group. Inj 500 U ......................................................................................1,640.00 1 FEIBA Inj 1,000 U ...................................................................................3,280.00 1 FEIBA MOROCTOCOG ALFA [RECOMBINANT FACTOR VIII] – [Xpharm] For patients with haemophilia, whose treatment is managed by the Haemophilia Treaters Group in conjunction with the National Haemophilia Management Group. Inj 250 iu vial ...................................................................................225.00 1 Xyntha Inj 500 iu vial ...................................................................................450.00 1 Xyntha Inj 1,000 iu vial ................................................................................900.00 1 Xyntha Inj 2,000 iu vial .............................................................................1,800.00 1 Xyntha Inj 3,000 iu vial .............................................................................2,700.00 1 Xyntha NONACOG ALFA [RECOMBINANT FACTOR IX] – [Xpharm] For patients with haemophilia, whose treatment is managed by the Haemophilia Treaters Group in conjunction with the National Haemophilia Management Group. Inj 250 iu vial ...................................................................................310.00 1 BeneFIX Inj 500 iu vial ...................................................................................620.00 1 BeneFIX Inj 1,000 iu vial .............................................................................1,240.00 1 BeneFIX Inj 2,000 iu vial .............................................................................2,480.00 1 BeneFIX OCTOCOG ALFA [RECOMBINANT FACTOR VIII] – [Xpharm] For patients with haemophilia, whose treatment is managed by the Haemophilia Treaters Group in conjunction with the National Haemophilia Management Group. Inj 250 iu vial ...................................................................................237.50 1 Advate 250.00 Kogenate FS Inj 500 iu vial ...................................................................................475.00 1 Advate 500.00 Kogenate FS Inj 1,000 iu vial ................................................................................950.00 1 Advate 1,000.00 Kogenate FS Inj 1,500 iu vial .............................................................................1,425.00 1 Advate Inj 2,000 iu vial .............................................................................1,900.00 1 Advate 2,000.00 Kogenate FS Inj 3,000 iu vial .............................................................................2,850.00 1 Advate 3,000.00 Kogenate FS SODIUM TETRADECYL SULPHATE F Inj 3% 2 ml ........................................................................................28.50 (73.00) TRANEXAMIC ACID Tab 500 mg .......................................................................................32.92 5 Fibro-vein 100

Cyklokapron

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

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

45


BLOOD AND BLOOD FORMING ORGANS

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

Vitamin K

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

Konakion MM Konakion MM

Antithrombotic Agents Antiplatelet Agents

ASPIRIN F Tab 100 mg .......................................................................................14.00 CLOPIDOGREL F Tab 75 mg – For clopidogrel oral liquid formulation refer, page 194 ............................................................................................... 5.48 5.87 (16.25) (Apo-Clopidogrel Tab 75 mg to be delisted 1 March 2014) DIPYRIDAMOLE F Tab 25 mg – For dipyridamole oral liquid formulation refer, page 194 ...................................................................................... 8.36 F Tab long-acting 150 mg ....................................................................11.52 PRASUGREL – Special Authority see SA1201 below – Retail pharmacy Tab 5 mg .........................................................................................108.00 Tab 10 mg .......................................................................................120.00 990

Ethics Aspirin EC

84 90

Arrow - Clopid

Apo-Clopidogrel

84 60 28 28

Persantin Pytazen SR Effient Effient

¾SA1201 Special Authority for Subsidy Initial application — (coronary angioplasty and bare metal stent) from any relevant practitioner. Approvals valid for 6 months where the patient has undergone coronary angioplasty in the previous 4 weeks and is clopidogrel-allergic*. Initial application — (drug eluting stent) from any relevant practitioner. Approvals valid for 12 months where the patient has had a drug-eluting cardiac stent inserted in the previous 4 weeks and is clopidogrel-allergic*. Initial application — (stent thromobosis) from any relevant practitioner. Approvals valid without further renewal unless notified where patient has experienced cardiac stent thrombosis whilst on clopidogrel. Renewal — (coronary angioplasty and bare metal stent) from any relevant practitioner. Approvals valid for 6 months where the patient has undergone coronary angioplasty or had a bare metal cardiac stent inserted in the previous 4 weeks and is clopidogrelallergic*. Renewal — (drug eluting stent) from any relevant practitioner. Approvals valid for 12 months where had a drug-eluting cardiac stent inserted in the previous 4 weeks and is clopidogrel-allergic*. Note: * Clopidogrel allergy is defined as a history of anaphylaxis, urticaria, generalised rash or asthma (in non-asthmatic patients) developing soon after clopidogrel is started and is considered unlikely to be caused by any other treatment. TICAGRELOR – Special Authority see SA1382 below – Retail pharmacy F Tab 90 mg .........................................................................................90.00 56 Brilinta ¾SA1382 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. continued. . .

46

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


BLOOD AND BLOOD FORMING ORGANS

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

continued. . . 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.

Heparin and Antagonist Preparations

DALTEPARIN SODIUM – Special Authority see SA1270 below – Retail pharmacy Inj 2,500 iu per 0.2 ml prefilled syringe .............................................19.97 Inj 5,000 iu per 0.2 ml prefilled syringe .............................................39.94 Inj 7,500 iu per 0.75 ml graduated syringe .......................................60.03 Inj 10,000 iu per 1 ml graduated syringe ..........................................77.55 Inj 12,500 iu per 0.5 ml prefilled syringe ...........................................99.96 Inj 15,000 iu per 0.6 ml prefilled syringe .........................................120.05 Inj 18,000 iu per 0.72 ml prefilled syringe .......................................158.47 10 10 10 10 10 10 10

Fragmin Fragmin Fragmin Fragmin Fragmin Fragmin Fragmin

¾SA1270 Special Authority for Subsidy Initial application — (Pregnancy or Malignancy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Low molecular weight heparin treatment is required during a patient’s pregnancy; or 2 For the treatment of venous thromboembolism where the patient has a malignancy. Initial application — (Venous thromboembolism other than in pregnancy or malignancy) from any relevant practitioner. Approvals valid for 1 month for applications meeting the following criteria: Any of the following: 1 For the short-term treatment of venous thromboembolism prior to establishing a therapeutic INR with oral anti-coagulant treatment; or 2 For the prophylaxis and treatment of venous thromboembolism in high risk surgery; or 3 To enable cessation/re-establishment of existing oral anticoagulant treatment pre/post surgery; or 4 For the prophylaxis and treatment of venous thromboembolism in Acute Coronary Syndrome surgical intervention; or 5 To be used in association with cardioversion of atrial fibrillation. Renewal — (Pregnancy or Malignancy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Low molecular weight heparin treatment is required during a patient’s pregnancy; or 2 For the treatment of venous thromboembolism where the patient has a malignancy. Renewal — (Venous thromboembolism other than in pregnancy or malignancy) from any relevant practitioner. Approvals valid for 1 month where low molecular weight heparin treatment or prophylaxis is required for a second or subsequent event (surgery, Acute Coronary Syndrome, cardioversion, or prior to oral anti-coagulation). ENOXAPARIN SODIUM – Special Authority see SA1174 on the next page – Retail pharmacy Inj 20 mg ...........................................................................................37.24 10 Clexane Inj 40 mg ...........................................................................................49.69 10 Clexane Inj 60 mg ...........................................................................................74.91 10 Clexane Inj 80 mg ...........................................................................................99.86 10 Clexane Inj 100 mg .......................................................................................125.06 10 Clexane Inj 120 mg .......................................................................................155.40 10 Clexane Inj 150 mg .......................................................................................177.60 10 Clexane

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

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

47


BLOOD AND BLOOD FORMING ORGANS

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

¾SA1174 Special Authority for Subsidy Initial application — (Pregnancy or Malignancy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Low molecular weight heparin treatment is required during a patients pregnancy; or 2 For the treatment of venous thromboembolism where the patient has a malignancy. Initial application — (Venous thromboembolism other than in pregnancy or malignancy) from any relevant practitioner. Approvals valid for 1 month for applications meeting the following criteria: Any of the following: 1 For the short-term treatment of venous thromboembolism prior to establishing a therapeutic INR with oral anti-coagulant treatment; or 2 For the prophylaxis and treatment of venous thromboembolism in high risk surgery; or 3 To enable cessation/re-establishment of existing oral anticoagulant treatment pre/post surgery; or 4 For the prophylaxis and treatment of venous thromboembolism in Acute Coronary Syndrome surgical intervention; or 5 To be used in association with cardioversion of atrial fibrillation. Renewal — (Pregnancy or Malignancy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Low molecular weight heparin treatment is required during a patient’s pregnancy; or 2 For the treatment of venous thromboembolism where the patient has a malignancy. Renewal — (Venous thromboembolism other than in pregnancy or malignancy) from any relevant practitioner. Approvals valid for 1 month where low molecular weight heparin treatment or prophylaxis is required for a second or subsequent event (surgery, ACS, cardioversion, or prior to oral anti-coagulation). HEPARIN SODIUM Inj 1,000 iu per ml, 5 ml ....................................................................13.36 10 Hospira 66.80 50 Hospira 11.44 10 Pfizer 46.30 50 Pfizer Inj 1,000 iu per ml, 35 ml ..................................................................16.00 1 Hospira Inj 5,000 iu per ml, 1 ml ....................................................................14.20 5 Hospira Inj 5,000 iu per ml, 5 ml ..................................................................182.00 50 Pfizer Inj 25,000 iu per ml, 0.2 ml .................................................................9.50 5 Hospira HEPARINISED SALINE F Inj 10 iu per ml, 5 ml .........................................................................32.50 PROTAMINE SULPHATE F Inj 10 mg per ml, 5 ml .......................................................................22.40 (101.61) 50 10 Artex

Pfizer

Oral Anticoagulants

DABIGATRAN Cap 75 mg – No more than 2 cap per day .....................................148.00 Cap 110 mg ....................................................................................148.00 Cap 150 mg ....................................................................................148.00 60 60 60

Pradaxa Pradaxa Pradaxa Xarelto

RIVAROXABAN – Special Authority see SA1066 on the next page – Retail pharmacy Tab 10 mg .......................................................................................153.00 15

48

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


BLOOD AND BLOOD FORMING ORGANS

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

¾SA1066 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 5 weeks for applications meeting the following criteria: Either: 1 For the prophylaxis of venous thromboembolism following a total hip replacement; or 2 For the prophylaxis of venous thromboembolism following a total knee replacement. Note: Rivaroxaban is only currently indicated and subsidised for up to 5 weeks therapy for prophylaxis of venous thromboembolism following a total hip replacement and up to 2 weeks therapy for prophylaxis of venous thromboembolism following a total knee replacement. Renewal from any relevant practitioner. Approvals valid for 5 weeks where prophylaxis for venous thromboembolism is required for patients following a subsequent total hip or knee replacement. WARFARIN SODIUM Note: Marevan and Coumadin are not interchangeable. F Tab 1 mg .............................................................................................3.46 50 Coumadin 6.86 100 Marevan F Tab 2 mg .............................................................................................4.31 50 Coumadin F Tab 3 mg .............................................................................................9.70 100 Marevan F Tab 5 mg .............................................................................................5.93 50 Coumadin 11.75 100 Marevan

Blood Colony-stimulating Factors

FILGRASTIM – Special Authority see SA1259 below – Retail pharmacy Inj 300 mcg per 0.5 ml prefilled syringe ..........................................540.00 Inj 480 mcg per 0.5 ml prefilled syringe ..........................................864.00 5 5

Zarzio Zarzio

¾SA1259 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 for applications meeting the following criteria: Any of the following: 1 Prevention of neutropenia in patients undergoing high risk chemotherapy for cancer (febrile neutropenia risk ≥ 20%*); or 2 Peripheral blood stem cell mobilisation in patients undergoing haematological transplantation; or 3 Peripheral blood stem cell mobilisation or bone marrow donation from healthy donors for transplantation; or 4 Treatment of severe chronic neutropenia (ANC < 0.5 × 109 /L); or 5 Treatment of drug-induced prolonged neutropenia (ANC < 0.5 × 109 /L). Note: *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. PEGFILGRASTIM – Special Authority see SA1384 below – Retail pharmacy Inj 6 mg per 0.6 ml syringe ..........................................................1,080.00 1 Neulastim ¾SA1384 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%*). Note: *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.

Fluids and Electrolytes Intravenous Administration

DEXTROSE F Inj 50%, 10 ml – Up to 5 inj available on a PSO ...............................19.50 F Inj 50%, 90 ml – Up to 5 inj available on a PSO ...............................11.25

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

5 1

Biomed Biomed

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

49


BLOOD AND BLOOD FORMING ORGANS

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

POTASSIUM CHLORIDE F Inj 75 mg per ml, 10 ml .....................................................................55.00

50

AstraZeneca

SODIUM BICARBONATE Inj 8.4%, 50 ml ..................................................................................19.95 1 Biomed a) Up to 5 inj available on a PSO b) Not in combination Inj 8.4%, 100 ml ................................................................................20.50 1 Biomed a) Up to 5 inj available on a PSO b) Not in combination SODIUM CHLORIDE Not funded for use as a nasal drop. Only funded for nebuliser use when in conjunction with an antibiotic intended for nebuliser use. Inf 0.9% – Up to 2000 ml available on a PSO ....................................3.06 500 ml Baxter 4.06 1,000 ml Baxter Only if prescribed on a prescription for renal dialysis, maternity or post-natal care in the home of the patient, or on a PSO for emergency use. (500 ml and 1,000 ml packs) Inj 23.4%, 20 ml ................................................................................31.25 5 Biomed For Sodium chloride oral liquid formulation refer Standard Formulae, page 197 Inj 0.9%, 5 ml – Up to 5 inj available on a PSO ................................10.85 50 Multichem 15.50 Pfizer Inj 0.9%, 10 ml – Up to 5 inj available on a PSO ..............................11.50 50 Multichem 15.50 Pfizer Inj 0.9%, 20 ml ....................................................................................4.72 6 Pharmacia 11.79 30 Pharmacia 8.41 20 Multichem TOTAL PARENTERAL NUTRITION (TPN) – Retail pharmacy-Specialist Infusion .............................................................................................CBS 1 OP

TPN

WATER 1) On a prescription or Practitioner’s Supply Order only when on the same form as an injection listed in the Pharmaceutical Schedule requiring a solvent or diluent; or 2) On a bulk supply order; or 3) When used in the extemporaneous compounding of eye drops. Purified for inj, 5 ml – Up to 5 inj available on a PSO .......................10.25 50 Multichem Purified for inj, 10 ml – Up to 5 inj available on a PSO .....................11.25 50 Multichem Purified for inj, 20 ml – Up to 5 inj available on a PSO .......................6.50 20 Multichem

Oral Administration

CALCIUM POLYSTYRENE SULPHONATE Powder ............................................................................................169.85 COMPOUND ELECTROLYTES Powder for oral soln – Up to 10 sach available on a PSO ..................1.12 1.80 DEXTROSE WITH ELECTROLYTES Soln with electrolytes ..........................................................................6.55 POTASSIUM BICARBONATE Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg ...................................................... 82.50 For phosphate supplementation

fully subsidised [HP4] refer page 7

300 g OP 5 10 1,000 ml OP

Calcium Resonium Electral Enerlyte Pedialyte Bubblegum

100

Phosphate-Sandoz

50

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


BLOOD AND BLOOD FORMING ORGANS

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

POTASSIUM CHLORIDE F Tab eff 548 mg (14 m eq) with chloride 285 mg (8 m eq) ...................5.26 (11.85) F Tab long-acting 600 mg ......................................................................7.42 SODIUM BICARBONATE Cap 840 mg ........................................................................................8.52 SODIUM POLYSTYRENE SULPHONATE Powder ..............................................................................................89.10

60 Chlorvescent 200 100 450 g OP

Span-K Sodibic Resonium-A

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

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

51


CARDIOVASCULAR SYSTEM

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

Alpha Adrenoceptor Blockers

DOXAZOSIN F Tab 2 mg .............................................................................................8.23 F Tab 4 mg ...........................................................................................12.40 PHENOXYBENZAMINE HYDROCHLORIDE F Cap 10 mg ..........................................................................................7.82 26.05 PRAZOSIN F Tab 1 mg .............................................................................................5.53 F Tab 2 mg .............................................................................................7.00 F Tab 5 mg ...........................................................................................11.70 TERAZOSIN F Tab 1 mg .............................................................................................0.50 F Tab 2 mg .............................................................................................0.45 F Tab 5 mg .............................................................................................0.68 500 500 30 100 100 100 100 28 28 28

Apo-Doxazosin Apo-Doxazosin Dibenyline Dibenyline Apo-Prazo Apo-Prazo Apo-Prazo Arrow Arrow Arrow

Agents Affecting the Renin-Angiotensin System ACE Inhibitors

CAPTOPRIL F Tab 12.5 mg ........................................................................................2.00 F Tab 25 mg ...........................................................................................2.40 F Tab 50 mg ...........................................................................................3.50 F‡ Oral liq 5 mg per ml ..........................................................................94.99 Oral liquid restricted to children under 12 years of age. CILAZAPRIL F Tab 0.5 mg ..........................................................................................2.00 F Tab 2.5 mg ..........................................................................................4.31 F Tab 5 mg .............................................................................................6.98 ENALAPRIL MALEATE F Tab 5 mg .............................................................................................0.36 5.94 1.07 1.19 F Tab 10 mg ...........................................................................................0.44 7.33 1.32 1.47 F Tab 20 mg – For enalapril maleate oral liquid formulation refer, page 194................................................................................. 0.57 1.72 1.91 (m-Enalapril Tab 5 mg to be delisted 1 May 2014) (m-Enalapril Tab 10 mg to be delisted 1 May 2014) (m-Enalapril Tab 20 mg to be delisted 1 May 2014) 100 100 100 95 ml OP

m-Captopril m-Captopril m-Captopril Capoten Zapril Zapril Zapril Acetec Acetec m-Enalapril Ethics Enalapril Acetec Acetec m-Enalapril Ethics Enalapril Acetec m-Enalapril Ethics Enalapril

90 90 90 30 500 90 100 30 500 90 100 30 90 100

52

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


CARDIOVASCULAR SYSTEM

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

LISINOPRIL F Tab 5 mg .............................................................................................3.58 F Tab 10 mg ...........................................................................................4.08 F Tab 20 mg ...........................................................................................4.88 PERINDOPRIL F Tab 2 mg .............................................................................................3.75 (18.50) F Tab 4 mg .............................................................................................4.80 (25.00) QUINAPRIL F Tab 5 mg .............................................................................................3.44 F Tab 10 mg ...........................................................................................4.64 F Tab 20 mg ...........................................................................................6.34

90 90 90 30 30

Arrow-Lisinopril Arrow-Lisinopril Arrow-Lisinopril Apo-Perindopril

Coversyl

Apo-Perindopril

Coversyl

90 90 90

Arrow-Quinapril 5 Arrow-Quinapril 10 Arrow-Quinapril 20

TRANDOLAPRIL Higher subsidy by endorsement is available for patients who were taking 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". 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. F Cap 1 mg – Higher subsidy of $18.67 per 28 cap with Endorsement..................................................................................... 3.06 28 (18.67) Gopten F Cap 2 mg – Higher subsidy of $27.00 per 28 cap with Endorsement..................................................................................... 4.43 28 (27.00) Gopten

ACE Inhibitors with Diuretics

CILAZAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 5 mg with hydrochlorothiazide 12.5 mg .......................................5.36 ENALAPRIL MALEATE WITH HYDROCHLOROTHIAZIDE F Tab 20 mg with hydrochlorothiazide 12.5 mg .....................................3.32 (8.70) QUINAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 10 mg with hydrochlorothiazide 12.5 mg .....................................3.37 F Tab 20 mg with hydrochlorothiazide 12.5 mg .....................................4.57 28 30 Co-Renitec 30 30

Inhibace Plus

Accuretic 10 Accuretic 20

Angiotension II Antagonists

CANDESARTAN CILEXETIL – Special Authority see SA1223 on the next page – Retail pharmacy F Tab 4 mg .............................................................................................4.13 90 Candestar F Tab 8 mg .............................................................................................6.10 90 Candestar F Tab 16 mg .........................................................................................10.18 90 Candestar F Tab 32 mg .........................................................................................17.66 90 Candestar

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

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

53


CARDIOVASCULAR SYSTEM

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

¾SA1223 Special Authority for Subsidy Initial application — (ACE inhibitor intolerance) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 Patient has persistent ACE inhibitor induced cough that is not resolved by ACE inhibitor retrial (same or new ACE inhibitor); or 2 Patient has a history of angioedema. Initial application — (Unsatisfactory response to ACE inhibitor) from any relevant practitioner. Approvals valid without further renewal unless notified where patient is not adequately controlled on maximum tolerated dose of an ACE inhibitor. LOSARTAN POTASSIUM F Tab 12.5 mg ........................................................................................2.88 90 Lostaar F Tab 25 mg ...........................................................................................3.20 90 Lostaar F Tab 50 mg ...........................................................................................5.22 90 Lostaar F Tab 100 mg .........................................................................................8.68 90 Lostaar

Angiotension II Antagonists with Diuretics

LOSARTAN POTASSIUM WITH HYDROCHLOROTHIAZIDE Tab 50 mg with hydrochlorothiazide 12.5 mg .....................................4.89 30

Arrow-Losartan &

Hydrochlorothiazide

Antiarrhythmics

For lignocaine hydrochloride refer to NERVOUS SYSTEM, Anaesthetics, Local, page 122 AMIODARONE HYDROCHLORIDE L Tab 100 mg – Retail pharmacy-Specialist ........................................18.65 30 L Tab 200 mg – Retail pharmacy-Specialist ........................................30.52 Inj 50 mg per ml, 3 ml ampoule – Up to 6 inj available on a PSO............................................................................................ 22.80 ATROPINE SULPHATE F Inj 600 mcg per ml, 1 ml ampoule – Up to 5 inj available on a PSO............................................................................................ 71.00 DIGOXIN F Tab 62.5 mcg – Up to 30 tab available on a PSO...............................6.67 F Tab 250 mcg – Up to 30 tab available on a PSO..............................14.52 F‡ Oral liq 50 mcg per ml ......................................................................16.60 DISOPYRAMIDE PHOSPHATE L Cap 100 mg ......................................................................................15.00 (23.87) L Cap 150 mg ......................................................................................26.21 FLECAINIDE ACETATE – Retail pharmacy-Specialist L Tab 50 mg .........................................................................................45.82 L Tab 100 mg – For flecainide acetate oral liquid formulation refer, page 194 ........................................................................... 80.92 L Cap long-acting 100 mg ...................................................................45.82 L Cap long-acting 200 mg ...................................................................80.92 Inj 10 mg per ml, 15 ml ampoule ......................................................52.45 30

Aratac Cordarone-X Aratac Cordarone-X Cordarone-X

6

50 240 240 60 ml 100

AstraZeneca Lanoxin PG Lanoxin Lanoxin

Rythmodan 100 60 60 30 30 5

Rythmodan Tambocor Tambocor Tambocor CR Tambocor CR Tambocor

54

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


CARDIOVASCULAR SYSTEM

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

MEXILETINE HYDROCHLORIDE L Cap 150 mg ......................................................................................65.00

100

Mexiletine

Hydrochloride USP Mexiletine Hydrochloride USP

L Cap 250 mg ....................................................................................102.00

100

PROPAFENONE HYDROCHLORIDE – Retail pharmacy-Specialist L Tab 150 mg .......................................................................................40.90

50

Rytmonorm

Antihypotensives

MIDODRINE – Special Authority see SA0934 below – Retail pharmacy Tab 2.5 mg ........................................................................................53.00 Tab 5 mg ...........................................................................................79.00 100 100

Gutron Gutron

¾SA0934 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Disabling orthostatic hypotension not due to drugs; and 2 Patient has tried fludrocortisone (unless contra-indicated) with unsatisfactory results; and 3 Patient has tried non pharmacological treatments such as support hose, increased salt intake, exercise, and elevation of head and trunk at night. Notes: Treatment should be started with small doses and titrated upwards as necessary. Hypertension should be avoided, and the usual target is a standing systolic blood pressure of 90 mm Hg. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

Beta Adrenoceptor Blockers

ATENOLOL F Tab 50 mg ...........................................................................................5.56 F Tab 100 mg .........................................................................................9.12 F Oral liq 25 mg per 5 ml .....................................................................21.25 Restricted to children under 12 years of age. BISOPROLOL Tab 2.5 mg ..........................................................................................3.88 Tab 5 mg .............................................................................................4.74 Tab 10 mg ...........................................................................................9.18 CARVEDILOL F Tab 6.25 mg ......................................................................................21.00 F Tab 12.5 mg ......................................................................................27.00 F Tab 25 mg – For carvedilol oral liquid formulation refer, page 194 ............................................................................................. 33.75 CELIPROLOL F Tab 200 mg .......................................................................................19.00 500 500 300 ml OP

Mylan Atenolol Mylan Atenolol Atenolol AFT Bosvate Bosvate Bosvate Dilatrend Dilatrend Dilatrend Celol

30 30 30 30 30 30 180

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

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

55


CARDIOVASCULAR SYSTEM

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

LABETALOL F Tab 50 mg ...........................................................................................8.23 F Tab 100 mg – For labetalol oral liquid formulation refer, page 194 ............................................................................................. 10.06 F Tab 200 mg .......................................................................................17.55 F Inj 5 mg per ml, 20 ml ampoule ........................................................59.06 (88.60) METOPROLOL SUCCINATE F Tab long-acting 23.75 mg ...................................................................0.96 F Tab long-acting 47.5 mg .....................................................................1.41 F Tab long-acting 95 mg ........................................................................2.42 F Tab long-acting 190 mg ......................................................................4.66 METOPROLOL TARTRATE F Tab 50 mg – For metoprolol tartrate oral liquid formulation refer, page 194 ........................................................................... 16.00 F Tab 100 mg .......................................................................................21.00 F Tab long-acting 200 mg ....................................................................18.00 F Inj 1 mg per ml, 5 ml vial ...................................................................24.00 NADOLOL F Tab 40 mg .........................................................................................15.57 F Tab 80 mg .........................................................................................23.74 PINDOLOL F Tab 5 mg .............................................................................................9.72 F Tab 10 mg .........................................................................................15.62 F Tab 15 mg .........................................................................................23.46 PROPRANOLOL F Tab 10 mg ...........................................................................................3.65 F Tab 40 mg ...........................................................................................4.65 F Cap long-acting 160 mg ...................................................................16.06 F Oral liq 4 mg per ml – Special Authority see SA1327 below – Retail pharmacy ........................................................................ CBS

100 100 100 5

Hybloc Hybloc Hybloc

Trandate

30 30 30 30

Metoprolol - AFT CR Metoprolol - AFT CR Metoprolol - AFT CR Metoprolol - AFT CR

100 60 28 5 100 100 100 100 100 100

Lopresor Lopresor Slow-Lopresor Lopresor Apo-Nadolol Apo-Nadolol Apo-Pindolol Apo-Pindolol Apo-Pindolol ApoPropranolol

100

ApoPropranolol

100 500 ml

Cardinol LA Roxane

¾SA1327 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 For the treatment of a child under 12 years with an haemangioma causing functional impairment (not for cosmetic reasons only); or 2 For the treatment of a child under 12 years with cardiac arrthymias or congenital cardiac abnormalities. Renewal from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 For the treatment of a child under 12 years with an haemangioma causing functional impairment (not for cosmetic reasons only); or 2 For the treatment of a child under 12 years with cardiac arrthymias or congenital cardiac abnormalities.

56

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


CARDIOVASCULAR SYSTEM

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

SOTALOL F Tab 80 mg – For sotalol oral liquid formulation refer, page 194 .........27.50 F Tab 160 mg .......................................................................................10.50 F Inj 10 mg per ml, 4 ml ampoule ........................................................65.39 TIMOLOL MALEATE F Tab 10 mg .........................................................................................10.55

500 100 5 100

Mylan Mylan Sotacor Apo-Timol

Calcium Channel Blockers Dihydropyridine Calcium Channel Blockers

AMLODIPINE F Tab 2.5 mg ..........................................................................................2.45 F Tab 5 mg – For amlodipine oral liquid formulation refer, page 194 ............................................................................................... 2.65 F Tab 10 mg ...........................................................................................4.15 FELODIPINE F Tab long-acting 2.5 mg .......................................................................2.90 F Tab long-acting 5 mg ..........................................................................3.10 F Tab long-acting 10 mg ........................................................................4.60 ISRADIPINE F Cap long-acting 2.5 mg ......................................................................7.50 F Cap long-acting 5 mg .........................................................................7.85 NIFEDIPINE F Tab long-acting 10 mg ......................................................................17.72 F Tab long-acting 20 mg ........................................................................9.59 F Tab long-acting 30 mg ........................................................................8.56 5.50 (19.90) F Tab long-acting 60 mg ......................................................................12.28 8.00 (29.50) 100 100 100 30 30 30 30 30 60 100 30

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

Adalat Oros

30

Adefin XL Arrow-Nifedipine XR

Adalat Oros

Other Calcium Channel Blockers

DILTIAZEM HYDROCHLORIDE F Tab 30 mg ...........................................................................................4.60 F Tab 60 mg – For diltiazem hydrochloride oral liquid formulation refer, page 194....................................................................... 8.50 F Cap long-acting 120 mg ...................................................................31.83 F Cap long-acting 180 mg ...................................................................47.67 F Cap long-acting 240 mg ...................................................................63.58 100 100 500 500 500

Dilzem Dilzem Apo-Diltiazem CD Apo-Diltiazem CD Apo-Diltiazem CD Pexsig

PERHEXILINE MALEATE – Special Authority see SA1260 on the next page – Retail pharmacy F Tab 100 mg .......................................................................................62.90 100

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

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

57


CARDIOVASCULAR SYSTEM

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

¾SA1260 Special Authority for Subsidy Initial application only from a cardiologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient has refractory angina; and 2 Patient is on the maximal tolerated dose of a beta-blocker, a calcium channel blocker and a long acting nitrate. Renewal only from a cardiologist or any relevant practitioner on the recommendation of a cardiologist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. VERAPAMIL HYDROCHLORIDE F Tab 40 mg ...........................................................................................7.01 100 Isoptin F Tab 80 mg – For verapamil hydrochloride oral liquid formulation refer, page 194..................................................................... 11.74 100 Isoptin F Tab long-acting 120 mg ....................................................................15.20 250 Verpamil SR F Tab long-acting 240 mg ....................................................................25.00 250 Verpamil SR F Inj 2.5 mg per ml, 2 ml ampoule – Up to 5 inj available on a PSO.............................................................................................. 7.54 5 Isoptin

Centrally-Acting Agents

CLONIDINE F Patch 2.5 mg, 100 mcg per day – Only on a prescription.................23.30 F Patch 5 mg, 200 mcg per day – Only on a prescription....................32.80 F Patch 7.5 mg, 300 mcg per day – Only on a prescription.................41.20 CLONIDINE HYDROCHLORIDE F Tab 25 mcg .......................................................................................15.09 F Tab 150 mcg .....................................................................................34.32 F Inj 150 mcg per ml, 1 ml ampoule ....................................................16.07 METHYLDOPA F Tab 125 mg .......................................................................................14.25 F Tab 250 mg .......................................................................................15.10 F Tab 500 mg .......................................................................................23.15 4 4 4 112 100 5 100 100 100

Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Clonidine BNM Catapres Catapres Prodopa Prodopa Prodopa

Diuretics Loop Diuretics

BUMETANIDE F Tab 1 mg ...........................................................................................16.36 F Inj 500 mcg per ml, 4 ml vial ...............................................................7.95 FUROSEMIDE [FRUSEMIDE] F Tab 40 mg – Up to 30 tab available on a PSO..................................10.25 F Tab 500 mg .......................................................................................25.00 F‡ Oral liq 10 mg per ml ........................................................................10.66 F Inj 10 mg per ml, 25 ml ampoule ......................................................48.14 F Inj 10 mg per ml, 2 ml ampoule – Up to 5 inj available on a PSO.............................................................................................. 1.30 100 5 1,000 50 30 ml OP 5 5

Burinex Burinex Diurin 40 Urex Forte Lasix Lasix Frusemide-Claris

Potassium Sparing Diuretics

AMILORIDE HYDROCHLORIDE F Tab 5 mg ...........................................................................................17.50 ‡ Oral liq 1 mg per ml ..........................................................................30.00 100 25 ml OP

Apo-Amiloride Biomed

58

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


CARDIOVASCULAR SYSTEM

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

METOLAZONE – Special Authority see SA1349 below – Retail pharmacy Tab 5 mg ...........................................................................................CBS

1 50

Metolazone Zaroxolyn

¾SA1349 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where used for the treatment of patients with refractory heart failure who are intolerant or have not responded to loop diuretics and/or loop-thiazide combination therapy. SPIRONOLACTONE F Tab 25 mg ...........................................................................................3.65 100 Spiractin Spirotone F Tab 100 mg .......................................................................................11.80 100 Spiractin Spirotone ‡ Oral liq 5 mg per ml ..........................................................................30.00 25 ml OP Biomed

Potassium Sparing Combination Diuretics

AMILORIDE HYDROCHLORIDE WITH FUROSEMIDE F Tab 5 mg with furosemide 40 mg ........................................................8.63 AMILORIDE HYDROCHLORIDE WITH HYDROCHLOROTHIAZIDE F Tab 5 mg with hydrochlorothiazide 50 mg ..........................................5.00 28 50

Frumil Moduretic

Thiazide and Related Diuretics

BENDROFLUMETHIAZIDE [BENDROFLUAZIDE] F Tab 2.5 mg – Up to 150 tab available on a PSO.................................6.48 May be supplied on a PSO for reasons other than emergency. F Tab 5 mg .............................................................................................9.95 CHLOROTHIAZIDE ‡ Oral liq 50 mg per ml ........................................................................26.00 CHLORTALIDONE [CHLORTHALIDONE] F Tab 25 mg ..........................................................................................4.80 8.00 (Igroton Tab 25 mg to be delisted 1 January 2014) INDAPAMIDE F Tab 2.5 mg ..........................................................................................2.25 500 500

ArrowBendrofluazide

ArrowBendrofluazide

25 ml OP 30 50

Biomed Igroton Hygroton

90

Dapa-Tabs

Lipid-Modifying Agents Fibrates

BEZAFIBRATE F Tab 200 mg .........................................................................................9.70 F Tab long-acting 400 mg ......................................................................5.70 GEMFIBROZIL F Tab 600 mg .......................................................................................17.60 90 30 60

Bezalip Bezalip Retard Lipazil

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

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

59


CARDIOVASCULAR SYSTEM

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

Other Lipid-Modifying Agents

ACIPIMOX F Cap 250 mg ......................................................................................18.75 NICOTINIC ACID F Tab 50 mg ...........................................................................................4.17 F Tab 500 mg .......................................................................................16.54 30 100 100

Olbetam Apo-Nicotinic Acid Apo-Nicotinic Acid

Resins

CHOLESTYRAMINE Powder for oral liq 4 g .......................................................................19.25 (52.68) COLESTIPOL HYDROCHLORIDE Grans for oral liq 5 g .........................................................................20.00 50 Questran-Lite 30

Colestid

HMG CoA Reductase Inhibitors (Statins)

Prescribing Guidelines Treatment with HMG CoA Reductase Inhibitors (statins) is recommended for patients with dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater. ATORVASTATIN – See prescribing guideline above F Tab 10 mg ...........................................................................................2.52 90 Zarator F Tab 20 mg ...........................................................................................4.17 90 Zarator F Tab 40 mg ...........................................................................................7.32 90 Zarator F Tab 80 mg .........................................................................................16.23 90 Zarator PRAVASTATIN – See prescribing guideline above F Tab 20 mg ...........................................................................................5.44 F Tab 40 mg ...........................................................................................9.28 SIMVASTATIN – See prescribing guideline above F Tab 10 mg ...........................................................................................1.40 F Tab 20 mg ...........................................................................................1.95 F Tab 40 mg ...........................................................................................3.18 F Tab 80 mg ...........................................................................................9.31 30 30 90 90 90 90

Cholvastin Cholvastin Arrow-Simva 10mg Arrow-Simva 20mg Arrow-Simva 40mg Arrow-Simva 80mg

Selective Cholesterol Absorption Inhibitors

EZETIMIBE – Special Authority see SA1045 below – Retail pharmacy Tab 10 mg .........................................................................................34.43 30

Ezetrol

¾SA1045 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years; and 2 Patient’s LDL cholesterol is 2.0 mmol/litre or greater; and 3 Any of the following: 3.1 The patient has rhabdomyolysis (defined as muscle aches and creatine kinase more than 10 × normal) when treated with one statin; or 3.2 The patient is intolerant to both simvastatin and atorvastatin; or 3.3 The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin. continued. . .

60

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


CARDIOVASCULAR SYSTEM

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

continued. . . Notes: A patient who has failed to reduce their LDL cholesterol to < 2.0 mmol/litre with the use of a less potent statin should use a more potent statin prior to consideration being given to the use of non-statin therapies. Other treatment options including fibrates, resins and nicotinic acid should be considered after failure of statin therapy. If a patient’s LDL cholesterol cannot be calculated because the triglyceride level is too high then a repeat test should be performed and if the LDL cholesterol again cannot be calculated then it can be considered that the LDL cholesterol is greater than 2.0 mmol/litre. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. EZETIMIBE WITH SIMVASTATIN – Special Authority see SA1046 below – Retail pharmacy 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 ¾SA1046 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 year; and 2 Patient’s LDL cholesterol is 2.0 mmol/litre or greater; and 3 The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin. Notes: A patient who has failed to reduce their LDL cholesterol to ≤ 2.0 mmol/litre with the use of a less potent statin should use a more potent statin prior to consideration being given to the use of non-statin therapies. Other treatment options including fibrates, resins and nicotinic acid should be considered after failure of statin therapy. If a patient’s LDL cholesterol cannot be calculated because the triglyceride level is too high then a repeat test should be performed and if the LDL cholesterol again cannot be calculated then it can be considered that the LDL cholesterol is greater than 2.0 mmol/litre. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

Nitrates

GLYCERYL TRINITRATE F Tab 600 mcg – Up to 100 tab available on a PSO..............................8.00 F Oral spray, 400 mcg per dose – Up to 250 dose available on a PSO........................................................................................... 4.45 F Patch 25 mg, 5 mg per day ...............................................................16.56 F Patch 50 mg, 10 mg per day .............................................................19.50 ISOSORBIDE MONONITRATE F Tab 20 mg .........................................................................................17.10 F Tab long-acting 40 mg ........................................................................7.50 F Tab long-acting 60 mg ........................................................................3.94 100 OP 250 dose OP 30 30 100 30 90

Lycinate Glytrin Nitroderm TTS Nitroderm TTS Ismo 20 Corangin Duride

Sympathomimetics

ADRENALINE Inj 1 in 1,000, 1 ml ampoule – Up to 5 inj available on a PSO............4.98 5.25 Inj 1 in 10,000, 10 ml ampoule – Up to 5 inj available on a PSO............................................................................................ 27.00 49.00 5

Aspen Adrenaline Hospira Hospira Aspen Adrenaline

5 10

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

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

61


CARDIOVASCULAR SYSTEM

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

ISOPRENALINE F Inj 200 mcg per ml, 1 ml ampoule ....................................................36.80 (135.00)

25 Isuprel

Vasodilators

AMYL NITRITE F Liq 98% in 0.3 ml cap .......................................................................62.92 (73.40) HYDRALAZINE HYDROCHLORIDE F Tab 25 mg – Special Authority see SA1321 below – Retail pharmacy ................................................................................... CBS F Inj 20 mg ampoule ............................................................................25.90 12 Baxter

1 56 5

Hydralazine Onelink Apresoline

¾SA1321 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 For the treatment of refractory hypertension; or 2 For the treatment of heart failure in combination with a nitrate, in patients who are intolerant or have not responded to ACE inhibitors and/or angiotensin receptor blockers. MINOXIDIL – Special Authority see SA1271 below – Retail pharmacy L Tab 10 mg .........................................................................................70.00 100 Loniten ¾SA1271 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid without further renewal unless notified where patient has severe refractory hypertension which has failed to respond to extensive multiple therapies. NICORANDIL – Special Authority see SA1263 below – Retail pharmacy L Tab 10 mg .........................................................................................27.95 60 Ikorel L Tab 20 mg .........................................................................................33.28 60 Ikorel ¾SA1263 Special Authority for Subsidy Initial application only from a cardiologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient has refractory angina; and 2 Patient is on the maximal tolerated dose of a beta-blocker, a calcium channel blocker and a long acting nitrate. Renewal only from a cardiologist or any relevant practitioner on the recommendation of a cardiologist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. PAPAVERINE HYDROCHLORIDE F Inj 12 mg per ml, 10 ml ampoule ......................................................73.12 5 Hospira PENTOXIFYLLINE [OXPENTIFYLLINE] Tab 400 mg .......................................................................................36.94 (42.26) 50 Trental 400

62

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


CARDIOVASCULAR SYSTEM

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

Endothelin Receptor Antagonists

¾SA0967 Special Authority for Subsidy Special Authority approved by the Pulmonary Arterial Hypertension Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Coordinator, PAH Panel PHARMAC, PO Box 10-254, WELLINGTON Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz AMBRISENTAN – Special Authority see SA0967 above – Retail pharmacy Tab 5 mg ......................................................................................4,585.00 Tab 10 mg ....................................................................................4,585.00 BOSENTAN – Special Authority see SA0967 above – Retail pharmacy Tab 62.5 mg .................................................................................2,000.00 4,585.00 Tab 125 mg ..................................................................................2,000.00 4,585.00 30 30 60 60

Volibris Volibris pms-Bosentan Tracleer pms-Bosentan Tracleer

Phosphodiesterase Type 5 Inhibitors

¾SA1293 Special Authority for Subsidy Initial application — (Raynaud’s Phenomenon* - for Pulmonary Arterial Hypertension see note below)) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 Patient has Raynaud’s Phenomenon*; and 2 Patient has severe digital ischaemia (defined as severe pain requiring hospital admission or with a high likelihood of digital ulceration; digital ulcers; or gangrene); and 3 Patient is following lifestyle management (avoidance of cold exposure, sufficient protection, smoking cessation support, avoidance of sympathomimetic drugs) ; and 4 Patient is being treated with calcium channel blockers and nitrates (or these are contraindicated/not tolerated). Notes: Sildenafil is also funded for patients with Pulmonary Arterial Hypertension who are approved by the Pulmonary Arterial Hypertension Panel (an application must be made using form SA1293-PAH). Application details may be obtained from: The Coordinator, PAH Panel PHARMAC, PO Box 10 254, Wellington Phone: (04) 916 7512 Facsimile: (04) 974 4858 Email: PAH@pharmac.govt.nz Indications marked with * are Unapproved Indications. SILDENAFIL – Special Authority see SA1293 above – Retail pharmacy Tab 25 mg ...........................................................................................1.85 4 Silagra Tab 50 mg ...........................................................................................1.85 4 Silagra Tab 100 mg – For sildenafil oral liquid formulation refer, page 194 ............................................................................................... 7.45 4 Silagra

Prostacyclin Analogues

¾SA0969 Special Authority for Subsidy Special Authority approved by the Pulmonary Arterial Hypertension Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Coordinator, PAH Panel PHARMAC, PO Box 10-254, WELLINGTON Tel: (04) 916 7512, Fax: (04) 974 4858, Email: PAH@pharmac.govt.nz

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

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

63


CARDIOVASCULAR SYSTEM

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

ILOPROST – Special Authority see SA0969 on the previous page – Retail pharmacy Nebuliser soln 10 mcg per ml, 2 ml .............................................1,185.00 30

Ventavis

64

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


DERMATOLOGICALS

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

Antiacne Preparations

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 90 ADAPALENE a) Maximum of 30 g per prescription b) Only on a prescription Crm 0.1% .........................................................................................22.89 Gel 0.1% ...........................................................................................22.89 ISOTRETINOIN – Special Authority see SA0955 below – Retail pharmacy Cap 10 mg ........................................................................................18.71 Cap 20 mg ........................................................................................28.91

30 g OP 30 g OP 120 120

Differin Differin Oratane Oratane

¾SA0955 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Patient has had an adequate trial on other available treatments and has received an inadequate response from these treatments or these are contraindicated; and 2 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 3 Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin; and 4 Either: 4.1 Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment; or 4.2 Patient is male. Note: Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body. Renewal from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Patient has had an adequate trial on other available treatments and has received an inadequate response from these treatments or these are contraindicated; and 2 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 3 Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin; and 4 Either: 4.1 Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment; or 4.2 Patient is male. Note: Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body. TRETINOIN Crm 0.5 mg per g – Maximum of 50 g per prescription ....................13.90 50 g OP ReTrieve

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

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

65


DERMATOLOGICALS

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

Antibacterials Topical

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 90 FUSIDIC ACID Crm 2% .............................................................................................3.25 a) Maximum of 15 g per prescription b) Only on a prescription c) Not in combination Oint 2% ..............................................................................................3.45 a) Maximum of 15 g per prescription b) Only on a prescription c) Not in combination HYDROGEN PEROXIDE F Crm 1% ..............................................................................................8.56 MUPIROCIN Oint 2% ...............................................................................................6.60 (9.26) a) Only on a prescription b) Not in combination SILVER SULPHADIAZINE Crm 1% ............................................................................................12.30 a) Up to 250 g available on a PSO b) Not in combination

15 g OP

Foban

15 g OP

Foban

15 g OP 15 g OP

Crystaderm

Bactroban

50 g OP

Flamazine

Antifungals Topical

For systemic antifungals, refer to INFECTIONS, Antifungals, page 96 AMOROLFINE a) Only on a prescription b) Not in combination Nail soln 5% ......................................................................................37.86 (61.87) CICLOPIROX OLAMINE a) Only on a prescription b) Not in combination Nail-soln 8% .......................................................................................8.23 Soln 1% ..............................................................................................4.36 (11.54) CLOTRIMAZOLE F Crm 1% ..............................................................................................0.54 a) Only on a prescription b) Not in combination F Soln 1% ..............................................................................................4.36 (7.55) a) Only on a prescription b) Not in combination

5 ml OP Loceryl

7 ml OP 20 ml OP

Apo-Ciclopirox

Batrafen

20 g OP

Clomazol

20 ml OP Canesten

66

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


DERMATOLOGICALS

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

ECONAZOLE NITRATE Crm 1% ..............................................................................................1.00 (7.48) a) Only on a prescription b) Not in combination Foaming soln 1%, 10 ml sachets ........................................................9.89 (17.23) a) Only on a prescription b) Not in combination MICONAZOLE NITRATE F Crm 2% ..............................................................................................0.46 a) Only on a prescription b) Not in combination F Lotn 2% ..............................................................................................4.36 (10.03) a) Only on a prescription b) Not in combination F Tinct 2% ..............................................................................................4.36 (12.10) a) Only on a prescription b) Not in combination NYSTATIN Crm 100,000 u per g ..........................................................................1.00 (7.90) a) Only on a prescription b) Not in combination

20 g OP Pevaryl

3 Pevaryl

15 g OP

Multichem

30 ml OP Daktarin

30 ml OP Daktarin

15 g OP Mycostatin

Antipruritic Preparations

CALAMINE a) Only on a prescription b) Not in combination Crm, aqueous, BP ..............................................................................1.77 Lotn, BP ............................................................................................13.45 CROTAMITON a) Only on a prescription b) Not in combination Crm 10% ............................................................................................3.48

100 g 2,000 ml

Pharmacy Health PSM

20 g OP

Itch-Soothe

MENTHOL – Only in combination Only in combination with aqueous cream, 10% urea cream, wool fat with mineral oil lotion, 1% hydrocortisone with wool fat and mineral oil lotion, and glycerol, paraffin and cetyl alcohol lotion Crystals ..............................................................................................6.50 25 g PSM 6.92 MidWest 29.60 100 g MidWest

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

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

67


DERMATOLOGICALS

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

Corticosteroids Topical

For systemic corticosteroids, refer to CORTICOSTEROIDS AND RELATED AGENTS, page 82

Corticosteroids - Plain

BETAMETHASONE DIPROPIONATE Crm 0.05% .........................................................................................2.96 8.97 Crm 0.05% in propylene glycol base ..................................................4.33 Oint 0.05% ..........................................................................................2.96 8.97 Oint 0.05% in propylene glycol base ..................................................4.33 BETAMETHASONE VALERATE F Crm 0.1% ...........................................................................................3.50 F Oint 0.1% ............................................................................................3.50 F Lotn 0.1% .........................................................................................10.05 CLOBETASOL PROPIONATE F Crm 0.05% .........................................................................................3.68 F Oint 0.05% ..........................................................................................3.68 CLOBETASONE BUTYRATE Crm 0.05% .........................................................................................5.38 (7.09) 16.13 (22.00) DIFLUCORTOLONE VALERATE Crm 0.1% ...........................................................................................8.97 (15.86) Fatty oint 0.1% ....................................................................................8.97 (15.86) 15 g OP 50 g OP 30 g OP 15 g OP 50 g OP 30 g OP 50 g OP 50 g OP 50 ml OP 30 g OP 30 g OP 30 g OP Eumovate 100 g OP Eumovate 50 g OP Nerisone 50 g OP Nerisone

Diprosone Diprosone Diprosone OV Diprosone Diprosone Diprosone OV Beta Cream Beta Ointment Betnovate Dermol Dermol

HYDROCORTISONE F Crm 1% – Only on a prescription .......................................................3.75 100 g 14.00 500 g F Powder – Only in combination .........................................................44.00 25 g Up to 5% in a dermatological base (not proprietary Topical Corticosteriod – Plain) with galenicals. Refer, page 193 HYDROCORTISONE BUTYRATE Lipocream 0.1% ..................................................................................2.30 30 g OP 6.85 100 g OP Oint 0.1% ............................................................................................6.85 100 g OP Milky emul 0.1% .................................................................................6.85 100 ml OP HYDROCORTISONE WITH WOOL FAT AND MINERAL OIL Lotn 1% with wool fat hydrous 3% and mineral oil – Only on a prescription................................................................................ 9.95 METHYLPREDNISOLONE ACEPONATE Crm 0.1% ...........................................................................................4.95 Oint 0.1% ............................................................................................4.95

Pharmacy Health Pharmacy Health ABM

or without other dermatological

Locoid Lipocream Locoid Lipocream Locoid Locoid Crelo

250 ml 15 g OP 15 g OP

DP Lotn HC Advantan Advantan

68

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


DERMATOLOGICALS

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

MOMETASONE FUROATE Crm 0.1% ...........................................................................................1.78 3.42 Oint 0.1% ............................................................................................1.78 3.42 Lotn 0.1% ...........................................................................................7.35 TRIAMCINOLONE ACETONIDE Crm 0.02% .........................................................................................6.63 Oint 0.02% ..........................................................................................6.69

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

m-Mometasone m-Mometasone m-Mometasone m-Mometasone Elocon Aristocort Aristocort

Corticosteroids - Combination

BETAMETHASONE VALERATE WITH CLIOQUINOL – Only on a prescription Crm 0.1% with clioquinol 3% ..............................................................3.49 (4.90) Oint 0.1% with clioquinol 3% ..............................................................3.49 (4.90) BETAMETHASONE VALERATE WITH FUSIDIC ACID Crm 0.1% with fusidic acid 2% ...........................................................3.49 (10.45) a) Maximum of 15 g per prescription b) Only on a prescription HYDROCORTISONE WITH MICONAZOLE – Only on a prescription F Crm 1% with miconazole nitrate 2% ...................................................2.10 15 g OP Betnovate-C 15 g OP Betnovate-C 15 g OP Fucicort

15 g OP

Micreme H Pimafucort Pimafucort

HYDROCORTISONE WITH NATAMYCIN AND NEOMYCIN – Only on a prescription Crm 1% with natamycin 1% and neomycin sulphate 0.5% ................2.79 15 g OP Oint 1% with natamycin 1% and neomycin sulphate 0.5% .................2.79 15 g OP TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g – Only on a prescription .............. 3.49 15 g OP (6.60)

Viaderm KC

Disinfecting and Cleansing Agents

CHLORHEXIDINE GLUCONATE – Subsidy by endorsement a) No more than 500 ml per month b) Only if prescribed for a dialysis patient and the prescription is endorsed accordingly. F Handrub 1% with ethanol 70% ...........................................................4.39 500 ml F Soln 4% ..............................................................................................5.90 500 ml

healthE Orion

TRICLOSAN – Subsidy by endorsement a) Maximum of 500 ml per prescription b) a) Only if prescribed for a patient identified with Methicillin-resistant Staphylococcus aureus (MRSA) prior to elective surgery in hospital and the prescription is endorsed accordingly; or b) Only if prescribed for a patient with recurrent Staphylococcus aureus infection and the prescription is endorsed accordingly Soln 1% ..............................................................................................4.50 500 ml OP Pharmacy Health 5.90 healthE

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

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

69


DERMATOLOGICALS

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

Barrier Creams and Emollients Barrier Creams

ZINC AND CASTOR OIL F Oint BP ...............................................................................................3.83 500 g

Multichem

Emollients

AQUEOUS CREAM F Crm .....................................................................................................1.96 CETOMACROGOL F Crm BP ...............................................................................................3.15 CETOMACROGOL WITH GLYCEROL Crm 90% with glycerol 10% ...............................................................4.50 500 g 500 g 500 ml OP

AFT PSM Pharmacy Health

Sorbolene with Glycerin Pharmacy Health Sorbolene with Glycerin

6.50

1,000 ml OP

EMULSIFYING OINTMENT F Oint BP ...............................................................................................3.04 OIL IN WATER EMULSION F Crm .....................................................................................................2.63 UREA F Crm 10% ............................................................................................1.65 3.07 WOOL FAT WITH MINERAL OIL – Only on a prescription F Lotn hydrous 3% with mineral oil ........................................................1.40 (3.50) 5.60 (9.54) 1.40 (4.53) 5.60 (11.95) (20.53) 1.40 (7.73) 5.60 (23.91)

500 g 500 g 100 g OP

AFT healthE Fatty Cream healthE Urea Cream Nutraplus

250 ml OP Hydroderm Lotion 1,000 ml Hydroderm Lotion 250 ml OP DP Lotion 1,000 ml DP Lotion Alpha-Keri Lotion 250 ml OP BK Lotion 1,000 ml BK Lotion

Other Dermatological Bases

PARAFFIN White soft – Only in combination .......................................................3.58 500 g (7.78) IPW 20.20 2,500 g IPW 3.58 500 g (8.69) PSM Only in combination with a dermatological galenical or as a diluent for a proprietary Topical Corticosteroid – Plain.

fully subsidised [HP4] refer page 7 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

70


DERMATOLOGICALS

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

Minor Skin Infections

POVIDONE IODINE Oint 10% .............................................................................................3.27 a) Maximum of 100 g per prescription b) Only on a prescription Antiseptic soln 10% ............................................................................0.19 (4.45) 1.28 (8.25) 6.20 1.28 (4.20) 6.20 Skin preparation, povidone iodine 10% with 30% alcohol ..................1.63 (3.65) 10.00 Skin preparation, povidone iodine 10% with 70% alcohol ..................1.63 (6.04) 8.13 (18.63) 25 g OP

Betadine

15 ml Betadine 100 ml Betadine 500 ml 100 ml 500 ml 100 ml 500 ml 100 ml 500 ml Orion

Betadine

Riodine

Riodine

Betadine Skin Prep

Betadine Skin Prep

Orion

Parasiticidal Preparations

GAMMA BENZENE HEXACHLORIDE Crm 1% ..............................................................................................3.50 50 g OP

Benhex

IVERMECTIN – Special Authority see SA1225 below – Retail pharmacy Tab 3 mg – Up to 100 tab available on a PSO..................................17.20 4 Stromectol 1) PSO for institutional use only. Must be endorsed with the name of the institution for which the PSO is required and a valid Special Authority for patient of that institution. 2) Ivermectin available on BSO provided the BSO includes a valid Special Authority for a patient of the institution. 3) For the purposes of subsidy of ivermectin, institution means age related residential care facilities, disability care facilities or penal institutions. ¾SA1225 Special Authority for Subsidy Initial application — (Scabies) from any relevant practitioner. Approvals valid for 1 month for applications meeting the following criteria: Both: 1 Applying clinician has discussed the diagnosis of scabies with a dermatologist, infectious disease physician or clinical microbiologist; and 2 Either: 2.1 Both: 2.1.1 The patient is in the community; and 2.1.2 Any of the following: 2.1.2.1 Patient has a severe scabies hyperinfestation (Crusted/ Norwegian scabies); or 2.1.2.2 The community patient is physically or mentally unable to comply with the application instructions of topical therapy; or 2.1.2.3 The patient has previously tried and failed to clear infestation using topical therapy; or 2.2 All of the following: 2.2.1 The Patient is a resident in an institution; and 2.2.2 All residents of the institution with scabies or at risk of carriage are to be treated for scabies concurrently; and continued. . .

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

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

71


DERMATOLOGICALS

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

continued. . . 2.2.3 Any of the following: 2.2.3.1 Patient has a severe scabies hyperinfestation (Crusted/ Norwegian scabies); or 2.2.3.2 The patient is physically or mentally unable to comply with the application instructions of topical therapy; or 2.2.3.3 Previous topical therapy has been tried and failed to clear the infestation. Note: Ivermectin is no more effective than topical therapy for treatment of standard scabies infestation. Initial application — (Other parasitic infections) only from an infectious disease specialist, clinical microbiologist or dermatologist. Approvals valid for 1 month for applications meeting the following criteria: Any of the following: 1 Filaricides; or 2 Cutaneous larva migrans (creeping eruption); or 3 Strongyloidiasis. Renewal — (Scabies) from any relevant practitioner. Approvals valid for 1 month for applications meeting the following criteria: Both: 1 Applying clinician has discussed the diagnosis of scabies with a dermatologist, infectious disease physician or clinical microbiologist; and 2 Either: 2.1 Both: 2.1.1 The patient is in the community; and 2.1.2 Any of the following: 2.1.2.1 Patient has a severe scabies hyperinfestation (Crusted/ Norwegian scabies); or 2.1.2.2 The community patient is physically or mentally unable to comply with the application instructions of topical therapy; or 2.1.2.3 The patient has previously tried and failed to clear infestation using topical therapy; or 2.2 All of the following: 2.2.1 The Patient is a resident in an institution; and 2.2.2 All residents of the institution with scabies or at risk of carriage are to be treated for scabies concurrently; and 2.2.3 Any of the following: 2.2.3.1 Patient has a severe scabies hyperinfestation (Crusted/ Norwegian scabies); or 2.2.3.2 The patient is physically or mentally unable to comply with the application instructions of topical therapy; or 2.2.3.3 Previous topical therapy has been tried and failed to clear the infestation. Note: Ivermectin is no more effective than topical therapy for treatment of standard scabies infestation. Renewal — (Other parasitic infections) only from an infectious disease specialist, clinical microbiologist or dermatologist. Approvals valid for 1 month for applications meeting the following criteria: Any of the following: 1 Filaricides; or 2 Cutaneous larva migrans (creeping eruption); or 3 Strongyloidiasis. MALATHION Liq 0.5% ..............................................................................................3.79 200 ml OP A-Lices Shampoo 1% ......................................................................................2.83 30 ml OP A-Lices MALATHION WITH PERMETHRIN AND PIPERONYL BUTOXIDE Spray 0.25% with permethrin 0.5% and piperonyl butoxide 2% .........11.15 PERMETHRIN Crm 5% ..............................................................................................4.20 Lotn 5% ..............................................................................................3.24 90 g OP 30 g OP 30 ml OP

Para Plus Lyderm A-Scabies

72

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


DERMATOLOGICALS

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

Psoriasis and Eczema Preparations

ACITRETIN – Special Authority see SA0954 below – Retail pharmacy Cap 10 mg ........................................................................................35.95 38.66 Cap 25 mg ........................................................................................83.11 85.40 100 60 60 100

Neotigason Novatretin Novatretin Neotigason

¾SA0954 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 2 Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin; and 3 Either: 3.1 Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment; or 3.2 Patient is male. Renewal from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice; and 2 Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin; and 3 Either: 3.1 Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment; or 3.2 Patient is male. BETAMETHASONE DIPROPIONATE WITH CALCIPOTRIOL Oint 500 mcg with calcipotriol 50 mcg ..............................................26.12 30 g OP Daivobet Topical gel 500 mcg with calcipotriol 50 mcg ....................................26.12 30 g OP Daivobet CALCIPOTRIOL Crm 50 mcg per g .............................................................................16.00 45.00 Oint 50 mcg per g .............................................................................45.00 Soln 50 mcg per ml ...........................................................................16.00 30 g OP 100 g OP 100 g OP 30 ml OP

Daivonex Daivonex Daivonex Daivonex

COAL TAR Soln BP – Only in combination ........................................................12.95 200 ml Midwest Up to 10 % Only in combination with a dermatological base or proprietary Topical Corticosteriod – Plain, refer, page 193 With or without other dermatological galenicals.

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

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

73


DERMATOLOGICALS

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

COAL TAR WITH ALLANTOIN, MENTHOL, PHENOL AND SULPHUR Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin crm 2.5% ....................................................................... 3.43 (4.35) 6.59 (8.00) COAL TAR WITH SALICYLIC ACID AND SULPHUR Soln 12% with salicylic acid 2% and sulphur 4% oint .........................7.95

30 g OP Egopsoryl TA 75 g OP Egopsoryl TA 40 g OP

Coco-Scalp

SALICYLIC ACID Powder – Only in combination .........................................................18.88 250 g PSM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain or collodion flexible, refer, page 193 2) With or without other dermatological galenicals. 3) Maximum 20 g or 20 ml per prescription when prescribed with white soft paraffin or collodion flexible. SULPHUR Precipitated – Only in combination ....................................................6.35 100 g Midwest 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, refer, page 193 2) With or without other dermatological galenicals. TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN – Only on a prescription F Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium ................................................................................. 3.05 500 ml Pinetarsol 5.82 1,000 ml Pinetarsol

Scalp Preparations

BETAMETHASONE VALERATE F Scalp app 0.1% ..................................................................................7.75 CLOBETASOL PROPIONATE F Scalp app 0.05% ................................................................................6.96 HYDROCORTISONE BUTYRATE Scalp lotn 0.1% ...................................................................................3.65 KETOCONAZOLE Shampoo 2% ......................................................................................3.08 a) Maximum of 100 ml per prescription b) Only on a prescription 100 ml OP 30 ml OP 100 ml OP 100 ml OP

Beta Scalp Dermol Locoid Sebizole

Sunscreens

SUNSCREENS, PROPRIETARY – Subsidy by endorsement Only if prescribed for a patient with severe photosensitivity secondary to a defined clinical condition and the prescription is endorsed accordingly. Crm .....................................................................................................2.55 100 g OP (5.89) Hamilton Sunscreen Lotn ....................................................................................................2.55 100 ml OP Marine Blue Lotion SPF 30+ 5.10 200 ml OP Marine Blue Lotion SPF 30+ 3.19 125 ml OP (6.94) Aquasun 30+

74

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


DERMATOLOGICALS

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

Wart Preparations

For salicylic acid preparations refer to PSORIASIS AND ECZEMA PREPARATIONS, page 73 IMIQUIMOD – Special Authority see SA0923 below – Retail pharmacy Crm 5% ............................................................................................62.00 12

Aldara

¾SA0923 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria: Any of the following: 1 The patient has external anogenital warts and podophyllotoxin has been tried and failed (or is contraindicated); or 2 The patient has external anogenital warts and podophyllotoxin is unable to be applied accurately to the site; or 3 The patient has confirmed superficial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate. Notes: Superficial basal cell carcinoma G Surgical excision remains first-line treatment for superficial basal cell carcinoma as it has a higher cure rate than imiquimod and allows histological assessment of tumour clearance. G Imiquimod has not been evaluated for the treatment of superficial basal cell carcinoma within 1 cm of the hairline, eyes, nose, mouth or ears. G Imiquimod is not indicated for recurrent, invasive, infiltrating, or nodular basal cell carcinoma. External anogenital warts G Imiquimod is only indicated for external genital and perianal warts (condyloma acuminata). Renewal from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria: Any of the following: 1 Inadequate response to initial treatment for anogenital warts; or 2 New confirmed superficial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate; or 3 Inadequate response to initial treatment for superficial basal cell carcinoma. Note: Every effort should be made to biopsy the lesion to confirm that it is a superficial basal cell carcinoma. PODOPHYLLOTOXIN Soln 0.5% .........................................................................................33.60 3.5 ml OP Condyline a) Maximum of 3.50 ml per prescription b) Only on a prescription

Other Skin Preparations Antineoplastics

FLUOROURACIL SODIUM Crm 5% ............................................................................................25.16 20 g OP

Efudix

Wound Management Products

MAGNESIUM SULPHATE F Paste .................................................................................................2.98 (4.90) (PSM Paste to be delisted 1 January 2014) 80 g PSM

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

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

75


GENITO-URINARY SYSTEM

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

Contraceptives - Non-hormonal Condoms

CONDOMS F 49 mm – Up to 144 dev available on a PSO.....................................13.36 F 52 mm – Up to 144 dev available on a PSO.....................................13.36 144 144

F 52 mm extra strength – Up to 144 dev available on a PSO..............13.36 F 53 mm – Up to 144 dev available on a PSO.......................................1.11 13.36 1.11 13.36

144 12 144 12 144

F 53 mm (chocolate) – Up to 144 dev available on a PSO....................1.11 13.36 F 53 mm (strawberry) – Up to 144 dev available on a PSO ..................1.11 13.36 F 54 mm, shaped – Up to 144 dev available on a PSO.........................1.12 (1.24) 13.36 (14.84) F 55 mm – Up to 144 dev available on a PSO.....................................13.36 F 56 mm – Up to 144 dev available on a PSO.......................................1.11 13.36

12 144 12 144 12 144

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

Lifestyles Flared Lifestyles Flared

144 12 144

Marquis Conforma Gold Knight Gold Knight Durex Extra Safe Durex Select

Flavours

F 56 mm, shaped – Up to 144 dev available on a PSO.........................1.11 13.36 F 60 mm – Up to 144 dev available on a PSO.....................................13.36

12 144 144

Durex Confidence Durex Confidence Shield XL

Contraceptive Devices

DIAPHRAGM – Up to 1 dev available on a PSO One of each size is permitted on a PSO. F 65 mm ...............................................................................................42.90 F 70 mm ...............................................................................................42.90 F 75 mm ...............................................................................................42.90 F 80 mm ...............................................................................................42.90 INTRA-UTERINE DEVICE a) Up to 40 dev available on a PSO b) Only on a PSO F IUD ...................................................................................................39.50

1 1 1 1

Ortho All-flex Ortho All-flex Ortho All-flex Ortho All-flex

1

Multiload Cu 375 Multiload Cu 375 SL

76

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


GENITO-URINARY SYSTEM

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

Contraceptives - Hormonal Combined Oral Contraceptives

¾SA0500 Special Authority for Alternate Subsidy Initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Either: 1.1 Patient is on a Social Welfare benefit; or 1.2 Patient has an income no greater than the benefit; and 2 Has tried at least one of the fully funded options and has been unable to tolerate it. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Patient is on a Social Welfare benefit; or 2 Patient has an income no greater than the benefit. Notes: The approval numbers of Special Authorities approved after 1 November 1999 are interchangeable between Mercilon and Marvelon. The additional subsidy will fund Mercilon and Marvelon up to the manufacturer’s price for each of these products as identified on the Schedule at 1 November 1999. Special Authorities approved before 1 November 1999 remain valid until the expiry date and can be renewed providing that women are still either: G on a Social Welfare benefit; or G have an income no greater than the benefit. The approval numbers of Special Authorities approved before 1 November 1999 are interchangeable for products within the combined oral contraceptives and progestogen-only contraceptives groups, except Loette and Microgynon 20 ED ETHINYLOESTRADIOL WITH DESOGESTREL F Tab 20 mcg with desogestrel 150 mcg and 7 inert tab .......................6.62 84 (16.50) Mercilon 28 a) Higher subsidy of $13.80 per 84 tab with Special Authority see SA0500 above b) Up to 84 tab available on a PSO F Tab 30 mcg with desogestrel 150 mcg and 7 inert tab .......................6.62 84 (16.50) Marvelon 28 a) Higher subsidy of $13.80 per 84 tab with Special Authority see SA0500 above b) Up to 84 tab available on a PSO ETHINYLOESTRADIOL WITH LEVONORGESTREL F Tab 20 mcg with levonorgestrel 100 mcg and 7 inert tab – Up to 84 tab available on a PSO........................................................ 2.95 84 Ava 20 ED F Tab 50 mcg with levonorgestrel 125 mcg and 7 inert tab – Up to 84 tab available on a PSO........................................................ 9.45 84 Microgynon 50 ED F Tab 30 mcg with levonorgestrel 150 mcg ...........................................6.62 63 (16.50) Microgynon 30 a) Higher subsidy of $15.00 per 63 tab with Special Authority see SA0500 above b) Up to 63 tab available on a PSO F Tab 30 mcg with levonorgestrel 150 mcg and 7 inert tab – Up to 84 tab available on a PSO........................................................ 2.45 84 Ava 30 ED

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

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

77


GENITO-URINARY SYSTEM

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

ETHINYLOESTRADIOL WITH NORETHISTERONE F Tab 35 mcg with norethisterone 1 mg – Up to 63 tab available on a PSO...................................................................................... 6.62 F Tab 35 mcg with norethisterone 1 mg and 7 inert tab – Up to 84 tab available on a PSO............................................................ 6.62 F Tab 35 mcg with norethisterone 500 mcg – Up to 63 tab available on a PSO .............................................................................. 6.62 F Tab 35 mcg with norethisterone 500 mcg and 7 inert tab – Up to 84 tab available on a PSO .................................................. 6.62

63 84 63 84

Brevinor 1/21 Brevinor 1/28 Brevinor 21 Norimin

NORETHISTERONE WITH MESTRANOL F Tab 1 mg with mestranol 50 mcg and 7 inert tab ...............................6.62 84 (13.80) Norinyl-1/28 a) Higher subsidy of $13.80 per 84 tab with Special Authority see SA0500 on the previous page b) Up to 84 tab available on a PSO (Norinyl-1/28 Tab 1 mg with mestranol 50 mcg and 7 inert tab to be delisted 1 March 2014)

Progestogen-only Contraceptives

¾SA0500 Special Authority for Alternate Subsidy Initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Either: 1.1 Patient is on a Social Welfare benefit; or 1.2 Patient has an income no greater than the benefit; and 2 Has tried at least one of the fully funded options and has been unable to tolerate it. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Patient is on a Social Welfare benefit; or 2 Patient has an income no greater than the benefit. Notes: The approval numbers of Special Authorities approved after 1 November 1999 are interchangeable between Mercilon and Marvelon. The additional subsidy will fund Mercilon and Marvelon up to the manufacturer’s price for each of these products as identified on the Schedule at 1 November 1999. Special Authorities approved before 1 November 1999 remain valid until the expiry date and can be renewed providing that women are still either: G on a Social Welfare benefit; or G have an income no greater than the benefit. The approval numbers of Special Authorities approved before 1 November 1999 are interchangeable for products within the combined oral contraceptives and progestogen-only contraceptives groups, except Loette and Microgynon 20 ED LEVONORGESTREL F Tab 30 mcg .........................................................................................6.62 84 (16.50) Microlut a) Higher subsidy of $13.80 per 84 tab with Special Authority see SA0500 above b) Up to 84 tab available on a PSO F Subdermal implant (2 × 75 mg rods) .............................................133.65 1 Jadelle MEDROXYPROGESTERONE ACETATE F Inj 150 mg per ml, 1 ml syringe – Up to 5 inj available on a PSO .........7.00 NORETHISTERONE F Tab 350 mcg – Up to 84 tab available on a PSO................................6.00 1 84

Depo-Provera Noriday 28

78

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


GENITO-URINARY SYSTEM

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

Emergency Contraceptives

LEVONORGESTREL F Tab 1.5 mg ..........................................................................................3.50 a) Up to 5 tab available on a PSO b) Maximum of 2 tab per prescription 1

Postinor-1

Antiandrogen Oral Contraceptives

Prescribers may code prescriptions “contraceptive” (code “O”) when used as indicated for contraception. The period of supply and prescription charge will be as per other contraceptives, as follows: G $5.00 prescription charge (patient co-payment) will apply. G prescription may be written for up to six months supply. Prescriptions coded in any other way are subject to the non contraceptive prescription charges, and the non-contraceptive period of supply. ie. Prescriptions may be written for up to three months supply. CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL F Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tabs – Up to 84 tab available on a PSO........................................................ 3.89 84 Ginet 84

Gynaecological Anti-infectives

ACETIC ACID WITH HYDROXYQUINOLINE AND RICINOLEIC ACID Jelly with glacial acetic acid 0.94%, hydroxyquinoline sulphate 0.025%, glycerol 5% and ricinoleic acid 0.75% with applicator ..................................................................................... 8.43 (24.00) CLOTRIMAZOLE F Vaginal crm 1% with applicators .........................................................1.45 F Vaginal crm 2% with applicators .........................................................2.20 MICONAZOLE NITRATE F Vaginal crm 2% with applicator ..........................................................2.75 (4.10) NYSTATIN Vaginal crm 100,000 u per 5 g with applicator(s) ...............................4.71

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

Clomazol Clomazol

Nilstat

Myometrial and Vaginal Hormone Preparations

ERGOMETRINE MALEATE Inj 500 mcg per ml, 1 ml – Up to 5 inj available on a PSO ...............31.00 OESTRIOL F Crm 1 mg per g with applicator ..........................................................6.30 F Pessaries 500 mcg .............................................................................6.53 OXYTOCIN – Up to 5 inj available on a PSO Inj 5 iu per ml, 1 ml ampoule ..............................................................4.75 5.94 Inj 10 iu per ml, 1 ml ampoule ............................................................5.98 7.48 Inj 5 iu with ergometrine maleate 500 mcg per ml, 1 ml ...................11.13 5 15 g OP 15 5 5 5

DBL Ergometrine Ovestin Ovestin Oxytocin BNM Syntocinon Oxytocin BNM Syntocinon Syntometrine

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

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

79


GENITO-URINARY SYSTEM

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

Pregnancy Tests - hCG Urine

PREGNANCY TESTS - HCG URINE a) Up to 200 test available on a PSO b) Only on a PSO Cassette ...........................................................................................22.80

40 test OP

Innovacon hCG One

Step Pregnancy Test

Urinary Agents

For urinary tract Infections refer to INFECTIONS, Antibacterials, page 110

5-Alpha Reductase Inhibitors

FINASTERIDE – Special Authority see SA0928 below – Retail pharmacy F Tab 5 mg .............................................................................................5.10 30

Rex Medical

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

Alpha-1A Adrenoreceptor Blockers

TAMSULOSIN HYDROCHLORIDE – Special Authority see SA1032 below – Retail pharmacy F Cap 400 mcg ....................................................................................13.51 100

Tamsulosin-Rex

¾SA1032 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Patient has symptomatic benign prostatic hyperplasia; and 2 The patient is intolerant of non-selective alpha blockers or these are contraindicated.

Other Urinary Agents

OXYBUTYNIN F Tab 5 mg ...........................................................................................11.20 F Oral liq 5 mg per 5 ml .......................................................................56.45 POTASSIUM CITRATE Oral liq 3 mmol per ml – Special Authority see SA1083 below – Retail pharmacy ..................................................................... 30.00 500 473 ml

Apo-Oxybutynin Apo-Oxybutynin

200 ml OP

Biomed

¾SA1083 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has recurrent calcium oxalate urolithiasis; and 2 The patient has had more than two renal calculi in the two years prior to the application. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefitting from the treatment.

fully subsidised [HP4] refer page 7 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

80


GENITO-URINARY SYSTEM

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

SODIUM CITRO-TARTRATE F Grans eff 4 g sachets .........................................................................2.71

28

Ural Vesicare Vesicare

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

¾SA0998 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has overactive bladder and a documented intolerance of, or is non-responsive to oxybutynin. TOLTERODINE – Special Authority see SA1272 below – Retail pharmacy Tab 1 mg ...........................................................................................14.56 56 Arrow-Tolterodine Tab 2 mg ...........................................................................................14.56 56 Arrow-Tolterodine ¾SA1272 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where patient has overactive bladder and a documented intolerance of, or is non-responsive to oxybutynin.

Detection of Substances in Urine

ORTHO-TOLIDINE F Compound diagnostic sticks ...............................................................7.50 (8.25) TETRABROMOPHENOL F Blue diagnostic strips .........................................................................7.02 (13.92) 50 test OP Hemastix 100 test OP Albustix

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

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

81


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

Calcium Homeostasis

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

Miacalcic

Corticosteroids and Related Agents for Systemic Use

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

DEXAMETHASONE F Tab 1 mg – Retail pharmacy-Specialist ..............................................5.87 100 Up to 30 tab available on a PSO F Tab 4 mg – Retail pharmacy-Specialist ..............................................8.16 100 Up to 30 tab available on a PSO Oral liq 1 mg per ml – Retail pharmacy-Specialist ...........................45.00 25 ml OP Oral liq prescriptions: 1) Must be written by a Paediatrician or Paediatric Cardiologist; or 2) On the recommendation of a Paediatrician or Paediatric Cardiologist. DEXAMETHASONE SODIUM PHOSPHATE Dexamethasone sodium phosphate injection will not be funded for oral use. F Inj 4 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................21.50 5 F Inj 4 mg per ml, 2 ml – Up to 5 inj available on a PSO .....................31.00 5 FLUDROCORTISONE ACETATE F Tab 100 mcg .....................................................................................14.32 HYDROCORTISONE F Tab 5 mg .............................................................................................8.10 F Tab 20 mg – For hydrocortisone oral liquid formulation refer, page 194 .................................................................................... 20.32 F Inj 100 ml vial ......................................................................................4.99 a) Up to 5 inj available on a PSO b) Only on a PSO METHYLPREDNISOLONE – Retail pharmacy-Specialist F Tab 4 mg ...........................................................................................60.00 F Tab 100 mg .....................................................................................166.52 METHYLPREDNISOLONE ACETATE Inj 40 mg per ml, 1 ml .........................................................................6.70 METHYLPREDNISOLONE ACETATE WITH LIDOCAINE [LIGNOCAINE] Inj 40 mg per ml with lidocaine [lignocaine] 1 ml ................................7.50 METHYLPREDNISOLONE SODIUM SUCCINATE – Retail pharmacy-Specialist Inj 40 mg per ml, 1 ml .........................................................................7.50 Inj 62.5 mg per ml, 2 ml ....................................................................18.50 Inj 500 mg .........................................................................................18.00 Inj 1 g ................................................................................................37.50 PREDNISOLONE SODIUM PHOSPHATE F Oral liq 5 mg per ml – Up to 30 ml available on a PSO ....................10.45 Restricted to children under 12 years of age. 100 100 100 1

Douglas Douglas Biomed

Hospira Hospira Florinef Douglas Douglas Solu-Cortef

100 20 1 1

Medrol Medrol Depo-Medrol Depo-Medrol with

Lidocaine

1 1 1 1 30 ml OP

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

82

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

PREDNISONE F Tab 1 mg .............................................................................................2.13 10.68 F Tab 2.5 mg ........................................................................................12.09 F Tab 5 mg – Up to 30 tab available on a PSO....................................11.09 F Tab 20 mg .........................................................................................29.03 TETRACOSACTRIN F Inj 250 mcg per ml, 1 ml ampoule ....................................................17.71 177.18 F Inj 1 mg per ml, 1 ml .........................................................................29.56 TRIAMCINOLONE ACETONIDE Inj 10 mg per ml, 1 ml .......................................................................21.90 Inj 40 mg per ml, 1 ml .......................................................................53.79

100 500 500 500 500 1 10 1 5 5

Apo-Prednisone

S29

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

Sex Hormones Non Contraceptive Androgen Agonists and Antagonists

CYPROTERONE ACETATE – Retail pharmacy-Specialist Tab 50 mg .........................................................................................18.80 Tab 100 mg .......................................................................................34.25 TESTOSTERONE Transdermal patch, 2.5 mg per day ..................................................80.00 TESTOSTERONE CYPIONATE – Retail pharmacy-Specialist Inj long-acting 100 mg per ml, 10 ml ................................................76.50 TESTOSTERONE ESTERS – Retail pharmacy-Specialist Inj 250 mg per ml, 1 ml .....................................................................12.98 TESTOSTERONE UNDECANOATE – Retail pharmacy-Specialist Cap 40 mg ........................................................................................31.17 Inj 250 mg per ml, 4 ml .....................................................................86.00 50 50 60 1 1 60 1

Siterone Siterone Androderm Depo-Testosterone Sustanon Ampoules Andriol Testocaps Reandron 1000

Hormone Replacement Therapy - Systemic

¾SA1018 Special Authority for Alternate Subsidy Initial application from any relevant practitioner. Approvals valid for 5 years for applications meeting the following criteria: Any of the following: 1 acute or significant liver disease - where oral oestrogens are contraindicated as determined by a gastroenterologist or general physician. The applicant must keep written confirmation from such a specialist with the patient’s record; or 2 oestrogen induced hypertension requiring antihypertensive therapy - documented evidence must be kept on file that raised blood pressure levels or inability to control blood pressure adequately occurred post oral oestrogens; or 3 hypertriglyceridaemia - documented evidence must be kept on file that triglyceride levels increased to at least 2 × normal triglyceride levels post oral oestrogens; or 4 Somatropin co-therapy - patient is being prescribed somatropin with subsidy provided under a valid approval issued under Special Authority. Note: Prescriptions with a valid Special Authority (CHEM) number will be reimbursed at the level of the lowest priced TDDS product within the specified dose group. Renewal from any relevant practitioner. Approvals valid for 5 years where the treatment remains appropriate and the patient is benefiting from treatment, or the patient remains on subsidised somatropin co-therapy.

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

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

83


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

Prescribing Guideline HRT should be taken at the lowest dose for the shortest period of time necessary to control symptoms. Patients should be reviewed 6 monthly in line with the updated NZGG “Evidence-based Best Practice Guideline on Hormone Replacement Therapy March 2004”.

Oestrogens

OESTRADIOL – See prescribing guideline above F Tab 1 mg .............................................................................................4.12 28 OP (10.55) Estrofem F Tab 2 mg .............................................................................................4.12 28 OP (10.55) Estrofem F TDDS 25 mcg per day .......................................................................3.01 8 (10.86) Estradot a) Higher subsidy of $10.86 per 8 patch with Special Authority see SA1018 on the previous page b) No more than 2 patch per week c) Only on a prescription F TDDS 3.9 mg (releases 50 mcg of oestradiol per day) .....................4.12 4 (13.18) Climara 50 (32.50) Femtran 50 a) Higher subsidy of $13.18 per 4 patch with Special Authority see SA1018 on the previous page b) No more than 1 patch per week c) Only on a prescription F TDDS 50 mcg per day .......................................................................4.12 8 (13.18) Estradot 50 mcg a) Higher subsidy of $13.18 per 8 patch with Special Authority see SA1018 on the previous page b) No more than 2 patch per week c) Only on a prescription F TDDS 7.8 mg (releases 100 mcg of oestradiol per day) ...................7.05 4 (16.14) Climara 100 (35.00) Femtran 100 a) Higher subsidy of $16.14 per 4 patch with Special Authority see SA1018 on the previous page b) No more than 1 patch per week c) Only on a prescription F TDDS 100 mcg per day .....................................................................7.05 8 (16.14) Estradot a) Higher subsidy of $16.14 per 8 patch with Special Authority see SA1018 on the previous page b) No more than 2 patch per week c) Only on a prescription OESTRADIOL VALERATE – See prescribing guideline above F Tab 1 mg ...........................................................................................12.36 84 Progynova F Tab 2 mg ...........................................................................................12.36 84 Progynova OESTROGENS – See prescribing guideline above F Conjugated, equine tab 300 mcg ........................................................3.01 (11.48) F Conjugated, equine tab 625 mcg ........................................................4.12 (11.48) 28 Premarin 28 Premarin

84

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

Progestogens

MEDROXYPROGESTERONE ACETATE – See prescribing guideline on the previous page F Tab 2.5 mg ..........................................................................................3.09 30 F Tab 5 mg ...........................................................................................13.06 100 F Tab 10 mg ...........................................................................................6.85 30

Provera Provera Provera

Progestogen and Oestrogen Combined Preparations

OESTRADIOL WITH NORETHISTERONE – See prescribing guideline on the previous page F Tab 1 mg with 0.5 mg norethisterone acetate .....................................5.40 28 OP (14.52) F Tab 2 mg with 1 mg norethisterone acetate ........................................5.40 28 OP (14.52) F Tab 2 mg with 1 mg norethisterone acetate (10), and 2 mg oestradiol tab (12) and 1 mg oestradiol tab (6) ............................ 5.40 28 OP (14.52)

Kliovance Kliogest

Trisequens

OESTROGENS WITH MEDROXYPROGESTERONE – See prescribing guideline on the previous page F Tab 625 mcg conjugated equine with 2.5 mg medroxyprogesterone acetate tab (28) ................................................................ 5.40 28 OP (22.96) Premia 2.5 Continuous F Tab 625 mcg conjugated equine with 5 mg medroxyprogesterone acetate tab (28) ................................................................ 5.40 28 OP (22.96) Premia 5 Continuous

Other Oestrogen Preparations

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

NZ Medical and

Scientific

30

Ovestin

Other Progestogen Preparations

LEVONORGESTREL F Levonorgestrel - releasing intrauterine system 20 mcg/24 hr – Special Authority see SA0782 below – Retail pharmacy ......... 269.50

1

Mirena

¾SA0782 Special Authority for Subsidy Initial application — (No previous use) only from a relevant specialist or general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient has a clinical diagnosis of heavy menstrual bleeding; and 2 The patient has failed to respond to or is unable to tolerate other appropriate pharmaceutical therapies as per the Heavy Menstrual Bleeding Guidelines; and 3 Either: 3.1 serum ferritin level < 16 mcg/l (within the last 12 months); or 3.2 haemoglobin level < 120 g/l. Note: Applications are not to be made for use in patients as contraception except where they meet the above criteria. continued. . .

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

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

85


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

continued. . . Initial application — (Previous use before 1 October 2002) only from a relevant specialist or general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient had a clinical diagnosis of heavy menstrual bleeding; and 2 Patient demonstrated clinical improvement of heavy menstrual bleeding; and 3 Applicant to state date of the previous insertion. Note: Applications are not to be made for use in patients as contraception except where they meet the above criteria. Renewal only from a relevant specialist or general practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Either: 1.1 Patient demonstrated clinical improvement of heavy menstrual bleeding; or 1.2 Previous insertion was removed or expelled within 3 months of insertion; and 2 Applicant to state date of the previous insertion. MEDROXYPROGESTERONE ACETATE F Tab 100 mg – Retail pharmacy-Specialist ........................................96.50 100 Provera F Tab 200 mg – Retail pharmacy-Specialist ........................................70.50 30 Provera NORETHISTERONE F Tab 5 mg – Up to 30 tab available on a PSO....................................26.50 PROGESTERONE Cap 100 mg – Special Authority see SA1392 below – Retail pharmacy ................................................................................... 16.50 100

Primolut N

30

Utrogestan

¾SA1392 Special Authority for Subsidy Initial application only from an obstetrician or gynaecologist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 For the prevention of pre-term labour*; and 2 Either: 2.1 The patient has a short cervix on ultrasound (defined as < 25 mm at 16 to 28 weeks); or 2.2 The patient has a history of pre-term birth at less than 28 weeks. 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)

Thyroid and Antithyroid Agents

CARBIMAZOLE Tab 5 mg ...........................................................................................10.80 LEVOTHYROXINE F Tab 25 mcg .........................................................................................3.89 ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 50 mcg .........................................................................................1.71 4.05 64.28 ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 100 mcg .......................................................................................1.78 4.21 66.78 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 100 90 28 90 1,000 28 90 1,000

Neo-Mercazole Synthroid Mercury Pharma Synthroid Eltroxin Mercury Pharma Synthroid Eltroxin

86

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

PROPYLTHIOURACIL – Special Authority see SA1199 below – Retail pharmacy Propylthiouracil is not recommended for patients under the age of 18 years unless the patient is pregnant and other treatments are contraindicated. Tab 50 mg .........................................................................................35.00 100 PTU ¾SA1199 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 The patient has hyperthyroidism; and 2 The patient is intolerant of carbimazole or carbimazole is contraindicated. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefitting from the treatment.

Trophic Hormones Growth Hormones

¾SA1279 Special Authority for Subsidy Special Authority approved by the Growth Hormone Committee Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: NZGHC Coordinator PHARMAC, PO Box 10-254, WELLINGTON Tel: 0800 808 476, Fax: (09) 929 3221, Email: growthhormone@pharmac.govt.nz SOMATROPIN – Special Authority see SA1279 above F Inj cartridge 16 iu (5.3 mg) .............................................................160.00 F Inj cartridge 36 iu (12 mg) ..............................................................360.00 1 1

Genotropin Genotropin

GnRH Analogues

GOSERELIN ACETATE Inj 3.6 mg ........................................................................................166.20 Inj 10.8 mg ......................................................................................443.76 LEUPRORELIN Inj 3.75 mg .....................................................................................221.60 Inj 3.75 mg prefilled syringe ...........................................................221.60 Inj 7.5 mg ........................................................................................166.20 Inj 11.25 mg ...................................................................................591.68 Inj 11.25 mg prefilled syringe .........................................................591.68 Inj 22.5 mg ......................................................................................443.76 Inj 30 mg .........................................................................................591.68 Inj 30 mg prefilled syringe ...........................................................1,109.40 Inj 45 mg .........................................................................................832.05 (Lucrin Depot Inj 3.75 mg to be delisted 1 February 2014) (Lucrin Depot Inj 11.25 mg to be delisted 1 February 2014) 1 1 1 1 1 1 1 1 1 1 1

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

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

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

87


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

Vasopressin Agonists

DESMOPRESSIN Tab 100 mcg – Special Authority see SA1401 below – Retail pharmacy ................................................................................... 36.40 Tab 200 mcg – Special Authority see SA1401 below – Retail pharmacy ................................................................................... 93.60 L Nasal drops 100 mcg per ml – Retail pharmacy-Specialist..............39.03 L Nasal spray 10 mcg per dose – Retail pharmacy-Specialist ............27.48 Inj 4 mcg per ml, 1 ml – Special Authority see SA1401 below – Retail pharmacy ..................................................................... 67.18

30 30 2.5 ml OP 6 ml OP

Minirin Minirin Minirin DesmopressinPH&T

10

Minirin

¾SA1401 Special Authority for Subsidy Initial application — (Desmopressin tablets for Nocturnal enuresis) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has primary nocturnal enuresis; and 2 The nasal forms of desmopressin are contraindicated; and 3 An enuresis alarm is contraindicated. Initial application — (Desmopressin tablets for Diabetes insipidus) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has cranial diabetes insipidus; and 2 The nasal forms of desmopressin are contraindicated. Renewal — (Desmopressin tablets) from any relevant practitioner. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from the treatment. Initial application — (Desmopressin injection) only from a relevant specialist. Approvals valid for 2 years where the patient cannot use desmopressin nasal spray or nasal drops. Renewal — (Desmopressin injection) only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

Other Endocrine Agents

CABERGOLINE Tab 0.5 mg – Maximum of 2 tab per prescription; can be waived by Special Authority see SA1370 below........................... 6.25 25.00

2 8

Dostinex Dostinex

¾SA1370 Special Authority for Waiver of Rule Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 pathological hyperprolactinemia; or 2 acromegaly*. Renewal — (for patients who have previously been funded under Special Authority form SA1031) from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has previously held a valid Special Authority which has expired and the treatment remains appropriate and the patient is benefiting from treatment. Note: Indication marked with * is an Unapproved indication. CLOMIPHENE CITRATE Tab 50 mg .........................................................................................29.84 10 Serophene

88

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

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

DANAZOL Cap 100 mg ......................................................................................68.33 Cap 200 mg ......................................................................................97.83 METYRAPONE Cap 250 mg – Retail pharmacy-Specialist .....................................520.00

100 100 50

Azol Azol Metopirone

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

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

89


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

Anthelmintics

ALBENDAZOLE – Special Authority see SA1318 below – Retail pharmacy Tab 400 mg .....................................................................................849.65 60

Eskazole

¾SA1318 Special Authority for Subsidy Initial application only from an infectious disease specialist or clinical microbiologist. Approvals valid for 6 months where the patient has hydatids. Renewal only from an infectious disease specialist or clinical microbiologist. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefitting from the treatment. MEBENDAZOLE – Only on a prescription Tab 100 mg .......................................................................................24.19 24 De-Worm Oral liq 100 mg per 5 ml .....................................................................2.18 15 ml (7.17) Vermox PRAZIQUANTEL Tab 600 mg .......................................................................................68.00 8

Biltricide

Antibacterials

a) For topical antibacterials, refer to DERMATOLOGICALS, page 66 b) For anti-infective eye preparations, refer to SENSORY ORGANS, page 188

Cephalosporins and Cephamycins

CEFACLOR MONOHYDRATE Cap 250 mg ......................................................................................26.00 Grans for oral liq 125 mg per 5 ml – Wastage claimable – see rule 3.3.2 on page 17 ................................................................... 3.53 CEFALEXIN MONOHYDRATE Cap 500 mg ........................................................................................5.70 Grans for oral liq 125 mg per 5 ml – Wastage claimable – see rule 3.3.2 on page 17 ................................................................... 8.50 Grans for oral liq 250 mg per 5 ml – Wastage claimable – see rule 3.3.2 on page 17 ................................................................. 11.50 100 100 ml 20 100 ml 100 ml

Ranbaxy-Cefaclor Ranbaxy-Cefaclor Cephalexin ABM Cefalexin Sandoz Cefalexin Sandoz

CEFAZOLIN SODIUM – Subsidy by endorsement Only if prescribed for dialysis or 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 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 CEFUROXIME AXETIL – Subsidy by endorsement Only if prescribed for prophylaxis of endocarditis and the prescription is endorsed accordingly. Tab 250 mg .......................................................................................29.40 50 Zinnat

90

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

CEFUROXIME SODIUM Inj 750 mg – Maximum of 1 inj per prescription; can be waived by endorsement............................................................................ 6.96 5 m-Cefuroxime Waiver by endorsement must state that the prescription is for dialysis or cystic fibrosis patient.

Macrolides

AZITHROMYCIN – Maximum of 5 days treatment per prescription; can be waived by endorsement For Endorsement, patient has either: 1) Received a lung transplant and requires treatment or prophylaxis for bronchiolitis obliterans syndrome*; or 2) Cystic fibrosis and has chronic infection with Pseudomonas aeruginosa or Pseudomonas related gram negative organisms*. Indications parked with * are Unapproved Indications Tab 250 mg .......................................................................................10.00 30 Apo-Azithromycin Tab 500 mg – Up to 8 tab available on a PSO....................................1.25 2 Apo-Azithromycin Grans for oral liq 200 mg per 5 ml – Wastage claimable – see rule 3.3.2 on page 17 ................................................................... 6.60 15 ml Zithromax CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA1131 below Tab 250 mg .........................................................................................4.19 14 Apo-Clarithromycin Grans for oral liq 125 mg per 5 ml – Wastage claimable – see rule 3.3.2 on page 17 ................................................................. 23.12 70 ml Klacid ¾SA1131 Special Authority for Waiver of Rule Initial application — (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Atypical mycobacterial infection; or 2 Mycobacterium tuberculosis infection where there is drug-resistance or intolerance to standard pharmaceutical agents. Renewal — (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. ERYTHROMYCIN ETHYL SUCCINATE Tab 400 mg .......................................................................................16.95 100 E-Mycin a) Up to 20 tab available on a PSO b) Up to 2 x the maximum PSO quantity for RFPP – see rule 5.2.6 on page 21 Grans for oral liq 200 mg per 5 ml .....................................................4.35 100 ml E-Mycin a) Up to 300 ml available on a PSO b) Up to 2 x the maximum PSO quantity for RFPP – see rule 5.2.6 on page 21 c) Wastage claimable – see rule 3.3.2 on page 17 Grans for oral liq 400 mg per 5 ml ......................................................5.85 100 ml E-Mycin a) Up to 200 ml available on a PSO b) Wastage claimable – see rule 3.3.2 on page 17 ERYTHROMYCIN LACTOBIONATE Inj 1 g ................................................................................................16.00 1 Erythrocin IV ERYTHROMYCIN STEARATE Tab 250 mg – Up to 30 tab available on a PSO................................14.95 (22.29) Tab 500 mg .......................................................................................29.90 (44.58) 100 ERA 100 ERA

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

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

91


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

ROXITHROMYCIN Tab 150 mg .........................................................................................7.48 Tab 300 mg .......................................................................................14.40

50 50

ArrowRoxithromycin

ArrowRoxithromycin

Penicillins

AMOXYCILLIN Cap 250 mg ......................................................................................16.18 500 a) Up to 30 cap available on a PSO b) Up to 10 x the maximum PSO quantity for RFPP – see rule 5.2.6 on page 21 Cap 500 mg ......................................................................................26.50 500 a) Up to 30 cap available on a PSO b) Up to 10 x the maximum PSO quantity for RFPP – see rule 5.2.6 on page 21 Grans for oral liq 125 mg per 5 ml ......................................................1.55 100 ml a) Up to 200 ml available on a PSO b) Wastage claimable – see rule 3.3.2 on page 17 Grans for oral liq 250 mg per 5 ml .....................................................1.10 100 ml a) Up to 300 ml available on a PSO b) Up to 10 x the maximum PSO quantity for RFPP – see rule 5.2.6 on page 21 c) Wastage claimable – see rule 3.3.2 on page 17 Drops 125 mg per 1.25 ml .................................................................4.00 30 ml OP Inj 250 mg .........................................................................................12.96 10 Inj 500 mg .........................................................................................15.08 10 Inj 1 g – Up to 5 inj available on a PSO............................................21.94 10 (Ospamox Paediatric Drops Drops 125 mg per 1.25 ml to be delisted 1 January 2014) AMOXYCILLIN CLAVULANATE Tab amoxycillin 500 mg with potassium clavulanate 125 mg – Up to 30 tab available on a PSO ............................................. 12.55 Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml ............................................................. 1.61 a) Up to 200 ml available on a PSO b) Wastage claimable – see rule 3.3.2 on page 17 Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml ............................................................... 2.19 a) Up to 200 ml available on a PSO b) Wastage claimable – see rule 3.3.2 on page 17 BENZATHINE BENZYLPENICILLIN Inj 1.2 mega u per 2.3 ml – Up to 5 inj available on a PSO ............315.00 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 600 mg – Up to 5 inj available on a PSO .....................................11.50

Alphamox Alphamox Ospamox Ospamox

Ospamox Paediatric

Drops

Ibiamox Ibiamox Ibiamox

100 100 ml

Curam Duo Augmentin

100 ml

Augmentin

10 10

Bicillin LA Sandoz

92

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

FLUCLOXACILLIN SODIUM Cap 250 mg – Up to 30 cap available on a PSO ..............................22.00 Cap 500 mg ......................................................................................74.00 Grans for oral liq 125 mg per 5 ml ......................................................2.49 a) Up to 200 ml available on a PSO b) Wastage claimable – see rule 3.3.2 on page 17 Grans for oral liq 250 mg per 5 ml ......................................................3.25 a) Up to 200 ml available on a PSO b) Wastage claimable – see rule 3.3.2 on page 17 Inj 250 mg .........................................................................................10.86 Inj 500 mg .........................................................................................11.32 Inj 1 g – Up to 5 inj available on a PSO............................................14.28 PENICILLIN G BENZATHINE [BENZATHINE BENZYLPENICILLIN] Inj 1.2 mega u per 2 ml – Up to 5 inj available on a PSO ..............315.00 (Bicillin LA Inj 1.2 mega u per 2 ml to be delisted 1 March 2014)

250 500 100 ml

Staphlex Staphlex AFT AFT AFT AFT Flucloxin Flucloxin Flucloxin Bicillin LA Cilicaine VK Cilicaine VK AFT AFT

100 ml

10 10 10 10

PHENOXYMETHYLPENICILLIN (PENICILLIN V) Cap potassium salt 250 mg – Up to 30 cap available on a PSO .........9.71 50 Cap potassium salt 500 mg ..............................................................11.70 50 a) Up to 20 cap available on a PSO b) Up to 2 x the maximum PSO quantity for RFPP – see rule 5.2.6 on page 21 Grans for oral liq 125 mg per 5 ml ......................................................1.68 100 ml a) Up to 200 ml available on a PSO b) Wastage claimable – see rule 3.3.2 on page 17 Grans for oral liq 250 mg per 5 ml .....................................................1.78 100 ml a) Up to 300 ml available on a PSO b) Up to 2 x the maximum PSO quantity for RFPP – see rule 5.2.6 on page 21 c) Wastage claimable – see rule 3.3.2 on page 17 PROCAINE PENICILLIN Inj 1.5 mega u – Up to 5 inj available on a PSO .............................123.50 5

Cilicaine

Tetracyclines

DOXYCYCLINE HYDROCHLORIDE F Tab 50 mg – Up to 30 tab available on a PSO....................................2.90 (6.00) F Tab 100 mg – Up to 30 tab available on a PSO..................................7.95 MINOCYCLINE HYDROCHLORIDE F Tab 50 mg – Additional subsidy by Special Authority see SA1355 below – Retail pharmacy ............................................... 5.79 (12.05) F Cap 100 mg ......................................................................................19.32 (52.04) 30 Doxy-50 250

Doxine

60 Mino-tabs 100 Minomycin

¾SA1355 Special Authority for Manufacturers Price Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has rosacea. TETRACYCLINE – Special Authority see SA1332 on the next page – Retail pharmacy Cap 500 mg ......................................................................................46.00 30 Tetracyclin Wolff

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

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

93


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA1332 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 For the eradication of helicobacter pylori following unsuccessful treatment with appropriate first-line therapy; and 2 For use only in combination with bismuth as part of a quadruple therapy regimen.

Other Antibiotics

For topical antibiotics, refer to DERMATOLOGICALS, page 66 CIPROFLOXACIN Recommended for patients with any of the following: i) microbiologically confirmed and clinically significant pseudomonas infection; or ii) prostatitis; or iii) pyelonephritis; or iv) gonorrhoea. Tab 250 mg – Up to 5 tab available on a PSO....................................2.20 Tab 500 mg – Up to 5 tab available on a PSO....................................3.00 10.71 Tab 750 mg .........................................................................................5.15 5.52 CLINDAMYCIN Cap hydrochloride 150 mg – Maximum of 4 cap per prescription; can be waived by endorsement - Retail pharmacy Specialist ...................................................................................... 5.80 Inj phosphate 150 mg per ml, 4 ml – Retail pharmacySpecialist .................................................................................. 100.00 CO-TRIMOXAZOLE F Tab trimethoprim 80 mg and sulphamethoxazole 400 mg – Up to 30 tab available on a PSO ................................................ 20.97 F Oral liq trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml – Up to 200 ml available on a PSO................................ 2.15

28 28 100 28 30

Cipflox Cipflox Cipflox Cipflox Ciprofloxacin Rex

16 10

Clindamycin ABM Dalacin C

500 100 ml

Trisul Deprim

COLISTIN SULPHOMETHATE – Retail pharmacy-Specialist – Subsidy by endorsement Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. Inj 150 mg .........................................................................................65.00 1 Colistin-Link FUSIDIC ACID Tab 250 mg – Retail pharmacy-Specialist ........................................34.50 12 Fucidin Prescriptions must be written by, or on the recommendation of, an infectious disease physician or a clinical microbiologist GENTAMICIN SULPHATE Inj 10 mg per ml, 1 ml – Subsidy by endorsement ..............................8.56 5 Hospira Only if prescribed for a dialysis or cystic fibrosis patient 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 Only if prescribed for a dialysis or cystic fibrosis patient 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 complicated urinary tract infection and the prescription is endorsed accordingly.

94

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

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 (Lincocin Inj 300 mg per ml, 2 ml to be delisted 1 January 2014) MOXIFLOXACIN – Special Authority see SA1358 below – Retail pharmacy No patient co-payment payable Tab 400 mg .......................................................................................52.00

5

Avelox

¾SA1358 Special Authority for Subsidy Initial application — (Tuberculosis) only from a respiratory specialist or infectious disease specialist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Both: 1.1 Active tuberculosis*; and 1.2 Any of the following: 1.2.1 Documented resistance to one or more first-line medications; or 1.2.2 Suspected resistance to one or more first-line medications (tuberculosis assumed to be contracted in an area with known resistance), as part of regimen containing other second-line agents; or 1.2.3 Impaired visual acuity (considered to preclude ethambutol use); or 1.2.4 Significant pre-existing liver disease or hepatotoxicity from tuberculosis medications; or 1.2.5 Significant documented intolerance and/or side effects following a reasonable trial of first-line medications; or 2 Mycobacterium avium-intracellulare complex not responding to other therapy or where such therapy is contraindicated.*. 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). Renewal only from a respiratory specialist or infectious disease specialist. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. 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). PAROMOMYCIN – Special Authority see SA1324 below – Retail pharmacy Cap 250 mg ....................................................................................126.00 16 Humatin ¾SA1324 Special Authority for Subsidy Initial application only from an infectious disease specialist or clinical microbiologist. Approvals valid for 1 month where the patient has confirmed cryptosporidium infection. Renewal only from an infectious disease specialist or clinical microbiologist. Approvals valid for 1 month where the patient has confirmed cryptosporidium infection. PYRIMETHAMINE – Special Authority see SA1328 on the next page – Retail pharmacy Tab 25 mg .........................................................................................26.14 30 Daraprim

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

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

95


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA1328 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 For the treatment of toxoplasmosis in patients with HIV for a period of 3 months; or 2 For pregnant patients for the term of the pregnancy; or 3 For infants with congenital toxoplasmosis until 12 months of age. SULFADIAZINE SODIUM – Special Authority see SA1331 below – Retail pharmacy Tab 500 mg .....................................................................................221.00 56 Wockhardt ¾SA1331 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 For the treatment of toxoplasmosis in patients with HIV for a period of 3 months; or 2 For pregnant patients for the term of the pregnancy; or 3 For infants with congenital toxoplasmosis until 12 months of age. TOBRAMYCIN Inj 40 mg per ml, 2 ml – Subsidy by endorsement ............................29.32 5 DBL Tobramycin Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. TRIMETHOPRIM F Tab 300 mg – Up to 30 tab available on a PSO..................................9.28 50 TMP VANCOMYCIN HYDROCHLORIDE – Subsidy by endorsement Only if prescribed for a dialysis or cystic fibrosis patient 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

Antifungals

a) For topical antifungals refer to DERMATOLOGICALS, page 66 b) For topical antifungals refer to GENITO URINARY, page 79 FLUCONAZOLE Cap 50 mg – Retail pharmacy-Specialist ...........................................4.77 28 Ozole Cap 150 mg – Subsidy by endorsement .............................................0.91 1 Ozole a) Maximum of 1 cap per prescription; can be waived by endorsement - Retail pharmacy - Specialist b) Patient has vaginal candida albicans and the practitioner considers that a topical imidazole (used intra-vaginally) is not recommended and the prescription is endorsed accordingly; can be waived by endorsement - Retail pharmacy - Specialist. Cap 200 mg – Retail pharmacy-Specialist .......................................13.34 28 Ozole Powder for oral suspension 10 mg per ml – Special Authority see SA1359 below – Retail pharmacy ...................................... 34.56 35 ml Diflucan Wastage claimable – see rule 3.3.2 on page 17 ¾SA1359 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 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: continued. . .

96

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . 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 months 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. ITRACONAZOLE Cap 100 mg – Subsidy by endorsement .............................................2.99 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. Oral liq 10 mg per ml – Special Authority see SA1322 below – Retail pharmacy ................................................................... 141.80 150 ml OP Sporanox ¾SA1322 Special Authority for Subsidy Initial application only from an infectious disease specialist, clinical microbiologist, clinical immunologist or any relevant practitioner on the recommendation of a infectious disease physician, clinical microbiologist or clinical immunologist. Approvals valid for 6 months where the patient has a congenital immune deficiency. Renewal from any relevant practitioner. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefitting from the treatment. KETOCONAZOLE Tab 200 mg – Retail pharmacy-Specialist ........................................38.12 30 Nizoral Prescriptions must be written by, or on the recommendation of, an infectious disease physician, clinical microbiologist, dermatologist, endocrinologist or oncologist NYSTATIN Tab 500,000 u ...................................................................................14.16 50 Nilstat Cap 500,000 u ..................................................................................12.81 50 Nilstat POSACONAZOLE – Special Authority see SA1285 below – Retail pharmacy Oral liq 40 mg per ml ......................................................................761.13 105 ml OP

Noxafil

¾SA1285 Special Authority for Subsidy Initial application only from a haematologist or infectious disease specialist. Approvals valid for 6 weeks for applications meeting the following criteria: Either: 1 Patient has acute myeloid leukaemia and is to be treated with high dose remission induction, re-induction or consolidation chemotherapy; or 2 Patient has received a stem cell transplant and has graft versus host disease and is on significant immunosuppressive therapy*. continued. . .

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

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

97


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . Renewal only from a haematologist or infectious disease specialist. Approvals valid for 6 weeks for applications meeting the following criteria: Either: 1 Patient has acute myeloid leukaemia and is to be treated with high dose remission induction, re-induction or consolidation therapy; or 2 Patient has received a stem cell transplant and has graft versus host disease and is on significant immunosuppression* and requires on going posaconazole treatment. Note: * Graft versus host disease (GVHD) on significant immunosuppression is defined as acute GVHD, grade II to IV, or extensive chronic GVHD, or if they were being treated with intensive immunosuppressive therapy consisting of either high-dose corticosteroids (≥ 1 mg per kilogram of body weight per day for patients with acute GVHD or ≥ 0.8 mg per kilogram every other day for patients with chronic GVHD), antithymocyte globulin, or a combination of two or more immunosuppressive agents or types of treatment. TERBINAFINE F Tab 250 mg – For terbinafine oral liquid formulation refer, page 194 ...................................................................................... 1.78 14 Dr Reddy’s Terbinafine VORICONAZOLE – Special Authority see SA1273 below – Retail pharmacy Tab 50 mg .......................................................................................730.00 56 Vfend Tab 200 mg ..................................................................................2,930.00 56 Vfend Powder for oral suspension 40 mg per ml – Wastage claimable – see rule 3.3.2 on page 17...................................... 730.00 70 ml Vfend ¾SA1273 Special Authority for Subsidy Initial application — (invasive fungal infection) only from a haematologist, infectious disease specialist or clinical microbiologist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient is immunocompromised; and 2 Applicant is part of a multidisciplinary team including an infectious disease specialist; and 3 Any of the following: 3.1 Patient has proven or probable invasive aspergillus infection; or 3.2 Patient has possible invasive aspergillus infection; or 3.3 Patient has fluconazole resistant candidiasis; or 3.4 Patient has mould strain such as Fusarium spp. and Scedosporium spp. Renewal — (invasive fungal infection) only from a haematologist, infectious disease specialist or clinical microbiologist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient is immunocompromised; and 2 Applicant is part of a multidisciplinary team including an infectious disease specialist; and 3 Any of the following: 3.1 Patient continues to require treatment for proven or probable invasive aspergillus infection; or 3.2 Patient continues to require treatment for possible invasive aspergillus infection; or 3.3 Patient has fluconazole resistant candidiasis; or 3.4 Patient has mould strain such as Fusarium spp. and Scedosporium spp.

Antimalarials

PRIMAQUINE PHOSPHATE – Special Authority see SA1326 on the next page – Retail pharmacy Tab 7.5 mg ......................................................................................117.00 56 Primacin

98

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA1326 Special Authority for Subsidy Initial application only from an infectious disease specialist or clinical microbiologist. Approvals valid for 1 month for applications meeting the following criteria: Both: 1 The patient has vivax or ovale malaria; and 2 Primaquine is to be given for a maximum of 21 days.

Antiparasitics Antiprotozoals

QUININE SULPHATE F Tab 300 mg .......................................................................................54.06 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 500

Q 300

Antitrichomonal Agents

METRONIDAZOLE Tab 200 mg – Up to 30 tab available on a PSO................................10.45 Tab 400 mg .......................................................................................18.15 Oral liq benzoate 200 mg per 5 ml ...................................................25.00 Suppos 500 mg ................................................................................24.48 ORNIDAZOLE Tab 500 mg .......................................................................................16.50 100 100 100 ml 10 10

Trichozole Trichozole Flagyl-S Flagyl Arrow-Ornidazole

Antituberculotics and Antileprotics

Note: There is no co-payment charge for all pharmaceuticals listed in the Antituberculotics and Antileprotics group regardless of immigration status. CLOFAZIMINE – Retail pharmacy-Specialist a) No patient co-payment payable b) Prescriptions must be written by, or on the recommendation of, an infectious disease physician, clinical microbiologist or dermatologist. F Cap 50 mg ......................................................................................197.50 100 Lamprene CYCLOSERINE – Retail pharmacy-Specialist a) No patient co-payment payable b) Prescriptions must be written by, or on the recommendation of, an infectious disease physician, clinical microbiologist or respiratory physician. Cap 250 mg .................................................................................1,140.63 100 King DAPSONE – Retail pharmacy-Specialist a) No patient co-payment payable b) Prescriptions must be written by, or on the recommendation of, an infectious disease physician, clinical microbiologist or dermatologist Tab 25 mg .........................................................................................95.00 100 Dapsone Tab 100 mg .....................................................................................110.00 100 Dapsone ETHAMBUTOL HYDROCHLORIDE – Retail pharmacy-Specialist a) No patient co-payment payable b) Prescriptions must be written by, or on the recommendation of, an infectious disease physician, clinical microbiologist or respiratory physician Tab 100 mg .......................................................................................48.01 56 Myambutol Tab 400 mg .......................................................................................49.34 56 Myambutol

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

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

99


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

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 F Tab 100 mg .......................................................................................20.00 100 PSM F Tab 100 mg with rifampicin 150 mg ..................................................90.04 100 Rifinah F Tab 150 mg with rifampicin 300 mg ................................................179.57 100 Rifinah PARA-AMINO SALICYLIC ACID – Retail pharmacy-Specialist a) No patient co-payment payable b) Specialist must be an infectious disease specialist, clinical microbiologist or respiratory specialist. Grans for oral liq 4 g sachet ...........................................................280.00 30 Paser PROTIONAMIDE – Retail pharmacy-Specialist a) No patient co-payment payable b) Specialist must be an infectious disease specialist, clinical microbiologist or respiratory specialist. Tab 250 mg .....................................................................................305.00 100 Peteha PYRAZINAMIDE – Retail pharmacy-Specialist a) No patient co-payment payable b) Prescriptions must be written by, or on the recommendation of, an infectious disease physician, clinical microbiologist or respiratory physician F Tab 500 mg – For pyrazinamide oral liquid formulation refer, page 194 .................................................................................... 59.00 100 AFT-Pyrazinamide RIFABUTIN – Retail pharmacy-Specialist a) No patient co-payment payable b) Prescriptions must be written by, or on the recommendation of, an infectious disease physician, respiratory physician or gastroenterologist F Cap 150 mg – For rifabutin oral liquid formulation refer, page 194 ........................................................................................... 213.19 30 Mycobutin RIFAMPICIN – Subsidy by endorsement a) No patient co-payment payable b) For confirmed recurrent Staphylococcus aureus infection in combination with other effective anti-staphylococcal antimicrobial based on susceptibilities and the prescription is endorsed accordingly; can be waived by endorsement - Retail pharmacy Specialist. Specialist must be an internal medicine physician, clinical microbiologist, dermatologist, paediatrician, or public health physician. F Tab 600 mg .....................................................................................114.40 30 Rifadin F Cap 150 mg ......................................................................................58.66 100 Rifadin F Cap 300 mg ....................................................................................122.36 100 Rifadin F Oral liq 100 mg per 5 ml ...................................................................12.66 60 ml Rifadin

Antivirals

For eye preparations refer to Eye Preparations, Anti-Infective Preparations, page 188

Hepatitis B Treatment

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

Hepsera

100

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA0829 Special Authority for Subsidy Initial application only from a gastroenterologist or infectious disease specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg+); and Documented resistance to lamivudine, defined as: 2 Patient has raised serum ALT (> 1 × ULN); and 3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and 4 Detection of M204I or M204V mutation; and 5 Either: 5.1 Both: 5.1.1 Patient is cirrhotic; and 5.1.2 adefovir dipivoxil to be used in combination with lamivudine; or 5.2 Both: 5.2.1 Patient is not cirrhotic; and 5.2.2 adefovir dipivoxil to be used as monotherapy. Renewal only from a gastroenterologist or infectious disease specialist. Approvals valid for 2 years where in the opinion of the treating physician, treatment remains appropriate and patient is benefiting from treatment. Notes: Lamivudine should be added to adefovir dipivoxil if a patient develops documented resistance to adefovir dipivoxil, defined as: i) raised serum ALT (> 1 × ULN); and ii) HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and iii) Detection of N236T or A181T/V mutation. Adefovir dipivoxil should be stopped 6 months following HBeAg seroconversion for patients who were HBeAg+ prior to commencing adefovir dipivoxil. The recommended dose of adefovir dipivoxil is no more than 10mg daily. In patients with renal insufficiency adefovir dipivoxil dose should be reduced in accordance with the datasheet guidelines. Adefovir dipivoxil should be avoided in pregnant women and children. ENTECAVIR – Special Authority see SA1361 below – Retail pharmacy Tab 0.5 mg ......................................................................................400.00 30 Baraclude ¾SA1361 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: continued. . .

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

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

101


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . G Entecavir should be continued for 6 months following documentation of complete HBeAg seroconversion (defined as loss of HBeAg plus appearance of anti-HBe plus loss of serum HBV DNA) for patients who were HBeAg positive prior to commencing this agent. This period of consolidation therapy should be extended to 12 months in patients with advanced fibrosis (Metavir Stage F3 or F4). G Entecavir should be taken on an empty stomach to improve absorption. LAMIVUDINE – Special Authority see SA1360 below – Retail pharmacy Tab 100 mg .......................................................................................32.50 28 Zetlam Oral liq 5 mg per ml ..........................................................................90.00 240 ml Zeffix ¾SA1360 Special Authority for Subsidy Initial application only from a gastroenterologist, infectious disease specialist, paediatrician, general physician or medical practitioner 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 HBV DNA positive cirrhosis prior to liver transplantation; or 2 HBsAg positive and have had a liver, kidney, heart, lung or bone marrow transplant; or 3 Hepatitis B virus naive 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). Renewal only from a gastroenterologist, infectious disease specialist, paediatrician, general physician or medical practitioner 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 <100,00 copies per ml by quantitative PCR at a reference laboratory; or Renewal when given in combination with adefovir dipivoxil for patients with cirrhosis and resistance to lamivudine 2 All of the following: 2.1 Lamivudine to be used in combination with adefovir dipivoxil; and 2.2 Patient is cirrhotic; and Documented resistance to lamivudine, defined as: 2.3 Patient has raised serum ALT (> 1 × ULN); and 2.4 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 2.5 Detection of M204I or M204V mutation; or Renewal when given in combination with adefovir dipivoxil for patients with resistance to adefovir dipivoxil 3 All of the following: 3.1 Lamivudine to be used in combination with adefovir dipivoxil; and Documented resistance to adefovir, defined as: 3.2 Patient has raised serum ALT (> 1 × ULN); and 3.3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 3.4 Detection of N236T or A181T/V mutation.

102

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

Herpesvirus Treatments

ACICLOVIR F Tab dispersible 200 mg .......................................................................1.78 F Tab dispersible 400 mg .......................................................................5.98 F Tab dispersible 800 mg .......................................................................6.64 VALACICLOVIR – Special Authority see SA1363 below – Retail pharmacy Tab 500 mg .....................................................................................102.72 25 56 35 30

Lovir Lovir Lovir Valtrex

¾SA1363 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. VALGANCICLOVIR – Special Authority see SA1404 below – Retail pharmacy Tab 450 mg ..................................................................................3,000.00 60 Valcyte ¾SA1404 Special Authority for Subsidy Initial application — (transplant cytomegalovirus prophylaxis) only from a relevant specialist. Approvals valid for 3 months where the patient has undergone a solid organ transplant and requires valganciclovir for CMV prophylaxis. Renewal — (transplant cytomegalovirus prophylaxis) only from a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Patient has undergone a solid organ transplant and received anti-thymocyte globulin and requires valganciclovir therapy for CMV prophylaxis; and 2 Patient is to receive a maximum of 90 days of valganciclovir prophylaxis following anti-thymocyte globulin. Initial application — (cytomegalovirus prophylaxis following anti-thymocyte globulin) only from a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Patient has undergone a solid organ transplant and received valganciclovir under Special Authority more than 2 years ago (27 months); and 2 Patient has received anti-thymocyte globulin and requires valganciclovir for CMV prophylaxis. Renewal — (cytomegalovirus prophylaxis following anti-thymocyte globulin) only from a relevant specialist. Approvals valid for 3 months where the patient has received a further course of anti-thymocyte globulin and requires valganciclovir for CMV prophylaxis. Initial application — (Lung transplant cytomegalovirus prophylaxis) only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Patient has undergone a lung transplant; and 2 Either: continued. . .

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

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

103


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . 2.1 The donor was cytomegalovirus positive and the patient is cytomegalovirus negative; or 2.2 The recipient is cytomegalovirus positive. Initial application — (Cytomegalovirus in immunocompromised patients) only from a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Patient is immunocompromised; and 2 Any of the following: 2.1 Patient has cytomegalovirus syndrome or tissue invasive disease; or 2.2 Patient has rapidly rising plasma CMV DNA in absence of disease; or 2.3 Patient has cytomegalovirus retinitis. Renewal — (Cytomegalovirus in immunocompromised patients) only from a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Patient is immunocompromised; and 2 Any of the following: 2.1 Patient has cytomegalovirus syndrome or tissue invasive disease; or 2.2 Patient has rapidly rising plasma CMV DNA in absence of disease; or 2.3 Patient has cytomegalovirus retinitis. Note: for the purpose of this Special Authority "immunocompromised" includes transplant recipients, patients with immunosuppressive diseases (e.g. HIV) or those receiving immunosuppressive treatment for other conditions.

Hepatitis B/ HIV/AIDS Treatment

TENOFOVIR DISOPROXIL FUMARATE – Subsidy by endorsement; can be waived by Special Authority see SA1362 below Endorsement for treatment of HIV: Prescription is deemed to be endorsed if tenofovir disoproxil fumarate is co-prescribed with another anti-retroviral subsidised under Special Authority SA1364 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 is included in the count of up to 4 subsidised antiretrovirals for the purposes of Special Authority SA1364, page 106 Tab 300 mg .....................................................................................531.00 30 Viread ¾SA1362 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 All of the following: 1.1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 1.2 Patient has had previous lamivudine, adefovir or entecavir therapy; and 1.3 HBV DNA greater than 20,000 IU/mL or increased ≥ 10 fold over nadir; and 1.4 Any of the following: 1.4.1 Lamivudine resistance - detection of M204I/V mutation; or 1.4.2 Adefovir resistance - detection of A181T/V or N236T mutation; or 1.4.3 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 specialist or general physician. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 Patient is HBsAg positive and pregnant; and continued. . .

104

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . 2 HBV DNA > 20,000 IU/mL and ALT > ULN. Renewal — (Confirmed Hepatitis B following funded tenofovir treatment for pregnancy within the previous two years) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 All of the following: 1.1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 1.2 Patient has had previous lamivudine, adefovir or entecavir therapy; and 1.3 HBV DNA greater than 20,000 IU/mL or increased ≥ 10 fold over nadir; and 1.4 Any of the following: 1.4.1 Lamivudine resistance - detection of M204I/V mutation; or 1.4.2 Adefovir resistance - detection of A181T/V or N236T mutation; or 1.4.3 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. Renewal — (Subsequent pregnancy or Breastfeeding, Active hepatitis B) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 Patient is HBsAg positive and pregnant or breastfeeding; and 2 HBV DNA > 20,000 IU/mL and ALT > ULN. Initial application — (Pregnant, prevention of vertical transmission) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Patient is HBsAg positive and pregnant; and 2 HBV DNA > 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 for applications meeting the following criteria: Both: 1 Patient is HBsAg positive and pregnant; and 2 HBV DNA > 20 million IU/mL and ALT normal. Notes: G Tenofovir disoproxil fumarate should be stopped 6 months following HBeAg seroconversion for patients who were HBeAg positive prior to commencing this agent and 6 months following HBsAg seroconversion for patients who were HBeAg negative prior to commencing this agent. G The recommended dose of Tenofovir disoproxil fumarate for the treatment of all three indications is 300 mg once daily. G In patients with renal insufficiency (calculated creatinine clearance less than 50ml/min), Tenofovir disoproxil fumarate dose should be reduced in accordance with the approved Medsafe datasheet guidelines. G Tenofovir disoproxil fumarate is not approved for use in children.

Hepatitis C Treatment

BOCEPREVIR – Special Authority see SA1402 on the next page – Retail pharmacy Cap 200 mg – Wastage claimable – see rule 3.3.2 on page 17 .......................................................................................... 5,015.00 336

Victrelis

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

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

105


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA1402 Special Authority for Subsidy Initial application — (chronic hepatitis C - genotype 1, first-line) 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 chronic hepatitis C, genotype 1; and 2 Patient has not received prior pegylated interferon treatment; and 3 Patient has IL-28B genotype CT or TT; and 4 Patient is to be treated in combination with pegylated interferon and ribavirin; and 5 Patient is hepatitis C protease inhibitor treatment-naive; and 6 Maximum of 44 weeks therapy. Initial application — (chronic hepatitis C - genotype 1, second-line) 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 chronic hepatitis C, genotype 1; and 2 Patient has received pegylated interferon treatment; and 3 Any of the following: 3.1 Patient was a responder relapser; or 3.2 Patient was a partial responder; or 3.3 Patient received pegylated interferon prior to 2004; and 4 Patient is to be treated in combination with pegylated interferon and ribavirin; and 5 Maximum of 44 weeks therapy. Notes: 9 G Due to risk of severe sepsis boceprevir should not be initiated if either Platelet count < 100 x10 /l or Albumin <35 g/l G The wastage rule applies to boceprevir to allow dispensing to occur more frequently than monthly

Antiretrovirals

¾SA1364 Special Authority for Subsidy Initial application — (Confirmed HIV) 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 < 500 cells/mm3 . Notes: Tenofovir disoproxil fumarate prescribed under endorsement for HIV 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. . .

106

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . Renewal — (Confirmed HIV) 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 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 Any of the following: 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 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 Any of the following: 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 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.

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

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

107


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

Non-nucleosides Reverse Transcriptase Inhibitors

EFAVIRENZ – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 50 mg .......................................................................................158.33 Tab 200 mg .....................................................................................474.99 Tab 600 mg .....................................................................................474.99 Oral liq 30 mg per ml ......................................................................145.79 ETRAVIRINE – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 200 mg .....................................................................................770.00 NEVIRAPINE – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 200 mg – Brand switch fee payable (Pharmacode 2433265) - see page 192 for details .......................................... 95.94 Oral suspension 10 mg per ml ........................................................134.55 30 90 30 180 ml OP 60

Stocrin Stocrin Stocrin Stocrin Intelence

60 240 ml

Nevirapine

Alphapharm

Viramune

Suspension

Nucleosides Reverse Transcriptase Inhibitors

ABACAVIR SULPHATE – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 300 mg .....................................................................................229.00 60 Oral liq 20 mg per ml ........................................................................50.00 240 ml OP

Ziagen Ziagen

ABACAVIR SULPHATE WITH LAMIVUDINE – Special Authority see SA1364 on page 106 – Retail pharmacy Note: abacavir with lamivudine (combination tablets) counts as two anti-retroviral medications for the purposes of the antiretroviral Special Authority. Tab 600 mg with lamivudine 300 mg ..............................................630.00 30 Kivexa DIDANOSINE [DDI] – Special Authority see SA1364 on page 106 – Retail pharmacy Cap 125 mg ....................................................................................115.05 Cap 200 mg ....................................................................................184.08 Cap 250 mg ....................................................................................230.10 Cap 400 mg ....................................................................................368.16 30 30 30 30

Videx EC Videx EC Videx EC Videx EC

EFAVIRENZ WITH EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE – Special Authority see SA1364 on page 106 – Retail pharmacy Note: Efavirenz with emtricitabine and tenofovir disoproxil fumarate counts as three anti-retroviral medications for the purposes of the anti-retroviral Special Authority Tab 600 mg with emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg .................................................................. 1,313.19 30 Atripla EMTRICITABINE – Special Authority see SA1364 on page 106 – Retail pharmacy Cap 200 mg ....................................................................................307.20 30

Emtriva

EMTRICITABINE WITH TENOFOVIR DISOPROXIL FUMARATE – Special Authority see SA1364 on page 106 – Retail pharmacy Note: Emtricitabine with tenofovir disoproxil fumarate counts as two anti-retroviral medications for the purposes of the antiretroviral Special Authority Tab 200 mg with tenofovir disoproxil fumarate 300 mg ..................838.20 30 Truvada LAMIVUDINE – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 150 mg .......................................................................................52.50 153.60 Oral liq 10 mg per ml ......................................................................102.50 60

Lamivudine

Alphapharm

240 ml OP

3TC 3TC

108

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

STAVUDINE [D4T] – Special Authority see SA1364 on page 106 – Retail pharmacy Cap 40 mg ......................................................................................503.80 60 Powder for oral soln 1 mg per ml ....................................................100.76 200 ml OP ZIDOVUDINE [AZT] – Special Authority see SA1364 on page 106 – Retail pharmacy Cap 100 mg ....................................................................................152.25 100 Oral liq 10 mg per ml ........................................................................30.45 200 ml OP

Zerit Zerit Retrovir Retrovir

ZIDOVUDINE [AZT] WITH LAMIVUDINE – Special Authority see SA1364 on page 106 – Retail pharmacy Note: zidovudine [AZT] with lamivudine (combination tablets) counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority. Tab 300 mg with lamivudine 150 mg ................................................63.50 60 Alphapharm 667.20 Combivir (Combivir Tab 300 mg with lamivudine 150 mg to be delisted 1 June 2014)

Protease Inhibitors

ATAZANAVIR SULPHATE – Special Authority see SA1364 on page 106 – Retail pharmacy Cap 150 mg ....................................................................................568.34 60 Cap 200 mg ....................................................................................757.79 60 DARUNAVIR – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 400 mg .....................................................................................837.50 Tab 600 mg ..................................................................................1,190.00 INDINAVIR – Special Authority see SA1364 on page 106 – Retail pharmacy Cap 200 mg ....................................................................................519.75 Cap 400 mg ....................................................................................519.75 60 60 360 180

Reyataz Reyataz Prezista Prezista Crixivan Crixivan

LOPINAVIR WITH RITONAVIR – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 100 mg with ritonavir 25 mg .....................................................183.75 60 Kaletra Tab 200 mg with ritonavir 50 mg .....................................................735.00 120 Kaletra Oral liq 80 mg with ritonavir 20 mg per ml ......................................735.00 300 ml OP Kaletra RITONAVIR – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 100 mg .......................................................................................43.31 Oral liq 80 mg per ml ......................................................................103.98 30 90 ml OP

Norvir Norvir

Strand Transfer Inhibitors

RALTEGRAVIR POTASSIUM – Special Authority see SA1364 on page 106 – Retail pharmacy Tab 400 mg ..................................................................................1,090.00 60

Isentress

Antiretrovirals - Additional Therapies HIV Fusion Inhibitors

ENFUVIRTIDE – Special Authority see SA0845 on the next page – Retail pharmacy Powder for inj 90 mg per ml × 60 ................................................2,380.00 1

Fuzeon

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

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

109


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

¾SA0845 Special Authority for Subsidy Initial application only from a named specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Confirmed HIV infection; and 2 Enfuvirtide to be given in combination with optimized background therapy (including at least 1 other antiretroviral drug that the patient has never previously been exposed to) for treatment failure; and 3 Either: 3.1 Patient has evidence of HIV replication, despite ongoing therapy; or 3.2 Patient has treatment-limiting toxicity to previous antiretroviral agents; and 4 Previous treatment with 3 different antiretroviral regimens has failed; and 5 All of the following: 5.1 Previous treatment with a non-nucleoside reverse transcriptase inhibitor has failed; and 5.2 Previous treatment with a nucleoside reverse transcriptase inhibitor has failed; and 5.3 Previous treatment with a protease inhibitor has failed. Renewal only from a named specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Evidence of at least a 10 fold reduction in viral load at 12; and 2 The treatment remains appropriate and the patient is benefiting from treatment.

Immune Modulators

Guidelines for the use of interferon in the treatment of hepatitis C: Physicians considering treatment of patients with hepatitis C should discuss cases with a gastroenterologist or an infectious disease physician. All subjects undergoing treatment require careful monitoring for side effects. Patients should be otherwise fit. Hepatocellular carcinoma should be excluded by ultrasound examination and alpha-fetoprotein level. Criteria for Treatment 1) Diagnosis G Anti-HCV positive on at least two occasions with a positive PCR for HCV-RNA and preferably confirmed by a supplementary RIBA test; or G PCR-RNA positive for HCV on at least 2 occasions if antibody negative; or G Anti-HCV positive on at least two occasions with a positive supplementary RIBA test with a negative PCR for HCV RNA but with a liver biopsy consistent with 2(b) following. Exclusion Criteria 1) Autoimmune liver disease. (Interferon may exacerbate autoimmune liver disease as well as other autoimmune diseases such as thyroid disease). 2) Pregnancy. 3) Neutropenia (<2.0 × 109 ) and/or thrombocytopenia. 4) Continuing alcohol abuse and/or continuing intravenous drug users. Dosage The current recommended dosage is 3 million units of interferon alfa-2a or interferon alfa-2b administered subcutaneously 3 times a week for 52 weeks (twelve months) Exit Criteria The patient’s response to interferon treatment should be reviewed at either three or four months. Interferon treatment should be discontinued in patients who do not show a substantial reduction (50%) in their mean pre-treatment ALT level at this stage.

110

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

INTERFERON ALFA-2A – PCT – Retail pharmacy-Specialist a) See prescribing guideline on the previous page b) Prescriptions must be written by, or on the recommendation of, an internal medicine physician or ophthalmologist Inj 3 m iu prefilled syringe .................................................................31.32 1 Roferon-A Inj 6 m iu prefilled syringe ................................................................62.64 1 Roferon-A Inj 9 m iu prefilled syringe ................................................................93.96 1 Roferon-A (Roferon-A Inj 6 m iu prefilled syringe to be delisted 1 February 2014) (Roferon-A Inj 9 m iu prefilled syringe to be delisted 1 February 2014) INTERFERON ALFA-2B – PCT – Retail pharmacy-Specialist a) See prescribing guideline on the previous page b) Prescriptions must be written by, or on the recommendation of, an internal medicine physician or ophthalmologist Inj 18 m iu, 1.2 ml multidose pen ....................................................187.92 1 Intron-A Inj 30 m iu, 1.2 ml multidose pen ....................................................313.20 1 Intron-A Inj 60 m iu, 1.2 ml multidose pen ....................................................626.40 1 Intron-A PEGYLATED INTERFERON ALFA-2A – Special Authority see SA1400 below – Retail pharmacy See prescribing guideline on the previous page Inj 135 mcg prefilled syringe ........................................................1,448.00 4 Pegasys Inj 180 mcg prefilled syringe ...........................................................900.00 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 ....................................................................................... 1,159.84 1 OP Pegasys RBV Combination Pack Inj 180 mcg prefilled syringe × 4 with ribavirin tab 200 mg × 168 ....................................................................................... 1,290.00 1 OP Pegasys RBV Combination Pack ¾SA1400 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: 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; 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: G Consider stopping treatment if there is absence of a virological response (defined as at least a 2-log reduction in viral load) following 12 weeks of treatment since this is predictive of treatment failure. G Consider reducing treatment to 24 weeks if serum HCV RNA level at Week 4 is undetectable by sensitive PCR assay (less than 50IU/ml) AND Baseline serum HCV RNA is less than 400,000IU/ml Renewal — (Chronic hepatitis C - genotype 1 infection) 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 chronic hepatitis C, genotype 1; and 2 Patient has had previous treatment with pegylated interferon and ribavirin; and continued. . .

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

111


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

continued. . . 3 Either: 3.1 Patient has responder relapsed; or 3.2 Patient was a partial responder; and 4 Patient is to be treated in combination with boceprevir; and 5 Maximum of 48 weeks therapy. Initial application — (Chronic Hepatitis C - genotype 1 infection treatment more than 4 years prior) 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 chronic hepatitis C, genotype 1; and 2 Patient has had previous treatment with pegylated interferon and ribavirin; and 3 Any of the following: 3.1 Patient has responder relapsed; or 3.2 Patient was a partial responder; or 3.3 Patient received interferon treatment prior to 2004; and 4 Patient is to be treated in combination with boceprevir; and 5 Maximum of 48 weeks therapy. 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: G Approved dose is 180 mcg once weekly. G The recommended dose of Pegylated Interferon alfa-2a is 180 mcg once weekly. G In patients with renal insufficiency (calculated creatinine clearance less than 50ml/min), Pegylated Interferon-alfa 2a dose should be reduced to 135 mcg once weekly. G In patients with neutropaenia and thrombocytopaenia, dose should be reduced in accordance with the datasheet guidelines. G Pegylated Interferon-alfa 2a is not approved for use in children.

Urinary Tract Infections

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

112

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


INFECTIONS - AGENTS FOR SYSTEMIC USE

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

NITROFURANTOIN F Tab 50 mg – For nitrofurantoin oral liquid formulation refer, page 194 .................................................................................... 22.20 F Tab 100 mg .......................................................................................37.50 NORFLOXACIN Tab 400 mg – Maximum of 6 tab per prescription; can be waived by endorsement - Retail pharmacy - Specialist.............. 15.45

100 100

Nifuran Nifuran

100

Arrow-Norfloxacin

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

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

113


MUSCULOSKELETAL SYSTEM

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

Anticholinesterases

NEOSTIGMINE METILSULFATE Inj 2.5 mg per ml, 1 ml ampoule .....................................................140.00 PYRIDOSTIGMINE BROMIDE L Tab 60 mg .........................................................................................38.90 50 100

AstraZeneca Mestinon

Non-Steroidal Anti-Inflammatory Drugs

¾SA1038 Special Authority for Manufacturers Price Note: Subsidy for patients with existing approvals prior to 1 September 2010. Approvals valid without further renewal unless notified. No new approvals will be granted from 1 September 2010. DICLOFENAC SODIUM F Tab EC 25 mg .....................................................................................4.00 100 Apo-Diclo F Tab 50 mg dispersible – Additional subsidy by Special Authority see SA1038 above – Retail pharmacy ............................. 1.50 20 (8.00) Voltaren D F Tab EC 50 mg ...................................................................................16.00 500 Apo-Diclo F Tab long-acting 75 mg ......................................................................24.52 500 Diclax SR F Tab long-acting 100 mg ....................................................................42.25 500 Diclax SR F Inj 25 mg per ml, 3 ml .......................................................................12.00 5 Voltaren Up to 5 inj available on a PSO F Suppos 12.5 mg .................................................................................1.85 10 Voltaren F Suppos 25 mg ....................................................................................2.22 10 Voltaren F Suppos 50 mg ....................................................................................3.84 10 Voltaren Up to 10 supp available on a PSO F Suppos 100 mg ..................................................................................6.36 10 Voltaren IBUPROFEN F Tab 200 mg .......................................................................................12.75 F Tab 400 mg – Additional subsidy by Special Authority see SA1038 above – Retail pharmacy ............................................... 0.77 (4.56) F Tab 600 mg – Additional subsidy by Special Authority see SA1038 above – Retail pharmacy ............................................... 1.15 (6.84) F Tab long-acting 800 mg ......................................................................8.12 F‡ Oral liq 20 mg per ml ..........................................................................2.69 KETOPROFEN F Cap long-acting 100 mg ...................................................................21.56 F Cap long-acting 200 mg ...................................................................43.12 1,000 30 Brufen 30 Brufen 30 200 ml 100 100

Arrowcare

Brufen SR Fenpaed Oruvail SR Oruvail SR

MEFENAMIC ACID – Additional subsidy by Special Authority see SA1038 above – Retail pharmacy F Cap 250 mg ........................................................................................0.50 20 (5.60) Ponstan 1.25 50 (9.16) Ponstan NAPROXEN F Tab 250 mg .......................................................................................21.25 F Tab 500 mg .......................................................................................22.25 F Tab long-acting 750 mg ....................................................................18.00 F Tab long-acting 1,000 mg .................................................................21.00

fully subsidised [HP4] refer page 7

500 250 90 90

Noflam 250 Noflam 500 Naprosyn SR 750 Naprosyn SR 1000

114

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


MUSCULOSKELETAL SYSTEM

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

SULINDAC – Additional subsidy by Special Authority see SA1038 on the previous page – Retail pharmacy F Tab 100 mg .........................................................................................2.66 50 (8.55) Aclin F Tab 200 mg .........................................................................................3.36 50 (15.10) Aclin TENOXICAM F Tab 20 mg .........................................................................................23.75 F Inj 20 mg vial ......................................................................................9.95 TIAPROFENIC ACID F Tab 300 mg .......................................................................................19.26 100 1 60

Tilcotil AFT Surgam

NSAIDs Other

MELOXICAM – Special Authority see SA1034 below – Retail pharmacy F Tab 7.5 mg ........................................................................................11.50 30

Arrow-Meloxicam

¾SA1034 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 The patient has moderate to severe haemophilia with less than or equal to 5% of normal circulating functional clotting factor; and 2 The patient has haemophilic arthropathy; and 3 Pain and inflammation associated with haemophilic arthropathy is inadequately controlled by alternative funded treatment options, or alternative funded treatment options are contraindicated.

Topical Products for Joint and Muscular Pain

CAPSAICIN Crm 0.025% – Special Authority see SA1289 below – Retail pharmacy ..................................................................................... 9.95

45 g OP

Zostrix

¾SA1289 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has osteoarthritis that is not responsive to paracetamol and oral non-steroidal anti-inflammatories are contraindicated.

Antirheumatoid Agents

AURANOFIN Tab 3 mg ...........................................................................................68.99 HYDROXYCHLOROQUINE F Tab 200 mg .......................................................................................18.00 LEFLUNOMIDE Tab 10 mg .........................................................................................55.00 Tab 20 mg .........................................................................................76.00 Tab 100 mg .......................................................................................54.44 PENICILLAMINE Tab 125 mg .......................................................................................61.93 Tab 250 mg .......................................................................................98.98 SODIUM AUROTHIOMALATE Inj 10 mg in 0.5 ml ampoule .............................................................76.87 Inj 20 mg in 0.5 ml ampoule ...........................................................113.17 Inj 50 mg in 0.5 ml ampoule ...........................................................217.23

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

60 100 30 30 3 100 100 10 10 10

Ridaura s29 Plaquenil Arava Arava Arava D-Penamine D-Penamine Myocrisin Myocrisin Myocrisin 115

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


MUSCULOSKELETAL SYSTEM

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

Drugs Affecting Bone Metabolism Alendronate for Osteoporosis

¾SA1039 Special Authority for Subsidy Initial application — (Underlying cause – Osteoporosis) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 6 Patient has had a Special Authority approval for zoledronic acid (Underlying cause - Osteoporosis) or raloxifene. Initial application — (Underlying cause – glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is receiving systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Any of the following: 2.1 The patient has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5) (see Note); or 2.2 The patient has a history of one significant osteoporotic fracture demonstrated radiologically; or 2.3 The patient has had a Special Authority approval for zoledronic acid (Underlying cause - glucocorticosteroid therapy) or raloxifene. Renewal — (Underlying cause was, and remains, glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year where the patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents). Renewal — (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - osteoporosis’ criteria) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 6 Patient has had a Special Authority approval for zoledronic acid (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - Osteoporosis’ criteria) or raloxifene. Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. continued. . .

116

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


MUSCULOSKELETAL SYSTEM

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

continued. . . b) Evidence suggests patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for treatment with bisphosphonates. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) In line with the Australian guidelines for funding alendronate, a vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. ALENDRONATE SODIUM – Special Authority see SA1039 on the previous page – Retail pharmacy F Tab 70 mg .........................................................................................22.90 4 Fosamax ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA1039 on the previous page – Retail pharmacy F Tab 70 mg with cholecalciferol 5,600 iu ............................................22.90 4 Fosamax Plus

Alendronate for Paget’s Disease

¾SA0949 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Paget’s disease; and 2 Any of the following: 2.1 Bone or articular pain; or 2.2 Bone deformity; or 2.3 Bone, articular or neurological complications; or 2.4 Asymptomatic disease, but risk of complications due to site (base of skull, spine, long bones of lower limbs); or 2.5 Preparation for orthopaedic surgery. Renewal from any relevant practitioner. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefiting from treatment. ALENDRONATE SODIUM – Special Authority see SA0949 above – Retail pharmacy F Tab 40 mg .......................................................................................133.00 30 Fosamax

Other Treatments

ETIDRONATE DISODIUM – See prescribing guideline below F Tab 200 mg .......................................................................................15.80 100 Arrow-Etidronate Prescribing Guidelines Etidronate for osteoporosis should be prescribed for 14 days (400 mg in the morning) and repeated every three months. It should not be taken at the same time of the day as any calcium supplementation (minimum dose – 500 mg per day of elemental calcium). Etidronate should be taken at least 2 hours before or after any food or fluid, except water. PAMIDRONATE DISODIUM Inj 3 mg per ml, 5 ml .........................................................................18.75 1 Pamisol Inj 3 mg per ml, 10 ml .......................................................................16.00 1 Pamidronate BNM Inj 6 mg per ml, 10 ml .......................................................................32.00 1 Pamidronate BNM Inj 9 mg per ml, 10 ml .......................................................................48.00 1 Pamidronate BNM RALOXIFENE HYDROCHLORIDE – Special Authority see SA1138 on the next page – Retail pharmacy F Tab 60 mg .........................................................................................53.76 28 Evista

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

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

117


MUSCULOSKELETAL SYSTEM

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

¾SA1138 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Notes); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Notes); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Notes); or 6 Patient has had a prior Special Authority approval for zoledronic acid (Underlying cause - Osteoporosis) or alendronate (Underlying cause - Osteoporosis). Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence suggests that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for raloxifene funding. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. RISEDRONATE SODIUM Tab 35 mg ...........................................................................................4.00 4 Risedronate Sandoz TERIPARATIDE – Special Authority see SA1139 below – Retail pharmacy Inj 250 mcg per ml, 2.4 ml ..............................................................490.00 1

Forteo

¾SA1139 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 18 months for applications meeting the following criteria: All of the following: 1 The patient has severe, established osteoporosis; and 2 The patient has a documented T-score less than or equal to -3.0 (see Notes); and 3 The patient has had two or more fractures due to minimal trauma; and 4 The patient has experienced at least one symptomatic new fracture after at least 12 months’ continuous therapy with a funded antiresorptive agent at adequate doses (see Notes). Notes: a) The bone mineral density (BMD) measurement used to derive the T-score must be made using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable b) Antiresorptive agents and their adequate doses for the purposes of this Special Authority are defined as: alendronate sodium tab 70 mg or tab 70 mg with cholecalciferol 5,600 iu once weekly; raloxifene hydrochloride tab 60 mg once daily; zoledronic acid 5 mg per year. If an intolerance of a severity necessitating permanent treatment withdrawal develops during the use of one antiresorptive agent, an alternate antiresorptive agent must be trialled so that the patient achieves the minimum requirement of 12 months’ continuous therapy. continued. . .

118

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


MUSCULOSKELETAL SYSTEM

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

continued. . . c) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. d) A maximum of 18 months of treatment (18 cartridges) will be subsidised. ZOLEDRONIC ACID – Special Authority see SA1187 below – Retail pharmacy Soln for infusion 5 mg in 100 ml .....................................................600.00 100 ml OP Aclasta ¾SA1187 Special Authority for Subsidy Initial application — (Paget’s disease) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Paget’s disease; and 2 Any of the following: 2.1 Bone or articular pain; or 2.2 Bone deformity; or 2.3 Bone, articular or neurological complications; or 2.4 Asymptomatic disease, but risk of complications; or 2.5 Preparation for orthopaedic surgery; and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Initial application — (Underlying cause - Osteoporosis) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Any of the following: 1.1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 1.2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 1.3 History of two significant osteoporotic fractures demonstrated radiologically; or 1.4 Documented T-Score ≤ -3.0 (see Note); or 1.5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 1.6 Patient has had a Special Authority approval for alendronate (Underlying cause - Osteoporosis) or raloxifene; and 2 The patient will not be prescribed more than one infusion in a 12-month period. Initial application — (Underlying cause - glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 The patient is receiving systemic glucocorticosteroid therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Any of the following: 2.1 The patient has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5) (see Note); or 2.2 The patient has a history of one significant osteoporotic fracture demonstrated radiologically; or 2.3 The patient has had a Special Authority approval for alendronate (Underlying cause - glucocorticosteroid therapy) or raloxifene; and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Renewal — (Paget’s disease) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: continued. . .

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

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

119


MUSCULOSKELETAL SYSTEM

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

continued. . . 1 Any of the following: 1.1 The patient has relapsed (based on increases in serum alkaline phosphatase); or 1.2 The patient’s serum alkaline phosphatase has not normalised following previous treatment with zoledronic acid; or 1.3 Symptomatic disease (prescriber determined); and 2 The patient will not be prescribed more than one infusion in the 12-month approval period. The patient must not have had more than 1 prior approval in the last 12 months. Renewal — (Underlying cause was, and remains, glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents); and 2 The patient will not be prescribed more than one infusion in the 12-month approval period. The patient must not have had more than 1 prior approval in the last 12 months. Renewal — (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - osteoporosis’ criteria) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Any of the following: 1.1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 1.2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 1.3 History of two significant osteoporotic fractures demonstrated radiologically; or 1.4 Documented T-Score ≤ -3.0 (see Note); or 1.5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 1.6 Patient has had a Special Authority approval for alendronate (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - Osteoporosis’ criteria) or raloxifene; and 2 The patient will not be prescribed more than one infusion in a 12-month period. Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence suggests that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for treatment with bisphosphonates. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body.

Hyperuricaemia and Antigout

ALLOPURINOL F Tab 100 mg .......................................................................................15.90 F Tab 300 mg – For allopurinol oral liquid formulation refer, page 194 .................................................................................... 16.75 1,000 500

Apo-Allopurinol Apo-Allopurinol

120

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


MUSCULOSKELETAL SYSTEM

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

BENZBROMARONE – Special Authority see SA1319 below – Retail pharmacy Tab 100 mg .......................................................................................45.00

100

Benzbromaron AL

100

¾SA1319 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Any of the following: 1.1 The patient has a serum urate level greater than 0.36 mmol/l despite treatment with allopurinol at doses of at least 600 mg/day and appropriate doses of probenecid; or 1.2 The patient has experienced intolerable side effects from allopurinol such that treatment discontinuation is required and serum urate remains greater than 0.36 mmol/l despite appropriate doses of probenecid; or 1.3 Both: 1.3.1 The patient has renal impairment and serum urate remains greater than 0.36 mmol/l despite optimal treatment with allopurinol (see Note); and 1.3.2 The patient has a rate of creatinine clearance greater than or equal to 20 ml/min; or 1.4 All of the following: 1.4.1 The patient is taking azathioprine and requires urate-lowering therapy; and 1.4.2 Allopurinol is contraindicated; and 1.4.3 Appropriate doses of probenecid are ineffective or probenecid cannot be used due to reduced renal function; and 2 The patient is receiving monthly liver function tests. Renewal from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefitting from the treatment; and 2 There is no evidence of liver toxicity and patient is continuing to receive regular (at least every three months) liver function tests. Notes: Benzbromarone has been associated with potentially fatal hepatotoxicity. Optimal treatment with allopurinol in patients with renal impairment is defined as treatment to the creatinine clearance-adjusted dose of allopurinol then, if serum urate remains greater than 0.36 mmol/l, a gradual increase of the dose of allopurinol to 600 mg or the maximum tolerated dose. The New Zealand Rheumatology Association has developed information for prescribers which can be accessed from its website at http://www.rheumatology.org.nz/benzbromarone_prescriber_information.cfm COLCHICINE F Tab 500 mcg .....................................................................................10.08 PROBENECID F Tab 500 mg .......................................................................................55.00 100 100

Colgout Probenecid-AFT

Muscle Relaxants

BACLOFEN F Tab 10 mg – For baclofen oral liquid formulation refer, page 194 ............................................................................................... 3.85 DANTROLENE F Cap 25 mg ........................................................................................65.00 F Cap 50 mg ........................................................................................77.00 ORPHENADRINE CITRATE Tab 100 mg .......................................................................................18.54

100 100 100 100

Pacifen Dantrium Dantrium Norflex

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

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

121


NERVOUS SYSTEM

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

Agents for Parkinsonism and Related Disorders Dopamine Agonists and Related Agents

AMANTADINE HYDROCHLORIDE L Cap 100 mg ......................................................................................38.24 APOMORPHINE HYDROCHLORIDE L Inj 10 mg per ml, 2 ml .....................................................................110.00 BROMOCRIPTINE MESYLATE F Tab 2.5 mg ........................................................................................32.08 F Cap 5 mg ..........................................................................................60.43 ENTACAPONE L Tab 200 mg .......................................................................................47.92 LEVODOPA WITH BENSERAZIDE F Tab dispersible 50 mg with benserazide 12.5 mg .............................10.00 F Cap 50 mg with benserazide 12.5 mg ................................................8.00 F Cap 100 mg with benserazide 25 mg ...............................................12.50 F Cap long-acting 100 mg with benserazide 25 mg ............................17.00 F Cap 200 mg with benserazide 50 mg ...............................................25.00 LEVODOPA WITH CARBIDOPA F Tab 100 mg with carbidopa 25 mg – For levodopa with carbidopa oral liquid formulation refer, page 194 ............................ 10.00 20.00 F Tab long-acting 200 mg with carbidopa 50 mg .................................47.50 F Tab 250 mg with carbidopa 25 mg ....................................................40.00 LISURIDE HYDROGEN MALEATE L Tab 200 mcg .....................................................................................25.00 PERGOLIDE L Tab 0.25 mg ......................................................................................48.00 L Tab 1 mg .........................................................................................170.00 PRAMIPEXOLE HYDROCHLORIDE L Tab 1 mg .............................................................................................7.20 24.39 L Tab 0.125 mg ......................................................................................1.95 L Tab 0.25 mg ........................................................................................2.40 7.20 L Tab 0.5 mg ..........................................................................................4.20 60 5 100 100 100 100 100 100 100 100

Symmetrel Apomine Apo-Bromocriptine Apo-Bromocriptine Entapone Madopar Rapid Madopar 62.5 Madopar 125 Madopar HBS Madopar 250

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

Sindopa Sinemet Sinemet CR Sinemet Dopergin Permax Permax Dr Reddy’s

Pramipexole

Ramipex Dr Reddy’s

Pramipexole

Dr Reddy’s

Pramipexole

Ramipex Dr Reddy’s

Pramipexole

122

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

ROPINIROLE HYDROCHLORIDE Tab 0.25 mg ........................................................................................2.36 6.20 Tab 1 mg .............................................................................................5.32 15.95 Tab 2 mg .............................................................................................7.72 24.95 Tab 5 mg ...........................................................................................14.48 38.00 SELEGILINE HYDROCHLORIDE F Tab 5 mg ...........................................................................................16.06

100 84 100 84 100 84 100 84 100

Apo-Ropinirole Ropin Apo-Ropinirole Ropin Apo-Ropinirole Ropin Apo-Ropinirole Ropin Apo-Selegiline Apo-Selegiline

S29

TOLCAPONE L Tab 100 mg .....................................................................................126.20

100

Tasmar

Anticholinergics

BENZTROPINE MESYLATE Tab 2 mg .............................................................................................7.99 Inj 1 mg per ml, 2 ml .........................................................................95.00 a) Up to 5 inj available on a PSO b) Only on a PSO ORPHENADRINE HYDROCHLORIDE Tab 50 mg .........................................................................................35.15 PROCYCLIDINE HYDROCHLORIDE Tab 5 mg .............................................................................................7.40 60 5

Benztrop Cogentin

250 100

Disipal Kemadrin

Agents for Essential Tremor, Chorea and Related Disorders

RILUZOLE – Special Authority see SA1403 below – Retail pharmacy Wastage claimable – see rule 3.3.2 on page 17 Tab 50 mg .......................................................................................400.00

56

Rilutek

¾SA1403 Special Authority for Subsidy Initial application only from a neurologist or respiratory specialist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient has amyotrophic lateral sclerosis with disease duration of 5 years or less; and 2 The patient has at least 60 percent of predicted forced vital capacity within 2 months prior to the initial application; and 3 The patient has not undergone a tracheostomy; and 4 The patient has not experienced respiratory failure; and 5 Any of the following: 5.1 The patient is ambulatory; or 5.2 The patient is able to use upper limbs; or 5.3 The patient is able to swallow. Renewal from any relevant practitioner. Approvals valid for 18 months for applications meeting the following criteria: All of the following: 1 The patient has not undergone a tracheostomy; and 2 The patient has not experienced respiratory failure; and continued. . .

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

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

123


NERVOUS SYSTEM

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

continued. . . 3 Any of the following: 3.1 The patient is ambulatory; or 3.2 The patient is able to use upper limbs; or 3.3 The patient is able to swallow. TETRABENAZINE Tab 25 mg .......................................................................................118.00

112

Motetis

Anaesthetics Local

LIDOCAINE [LIGNOCAINE] Gel 2%, 10 ml urethral syringe – Subsidy by endorsement...............43.26 10 Pfizer a) Up to 5 each available on a PSO b) Subsidised only if prescribed for urethral or cervical administration and the prescription is endorsed accordingly. LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE Viscous soln 2% ...............................................................................55.00 200 ml Xylocaine Viscous Inj 1%, 5 ml ampoule – Up to 25 inj available on a PSO ....................8.75 25 Lidocaine-Claris 17.50 50 (35.00) Xylocaine Inj 2%, 5 ml ampoule – Up to 5 inj available on a PSO ......................6.90 25 Lidocaine-Claris Inj 1%, 20 ml ampoule – Up to 5 inj available on a PSO ....................2.40 1 Lidocaine-Claris 12.00 5 (20.00) Xylocaine Inj 2%, 20 ml ampoule – Up to 5 inj available on a PSO ....................2.40 1 Lidocaine-Claris LIDOCAINE [LIGNOCAINE] WITH CHLORHEXIDINE Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringes – Subsidy by endorsement ............................................................ 43.26 10 Pfizer a) Up to 5 each available on a PSO b) Subsidised only if prescribed for urethral or cervical administration and the prescription is endorsed accordingly. LIDOCAINE [LIGNOCAINE] WITH PRILOCAINE – Special Authority see SA0906 below – Retail pharmacy Crm 2.5% with prilocaine 2.5% ........................................................45.00 30 g OP EMLA Crm 2.5% with prilocaine 2.5% (5 g tubes) ......................................45.00 5 EMLA ¾SA0906 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years where the patient is a child with a chronic medical condition requiring frequent injections or venepuncture. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

Analgesics

For Anti-inflammatory NSAIDS refer to MUSCULOSKELETAL, page 114

Non-opioid Analgesics

ASPIRIN F Tab EC 300 mg ...................................................................................2.00 (8.10) F Tab dispersible 300 mg – Up to 30 tab available on a PSO ...............2.00 100 Aspec 300 100

Ethics Aspirin

124

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

CAPSAICIN – Subsidy by endorsement a) For aspirin & chloroform application refer, page 197 b) Subsidised only if prescribed for post-herpetic neuralgia or diabetic peripheral neuropathy and the prescription is endorsed accordingly. Crm 0.075% .....................................................................................12.50 45 g OP Zostrix HP NEFOPAM HYDROCHLORIDE Tab 30 mg .........................................................................................23.40 PARACETAMOL F Tab 500 mg – Up to 30 tab available on a PSO..................................9.38 F‡ Oral liq 120 mg per 5 ml .....................................................................2.21 a) Up to 200 ml available on a PSO b) Not in combination F‡ Oral liq 250 mg per 5 ml .....................................................................6.70 a) Up to 100 ml available on a PSO b) Not in combination F Suppos 125 mg ..................................................................................7.49 F Suppos 250 mg ................................................................................14.40 F Suppos 500 mg ................................................................................20.70 90 1,000 500 ml

Acupan Parafast Ethics Paracetamol Paracare Double

Strength

1,000 ml

20 20 50

Panadol Panadol Paracare

Opioid Analgesics

CODEINE PHOSPHATE – Safety medicine; prescriber may determine dispensing frequency Tab 15 mg ...........................................................................................4.75 100 Tab 30 mg ...........................................................................................5.80 100 Tab 60 mg .........................................................................................12.50 100 DIHYDROCODEINE TARTRATE Tab long-acting 60 mg ......................................................................13.64 FENTANYL a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency Inj 50 mcg per ml, 2 ml .......................................................................4.50 Inj 50 mcg per ml, 10 ml ...................................................................11.77 Transdermal patch 12.5 mcg per hour ................................................8.90 Transdermal patch 25 mcg per hour ...................................................9.15 Transdermal patch 50 mcg per hour .................................................11.50 Transdermal patch 75 mcg per hour .................................................13.60 Transdermal patch 100 mcg per hour ...............................................14.50 60

PSM PSM PSM DHC Continus

10 10 5 5 5 5 5

Boucher and Muir Boucher and Muir Mylan Fentanyl

Patch

Mylan Fentanyl

Patch

Mylan Fentanyl

Patch

Mylan Fentanyl

Patch

Mylan Fentanyl

Patch

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

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

125


NERVOUS SYSTEM

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

METHADONE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency d) Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). e) For methadone hydrochloride oral liquid refer, page 197 Tab 5 mg .............................................................................................1.85 10 Methatabs ‡ Oral liq 2 mg per ml ............................................................................5.55 200 ml Biodone ‡ Oral liq 5 mg per ml ............................................................................5.55 200 ml Biodone Forte ‡ Oral liq 10 mg per ml ..........................................................................6.55 200 ml Biodone Extra Forte Inj 10 mg per ml, 1 ml .......................................................................61.00 10 AFT MORPHINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency ‡ Oral liq 1 mg per ml ............................................................................8.84 ‡ Oral liq 2 mg per ml ..........................................................................11.62 ‡ Oral liq 5 mg per ml ..........................................................................14.65 ‡ Oral liq 10 mg per ml ........................................................................21.55 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency Tab immediate-release 10 mg ............................................................2.80 Tab long-acting 10 mg ........................................................................1.95 Tab immediate-release 20 mg ............................................................5.52 Tab long-acting 30 mg ........................................................................2.98 Tab long-acting 60 mg ........................................................................5.75 Tab long-acting 100 mg ......................................................................6.45 Cap long-acting 10 mg .......................................................................1.70 Cap long-acting 30 mg .......................................................................2.50 Cap long-acting 60 mg .......................................................................5.40 Cap long-acting 100 mg .....................................................................6.38 Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO .......................5.51 Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................4.79 Inj 15 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................5.01 Inj 30 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................5.30 MORPHINE TARTRATE 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

200 ml 200 ml 200 ml 200 ml

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

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

Sevredol Arrow-Morphine LA Sevredol Arrow-Morphine LA Arrow-Morphine LA Arrow-Morphine LA m-Eslon m-Eslon m-Eslon m-Eslon DBL Morphine

Sulphate

DBL Morphine

Sulphate

DBL Morphine

Sulphate

DBL Morphine

Sulphate

5 5

Hospira Hospira

126

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

OXYCODONE HYDROCHLORIDE a) Only on a controlled drug form b) See prescribing guideline below c) No patient co-payment payable d) Safety medicine; prescriber may determine dispensing frequency Tab controlled-release 5 mg ...............................................................7.51 Tab controlled-release 10 mg .............................................................6.75 (11.14) Tab controlled-release 20 mg ...........................................................11.50 (18.93) Tab controlled-release 40 mg ...........................................................18.50 (33.29) Tab controlled-release 80 mg ...........................................................34.00 (58.03) Cap immediate-release 5 mg .............................................................2.83 Cap immediate-release 10 mg ...........................................................5.58 Cap immediate-release 20 mg ...........................................................9.77 ‡ Oral liq 5 mg per 5 ml .......................................................................11.20 Inj 10 mg per ml, 1 ml .......................................................................10.08 Inj 10 mg per ml, 2 ml .......................................................................19.87 Inj 50 mg per ml, 1 ml .......................................................................60.00 (OxyContin Tab controlled-release 10 mg to be delisted 1 January 2014) (OxyContin Tab controlled-release 20 mg to be delisted 1 January 2014) (OxyContin Tab controlled-release 40 mg to be delisted 1 January 2014) (OxyContin Tab controlled-release 80 mg to be delisted 1 January 2014)

20 20 20 20 20 20 20 20 250 ml 5 5 5

OxyContin Oxydone BNM

OxyContin

Oxydone BNM

OxyContin

Oxydone BNM

OxyContin

Oxydone BNM

OxyContin

OxyNorm OxyNorm OxyNorm OxyNorm Oxycodone Orion Oxycodone Orion OxyNorm

Prescribing Guideline Prescribers should note that oxycodone is significantly more expensive than long-acting morphine sulphate and clinical advice suggests that it is reasonable to consider this as a second-line agent to be used after morphine. PARACETAMOL WITH CODEINE – Safety medicine; prescriber may determine dispensing frequency F Tab paracetamol 500 mg with codeine phosphate 8 mg ....................2.70 100 Paracetamol + Codeine (Relieve) PETHIDINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency Tab 50 mg ...........................................................................................3.95 10 PSM Tab 100 mg .........................................................................................5.80 10 PSM Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................5.51 5 DBL Pethidine Hydrochloride Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .....................5.83 5 DBL Pethidine Hydrochloride TRAMADOL HYDROCHLORIDE Tab sustained-release 100 mg ...........................................................2.14 20 Tramal SR 100 Tab sustained-release 150 mg ...........................................................3.21 20 Tramal SR 150 Tab sustained-release 200 mg ...........................................................4.28 20 Tramal SR 200 Cap 50 mg ..........................................................................................4.95 100 Arrow-Tramadol

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

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

127


NERVOUS SYSTEM

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

Antidepressants Cyclic and Related Agents

AMITRIPTYLINE – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg ...........................................................................................3.32 100 Tab 25 mg ...........................................................................................1.85 100 Tab 50 mg ...........................................................................................3.60 100

Arrow Amitriptyline Amitrip Amitrip

CLOMIPRAMINE HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg .........................................................................................12.60 100 Apo-Clomipramine Tab 25 mg ...........................................................................................8.68 100 Apo-Clomipramine DOTHIEPIN HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 75 mg .........................................................................................10.50 100 Dopress Cap 25 mg ..........................................................................................6.17 100 Dopress DOXEPIN HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Cap 10 mg ..........................................................................................6.30 100 Anten Cap 25 mg ..........................................................................................6.86 100 Anten Cap 50 mg ..........................................................................................8.55 100 Anten IMIPRAMINE HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg ...........................................................................................5.48 50 Tofranil 6.58 60 Tofranil Tab 25 mg ...........................................................................................8.80 50 Tofranil MAPROTILINE HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 25 mg .........................................................................................25.06 100 Ludiomil Tab 75 mg .........................................................................................14.01 20 Ludiomil 21.01 30 Ludiomil MIANSERIN HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 30 mg .........................................................................................24.86 30 Tolvon NORTRIPTYLINE HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg ...........................................................................................4.00 100 Norpress Tab 25 mg ...........................................................................................9.00 180 Norpress

Monoamine-Oxidase Inhibitors (MAOIs) - Non Selective

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

Nardil Parnate

Monoamine-Oxidase Type A Inhibitors

MOCLOBEMIDE Note: There is a significant cost differential between moclobemide and fluoxetine (moclobemide being about three times more expensive). For depressive syndromes it is therefore more cost-effective to start treatment with fluoxetine first before considering prescribing moclobemide. F Tab 150 mg .......................................................................................81.83 500 Apo-Moclobemide F Tab 300 mg .......................................................................................29.51 100 Apo-Moclobemide

128

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

Selective Serotonin Reuptake Inhibitors

CITALOPRAM HYDROBROMIDE F Tab 20 mg ...........................................................................................2.34 ESCITALOPRAM F Tab 10 mg ...........................................................................................2.65 F Tab 20 mg ...........................................................................................4.20 84 28 28

Arrow-Citalopram Loxalate Loxalate

FLUOXETINE HYDROCHLORIDE F Tab dispersible 20 mg, scored – Subsidy by endorsement .................2.50 30 Fluox Subsidised by endorsement 1) When prescribed for a patient who cannot swallow whole tablets or capsules and the prescription is endorsed accordingly; or 2) When prescribed in a daily dose that is not a multiple of 20 mg in which case the prescription is deemed to be endorsed. Note: Tablets should be combined with capsules to facilitate incremental 10 mg doses. F Cap 20 mg ..........................................................................................2.70 84 Fluox PAROXETINE HYDROCHLORIDE F Tab 20 mg ...........................................................................................2.38 4.32 SERTRALINE F Tab 50 mg ...........................................................................................3.64 F Tab 100 mg .........................................................................................6.28 30 90 90 90

Loxamine Loxamine Arrow-Sertraline Arrow-Sertraline

Other Antidepressants

MIRTAZAPINE – Special Authority see SA0994 below – Retail pharmacy Tab 30 mg ...........................................................................................8.78 Tab 45 mg .........................................................................................13.95 30 30

Avanza Avanza

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

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

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

129


NERVOUS SYSTEM

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

VENLAFAXINE Tab 37.5 mg ........................................................................................5.06 Tab 75 mg ...........................................................................................6.44 Tab 150 mg .........................................................................................8.86 Tab 225 mg .......................................................................................14.34 Cap 37.5 mg – Special Authority see SA1061 below – Retail pharmacy ..................................................................................... 8.71 Cap 75 mg – Special Authority see SA1061 below – Retail pharmacy ................................................................................... 17.42 Cap 150 mg – Special Authority see SA1061 below – Retail pharmacy ................................................................................... 21.35

28 28 28 28

Arrow-Venlafaxine

XR

Arrow-Venlafaxine

XR

Arrow-Venlafaxine

XR

Arrow-Venlafaxine

XR

28 28 28

Efexor XR Efexor XR Efexor XR

¾SA1061 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 The patient has ’treatment-resistant’ depression; and 2 Either: 2.1 The patient must have had a trial of two different antidepressants and have had an inadequate response from an adequate dose over an adequate period of time (usually at least four weeks); or 2.2 Both: 2.2.1 The patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2 The patient must have had a trial of one other antidepressant and have had an inadequate response from an adequate dose over an adequate period of time. Renewal from any medical practitioner. Approvals valid for 2 years where the patient has a high risk of relapse (prescriber determined).

Antiepilepsy Drugs Agents for Control of Status Epilepticus

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

Rivotril Hospira

5 5 5 5 5

Stesolid Stesolid AFT Hospira Hospira

130

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

Control of Epilepsy

CARBAMAZEPINE F Tab 200 mg .......................................................................................14.53 F Tab long-acting 200 mg ....................................................................16.98 F Tab 400 mg .......................................................................................34.58 F Tab long-acting 400 mg ....................................................................39.17 F‡ Oral liq 100 mg per 5 ml ...................................................................26.37 100 100 100 100 250 ml

Tegretol Tegretol CR Tegretol Tegretol CR Tegretol Frisium Rivotril Zarontin Zarontin Arrow-Gabapentin Nupentin Arrow-Gabapentin Nupentin Arrow-Gabapentin Nupentin

CLOBAZAM – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg ...........................................................................................9.12 50 ‡ Safety cap for extemporaneously compounded oral liquid preparations. CLONAZEPAM – Safety medicine; prescriber may determine dispensing frequency ‡ Oral drops 2.5 mg per ml ....................................................................7.38 10 ml OP ETHOSUXIMIDE F Cap 250 mg ......................................................................................32.90 F‡ Oral liq 250 mg per 5 ml ...................................................................13.60 GABAPENTIN – Special Authority see SA1071 below – Retail pharmacy L Cap 100 mg ........................................................................................7.16 L Cap 300 mg – For gabapentin oral liquid formulation refer, page 194 .................................................................................... 11.00 11.50 L Cap 400 mg ......................................................................................13.75 14.75 200 200 ml 100

100 100

¾SA1071 Special Authority for Subsidy Initial application — (Epilepsy) from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Either: 1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents. Note: "Optimal treatment with other antiepilepsy agents" is defined as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Initial application — (Neuropathic pain) from any relevant practitioner. Approvals valid for 3 months where the patient has tried and failed, or has been unable to tolerate, treatment with a tricyclic antidepressant. Renewal — (Epilepsy) from any relevant practitioner. Approvals valid without further renewal unless notified where the patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life. Note: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Renewal — (Neuropathic pain) from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 The patient has demonstrated a marked improvement in their control of pain (prescriber determined); or 2 The patient has previously demonstrated clinical responsiveness to gabapentin and has now developed neuropathic pain in a new site.

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

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

131


NERVOUS SYSTEM

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

GABAPENTIN (NEURONTIN) – Special Authority see SA0973 below – Retail pharmacy L Tab 600 mg .......................................................................................67.50 100 L Cap 100 mg ......................................................................................13.26 100 L Cap 300 mg – For gabapentin (neurontin) oral liquid formulation refer, page 194.................................................................. 39.76 100 L Cap 400 mg ......................................................................................53.01 100

Neurontin Neurontin Neurontin Neurontin

¾SA0973 Special Authority for Subsidy Notes: Subsidy for patients pre-approved by PHARMAC on 1 August 2009. Approvals valid without further renewal unless notified. No new approvals will be granted from 1 August 2009. LACOSAMIDE – Special Authority see SA1125 below – Retail pharmacy L Tab 50 mg .........................................................................................25.04 14 Vimpat L Tab 100 mg .......................................................................................50.06 14 Vimpat 200.24 56 Vimpat L Tab 150 mg .......................................................................................75.10 14 Vimpat 300.40 56 Vimpat L Tab 200 mg .....................................................................................400.55 56 Vimpat ¾SA1125 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Both: 1 Patient has partial-onset epilepsy; and 2 Seizures are not adequately controlled by, or patient has experienced unacceptable side effects from, optimal treatment with all of the following: sodium valproate, topiramate, levetiracetam and any two of carbamazepine, lamotrigine and phenytoin sodium (see Note). Note: "Optimal treatment" is defined as treatment which is indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Women of childbearing age are not required to have a trial of sodium valproate. Renewal from any relevant practitioner. Approvals valid for 24 months where the patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life compared with that prior to starting lacosamide treatment (see Note). Note: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. LAMOTRIGINE L Tab dispersible 2 mg ...........................................................................6.74 30 Lamictal L Tab dispersible 5 mg ...........................................................................9.64 30 Lamictal 15.00 56 Arrow-Lamotrigine L Tab dispersible 25 mg .......................................................................19.38 56 Logem 20.40 Arrow-Lamotrigine Mogine 29.09 Lamictal L Tab dispersible 50 mg .......................................................................32.97 56 Logem 34.70 Arrow-Lamotrigine Mogine 47.89 Lamictal L Tab dispersible 100 mg .....................................................................56.91 56 Logem 59.90 Arrow-Lamotrigine Mogine 79.16 Lamictal

132

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

LEVETIRACETAM Tab 250 mg .......................................................................................24.03 Tab 500 mg – For levetiracetam oral liquid formulation refer, page 194 .................................................................................... 28.71 Tab 750 mg .......................................................................................45.23 PHENOBARBITONE For phenobarbitone oral liquid refer, page 197 F Tab 15 mg .........................................................................................28.00 F Tab 30 mg .........................................................................................29.00 PHENYTOIN SODIUM F Tab 50 mg .........................................................................................42.09 F Cap 30 mg ........................................................................................19.13 F Cap 100 mg ......................................................................................17.21 F‡ Oral liq 30 mg per 5 ml .....................................................................19.16 PRIMIDONE F Tab 250 mg .......................................................................................17.25 SODIUM VALPROATE F Tab 100 mg .......................................................................................13.65 F Tab 200 mg EC .................................................................................27.44 F Tab 500 mg EC .................................................................................52.24 F‡ Oral liq 200 mg per 5 ml ...................................................................20.48 F Inj 100 mg per ml, 4 ml .....................................................................41.50 STIRIPENTOL – Special Authority see SA1330 below – Retail pharmacy Cap 250 mg ....................................................................................509.29 Powder for oral liq 250 mg sachet ..................................................509.29

60 60 60

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

500 500 200 200 200 500 ml 100 100 100 100 300 ml 1 60 60

¾SA1330 Special Authority for Subsidy Initial application only from a paediatric neurologist or Practitioner on the recommendation of a paediatric neurologist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Patient has confirmed diagnosis of Dravet syndrome; and 2 Seizures have been inadequately controlled by appropriate courses of sodium valproate, clobazam and at least two of the following: topiramate, levetiracetam, ketogenic diet. Renewal from any relevant practitioner. Approvals valid without further renewal unless notified where the patient continues to benefit from treatment as measured by reduced seizure frequency from baseline. TOPIRAMATE L Tab 25 mg .........................................................................................11.07 60 Arrow-Topiramate 26.04 Topamax L Tab 50 mg .........................................................................................18.81 60 Arrow-Topiramate 44.26 Topamax L Tab 100 mg .......................................................................................31.99 60 Arrow-Topiramate 75.25 Topamax L Tab 200 mg .......................................................................................55.19 60 Arrow-Topiramate 129.85 Topamax L Sprinkle cap 15 mg ...........................................................................20.84 60 Topamax L Sprinkle cap 25 mg ...........................................................................26.04 60 Topamax VIGABATRIN – Special Authority see SA1072 on the next page – Retail pharmacy L Tab 500 mg .....................................................................................119.30 100

Sabril

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

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

133


NERVOUS SYSTEM

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

¾SA1072 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Both: 1 Either: 1.1 Patient has infantile spasms; or 1.2 Both: 1.2.1 Patient has epilepsy; and 1.2.2 Either: 1.2.2.1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 1.2.2.2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents; and 2 Either: 2.1 Patient is, or will be, receiving regular automated visual field testing (ideally before starting therapy and on a 6-monthly basis thereafter); or 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual fields. Notes: “Optimal treatment with other antiepilepsy agents” is defined as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Vigabatrin is associated with a risk of irreversible visual field defects, which may be asymptomatic in the early stages. Renewal from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 The patient has demonstrated a significant and sustained improvement in seizure rate or severity and or quality of life; and 2 Either: 2.1 Patient is receiving regular automated visual field testing (ideally every 6 months) on an ongoing basis for duration of treatment with vigabatrin; or 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual fields. Notes: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Vigabatrin is associated with a risk of irreversible visual field defects, which may be asymptomatic in the early stages.

Antimigraine Preparations

For Anti-inflammatory NSAIDS refer to MUSCULOSKELETAL, page 114

Acute Migraine Treatment

ERGOTAMINE TARTRATE WITH CAFFEINE Tab 1 mg with caffeine 100 mg .........................................................31.00 METOCLOPRAMIDE HYDROCHLORIDE WITH PARACETAMOL Tab 5 mg with paracetamol 500 mg ....................................................6.77 RIZATRIPTAN Tab orodispersible 10 mg .................................................................18.00 SUMATRIPTAN Tab 50 mg .........................................................................................29.80 Tab 100 mg .......................................................................................54.80 Inj 12 mg per ml, 0.5 ml cartridge – Maximum of 10 inj per prescription................................................................................. 13.80 100 60 30 100 100 2 OP

Cafergot Paramax Rizamelt Arrow-Sumatriptan Arrow-Sumatriptan Arrow-Sumatriptan

134

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

Prophylaxis of Migraine

For Beta Adrenoceptor Blockers refer to CARDIOVASCULAR SYSTEM, page 55 PIZOTIFEN F Tab 500 mcg .....................................................................................23.21

100

Sandomigran

Antinausea and Vertigo Agents

For Antispasmodics refer to ALIMENTARY TRACT, page 26 APREPITANT – Special Authority see SA0987 below – Retail pharmacy Cap 2 × 80 mg and 1 × 125 mg ....................................................116.00

3 OP

Emend Tri-Pack

¾SA0987 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing highly emetogenic chemotherapy and/or anthracycline-based chemotherapy for the treatment of malignancy. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing highly emetogenic chemotherapy and/or anthracycline-based chemotherapy for the treatment of malignancy. BETAHISTINE DIHYDROCHLORIDE F Tab 16 mg .........................................................................................10.00 84 Vergo 16 CYCLIZINE HYDROCHLORIDE Tab 50 mg ...........................................................................................0.59 CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml .......................................................................14.95 DOMPERIDONE F Tab 10 mg – For domperidone oral liquid formulation refer, page 194 ...................................................................................... 3.25 HYOSCINE HYDROBROMIDE F Inj 400 mcg per ml, 1 ml .....................................................................6.66 Patch 1.5 mg – Special Authority see SA1387 below – Retail pharmacy ................................................................................... 11.95 10 5

Nausicalm Nausicalm

100 5 2

Prokinex Hospira Scopoderm TTS

¾SA1387 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: 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 2 Control of clozapine-induced hypersalivation where trials of at least two other alternative treatments have proven ineffective. Renewal from any relevant practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. METOCLOPRAMIDE HYDROCHLORIDE F Tab 10 mg – For metoclopramide hydrochloride oral liquid formulation refer, page 194........................................................... 3.95 100 Metamide F Inj 5 mg per ml, 2 ml – Up to 5 inj available on a PSO .......................4.50 10 Pfizer

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

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

135


NERVOUS SYSTEM

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

ONDANSETRON F Tab 4 mg .............................................................................................5.10 5.51 F Tab disp 4 mg .....................................................................................1.70 17.18 F Tab 8 mg .............................................................................................1.70 6.19 F Tab disp 8 mg .....................................................................................2.00 (Zofran Zydis Tab disp 4 mg to be delisted 1 March 2014) PROCHLORPERAZINE F Tab 3 mg buccal .................................................................................5.97 (15.00) F Tab 5 mg – Up to 30 tab available on a PSO....................................16.85 F Inj 12.5 mg per ml, 1 ml – Up to 5 inj available on a PSO ................25.81 F Suppos 25 mg ..................................................................................23.87 PROMETHAZINE THEOCLATE F Tab 25 mg ...........................................................................................1.20 (6.24) TROPISETRON a) Maximum of 6 cap per prescription b) Maximum of 3 cap per dispensing c) Not more than one prescription per month. Cap 5 mg ..........................................................................................77.41

30 50 10

Dr Reddy’s

Ondansetron

Onrex Dr Reddy’s

Ondansetron

10 50 10

Zofran Zydis Dr Reddy’s

Ondansetron

Onrex Dr Reddy’s

Ondansetron

50 Buccastem 500 10 5 10 Avomine

Antinaus Stemetil Stemetil

5

Navoban

Antipsychotics

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

General

AMISULPRIDE – Safety medicine; prescriber may determine dispensing frequency Tab 100 mg .........................................................................................6.22 30 Tab 200 mg .......................................................................................21.92 60 Tab 400 mg .......................................................................................44.52 60 Oral liq 100 mg per ml ......................................................................52.50 60 ml ARIPIPRAZOLE – Special Authority see SA0920 on the next page – Retail pharmacy Safety medicine; prescriber may determine dispensing frequency Tab 10 mg .......................................................................................123.54 Tab 15 mg .......................................................................................175.28 Tab 20 mg .......................................................................................213.42 Tab 30 mg .......................................................................................260.07

Solian Solian Solian Solian Abilify Abilify Abilify Abilify

30 30 30 30

136

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

¾SA0920 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient is suffering from schizophrenia or related psychoses; and 2 Either: 2.1 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of unacceptable side effects; or 2.2 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of inadequate clinical response. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. CHLORPROMAZINE HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg – Up to 30 tab available on a PSO..................................12.36 100 Largactil Tab 25 mg – Up to 30 tab available on a PSO..................................13.02 100 Largactil Tab 100 mg – Up to 30 tab available on a PSO................................30.61 100 Largactil Inj 25 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................25.66 10 Largactil CLOZAPINE – Hospital pharmacy [HP4] Safety medicine; prescriber may determine dispensing frequency Tab 25 mg .........................................................................................13.37 26.74 6.69 13.37 Tab 50 mg ...........................................................................................8.67 17.33 Tab 100 mg .......................................................................................34.65 69.30 17.33 34.65 Tab 200 mg .......................................................................................34.65 69.30 Suspension 50 mg per ml .................................................................17.33 HALOPERIDOL – Safety medicine; prescriber may determine dispensing frequency Tab 500 mcg – Up to 30 tab available on a PSO................................6.23 Tab 1.5 mg – Up to 30 tab available on a PSO...................................9.43 Tab 5 mg – Up to 30 tab available on a PSO....................................29.72 Oral liq 2 mg per ml – Up to 200 ml available on a PSO ..................23.84 Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................21.55

50 100 50 100 50 100 50 100 50 100 50 100 100 ml 100 100 100 100 ml 10

Clozaril Clozaril Clopine Clopine Clopine Clopine Clozaril Clozaril Clopine Clopine Clopine Clopine Clopine Serenace Serenace Serenace Serenace Serenace

LEVOMEPROMAZINE MALEATE – Safety medicine; prescriber may determine dispensing frequency Tab 25 mg .........................................................................................16.93 100 Nozinan Tab 100 mg .......................................................................................43.96 100 Nozinan Inj 25 mg per ml, 1 ml .......................................................................73.68 10 Nozinan LITHIUM CARBONATE – Safety medicine; prescriber may determine dispensing frequency Tab 250 mg .......................................................................................34.30 500 Tab 400 mg .......................................................................................12.83 100 Tab long-acting 400 mg ....................................................................19.20 100 Cap 250 mg ........................................................................................9.42 100

Lithicarb FC Lithicarb FC Priadel Douglas

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

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

137


NERVOUS SYSTEM

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

OLANZAPINE – Safety medicine; prescriber may determine dispensing frequency Tab 2.5 mg ..........................................................................................2.00

28

Dr Reddy’s

Olanzapine

Olanzine Zypine

(51.07) Tab 5 mg .............................................................................................3.85 Zyprexa 28

Dr Reddy’s

Olanzapine

Olanzine Zypine

(101.21) Tab orodispersible 5 mg .....................................................................6.36 Zyprexa 28

Dr Reddy’s

Olanzapine

Tab 10 mg ...........................................................................................6.35

28

Olanzine-D Zypine ODT Dr Reddy’s

Olanzapine

Olanzine Zypine

(204.49) Tab orodispersible 10 mg ...................................................................8.76 Zyprexa 28

Dr Reddy’s

Olanzapine

Olanzine-D Zypine ODT

Wafer 5 mg .........................................................................................6.36 (102.19) Wafer 10 mg .......................................................................................8.76 (204.37) PERICYAZINE – Safety medicine; prescriber may determine dispensing frequency Tab 2.5 mg ........................................................................................12.49 Tab 10 mg .........................................................................................44.45 QUETIAPINE – Safety medicine; prescriber may determine dispensing frequency Tab 25 mg ...........................................................................................7.00 28 Zyprexa Zydis 28 Zyprexa Zydis 100 100 60

Neulactil Neulactil Dr Reddy’s

Quetiapine

10.50 Tab 100 mg .......................................................................................14.00 21.00

90 60 90

Seroquel Quetapel Seroquel Dr Reddy’s

Quetiapine

Tab 200 mg .......................................................................................24.00

60

Quetapel Dr Reddy’s

Quetiapine

36.00 Tab 300 mg .......................................................................................40.00

90 60

Seroquel Quetapel Dr Reddy’s

Quetiapine

60.00

90

Seroquel Quetapel

138

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

RISPERIDONE – Safety medicine; prescriber may determine dispensing frequency Tab orodispersible 0.5 mg – Special Authority see SA0927 below – Retail pharmacy ........................................................... 21.42 Tab 0.5 mg ..........................................................................................3.51

28 60

Risperdal Quicklet Apo-Risperidone Dr Reddy’s

Risperidone

Ridal

1.17 (2.86) Tab 1 mg .............................................................................................6.00 20 Risperdal 60

Apo-Risperidone Dr Reddy’s

Risperidone

Ridal

(16.92) Tab orodispersible 1 mg – Special Authority see SA0927 below – Retail pharmacy ............................................................... 42.84 Tab 2 mg ...........................................................................................11.00 Risperdal 28 60

Risperdal Quicklet Apo-Risperidone Dr Reddy’s

Risperidone

Ridal

(33.84) Tab orodispersible 2 mg – Special Authority see SA0927 below – Retail pharmacy ............................................................... 85.71 Tab 3 mg ...........................................................................................15.00 Risperdal 28 60

Risperdal Quicklet Apo-Risperidone Dr Reddy’s

Risperidone

Ridal

(50.78) Tab 4 mg ...........................................................................................20.00 Risperdal 60

Apo-Risperidone Dr Reddy’s

Risperidone

Ridal

(67.68) Oral liq 1 mg per ml ..........................................................................18.35 (25.26) Risperdal 30 ml

Apo-Risperidone Risperon

Risperdal

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

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

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

139


NERVOUS SYSTEM

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

continued. . . Renewal from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 2 The patient is under direct supervision for administration of medicine. Note: Risperdal Quicklets cost significantly more than risperidone tablets and should only be used where necessary. TRIFLUOPERAZINE HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 1 mg .............................................................................................9.83 100 Stelazine Tab 2 mg ...........................................................................................14.64 100 Stelazine Tab 5 mg ...........................................................................................16.66 100 Stelazine ZIPRASIDONE – Subsidy by endorsement a) Safety medicine; prescriber may determine dispensing frequency b) Ziprasidone is subsidised for patients suffering from schizophrenia or related psychoses after a trial of an effective dose of risperidone or quetiapine that has been discontinued, or is in the process of being discontinued, because of unacceptable side effects or inadequate response, and the prescription is endorsed accordingly. Cap 20 mg ........................................................................................87.88 60 Zeldox Cap 40 mg ......................................................................................164.78 60 Zeldox Cap 60 mg ......................................................................................247.17 60 Zeldox Cap 80 mg ......................................................................................329.56 60 Zeldox ZUCLOPENTHIXOL HYDROCHLORIDE – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg .........................................................................................31.45 100 Clopixol

Depot Injections

FLUPENTHIXOL DECANOATE – Safety medicine; prescriber may determine dispensing frequency Inj 20 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................13.14 5 Fluanxol Inj 20 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................20.90 5 Fluanxol Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO .................40.87 5 Fluanxol FLUPHENAZINE DECANOATE – Safety medicine; prescriber may determine dispensing frequency Inj 12.5 mg per 0.5 ml, 0.5 ml – Up to 5 inj available on a PSO .........17.60 5 Modecate Inj 25 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................27.90 5 Modecate Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO ...............154.50 5 Modecate HALOPERIDOL DECANOATE – Safety medicine; prescriber may determine dispensing frequency Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................28.39 5 Haldol Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO .................55.90 5 Haldol Concentrate OLANZAPINE – Special Authority see SA1146 below – Retail pharmacy Safety medicine; prescriber may determine dispensing frequency Inj 210 mg .......................................................................................280.00 Inj 300 mg .......................................................................................460.00 Inj 405 mg .......................................................................................560.00

1 1 1

Zyprexa Relprevv Zyprexa Relprevv Zyprexa Relprevv

¾SA1146 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient has schizophrenia; and 2 The patient has tried but failed to comply with treatment using oral atypical antipsychotic agents; and 3 The patient has been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment for 30 days or more in the last 12 months. continued. . .

140

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

continued. . . Renewal from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had less than 12 months’ treatment with olanzapine depot injection; and 1.2 There is no clinical reason to discontinue treatment; or 2 The initiation of olanzapine depot injection has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of olanzapine depot injection. Note: The patient should be monitored for post-injection syndrome for at least two hours after each injection. PIPOTHIAZINE PALMITATE – Safety medicine; prescriber may determine dispensing frequency Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .................178.48 10 Piportil Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .................353.32 10 Piportil RISPERIDONE – Special Authority see SA0926 below – Retail pharmacy Safety medicine; prescriber may determine dispensing frequency Inj 25 mg per 2 ml ...........................................................................175.00 Inj 37.5 mg per 2 ml ........................................................................230.00 Inj 50 mg per 2 ml ...........................................................................280.00

1 1 1

Risperdal Consta Risperdal Consta Risperdal Consta

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

Anxiolytics

ALPRAZOLAM – Safety medicine; prescriber may determine dispensing frequency Tab 250 mcg .......................................................................................2.50 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 500 mcg .......................................................................................3.25 4.10 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 1 mg .............................................................................................5.00 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 50

Arrow-Alprazolam Xanax Xanax Arrow-Alprazolam Arrow-Alprazolam Xanax

50

50

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

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

141


NERVOUS SYSTEM

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

BUSPIRONE HYDROCHLORIDE Tab 5 mg ...........................................................................................28.00 Tab 10 mg .........................................................................................17.00 CLONAZEPAM – Safety medicine; prescriber may determine dispensing frequency Tab 500 mcg .......................................................................................6.68 Tab 2 mg ...........................................................................................12.75 DIAZEPAM – Safety medicine; prescriber may determine dispensing frequency Tab 2 mg ...........................................................................................11.44 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 5 mg ...........................................................................................13.71 ‡ Safety cap for extemporaneously compounded oral liquid preparations. LORAZEPAM – Safety medicine; prescriber may determine dispensing frequency Tab 1 mg ...........................................................................................16.42 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 2.5 mg ........................................................................................11.17 ‡ Safety cap for extemporaneously compounded oral liquid preparations. OXAZEPAM – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg ...........................................................................................5.89 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 15 mg ...........................................................................................8.13 ‡ Safety cap for extemporaneously compounded oral liquid preparations.

100 100 100 100 500 500

Pacific Buspirone Pacific Buspirone Paxam Paxam Arrow-Diazepam Arrow-Diazepam Ativan Ativan Ox-Pam Ox-Pam

250 100

100 100

Multiple Sclerosis Treatments

¾SA1062 Special Authority for Subsidy Special Authority approved by the Multiple Sclerosis Treatment Committee Notes: Budget managed by appointed clinicians on the Multiple Sclerosis Treatment Assessments Committee (MSTAC). Applications will be considered by MSTAC at its regular meetings and approved subject to eligibility according to the Entry and Stopping criteria (below). Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The coordinator Phone: 04 460 4990 Multiple Sclerosis Treatment Assessment Committee Facsimile: 04 916 7571 PHARMAC PO Box 10 254 Email: mstaccoordinator@pharmac.govt.nz Wellington Completed application forms must be sent to the coordinator for MSTAC and will be considered by MSTAC at the next practicable opportunity. Notification of MSTAC’s decision will be sent to the patient, the applying clinician and the patient’s GP (if specified). These agents will NOT be subsidised if dispensed from a community or hospital pharmacy. Regular supplies will be distributed to all approved patients or their clinicians by courier. Prescribers must send quarterly prescriptions for approved patients to the MSTAC coordinator. Only prescriptions for 6 million iu of interferon beta-1-alpha per week, or 8 million iu of interferon beta-1-beta every other day, or 20 mg glatiramer acetate daily will be subsidised. Appeals against MSTAC’s decision and/or the processing of any application may be lodged with the MSTAC coordinator. Concerns that cannot be or have not been adequately addressed by MSTAC will be forwarded to a separate Appeal Committee if necessary. Switching between treatments is permitted within the 12 month approval period without reapproval by MSTAC. The MSTAC coordinator should be notified of the change and a new prescription provided. Entry Criteria continued. . .

142

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

continued. . .

1) Diagnosis of multiple sclerosis (MS) must be confirmed by a neurologist. Diagnosis should as a rule include MRI confirmation. For patients diagnosed before MRI was widely utilised in New Zealand, confirmation of diagnosis via clinical assessment and laboratory/ancillary data must be provided; and 2) patients must have active relapsing MS (confirmed by MR scan where necessary) with or without underlying progression; and 3) patients must have either: a) EDSS score 2.5 - 5.5 with 2+ relapses: G experienced at least 2 significant relapses of MS in the previous 12 months, and G an EDSS score of between 2.5 and 5.5 inclusive; or b) EDSS score 2.0 with 3+ relapses: G experienced at least 3 significant relapses of MS in the previous 12 months, and G an EDSS score of 2.0; and 4) Each relapse must: a) be confirmed by a neurologist or general physician (the patient may not necessarily have been seen during the relapse but the neurologist/physician must be satisfied that the clinical features were characteristic and met the specified criteria); b) be associated with characteristic new symptom(s)/sign(s) or substantial worsening of previously experienced symptom(s)/sign(s); c) last at least one week; d) follow a period of stability of at least one month; e) be severe enough to change either the EDSS or at least one of the Kurtzke functional systems scores by at least 1 point; f) be distinguishable from the effects of general fatigue; and g) not be associated with a fever (T>37.5◦ C); and 5) applications must be made at least four weeks after the date of the onset of the last known relapse; and 6) patients must have no previous history of lack of response to beta-interferon or glatiramer acetate (see criteria for stopping). 7) applications must be submitted to the Multiple Sclerosis Treatment Assessment Committee (MSTAC) by the patient’s neurologist or a general physician; and 8) patients must agree (via informed consent) to co-operate if as a result of their meeting the stopping criteria, funding is withdrawn. Patients must agree to the collection of clinical data relating to their MS and use of those data by PHARMAC; and 9) patients must agree to allow clinical data to be collected and reviewed by MSTAC annually for each year in which they receive funding for beta-interferon or glatiramer acetate. Stopping Criteria 1) Confirmed progression of disability that is sustained for six months during a minimum of one year of treatment. Progression of disability is defined as any of: a) an increase of 2 EDSS points where starting EDSS was 2.0; or b) an increase of 1.5 EDSS points where starting EDSS was 2.5 or 3.0; or c) an increase of 1 EDSS point where starting EDSS 3.5 or greater; or d) an increase in EDSS score to 6.0 or more; or 2) stable or increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment)(see note); or 3) pregnancy and/or lactation; or 4) within the 12 month approval year, intolerance to interferon beta-1-alpha, and/or interferon beta-1-beta and/or glatiramer acetate; or 5) non-compliance with treatment, including refusal to undergo annual assessment or refusal to allow the results of the assessment to be submitted to MSTAC; or continued. . .

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

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

143


NERVOUS SYSTEM

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

continued. . . 6) patients may, subject to conclusions drawn from published evidence available at the time, be excluded if they develop a high titre of neutralising anti-bodies to beta-interferon or glatiramer acetate. Note: Patients who have a stable or increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment) and who do not meet any of the other Stopping Criteria at annual review may switch to a different class of funded treatment (i.e. patients may switch from either of the beta-interferons [interferon beta-1-beta or interferon beta-1-alpha] to glatiramer acetate or vice versa). Patients may switch classes of treatment for this reason only once, after which they will be required to stop funded treatment if they meet any of the Stopping Criteria at annual review (including the criterion relating to stable or increasing relapse rate over 12 months of treatment). GLATIRAMER ACETATE – Special Authority see SA1062 on page 142 Inj 20 mg prefilled syringe ...........................................................1,089.25 28 Copaxone INTERFERON BETA-1-ALPHA – Special Authority see SA1062 on page 142 Inj 6 million iu prefilled syringe ....................................................1,320.87 Injection 6 million iu per 0.5 ml pen injector .................................1,320.87 Inj 6 million iu per vial ..................................................................1,320.87 INTERFERON BETA-1-BETA – Special Authority see SA1062 on page 142 Inj 8 million iu per 1 ml .................................................................1,322.89 4 4 4 15

Avonex Avonex Pen Avonex Betaferon

Sedatives and Hypnotics

LORMETAZEPAM – Safety medicine; prescriber may determine dispensing frequency Tab 1 mg .............................................................................................3.11 30 (23.50) ‡ Safety cap for extemporaneously compounded oral liquid preparations. MIDAZOLAM – Safety medicine; prescriber may determine dispensing frequency Inj 1 mg per ml, 5 ml .........................................................................10.00 10 10.75 Inj 5 mg per ml, 3 ml .........................................................................11.90 5 NITRAZEPAM – Safety medicine; prescriber may determine dispensing frequency Tab 5 mg .............................................................................................4.98 100 ‡ Safety cap for extemporaneously compounded oral liquid preparations. PHENOBARBITONE SODIUM – Special Authority see SA1386 below – Retail pharmacy Inj 200 mg per ml, 1 ml ampoule ......................................................46.20 10

Noctamid

Pfizer Hypnovel Hypnovel Pfizer Nitrados

Martindale

¾SA1386 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. TEMAZEPAM – Safety medicine; prescriber may determine dispensing frequency Tab 10 mg ...........................................................................................1.27 25 Normison ‡ Safety cap for extemporaneously compounded oral liquid preparations.

144

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

TRIAZOLAM – Safety medicine; prescriber may determine dispensing frequency Tab 125 mcg .......................................................................................5.10 (7.25) ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 250 mcg .......................................................................................4.10 (8.70) ‡ Safety cap for extemporaneously compounded oral liquid preparations. ZOPICLONE Tab 7.5 mg ..........................................................................................1.90 11.90

100 Hypam 100 Hypam

30 500

Apo-Zopiclone Apo-Zopiclone

Stimulants/ADHD Treatments Stimulants/ADHD treatments

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

Strattera Strattera Strattera Strattera Strattera Strattera Strattera

¾SA0951 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient has ADHD (Attention Deficit and Hyperactivity Disorder) diagnosed according to DSM-IV or ICD 10 criteria; and 2 Once-daily dosing; and 3 Any of the following: 3.1 Treatment with a subsidised formulation of a stimulant has resulted in the development or worsening of serious adverse reactions or where the combination of subsidised stimulant treatment with another agent would pose an unacceptable medical risk; or 3.2 Treatment with a subsidised formulation of a stimulant has resulted in worsening of co-morbid substance abuse or there is a significant risk of diversion with subsidised stimulant therapy; or 3.3 An effective dose of a subsidised formulation of a stimulant has been trialled and has been discontinued because of inadequate clinical response; and 4 The patient will not be receiving treatment with atomoxetine in combination with a subsidised formulation of a stimulant, except for the purposes of transitioning from subsidised stimulant therapy to atomoxetine. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. Note: A "subsidised formulation of a stimulant" refers to currently subsidised methylphenidate hydrochloride tablet formulations (immediate-release, sustained-release and extended-release) or dexamphetamine sulphate tablets. DEXAMPHETAMINE SULPHATE – Special Authority see SA1149 on the next page – Retail pharmacy a) Only on a controlled drug form b) Safety medicine; prescriber may determine dispensing frequency Tab 5 mg ...........................................................................................16.50 100 PSM

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

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

145


NERVOUS SYSTEM

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

¾SA1149 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients aged 5 years or over; and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient. Initial application — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Renewal — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient. Renewal — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment. METHYLPHENIDATE HYDROCHLORIDE – Special Authority see SA1150 below – Retail pharmacy a) Only on a controlled drug form b) Safety medicine; prescriber may determine dispensing frequency Tab immediate-release 5 mg ..............................................................3.20 30 Rubifen Tab immediate-release 10 mg ............................................................3.00 30 Ritalin Rubifen Tab immediate-release 20 mg ............................................................7.85 30 Rubifen Tab sustained-release 20 mg ...........................................................10.95 30 Rubifen SR 50.00 100 Ritalin SR ¾SA1150 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients aged 5 years or over; and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient. continued. . .

146

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

continued. . . Initial application — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Renewal — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient. Renewal — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment. METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE – Special Authority see SA1151 below – Retail pharmacy a) Only on a controlled drug form b) Safety medicine; prescriber may determine dispensing frequency Tab extended-release 18 mg ............................................................58.96 30 Concerta Tab extended-release 27 mg ............................................................65.44 30 Concerta Tab extended-release 36 mg ............................................................71.93 30 Concerta Tab extended-release 54 mg ............................................................86.24 30 Concerta Cap modified-release 10 mg ............................................................19.50 30 Ritalin LA Cap modified-release 20 mg ............................................................25.50 30 Ritalin LA Cap modified-release 30 mg ............................................................31.90 30 Ritalin LA Cap modified-release 40 mg ............................................................38.25 30 Ritalin LA ¾SA1151 Special Authority for Subsidy Initial application only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deficit and Hyperactivity Disorder); and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 4 Either: 4.1 Patient is taking a currently subsidised formulation of methylphenidate hydrochloride (immediate-release or sustainedrelease) which has not been effective due to significant administration and/or compliance difficulties; or 4.2 There is significant concern regarding the risk of diversion or abuse of immediate-release methylphenidate hydrochloride. Renewal only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: continued. . .

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

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

147


NERVOUS SYSTEM

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

continued. . . 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient. MODAFINIL – Special Authority see SA1126 below – Retail pharmacy Tab 100 mg .......................................................................................72.50 30 Modavigil ¾SA1126 Special Authority for Subsidy Initial application only from a neurologist or respiratory specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 The patient has a diagnosis of narcolepsy and has excessive daytime sleepiness associated with narcolepsy occurring almost daily for three months or more; and 2 Either: 2.1 The patient has a multiple sleep latency test with a mean sleep latency of less than or equal to 10 minutes and 2 or more sleep onset rapid eye movement periods; or 2.2 The patient has at least one of: cataplexy, sleep paralysis or hypnagogic hallucinations; and 3 Either: 3.1 An effective dose of a subsidised formulation of methylphenidate or dexamphetamine has been trialled and discontinued because of intolerable side effects; or 3.2 Methylphenidate and dexamphetamine are contraindicated. Renewal only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment.

Treatments for Dementia

DONEPEZIL HYDROCHLORIDE F Tab 5 mg .............................................................................................7.71 F Tab 10 mg .........................................................................................14.06 90 90

Donepezil-Rex Donepezil-Rex

Treatments for Substance Dependence

BUPRENORPHRINE WITH NALOXONE – Special Authority see SA1203 below – Retail pharmacy a) No patient co-payment payable b) Safety medicine; prescriber may determine dispensing frequency Tab sublingual 2 mg with naloxone 0.5 mg .......................................57.40 28 Suboxone Tab sublingual 8 mg with naloxone 2 mg ........................................166.00 28 Suboxone ¾SA1203 Special Authority for Subsidy Initial application — (Detoxification) from any medical practitioner. Approvals valid for 1 month for applications meeting the following criteria: All of the following: 1 Patient is opioid dependent; and 2 Patient is currently engaged with an opioid treatment service approved by the Ministry of Health; and 3 Applicant works in an opioid treatment service approved by the Ministry of Health.. Initial application — (Maintenance treatment) from any medical practitioner. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient is opioid dependent; and 2 Patient will not be receiving methadone; and continued. . .

148

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


NERVOUS SYSTEM

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

continued. . . 3 Patient is currently enrolled in an opioid substitution treatment program in a service approved by the Ministry of Health; and 4 Applicant works in an opioid treatment service approved by the Ministry of Health. Renewal — (Detoxification) from any medical practitioner. Approvals valid for 1 month for applications meeting the following criteria: All of the following: 1 Patient is opioid dependent; and 2 Patient has previously trialled but failed detoxification with buprenorphine with naloxone with relapse back to opioid use and another attempt is planned; and 3 Patient is currently engaged with an opioid treatment service approved by the Ministry of Health; and 4 Applicant works in an opioid treatment service approved by the Ministry of Health. Renewal — (Maintenance treatment) from any medical practitioner. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient is or has been receiving maintenance therapy with buprenorphine with naloxone (and is not receiving methadone); and 2 Patient is currently enrolled in an opioid substitution program in a service approved by the Ministry of Health; and 3 Applicant works in an opioid treatment service approved by the Ministry of Health or is a medical practitioner authorised by the service to manage treatment in this patient. Renewal — (Maintenance treatment where the patient has previously had an initial application for detoxification) from any medical practitioner. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient received but failed detoxification with buprenorphine with naloxone; and 2 Maintenance therapy with buprenorphine with naloxone is planned (and patient will not be receiving methadone); and 3 Patient is currently enrolled in an opioid substitution program in a service approved by the Ministry of Health; and 4 Applicant works in an opioid treatment service approved by the Ministry of Health. BUPROPION HYDROCHLORIDE Tab modified-release 150 mg .............................................................4.97 30 Zyban DISULFIRAM Tab 200 mg .......................................................................................24.30 100

Antabuse Naltraccord

NALTREXONE HYDROCHLORIDE – Special Authority see SA1408 below – Retail pharmacy Tab 50 mg .........................................................................................76.00 30

¾SA1408 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Patient is currently enrolled in a recognised comprehensive treatment programme for alcohol dependence; and 2 Applicant works in or with a community Alcohol and Drug Service contracted to one of the District Health Boards or accredited against the New Zealand Alcohol and Other Drug Sector Standard or the National Mental Health Sector Standard. Renewal from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Compliance with the medication (prescriber determined); and 2 Any of the following: 2.1 Patient is still unstable and requires further treatment; or 2.2 Patient achieved significant improvement but requires further treatment; or 2.3 Patient is well controlled but requires maintenance therapy.

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

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

149


NERVOUS SYSTEM

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

NICOTINE Nicotine will not be funded under the Dispensing Frequency Rule in amounts less than 4 weeks of treatment. Patch 7 mg – Up to 28 patch available on a PSO ............................18.13 28 Habitrol Patch 14 mg – Up to 28 patch available on a PSO ..........................18.81 28 Habitrol Patch 21 mg – Up to 28 patch available on a PSO ..........................19.14 28 Habitrol Lozenge 1 mg – Up to 216 loz available on a PSO ..........................19.94 216 Habitrol Lozenge 2 mg – Up to 216 loz available on a PSO ..........................24.27 216 Habitrol Gum 2 mg (Classic) – Up to 384 piece available on a PSO .............36.47 384 Habitrol Gum 2 mg (Fruit) – Up to 384 piece available on a PSO .................36.47 384 Habitrol Gum 2 mg (Mint) – Up to 384 piece available on a PSO..................36.47 384 Habitrol Gum 4 mg (Classic) – Up to 384 piece available on a PSO .............42.04 384 Habitrol Gum 4 mg (Fruit) – Up to 384 piece available on a PSO .................42.04 384 Habitrol Gum 4 mg (Mint) – Up to 384 piece available on a PSO..................42.04 384 Habitrol VARENICLINE TARTRATE – Special Authority see SA1161 below – Retail pharmacy a) Varenicline will not be funded under the Dispensing Frequency Rule in amounts less than 2 weeks of treatment. b) A maximum of 3 months’ varenicline will be subsidised on each Special Authority approval. Tab 1 mg ...........................................................................................67.74 28 Champix 135.48 56 Champix Tab 0.5 mg × 11 and 1 mg × 14 ......................................................60.48 25 OP Champix ¾SA1161 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 5 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 Either: 3.1 The patient has tried but failed to quit smoking after at least two separate trials of nicotine replacement therapy, at least one of which included the patient receiving comprehensive advice on the optimal use of nicotine replacement therapy; or 3.2 The patient has tried but failed to quit smoking using bupropion or nortriptyline; and 4 The patient has not used funded varenicline in the last 12 months; and 5 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and 6 The patient is not pregnant; and 7 The patient will not be prescribed more than 3 months’ funded varenicline (see note). Renewal from any relevant practitioner. Approvals valid for 5 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 The patient has not used funded varenicline in the last 12 months; and 4 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and 5 The patient is not pregnant; and 6 The patient will not be prescribed more than 3 months’ funded varenicline (see note). The patient must not have had an approval in the past 12 months. Note: a maximum of 3 months’ varenicline will be subsidised on each Special Authority approval.

150

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

Chemotherapeutic Agents Alkylating Agents

BUSULPHAN – PCT – Retail pharmacy-Specialist Tab 2 mg ...........................................................................................59.50 CARBOPLATIN – PCT only – Specialist Inj 10 mg per ml, 5 ml .......................................................................20.00 Inj 10 mg per ml, 15 ml .....................................................................19.50 22.50 Inj 10 mg per ml, 45 ml .....................................................................48.50 50.00 Inj 10 mg per ml, 100 ml .................................................................105.00 Inj 1 mg for ECP .................................................................................0.13 CARMUSTINE – PCT only – Specialist Inj 100 mg .......................................................................................204.13 Inj 100 mg for ECP .........................................................................204.13 CHLORAMBUCIL – PCT – Retail pharmacy-Specialist Tab 2 mg ...........................................................................................22.35 CISPLATIN – PCT only – Specialist Inj 1 mg per ml, 50 ml .......................................................................15.00 Inj 1 mg per ml, 100 ml .....................................................................21.00 Inj 1 mg for ECP .................................................................................0.27 CYCLOPHOSPHAMIDE Tab 50 mg – PCT – Retail pharmacy-Specialist.............................25.71 158.00 Wastage claimable – see rule 3.3.2 on page 17 Inj 1 g – PCT – Retail pharmacy-Specialist.....................................26.70 127.80 Inj 2 g – PCT only – Specialist.........................................................56.90 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.03 (Cycloblastin Tab 50 mg to be delisted 1 April 2014) IFOSFAMIDE – PCT only – Specialist Inj 1 g ................................................................................................96.00 Inj 2 g ..............................................................................................180.00 Inj 1 mg for ECP .................................................................................0.10 LOMUSTINE – PCT only – Specialist Cap 10 mg ......................................................................................132.59 Cap 40 mg ......................................................................................399.15 MELPHALAN Tab 2 mg – PCT – Retail pharmacy-Specialist................................31.31 Inj 50 mg – PCT only – Specialist....................................................52.15 100 1 1 1

Myleran Carboplatin Ebewe Carbaccord Carboplatin Ebewe Carbaccord Carboplatin Ebewe DBL Carboplatin Carboplatin Ebewe Baxter BiCNU Baxter Leukeran FC Cisplatin Ebewe Hospira Cisplatin Ebewe Hospira Baxter Cycloblastin Procytox Endoxan Cytoxan Endoxan Baxter Holoxan Holoxan Baxter CeeNU CeeNU Alkeran Alkeran

1 1 mg 1 100 mg OP 25 1 1 1 mg 50 100 1 6 1 1 mg

1 1 1 mg 20 20 25 1

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

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

151


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

OXALIPLATIN – PCT only – Specialist Inj 50 mg ...........................................................................................15.32 55.00 200.00 Inj 100 mg .........................................................................................25.01 110.00 400.00 Inj 1 mg for ECP .................................................................................0.28 THIOTEPA – PCT only – Specialist Inj 15 mg ...........................................................................................CBS

1

Oxaliplatin Actavis

50

1

Oxaliplatin Ebewe Eloxatin Oxaliplatin Actavis

100

1 mg 1

Oxaliplatin Ebewe Eloxatin Baxter Bedford THIO-TEPA Tepadina

Antimetabolites

CALCIUM FOLINATE Tab 15 mg – PCT – Retail pharmacy-Specialist..............................82.45 Inj 3 mg per ml, 1 ml – PCT – Retail pharmacy-Specialist ..............17.10 Inj 50 mg – PCT – Retail pharmacy-Specialist................................24.50 Inj 100 mg – PCT only – Specialist....................................................9.75 Inj 300 mg – PCT only – Specialist..................................................30.00 Inj 1 g – PCT only – Specialist.........................................................90.00 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.10 CAPECITABINE – Retail pharmacy-Specialist Tab 150 mg .....................................................................................115.00 Tab 500 mg .....................................................................................705.00 CLADRIBINE – PCT only – Specialist Inj 1 mg per ml, 10 ml ..................................................................5,249.72 Inj 10 mg for ECP ...........................................................................749.96 CYTARABINE Inj 20 mg per ml, 5 ml vial – PCT – Retail pharmacy-Specialist .........55.00 80.00 Inj 500 mg – PCT – Retail pharmacy-Specialist..............................18.15 95.36 Inj 100 mg per ml, 10 ml vial – PCT – Retail pharmacySpecialist ...................................................................................... 8.83 42.65 Inj 100 mg per ml, 20 ml vial – PCT – Retail pharmacySpecialist .................................................................................... 17.65 34.47 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.11 Inj 100 mg intrathecal syringe for ECP – PCT only – Specialist .........11.00 10 5 5 1 1 1 1 mg 60 120 7 10 mg OP 5 1 5 1

DBL Leucovorin

Calcium

Hospira Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Baxter Xeloda Xeloda Leustatin Baxter Pfizer Hospira Pfizer Hospira Pfizer Hospira Pfizer Hospira Baxter Baxter

1 10 mg 100 mg OP

152

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

FLUDARABINE PHOSPHATE – PCT only – Specialist Tab 10 mg .......................................................................................433.50 Inj 50 mg .........................................................................................525.00 1,430.00 Inj 50 mg for ECP ...........................................................................105.00 FLUOROURACIL SODIUM Inj 50 mg per ml, 10 ml – PCT only – Specialist..............................26.25 Inj 50 mg per ml, 20 ml – PCT only – Specialist................................7.50 Inj 25 mg per ml, 100 ml – PCT only – Specialist............................13.55 Inj 50 mg per ml, 50 ml – PCT only – Specialist..............................18.00 Inj 50 mg per ml, 100 ml – PCT only – Specialist............................34.50 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.77 GEMCITABINE HYDROCHLORIDE – PCT only – Specialist Inj 1 g ................................................................................................62.50

20 5 50 mg OP 5 1 1 1 1 100 mg 1

Fludara Oral Fludarabine Ebewe Fludara Baxter Fluorouracil Ebewe Fluorouracil Ebewe Hospira Fluorouracil Ebewe Fluorouracil Ebewe Baxter DBL Gemcitabine Gemcitabine

Actavis 1000

349.20 Inj 200 mg .........................................................................................12.50

1

Gemcitabine Ebewe Gemzar Gemcitabine

Actavis 200

78.00 Inj 1 mg for ECP .................................................................................0.07 IRINOTECAN – PCT only – Specialist Inj 20 mg per ml, 2 ml .........................................................................9.34 41.00 Inj 20 mg per ml, 5 ml .......................................................................23.34 100.00 Inj 1 mg for ECP .................................................................................0.24 MERCAPTOPURINE – PCT – Retail pharmacy-Specialist Tab 50 mg .........................................................................................49.41

1 mg 1

Gemcitabine Ebewe Gemzar Baxter Irinotecan Actavis

40

1

Camptosar Irinotecan-Rex Irinotecan Actavis

100

1 mg 25

Camptosar Irinotecan-Rex Baxter Puri-nethol

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

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

153


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

METHOTREXATE F Tab 2.5 mg – PCT – Retail pharmacy-Specialist...............................5.22 F Tab 10 mg – PCT – Retail pharmacy-Specialist..............................40.93 F Inj 2.5 mg per ml, 2 ml – PCT – Retail pharmacy-Specialist ...........23.65 F Inj 7.5 mg prefilled syringe ...............................................................17.19 F Inj 10 mg prefilled syringe ................................................................17.25 F Inj 15 mg prefilled syringe ................................................................17.38 F Inj 20 mg prefilled syringe ................................................................17.50 F Inj 25 mg prefilled syringe ................................................................17.63 F Inj 30 mg prefilled syringe ................................................................17.75 F F F F 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 Inj 100 mg per ml, 10 ml – PCT – Retail pharmacy-Specialist .........25.00 Inj 25 mg per ml, 40 ml – PCT – Retail pharmacy-Specialist .........25.00

30 50 5 1 1 1 1 1 1 5 1 1 1 1 1 mg 5 mg OP

Methoblastin Methoblastin Hospira Methotrexate

Sandoz

Methotrexate

Sandoz

Methotrexate

Sandoz

Methotrexate

Sandoz

Methotrexate

Sandoz

Methotrexate

Sandoz

Hospira Hospira Methotrexate Ebewe DBL

Methotrexate

F Inj 100 mg per ml, 50 ml – PCT – Retail pharmacy-Specialist .........125.00 F Inj 1 mg for ECP – PCT only – Specialist ..........................................0.10 F Inj 5 mg intrathecal syringe for ECP – PCT only – Specialist............4.73 (DBL Methotrexate Inj 25 mg per ml, 40 ml to be delisted 1 May 2014) THIOGUANINE – PCT – Retail pharmacy-Specialist Tab 40 mg .........................................................................................97.16

Methotrexate Ebewe Baxter Baxter

25

Lanvis

Other Cytotoxic Agents

AMSACRINE – PCT only – Specialist Inj 75 mg ...........................................................................................CBS ANAGRELIDE HYDROCHLORIDE – PCT only – Specialist Cap 0.5 mg .......................................................................................CBS ARSENIC TRIOXIDE – PCT only – Specialist Inj 10 mg ......................................................................................4,817.00 BLEOMYCIN SULPHATE – PCT only – Specialist Inj 15,000 iu ....................................................................................120.00 Inj 1,000 iu for ECP ............................................................................9.28 6 100

Amsidine Agrylin Teva AFT DBL Bleomycin

Sulfate

10 1 1,000 iu

Baxter Velcade Velcade Baxter

BORTEZOMIB – PCT only – Specialist – Special Authority see SA1127 on the next page Inj 1 mg ...........................................................................................540.70 1 Inj 3.5 mg .....................................................................................1,892.50 1 Inj 1 mg for ECP .............................................................................594.77 1 mg

154

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA1127 Special Authority for Subsidy Initial application — (Treatment naive multiple myeloma/amyloidosis) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 15 months for applications meeting the following criteria: Both: 1 Either: 1.1 The patient has treatment-naive symptomatic multiple myeloma; or 1.2 The patient has treatment-naive symptomatic systemic AL amyloidosis *; and 2 Maximum of 9 treatment cycles. Note: Indications marked with * are Unapproved Indications. Initial application — (Relapsed/refractory multiple myeloma/amyloidosis) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 8 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 The patient has relapsed or refractory multiple myeloma; or 1.2 The patient has relapsed or refractory systemic AL amyloidosis *; and 2 The patient has received only one prior front line chemotherapy for multiple myeloma or amyloidosis; and 3 The patient has not had prior publicly funded treatment with bortezomib; and 4 Maximum of 4 treatment cycles. Note: Indications marked with * are Unapproved Indications. Renewal — (Relapsed/refractory multiple myeloma/amyloidosis) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 8 months for applications meeting the following criteria: Both: 1 The patient’s disease obtained at least a partial response from treatment with bortezomib at the completion of cycle 4; and 2 Maximum of 4 further treatment cycles (making a total maximum of 8 consecutive treatment cycles). Notes: Responding relapsed/refractory multiple myeloma patients should receive no more than 2 additional cycles of treatment beyond the cycle at which a confirmed complete response was first achieved. A line of therapy is considered to comprise either: a) a known therapeutic chemotherapy regimen and supportive treatments; or b) a transplant induction chemotherapy regimen, stem cell transplantation and supportive treatments. Refer to datasheet for recommended dosage and number of doses of bortezomib per treatment cycle. COLASPASE [L-ASPARAGINASE] – PCT only – Specialist Inj 10,000 iu ....................................................................................102.32 1 Leunase Inj 10,000 iu for ECP ......................................................................102.32 10,000 iu OP Baxter DACARBAZINE – PCT only – Specialist Inj 200 mg vial ..................................................................................51.84 Inj 200 mg for ECP ...........................................................................51.84 DACTINOMYCIN [ACTINOMYCIN D] – PCT only – Specialist Inj 0.5 mg ..........................................................................................13.52 Inj 0.5 mg for ECP ............................................................................13.52 DAUNORUBICIN – PCT only – Specialist Inj 2 mg per ml, 10 ml .....................................................................118.72 Inj 20 mg for ECP ...........................................................................118.72 1 200 mg OP 1 0.5 mg OP 1 20 mg OP

Hospira Baxter Cosmegen Baxter Pfizer Baxter

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

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

155


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

DOCETAXEL – PCT only – Specialist Inj 20 mg ..........................................................................................48.75 Inj 20 mg per ml, 1 ml .......................................................................48.75 Inj 20 mg per ml, 4 ml .....................................................................195.00 Inj 80 mg ........................................................................................195.00 Inj 1 mg for ECP .................................................................................2.63 (Docetaxel Ebewe Inj 20 mg to be delisted 1 February 2014) (Docetaxel Ebewe Inj 80 mg to be delisted 1 February 2014) DOXORUBICIN – PCT only – Specialist Inj 10 mg ...........................................................................................10.00 Inj 50 mg ...........................................................................................17.00 40.00

1 1 1 1 1 mg

Docetaxel Ebewe Docetaxel Sandoz Taxotere Taxotere Docetaxel Ebewe Docetaxel Sandoz Baxter

1 1

Doxorubicin Ebewe Arrow-Doxorubicin DBL Doxorubicin DBL Doxorubicin

S29

Inj 100 mg .........................................................................................80.00 Inj 200 mg .........................................................................................65.00 150.00 Inj 1 mg for ECP .................................................................................0.37 EPIRUBICIN – PCT only – Specialist Inj 2 mg per ml, 5 ml .........................................................................25.00 Inj 2 mg per ml, 25 ml .......................................................................39.38 87.50 Inj 2 mg per ml, 50 ml .......................................................................58.20 125.00 Inj 2 mg per ml, 100 ml .....................................................................94.50 210.00 Inj 1 mg for ECP .................................................................................0.82 ETOPOSIDE Cap 50 mg – PCT – Retail pharmacy-Specialist ...........................340.73 Cap 100 mg – PCT – Retail pharmacy-Specialist .........................340.73 Inj 20 mg per ml, 5 ml – PCT – Retail pharmacy-Specialist ............25.00 612.20 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.30 ETOPOSIDE PHOSPHATE – PCT only – Specialist Inj 100 mg (of etoposide base) .........................................................40.00 Inj 1 mg (of etoposide base) for ECP .................................................0.47 HYDROXYUREA – PCT – Retail pharmacy-Specialist Cap 500 mg ......................................................................................31.76

1 1

1 mg 1 1

Doxorubicin Ebewe Doxorubicin Ebewe Arrow-Doxorubicin Adriamycin Doxorubicin Ebewe Baxter Epirubicin Ebewe DBL Epirubicin

Hydrochloride

1

Epirubicin Ebewe DBL Epirubicin

Hydrochloride

1

Epirubicin Ebewe DBL Epirubicin

Hydrochloride

1 mg 20 10 1 10 1 mg 1 1 mg 100

Epirubicin Ebewe Baxter Vepesid Vepesid Hospira Vepesid Baxter Etopophos Baxter Hydrea

156

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

IDARUBICIN HYDROCHLORIDE – PCT only – Specialist Cap 5 mg ........................................................................................115.00 Cap 10 mg ......................................................................................144.50 Inj 5 mg ...........................................................................................100.00 Inj 10 mg .........................................................................................200.00 Inj 1 mg for ECP ...............................................................................22.20 MESNA – PCT only – Specialist Tab 400 mg .....................................................................................227.50 Tab 600 mg .....................................................................................339.50 Inj 100 mg per ml, 4 ml ampoule ....................................................148.05 Inj 100 mg per ml, 10 ml ampoule ..................................................339.90 Inj 1 mg for ECP .................................................................................2.47 MITOMYCIN C – PCT only – Specialist Inj 5 mg vial ......................................................................................79.75 Inj 1 mg for ECP ...............................................................................16.43 MITOZANTRONE – PCT only – Specialist Inj 2 mg per ml, 5 ml .......................................................................110.00 Inj 2 mg per ml, 10 ml .....................................................................100.00 Inj 2 mg per ml, 12.5 ml ..................................................................407.50 Inj 1 mg for ECP .................................................................................5.65 PACLITAXEL – PCT only – Specialist Inj 30 mg .........................................................................................137.50 Inj 100 mg .........................................................................................91.67 Inj 150 mg .......................................................................................137.50

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

Zavedos Zavedos Zavedos Zavedos Baxter Uromitexan Uromitexan Uromitexan Uromitexan Baxter Arrow Baxter Mitozantrone Ebewe Mitozantrone Ebewe Onkotrone Baxter Paclitaxel Ebewe Paclitaxel Actavis Paclitaxel Ebewe Anzatax Paclitaxel Actavis Paclitaxel Ebewe Anzatax Paclitaxel Actavis Paclitaxel Ebewe Paclitaxel Ebewe Baxter Oncaspar

Inj 300 mg .......................................................................................275.00

1

Inj 600 mg .......................................................................................550.00 Inj 1 mg for ECP .................................................................................1.02 PEGASPARGASE – PCT only – Special Authority see SA1325 below Inj 3,750 IU per 5 ml ....................................................................3,005.00

1 1 mg 1

¾SA1325 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has newly diagnosed acute lymphoblastic leukaemia; and 2 Pegaspargase to be used with a contemporary intensive multi-agent chemotherapy treatment protocol; and 3 Treatment is with curative intent. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has relapsed acute lymphoblastic leukaemia; and 2 Pegaspargase to be used with a contemporary intensive multi-agent chemotherapy treatment protocol; and 3 Treatment is with curative intent. PENTOSTATIN [DEOXYCOFORMYCIN] – PCT only – Specialist Inj 10 mg ...........................................................................................CBS 1 Nipent

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

157


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

PROCARBAZINE HYDROCHLORIDE – PCT only – Specialist Cap 50 mg ......................................................................................225.00 TEMOZOLOMIDE – Special Authority see SA1063 below – Retail pharmacy Cap 5 mg ............................................................................................8.00 Cap 20 mg ........................................................................................36.00 Cap 100 mg ....................................................................................175.00 Cap 250 mg ....................................................................................410.00

50 5 5 5 5

Natulan Temaccord Temaccord Temaccord Temaccord

¾SA1063 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 10 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Patient has newly diagnosed glioblastoma multiforme; or 1.2 Patient has newly diagnosed anaplastic astrocytoma*; and 2 Temozolomide is to be (or has been) given concomitantly with radiotherapy; and 3 Following concomitant treatment temozolomide is to be used for a maximum of six cycles of 5 days treatment, at a maximum dose of 200 mg/m2 . Notes: Indication marked with a * is an Unapproved Indication. Temozolomide is not subsidised for the treatment of relapsed glioblastoma multiforme. Reapplications will not be approved. Studies of temozolomide show that its benefit is predominantly in those patients with a good performance status (WHO grade 0 or 1 or Karnofsky score >80), and in patients who have had at least a partial resection of the tumour. THALIDOMIDE – PCT only – Specialist – Special Authority see SA1124 below Cap 50 mg ......................................................................................504.00 28 Thalomid Cap 100 mg .................................................................................1,008.00 28 Thalomid ¾SA1124 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient has multiple myeloma; or 2 The patient has systemic AL amyloidosis*. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notified where the patient has obtained a response from treatment during the initial approval period. Notes: Prescription must be written by a registered prescriber in the thalidomide risk management programme operated by the supplier. Maximum dose of 400 mg daily as monotherapy or in a combination therapy regimen. Indication marked with * is an Unapproved Indication. TRETINOIN Cap 10 mg – PCT – Retail pharmacy-Specialist ...........................435.90 100 Vesanoid VINBLASTINE SULPHATE Inj 10 mg – PCT – Retail pharmacy-Specialist................................27.50 137.50 Inj 1 mg for ECP – PCT only – Specialist ..........................................3.05 VINCRISTINE SULPHATE Inj 1 mg per ml, 1 ml – PCT – Retail pharmacy-Specialist ..............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 1 5 1 mg 5 5 1 mg

Hospira Hospira Baxter Hospira Hospira Baxter

158

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

VINORELBINE – PCT only – Specialist Inj 10 mg per ml, 1 ml .......................................................................12.85 42.00 Inj 10 mg per ml, 5 ml .......................................................................64.25 210.00 Inj 1 mg for ECP .................................................................................1.45

1 1 1 mg

Navelbine Vinorelbine Ebewe Navelbine Vinorelbine Ebewe Baxter

Protein-tyrosine Kinase Inhibitors

DASATINIB – Special Authority see SA0976 below Tab 20 mg ....................................................................................3,774.06 Tab 50 mg ....................................................................................6,214.20 Tab 70 mg ....................................................................................7,692.58 Tab 100 mg ..................................................................................6,214.20 60 60 60 30

Sprycel Sprycel Sprycel Sprycel

¾SA0976 Special Authority for Subsidy Special Authority approved by the CML/GIST Co-ordinator Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz, and prescriptions should be sent to: The CML/GIST Co-ordinator Phone: (04) 460 4990 PHARMAC Facsimile: (04) 916 7571 PO Box 10 254 Email: mary.chesterfield@pharmac.govt.nz Wellington Special Authority criteria for CML - access by application a) Funded for patients with diagnosis (confirmed by a haematologist) of a chronic myeloid leukaemia (CML) in blast crisis, accelerated phase, or in chronic phase. b) Maximum dose of 140 mg/day for accelerated or blast phase, and 100 mg/day for chronic phase CML. c) Subsidised for use as monotherapy only. d) Initial approvals valid seven months. e) Subsequent approval(s) are granted on application and are valid for six months. The first reapplication (after seven months) should provide details of the haematological response. The third reapplication should provide details of the cytogenetic response after 14-18 months from initiating therapy. All other reapplications should provide details of haematological response, and cytogenetic response if such data is available. Applications to be made and subsequent prescriptions can be written by a haematologist or an oncologist. Note: Dasatinib is indicated for the treatment of adults with chronic, accelerated or blast phase CML with resistance or intolerance to prior therapy including imatinib. Guideline on discontinuation of treatment for patients with CML a) Prescribers should consider discontinuation of treatment if, after 6 months from initiating therapy, a patient did not obtain a haematological response as defined as any one of the following three levels of response: 1) complete haematologic response (as characterised by an absolute neutrophil count (ANC) > 1.5 × 109 /L, platelets > 100 × 109 /L, absence of peripheral blood (PB) blasts, bone marrow (BM) blasts < 5% (or FISH Ph+ 0-35% metaphases), and absence of extramedullary disease); or 2) no evidence of leukaemia (as characterised by an absolute neutrophil count (ANC) > 1.0 × 109 /L, platelets > 20 × 109 /L, absence of peripheral blood (PB) blasts, bone marrow (BM) blasts < 5% (or FISH Ph+ 0-35% metaphases), and absence of extramedullary disease); or 3) return to chronic phase (as characterised by BM and PB blasts < 15%, BM and PB blasts and promyelocytes < 30%, PB basophils < 20% and absence of extramedullary disease other than spleen and liver). b) Prescribers should consider discontinuation of treatment if, after 18 months from initiating therapy, a patient did not obtain a major cytogenetic response defined as 0-35% Ph+ metaphases. ERLOTINIB HYDROCHLORIDE – Retail pharmacy-Specialist – Special Authority see SA1044 on the next page Tab 100 mg ..................................................................................3,100.00 30 Tarceva Tab 150 mg ..................................................................................3,950.00 30 Tarceva

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

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

159


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA1044 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 4 months for applications meeting the following criteria: All of the following: 1 Patient has advanced, unresectable, Non Small Cell Lung Cancer (NSCLC); and 2 Patient has documented disease progression following treatment with first line platinum based chemotherapy; and 3 Erlotinib is to be given for a maximum of 3 months. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 6 months where radiological assessment (preferably including CT scan) indicates NSCLC has not progressed. GEFITINIB – Retail pharmacy-Specialist Tab 250 mg – Special Authority see SA1226 below....................1,700.00 30 Iressa ¾SA1226 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 4 months for applications meeting the following criteria: Either: 1 All of the following: 1.1 Patient has treatment naive locally advanced, or metastatic, unresectable, non-squamous Non Small Cell Lung Cancer (NSCLC); and 1.2 There is documentation confirming that disease expresses activating mutations of EGFR tyrosine kinase; and 1.3 Gefitinib is to be given for a maximum of 3 months; or 2 The patient received gefitinib treatment prior to 1 August 2012 and radiological assessment (preferably including CT scan) indicates NSCLC has not progressed. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 6 months where radiological assessment (preferably including CT scan) indicates NSCLC has not progressed. IMATINIB MESILATE – Special Authority see SA0643 below Tab 100 mg ..................................................................................2,400.00 60 Glivec ¾SA0643 Special Authority for Subsidy Special Authority approved by the CML/GIST Co-ordinator Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz, and prescriptions should be sent to: The CML/GIST Co-ordinator Phone: (04) 460 4990 PHARMAC Facsimile: (04) 916 7571 PO Box 10 254 Email: mary.chesterfield@pharmac.govt.nz Wellington Special Authority criteria for CML – access by application a) Funded for patients with diagnosis (confirmed by a haematologist) of a chronic myeloid leukaemia (CML) in blast crisis, accelerated phase, or in chronic phase. b) Maximum dose of 600 mg/day for accelerated or blast phase, and 400 mg/day for chronic phase CML. c) Subsidised for use as monotherapy only. d) Initial approvals valid seven months. e) Subsequent approval(s) are granted on application and are valid for six months. The first reapplication (after seven months) should provide details of the haematological response. The third reapplication should provide details of the cytogenetic response after 14-18 months from initiating therapy. All other reapplications should provide details of haematological response, and cytogenetic response if such data is available. Applications to be made and subsequent prescriptions can be written by a haematologist or an oncologist. Guideline on discontinuation of treatment for patients with CML a) Prescribers should consider discontinuation of treatment if after 6 months from initiating therapy a patient did not obtain a haematological response as defined as any one of the following three levels of response: continued. . .

160

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 1) complete haematologic response (as characterised by an absolute neutrophil count (ANC) > 1.5 × 109 /L, platelets > 100 × 109 /L, absence of peripheral blood (PB) blasts, bone marrow (BM) blasts < 5% (or FISH Ph+ 0-35% metaphases), and absence of extramedullary disease); or 2) no evidence of leukaemia (as characterised by an absolute neutrophil count (ANC) > 1.0 × 109 /L, platelets > 20 × 109 /L, absence of peripheral blood (PB) blasts, bone marrow (BM) blasts < 5% (or FISH Ph+ 0-35% metaphases), and absence of extramedullary disease); or 3) return to chronic phase (as characterised by BM and PB blasts < 15%, BM and PB blasts and promyelocytes < 30%, PB basophils < 20% and absence of extramedullary disease other than spleen and liver). b) Prescribers should consider discontinuation of treatment if after 18 months from initiating therapy a patient did not obtain a major cytogenetic response defined as 0-35% Ph+ metaphases. Special Authority criteria for GIST – access by application a) Funded for patients: 1) with a diagnosis (confirmed by an oncologist) of unresectable and/or metastatic malignant gastrointestinal stromal tumour (GIST); and 2) who have immunohistochemical documentation of c-kit (CD117) expression by the tumour. b) Maximum dose of 400 mg/day. c) Applications to be made and subsequent prescriptions can be written by an oncologist. d) Initial and subsequent applications are valid for one year. The re-application criterion is an adequate clinical response to the treatment with imatinib (prescriber determined). LAPATINIB DITOSYLATE – Special Authority see SA1191 below – Retail pharmacy Tab 250 mg ..................................................................................1,899.00 70 Tykerb ¾SA1191 Special Authority for Subsidy Initial application — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 All of the following: 1.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 1.2 The patient has not previously received trastuzumab treatment for HER 2 positive metastatic breast cancer; and 1.3 Lapatinib not to be given in combination with trastuzumab; and 1.4 Lapatinib to be discontinued at disease progression; or 2 All of the following: 2.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2.2 The patient started trastuzumab for metastatic breast cancer but discontinued trastuzumab within 3 months of starting treatment due to intolerance; and 2.3 The cancer did not progress whilst on trastuzumab; and 2.4 Lapatinib not to be given in combination with trastuzumab; and 2.5 Lapatinib to be discontinued at disease progression. Renewal — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 The cancer has not progressed at any time point during the previous 12 months whilst on lapatinib; and 3 Lapatinib not to be given in combination with trastuzumab; and 4 Lapatinib to be discontinued at disease progression. PAZOPANIB – Special Authority see SA1190 on the next page – Retail pharmacy Tab 200 mg ..................................................................................1,334.70 30 Votrient Tab 400 mg ..................................................................................2,669.40 30 Votrient

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

161


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA1190 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 The patient has metastatic renal cell carcinoma; and 2 Any of the following: 2.1 The patient is treatment naive; or 2.2 The patient has only received prior cytokine treatment; or 2.3 Both: 2.3.1 The patient has discontinued sunitinib within 3 months of starting treatment due to intolerance; and 2.3.2 The cancer did not progress whilst on sunitinib; and 3 The patient has good performance status (WHO/ECOG grade 0-2); and 4 The disease is of predominant clear cell histology; and The patient has intermediate or poor prognosis defined as: 5 Any of the following: 5.1 Lactate dehydrogenase level > 1.5 times upper limit of normal; or 5.2 Haemoglobin level < lower limit of normal; or 5.3 Corrected serum calcium level > 10 mg/dL (2.5 mmol/L); or 5.4 Interval of < 1 year from original diagnosis to the start of systemic therapy; or 5.5 Karnofsky performance score of ≤ 70; or 5.6 ≥ 2 sites of organ metastasis; and 6 Pazopanib to be used for a maximum of 3 months. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 No evidence of disease progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Notes: Pazopanib treatment should be stopped if disease progresses. Poor prognosis patients are defined as having at least 3 of criteria 5.1-5.6. Intermediate prognosis patients are defined as having 1 or 2 of criteria 5.1-5.6. SUNITINIB – Special Authority see SA1266 below – Retail pharmacy Cap 12.5 mg ................................................................................2,315.38 28 Sutent Cap 25 mg ...................................................................................4,630.77 28 Sutent Cap 50 mg ...................................................................................9,261.54 28 Sutent ¾SA1266 Special Authority for Subsidy Initial application — (RCC) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 The patient has metastatic renal cell carcinoma; and 2 Any of the following: 2.1 The patient is treatment naive; or 2.2 The patient has only received prior cytokine treatment; or 2.3 The patient has only received prior treatment with an investigational agent within the confines of a bona fide clinical trial which has Ethics Committee approval; or 2.4 Both: 2.4.1 The patient has discontinued pazopanib within 3 months of starting treatment due to intolerance; and 2.4.2 The cancer did not progress whilst on pazopanib; and 3 The patient has good performance status (WHO/ECOG grade 0-2); and 4 The disease is of predominant clear cell histology; and continued. . .

162

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . The patient has intermediate or poor prognosis defined as: 5 Any of the following: 5.1 Lactate dehydrogenase level > 1.5 times upper limit of normal; or 5.2 Haemoglobin level < lower limit of normal; or 5.3 Corrected serum calcium level > 10 mg/dL (2.5 mmol/L); or 5.4 Interval of < 1 year from original diagnosis to the start of systemic therapy; or 5.5 Karnofsky performance score of ≤ 70; or 5.6 ≥ 2 sites of organ metastasis; and 6 Sunitinib to be used for a maximum of 2 cycles. Initial application — (GIST) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 The patient has unresectable or metastatic malignant gastrointestinal stromal tumour (GIST); and 2 Either: 2.1 The patient’s disease has progressed following treatment with imatinib; or 2.2 The patient has documented treatment-limiting intolerance, or toxicity to, imatinib. Renewal — (RCC) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 No evidence of disease progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Renewal — (GIST) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: The patient has responded to treatment or has stable disease as determined by Choi’s modified CT response evaluation criteria as follows: 1 Any of the following: 1.1 The patient has had a complete response (disappearance of all lesions and no new lesions); or 1.2 The patient has had a partial response (a decrease in size of ≥ 10% or decrease in tumour density in Hounsfield Units (HU) of ≥ 15% on CT and no new lesions and no obvious progression of non measurable disease); or 1.3 The patient has stable disease (does not meet criteria the two above) and does not have progressive disease and no symptomatic deterioration attributed to tumour progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Notes: RCC - Sunitinib treatment should be stopped if disease progresses. Poor prognosis patients are defined as having at least 3 of criteria 5.1-5.6. Intermediate prognosis patients are defined as having 1 or 2 of criteria 5.1-5.6 GIST - It is recommended that response to treatment be assessed using Choi’s modified CT response evaluation criteria (J Clin Oncol, 2007, 25:1753-1759). Progressive disease is defined as either: an increase in tumour size of ≥ 10% and not meeting criteria of partial response (PR) by tumour density (HU) on CT; or: new lesions, or new intratumoral nodules, or increase in the size of the existing intratumoral nodules.

Endocrine Therapy

For GnRH ANALOGUES – refer to HORMONE PREPARATIONS, Trophic Hormones, page 87 BICALUTAMIDE – Special Authority see SA0941 below – Retail pharmacy Tab 50 mg .........................................................................................10.00 28

Bicalaccord

¾SA0941 Special Authority for Subsidy Initial application from any medical practitioner. Approvals valid without further renewal unless notified where the patient has advanced prostate cancer.

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

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

163


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

FLUTAMIDE – Retail pharmacy-Specialist Tab 250 mg .......................................................................................16.50 55.00 MEGESTROL ACETATE – Retail pharmacy-Specialist Tab 160 mg .......................................................................................51.55 OCTREOTIDE (SOMATOSTATIN ANALOGUE) Inj 50 mcg per ml, 1 ml .....................................................................19.24 Inj 100 mcg per ml, 1 ml ...................................................................36.38 Inj 500 mcg per ml, 1 ml .................................................................131.25

30 100 30 5 5 5

Flutamin S29 Flutamin Apo-Megestrol Octreotide MaxRx Octreotide MaxRx Octreotide MaxRx

OCTREOTIDE LAR (SOMATOSTATIN ANALOGUE) – Special Authority see SA1016 below – Retail pharmacy Inj LAR 10 mg prefilled syringe ...................................................1,772.50 1 Sandostatin LAR Inj LAR 20 mg prefilled syringe ...................................................2,358.75 1 Sandostatin LAR Inj LAR 30 mg prefilled syringe ...................................................2,951.25 1 Sandostatin LAR ¾SA1016 Special Authority for Subsidy Initial application — (Malignant Bowel Obstruction) from any relevant practitioner. Approvals valid for 2 months for applications meeting the following criteria: All of the following: 1 The patient has nausea* and vomiting* due to malignant bowel obstruction*; and 2 Treatment with antiemetics, rehydration, antimuscarinic agents, corticosteroids and analgesics for at least 48 hours has failed; and 3 Octreotide to be given at a maximum dose 1500 mcg daily for up to 4 weeks. Note: Indications marked with * are Unapproved Indications. Renewal — (Malignant Bowel Obstruction) from any relevant practitioner. Approvals valid for 3 months where the treatment remains appropriate and the patient is benefiting from treatment. Initial application — (Acromegaly) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 The patient has acromegaly; and 2 Any of the following: 2.1 Treatment with surgery, radiotherapy and a dopamine agonist has failed; or 2.2 Treatment with octreotide is for an interim period while awaiting the effects of radiotherapy and a dopamine agonist has failed; or 2.3 The patient is unwilling, or unable, to undergo surgery and/or radiotherapy. Renewal — (Acromegaly) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 IGF1 levels have decreased since starting octreotide; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Note: In patients with Acromegaly octreotide treatment should be discontinued if IGF1 levels have not decreased after 3 months treatment. In patients treated with radiotherapy octreotide treatment should be withdrawn every 2 years, for 1 month, for assessment of remission. Octreotide treatment should be stopped where there is biochemical evidence of remission (normal IGF1 levels) following octreotide treatment withdrawal for at least 4 weeks Initial application — (Other Indications) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 VIPomas and Glucagonomas - for patients who are seriously ill in order to improve their clinical state prior to definitive surgery; or 2 Both: continued. . .

164

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 2.1 Gastrinoma; and 2.2 Either: 2.2.1 Patient has failed surgery; or 2.2.2 Patient in metastatic disease after H2 antagonists (or proton pump inhibitors) have failed; or 3 Both: 3.1 Insulinomas; and 3.2 Surgery is contraindicated or has failed; or 4 For pre-operative control of hypoglycaemia and for maintenance therapy; or 5 Both: 5.1 Carcinoid syndrome (diagnosed by tissue pathology and/or urinary 5HIAA analysis); and 5.2 Disabling symptoms not controlled by maximal medical therapy. Note: The use of octreotide in patients with fistulae, oesophageal varices, miscellaneous diarrhoea and hypotension will not be funded as a Special Authority item Renewal — (Other Indications) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. TAMOXIFEN CITRATE F Tab 10 mg ...........................................................................................2.63 60 Genox 17.50 100 Genox F Tab 20 mg ...........................................................................................2.63 30 Genox 8.75 100 Genox

Aromatase Inhibitors

ANASTROZOLE F Tab 1 mg ...........................................................................................26.55 30

Aremed Arimidex DP-Anastrozole Aromasin Letraccord

EXEMESTANE F Tab 25 mg .........................................................................................22.57 LETROZOLE F Tab 2.5 mg ..........................................................................................4.85

30 30

Immunosuppressants Cytotoxic Immunosuppressants

AZATHIOPRINE – Retail pharmacy-Specialist F Tab 50 mg – For azathioprine oral liquid formulation refer, page 194 .................................................................................... 18.45 F Inj 50 mg ...........................................................................................60.00 (Imuran Tab 50 mg to be delisted 1 March 2014)

100 1

Imuprine Imuran Imuran

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

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

165


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

MYCOPHENOLATE MOFETIL – Special Authority see SA1041 below – Retail pharmacy Dispensing pharmacy should check which brand to dispense with the prescriber if prescribed generically. Tab 500 mg .......................................................................................25.00 50 Cellcept Myaccord (60.00) Ceptolate Cap 250 mg ......................................................................................25.00 100 Cellcept Myaccord 12.50 50 (30.00) Ceptolate Powder for oral liq 1 g per 5 ml – Subsidy by endorsement ............285.00 165 ml OP Cellcept Mycophenolate powder for oral liquid is subsidised only for patients unable to swallow tablets and capsules, and when the prescription is endorsed accordingly. (Myaccord Tab 500 mg to be delisted 1 February 2014) (Ceptolate Tab 500 mg to be delisted 1 February 2014) (Myaccord Cap 250 mg to be delisted 1 February 2014) (Ceptolate Cap 250 mg to be delisted 1 February 2014) ¾SA1041 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 Transplant recipient; or 2 Both: Patients with diseases where 2.1 Steroids and azathioprine have been trialled and discontinued because of unacceptable side effects or inadequate clinical response; and 2.2 Either: Patients with diseases where 2.2.1 Cyclophosphamide has been trialled and discontinued because of unacceptable side effects or inadequate clinical response; or 2.2.2 Cyclophosphamide treatment is contraindicated.

Fusion Proteins

ETANERCEPT – Special Authority see SA1372 below – Retail pharmacy Inj 25 mg .........................................................................................949.96 Inj 50 mg autoinjector ..................................................................1,899.92 Inj 50 mg prefilled syringe ...........................................................1,899.92 4 4 4

Enbrel Enbrel Enbrel

¾SA1372 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 adalimumab for juvenile idiopathic arthritis (JIA); and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for JIA; or 2 All of the following: continued. . .

166

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . .

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 Juvenile Idiopathic Arthritis (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 1020 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: 2.5.1 Either: 2.5.1.1 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. Initial application — (rheumatoid arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with sulphasalazine and hydroxychloroquine sulphate (at maximum tolerated doses); and 2.5 Any of the following: 2.5.1 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with the maximum tolerated dose of cyclosporin; or 2.5.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with intramuscular gold; or 2.5.3 Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate; and 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 swollen, tender joints; or 2.6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.7 Either: 2.7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. continued. . .

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

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

167


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . Initial application — (severe chronic plaque psoriasis) only from a dermatologist. Approvals valid for 4 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for severe chronic plaque psoriasis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for severe chronic plaque psoriasis; or 2 All of the following: 2.1 Either: 2.1.1 Patient has "whole body" severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 2.1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2.2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and 2.3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 2.4 The most recent PASI assessment is no more than 1 month old at the time of application. Note: "Inadequate response" is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. Initial application — (ankylosing spondylitis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for ankylosing spondylitis; or 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis present for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 Patient’s ankylosing spondylitis has not responded adequately to treatment with two or more non-steroidal antiinflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist; and 2.5 Either: 2.5.1 Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober’s test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right); or continued. . .

168

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 2.5.2 Patient has limitation of chest expansion by at least 2.5 cm below the average normal values corrected for age and gender (see Notes); and 2.6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of initial application. Average normal chest expansion corrected for age and gender: 18-24 years - Male: 7.0 cm; Female: 5.5 cm 25-34 years - Male: 7.5 cm; Female: 5.5 cm 35-44 years - Male: 6.5 cm; Female: 4.5 cm 45-54 years - Male: 6.0 cm; Female: 5.0 cm 55-64 years - Male: 5.5 cm; Female: 4.0 cm 65-74 years - Male: 4.0 cm; Female: 4.0 cm 75+ years - Male: 3.0 cm; Female: 2.5 cm Initial application — (psoriatic arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for psoriatic arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.3 Patient has tried and not responded to at least three months of sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses); and 2.4 Either: 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 15 swollen, tender joints; or 2.4.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.5 Any of the following: 2.5.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Renewal — (juvenile idiopathic arthritis) only from a named specialist, rheumatologist or Practitioner on the recommendation of a named specialist or rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a named specialist or rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a named specialist or rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Either: continued. . .

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

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

169


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 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 in active joint count and continued improvement in physician’s global assessment from baseline. Renewal — (rheumatoid arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Either: 3.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 3.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 4 Etanercept to be administered at doses no greater than 50 mg every 7 days. Renewal — (severe chronic plaque psoriasis) only from a dermatologist or Practitioner on the recommendation of a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a dermatologist; or 1.2 Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Either: 2.1 Both: 2.1.1 Patient had "whole body" severe chronic plaque psoriasis at the start of treatment; and 2.1.2 Following each prior etanercept treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-treatment baseline value; or 2.2 Both: 2.2.1 Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 2.2.2 Either: 2.2.2.1 Following each prior etanercept treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 2.2.2.2 Following each prior etanercept treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-treatment baseline value; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. Note: A treatment course is defined as a minimum of 12 weeks of etanercept treatment Renewal — (ankylosing spondylitis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and continued. . .

170

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 2 Following 12 weeks of etanercept treatment, BASDAI has improved by 4 or more points from pre-treatment baseline on a 10 point scale, or by 50%, whichever is less; and 3 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 4 Etanercept to be administered at doses no greater than 50 mg every 7 days. Renewal — (psoriatic arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 2.2 The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to prior etanercept treatment in the opinion of the treating physician; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days.

Immune Modulators

ANTITHYMOCYTE GLOBULIN (EQUINE) – PCT only – Specialist Inj 50 mg per ml, 5 ml ..................................................................2,137.50 BACILLUS CALMETTE-GUERIN (BCG) VACCINE – PCT only – Specialist Subsidised only for bladder cancer. Inj 2-8 × 100 million CFU ...............................................................149.37 5

ATGAM OncoTICE

1

Monoclonal Antibodies

ADALIMUMAB – Special Authority see SA1371 below – Retail pharmacy Inj 20 mg per 0.4 ml prefilled syringe ..........................................1,799.92 Inj 40 mg per 0.8 ml prefilled pen ................................................1,799.92 Inj 40 mg per 0.8 ml prefilled syringe ..........................................1,799.92 2 2 2

Humira HumiraPen Humira

¾SA1371 Special Authority for Subsidy Initial application — (rheumatoid arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and continued. . .

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

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

171


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with sulphasalazine and hydroxychloroquine sulphate (at maximum tolerated doses); and 2.5 Any of the following: 2.5.1 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with the maximum tolerated dose of cyclosporin; or 2.5.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with intramuscular gold; or 2.5.3 Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate; and 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 swollen, tender joints; or 2.6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.7 Either: 2.7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Initial application — (Crohn’s disease) only from a gastroenterologist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient has severe active Crohn’s disease; and 2 Any of the following: 2.1 Patient has a Crohn’s Disease Activity Index (CDAI) score of greater than or equal to 300; or 2.2 Patient has extensive small intestine disease affecting more than 50 cm of the small intestine; or 2.3 Patient has evidence of short gut syndrome or would be at risk of short gut syndrome with further bowel resection; or 2.4 Patient has an ileostomy or colostomy, and has intestinal inflammation; and 3 Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses (unless contraindicated) and corticosteroids; and 4 Surgery (or further surgery) is considered to be clinically inappropriate. Initial application — (severe chronic plaque psoriasis) only from a dermatologist. Approvals valid for 4 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for severe chronic plaque psoriasis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for severe chronic plaque psoriasis; or 2 All of the following: 2.1 Either: 2.1.1 Patient has "whole body" severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 2.1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2.2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and continued. . .

172

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 2.3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 2.4 The most recent PASI assessment is no more than 1 month old at the time of application. Note: "Inadequate response" is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. Initial application — (ankylosing spondylitis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for ankylosing spondylitis; or 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 Patient’s ankylosing spondylitis has not responded adequately to treatment with two or more non-steroidal antiinflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist; and 2.5 Either: 2.5.1 Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober’s test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right); or 2.5.2 Patient has limitation of chest expansion by at least 2.5 cm below the following average normal values corrected for age and gender (see Notes); and 2.6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of initial application. Average normal chest expansion corrected for age and gender: 18-24 years - Male: 7.0 cm; Female: 5.5 cm 25-34 years - Male: 7.5 cm; Female: 5.5 cm 35-44 years - Male: 6.5 cm; Female: 4.5 cm 45-54 years - Male: 6.0 cm; Female: 5.0 cm 55-64 years - Male: 5.5 cm; Female: 4.0 cm 65-74 years - Male: 4.0 cm; Female: 4.0 cm 75+ years - Male: 3.0 cm; Female: 2.5 cm Initial application — (psoriatic arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for psoriatic arthritis; and 1.2 Either: continued. . .

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

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

173


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.3 Patient has tried and not responded to at least three months of sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses); and 2.4 Either: 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 15 swollen, tender joints; or 2.4.2 Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.5 Any of the following: 2.5.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. 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 1020 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: 2.5.1 Either: 2.5.1.1 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. Initial application — (fistulising Crohn’s disease) only from a gastroenterologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient has confirmed Crohn’s disease; and 2 Either: continued. . .

174

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 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 — (rheumatoid arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Either: 3.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 3.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 4 Either: 4.1 Adalimumab to be administered at doses no greater than 40 mg every 14 days; or 4.2 Patient cannot take concomitant methotrexate and requires doses of adalimumab higher than 40 mg every 14 days to maintain an adequate response. Renewal — (Crohn’s disease) only from a gastroenterologist or Practitioner on the recommendation of a gastroenterologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a gastroenterologist; or 1.2 Applicant is a Practitioner and confirms that a gastroenterologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Either: 2.1.1 CDAI score has reduced by 100 points from the CDAI score when the patient was initiated on adalimumab; or 2.1.2 CDAI score is 150 or less; or 2.2 Both: 2.2.1 The patient has demonstrated an adequate response to treatment but CDAI score cannot be assessed; and 2.2.2 Applicant to indicate the reason that CDAI score cannot be assessed; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Renewal — (severe chronic plaque psoriasis) only from a dermatologist or Practitioner on the recommendation of a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a dermatologist; or 1.2 Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Both: 2.1.1 Patient had "whole body" severe chronic plaque psoriasis at the start of treatment; and continued. . .

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

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

175


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 2.1.2 Following each prior adalimumab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-adalimumab treatment baseline value; or 2.2 Both: 2.2.1 Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 2.2.2 Either: 2.2.2.1 Following each prior adalimumab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 2.2.2.2 Following each prior adalimumab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-adalimumab treatment baseline value; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Note: A treatment course is defined as a minimum of 12 weeks adalimumab treatment Renewal — (ankylosing spondylitis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Following 12 weeks of adalimumab treatment, BASDAI has improved by 4 or more points from pre-adalimumab baseline on a 10 point scale, or by 50%, whichever is less; and 3 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 4 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Renewal — (psoriatic arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 2.2 The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to prior adalimumab treatment in the opinion of the treating physician; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. 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: continued. . .

176

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 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 in active 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 for applications meeting the following criteria: Both: 1 Either: 1.1 Applicant is a gastroenterologist; or 1.2 Applicant is a Practitioner and confirms that a gastroenterologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 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. RITUXIMAB – PCT only – Specialist – Special Authority see SA1152 below Inj 100 mg per 10 ml vial .............................................................1,075.50 2 Mabthera Inj 500 mg per 50 ml vial .............................................................2,688.30 1 Mabthera Inj 1 mg for ECP .................................................................................5.64 1 mg Baxter ¾SA1152 Special Authority for Subsidy Initial application — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has B-cell post-transplant lymphoproliferative disorder*; and 2 To be used for a maximum of 8 treatment cycles. Note: Indications marked with * are Unapproved Indications. Initial application — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has indolent low grade NHL with relapsed disease following prior chemotherapy; and 1.2 To be used for a maximum of 6 treatment cycles; or 2 Both: 2.1 The patient has indolent, low grade lymphoma requiring first-line systemic chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/Waldenstrom macroglobulinaemia. Initial application — (Aggressive CD20 positive NHL) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 All of the following: 1.1 The patient has treatment naive aggressive CD20 positive NHL; and 1.2 To be used with a multi-agent chemotherapy regimen given with curative intent; and 1.3 To be used for a maximum of 8 treatment cycles; or 2 Both: 2.1 The patient has aggressive CD20 positive NHL with relapsed disease following prior chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ’Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia continued. . .

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

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

177


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . Initial application — (Chronic Lymphocytic Leukaemia) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has progressive Binet stage A, B or C chronic lymphocytic leukaemia (CLL) requiring treatment; and 2 The patient is rituximab treatment naive; and 3 Either: 3.1 The patient is chemotherapy treatment naive; or 3.2 Both: 3.2.1 The patient’s disease has relapsed following no more than three prior lines of chemotherapy treatment; and 3.2.2 The patient has had a treatment-free interval of 12 months or more if previously treated with fludarabine and cyclophosphamide chemotherapy; and 4 The patient has good performance status; and 5 The patient has good renal function (creatinine clearance ≥ 30 ml/min); and 6 The patient does not have chromosome 17p deletion CLL; and 7 Rituximab to be administered in combination with fludarabine and cyclophosphamide for a maximum of 6 treatment cycles; and 8 It is planned that the patient receives full dose fludarabine and cyclophosphamide (orally or dose equivalent intravenous administration). Note: ’Chronic lymphocytic leukaemia (CLL)’ includes small lymphocytic lymphoma. A line of chemotherapy treatment is considered to comprise a known standard therapeutic chemotherapy regimen and supportive treatments. ’Good performance status’ means ECOG score of 0-1, however, in patients temporarily debilitated by their CLL disease symptoms a higher ECOG (2 or 3) is acceptable where treatment with rituximab is expected to improve symptoms and improve ECOG score to <2. Renewal — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has B-cell post-transplant lymphoproliferative disorder*; and 3 To be used for no more than 6 treatment cycles. Note: Indications marked with * are Unapproved Indications. Renewal — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has indolent, low-grade NHL with relapsed disease following prior chemotherapy; and 3 To be used for no more than 6 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/Waldenstrom macroglobulinaemia. Renewal — (Aggressive CD20 positive NHL) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has relapsed refractory/aggressive CD20 positive NHL; and 3 To be used with a multi-agent chemotherapy regimen given with curative intent; and 4 To be used for a maximum of 4 treatment cycles. Note: ’Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia TRASTUZUMAB – PCT only – Specialist – Special Authority see SA1192 on the next page Inj 150 mg vial .............................................................................1,350.00 1 Herceptin Inj 440 mg vial .............................................................................3,875.00 1 Herceptin Inj 1 mg for ECP .................................................................................9.36 1 mg Baxter

178

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

¾SA1192 Special Authority for Subsidy Initial application — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 All of the following: 1.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 1.2 The patient has not previously received lapatinib treatment for HER 2 positive metastatic breast cancer; and 1.3 Trastuzumab not to be given in combination with lapatinib; and 1.4 Trastuzumab to be discontinued at disease progression; or 2 All of the following: 2.1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2.2 The patient started lapatinib treatment for metastatic breast cancer but discontinued lapatinib within 3 months of starting treatment due to intolerance; and 2.3 The cancer did not progress whilst on lapatinib; and 2.4 Trastuzumab not to be given in combination with lapatinib; and 2.5 Trastuzumab to be discontinued at disease progression. Renewal — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 The cancer has not progressed at any time point during the previous 12 months whilst on trastuzumab; and 3 Trastuzumab not to be given in combination with lapatinib; and 4 Trastuzumab to be discontinued at disease progression. Initial application — (early breast cancer*) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 15 months for applications meeting the following criteria: All of the following: 1 The patient has early breast cancer expressing HER 2 IHC 3+ or ISH + (including FISH or other current technology); and 2 Maximum cumulative dose of 106 mg/kg (12 months’ treatment); and 3 Any of the following: 3.1 9 weeks’ concurrent treatment with adjuvant chemotherapy is planned; or 3.2 12 months’ concurrent treatment with adjuvant chemotherapy is planned; or 3.3 12 months’ sequential treatment following adjuvant chemotherapy is planned; or 3.4 Other treatment regimen, in association with adjuvant chemotherapy, is planned. Renewal — (early breast cancer*) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 The patient received prior adjuvant trastuzumab treatment for early breast cancer; and 3 Any of the following: 3.1 All of the following: 3.1.1 The patient has not previously received lapatinib treatment for metastatic breast cancer; and 3.1.2 Trastuzumab not to be given in combination with lapatinib; and 3.1.3 Trastuzumab to be discontinued at disease progression; or 3.2 All of the following: continued. . .

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

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

179


ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

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

continued. . . 3.2.1 The patient started lapatinib treatment for metastatic breast cancer but discontinued lapatinib within 3 months of starting treatment due to intolerance; and 3.2.2 The cancer did not progress whilst on lapatinib; and 3.2.3 Trastuzumab not to be given in combination with lapatinib; and 3.2.4 Trastuzumab to be discontinued at disease progression; or 3.3 All of the following: 3.3.1 The cancer has not progressed at any time point during the previous 12 months whilst on trastuzumab; and 3.3.2 Trastuzumab not to be given in combination with lapatinib; and 3.3.3 Trastuzumab to be discontinued at disease progression. Note: * For patients with relapsed HER-2 positive disease who have previously received adjuvant trastuzumab for early breast cancer.

Other Immunosuppressants

CYCLOSPORIN Cap 25 mg ........................................................................................44.63 Cap 50 mg ........................................................................................88.91 Cap 100 mg ....................................................................................177.81 Oral liq 100 mg per ml ....................................................................198.13 SIROLIMUS – Special Authority see SA0866 below – Retail pharmacy Tab 1 mg .........................................................................................813.00 Tab 2 mg ......................................................................................1,626.00 Oral liq 1 mg per ml ........................................................................487.80 50 50 50 50 ml OP 100 100 60 ml OP

Neoral Neoral Neoral Neoral Rapamune Rapamune Rapamune

¾SA0866 Special Authority for Subsidy Initial application from any medical practitioner. Approvals valid without further renewal unless notified where the drug is to be used for rescue therapy for an organ transplant recipient. Notes: Rescue therapy defined as unresponsive to calcineurin inhibitor treatment as defined by refractory rejection; or intolerant to calcineurin inhibitor treatment due to any of the following: G GFR<30 ml/min; or G Rapidly progressive transplant vasculopathy; or G Rapidly progressive obstructive bronchiolitis; or G HUS or TTP; or G Leukoencepthalopathy; or G Significant malignant disease TACROLIMUS – Special Authority see SA0669 below – Retail pharmacy Cap 0.5 mg .....................................................................................214.00 100 Prograf Cap 1 mg ........................................................................................428.00 100 Prograf Cap 5 mg – For tacrolimus oral liquid formulation refer, page 194 ........................................................................................ 1,070.00 50 Prograf ¾SA0669 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid without further renewal unless notified where the patient is an organ transplant recipient. Note: Subsidy applies for either primary or rescue therapy.

180

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


RESPIRATORY SYSTEM AND ALLERGIES

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

Antiallergy Preparations

¾SA1367 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. BEE VENOM ALLERGY TREATMENT – Special Authority see SA1367 above – Retail pharmacy Maintenance kit - 6 vials 120 mcg freeze dried venom, 6 diluent 1.8 ml ................................................................................. 285.00 1 OP Albay Treatment kit - 1 vial 550 mcg freeze dried venom, 1 diluent 9 ml, 3 diluent 1.8 ml ............................................................... 285.00 1 OP Albay WASP VENOM ALLERGY TREATMENT – Special Authority see SA1367 above – 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

Antihistamines

CETIRIZINE HYDROCHLORIDE F Tab 10 mg ...........................................................................................1.59 F‡ Oral liq 1 mg per ml ............................................................................3.52 CHLORPHENIRAMINE MALEATE F‡ Oral liq 2 mg per 5 ml .........................................................................8.06 DEXTROCHLORPHENIRAMINE MALEATE F Tab 2 mg .............................................................................................1.01 (5.99) 2.02 (8.40) F‡ Oral liq 2 mg per 5 ml .........................................................................1.77 (10.29) FEXOFENADINE HYDROCHLORIDE F Tab 60 mg ...........................................................................................4.34 (11.53) F Tab 120 mg .........................................................................................4.74 (11.53) 14.22 (29.81) LORATADINE F Tab 10 mg ...........................................................................................1.30 (2.09) F Oral liq 1 mg per ml ............................................................................3.10 (Loraclear Hayfever Relief Tab 10 mg to be delisted 1 March 2014) 100 200 ml 500 ml 20 Polaramine 40 Polaramine 100 ml Polaramine 20 Telfast 10 Telfast 30 Telfast 100

Zetop Cetirizine - AFT Histafen

Lorafix

Loraclear Hayfever Relief Lorapaed

100 ml

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

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

181


RESPIRATORY SYSTEM AND ALLERGIES

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

PROMETHAZINE HYDROCHLORIDE F Tab 10 mg ...........................................................................................1.99 F Tab 25 mg ...........................................................................................2.99 F‡ Oral liq 5 mg per 5 ml .........................................................................2.79 F Inj 25 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................11.00 TRIMEPRAZINE TARTRATE ‡ Oral liq 30 mg per 5 ml .......................................................................2.79 (8.06)

50 50 100 ml 5 100 ml OP

Allersoothe Allersoothe Allersoothe Hospira

Vallergan Forte

Inhaled Corticosteroids

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 50 mcg per dose CFC-free .......................................8.54 Aerosol inhaler, 100 mcg per dose CFC-free ...................................12.50 Aerosol inhaler, 250 mcg per dose CFC-free ...................................22.67 BUDESONIDE Powder for inhalation, 100 mcg per dose .........................................17.00 Powder for inhalation, 200 mcg per dose ........................................15.20 19.00 Powder for inhalation, 400 mcg per dose ........................................25.60 32.00 (Budenocort Powder for inhalation, 200 mcg per dose to be delisted 1 April 2014) (Budenocort Powder for inhalation, 400 mcg per dose to be delisted 1 April 2014) FLUTICASONE Aerosol inhaler, 50 mcg per dose CFC-free .......................................7.50 Powder for inhalation, 50 mcg per dose .............................................7.50 Powder for inhalation, 100 mcg per dose ...........................................7.50 Aerosol inhaler, 125 mcg per dose CFC-free ...................................13.60 Aerosol inhaler, 250 mcg per dose CFC-free ...................................27.20 Powder for inhalation, 250 mcg per dose .........................................13.60 120 dose OP 60 dose OP 60 dose OP 120 dose OP 120 dose OP 60 dose OP 200 dose OP 200 dose OP 200 dose OP 200 dose OP 200 dose OP

Beclazone 50 Beclazone 100 Beclazone 250 Pulmicort

Turbuhaler

Budenocort Pulmicort

Turbuhaler

200 dose OP

Budenocort Pulmicort

Turbuhaler

Flixotide Flixotide Accuhaler Flixotide Accuhaler Flixotide Flixotide Flixotide Accuhaler

Inhaled Long-acting Beta-adrenoceptor Agonists

Prescribing Guideline for Inhaled Long-Acting Beta-Adrenoceptor Agonists The addition of inhaled long-acting beta-adrenoceptor agonists (LABAs) to inhaled corticosteroids is recommended: G For younger children (aged under 12 years) where asthma is poorly controlled despite using inhaled corticosteroids for at least three months at total daily doses of 200 mcg beclomethasone or budesonide (or 100 mcg fluticasone). G For adults and older children (aged 12 years and over) where asthma is poorly controlled despite using inhaled corticosteroids for at least three months at total daily doses of 400 mcg beclomethasone or budesonide (or 200 mcg fluticasone). Note: Further information on the place of inhaled corticosteroids and inhaled LABAs in the management of asthma can be found in the New Zealand guidelines for asthma in adults (www.nzgg.org.nz) and in the New Zealand guidelines for asthma in children aged 1-15 (www.paediatrics.org.nz).

182

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


RESPIRATORY SYSTEM AND ALLERGIES

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

EFORMOTEROL FUMARATE – See prescribing guideline on the previous page Powder for inhalation, 6 mcg per dose, breath activated ..................10.32 60 dose OP (16.90) Powder for inhalation, 12 mcg per dose, and monodose device ............................................................................................ 20.64 60 dose (35.80) SALMETEROL – See prescribing guideline on the previous page Aerosol inhaler CFC-free, 25 mcg per dose .....................................26.46 Powder for inhalation, 50 mcg per dose, breath activated ................26.46 120 dose OP 60 dose OP

Oxis Turbuhaler

Foradil

Serevent Serevent Accuhaler

Inhaled Corticosteroids with Long-Acting Beta-Adrenoceptor Agonists

¾SA1179 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 All of the following: 1.1 Patient is a child under the age of 12; and 1.2 Has been treated with inhaled corticosteroids of at least 400 mcg per day beclomethasone or budesonide, or 200 mcg per day fluticasone; and 1.3 The prescriber considers that the patient would receive additional clinical benefit from switching to a combination product; or 2 All of the following: 2.1 Patient is over the age of 12; and 2.2 Has been treated with inhaled corticosteroids of at least 800 mcg per day beclomethasone or budesonide, or 500 mcg per day fluticasone; and 2.3 The prescriber considers that the patient would receive additional clinical benefit from switching to a combination product. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. BUDESONIDE WITH EFORMOTEROL – Special Authority see SA1179 above – Retail pharmacy Aerosol inhaler 100 mcg with eformoterol fumarate 6 mcg ..............26.49 120 dose OP Vannair Powder for inhalation 100 mcg with eformoterol fumarate 6 mcg ......................................................................................... 55.00 120 dose OP Symbicort Turbuhaler 100/6 Aerosol inhaler 200 mcg with eformoterol fumarate 6 mcg ..............31.25 120 dose OP Vannair Powder for inhalation 200 mcg with eformoterol fumarate 6 mcg ......................................................................................... 60.00 120 dose OP Symbicort Turbuhaler 200/6 Powder for inhalation 400 mcg with eformoterol fumarate 12 mcg – No more than 2 dose per day .................................... 60.00 60 dose OP Symbicort Turbuhaler 400/12 FLUTICASONE WITH SALMETEROL – Special Authority see SA1179 above – Retail pharmacy Aerosol inhaler 50 mcg with salmeterol 25 mcg ...............................37.48 120 dose OP Aerosol inhaler 125 mcg with salmeterol 25 mcg .............................49.69 120 dose OP Powder for inhalation 100 mcg with salmeterol 50 mcg – No more than 2 dose per day........................................................... 37.48 60 dose OP Powder for inhalation 250 mcg with salmeterol 50 mcg – No more than 2 dose per day........................................................... 49.69 60 dose OP

Seretide Seretide Seretide Accuhaler Seretide Accuhaler

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

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

183


RESPIRATORY SYSTEM AND ALLERGIES

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

Beta-Adrenoceptor Agonists

SALBUTAMOL ‡ Oral liq 400 mcg per ml ......................................................................1.99 2.06 Infusion 1 mg per ml, 5 ml ..............................................................118.38 (130.21) Inj 500 mcg per ml, 1 ml – Up to 5 inj available on a PSO ...............12.90 150 ml 10 Ventolin 5

Salapin Ventolin Ventolin

Inhaled Beta-Adrenoceptor Agonists

SALBUTAMOL Aerosol inhaler, 100 mcg per dose CFC free – Up to 1000 dose available on a PSO .............................................................. 3.80 (6.00) Nebuliser soln, 1 mg per ml, 2.5 ml – Up to 30 neb available on a PSO...................................................................................... 3.25 Nebuliser soln, 2 mg per ml, 2.5 ml – Up to 30 neb available on a PSO...................................................................................... 3.44 TERBUTALINE SULPHATE Powder for inhalation, 250 mcg per dose, breath activated ..............22.00

200 dose OP

Respigen Salamol

Ventolin

20 20 200 dose OP

Asthalin Asthalin Bricanyl Turbuhaler

Inhaled Anticholinergic Agents

IPRATROPIUM BROMIDE Aerosol inhaler, 20 mcg per dose CFC-free .....................................16.20 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 a PSO...................................................................................... 3.37 200 dose OP 20 20

Atrovent Univent Univent Spiriva

TIOTROPIUM BROMIDE – Special Authority see SA1193 below – Retail pharmacy Powder for inhalation, 18 mcg per dose ...........................................70.00 30 dose

¾SA1193 Special Authority for Subsidy Initial application only from a general practitioner or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 To be used for the long-term maintenance treatment of bronchospasm and dyspnoea associated with COPD; and 2 In addition to standard treatment, the patient has trialled a short acting bronchodilator of at least 40 mcg ipratropium q.i.d for one month; and 3 Either: The patient’s breathlessness according to the Medical Research Council (UK) dyspnoea scale is: 3.1 Grade 4 (stops for breath after walking about 100 meters or after a few minutes on the level); or 3.2 Grade 5 (too breathless to leave the house, or breathless when dressing or undressing); and Applicant must state recent measurement of: 4 All of the following: 4.1 Actual FEV1 (litres); and 4.2 Predicted FEV1 (litres); and 4.3 Actual FEV1 as a % of predicted (must be below 60%); and 5 Either: continued. . .

184

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


RESPIRATORY SYSTEM AND ALLERGIES

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

continued. . . 5.1 Patient is not a smoker (for reporting purposes only); or 5.2 Patient is a smoker and has been offered smoking cessation counselling; and 6 The patient has been offered annual influenza immunisation. Renewal only from a general practitioner or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Patient is compliant with the medication; and 2 Patient has experienced improved COPD symptom control (prescriber determined); and Applicant must state recent measurement of: 3 All of the following: 3.1 Actual FEV1 (litres); and 3.2 Predicted FEV1 (litres); and 3.3 Actual FEV1 as a % of predicted.

Inhaled Beta-Adrenoceptor Agonists with Anticholinergic Agents

SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 mcg with ipratropium bromide, 20 mcg per dose CFC-free ..................................................................... 12.19 Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml – Up to 20 neb available on a PSO ........................... 3.75

200 dose OP 20

Duolin HFA Duolin

Leukotriene Receptor Antagonists

MONTELUKAST – Special Authority see SA1409 below – Retail pharmacy Prescribing Guideline: Clinical evidence indicates that the effectiveness of montelukast is strongest when montelukast is used in short treatment courses. Tab 4 mg ...........................................................................................18.48 28 Singulair Tab 5 mg ...........................................................................................18.48 28 Singulair Tab 10 mg .........................................................................................18.48 28 Singulair ¾SA1409 Special Authority for Subsidy Initial application — (Pre-school wheeze) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 To be used for the treatment of intermittent severe wheezing (possibly viral); and 2 The patient has had at least three episodes in the previous 12 months of acute wheeze severe enough to seek medical attention. Renewal — (Pre-school wheeze) from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. Initial application — (exercise-induced asthma) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 Patient has been trialled with maximal asthma therapy, including inhaled corticosteroids and long-acting beta-adrenoceptor agonists; and 2 Patient continues to receive optimal inhaled corticosteroid therapy; and 3 Patient continues to experience frequent episodes of exercise-induced bronchoconstriction. Initial application — (aspirin desensitisation) only from a clinical immunologist or allergist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: continued. . .

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

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

185


RESPIRATORY SYSTEM AND ALLERGIES

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

continued. . . 1 Patient is undergoing aspirin desensitisation therapy under the supervision of a clinical immunologist or allergist; and 2 Patient has moderate to severe aspirin-exacerbated respiratory disease or Samter’s triad; and 3 Nasal polyposis, confirmed radiologically or surgically; and 4 Documented aspirin or NSAID allergy confirmed by aspirin challenge or a clinical history of severe reaction to aspirin or NSAID where challenge would be considered dangerous.

Mast Cell Stabilisers

NEDOCROMIL Aerosol inhaler, 2 mg per dose CFC-free .........................................28.07 SODIUM CROMOGLYCATE Powder for inhalation, 20 mg per dose .............................................17.94 Aerosol inhaler, 5 mg per dose CFC-free .........................................28.07 112 dose OP 50 dose 112 dose OP

Tilade Intal Spincaps Intal Forte CFC Free

Methylxanthines

AMINOPHYLLINE F Inj 25 mg per ml, 10 ml – Up to 5 inj available on a PSO .................53.75 THEOPHYLLINE F Tab long-acting 250 mg ....................................................................21.51 F‡ Oral liq 80 mg per 15 ml ...................................................................15.50 5 100 500 ml

DBL Aminophylline Nuelin-SR Nuelin

Mucolytics

DORNASE ALFA – Special Authority see SA0611 below – Retail pharmacy Nebuliser soln, 2.5 mg per 2.5 ml ampoule ....................................250.00 6

Pulmozyme

¾SA0611 Special Authority for Subsidy Special Authority approved by the Cystic Fibrosis Advisory Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Co-ordinator, Cystic Fibrosis Advisory Panel Phone: (04) 460 4990 PHARMAC, PO Box 10 254 Facsimile: (04) 916 7571 Wellington Email: CFPanel@pharmac.govt.nz Prescriptions for patients approved for treatment must be written by respiratory physicians or paediatricians who have experience and expertise in treating cystic fibrosis. SODIUM CHLORIDE Not funded for use as a nasal drop. Soln 7% ............................................................................................23.50 90 ml OP Biomed

Nasal Preparations Allergy Prophylactics

BECLOMETHASONE DIPROPIONATE Metered aqueous nasal spray, 50 mcg per dose ................................2.35 (4.85) Metered aqueous nasal spray, 100 mcg per dose ..............................2.46 (5.75) 200 dose OP Alanase 200 dose OP Alanase

186

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


RESPIRATORY SYSTEM AND ALLERGIES

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

BUDESONIDE Metered aqueous nasal spray, 50 mcg per dose ................................2.35 (4.85) Metered aqueous nasal spray, 100 mcg per dose ..............................2.61 (5.75) FLUTICASONE PROPIONATE Metered aqueous nasal spray, 50 mcg per dose ................................2.30 IPRATROPIUM BROMIDE Aqueous nasal spray, 0.03% ..............................................................4.03

200 dose OP Butacort Aqueous 200 dose OP Butacort Aqueous 120 dose OP

Flixonase Hayfever

& Allergy

15 ml OP

Univent

Respiratory Devices

MASK FOR SPACER DEVICE a) Up to 20 dev available on a PSO b) Only on a PSO c) Only for children aged six years and under Size 2 ..................................................................................................2.99 PEAK FLOW METER a) Up to 10 dev available on a PSO b) Only on a PSO Low range .........................................................................................11.44 Normal range ....................................................................................11.44 SPACER DEVICE a) Up to 20 dev available on a PSO b) Only on a PSO 230 ml (single patient) ........................................................................4.72 800 ml .................................................................................................8.50

1

EZ-fit Paediatric

Mask

1 1

Breath-Alert Breath-Alert

1 1

Space Chamber

Plus

Volumatic

SPACER DEVICE AUTOCLAVABLE a) Up to 5 dev available on a PSO b) Only on a PSO 230 ml (autoclavable) – Subsidy by endorsement.............................11.60 1 Space Chamber Available where the prescriber requires a spacer device that is capable of sterilisation in an autoclave and the PSO is endorsed accordingly.

Respiratory Stimulants

CAFFEINE CITRATE Oral liq 20 mg per ml (10 mg base per ml) .......................................14.85 25 ml OP

Biomed

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

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

187


SENSORY ORGANS

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

Ear Preparations

ACETIC ACID WITH 1, 2- PROPANEDIOL DIACETATE AND BENZETHONIUM For Vosol ear drops with hydrocortisone powder refer, page 197 Ear drops 2% with 1, 2-Propanediol diacetate 3% and benzethonium chloride 0.02% ..................................................... 6.97 CHLORAMPHENICOL Ear drops 0.5% ..................................................................................2.20 (Chloromycetin Ear drops 0.5% to be delisted 1 February 2014) FLUMETASONE PIVALATE Ear drops 0.02% with clioquinol 1% ...................................................4.46

35 ml OP 5 ml OP

Vosol Chloromycetin Locacorten-Viaform

ED’s

7.5 ml OP

Locorten-Vioform

TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN Ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g ......................................... 5.16 7.5 ml OP

Kenacomb

Ear/Eye Preparations

DEXAMETHASONE WITH FRAMYCETIN AND GRAMICIDIN Ear/Eye drops 500 mcg with framycetin sulphate 5 mg and gramicidin 50 mcg per ml ............................................................ 4.50 (9.27) FRAMYCETIN SULPHATE Ear/Eye drops 0.5% ............................................................................4.13 (8.65)

8 ml OP Sofradex 8 ml OP Soframycin

Eye Preparations

Eye preparations are only funded for use in the eye, unless explicitly stated otherwise.

Anti-Infective Preparations

ACICLOVIR F Eye oint 3% ......................................................................................37.53 4.5 g OP

Zovirax

CHLORAMPHENICOL Eye oint 1% ........................................................................................2.76 4 g OP Chlorsig Eye drops 0.5% ..................................................................................1.20 10 ml OP Chlorafast Funded for use in the ear*. Indications marked with * are Unapproved Indications. CIPROFLOXACIN Eye Drops 0.3% ................................................................................12.43 5 ml OP Ciloxan For treatment of bacterial keratitis or severe bacterial conjunctivitis resistant to chloramphenicol. FUSIDIC ACID Eye drops 1% .....................................................................................4.50 5 g OP Fucithalmic GENTAMICIN SULPHATE Eye drops 0.3% ................................................................................11.40 PROPAMIDINE ISETHIONATE F Eye drops 0.1% ..................................................................................2.97 (7.99) 5 ml OP 10 ml OP Brolene

Genoptic

188

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


SENSORY ORGANS

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

TOBRAMYCIN Eye oint 0.3% ...................................................................................10.45 Eye drops 0.3% ................................................................................11.48

3.5 g OP 5 ml OP

Tobrex Tobrex

Corticosteroids and Other Anti-Inflammatory Preparations

DEXAMETHASONE F Eye oint 0.1% .....................................................................................5.86 F Eye drops 0.1% ..................................................................................4.50 DEXAMETHASONE WITH NEOMYCIN AND POLYMYXIN B SULPHATE F Eye oint 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per g ............................................................. 5.39 F Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml ...................................................... 4.50 DICLOFENAC SODIUM F Eye drops 1 mg per ml .....................................................................13.80 FLUOROMETHOLONE F Eye drops 0.1% ..................................................................................3.80 LEVOCABASTINE Eye drops 0.5 mg per ml ....................................................................8.71 (10.34) LODOXAMIDE TROMETAMOL Eye drops 0.1% ..................................................................................8.71 PREDNISOLONE ACETATE F Eye drops 0.12% ................................................................................4.50 F Eye drops 1% .....................................................................................4.50 SODIUM CROMOGLYCATE Eye drops 2% .....................................................................................1.18 3.5 g OP 5 ml OP

Maxidex Maxidex

3.5 g OP 5 ml OP 5 ml OP 5 ml OP 4 ml OP

Maxitrol Maxitrol Voltaren Ophtha Flucon

Livostin 10 ml OP 5 ml OP 5 ml OP 5 ml OP

Lomide Pred Mild Pred Forte Rexacrom

Glaucoma Preparations - Beta Blockers

BETAXOLOL HYDROCHLORIDE F Eye drops 0.25% ..............................................................................11.80 F Eye drops 0.5% ..................................................................................7.50 LEVOBUNOLOL F Eye drops 0.25% ................................................................................7.00 F Eye drops 0.5% ..................................................................................7.00 TIMOLOL MALEATE F Eye drops 0.25% ................................................................................2.08 F Eye drops 0.25%, gel forming ............................................................3.30 F Eye drops 0.5% ..................................................................................2.08 F Eye drops 0.5%, gel forming ..............................................................3.78 5 ml OP 5 ml OP 5 ml OP 5 ml OP 5 ml OP 2.5 ml OP 5 ml OP 2.5 ml OP

Betoptic S Betoptic Betagan Betagan Arrow-Timolol Timoptol XE Arrow-Timolol Timoptol XE

Glaucoma Preparations - Carbonic Anhydrase Inhibitors

ACETAZOLAMIDE F Tab 250 mg – For acetazolamide oral liquid formulation refer, page 194 .................................................................................... 17.03 BRINZOLAMIDE F Eye Drops 1% .....................................................................................9.77

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

100 5 ml OP

Diamox Azopt 189

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


SENSORY ORGANS

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

DORZOLAMIDE HYDROCHLORIDE F Eye drops 2% .....................................................................................9.77 (13.95) DORZOLAMIDE HYDROCHLORIDE WITH TIMOLOL MALEATE F Eye drops 2% with timolol maleate 0.5% .........................................15.50

5 ml OP Trusopt 5 ml OP

Cosopt

Glaucoma Preparations - Prostaglandin Analogues

BIMATOPROST – Retail pharmacy-Specialist F Eye drops 0.03% ..............................................................................18.50 LATANOPROST – Retail pharmacy-Specialist F Eye drops 50 mcg per ml, 2.5 ml ........................................................1.99 TRAVOPROST – Retail pharmacy-Specialist F Eye drops 0.004% ............................................................................19.50 3 ml OP 2.5 ml OP 2.5 ml OP

Lumigan Hysite Travatan

Glaucoma Preparations - Other

BRIMONIDINE TARTRATE F Eye Drops 0.2% ..................................................................................6.45 BRIMONIDINE TARTRATE WITH TIMOLOL MALEATE F Eye drops 0.2% with timolol maleate 0.5% ......................................18.50 PILOCARPINE F Eye drops 1% .....................................................................................4.26 F Eye drops 2% .....................................................................................5.35 F Eye drops 4% .....................................................................................7.99 Subsidised for oral use pursuant to the Standard Formulae. F Eye drops 2% single dose – Special Authority see SA0895 below – Retail pharmacy ........................................................... 31.95 (32.72) 5 ml OP 5 ml OP 15 ml OP 15 ml OP 15 ml OP

Arrow-Brimonidine Combigan Isopto Carpine Isopto Carpine Isopto Carpine

20 dose Minims

¾SA0895 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Patient has to use an unpreserved solution due to an allergy to the preservative; or 2 Patient wears soft contact lenses. Note: Minims for a general practice are considered to be “tools of trade” and are not approved as special authority items. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

Mydriatics and Cycloplegics

ATROPINE SULPHATE F Eye drops 1% ...................................................................................17.36 CYCLOPENTOLATE HYDROCHLORIDE F Eye drops 1% .....................................................................................8.76 TROPICAMIDE F Eye drops 0.5% ..................................................................................7.15 F Eye drops 1% .....................................................................................8.66 15 ml OP 15 ml OP 15 ml OP 15 ml OP

Atropt Cyclogyl Mydriacyl Mydriacyl

190

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


SENSORY ORGANS

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

Preparations for Tear Deficiency

For acetylcysteine eye drops refer, page 197 HYPROMELLOSE F Eye drops 0.5% ..................................................................................2.00 (3.92) HYPROMELLOSE WITH DEXTRAN F Eye drops 0.3% with dextran 0.1% .....................................................2.30 POLYVINYL ALCOHOL F Eye drops 1.4% ..................................................................................2.68 F Eye drops 3% .....................................................................................3.75

15 ml OP Methopt 15 ml OP 15 ml OP 15 ml OP

Poly-Tears Vistil Vistil Forte

Preservative Free Ocular Lubricants

¾SA1388 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 12 months for applications 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. CARBOMER – Special Authority see SA1388 above – Retail pharmacy Ophthalmic gel 0.3%, 0.5 g ................................................................8.25 30 Poly-Gel MACROGOL 400 AND PROPYLENE GLYCOL – Special Authority see SA1388 above – Retail pharmacy Eye drops 0.4% and propylene glycol 0.3%, 0.4 ml ...........................4.30 24 Systane Unit Dose SODIUM HYALURONATE – Special Authority see SA1388 above – Retail pharmacy Eye drops 1 mg per ml .....................................................................22.00 10 ml OP Hylo-Fresh 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.

Other Eye Preparations

NAPHAZOLINE HYDROCHLORIDE F Eye drops 0.1% ..................................................................................4.15 OLOPATADINE Eye drops 0.1% ................................................................................17.00 PARAFFIN LIQUID WITH SOFT WHITE PARAFFIN F Eye oint with soft white paraffin .........................................................3.63 (Lacri-Lube Eye oint with soft white paraffin to be delisted 1 March 2014) PARAFFIN LIQUID WITH WOOL FAT LIQUID F Eye oint 3% with wool fat liq 3% .........................................................3.63 RETINOL PALMITATE Eye oint 138 mcg per g .......................................................................3.80 3.5 g OP 5 g OP 15 ml OP 5 ml OP 3.5 g OP

Naphcon Forte Patanol Lacri-Lube Refresh Night Time Poly-Visc VitA-POS

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

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

191


VARIOUS

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

Agents Used in the Treatment of Poisonings Antidotes

ACETYLCYSTEINE – Retail pharmacy-Specialist Inj 200 mg per ml, 10 ml .................................................................178.00 Inj 200 mg per ml, 30 ml .................................................................219.00 NALOXONE HYDROCHLORIDE a) Up to 5 inj available on a PSO b) Only on a PSO F Inj 400 mcg per ml, 1 ml ...................................................................33.00 10 4

Martindale

Acetylcysteine

Acetadote

5

Hospira

Removal and Elimination

CHARCOAL F Oral liq 50 g per 250 ml ....................................................................43.50 a) Up to 250 ml available on a PSO b) Only on a PSO DEFERIPRONE – Special Authority see SA1042 below – Retail pharmacy Tab 500 mg .....................................................................................533.17 Oral liq 100 mg per 1 ml .................................................................266.59 250 ml OP

Carbosorb-X

100 250 ml OP

Ferriprox Ferriprox

¾SA1042 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid without further renewal unless notified where the patient has been diagnosed with chronic transfusional iron overload due to congenital inherited anaemia. Note: For the purposes of this Special Authority, a relevant specialist is defined as a haematologist. DESFERRIOXAMINE MESYLATE F Inj 500 mg .........................................................................................99.00 10 Hospira SODIUM CALCIUM EDETATE F Inj 200 mg per ml, 5 ml .....................................................................53.31 (156.71) 6 Calcium Disodium Versenate

192

fully subsidised [HP4] refer page 7

Unapproved medicine supplied under Section 29 Sole Subsidised Supply


SECTION C: EXTEMPORANEOUSLY COMPOUNDED PRODUCTS AND GALENICALS

INTRODUCTION

The following extemporaneously compounded products are eligible for subsidy:

G G G G

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

Glossary

Dermatological base: The products listed in the Barrier creams and Emollients section and the Topical Corticosteroids-Plain section of the Pharmaceutical Schedule are classified as dermatological bases for the purposes of extemporaneous compounding and are the bases to which the dermatological galenicals can be added. Also the dermatological bases in the Barrier Creams and Emollients section of the Pharmaceutical Schedule can be used for diluting proprietary Topical Corticosteroid-Plain preparations. The following products are dermatological bases:

G G G G G G G G G G G

Aqueous cream Cetomacrogol cream BP Collodion flexible Emulsifying ointment BP Hydrocortisone with wool fat and mineral oil lotion Oil in water emulsion Urea cream 10% White soft paraffin Wool fat with mineral oil lotion Zinc and castor oil ointment BP Proprietary Topical Corticosteroid-Plain preparations

Dermatological galenical: Dermatological galenicals will only be subsidised when added to a dermatological base. More than one dermatological galenical can be added to a dermatological base. The following are dermatological galenicals:

G G G G G

Coal tar solution BP - up to 10% Hydrocortisone powder - up to 5% Menthol crystals Salicylic acid powder Sulphur precipitated powder

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

193


Explanatory notes

Oral liquid mixtures Oral liquid mixtures are subsidised for patients unable to swallow subsidised solid oral dose forms where no suitable alternative proprietary formulation is subsidised. Suitable alternatives include dispersible and sublingual formulations, oral liquid formulations or rectal formulations. Before extemporaneously compounding an oral liquid mixture, other alternatives such as dispersing the solid dose form (if appropriate) or crushing the solid dose form in jam, honey or soft foods such as yoghurt should be explored. The Emixt website www.pharminfotech.co.nz has evidence-based formulations which are intended to standardise compounded oral liquids within New Zealand. Pharmaceuticals with standardised formula for compounding in Ora products Acetazolamide 25 mg/ml Allopurinol 20 mg/ml Amlodipine 1 mg/ml Azathioprine 50 mg/ml Baclofen 10 mg/ml Carvedilol 1 mg/ml Clopidogrel 5 mg/ml Diazoxide 10 mg/ml Diltiazem hydrochloride 12 mg/ml Dipyridamole 10 mg/ml Domperidone 1 mg/ml Enalapril 1 mg/ml *Note this is a DCS formulation PHARMAC endorses the recommendations of the Emixt website and encourages New Zealand pharmacists to use these formulations when compounding is appropriate. The Emixt website also provides stability and expiry data for compounded products. For the majority of products compounded with Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet or Ora-Sweet SF a four week expiry is appropriate. Please note that no oral liquid mixture will be eligible for Subsidy unless all the requirements of Section B and C of the Schedule applicable to that pharmaceutical are met. Some community pharmacies may not have appropriate equipment to compound all of the listed products, please use appropriate clinical judgement. Subsidy for extemporaneously compounded oral liquid mixtures is based on: qs Solid dose form qs Preservative Suspending agent qs Water to 100% or qs Solid dose form Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet and/or Ora-Sweet SF to 100% Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients such as flavouring and colouring agents, but these extra ingredients will not be reimbursed. The subsidised ingredients in the formula will be reimbursed and a compounding fee paid. The majority of extemporaneously compounded oral liquid mixtures should contain a preservative and suspending agent. G Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet and Ora-Sweet SF when used correctly are an appropriate preservative and suspending agent. G Methylcellulose 3% is considered a suitable suspending agent and compound hydroxybenzoate solution or methyl hydroxybenzoate 10% solution are considered to be suitable preservatives. Usually 1 ml of these preservative solutions is added to 100 ml of oral liquid mixture. Some solid oral dose forms are not appropriate for compounding into oral liquid mixtures and should therefore not be used/considered for extemporaneously compounded oral liquid mixtures. This includes long-acting solid dose formulations, enteric coated tablets or capsules, sugar coated tablets, hard gelatin capsules and chemotherapeutic agents. Flecainide 20 mg/ml Gabapentin 100 mg/ml Gabapentin (Neurontin) 100 mg/ml Hydrocortisone 1 mg/ml Labetolol 10 mg/ml Levetiracetam 100 mg/ml Levodopa with carbidopa (5 mg levodopa + 1.25 mg carbidopa)/ml Metoclopramide 1 mg/ml Metoprolol tartrate 10 mg/ml Nitrofurantoin 10 mg/ml Pyrazinamide 100 mg/ml Rifabutin 20 mg/ml Sildenafil 2 mg/ml Sotalol 5 mg/ml Sulphasalazine 100 mg/ml Tacrolimus 1 mg/ml Terbinafine 25 mg/ml Ursodeoxycholic acid 50 mg/ml Valganciclovir 60 mg/ml* Verapamil hydrochloride 50 mg/ml

194


EXTEMPORANEOUSLY COMPOUNDED PRODUCTS AND GALENICALS

The following practices will not be subsidised: G Where a Standard Formula exists in the Pharmaceutical Schedule for a solid dose form, compounding the solid dose form in Ora-Blend, Ora-Blend SF, Ora-Plus, Ora-Sweet and/or Ora-Sweet SF. G Mixing one or more proprietary oral liquids (eg an antihistamine with pholcodine linctus). G Extemporaneously compounding an oral liquid with more than one solid dose chemical. G Mixing more than one extemporaneously compounded oral liquid mixture. G Mixing one or more extemporaneously compounded oral liquid mixtures with one or more proprietary oral liquids. G The addition of a chemical/powder/agent/solution to a proprietary oral liquid or extemporaneously compounded oral mixture. Standard formulae A list of standard formulae is contained in this section. All ingredients associated with a standard formula will be subsidised and an appropriate compounding fee paid. Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients, but these extra ingredients will not be reimbursed. The subsidised ingredients in the formula will be reimbursed and a compounding fee paid. Dermatological Preparations Proprietary topical corticosteroid preparations may be diluted with a dermatological base (see page 193) from the Barrier Creams and Emollients section of the Pharmaceutical Schedule (Retail pharmacy-Specialist). Dilution of proprietary topical corticosteroid preparations should only be prescribed for withdrawing patients off higher strength proprietary topical corticosteroid products where there is no suitable proprietary product of a lower strength available or an extemporaneously compounded product with up to 5% hydrocortisone is not appropriate. (In general proprietary topical corticosteroid preparations should not be diluted because dilution effects can be unpredictable and may not be linear, and usually there is no stability data available for diluted products). One or more dermatological galenicals may be added to a dermatological base (including proprietary topical corticosteroid preparations). Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients, but these extra ingredients will not be reimbursed. The subsidised ingredients in the formula will be reimbursed and a compounding fee paid. The addition of dermatological galenicals to diluted proprietary Topical Corticosteroids-Plain will not be subsidised. The flow diagram on the next page may assist you in deciding whether or not a dermatological ECP is subsidised.

195


EXTEMPORANEOUSLY COMPOUNDED PRODUCTS AND GALENICALS

196


EXTEMPORANEOUSLY COMPOUNDED PRODUCTS AND GALENICALS

Standard Formulae

ACETYLCYSTEINE EYE DROPS Acetylcysteine inj 200 mg per ml, 10 ml qs Suitable eye drop base qs ASPIRIN AND CHLOROFORM APPLICATION Aspirin Soluble tabs 300 mg 12 tabs Chloroform to 100 ml CODEINE LINCTUS PAEDIATRIC (3 mg per 5 ml) Codeine phosphate 60 mg Glycerol 40 ml Preservative qs Water to 100 ml CODEINE LINCTUS DIABETIC (15 mg per 5 ml) Codeine phosphate 300 mg Glycerol 40 ml Preservative qs Water to 100 ml FOLINIC MOUTHWASH Calcium folinate 15 mg tab 1 tab Preservative qs Water to 500 ml (Preservative should be used if quantity supplied is for more than 5 days. Maximum 500 ml per prescription.) MAGNESIUM HYDROXIDE MIXTURE Magnesium hydroxide paste Methyl hydroxybenzoate Water METHADONE MIXTURE Methadone powder Glycerol Water 275 g 1.5 g 770 ml qs qs to 100 ml

OMEPRAZOLE SUSPENSION Omeprazole capules or powder Sodium bicarbonate powder BP Water PHENOBARBITONE ORAL LIQUID Phenobarbitone Sodium Glycerol BP Water

qs 8.4 g to 100 ml 1g 70 ml to 100 ml

PHENOBARBITONE SODIUM PAEDIATRIC ORAL LIQUID (10 mg per ml) Phenobarbitone Sodium 400 mg Glycerol BP 4 ml Water to 40 ml PILOCARPINE ORAL LIQUID Pilocarpine 4% eye drops qs Preservative qs Water to 500 ml (Preservative should be used if quantity supplied is for more than 5 days.) SALIVA SUBSTITUTE FORMULA Methylcellulose 5g Preservative qs Water to 500 ml (Preservative should be used if quantity supplied is for more than 5 days. Maximum 500 ml per prescription.) SODIUM CHLORIDE ORAL LIQUID Sodium chloride inj 23.4%, 20 ml qs Water qs (Only funded if prescribed for treatment of hyponatraemia) VOSOL EAR DROPS WITH HYDROCORTISONE POWDER 1% Hydrocortisone powder 1% Vosol Ear Drops to 35 ml

METHYL HYDROXYBENZOATE 10% SOLUTION Methyl hydroxybenzoate 10 g Propylene glycol to 100 ml (Use 1 ml of the 10% solution per 100 ml of oral liquid mixture)

197


EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS

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

Extemporaneously Compounded Preparations and Galenicals

BENZOIN Tincture compound BP .......................................................................2.44 (5.10) 24.42 (38.00) CHLOROFORM – Only in combination Only in aspirin and chloroform application. Chloroform BP ..................................................................................25.50 50 ml PSM 500 ml PSM

500 ml

PSM

CODEINE PHOSPHATE – Safety medicine; prescriber may determine dispensing frequency Powder – Only in combination .........................................................12.62 5g (25.46) Douglas 63.09 25 g (90.09) Douglas a) Only in extemporaneously compounded codeine linctus diabetic or codeine linctus paediatric. b) ‡ Safety cap for extemporaneously compounded oral liquid preparations. COLLODION FLEXIBLE Collodion flexible ..............................................................................19.30 100 ml PSM COMPOUND HYDROXYBENZOATE – Only in combination Only in extemporaneously compounded oral mixtures. Soln ..................................................................................................34.18 GLYCERIN WITH SODIUM SACCHARIN – Only in combination Only in combination with Ora-Plus. Suspension .......................................................................................35.50 GLYCERIN WITH SUCROSE – Only in combination Only in combination with Ora-Plus. Suspension .......................................................................................35.50 GLYCEROL F Liquid – Only in combination ...........................................................17.86 Only in extemporaneously compounded oral liquid preparations. MAGNESIUM HYDROXIDE Paste ................................................................................................22.61

100 ml

David Craig Ora-Sweet SF Ora-Sweet healthE PSM

473 ml

473 ml 2,000 ml

500 g

METHADONE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable c) Safety medicine; prescriber may determine dispensing frequency d) Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). Powder ................................................................................................7.84 1g AFT ‡ Safety cap for extemporaneously compounded oral liquid preparations. METHYL HYDROXYBENZOATE Powder ................................................................................................8.00 25 g PSM 8.98 Midwest METHYLCELLULOSE Powder ..............................................................................................36.95 Suspension – Only in combination ..................................................35.50 100 g 473 ml

MidWest Ora-Plus

198

fully subsidised

[HP3], [HP4] refer page 7


EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS

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

METHYLCELLULOSE WITH GLYCERIN AND SODIUM SACCHARIN – Only in combination Suspension .......................................................................................35.50 473 ml METHYLCELLULOSE WITH GLYCERIN AND SUCROSE – Only in combination Suspension .......................................................................................35.50 473 ml

Ora-Blend SF Ora-Blend MidWest MidWest

PHENOBARBITONE SODIUM Powder – Only in combination .........................................................52.50 10 g 325.00 100 g a) Only in children up to 12 years b) ‡ Safety cap for extemporaneously compounded oral liquid preparations. PROPYLENE GLYCOL Only in extemporaneously compounded methyl hydroxybenzoate 10% solution. Liq .....................................................................................................10.50 500 ml 11.25 SODIUM BICARBONATE Powder BP – Only in combination .....................................................8.95 500 g 9.80 (29.50) Only in extemporaneously compounded omeprazole and lansoprazole suspension. SYRUP (PHARMACEUTICAL GRADE) – Only in combination Only in extemporaneously compounded oral liquid preparations. Liq .....................................................................................................21.75 2,000 ml WATER Tap – Only in combination .................................................................0.00 1 ml

PSM Midwest Midwest

David Craig

Midwest Tap water

fully subsidised

[HP3], [HP4] refer page 7

199


SECTION D: SPECIAL FOODS

EXPLANATORY NOTES

The list of special foods to which Subsidies apply is contained in this section. The list of available products, guidelines for use, subsidies and charges is reviewed as required. Applications for new listings and changes to subsidies and access criteria will be considered by the special foods sub-committee of PTAC which meets as and when required. In all cases, subsidies are available by Special Authority only. This means that, unless a patient has a valid Special Authority number for their special food requirements, they must pay the full cost of the products themselves. Eligibility for Special Authority Special Authorities will be approved for patients meeting conditions specified under the Conditions and Guidelines for each product. In some cases there are also limits to how products can be prescribed (for example quantity, use or duration). Only those brands, presentations and flavours of special foods listed in this section are subsidised. Who can apply for Special Authority? Only from a dietitian, relevant specialist or a vocationally registered general practitioner. Reapplications: Only from a dietitian, relevant specialist or a vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or a vocationally registered general practitioner. Other general practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and the date contacted. All applications must be made on an official form available from the PHARMAC website www.pharmac.govt.nz. All applications must include specific details as requested on the form relating to the application. Applications must be forwarded to: Ministry of Health Sector Services Private Bag 3015 WHANGANUI 4540 Freefax 0800 100 131 Subsidies and manufacturer’s surcharges The Subsidies for some special foods are based on the lowest priced product within each group. Where this is so, or where special foods are otherwise not fully subsidised, a manufacturer’s surcharge may be payable by the patient. The manufacturer’s surcharge is the difference between the price of the product and the subsidy attached to it and may be subject to mark-ups applied at a pharmacy level. As a result the manufacturer’s surcharge may vary. Fully subsidised alternatives are available in most cases (as indicated by a tick in the left hand column). Patients should only have to pay a co-payment on these products. Where are special foods available from? Distribution arrangements for special foods vary from region to region. Special foods are available from hospital pharmacies providing an outpatient dispensing service as well as retail pharmacies in the Northern, Midland and Central (including Nelson and Blenheim) regions. Definitions Failure to thrive Growth deficiency An inability to gain or maintain weight resulting in physiological impairment. Where the weight of the child is less than the fifth or possibly third percentile for their age, with evidence of malnutrition Initial Applications:

200


SPECIAL FOODS

Dietitian Prescribing Prescriptions from Dietitians will be only valid for subsidy where they are for special foods, as listed in this section, or where they are for the following products: ASCORBIC ACID Tab 100 mg CALCIUM CARBONATE Tab eff 1.75 g (1 g elemental) Tab 1.25 g (500 mg elemental) COMPOUND ELECTROLYTES Powder for oral soln DEXTROSE WITH ELECTROLYTES Soln with electrolytes FERROUS FUMARATE Tab 200 mg (65 mg elemental) FERROUS FUMARATE WITH FOLIC ACID Tab 310 mg (100 mg elemental) with folic acid 350 mcg FERROUS SULPHATE Tab long-acting 325 mg (105 mg elemental) Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml) FERROUS SULPHATE WITH FOLIC ACID Tab long-acting 325 mg (105 mg elemental) with folic acid 350 mcg FOLIC ACID Tab 0.8 mg MULTIVITAMINS Powder PANCREATIC ENZYME Cap EC 10,000 BP u lipase, 9,000 BP u amylase and 210 BP u protease POTASSIUM BICARBONATE Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg POTASSIUM CHLORIDE Tab eff 548 mg (14 m eq) with chloride 285 mg (8 m eq) Tab long-acting 600 mg POTASSIUM IODATE Tab 256 mcg (150 mcg elemental iodine) PYRIDOXINE HYDROCHLORIDE Tab 25 mg Tab 50 mg SODIUM CHLORIDE Inj 23.4%, 20 ml SODIUM FLUORIDE Tab 1.1 mg (0.5 mg elemental) THIAMINE HYDROCHLORIDE Tab 50 mg VITAMIN A WITH VITAMINS D AND C Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops VITAMIN B COMPLEX Tab, strong, BPC VITAMINS Tab (BPC cap strength) Cap (fat soluble vitamins A, D, E, K)

201


SPECIAL FOODS

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

Nutrient Modules Carbohydrate

¾SA1373 Special Authority for Subsidy Initial application — (Cystic fibrosis or kidney disease) 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. 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 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. Renewal — (Cystic fibrosis or renal failure) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian,relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. Renewal — (Indications other than cystic fibrosis or renal failure) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. CARBOHYDRATE SUPPLEMENT – Special Authority see SA1373 above – Hospital pharmacy [HP3] Powder ................................................................................................5.29 400 g OP Polycal 1.30 368 g OP (12.00) Moducal (Moducal Powder to be delisted 1 June 2014)

Carbohydrate And Fat

¾SA1376 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: continued. . .

202

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

continued. . . 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 2.3 bronchopulmonary dysplasia; or 2.4 premature and post premature infants. Renewal — (Cystic fibrosis) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. Renewal — (Indications other than cystic fibrosis) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. CARBOHYDRATE AND FAT SUPPLEMENT – Special Authority see SA1376 on the previous page – Hospital pharmacy [HP3] Powder (neutral) ...............................................................................60.31 400 g OP Duocal Super Soluble Powder

Fat

¾SA1374 Special Authority for Subsidy Initial application — (Inborn errors of metabolism) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years where the patient has inborn errors of metabolism. Initial application — (Indications other than inborn errors of metabolism) only from a 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 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. Renewal — (Inborn errors of metabolism) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. continued. . .

fully subsidised

[HP3], [HP4] refer page 7

203


SPECIAL FOODS

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

continued. . . Renewal — (Indications other than inborn errors of metabolism) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. FAT SUPPLEMENT – Special Authority see SA1374 on the previous page – Hospital pharmacy [HP3] Emulsion (neutral) ............................................................................12.30 200 ml OP Calogen 30.75 500 ml OP Calogen Emulsion (strawberry) .......................................................................12.30 200 ml OP Calogen Oil .....................................................................................................30.00 500 ml OP MCT oil (Nutricia) Oil, 250 ml ......................................................................................114.92 4 OP Liquigen

Protein

¾SA1375 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 protein losing enteropathy; or 2 high protein needs; or 3 for use as a component in a modular formula. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. PROTEIN SUPPLEMENT – Special Authority see SA1375 above – Hospital pharmacy [HP3] Powder ................................................................................................7.90 225 g OP Protifar 8.95 227 g OP Resource Beneprotein Powder (vanilla) ................................................................................12.90 275 g OP Promod

Oral Supplements/Complete Diet (Nasogastric/Gastrostomy Tube Feed) Respiratory Products

¾SA1094 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. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. CORD ORAL FEED 1.5KCAL/ML – Special Authority see SA1094 above – Hospital pharmacy [HP3] Liquid ..................................................................................................1.66 237 ml OP Pulmocare

204

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

Diabetic Products

¾SA1095 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 is a type I or and II diabetic who is suffering weight loss and malnutrition that requires nutritional support. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. DIABETIC ENTERAL FEED 1KCAL/ML – Special Authority see SA1095 above – Hospital pharmacy [HP3] Liquid ..................................................................................................7.50 1,000 ml OP Diason RTH Glucerna Select RTH DIABETIC ORAL FEED 1KCAL/ML – Special Authority see SA1095 above – Hospital pharmacy [HP3] Liquid (strawberry) ..............................................................................1.50 200 ml OP Diasip Liquid (vanilla) ....................................................................................1.50 200 ml OP Diasip 1.88 250 ml OP Glucerna Select 1.78 237 ml OP (2.10) Resource Diabetic

Fat Modified Products

¾SA1381 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 Patient has metabolic disorders of fat metabolism; or 2 Patient has a chyle leak; or 3 Modified as a modular feed for adults. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. FAT MODIFIED FEED – Special Authority see SA1381 above – Hospital pharmacy [HP3] Powder ..............................................................................................60.48 400 g OP Monogen

High Protein Products

¾SA1378 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: 1 decompensating liver disease without encephalopathy; or 2 protein losing gastro-enteropathy. continued. . .

fully subsidised

[HP3], [HP4] refer page 7

205


SPECIAL FOODS

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

continued. . . Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. HIGH PROTEIN ORAL FEED 1KCAL/ML – Special Authority see SA1378 on the previous page – Hospital pharmacy [HP3] Liquid ..................................................................................................1.90 200 ml OP Fortimel Regular

Paediatric Products For Children Awaiting Liver Transplant

¾SA1098 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) who requires a liver transplant. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. ENTERAL/ORAL FEED 1KCAL/ML – Special Authority see SA1098 above – Hospital pharmacy [HP3] Powder (unflavoured) .......................................................................78.97 400 g OP Heparon Junior

Paediatric Products For Children With Chronic Renal Failure

¾SA1099 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. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. ENTERAL/ORAL FEED 1KCAL/ML – Special Authority see SA1099 above – Hospital pharmacy [HP3] Liquid ................................................................................................54.00 400 g OP Kindergen

Paediatric Products

¾SA1379 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 continued. . .

206

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

continued. . . 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. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. PAEDIATRIC ENTERAL FEED 1KCAL/ML – Special Authority see SA1379 on the previous page – Hospital pharmacy [HP3] Liquid ..................................................................................................2.68 500 ml OP Nutrini RTH Pediasure RTH PAEDIATRIC ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA1379 on the previous page – Hospital pharmacy [HP3] Liquid ..................................................................................................6.00 500 ml OP Nutrini Energy Multi Fibre Nutrini Energy RTH PAEDIATRIC ORAL FEED – Special Authority see SA1379 on the previous page – Hospital pharmacy [HP3] Powder (vanilla) ................................................................................20.00 900 g OP Pediasure PAEDIATRIC ORAL FEED 1.5KCAL/ML – Special Authority see SA1379 on the previous page – Hospital pharmacy [HP3] Liquid (strawberry) ..............................................................................1.60 200 ml OP Fortini Liquid (vanilla) ....................................................................................1.60 200 ml OP Fortini PAEDIATRIC ORAL FEED 1KCAL/ML – Special Authority see SA1379 on the previous page – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.07 200 ml OP Pediasure Liquid (strawberry) ..............................................................................1.07 200 ml OP Pediasure Liquid (vanilla) ....................................................................................1.07 200 ml OP Pediasure 1.34 250 ml OP Pediasure PAEDIATRIC ORAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA1379 on the previous page – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.60 200 ml OP Fortini Multi Fibre Liquid (strawberry) ..............................................................................1.60 200 ml OP Fortini Multi Fibre Liquid (vanilla) ....................................................................................1.60 200 ml OP Fortini Multi Fibre

Renal Products

¾SA1101 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 kidney disease. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. RENAL ENTERAL FEED 2 KCAL/ML – Special Authority see SA1101 above – Hospital pharmacy [HP3] Liquid ..................................................................................................6.08 500 ml OP Nepro RTH

fully subsidised

[HP3], [HP4] refer page 7

207


SPECIAL FOODS

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

RENAL ORAL FEED 2KCAL/ML – Special Authority see SA1101 on the previous page – Hospital pharmacy [HP3] Liquid ..................................................................................................2.43 200 ml OP Nepro (strawberry) Nepro (vanilla) 3.80 237 ml OP Suplena 2.88 (3.31) NovaSource Renal Liquid (apricot) ....................................................................................2.88 125 ml OP Renilon 7.5 Liquid (caramel) ..................................................................................2.88 125 ml OP Renilon 7.5 Liquid (apricot) 125 ml ......................................................................11.52 4 OP Renilon 7.5 Liquid (caramel) 125 ml ....................................................................11.52 4 OP Renilon 7.5

Specialised And Elemental Products

¾SA1377 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 4 eosinophilic oesophagitis; or 5 inflammatory bowel disease; or 6 patients with multiple food allergies requiring enteral feeding. Notes: Each of these products is highly specialised and would be prescribed only by an expert for a specific disorder. The alternative is hospitalisation. Elemental 028 Extra is more expensive than other products listed in this section and should only be used where the alternatives have been tried first and/or are unsuitable. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. ENTERAL/ORAL ELEMENTAL FEED 1KCAL/ML – Special Authority see SA1377 above – Hospital pharmacy [HP3] Powder ................................................................................................4.40 79 g OP Vital HN 7.50 76 g OP Alitraq ORAL ELEMENTAL FEED 0.8KCAL/ML – Special Authority see SA1377 above – Hospital pharmacy [HP3] Liquid (grapefruit) ...............................................................................9.50 250 ml OP Elemental 028 Extra Liquid (pineapple & orange) ...............................................................9.50 250 ml OP Elemental 028 Extra Liquid (summer fruit) ..........................................................................9.50 250 ml OP Elemental 028 Extra ORAL ELEMENTAL FEED 1KCAL/ML – Special Authority see SA1377 above – Hospital pharmacy [HP3] Powder (unflavoured) .........................................................................4.50 80.4 g OP Vivonex TEN SEMI-ELEMENTAL ENTERAL FEED 1KCAL/ML – Special Authority see SA1377 above – Hospital pharmacy [HP3] Liquid ................................................................................................12.04 1,000 ml OP Peptisorb

208

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

Paediatric Products For Children With Low Energy Requirements

¾SA1196 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 aged one to eight years; and 2 The child has a low energy requirement but normal protein and micronutrient requirements. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. PAEDIATRIC ENTERAL FEED WITH FIBRE 0.76 KCAL/ML – Special Authority see SA1196 above – Hospital pharmacy [HP3] Liquid ..................................................................................................4.00 500 ml OP Nutrini Low Energy Multi Fibre

Standard Supplements

¾SA1228 Special Authority for Subsidy Initial application — (Children) 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 The patient is under 18 years of age; and 2 Any of the following: 2.1 The patient has a condition causing malabsorption; or 2.2 The patient has failure to thrive; or 2.3 The patient has increased nutritional requirements; and 3 Nutrition goal has been set (eg reach a specific weight or BMI). Renewal — (Children) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of 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 The patient is under 18 years of age; and 2 The treatment remains appropriate and the patient is benefiting from treatment; and 3 A nutrition goal has been set (eg reach a specific weight or BMI). Initial application — (Adults) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Any of the following: Patient is Malnourished 1.1 Patient has a body mass index (BMI) of less than 18.5 kg/m2; or 1.2 Patient has unintentional weight loss greater than 10% within the last 3-6 months; or 1.3 Patient has a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3-6 months; and 2 Any of the following: Patient has not responded to first-line dietary measures over a 4 week period by: 2.1 Increasing their food intake frequency (eg snacks between meals); or 2.2 Using high-energy foods (e.g. milkshakes, full fat milk, butter, cream, cheese, sugar etc); or 2.3 Using over the counter supplements (e.g. Complan); and continued. . .

fully subsidised

[HP3], [HP4] refer page 7

209


SPECIAL FOODS

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

continued. . . 3 A nutrition goal has been set (e.g. to reach a specific weight or BMI). Renewal — (Adults) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 A nutrition goal has been set (eg reach a specific weight or BMI); and 2 Any of the following: Patient is Malnourished 2.1 Patient has a body mass index (BMI) of less than 18.5 kg/m2; or 2.2 Patient has unintentional weight loss greater than 10% within the last 3-6 months; or 2.3 Patient has a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3-6 months. Initial application — (Adults transitioning from hospital Discretionary Community Supply) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient has had up to a 30 day supply of a 1.0 or a 1.5 kcal/ml Standard Oral Supplement; and 2 A nutrition goal has been set (eg reach a specific weight or BMI); and 3 Any of the following: Patient is Malnourished 3.1 Patient has a body mass index (BMI) of less than 18.5 kg/m2; or 3.2 Patient has unintentional weight loss greater than 10% within the last 3-6 months; or 3.3 Patient has a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3-6 months. Initial application — (Short-term medical condition) 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 Is being feed via a nasogastric tube or a nasogastric tube is to be inserted for feeding; or 2 Malignancy and is considered likely to develop malnutrition as a result; or 3 Is undergoing a bone marrow transplant; or 4 Tempomandibular surgery; or 5 Both: 5.1 Pregnant; and 5.2 Any of the following: 5.2.1 Patient is in early pregnancy (<13 weeks) and has severe clinical hyperemesis gravidarum requiring admission to hospital and is unlikely to meet her nutritional requirements due to continuing hyperemesis gravidarum; or 5.2.2 Patient has clinical hyperemesis gravidarum continuing past 13 weeks and either there is concern that the patient is unlikely to meet the Institute of Medicine’s (1990) recommended weight gain guidelines for pregnancy or the patient’s weight has not increased past her booking/pre-pregnancy weight; or 5.2.3 Patient is having multiple births and is under the care of an obstetric team who consider the nutritional needs of the patient are not being meet. Renewal — (Short-term medical condition) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of 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 Is being fed via a nasogastric tube; or 2 Malignancy and is considered likely to develop malnutrition as a result; or 3 Has undergone a bone marrow transplant; or 4 Tempomandibular surgery; or 5 Both: 5.1 Pregnant; and continued. . .

210

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

continued. . . 5.2 Any of the following: 5.2.1 Patient is in early pregnancy (<13 weeks) and has severe clinical hyperemesis gravidarum requiring admission to hospital and is unlikely to meet her nutritional requirements due to continuing hyperemesis gravidarum; or 5.2.2 Patient has clinical hyperemesis gravidarum continuing past 13 weeks and either there is concern that the patient is unlikely to meet the Institute of Medicine’s (1990) recommended weight gain guidelines for pregnancy or the patient’s weight has not increased past her booking/pre-pregnancy weight; or 5.2.3 Patient is having multiple births and is under the care of an obstetric team who consider the nutritional needs of the patient are not being meet. Initial application — (Long-term medical condition) only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 Is being fed via a tube or a tube is to be inserted for the purpose of feeding (not nasogastric tube - refer to specific medical condition criteria); or 2 Cystic Fibrosis; or 3 Liver disease; or 4 Chronic Renal failure; or 5 Inflammatory bowel disease; or 6 Chronic obstructive pulmonary disease with hypercapnia; or 7 Short bowel syndrome; or 8 Bowel fistula; or 9 Severe chronic neurological conditions; or 10 Epidermolysis bullosa; or 11 AIDS (CD4 count < 200 cells/mm3 ); or 12 Chronic pancreatitis. Renewal — (Chronic disease OR tube feeding for patients who have previously been funded under Special Authority forms SA0702 or SA0583) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 Is being fed via a tube or a tube is to be inserted for the purpose of feeding (not nasogastric tube - refer to specific medical condition criteria); or 2 Cystic Fibrosis; or 3 Liver disease; or 4 Chronic Renal failure; or 5 Inflammatory bowel disease; or 6 Chronic obstructive pulmonary disease with hypercapnia; or 7 Short bowel syndrome; or 8 Bowel fistula; or 9 Severe chronic neurological conditions. ENTERAL FEED 1.5KCAL/ML – Special Authority see SA1228 on page 209 – Hospital pharmacy [HP3] Liquid ..................................................................................................7.00 1,000 ml Nutrison Energy ENTERAL FEED 1KCAL/ML – Special Authority see SA1228 on page 209 – Hospital pharmacy [HP3] Liquid ..................................................................................................1.24 250 ml OP Isosource Standard Osmolite 5.29 1,000 ml OP Isosource Standard RTH Nutrison Standard RTH 2.65 500 ml OP Osmolite RTH 5.29 1,000 ml OP Osmolite RTH

fully subsidised [HP3], [HP4] refer page 7

211


SPECIAL FOODS

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

ENTERAL FEED WITH FIBRE 1 KCAL/ML – Special Authority see SA1228 on page 209 – Hospital pharmacy [HP3] Liquid ..................................................................................................1.32 237 ml OP Jevity 2.65 500 ml OP Jevity RTH 5.29 1,000 ml OP Jevity RTH Nutrison Multi Fibre ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA1228 on page 209 – Hospital pharmacy [HP3] Liquid ..................................................................................................1.75 250 ml OP Ensure Plus HN 7.00 1,000 ml OP Ensure Plus RTH Jevity HiCal RTH Nutrison Energy Multi Fibre ORAL FEED (POWDER) – Special Authority see SA1228 on page 209 – Hospital pharmacy [HP3] Powder (chocolate) ...........................................................................10.22 900 g OP Sustagen Hospital Formula 13.00 Ensure Powder (vanilla) ..................................................................................9.50 900 g OP Fortisip 10.22 Sustagen Hospital Formula 13.00 850 g OP Ensure

212

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

ORAL FEED 1.5KCAL/ML – Special Authority see SA1228 on page 209 – Hospital pharmacy [HP3] Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube, or who have severe epidermolysis bullosa. The prescription must be endorsed accordingly. Liquid (banana) – Higher subsidy of $1.26 per 200 ml with Endorsement ................................................................................ 0.72 200 ml OP (1.26) Ensure Plus (1.26) Fortisip Liquid (chocolate) – Higher subsidy of up to $1.33 per 237 ml with Endorsement......................................................................... 0.72 200 ml OP (1.26) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus 0.72 200 ml OP (1.26) Fortisip Liquid (fruit of the forest) – Higher subsidy of $1.26 per 200 ml with Endorsement......................................................................... 0.72 200 ml OP (1.26) Ensure Plus Liquid (strawberry) – Higher subsidy of up to $1.33 per 237 ml with Endorsement............................................................. 0.72 200 ml OP (1.26) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus 0.72 200 ml OP (1.26) Fortisip Liquid (toffee) – Higher subsidy of $1.26 per 200 ml with Endorsement..................................................................................... 0.72 200 ml OP (1.26) Fortisip Liquid (tropical fruit) – Higher subsidy of $1.26 per 200 ml with Endorsement......................................................................... 0.72 200 ml OP (1.26) Fortisip Liquid (vanilla) – Higher subsidy of up to $1.33 per 237 ml with Endorsement......................................................................... 0.72 200 ml OP (1.26) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus 0.72 200 ml OP (1.26) Fortisip ORAL FEED WITH FIBRE 1.5 KCAL/ML – Special Authority see SA1228 on page 209 – Hospital pharmacy [HP3] Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube, or who have severe epidermolysis bullosa. The prescription must be endorsed accordingly. Liquid (chocolate) – Higher subsidy of $1.26 per 200 ml with Endorsement ................................................................................ 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (strawberry) – Higher subsidy of $1.26 per 200 ml with Endorsement ................................................................................ 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (vanilla) – Higher subsidy of $1.26 per 200 ml with Endorsement ................................................................................ 0.72 200 ml OP (1.26) Fortisip Multi Fibre

fully subsidised

[HP3], [HP4] refer page 7

213


SPECIAL FOODS

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

High Calorie Products

¾SA1195 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: All of the following: 1 Cystic fibrosis; and 2 other lower calorie products have been tried; and 3 patient has substantially increased metabolic requirements. 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 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. Renewal — (Cystic fibrosis) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. Renewal — (Indications other than cystic fibrosis) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. ENTERAL FEED 2 KCAL/ML – Special Authority see SA1195 above – Hospital pharmacy [HP3] Liquid ..................................................................................................5.50 500 ml OP Nutrison Concentrated 11.00 1,000 ml OP Two Cal HN RTH ORAL FEED 2 KCAL/ML – Special Authority see SA1195 above – Hospital pharmacy [HP3] Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube, or who have severe epidermolysis bullosa. The prescription must be endorsed accordingly. Liquid (vanilla) – Higher subsidy of $1.90 per 200 ml with Endorsement ................................................................................ 0.96 200 ml OP (1.90) Two Cal HN

214

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

Food Thickeners

¾SA1106 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 motor neurone disease with swallowing disorder. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. FOOD THICKENER – Special Authority see SA1106 above – Hospital pharmacy [HP3] Powder ................................................................................................7.25 380 g OP Feed Thickener Karicare Aptamil

Gluten Free Foods

The funding of gluten free foods is no longer being actively managed by PHARMAC from 1 April 2011. This means that we are no longer considering the listing of new products, or making subsidy, or other changes to the existing listings. As a result we anticipate that the range of funded items will reduce over time. Management of Coeliac disease with a gluten free diet is necessary for good outcomes. A range of gluten free options are available through retail outlets. ¾SA1107 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 Gluten enteropathy has been diagnosed by biopsy; or 2 Patient suffers from dermatitis herpetiformis. GLUTEN FREE BAKING MIX – Special Authority see SA1107 above – Hospital pharmacy [HP3] Powder ................................................................................................2.81 1,000 g OP (5.15) Healtheries Simple Baking Mix GLUTEN FREE BREAD MIX – Special Authority see SA1107 above – Hospital pharmacy [HP3] Powder ................................................................................................3.93 1,000 g OP (7.32) 4.77 (8.71) 3.51 (10.87) GLUTEN FREE FLOUR – Special Authority see SA1107 above – Hospital pharmacy [HP3] Powder ................................................................................................5.62 2,000 g OP (18.10)

NZB Low Gluten Bread Mix Bakels Gluten Free Health Bread Mix Horleys Bread Mix

Horleys Flour

fully subsidised

[HP3], [HP4] refer page 7

215


SPECIAL FOODS

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

GLUTEN FREE PASTA – Special Authority see SA1107 on the previous page – Hospital pharmacy [HP3] Buckwheat Spirals ..............................................................................2.00 250 g OP (3.11) Orgran Corn and Vegetable Shells .................................................................2.00 250 g OP (2.92) Orgran Corn and Vegetable Spirals ................................................................2.00 250 g OP (2.92) Orgran Rice and Corn Lasagne Sheets .........................................................1.60 200 g OP (3.82) Orgran Rice and Corn Macaroni .....................................................................2.00 250 g OP (2.92) Orgran Rice and Corn Penne .........................................................................2.00 250 g OP (2.92) Orgran Rice and Maize Pasta Spirals .............................................................2.00 250 g OP (2.92) Orgran Rice and Millet Spirals ........................................................................2.00 250 g OP (3.11) Orgran Rice and corn spaghetti noodles ........................................................2.00 375 g OP (2.92) Orgran Vegetable and Rice Spirals ................................................................2.00 250 g OP (2.92) Orgran Italian long style spaghetti ..................................................................2.00 220 g OP (3.11) Orgran

Foods And Supplements For Inborn Errors Of Metabolism

¾SA1108 Special Authority for Subsidy Initial application only from a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 Dietary management of homocystinuria; or 2 Dietary management of maple syrup urine disease; or 3 Dietary management of phenylketonuria (PKU); or 4 For use as a supplement to the Ketogenic diet in patients diagnosed with epilepsy.

Supplements For Homocystinuria

AMINOACID FORMULA WITHOUT METHIONINE – Special Authority see SA1108 above – Hospital pharmacy [HP3] Powder ............................................................................................461.94 500 g OP XMET Maxamum

Supplements For MSUD

AMINOACID FORMULA WITHOUT VALINE, LEUCINE AND ISOLEUCINE – Special Authority see SA1108 above – Hospital pharmacy [HP3] Powder ............................................................................................300.54 500 g OP MSUD Maxamaid 437.22 MSUD Maxamum

216

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

Supplements For PKU

AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA1108 on the previous page – Hospital pharmacy [HP3] Tabs ..................................................................................................99.00 75 OP Phlexy 10 Powder (unflavoured) 29 g sachets ................................................330.12 30 PKU Anamix Junior Infant formula ..................................................................................174.72 400 g OP PKU Anamix Infant Powder (orange) .............................................................................221.00 500 g OP XP Maxamaid 320.00 XP Maxamum Powder (unflavoured) .....................................................................221.00 500 g OP XP Maxamaid 320.00 XP Maxamum Liquid (berry) ....................................................................................13.10 125 ml OP PKU Anamix Junior LQ Liquid (citrus) ....................................................................................15.65 62.5 ml OP PKU Lophlex LQ 10 31.20 125 ml OP PKU Lophlex LQ 20 Liquid (forest berries) ........................................................................30.00 250 ml OP Easiphen Liquid Liquid (juicy berries) .........................................................................15.65 62.5 ml OP PKU Lophlex LQ 10 31.20 125 ml OP PKU Lophlex LQ 20 Liquid (juicy orange) .........................................................................15.65 62.5 ml OP PKU Lophlex LQ 10 31.20 125 ml OP PKU Lophlex LQ 20 Liquid (orange) .................................................................................13.10 125 ml OP PKU Anamix Junior LQ Liquid (unflavoured) ..........................................................................13.10 125 ml OP PKU Anamix Junior LQ

Foods

LOW PROTEIN BAKING MIX – Special Authority see SA1108 on the previous page – Hospital pharmacy [HP3] Powder ................................................................................................8.22 500 g OP Loprofin Mix LOW PROTEIN PASTA – Special Authority see SA1108 on the previous page – Hospital pharmacy [HP3] Animal shapes ..................................................................................11.91 500 g OP Loprofin Lasagne ..............................................................................................5.95 250 g OP Loprofin Low protein rice pasta ......................................................................11.91 500 g OP Loprofin Macaroni .............................................................................................5.95 250 g OP Loprofin Penne ...............................................................................................11.91 500 g OP Loprofin Spaghetti ..........................................................................................11.91 500 g OP Loprofin Spirals ...............................................................................................11.91 500 g OP Loprofin

Infant Formulae For Premature Infants

PRETERM POST-DISCHARGE INFANT FORMULA – Special Authority see SA1198 below – Hospital pharmacy [HP3] Powder ..............................................................................................15.25 400 g OP S-26 Gold Premgro ¾SA1198 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: Both: 1 The infant was born before 33 weeks gestation or weighed less than 1.5 kg at birth; and 2 Either: 2.1 The infant has faltering growth (downward crossing of percentiles); or 2.2 The infant is not maintaining, or is considered unlikely to maintain, adequate growth on standard infant formula.

fully subsidised

[HP3], [HP4] refer page 7

217


SPECIAL FOODS

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

For Williams Syndrome

¾SA1110 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 is an infant suffering from Williams Syndrome and associated hypercalcaemia. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. LOW CALCIUM INFANT FORMULA – Special Authority see SA1110 above – Hospital pharmacy [HP3] Powder ..............................................................................................44.40 400 g OP Locasol

Gastrointestinal and Other Malabsorptive Problems

AMINO ACID FORMULA – Special Authority see SA1219 below – Hospital pharmacy [HP3] Powder ................................................................................................6.00 48.5 g OP 53.00 400 g OP Powder (unflavoured) .......................................................................53.00 400 g OP

Powder (vanilla) ................................................................................53.00

400 g OP

Vivonex Pediatric Neocate LCP Elecare Elecare LCP Neocate Advance Neocate Gold Elecare Neocate Advance

¾SA1219 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 Extensively hydrolysed formula has been reasonably trialled and is inappropriate due to documented severe intolerance or allergy or malabsorption; or 2 History of anaphylaxis to cows milk protein formula or dairy products; or 3 Eosinophilic oesophagitis. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 An assessment as to whether the infant can be transitioned to a cows milk protein, soy, or extensively hydrolysed infant formula has been undertaken; and 2 The outcome of the assessment is that the infant continues to require an amino acid infant formula; and 3 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1380 on the next page – Hospital pharmacy [HP3] Powder ..............................................................................................15.21 450 g OP Pepti Junior Gold Karicare Aptamil

218

fully subsidised

[HP3], [HP4] refer page 7


SPECIAL FOODS

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

¾SA1380 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 7 Cystic fibrosis; or 8 Proven fat malabsorption; or 9 Severe intestinal motility disorders causing significant malabsorption; or 10 Intestinal failure. Renewal only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 An assessment as to whether the infant can be transitioned to a cows milk protein or soy infant formula has been undertaken; and 2 The outcome of the assessment is that the infant continues to require an extensively hydrolysed infant formula; and 3 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted. Renewal — (Step Down from Amino Acid Formula) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The infant is currently receiving funded amino acid formula; and 2 The infant is to be trialled on, or transitioned to, an extensively hydrolysed formula; and 3 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and the date contacted.

Ketogenic Diet

¾SA1197 Special Authority for Subsidy Initial application only from a metabolic physician or paediatric neurologist. Approvals valid for 3 months where the patient has intractable epilepsy, pyruvate dehydrogenase deficiency or glucose transported type-1 deficiency and other conditions requiring a ketogenic diet. Renewal only from a metabolic physician or paediatric neurologist. Approvals valid for 2 years where the patient is on a ketogenic diet and the patient is benefiting from the diet. HIGH FAT LOW CARBOHYDRATE FORMULA – Special Authority see SA1197 above – Retail pharmacy Powder (unflavoured) .......................................................................35.50 300 g OP KetoCal 4:1 Ketocal 3:1 Powder (vanilla) ................................................................................35.50 300 g OP KetoCal 4:1

fully subsidised

[HP3], [HP4] refer page 7

219


SECTION E PART I PRACTITIONER’S SUPPLY ORDERS Pharmaceuticals and quantities that may be obtained on a Practitioner’s Supply Order

ADRENALINE Inj 1 in 1,000, 1 ml ampoule........................................ 5 Inj 1 in 10,000, 10 ml ampoule.................................... 5 AMINOPHYLLINE Inj 25 mg per ml, 10 ml ............................................... 5 AMIODARONE HYDROCHLORIDE Inj 50 mg per ml, 3 ml ampoule .................................. 6 AMOXYCILLIN Cap 250 mg .............................................................. 30 Cap 500 mg .............................................................. 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 300 ml Inj 1 g.......................................................................... 5 AMOXYCILLIN CLAVULANATE Tab amoxycillin 500 mg with potassium clavulanate 125 mg ..............................................30 Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml................................................................ 200 ml Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml................................................................ 200 ml ASPIRIN Tab dispersible 300 mg............................................. 30 ATROPINE SULPHATE Inj 600 mcg per ml, 1 ml ampoule............................... 5 AZITHROMYCIN Tab 500 mg – See note on page 91............................ 8 BENDROFLUMETHIAZIDE [BENDROFLUAZIDE] Tab 2.5 mg – See note on page 59......................... 150 BENZATHINE BENZYLPENICILLIN Inj 1.2 mega u per 2.3 ml ............................................ 5 BENZTROPINE MESYLATE Inj 1 mg per ml, 2 ml ................................................... 5 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 600 mg................................................................... 5 BLOOD GLUCOSE DIAGNOSTIC TEST METER Meter with 50 lancets, a lancing device and 10 diagnostic test strips – Subsidy by endorsement – See note on page 30 .....................1 BLOOD GLUCOSE DIAGNOSTIC TEST STRIP Blood glucose test strips – See note on page 30 .................................................................. 50 test BLOOD KETONE DIAGNOSTIC TEST METER Meter – See note on page 29 ..................................... 1 CEFTRIAXONE SODIUM Inj 500 mg – Subsidy by endorsement – See note on page 90 .....................................................5 Inj 1 g – Subsidy by endorsement – See note on page 90 .....................................................5 CHARCOAL Oral liq 50 g per 250 ml ..................................... 250 ml CHLORPROMAZINE HYDROCHLORIDE Tab 10 mg ................................................................. 30 Tab 25 mg ................................................................. 30 Tab 100 mg ............................................................... 30 Inj 25 mg per ml, 2 ml ................................................. 5 CIPROFLOXACIN Tab 250 mg – See note on page 94............................ 5 Tab 500 mg – See note on page 94............................ 5 CO-TRIMOXAZOLE Tab trimethoprim 80 mg and sulphamethoxazole 400 mg..................................30 Oral liq trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml................................................................ 200 ml COMPOUND ELECTROLYTES Powder for oral soln ................................................. 10 CONDOMS 49 mm..................................................................... 144 52 mm..................................................................... 144 52 mm extra strength.............................................. 144 53 mm..................................................................... 144 53 mm (chocolate) .................................................. 144 53 mm (strawberry)................................................. 144 54 mm, shaped ....................................................... 144 55 mm..................................................................... 144 56 mm..................................................................... 144 56 mm, shaped ....................................................... 144 60 mm..................................................................... 144 CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tabs............................................................84 DEXAMETHASONE Tab 1 mg – Retail pharmacy-Specialist .................... 30 Tab 4 mg – Retail pharmacy-Specialist .................... 30 continued. . .

220

fully subsidised brand available Please refer to Section A for a definition, and conditions of supply, of Practitioner’s Supply Orders.


PRACTITIONER’S SUPPLY ORDERS

(continued) DEXAMETHASONE SODIUM PHOSPHATE Inj 4 mg per ml, 1 ml – See note on page 82.............. 5 Inj 4 mg per ml, 2 ml – See note on page 82.............. 5 DEXTROSE Inj 50%, 10 ml ............................................................. 5 Inj 50%, 90 ml ............................................................. 5 DIAPHRAGM 65 mm – See note on page 76 ................................... 1 70 mm – See note on page 76 ................................... 1 75 mm – See note on page 76 ................................... 1 80 mm – See note on page 76 ................................... 1 DIAZEPAM Inj 5 mg per ml, 2 ml – Subsidy by endorsement – See note on page 130 ...................5 Rectal tubes 5 mg....................................................... 5 Rectal tubes 10 mg..................................................... 5 DICLOFENAC SODIUM Inj 25 mg per ml, 3 ml ................................................. 5 Suppos 50 mg........................................................... 10 DIGOXIN Tab 62.5 mcg ............................................................ 30 Tab 250 mcg ............................................................. 30 DOXYCYCLINE HYDROCHLORIDE Tab 50 mg ................................................................. 30 Tab 100 mg ............................................................... 30 ERGOMETRINE MALEATE Inj 500 mcg per ml, 1 ml ............................................. 5 ERYTHROMYCIN ETHYL SUCCINATE Tab 400 mg ............................................................... 20 Grans for oral liq 200 mg per 5 ml ..................... 300 ml Grans for oral liq 400 mg per 5 ml ..................... 200 ml ERYTHROMYCIN STEARATE Tab 250 mg ............................................................... 30 ETHINYLOESTRADIOL WITH DESOGESTREL Tab 20 mcg with desogestrel 150 mcg and 7 inert tab ................................................................84 Tab 30 mcg with desogestrel 150 mcg and 7 inert tab ................................................................84 ETHINYLOESTRADIOL WITH LEVONORGESTREL Tab 20 mcg with levonorgestrel 100 mcg and 7 inert tab .............................................................84 Tab 50 mcg with levonorgestrel 125 mcg and 7 inert tab .............................................................84 Tab 30 mcg with levonorgestrel 150 mcg.................. 63 Tab 30 mcg with levonorgestrel 150 mcg and 7 inert tab .............................................................84 ETHINYLOESTRADIOL WITH NORETHISTERONE Tab 35 mcg with norethisterone 1 mg....................... 63 Tab 35 mcg with norethisterone 1 mg and 7 inert tab ................................................................84 Tab 35 mcg with norethisterone 500 mcg ................. 63 Tab 35 mcg with norethisterone 500 mcg and 7 inert tab ......................................................84 FLUCLOXACILLIN SODIUM Cap 250 mg .............................................................. 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 200 ml Inj 1 g.......................................................................... 5 FLUPENTHIXOL DECANOATE Inj 20 mg per ml, 1 ml ................................................. 5 Inj 20 mg per ml, 2 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 FLUPHENAZINE DECANOATE Inj 12.5 mg per 0.5 ml, 0.5 ml ..................................... 5 Inj 25 mg per ml, 1 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 FUROSEMIDE [FRUSEMIDE] Tab 40 mg ................................................................. 30 Inj 10 mg per ml, 2 ml ampoule .................................. 5 GLUCAGON HYDROCHLORIDE Inj 1 mg syringe kit...................................................... 5 GLYCERYL TRINITRATE Tab 600 mcg ........................................................... 100 Oral spray, 400 mcg per dose........................ 250 dose HALOPERIDOL Tab 500 mcg ............................................................. 30 Tab 1.5 mg ................................................................ 30 Tab 5 mg ................................................................... 30 Oral liq 2 mg per ml ........................................... 200 ml Inj 5 mg per ml, 1 ml ................................................... 5 HALOPERIDOL DECANOATE Inj 50 mg per ml, 1 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 HYDROCORTISONE Inj 100 ml vial.............................................................. 5 HYDROXOCOBALAMIN Inj 1 mg per ml, 1 ml ................................................... 6 HYOSCINE N-BUTYLBROMIDE Inj 20 mg, 1 ml ............................................................ 5 INTRA-UTERINE DEVICE IUD............................................................................ 40 continued. . .

fully subsidised brand available Please refer to Section A for a definition, and conditions of supply, of Practitioner’s Supply Orders.

221


PRACTITIONER’S SUPPLY ORDERS

(continued) IPRATROPIUM BROMIDE Nebuliser soln, 250 mcg per ml, 1 ml ....................... 40 Nebuliser soln, 250 mcg per ml, 2 ml ....................... 40 IVERMECTIN Tab 3 mg – See note on page 71............................ 100 KETONE BLOOD BETA-KETONE ELECTRODES Test strip ................................................................... 10 LEVONORGESTREL Tab 30 mcg ............................................................... 84 Tab 1.5 mg .................................................................. 5 LIDOCAINE [LIGNOCAINE] Gel 2%, 10 ml urethral syringe – Subsidy by endorsement – See note on page 124 ...................5 LIDOCAINE [LIGNOCAINE] HYDROCHLORIDE Inj 1%, 5 ml ampoule ................................................ 25 Inj 2%, 5 ml ampoule .................................................. 5 Inj 1%, 20 ml ampoule ................................................ 5 Inj 2%, 20 ml ampoule ................................................ 5 LIDOCAINE [LIGNOCAINE] WITH CHLORHEXIDINE Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringes – Subsidy by endorsement – See note on page 124 ...................5 LOPERAMIDE HYDROCHLORIDE Tab 2 mg ................................................................... 30 Cap 2 mg .................................................................. 30 MASK FOR SPACER DEVICE Size 2 – See note on page 187 ................................ 20 MEDROXYPROGESTERONE ACETATE Inj 150 mg per ml, 1 ml syringe................................... 5 METOCLOPRAMIDE HYDROCHLORIDE Inj 5 mg per ml, 2 ml ................................................... 5 METRONIDAZOLE Tab 200 mg ............................................................... 30 MORPHINE SULPHATE Inj 5 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 10 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 15 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 30 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 NALOXONE HYDROCHLORIDE Inj 400 mcg per ml, 1 ml ............................................. 5 NICOTINE Patch 7 mg – See note on page 150 ........................ 28 Patch 14 mg – See note on page 150 ...................... 28 Patch 21 mg – See note on page 150 ...................... 28 Lozenge 1 mg – See note on page 150.................. 216 Lozenge 2 mg – See note on page 150.................. 216 Gum 2 mg (Classic) – See note on page 150......... 384 Gum 2 mg (Fruit) – See note on page 150 ............. 384 Gum 2 mg (Mint) – See note on page 150 ............. 384 Gum 4 mg (Classic) – See note on page 150......... 384 Gum 4 mg (Fruit) – See note on page 150 ............. 384 Gum 4 mg (Mint) – See note on page 150 ............. 384 NORETHISTERONE Tab 350 mcg ............................................................. 84 Tab 5 mg ................................................................... 30 NORETHISTERONE WITH MESTRANOL Tab 1 mg with mestranol 50 mcg and 7 inert tab ........................................................................84 OXYTOCIN Inj 5 iu per ml, 1 ml ampoule....................................... 5 Inj 10 iu per ml, 1 ml ampoule..................................... 5 Inj 5 iu with ergometrine maleate 500 mcg per ml, 1 ml.............................................................5 PARACETAMOL Tab 500 mg ............................................................... 30 Oral liq 120 mg per 5 ml .................................... 200 ml Oral liq 250 mg per 5 ml .................................... 100 ml PEAK FLOW METER Low range ................................................................. 10 Normal range............................................................ 10 PENICILLIN G BENZATHINE [BENZATHINE BENZYLPENICILLIN] Inj 1.2 mega u per 2 ml ............................................... 5 PETHIDINE HYDROCHLORIDE Inj 50 mg per ml, 1 ml – Only on a controlled drug form ................................................................5 Inj 50 mg per ml, 2 ml – Only on a controlled drug form ................................................................5 PHENOXYMETHYLPENICILLIN (PENICILLIN V) Cap potassium salt 250 mg ...................................... 30 Cap potassium salt 500 mg ...................................... 20 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 300 ml PHENYTOIN SODIUM Inj 50 mg per ml, 2 ml ................................................. 5 Inj 50 mg per ml, 5 ml ................................................. 5 continued. . .

222

fully subsidised brand available Please refer to Section A for a definition, and conditions of supply, of Practitioner’s Supply Orders.


PRACTITIONER’S SUPPLY ORDERS

(continued) PHYTOMENADIONE Inj 2 mg per 0.2 ml ...................................................... 5 Inj 10 mg per ml, 1 ml ................................................. 5 PIPOTHIAZINE PALMITATE Inj 50 mg per ml, 1 ml ................................................. 5 Inj 50 mg per ml, 2 ml ................................................. 5 PREDNISOLONE SODIUM PHOSPHATE Oral liq 5 mg per ml – See note on page 82 .................................................................... 30 ml PREDNISONE Tab 5 mg ................................................................... 30 PREGNANCY TESTS - HCG URINE Cassette........................................................... 200 test PROCAINE PENICILLIN Inj 1.5 mega u............................................................. 5 PROCHLORPERAZINE Tab 5 mg ................................................................... 30 Inj 12.5 mg per ml, 1 ml .............................................. 5 PROMETHAZINE HYDROCHLORIDE Inj 25 mg per ml, 2 ml ................................................. 5 SALBUTAMOL Inj 500 mcg per ml, 1 ml ............................................. 5 Aerosol inhaler, 100 mcg per dose CFC free .......................................................... 1000 dose Nebuliser soln, 1 mg per ml, 2.5 ml .......................... 30 Nebuliser soln, 2 mg per ml, 2.5 ml .......................... 30 SALBUTAMOL WITH IPRATROPIUM BROMIDE Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml ............................20 SILVER SULPHADIAZINE Crm 1%................................................................ 250 g SODIUM BICARBONATE Inj 8.4%, 50 ml ............................................................ 5 Inj 8.4%, 100 ml .......................................................... 5 SODIUM CHLORIDE Inf 0.9% – See note on page 50 ...................... 2000 ml Inj 0.9%, 5 ml – See note on page 50......................... 5 Inj 0.9%, 10 ml – See note on page 50....................... 5 SPACER DEVICE 230 ml (single patient) .............................................. 20 800 ml....................................................................... 20 SPACER DEVICE AUTOCLAVABLE 230 ml (autoclavable) – Subsidy by endorsement – See note on page 187 ...................5 TRIMETHOPRIM Tab 300 mg ............................................................... 30 VERAPAMIL HYDROCHLORIDE Inj 2.5 mg per ml, 2 ml ampoule ................................. 5 WATER Purified for inj, 5 ml – See note on page 50................ 5 Purified for inj, 10 ml – See note on page 50.............. 5 Purified for inj, 20 ml – See note on page 50.............. 5 ZUCLOPENTHIXOL DECANOATE Inj 200 mg per ml, 1 ml ............................................... 5

fully subsidised brand available Please refer to Section A for a definition, and conditions of supply, of Practitioner’s Supply Orders.

223


SECTION E PART II: RURAL AREAS

Rural Areas for Practitioner’s Supply Orders

NORTH ISLAND Northland DHB Dargaville Hikurangi Kaeo Kaikohe Kaitaia Kawakawa Kerikeri Mangonui Maungaturoto Moerewa Ngunguru Paihia Rawene Ruakaka Russell Tutukaka Waipu Whangaroa Waitemata DHB Helensville Huapai Kumeu Snells Beach Waimauku Warkworth Wellsford Auckland DHB Great Barrier Island Oneroa Ostend Counties Manukau DHB Tuakau Waiuku Waikato DHB Coromandel Huntly Kawhia Matamata Morrinsville Ngatea Otorohanga Paeroa Pauanui Beach Putaruru Raglan Tairua Taumarunui Te Aroha Te Kauwhata Te Kuiti Tokoroa Waihi Whangamata Whitianga Bay of Plenty DHB Edgecumbe Katikati Kawerau Murupara Opotiki Taneatua Te Kaha Waihi Beach Whakatane Lakes DHB Mangakino Turangi Tairawhiti DHB Ruatoria Te Araroa Te Karaka Te Puia Springs Tikitiki Tokomaru Bay Tolaga Bay Taranaki DHB Eltham Inglewood Manaia Oakura Okato Opunake Patea Stratford Waverley Hawkes Bay DHB Chatham Islands Waipawa Waipukurau Wairoa Whanganui DHB Bulls Marton Ohakune Raetihi Taihape Waiouru MidCentral DHB Dannevirke Foxton Levin Otaki Pahiatua Shannon Woodville Wairarapa DHB Carteron Featherston Greytown Martinborough SOUTH ISLAND Nelson/Marlborough DHB Havelock Mapua Motueka Murchison Picton Takaka Wakefield West Coast DHB Dobson Greymouth Hokitika Karamea Reefton South Westland Westport Whataroa Canterbury DHB Akaroa Amberley Amuri Cheviot Darfield Diamond Harbour Hanmer Springs Kaikoura Leeston Lincoln Methven Oxford Rakaia Rolleston Rotherham Templeton Waikari

South Canterbury DHB Fairlie Geraldine Pleasant Point Temuka Twizel Waimate

Southern DHB Alexandra Balclutha Cromwell Gore Kurow Lawrence Lumsden Mataura Milton Oamaru Oban Otautau Outram Owaka Palmerston Queenstown Ranfurly Riverton Roxburgh Tapanui Te Anau Tokonui Tuatapere Wanaka Winton

224

fully subsidised brand available Please refer to Section A for a definition, and conditions of supply, of Practitioner’s Supply Orders.


SECTION F: COMMUNITY PHARMACEUTICALS DISPENSING PERIOD EXEMPTIONS SECTION F: PART I

A Community Pharmaceutical identified with a F within the other sections of the Pharmaceutical Schedule: a) is exempt from any requirement to dispense in Monthly Lots; b) will only be subsidised if it is dispensed in a 90 Day Lot unless it is under the Dispensing Frequency Rule. A Community Pharmaceutical that is an oral contraceptive and that is identified with a F within the other sections of the Pharmaceutical Schedule: a) is exempt from any requirement to dispense in Monthly Lots; b) will only be subsidised if it is dispensed in a 180 Day Lot unless it is is under the Dispensing Frequency Rule.

SECTION F: PART II: CERTIFIED EXEMPTIONS AND ACCESS EXEMPTIONS TO MONTHLY DISPENSING

A Community Pharmaceutical, other than a Community Pharmaceutical identified with a F within the other sections of the Pharmaceutical Schedule, may be dispensed in a 90 Day Lot if: a) the Community Pharmaceutical is identified with a L within the other sections of the Pharmaceutical Schedule and the prescriber/pharmacist has endorsed/annotated the Prescription item(s) on the Prescription to which the exemption applies “certified exemption”. In endorsing/annotating the Prescription items for a certified exemption, the prescriber/pharmacist is certifying that: i) the patient wished to have the medicine dispensed in a quantity greater than a Monthly Lot; and ii) the patient has been stabilised on the same medicine for a reasonable period of time; and iii) the prescriber/pharmacist has reason to believe the patient will continue on the medicine and is compliant. b) a patient, who has difficulty getting to and from a pharmacy, signs the back of the Prescription to qualify for an Access Exemption. In signing the Prescription, the patient or his or her nominated representative must also certify which of the following criteria they meet: i) have limited physical mobility; ii) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; iii) are relocating to another area; iv) are travelling extensively and will be out of town when the repeat prescriptions are due.

SECTION F: PART III: FLEXIBLE AND VARIABLE DISPENSING PERIODS FOR PHARMACY

A Community Pharmaceutical, other than a Community Pharmaceutical identified with a F within the other sections of the Pharmaceutical Schedule, may be dispensed in variable dispensing periods under the following conditions: a) for stock management where the original pack(s) result in dispensing greater than 30 days supply, b) to synchronise a patients medication where multiple medicines result in uneven supply periods, note if dispensing a medicine other than a Pharmaceutical identified with a F please refer to Section F; Part II Note – the total quantity and dispensing period can not exceed the total quantity and period prescribed on the prescription.

225


SECTION F

The following Community Pharmaceuticals are identified with a L within the other sections of the Pharmaceutical Schedule and may be dispensed in a 90 Day Lot if endorsed as a certified exemption in accordance with paragraph (a) in Section F Part II above. ALIMENTARY TRACT AND METABOLISM INSULIN ASPART INSULIN ASPART WITH INSULIN ASPART PROTAMINE INSULIN GLARGINE INSULIN GLULISINE INSULIN ISOPHANE INSULIN ISOPHANE WITH INSULIN NEUTRAL INSULIN LISPRO INSULIN LISPRO WITH INSULIN LISPRO PROTAMINE INSULIN NEUTRAL NERVOUS SYSTEM AMANTADINE HYDROCHLORIDE APOMORPHINE HYDROCHLORIDE CARDIOVASCULAR SYSTEM AMIODARONE HYDROCHLORIDE Tab 100 mg Cordarone-X Tab 200 mg Cordarone-X DISOPYRAMIDE PHOSPHATE FLECAINIDE ACETATE Tab 50 mg Tab 100 mg Cap long-acting 100 mg Cap long-acting 200 mg Tambocor Tambocor Tambocor CR Tambocor CR ENTACAPONE GABAPENTIN GABAPENTIN (NEURONTIN) LACOSAMIDE LAMOTRIGINE LISURIDE HYDROGEN MALEATE PERGOLIDE PRAMIPEXOLE HYDROCHLORIDE TOLCAPONE TOPIRAMATE VIGABATRIN MUSCULOSKELETAL SYSTEM PYRIDOSTIGMINE BROMIDE HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES DESMOPRESSIN Nasal drops 100 mcg Minirin per ml Nasal spray 10 mcg per Desmopressin-PH&T dose

MEXILETINE HYDROCHLORIDE MINOXIDIL NICORANDIL PROPAFENONE HYDROCHLORIDE

226


SECTION G: SAFETY CAP MEDICINES

Pharmacists are required, under the Code of Ethics of the Pharmacy Council of New Zealand, to endeavour to use safety caps when dispensing any of the medicines listed in Section G in an oral liquid formulation pursuant to a prescription or Practitioner’s Supply Order. This includes all proprietary and extemporaneously compounded oral liquid preparations of those pharmaceuticals listed in Section G of the Pharmaceutical Schedule. These medicines will be identified throughout Section B of the Pharmaceutical Schedule with the symbol ‘‡’.

Exemptions

Oral liquid preparations of the pharmaceuticals listed in Section G of the Pharmaceutical Schedule will be dispensed in a container with a safety cap unless: G the practitioner has endorsed the Prescription or Practitioner’s Supply Order, stating that, the Pharmaceutical is not to be dispensed in a container with a safety cap; or G the Contractor has annotated the Prescription or Practitioner’s Supply Order stating that, because of infirmity of the particular person, the Pharmaceutical to be used by that person should not be dispensed in a container with a safety cap; or G the Pharmaceutical is packaged in an Original Pack so designed that on the professional judgement of the Contractor, transfer to a container with a safety cap would be inadvisable or a retrograde procedure.

Reimbursment

Pharmacists will be reimbursed according to their agreement. Where an additional fee is paid on safety caps it will be paid on all dispensings of oral liquid preparations for those pharmaceuticals listed in Section G of the Pharmaceutical Schedule unless the practitioner has endorsed or the contractor has annotated the Prescription or Practitioner’s Supply Order that a safety cap has not been supplied.

Safety Caps (NZS 5825:1991)

20 mm.................................. .Clic-Loc, United Closures & Plastics PLC, England Kerr, Cormack Packaging, Sydney, under licence to Kerr USA 24 mm.................................. .Clic-Loc, United Closures & Plastics PLC, England Clic-Loc, ACI Closures under license to Owens-Illinois Kerr, Cormack Packaging, Sydney, under licence to Kerr USA 28 mm.................................. .Clic-Loc, United Closures & Plastics PLC, England Clic-Loc, ACI Closures under license to Owens-Illinois Kerr, Cormack Packaging, Sydney, under licence to Kerr USA PDL Squeezlok PDL FG

227


SAFETY CAP MEDICINES

ALIMENTARY TRACT AND METABOLISM FERROUS SULPHATE Oral liq 30 mg per 1 ml Ferodan (6 mg elemental per 1 ml) CARDIOVASCULAR SYSTEM AMILORIDE HYDROCHLORIDE Oral liq 1 mg per ml Biomed CAPTOPRIL Oral liq 5 mg per ml CHLOROTHIAZIDE Oral liq 50 mg per ml DIGOXIN Oral liq 50 mcg per ml Capoten Biomed Lanoxin CARBAMAZEPINE Oral liq 100 mg per 5 ml

Tegretol

CLOBAZAM Tab 10 mg Frisium (Extemporaneously compounded oral liquid preparations) CLONAZEPAM Oral drops 2.5 mg per Rivotril ml DIAZEPAM Tab 2 mg Arrow-Diazepam Tab 5 mg Arrow-Diazepam (Extemporaneously compounded oral liquid preparations) ETHOSUXIMIDE Oral liq 250 mg per 5 ml

FUROSEMIDE [FRUSEMIDE] Oral liq 10 mg per ml Lasix SPIRONOLACTONE Oral liq 5 mg per ml Biomed

Zarontin

LORAZEPAM Tab 1 mg Ativan Tab 2.5 mg Ativan (Extemporaneously compounded oral liquid preparations) LORMETAZEPAM Tab 1 mg Noctamid (Extemporaneously compounded oral liquid preparations) METHADONE HYDROCHLORIDE Oral liq 2 mg per ml Biodone Oral liq 5 mg per ml Biodone Forte Oral liq 10 mg per ml Biodone Extra Forte MORPHINE HYDROCHLORIDE Oral liq 1 mg per ml RA-Morph Oral liq 2 mg per ml RA-Morph Oral liq 5 mg per ml RA-Morph Oral liq 10 mg per ml RA-Morph NITRAZEPAM Tab 5 mg Nitrados (Extemporaneously compounded oral liquid preparations) OXAZEPAM Tab 10 mg Ox-Pam Tab 15 mg Ox-Pam (Extemporaneously compounded oral liquid preparations) OXYCODONE HYDROCHLORIDE Oral liq 5 mg per 5 ml OxyNorm PARACETAMOL Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml Ethics Paracetamol Paracare Double Strength

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES LEVOTHYROXINE Tab 25 mcg Synthroid Tab 50 mcg Eltroxin Mercury Pharma Synthroid Tab 100 mcg Eltroxin Mercury Pharma Synthroid (Extemporaneously compounded oral liquid preparations) INFECTIONS - AGENTS FOR SYSTEMIC USE QUININE SULPHATE Tab 300 mg Q 300 (Extemporaneously compounded oral liquid preparations) MUSCULOSKELETAL SYSTEM IBUPROFEN Oral liq 20 mg per ml Fenpaed NERVOUS SYSTEM ALPRAZOLAM Tab 250 mcg

Xanax Arrow-Alprazolam Tab 500 mcg Xanax Arrow-Alprazolam Tab 1 mg Xanax Arrow-Alprazolam (Extemporaneously compounded oral liquid preparations)

228


SAFETY CAP MEDICINES

PHENYTOIN SODIUM Oral liq 30 mg per 5 ml SODIUM VALPROATE Oral liq 200 mg per 5 ml SALBUTAMOL Oral liq 400 mcg per ml

Dilantin Epilim S/F Liquid Epilim Syrup

Ventolin Salapin

THEOPHYLLINE Oral liq 80 mg per 15 ml

Nuelin

TEMAZEPAM Tab 10 mg Normison (Extemporaneously compounded oral liquid preparations) TRIAZOLAM Tab 125 mcg Hypam Tab 250 mcg Hypam (Extemporaneously compounded oral liquid preparations) RESPIRATORY SYSTEM AND ALLERGIES CETIRIZINE HYDROCHLORIDE Oral liq 1 mg per ml Cetirizine - AFT CHLORPHENIRAMINE MALEATE Oral liq 2 mg per 5 ml Histafen DEXTROCHLORPHENIRAMINE MALEATE Oral liq 2 mg per 5 ml Polaramine PROMETHAZINE HYDROCHLORIDE Oral liq 5 mg per 5 ml Allersoothe

TRIMEPRAZINE TARTRATE Oral liq 30 mg per 5 ml Vallergan Forte EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS CODEINE PHOSPHATE Powder Douglas (Extemporaneously compounded oral liquid preparations) METHADONE HYDROCHLORIDE Powder AFT (Extemporaneously compounded oral liquid preparations) PHENOBARBITONE SODIUM Powder MidWest (Extemporaneously compounded oral liquid preparations)

229


NATIONAL IMMUNISATION SCHEDULE

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

Vaccinations

BACILLUS CALMETTE-GUERIN VACCINE – [Xpharm] For infants at increased risk of tuberculosis. Increased risk is defined as: 1) living in a house or family with a person with current or past history of TB or 2) have one or more household members or carers who within the last 5 years lived in a country with a rate of TB > or equal to 40 per 100,000 for 6 months or longer or 3) during their first 5 years will be living 3 months or longer in a country with a rate of TB > or equal to 40 per 100,000 Note a list of countries with high rates of TB are available at www.moh.govt.nz/immunisation or www.bcgatlas.org/index.php. Inj multi-dose vial (10 dose) 0.5 ml .....................................................0.00 1 BCG Vaccine DIPHTHERIA AND TETANUS VACCINE – [Xpharm] For adults aged 45 and 65 years old, and for susceptible individuals. Inj 0.5 ml .............................................................................................0.00

1

ADT Booster

DIPHTHERIA, TETANUS AND PERTUSSIS VACCINE – [Xpharm] For children aged 11 years old and pregnant women between gestional weeks 28 and 38 during epidemics. Inj 0.5 ml .............................................................................................0.00 1 Boostrix DIPHTHERIA, TETANUS, PERTUSSIS AND POLIO VACCINE – [Xpharm] For children aged 4 years old. Inj 0.5 ml .............................................................................................0.00

1

Infanrix-IPV

DIPHTHERIA, TETANUS, PERTUSSIS, POLIO, HEPATITIS B AND HAEMOPHILUS INFLUENZAE TYPE B VACCINE – [Xpharm] For children aged 6 weeks, 3 months, and 5 months old. Inj 0.5 ml .............................................................................................0.00 1 Infanrix-hexa HAEMOPHILUS INFLUENZAE TYPE B VACCINE – [Xpharm] For children aged 15 months old, children aged 0-16 years with functional asplenia, or for patients pre- and post-splenectomy. Inj 0.5 ml .............................................................................................0.00 1 Act-HIB HEPATITIS A VACCINE – [Xpharm] A single dose of hepatitis A vaccine is funded for the following eligible patients on the recommendation of the statutory medical officer of health: G Children, aged 1-4 years inclusive who reside in Ashburton district; or G Children, aged 1-9 years inclusive, residing in Ashburton; or G Children, aged 1-9 years inclusive, who attend a preschool or school in Ashburton; or

G

Children, aged older than 9 years, who attend a school with children aged 9 years old or less, in Ashburton Inj ........................................................................................................0.00 1 Havrix Junior HEPATITIS B VACCINE – [Xpharm] For household or sexual contacts of known hepatitis B carriers, or for children born to mothers who are hepatitis B surface antigen (HBsAg) postive. Inj 0.5 ml .............................................................................................0.00 1 HBvaxPro HUMAN PAPILLOMAVIRUS (6, 11, 16 AND 18) VACCINE [HPV] – [Xpharm] Three doses over a period of six months for young women aged between 12 and 19 years old. Inj 0.5 ml .............................................................................................0.00 1 Gardasil INFLUENZA VACCINE – [Xpharm] Inj ......................................................................................................90.00 (Fluvax Inj to be delisted 1 January 2014) 10

Fluarix Fluvax


NATIONAL IMMUNISATION SCHEDULE

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

A) 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 who: i) have any of 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 either of the following chronic respiratory disease: 1) asthma, if on a regular preventative therapy, or 2) other chronic respiratory disease with impaired lung function; iii) have diabetes; iv) have chronic renal disease; v) have any cancer, excluding basal and squamous skin cancers if not invasive; vi) 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) are pregnant c) people under 18 years of age living within the boundaries of the Canterbury District Health Board. d) children aged four and under who have been hospitalised for respiratory illness or have a history of significant respiratory illness; Unless meeting the criteria set out 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, B) Doctors are the only Contractors entitled to claim payment from the Funder for the supply of influenza vaccine to patients eligible under the above criteria for subsidised immunisation and they may only do so in respect of the influenza vaccine listed in the Pharmaceutical Schedule. C) Individual DHBs may fund patients over and above the above criteria. The claiming process for these additional patients should be determined between the DHB and Contractor. D) 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. MEASLES, MUMPS AND RUBELLA VACCINE – [Xpharm] For children aged 15 months and 4 years old or for any individual susceptible to measles, mumps or rubella. Inj 0.5 ml .............................................................................................0.00 1 M-M-R II MENINGOCOCCAL A, C, Y AND W-135 VACCINE – [Xpharm] For patients pre- and post-splenectomy or children aged 0-16 years with functional asplenia. For organisation and community based outbreaks. Inj 0.5 ml .............................................................................................0.00 1 Menomune PNEUMOCOCCAL (PCV13) VACCINE – [Xpharm] For high risk children under the age of 5 and those aged less than 16 years pre- or post-splenectomy or with functional asplenia. Inj 0.5 ml .............................................................................................0.00 1 Prevenar 13 PNEUMOCOCCAL POLYSACCHARIDE VACCINE – [Xpharm] For patients pre- and post-splenectomy or children aged 0-16 years with functional asplenia. Inj 0.5 ml .............................................................................................0.00 1 Pneumovax 23 PNEUMOCOCCAL VACCINE – [Xpharm] For children aged 6 weeks, 3 months, and 5 months, and 15 months old. Inj 0.5 ml .............................................................................................0.00

1

Synflorix


NATIONAL IMMUNISATION SCHEDULE

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

POLIOMYELITIS VACCINE – [Xpharm] A primary course of three doses for previously unvaccinated individuals. Inj 0.5 ml .............................................................................................0.00

1

IPOL


INDEX Generic Chemicals and Brands

- Symbols 3TC ...............................................108 50X 3.0 Reservoir ...........................36 -AA-Lices ............................................72 A-Scabies .......................................72 Abacavir sulphate .........................108 Abacavir sulphate with lamivudine ............................... 108 Abilify ............................................136 ABM Hydroxocobalamin .................40 Acarbose ........................................29 Accarb ............................................29 Accu-Chek Ketur-Test .....................29 Accu-Chek Performa ......................30 Accuretic 10 ....................................53 Accuretic 20 ....................................53 Acetadote .....................................192 Acetazolamide ..............................189 Acetec .............................................52 Acetic acid with 1, 2- propanediol diacetate and benzethonium .......................... 188 Acetic acid with hydroxyquinoline and ricinoleic acid ...................... 79 Acetylcysteine ...............................192 Aci-Jel .............................................79 Aciclovir Infection ....................................103 Sensory ....................................188 Acidex .............................................24 Acipimox .........................................60 Acitretin ...........................................73 Aclasta ..........................................119 Aclin ..............................................115 Act-HIB .........................................230 Actinomycin D ...............................155 Actrapid ..........................................28 Actrapid Penfill ................................28 Acupan .........................................125 Adalat 10 ........................................57 Adalat Oros .....................................57 Adalimumab ..................................171 Adapalene ......................................65 Adefin XL ........................................57 Adefovir dipivoxil ...........................100 ADR Cartridge 1.8 ..........................36 ADR Cartridge 3.0 ..........................36 Adrenaline ......................................61 Adriamycin ....................................156 ADT Booster .................................230 Advantan ........................................68 Advate ............................................45 AFT-Pyrazinamide ........................100 Agents Affecting the Renin-Angiotensin System .........52 Agents for Parkinsonism and Related Disorders .................... 122 Agents Used in the Treatment of Poisonings ............................... 192 Agrylin ..........................................154 Alanase .........................................186 Albay .............................................181 Albendazole ....................................90 Albustix ...........................................81 Aldara .............................................75 Alendronate sodium ......................117 Alendronate sodium with cholecalciferol .......................... 117 Alfacalcidol .....................................41 Alginic acid .....................................24 Alitraq ...........................................208 Alkeran .........................................151 Allersoothe ....................................182 Allopurinol .....................................120 Alpha Adrenoceptor Blockers .........52 Alpha-Keri Lotion ............................70 Alphamox ........................................92 Alprazolam ....................................141 Alu-Tab ...........................................24 Aluminium hydroxide ......................24 Amantadine hydrochloride ............122 Ambrisentan ...................................63 Amiloride hydrochloride ..................58 Amiloride hydrochloride with furosemide ................................. 59 Amiloride hydrochloride with hydrochlorothiazide ................... 59 Aminophylline ...............................186 Amiodarone hydrochloride ..............54 Amisulpride ...................................136 Amitrip ..........................................128 Amitriptyline ..................................128 Amlodipine ......................................57 Amorolfine ......................................66 Amoxycillin ......................................92 Amoxycillin clavulanate ..................92 Amphotericin B ...............................40 Amsacrine ....................................154 Amsidine .......................................154 Amyl nitrite ......................................62 Anaesthetics .................................124 Anagrelide hydrochloride ..............154 Analgesics ....................................124 Anastrozole ...................................165 Andriol Testocaps ...........................83 Androderm ......................................83 Animas Battery Cap .......................32 Animas Cartridge ............................36 Animas Vibe ...................................32 Antabuse ......................................149 Antacids and Antiflatulants .............24 Anten ............................................128 Anthelmintics ..................................90 Antiacne Preparations ....................65 Antiallergy Preparations ...............181 Antianaemics ..................................44 Antiandrogen Oral Contraceptives ........................... 79 Antiarrhythmics ...............................54 Antibacterials ..................................90 Antibacterials Topical ......................66 Anticholinesterases ......................114 Antidepressants ............................128 Antidiarrhoeals ................................24 Antiepilepsy Drugs .......................130 Antifibrinolytics, Haemostatics and Local Sclerosants ............... 45 Antifungals ......................................96 Antifungals Topical ..........................66 Antihistamines ..............................181 Antihypotensives .............................55 Antimalarials ...................................98 Antimigraine Preparations ............134 Antinaus ........................................136 Antinausea and Vertigo Agents ..................................... 135 Antiparasitics ..................................99 Antipruritic Preparations .................67 Antipsychotics ...............................136 Antiretrovirals ................................106 Antiretrovirals - Additional Therapies ................................. 109 Antirheumatoid Agents .................115 Antispasmodics and Other Agents Altering Gut Motility ....................................... 26 Antithrombotic Agents ....................46 Antithymocyte globulin (equine) ................................... 171 Antitrichomonal Agents ..................99 Antituberculotics and Antileprotics ............................... 99 Antiulcerants ...................................26 Antivirals .......................................100 Anxiolytics .....................................141

233


INDEX Generic Chemicals and Brands

Anzatax .........................................157 Apidra .............................................28 Apidra SoloStar ..............................28 Apo-Allopurinol .............................120 Apo-Amiloride .................................58 Apo-Amlodipine ..............................57 Apo-Azithromycin ...........................91 Apo-Bromocriptine ........................122 Apo-Ciclopirox ................................66 Apo-Cimetidine ...............................26 Apo-Clarithromycin Alimentary ..................................26 Infection ......................................91 Apo-Clomipramine ........................128 Apo-Clopidogrel ..............................46 Apo-Diclo ......................................114 Apo-Diltiazem CD ...........................57 Apo-Doxazosin ...............................52 Apo-Folic Acid ................................44 Apo-Gliclazide ................................29 Apo-Megestrol ..............................164 Apo-Moclobemide .........................128 Apo-Nadolol ....................................56 Apo-Nicotinic Acid ..........................60 Apo-Oxybutynin ..............................80 Apo-Perindopril ...............................53 Apo-Pindolol ...................................56 Apo-Prazo .......................................52 Apo-Prednisone ..............................83 Apo-Prednisone S29 ......................83 Apo-Primidone ..............................133 Apo-Propranolol ..............................56 Apo-Pyridoxine ...............................40 Apo-Risperidone ...........................139 Apo-Ropinirole ..............................123 Apo-Selegiline ..............................123 Apo-Selegiline S29 .......................123 Apo-Thiamine .................................41 Apo-Timol .......................................57 Apo-Zopiclone ..............................145 Apomine .......................................122 Apomorphine hydrochloride .........122 Aprepitant .....................................135 Apresoline .......................................62 Aquasun 30+ ..................................74 Aqueous cream ..............................70 Aratac .............................................54 Arava ............................................115 Aremed .........................................165 Arimidex ........................................165 Aripiprazole ...................................136 Aristocort ........................................69 Aromasin ......................................165 Arrow - Clopid .................................46 Arrow Amitriptyline ........................128 Arrow-Alprazolam .........................141 Arrow-Bendrofluazide .....................59 Arrow-Brimonidine ........................190 Arrow-Calcium ................................42 Arrow-Citalopram ..........................129 Arrow-Diazepam ...........................142 Arrow-Doxorubicin ........................156 Arrow-Etidronate ...........................117 Arrow-Gabapentin ........................131 Arrow-Lamotrigine ........................132 Arrow-Lisinopril ...............................53 Arrow-Losartan & Hydrochlorothiazide ................... 54 Arrow-Meloxicam ..........................115 Arrow-Morphine LA ......................126 Arrow-Nifedipine XR .......................57 Arrow-Norfloxacin .........................113 Arrow-Ornidazole ............................99 Arrow-Quinapril 10 ..........................53 Arrow-Quinapril 20 ..........................53 Arrow-Quinapril 5 ............................53 Arrow-Ranitidine .............................27 Arrow-Roxithromycin ......................92 Arrow-Sertraline ...........................129 Arrow-Simva 10mg .........................60 Arrow-Simva 20mg .........................60 Arrow-Simva 40mg .........................60 Arrow-Simva 80mg .........................60 Arrow-Sumatriptan ........................134 Arrow-Timolol ...............................189 Arrow-Tolterodine ...........................81 Arrow-Topiramate .........................133 Arrow-Tramadol ............................127 Arrow-Venlafaxine XR ...................130 Arsenic trioxide .............................154 Asacol .............................................25 Asamax ...........................................25 Ascorbic acid ..................................41 Aspec 300 .....................................124 Aspen Adrenaline ...........................61 Aspen Ceftriaxone ..........................90 Aspirin Blood ..........................................46 Nervous ....................................124 Asthalin .........................................184 Atazanavir sulphate ......................109 Atenolol ...........................................55 Atenolol AFT ...................................55 ATGAM .........................................171 Ativan ............................................142 Atomoxetine ..................................145 Atorvastatin ....................................60 Atripla ...........................................108 Atropine sulphate Cardiovascular ...........................54 Sensory ....................................190 Atropt ............................................190 Atrovent ........................................184 Augmentin ......................................92 Auranofin ......................................115 Ava 20 ED .......................................77 Ava 30 ED .......................................77 Avanza ..........................................129 Avelox .............................................95 Avomine ........................................136 Avonex ..........................................144 Avonex Pen ...................................144 Azathioprine .................................165 Azithromycin ...................................91 Azol .................................................89 Azopt ............................................189 AZT ...............................................109 -BB-D Micro-Fine ...............................31 B-D Ultra Fine .................................31 B-D Ultra Fine II ..............................31 B-PlexADE ......................................41 Bacillus Calmette-Guerin (BCG) vaccine .................................... 171 Bacillus Calmette-Guerin vaccine .................................... 230 Baclofen ........................................121 Bactroban .......................................66 Bakels Gluten Free Health Bread Mix ........................................... 215 Baraclude .....................................101 Barrier Creams and Emollients .................................. 70 Batrafen ..........................................66 BCG Vaccine ................................230 Beclazone 100 ..............................182 Beclazone 250 ..............................182 Beclazone 50 ................................182 Beclomethasone dipropionate ..................... 182, 186 Bee venom allergy treatment ................................. 181 Bendrofluazide ................................59 Bendroflumethiazide [Bendrofluazide] ......................... 59 BeneFIX ..........................................45 Benhex ...........................................71 Benzathine benzylpenicillin ............93 Benzbromaron AL 100 ..................121

234


INDEX Generic Chemicals and Brands

Benzbromarone ............................121 Benzoin .........................................198 Benztrop .......................................123 Benztropine mesylate ...................123 Benzydamine hydrochloride ...........39 Benzylpenicillin sodium (penicillin G) ............................................... 92 Beta Adrenoceptor Blockers ...........55 Beta Cream ....................................68 Beta Ointment .................................68 Beta Scalp ......................................74 Beta-Adrenoceptor Agonists .........184 Betadine .........................................71 Betadine Skin Prep .........................71 Betaferon ......................................144 Betagan ........................................189 Betahistine dihydrochloride ..........135 Betamethasone dipropionate ..........68 Betamethasone dipropionate with calcipotriol .......................... 73 Betamethasone sodium phosphate with betamethasone acetate ............. 82 Betamethasone valerate ...........68, 74 Betamethasone valerate with clioquinol .................................... 69 Betamethasone valerate with fusidic acid ................................. 69 Betaxolol hydrochloride ................189 Betnovate .......................................68 Betnovate-C ....................................69 Betoptic .........................................189 Betoptic S .....................................189 Bezafibrate .....................................59 Bezalip ............................................59 Bezalip Retard ................................59 Bicalaccord ...................................163 Bicalutamide .................................163 Bicillin LA ..................................92, 93 BiCNU ...........................................151 Biltricide ..........................................90 Bimatoprost ..................................190 Biodone ........................................126 Biodone Extra Forte ......................126 Biodone Forte ...............................126 Bisacodyl ........................................39 Bismuth trioxide ..............................27 Bisoprolol ........................................55 BK Lotion ........................................70 Bleomycin sulphate ......................154 Blood Colony-stimulating Factors ....................................... 49 Blood glucose diagnostic test meter ......................................... 30 Blood glucose diagnostic test strip ............................................ 30 Blood glucose test strips (visually impaired) .................................... 31 Blood ketone diagnostic test meter ......................................... 29 Boceprevir ....................................105 Bonjela ............................................40 Boostrix ........................................230 Bortezomib ...................................154 Bosentan ........................................63 Bosvate ...........................................55 Bplex ...............................................41 Breath-Alert ..................................187 Brevinor 1/21 ..................................78 Brevinor 1/28 ..................................78 Brevinor 21 .....................................78 Bricanyl Turbuhaler .......................184 Brilinta ............................................46 Brimonidine tartrate ......................190 Brimonidine tartrate with timolol maleate .................................... 190 Brinzolamide .................................189 Brolene .........................................188 Bromocriptine mesylate ................122 Brufen ...........................................114 Brufen SR .....................................114 Buccastem ....................................136 Budenocort ...................................182 Budesonide Alimentary ..................................24 Respiratory .......................182, 187 Budesonide with eformoterol .............................. 183 Bumetanide ....................................58 Buprenorphrine with naloxone .................................. 148 Bupropion hydrochloride ...............149 Burinex ...........................................58 Buscopan ........................................26 Buspirone hydrochloride ...............142 Busulphan .....................................151 Butacort Aqueous .........................187 -CCabergoline ....................................88 Cafergot ........................................134 Caffeine citrate .............................187 Cal-d-Forte .....................................41 Calamine ........................................67 Calcipotriol ......................................73 Calcitonin ........................................82 Calcitriol ..........................................41 Calcitriol-AFT ..................................41 Calcium carbonate ....................24, 42 Calcium Channel Blockers .............57 Calcium Disodium Versenate ................................ 192 Calcium folinate ............................152 Calcium Folinate Ebewe ...............152 Calcium gluconate ..........................42 Calcium Homeostasis .....................82 Calcium polystyrene sulphonate ................................. 50 Calcium Resonium .........................50 Calogen ........................................204 Calsource .......................................42 Camptosar ....................................153 Candesartan cilexetil ......................53 Candestar .......................................53 Canesten ........................................66 Capecitabine .................................152 Capoten ..........................................52 Capsaicin Musculoskeletal System ...........115 Nervous ....................................125 Captopril .........................................52 Carafate ..........................................27 Carbaccord ...................................151 Carbamazepine ............................131 Carbimazole ...................................86 Carbomer ......................................191 Carboplatin ...................................151 Carboplatin Ebewe .......................151 Carbosorb-X .................................192 Cardinol LA .....................................56 CareSens ........................................30 CareSens II .....................................30 CareSens N ....................................30 CareSens N POP ...........................30 Carmustine ...................................151 Carvedilol .......................................55 Catapres .........................................58 Catapres-TTS-1 ..............................58 Catapres-TTS-2 ..............................58 Catapres-TTS-3 ..............................58 CeeNU ..........................................151 Cefaclor monohydrate ....................90 Cefalexin monohydrate ...................90 Cefalexin Sandoz ............................90 Cefazolin sodium ............................90 Ceftriaxone sodium ........................90 Cefuroxime axetil ............................90 Cefuroxime sodium .........................91 Celestone Chronodose ...................82 Celiprolol .........................................55

235


INDEX Generic Chemicals and Brands

Cellcept .........................................166 Celol ...............................................55 Centrally-Acting Agents ..................58 Cephalexin ABM .............................90 Ceptolate ......................................166 Cerezyme .......................................39 Cetirizine - AFT ............................181 Cetirizine hydrochloride ................181 Cetomacrogol .................................70 Cetomacrogol with glycerol ............70 Champix .......................................150 Charcoal .......................................192 Chemotherapeutic Agents ............151 Chlorafast .....................................188 Chlorambucil .................................151 Chloramphenicol ...........................188 Chlorhexidine gluconate Alimentary ..................................39 Dermatological ...........................69 Chloroform ....................................198 Chloromycetin ...............................188 Chlorothiazide .................................59 Chlorpheniramine maleate ...........181 Chlorpromazine hydrochloride ........................... 137 Chlorsig ........................................188 Chlortalidone [Chlorthalidone] ......................... 59 Chlorthalidone ................................59 Chlorvescent ..................................51 Cholecalciferol ................................41 Cholestyramine ...............................60 Choline salicylate with cetalkonium chloride .................. 40 Cholvastin .......................................60 Ciclopirox olamine ..........................66 Cilazapril .........................................52 Cilazapril with hydrochlorothiazide ................... 53 Cilicaine ..........................................93 Cilicaine VK ....................................93 Ciloxan ..........................................188 Cimetidine .......................................26 Cipflox .............................................94 Ciprofloxacin Infection ......................................94 Sensory ....................................188 Ciprofloxacin Rex ............................94 Cisplatin ........................................151 Cisplatin Ebewe ............................151 Citalopram hydrobromide .............129 Cladribine .....................................152 Clarithromycin Alimentary ..................................26 Infection ......................................91 Clexane ..........................................47 Climara 100 ....................................84 Climara 50 ......................................84 Clindamycin ....................................94 Clindamycin ABM ...........................94 Clobazam .....................................131 Clobetasol propionate ...............68, 74 Clobetasone butyrate .....................68 Clofazimine .....................................99 Clomazol Dermatological ...........................66 Genito-Urinary ............................79 Clomiphene citrate ..........................88 Clomipramine hydrochloride .........128 Clonazepam .................130–131, 142 Clonidine .........................................58 Clonidine BNM ................................58 Clonidine hydrochloride ..................58 Clopidogrel .....................................46 Clopine .........................................137 Clopixol .................................140, 141 Clotrimazole Dermatological ...........................66 Genito-Urinary ............................79 Clozapine ......................................137 Clozaril .........................................137 Co-Renitec ......................................53 Co-trimoxazole ...............................94 Coal tar ...........................................73 Coal tar with allantoin, menthol, phenol and sulphur .................... 74 Coal tar with salicylic acid and sulphur ....................................... 74 Coco-Scalp .....................................74 Codeine phosphate Extemporaneous ......................198 Nervous ....................................125 Cogentin .......................................123 Colaspase [L-asparaginase] .........155 Colchicine .....................................121 Colestid ...........................................60 Colestipol hydrochloride .................60 Colgout .........................................121 Colifoam .........................................25 Colistin sulphomethate ...................94 Colistin-Link ....................................94 Collodion flexible ..........................198 Colofac ...........................................26 Coloxyl ............................................38 Combigan .....................................190 Combivir .......................................109 Comfort ...........................................34 Comfort Short .................................34 Compound electrolytes ...................50 Compound hydroxybenzoate ..................... 198 Concerta .......................................147 Condoms ........................................76 Condyline ........................................75 Contact-D .......................................33 Contraceptives - Hormonal .............77 Contraceptives Non-hormonal ............................ 76 Copaxone .....................................144 Corangin .........................................61 Cordarone-X ...................................54 Corticosteroids and Related Agents for Systemic Use ........... 82 Corticosteroids Topical ...................68 Cosmegen ....................................155 Cosopt ..........................................190 Coumadin .......................................49 Coversyl ..........................................53 Creon 10000 ...................................37 Creon Forte ....................................37 Crixivan .........................................109 Crotamiton ......................................67 Crystaderm .....................................66 Curam Duo .....................................92 Cvite ...............................................41 Cyclizine hydrochloride .................135 Cyclizine lactate ............................135 Cycloblastin ..................................151 Cyclogyl ........................................190 Cyclopentolate hydrochloride ........................... 190 Cyclophosphamide .......................151 Cycloserine .....................................99 Cyclosporin ...................................180 Cyklokapron ....................................45 Cyproterone acetate .......................83 Cyproterone acetate with ethinyloestradiol ......................... 79 Cytarabine ....................................152 Cytotec ...........................................26 Cytoxan ........................................151 -DD-Penamine ..................................115 d4T ...............................................108 Dabigatran ......................................48 Dacarbazine .................................155 Dactinomycin [Actinomycin D] ............................................. 155 Daivobet .........................................73

236


INDEX Generic Chemicals and Brands

Daivonex .........................................73 Daktarin ..........................................67 Dalacin C ........................................94 Dalteparin sodium ..........................47 Danazol ..........................................89 Danthron with poloxamer ................39 Dantrium .......................................121 Dantrolene ....................................121 Daonil .............................................29 Dapa-Tabs ......................................59 Dapsone .........................................99 Daraprim .........................................95 Darunavir ......................................109 Dasatinib .......................................159 Daunorubicin ................................155 DBL Aminophylline .......................186 DBL Bleomycin Sulfate .................154 DBL Carboplatin ...........................151 DBL Doxorubicin ...........................156 DBL Doxorubicin S29 ...................156 DBL Epirubicin Hydrochloride .......................... 156 DBL Ergometrine ............................79 DBL Gemcitabine .........................153 DBL Leucovorin Calcium ..............152 DBL Methotrexate .........................154 DBL Morphine Sulphate ...............126 DBL Pethidine Hydrochloride .......................... 127 DBL Tobramycin .............................96 DDI ...............................................108 De Nol .............................................27 De-Worm ........................................90 Decozol ...........................................40 Deferiprone ...................................192 Deoxycoformycin ..........................157 Depo-Medrol ...................................82 Depo-Medrol with Lidocaine ...........82 Depo-Provera .................................78 Depo-Testosterone .........................83 Deprim ............................................94 Dermol ......................................68, 74 Desferrioxamine mesylate ............192 Desmopressin .................................88 Desmopressin-PH&T ......................88 Detection of Substances in Urine .......................................... 81 Dexamethasone Hormone ....................................82 Sensory ....................................189 Dexamethasone sodium phosphate .................................. 82 Dexamethasone with framycetin and gramicidin ......................... 188 Dexamethasone with neomycin and polymyxin b sulphate .........189 Dexamphetamine sulphate ...........145 Dextrochlorpheniramine maleate .................................... 181 Dextrose .........................................49 Dextrose with electrolytes ...............50 DHC Continus ...............................125 Diabetes .........................................27 Diabetes Management ...................29 Diacomit ........................................133 Diamide Relief ................................24 Diamox .........................................189 Diaphragm ......................................76 Diasip ............................................205 Diason RTH ..................................205 Diastop ...........................................24 Diazepam .............................130, 142 Diazoxide ........................................27 Dibenyline .......................................52 Diclax SR ......................................114 Diclofenac sodium Musculoskeletal System ...........114 Sensory ....................................189 Didanosine [DDI] ..........................108 Differin ............................................65 Difflam ............................................39 Diflucan ...........................................96 Diflucortolone valerate ....................68 Digestives Including Enzymes .................................... 37 Digoxin ............................................54 Dihydrocodeine tartrate ................125 Dilantin ..........................................133 Dilantin Infatab ..............................133 Dilatrend .........................................55 Diltiazem hydrochloride ..................57 Dilzem .............................................57 Dipentum ........................................25 Diphenoxylate hydrochloride with atropine sulphate ....................... 24 Diphtheria and tetanus vaccine .................................... 230 Diphtheria, tetanus and pertussis vaccine .................................... 230 Diphtheria, tetanus, pertussis and polio vaccine ..................... 230 Diphtheria, tetanus, pertussis, polio, hepatitis B and haemophilus influenzae type B vaccine .................................... 230 Diprosone .......................................68 Diprosone OV .................................68 Dipyridamole ...................................46 Disinfecting and Cleansing Agents ....................................... 69 Disipal ...........................................123 Disopyramide phosphate ................54 Disulfiram ......................................149 Diuretics ..........................................58 Diurin 40 .........................................58 Docetaxel ......................................156 Docetaxel Ebewe ..........................156 Docetaxel Sandoz ........................156 Docusate sodium ............................38 Docusate sodium with sennosides ................................ 38 Domperidone ................................135 Donepezil hydrochloride ...............148 Donepezil-Rex ..............................148 Dopergin .......................................122 Dopress ........................................128 Dornase alfa .................................186 Dorzolamide hydrochloride ...........190 Dorzolamide hydrochloride with timolol maleate ........................ 190 Dostinex ..........................................88 Dothiepin hydrochloride ................128 Doxazosin .......................................52 Doxepin hydrochloride ..................128 Doxine ............................................93 Doxorubicin ...................................156 Doxorubicin Ebewe .......................156 Doxy-50 ..........................................93 Doxycycline hydrochloride ..............93 DP Lotion ........................................70 DP Lotn HC ....................................68 DP-Anastrozole ............................165 Dr Reddy’s Olanzapine .................138 Dr Reddy’s Omeprazole .................27 Dr Reddy’s Ondansetron ..............136 Dr Reddy’s Pantoprazole ................27 Dr Reddy’s Pramipexole ...............122 Dr Reddy’s Quetiapine .................138 Dr Reddy’s Risperidone ................139 Dr Reddy’s Terbinafine ...................98 Drugs Affecting Bone Metabolism .............................. 116 Dulcolax ..........................................39 Duocal Super Soluble Powder ..................................... 203 Duolin ...........................................185 Duolin HFA ...................................185 Durex Confidence ...........................76 Durex Extra Safe ............................76

237


INDEX Generic Chemicals and Brands

Durex Select Flavours ....................76 Duride .............................................61 Dynacirc-SRO .................................57 -EE-Mycin ...........................................91 Ear Preparations ...........................188 Ear/Eye Preparations ...................188 Easiphen Liquid ............................217 Econazole nitrate ............................67 Efavirenz .......................................108 Efavirenz with emtricitabine and tenofovir disoproxil fumarate .................................. 108 Efexor XR .....................................130 Effient .............................................46 Eformoterol fumarate ....................183 Efudix ..............................................75 Egopsoryl TA ..................................74 Elecare .........................................218 Elecare LCP .................................218 Electral ............................................50 Elemental 028 Extra .....................208 Eligard ............................................87 Elocon .............................................69 Eloxatin .........................................152 Eltroxin ............................................86 Emend Tri-Pack ............................135 EMLA ............................................124 Emtricitabine .................................108 Emtricitabine with tenofovir disoproxil fumarate .................. 108 Emtriva .........................................108 Emulsifying ointment ......................70 Enalapril maleate ............................52 Enalapril maleate with hydrochlorothiazide ................... 53 Enbrel ...........................................166 Endocrine Therapy .......................163 Endoxan .......................................151 Enerlyte ..........................................50 Enfuvirtide ....................................109 Enoxaparin sodium .........................47 Ensure ..........................................212 Ensure Plus ..................................213 Ensure Plus HN ............................212 Ensure Plus RTH ..........................212 Entacapone ..................................122 Entapone ......................................122 Entecavir .......................................101 Entocort CIR ...................................24 Epilim ............................................133 Epilim Crushable ..........................133 Epilim IV .......................................133 Epilim S/F Liquid ...........................133 Epilim Syrup .................................133 Epirubicin ......................................156 Epirubicin Ebewe ..........................156 Eprex ..............................................44 Eptacog alfa [Recombinant factor VIIa] ........................................... 45 ERA ................................................91 Ergometrine maleate ......................79 Ergotamine tartrate with caffeine .................................... 134 Erlotinib hydrochloride ..................159 Erythrocin IV ...................................91 Erythromycin ethyl succinate ..........91 Erythromycin lactobionate ..............91 Erythromycin stearate ....................91 Erythropoietin alpha .......................44 Erythropoietin beta .........................44 Escitalopram .................................129 Eskazole .........................................90 Estradot ..........................................84 Estrofem .........................................84 Etanercept ....................................166 Ethambutol hydrochloride ...............99 Ethics Aspirin ................................124 Ethics Aspirin EC ............................46 Ethics Enalapril ...............................52 Ethics Paracetamol .......................125 Ethinyloestradiol .............................85 Ethinyloestradiol with desogestrel ................................ 77 Ethinyloestradiol with levonorgestrel ............................ 77 Ethinyloestradiol with norethisterone ............................ 78 Ethosuximide ................................131 Etidronate disodium ......................117 Etopophos ....................................156 Etoposide ......................................156 Etoposide phosphate ....................156 Etravirine ......................................108 Eumovate .......................................68 Evista ............................................117 Exemestane ..................................165 Extemporaneously Compounded Preparations and Galenicals ................................ 198 Eye Preparations ..........................188 EZ-fit Paediatric Mask ..................187 Ezetimibe ........................................60 Ezetimibe with simvastatin .............61 Ezetrol ............................................60 -FFactor eight inhibitors bypassing agent ......................................... 45 Feed Thickener Karicare Aptamil ..................................... 215 FEIBA .............................................45 Felodipine .......................................57 Femtran 100 ...................................84 Femtran 50 .....................................84 Fenpaed .......................................114 Fentanyl ........................................125 Ferodan ..........................................42 Ferriprox .......................................192 Ferro-F-Tabs ...................................42 Ferro-tab .........................................42 Ferrograd ........................................42 Ferrograd F .....................................42 Ferrous fumarate ............................42 Ferrous fumarate with folic acid ............................................ 42 Ferrous sulphate .............................42 Ferrous sulphate with folic acid ............................................ 42 Ferrum H ........................................42 Fexofenadine hydrochloride .........181 Fibro-vein ........................................45 Filgrastim ........................................49 Finasteride ......................................80 Flagyl ..............................................99 Flagyl-S ..........................................99 Flamazine .......................................66 Flecainide acetate ..........................54 Fleet Phosphate Enema .................39 Flixonase Hayfever & Allergy ...................................... 187 Flixotide ........................................182 Flixotide Accuhaler .......................182 Florinef ...........................................82 Fluanxol ........................................140 Fluarix ...........................................230 Flucloxacillin sodium .......................93 Flucloxin .........................................93 Flucon ...........................................189 Fluconazole ....................................96 Fludara .........................................153 Fludara Oral ..................................153 Fludarabine Ebewe .......................153 Fludarabine phosphate .................153 Fludrocortisone acetate ..................82 Fluids and Electrolytes ...................49 Flumetasone pivalate ...................188 Fluocortolone caproate with

238


INDEX Generic Chemicals and Brands

fluocortolone pivalate and cinchocaine ................................ 26 Fluorometholone ...........................189 Fluorouracil Ebewe .......................153 Fluorouracil sodium Dermatological ...........................75 Oncology ..................................153 Fluox .............................................129 Fluoxetine hydrochloride ...............129 Flupenthixol decanoate ................140 Fluphenazine decanoate ..............140 Flutamide ......................................164 Flutamin ........................................164 Flutamin S29 ................................164 Fluticasone ...................................182 Fluticasone propionate .................187 Fluticasone with salmeterol ..........183 Fluvax ...........................................230 Foban .............................................66 Folic acid ........................................44 Food Thickeners ...........................215 Foods And Supplements For Inborn Errors Of Metabolism .............................. 216 Foradil ...........................................183 Forteo ...........................................118 Fortimel Regular ...........................206 Fortini ...........................................207 Fortini Multi Fibre ..........................207 Fortisip ..................................212, 213 Fortisip Multi Fibre ........................213 Fosamax .......................................117 Fosamax Plus ...............................117 Fragmin ..........................................47 Framycetin sulphate .....................188 Freestyle Optium ......................29, 30 Freestyle Optium Ketone ................29 Frisium ..........................................131 Frumil ..............................................59 Frusemide .......................................58 Frusemide-Claris ............................58 Fucicort ...........................................69 Fucidin ............................................94 Fucithalmic ...................................188 Fungilin ...........................................40 Furosemide [Frusemide] .................58 Fusidic acid Dermatological ...........................66 Infection ......................................94 Sensory ....................................188 Fuzeon ..........................................109 -GGabapentin ...................................131 Gabapentin (Neurontin) ................132 Gamma benzene hexachloride .............................. 71 Gardasil ........................................230 Gastrosoothe ..................................26 Gaviscon Double Strength ..............24 Gaviscon Infant ...............................24 Gefitinib ........................................160 Gemcitabine Actavis 1000 ............153 Gemcitabine Actavis 200 ..............153 Gemcitabine Ebewe .....................153 Gemcitabine hydrochloride ...........153 Gemfibrozil .....................................59 Gemzar .........................................153 Genoptic .......................................188 Genotropin ......................................87 Genox ...........................................165 Gentamicin sulphate Infection ......................................94 Sensory ....................................188 Ginet 84 ..........................................79 Glatiramer acetate ........................144 Glibenclamide .................................29 Gliclazide ........................................29 Glipizide ..........................................29 Glivec ............................................160 Glucagen Hypokit ...........................27 Glucagon hydrochloride ..................27 Glucerna Select ............................205 Glucerna Select RTH ....................205 Gluten Free Foods ........................215 Glycerin with sodium saccharin ................................. 198 Glycerin with sucrose ...................198 Glycerol Alimentary ..................................38 Extemporaneous ......................198 Glyceryl trinitrate Alimentary ..................................26 Cardiovascular ...........................61 Glytrin .............................................61 Gold Knight .....................................76 Gopten ............................................53 Goserelin acetate ...........................87 Gutron .............................................55 Gynaecological Anti-infectives ............................ 79 -HHabitrol .........................................150 Haemophilus influenzae type B vaccine .................................... 230 Haldol ...........................................140 Haldol Concentrate .......................140 Haloperidol ...................................137 Haloperidol decanoate .................140 Hamilton Sunscreen .......................74 Havrix Junior .................................230 HBvaxPro .....................................230 healthE Fatty Cream .......................70 healthE Urea Cream .......................70 Healtheries Simple Baking Mix ........................................... 215 Hemastix .........................................81 Heparin sodium ..............................48 Heparinised saline ..........................48 Heparon Junior .............................206 Hepatitis A vaccine .......................230 Hepatitis B vaccine .......................230 Hepsera ........................................100 Herceptin ......................................178 Hexamine hippurate .....................112 Hiprex ...........................................112 Histafen ........................................181 Holoxan ........................................151 Horleys Bread Mix ........................215 Horleys Flour ................................215 Hormone Replacement Therapy Systemic .................................... 83 HPV ..............................................230 Humalog .........................................28 Humalog Mix 25 ..............................28 Humalog Mix 50 ..............................28 Human papillomavirus (6, 11, 16 and 18) vaccine [HPV] ............. 230 Humatin ..........................................95 Humira ..........................................171 HumiraPen ....................................171 Humulin 30/70 ................................28 Humulin NPH ..................................28 Humulin R .......................................28 Hybloc .............................................56 Hydralazine .....................................62 Hydralazine hydrochloride ..............62 Hydrea ..........................................156 Hydrocortisone Dermatological ...........................68 Hormone ....................................82 Hydrocortisone acetate ..................25 Hydrocortisone butyrate ...........68, 74 Hydrocortisone with cinchocaine ................................ 26 Hydrocortisone with miconazole ................................ 69 Hydrocortisone with natamycin and neomycin ............................ 69 Hydrocortisone with wool fat and

239


INDEX Generic Chemicals and Brands

mineral oil .................................. 68 Hydroderm Lotion ...........................70 Hydrogen peroxide Alimentary ..................................40 Dermatological ...........................66 Hydroxocobalamin ..........................40 Hydroxychloroquine ......................115 Hydroxyurea .................................156 Hygroton .........................................59 Hylo-Fresh ....................................191 Hyoscine hydrobromide ................135 Hyoscine N-butylbromide ...............26 Hypam ..........................................145 Hyperuricaemia and Antigout ................................... 120 Hypnovel .......................................144 Hypromellose ................................191 Hypromellose with Dextran ...........191 Hysite ............................................190 -IIbiamox ...........................................92 Ibuprofen ......................................114 Idarubicin hydrochloride ...............157 Ifosfamide .....................................151 Igroton ............................................59 Ikorel ...............................................62 Iloprost ............................................64 Imatinib mesilate ...........................160 Imiglucerase ...................................39 Imipramine hydrochloride .............128 Imiquimod .......................................75 Immune Modulators ......................110 Immunosuppressants ...................165 Imuprine .......................................165 Imuran ..........................................165 Indapamide .....................................59 Indinavir ........................................109 Infanrix-hexa .................................230 Infanrix-IPV ...................................230 Infant Formulae ............................217 Influenza vaccine ..........................230 Inhaled Anticholinergic Agents ..................................... 184 Inhaled Corticosteroids .................182 Inhaled Long-acting Beta-adrenoceptor Agonists ................................... 182 Inhibace Plus ..................................53 Innovacon hCG One Step Pregnancy Test .......................... 80 Inset 30 ...........................................34 Inset II .............................................35 Insulin aspart ..................................28 Insulin aspart with insulin aspart protamine ................................... 28 Insulin glargine ...............................28 Insulin glulisine ...............................28 Insulin isophane ..............................28 Insulin isophane with insulin neutral ........................................ 28 Insulin lispro ....................................28 Insulin lispro with insulin lispro protamine ................................... 28 Insulin neutral .................................28 Insulin pen needles .........................31 Insulin pump ...................................32 Insulin pump accessories ...............32 Insulin pump infusion set (steel cannula) ..................................... 33 Insulin pump infusion set (teflon cannula, angle insertion with insertion device) ........................ 34 Insulin pump infusion set (teflon cannula, angle insertion) ........... 34 Insulin pump infusion set (teflon cannula, straight insertion with insertion device) ........................ 35 Insulin pump infusion set (teflon cannula, straight insertion) .........36 Insulin pump reservoir ....................36 Insulin syringes, disposable with attached needle ......................... 31 Intal Forte CFC Free .....................186 Intal Spincaps ...............................186 Intelence .......................................108 Interferon alfa-2a ..........................111 Interferon alfa-2b ..........................111 Interferon beta-1-alpha .................144 Interferon beta-1-beta ...................144 Intra-uterine device .........................76 Intron-A .........................................111 IPOL .............................................232 Ipratropium bromide .............184, 187 Iressa ............................................160 Irinotecan ......................................153 Irinotecan Actavis 100 ..................153 Irinotecan Actavis 40 ....................153 Irinotecan-Rex ..............................153 Iron polymaltose .............................42 Isentress .......................................109 Ismo 20 ...........................................61 Isoniazid .......................................100 Isoprenaline ....................................62 Isoptin .............................................58 Isopto Carpine ..............................190 Isosorbide mononitrate ...................61 Isosource Standard ......................211 Isosource Standard RTH ..............211 Isotretinoin ......................................65 Ispaghula (psyllium) husk ...............38 Isradipine ........................................57 Isuprel .............................................62 Itch-Soothe .....................................67 Itraconazole ....................................97 Itrazole ............................................97 Ivermectin .......................................71 -JJadelle ............................................78 Jevity ............................................212 Jevity HiCal RTH ..........................212 Jevity RTH ....................................212 -KKaletra ..........................................109 Kemadrin ......................................123 Kenacomb ....................................188 Kenacort-A ......................................83 Kenacort-A40 ..................................83 Ketocal 3:1 ....................................219 KetoCal 4:1 ...................................219 Ketoconazole Dermatological ...........................74 Infection ......................................97 Ketogenic Diet ..............................219 Ketone blood beta-ketone electrodes .................................. 29 Ketoprofen ....................................114 Ketostix ...........................................29 Kindergen .....................................206 Kivexa ...........................................108 Klacid ..............................................91 Kliogest ...........................................85 Kliovance ........................................85 Kogenate FS ...................................45 Konakion MM ..................................46 Konsyl-D .........................................38 -LL-asparaginase .............................155 Labetalol .........................................56 Lacosamide ..................................132 Lacri-Lube ....................................191 Lactulose ........................................38 Laevolac .........................................38 Lamictal ........................................132 Lamivudine ...........................102, 108 Lamivudine Alphapharm ...............108 Lamotrigine ...................................132 Lamprene .......................................99

240


INDEX Generic Chemicals and Brands

Lanoxin ...........................................54 Lanoxin PG .....................................54 Lansoprazole ..................................27 Lantus .............................................28 Lantus SoloStar ..............................28 Lanvis ...........................................154 Lapatinib Ditosylate ......................161 Largactil ........................................137 Lasix ...............................................58 Latanoprost ...................................190 Lax-Sachets ....................................38 Lax-Tab ...........................................39 Laxatives ........................................38 Laxofast 120 ...................................38 Laxofast 50 .....................................38 Laxsol .............................................38 Leflunomide ..................................115 Letraccord .....................................165 Letrozole .......................................165 Leukeran FC .................................151 Leukotriene Receptor Antagonists .............................. 185 Leunase ........................................155 Leuprorelin ......................................87 Leustatin .......................................152 Levetiracetam ...............................133 Levetiracetam-Rex ........................133 Levobunolol ..................................189 Levocabastine ..............................189 Levodopa with benserazide ..........122 Levodopa with carbidopa ..............122 Levomepromazine maleate ..........137 Levonorgestrel Genito-Urinary ......................78–79 Hormone ....................................85 Levothyroxine ..................................86 Lidocaine [Lignocaine] ..................124 Lidocaine [Lignocaine] hydrochloride ........................... 124 Lidocaine [Lignocaine] with chlorhexidine ........................... 124 Lidocaine [Lignocaine] with prilocaine ................................. 124 Lidocaine-Claris ............................124 Lifestyles Flared .............................76 Lignocaine ..............................82, 124 Hormone ....................................82 Nervous ....................................124 Lincocin ..........................................95 Lincomycin ......................................95 Lipazil .............................................59 Lipid-Modifying Agents ...................59 Liquigen ........................................204 Lisinopril .........................................53 Lisuride hydrogen maleate ...........122 Lithicarb FC ..................................137 Lithium carbonate .........................137 Livostin .........................................189 Locacorten-Viaform ED’s ..............188 Local preparations for Anal and Rectal Disorders ........................ 26 Locasol .........................................218 Loceryl ............................................66 Locoid .......................................68, 74 Locoid Crelo ...................................68 Locoid Lipocream ...........................68 Locorten-Vioform ..........................188 Lodoxamide trometamol ...............189 Logem ...........................................132 Lomide ..........................................189 Lomustine .....................................151 Loniten ............................................62 Loperamide hydrochloride ..............24 Lopinavir with ritonavir ..................109 Lopresor .........................................56 Loprofin .........................................217 Loprofin Mix ..................................217 Loraclear Hayfever Relief .............181 Lorafix ...........................................181 Lorapaed ......................................181 Loratadine .....................................181 Lorazepam ....................................142 Lormetazepam .............................144 Losartan potassium ........................54 Losartan potassium with hydrochlorothiazide ................... 54 Lostaar ............................................54 Lovir ..............................................103 Loxalate ........................................129 Loxamine ......................................129 Lucrin Depot ...................................87 Lucrin Depot PDS ...........................87 Ludiomil ........................................128 Lumigan ........................................190 Lycinate ..........................................61 Lyderm ............................................72 -Mm-Captopril .....................................52 m-Cefuroxime .................................91 m-Enalapril .....................................52 m-Eslon ........................................126 M-M-R II ........................................231 m-Mometasone ...............................69 Mabthera ......................................177 Macrogol 3350 ................................38 Macrogol 400 and propylene glycol ....................................... 191 Madopar 125 ................................122 Madopar 250 ................................122 Madopar 62.5 ...............................122 Madopar HBS ...............................122 Madopar Rapid .............................122 Magnesium hydroxide ...................198 Magnesium sulphate Alimentary ..................................42 Dermatological ...........................75 Malathion ........................................72 Malathion with permethrin and piperonyl butoxide ...................... 72 Maprotiline hydrochloride .............128 Marevan ..........................................49 Marine Blue Lotion SPF 30+ ..........74 Marquis Black .................................76 Marquis Conforma ..........................76 Marquis Protecta ............................76 Marquis Selecta ..............................76 Marquis Sensolite ...........................76 Marquis Supalite .............................76 Marquis Titillata ..............................76 MarquisTantiliza ..............................76 Martindale Acetylcysteine .............192 Marvelon 28 ....................................77 Mask for spacer device .................187 Mast Cell Stabilisers .....................186 Maxidex ........................................189 Maxitrol .........................................189 MCT oil (Nutricia) .........................204 Measles, mumps and rubella vaccine .................................... 231 Mebendazole ..................................90 Mebeverine hydrochloride ..............26 Medrol .............................................82 Medroxyprogesterone acetate Genito-Urinary ............................78 Hormone ..............................85–86 Mefenamic acid ............................114 Megestrol acetate .........................164 Meloxicam ....................................115 Melphalan .....................................151 Meningococcal A, C, Y and W-135 vaccine ......................... 231 Menomune ....................................231 Menthol ...........................................67 Mercaptopurine ............................153 Mercilon 28 .....................................77 Mesalazine .....................................25 Mesna ...........................................157 Mestinon .......................................114

241


INDEX Generic Chemicals and Brands

Metabolic Disorder Agents .............39 Metamide ......................................135 Metformin hydrochloride .................29 Methadone hydrochloride Extemporaneous ......................198 Nervous ....................................126 Methatabs .....................................126 Methoblastin .................................154 Methopt .........................................191 Methotrexate .................................154 Methotrexate Ebewe .....................154 Methotrexate Sandoz ...................154 Methyl hydroxybenzoate ...............198 Methylcellulose .............................198 Methylcellulose with glycerin and sodium saccharin .................... 199 Methylcellulose with glycerin and sucrose .................................... 199 Methyldopa .....................................58 Methylphenidate hydrochloride ........................... 146 Methylphenidate hydrochloride extended-release ..................... 147 Methylprednisolone ........................82 Methylprednisolone aceponate .................................. 68 Methylprednisolone acetate ............82 Methylprednisolone acetate with lidocaine [Lignocaine] ................ 82 Methylprednisolone sodium succinate ................................... 82 Methylxanthines ............................186 Metoclopramide hydrochloride ........................... 135 Metoclopramide hydrochloride with paracetamol ..................... 134 Metolazone .....................................59 Metopirone ......................................89 Metoprolol - AFT CR .......................56 Metoprolol succinate .......................56 Metoprolol tartrate ..........................56 Metronidazole .................................99 Metyrapone .....................................89 Mexiletine hydrochloride .................55 Mexiletine Hydrochloride USP ........................................... 55 Miacalcic .........................................82 Mianserin hydrochloride ...............128 Micolette .........................................39 Miconazole .....................................40 Miconazole nitrate Dermatological ...........................67 Genito-Urinary ............................79 Micreme ..........................................79 Micreme H ......................................69 Microgynon 30 ................................77 Microgynon 50 ED ..........................77 Microlut ...........................................78 Midazolam ....................................144 Midodrine ........................................55 Minerals ..........................................42 Minidiab ..........................................29 Minirin .............................................88 Mino-tabs ........................................93 Minocycline hydrochloride ..............93 Minomycin ......................................93 Minor Skin Infections ......................71 Minoxidil ..........................................62 Mirena .............................................85 Mirtazapine ...................................129 Misoprostol .....................................26 Mitomycin C ..................................157 Mitozantrone .................................157 Mitozantrone Ebewe .....................157 Mixtard 30 .......................................28 Moclobemide ................................128 Modafinil .......................................148 Modavigil ......................................148 Modecate ......................................140 Moducal ........................................202 Moduretic ........................................59 Mogine ..........................................132 Mometasone furoate .......................69 Monogen .......................................205 Montelukast ..................................185 Moroctocog alfa [Recombinant factor VIII] .................................. 45 Morphine hydrochloride ................126 Morphine sulphate ........................126 Morphine tartrate ..........................126 Motetis ..........................................124 Mouth and Throat ...........................39 Moxifloxacin ....................................95 MSUD Maxamaid .........................216 MSUD Maxamum .........................216 Mucilaginous laxatives with stimulants .................................. 38 Mucolytics .....................................186 MultiADE .........................................41 Multiload Cu 375 .............................76 Multiload Cu 375 SL .......................76 Multiple Sclerosis Treatments ............................... 142 Multivitamins ...................................41 Mupirocin ........................................66 Muscle Relaxants .........................121 Mvite ...............................................41 Myaccord ......................................166 Myambutol ......................................99 Mycobutin .....................................100 Mycophenolate mofetil ..................166 Mycostatin ......................................67 Mydriacyl ......................................190 Mylan Atenolol ................................55 Mylan Fentanyl Patch ...................125 Mylanta P ........................................24 Myleran .........................................151 Myocrisin ......................................115 Myometrial and Vaginal Hormone Preparations .............................. 79 -NNadolol ...........................................56 Nalcrom ..........................................25 Naloxone hydrochloride ................192 Naltraccord ...................................149 Naltrexone hydrochloride ..............149 Naphazoline hydrochloride ...........191 Naphcon Forte ..............................191 Naprosyn SR 1000 .......................114 Naprosyn SR 750 .........................114 Naproxen ......................................114 Nardil ............................................128 Nasal Preparations .......................186 Natulan .........................................158 Nausicalm .....................................135 Navelbine ......................................159 Navoban .......................................136 Nedocromil ...................................186 Nefopam hydrochloride ................125 Neo-Mercazole ...............................86 Neocate Advance .........................218 Neocate Gold ................................218 Neocate LCP ................................218 Neoral ...........................................180 NeoRecormon ................................44 Neostigmine metilsulfate ..............114 Neotigason .....................................73 Nepro (strawberry) ........................208 Nepro (vanilla) ..............................208 Nepro RTH ...................................207 Nerisone .........................................68 Neulactil ........................................138 Neulastim ........................................49 NeuroKare ......................................42 Neurontin ......................................132 Nevirapine ....................................108 Nevirapine Alphapharm ................108 Nicorandil ........................................62 Nicotine .........................................150

242


INDEX Generic Chemicals and Brands

Nicotinic acid ..................................60 Nifedipine ........................................57 Nifuran ..........................................113 Nilstat Alimentary ..................................40 Genito-Urinary ............................79 Infection ......................................97 Nipent ...........................................157 Nitrados ........................................144 Nitrates ...........................................61 Nitrazepam ...................................144 Nitroderm TTS ................................61 Nitrofurantoin ................................113 Nizoral ............................................97 Noctamid ......................................144 Nodia ..............................................24 Noflam 250 ...................................114 Noflam 500 ...................................114 Non-Steroidal Anti-Inflammatory Drugs ....................................... 114 Nonacog alfa [Recombinant factor IX] .................................... 45 Norethisterone Genito-Urinary ............................78 Hormone ....................................86 Norethisterone with mestranol ................................... 78 Norflex ..........................................121 Norfloxacin ....................................113 Noriday 28 ......................................78 Norimin ...........................................78 Norinyl-1/28 ....................................78 Normacol Plus ................................38 Normison ......................................144 Norpress .......................................128 Nortriptyline hydrochloride ............128 Norvir ............................................109 NovaSource Renal .......................208 Novatretin .......................................73 NovoFine ........................................31 NovoMix 30 FlexPen .......................28 NovoRapid ......................................28 NovoRapid Penfill ...........................28 NovoSeven RT ................................45 Novoseven RT ................................45 Noxafil .............................................97 Nozinan ........................................137 Nuelin ...........................................186 Nuelin-SR .....................................186 Nupentin .......................................131 Nutraplus ........................................70 Nutrient Modules ..........................202 Nutrini Energy Multi Fibre .............207 Nutrini Energy RTH ......................207 Nutrini Low Energy Multi Fibre ........................................ 209 Nutrini RTH ...................................207 Nutrison Concentrated .................214 Nutrison Energy ............................211 Nutrison Energy Multi Fibre ..........212 Nutrison Multi Fibre ......................212 Nutrison Standard RTH ................211 Nyefax Retard .................................57 Nystatin Alimentary ..................................40 Dermatological ...........................67 Genito-Urinary ............................79 Infection ......................................97 NZB Low Gluten Bread Mix ..........215 -OOctocog alfa [Recombinant factor VIII] ............................................ 45 Octreotide (somatostatin analogue) ................................. 164 Octreotide LAR (somatostatin analogue) ................................. 164 Octreotide MaxRx .........................164 Oestradiol .......................................84 Oestradiol valerate .........................84 Oestradiol with norethisterone ............................ 85 Oestriol Genito-Urinary ............................79 Hormone ....................................85 Oestrogens .....................................84 Oestrogens with medroxyprogesterone ................ 85 Oil in water emulsion ......................70 Olanzapine ...........................138, 140 Olanzine .......................................138 Olanzine-D ....................................138 Olbetam ..........................................60 Olopatadine ..................................191 Olsalazine .......................................25 Omeprazole ....................................27 Omezol Relief .................................27 Oncaspar ......................................157 OncoTICE .....................................171 Ondansetron .................................136 One-Alpha ......................................41 Onelink ...........................................62 Onkotrone .....................................157 Onrex ............................................136 Ora-Blend .....................................199 Ora-Blend SF ................................199 Ora-Plus .......................................198 Ora-Sweet ....................................198 Ora-Sweet SF ...............................198 Orabase ..........................................40 Oracort ...........................................40 Oral Supplements/Complete Diet (Nasogastric/Gastrostomy Tube Feed) .............................. 204 Oratane ...........................................65 Orgran ..........................................216 Ornidazole ......................................99 Orphenadrine citrate .....................121 Orphenadrine hydrochloride .........123 Ortho All-flex ...................................76 Ortho-tolidine ..................................81 Oruvail SR ....................................114 Osmolite .......................................211 Osmolite RTH ...............................211 Ospamox ........................................92 Ospamox Paediatric Drops .............92 Other Endocrine Agents .................88 Other Oestrogen Preparations .............................. 85 Other Progestogen Preparations .............................. 85 Other Skin Preparations .................75 Ovestin Genito-Urinary ............................79 Hormone ....................................85 Ox-Pam ........................................142 Oxaliplatin .....................................152 Oxaliplatin Actavis 100 .................152 Oxaliplatin Actavis 50 ...................152 Oxaliplatin Ebewe .........................152 Oxazepam ....................................142 Oxis Turbuhaler ............................183 Oxpentifylline ..................................62 Oxybutynin ......................................80 Oxycodone hydrochloride .............127 Oxycodone Orion .........................127 OxyContin .....................................127 Oxydone BNM ..............................127 OxyNorm ......................................127 Oxytocin ..........................................79 Oxytocin BNM .................................79 Ozole ..............................................96 -PPacifen ..........................................121 Pacific Buspirone ..........................142 Paclitaxel ......................................157 Paclitaxel Actavis ..........................157 Paclitaxel Ebewe ..........................157 Paediatric Seravit ...........................41 Pamidronate BNM ........................117

243


INDEX Generic Chemicals and Brands

Pamidronate disodium ..................117 Pamisol .........................................117 Panadol ........................................125 Pancreatic enzyme .........................37 Pantoprazole ...................................27 Panzytrat ........................................37 Papaverine hydrochloride ...............62 Para Plus ........................................72 Para-amino salicylic acid ..............100 Paracare .......................................125 Paracare Double Strength ............125 Paracetamol .................................125 Paracetamol + Codeine (Relieve) .................................. 127 Paracetamol with codeine ............127 Paradigm 1.8 Reservoir ..................36 Paradigm 3.0 Reservoir ..................36 Paradigm 522 .................................32 Paradigm 722 .................................32 Paradigm Mio MMT-921 ..................35 Paradigm Mio MMT-923 ..................35 Paradigm Mio MMT-925 ..................35 Paradigm Mio MMT-941 ..................35 Paradigm Mio MMT-943 ..................35 Paradigm Mio MMT-945 ..................35 Paradigm Mio MMT-965 ..................35 Paradigm Mio MMT-975 ..................35 Paradigm Quick-Set MMT-386 .................................... 36 Paradigm Quick-Set MMT-387 .................................... 36 Paradigm Quick-Set MMT-396 .................................... 36 Paradigm Quick-Set MMT-397 .................................... 36 Paradigm Quick-Set MMT-398 .................................... 36 Paradigm Quick-Set MMT-399 .................................... 36 Paradigm Silhouette MMT-368 .................................... 34 Paradigm Silhouette MMT-377 .................................... 34 Paradigm Silhouette MMT-378 .................................... 34 Paradigm Silhouette MMT-381 .................................... 34 Paradigm Silhouette MMT-382 .................................... 34 Paradigm Silhouette MMT-383 .................................... 34 Paradigm Silhouette MMT-384 .................................... 34 Paradigm Sure-T MMT-864 ............33 Paradigm Sure-T MMT-866 ............33 Paradigm Sure-T MMT-874 ............33 Paradigm Sure-T MMT-876 ............33 Paradigm Sure-T MMT-884 ............33 Paradigm Sure-T MMT-886 ............33 Parafast ........................................125 Paraffin ...........................................70 Paraffin liquid with soft white paraffin ..................................... 191 Paraffin liquid with wool fat liquid ........................................ 191 Paraldehyde ..................................130 Paramax .......................................134 Parasiticidal Preparations ...............71 Parnate .........................................128 Paromomycin ..................................95 Paroxetine hydrochloride ..............129 Paser ............................................100 Patanol .........................................191 Paxam ..........................................142 Pazopanib .....................................161 Peak flow meter ............................187 Pedialyte - Bubblegum ....................50 Pediasure .....................................207 Pediasure RTH .............................207 Pegaspargase ..............................157 Pegasys ........................................111 Pegasys RBV Combination Pack ......................................... 111 Pegfilgrastim ...................................49 Pegylated interferon alfa-2a ..........111 Penicillamine ................................115 Penicillin G benzathine [Benzathine benzylpenicillin] ......................... 93 PenMix 30 .......................................28 PenMix 40 .......................................28 PenMix 50 .......................................28 Pentasa ..........................................25 Pentostatin [Deoxycoformycin] ................... 157 Pentoxifylline [Oxpentifylline] ..........62 Pepti Junior Gold Karicare Aptamil ..................................... 218 Peptisoothe .....................................27 Peptisorb ......................................208 Pergolide ......................................122 Perhexiline maleate ........................57 Pericyazine ...................................138 Perindopril ......................................53 Permax .........................................122 Permethrin ......................................72 Persantin ........................................46 Peteha ..........................................100 Pethidine hydrochloride ................127 Pevaryl ............................................67 Pexsig .............................................57 Phenelzine sulphate .....................128 Phenobarbitone ............................133 Phenobarbitone sodium Extemporaneous ......................199 Nervous ....................................144 Phenoxybenzamine hydrochloride ............................. 52 Phenoxymethylpenicillin (Penicillin V) ............................... 93 Phenytoin sodium .................130, 133 Phlexy 10 ......................................217 Phosphate-Sandoz .........................50 Phytomenadione .............................46 Pilocarpine ....................................190 Pimafucort ......................................69 Pindolol ...........................................56 Pinetarsol ........................................74 Pinorax ...........................................39 Pinorax Forte ..................................39 Pioglitazone ....................................29 Piportil ..........................................141 Pipothiazine palmitate ..................141 Pizaccord ........................................29 Pizotifen ........................................135 PKU Anamix Infant .......................217 PKU Anamix Junior ......................217 PKU Anamix Junior LQ .................217 PKU Lophlex LQ 10 ......................217 PKU Lophlex LQ 20 ......................217 Plaquenil .......................................115 Plendil ER .......................................57 pms-Bosentan ................................63 Pneumococcal (PCV13) vaccine .................................... 231 Pneumococcal polysaccharide vaccine .................................... 231 Pneumococcal vaccine .................231 Pneumovax 23 ..............................231 Podophyllotoxin ..............................75 Polaramine ....................................181 Poliomyelitis vaccine .....................232 Poloxamer .......................................38 Poly-Gel ........................................191 Poly-Tears .....................................191 Poly-Visc .......................................191 Polycal ..........................................202 Polyvinyl alcohol ...........................191 Ponstan ........................................114

244


INDEX Generic Chemicals and Brands

Posaconazole .................................97 Postinor-1 .......................................79 Potassium bicarbonate ...................50 Potassium chloride ...................50–51 Potassium citrate ............................80 Potassium iodate ............................42 Povidone iodine ..............................71 Pradaxa ..........................................48 Pramipexole hydrochloride ...........122 Prasugrel ........................................46 Pravastatin ......................................60 Praziquantel ....................................90 Prazosin ..........................................52 Pred Forte ....................................189 Pred Mild ......................................189 Prednisolone acetate ....................189 Prednisolone sodium phosphate .................................. 82 Prednisone .....................................83 Pregnancy Tests - hCG Urine .........80 Premarin .........................................84 Premia 2.5 Continuous ...................85 Premia 5 Continuous ......................85 Prevenar 13 ..................................231 Prezista .........................................109 Priadel ..........................................137 Primacin .........................................98 Primaquine phosphate ...................98 Primidone .....................................133 Primolut N .......................................86 Probenecid ...................................121 Probenecid-AFT ...........................121 Procaine penicillin ...........................93 Procarbazine hydrochloride ..........158 Prochlorperazine ..........................136 Proctosedyl .....................................26 Procyclidine hydrochloride ............123 Procytox ........................................151 Prodopa ..........................................58 Progesterone ..................................86 Proglicem ........................................27 Prograf ..........................................180 Progynova ......................................84 Prokinex ........................................135 Promethazine hydrochloride .........182 Promethazine theoclate ................136 Promod .........................................204 Propafenone hydrochloride ............55 Propamidine isethionate ...............188 Propranolol .....................................56 Propylene glycol ...........................199 Propylthiouracil ...............................87 Protamine sulphate .........................48 Protaphane .....................................28 Protaphane Penfill ..........................28 Protifar ..........................................204 Protionamide ................................100 Provera .....................................85, 86 PSO ......................................220–223 Psoriasis and Eczema Preparations .............................. 73 PTU ................................................87 Pulmicort Turbuhaler ....................182 Pulmocare ....................................204 Pulmozyme ...................................186 Puri-nethol ....................................153 Pyrazinamide ................................100 Pyridostigmine bromide ................114 PyridoxADE ....................................40 Pyridoxine hydrochloride ................40 Pyrimethamine ...............................95 Pytazen SR .....................................46 -QQ 300 ..............................................99 Questran-Lite ..................................60 Quetapel .......................................138 Quetiapine ....................................138 Quick-Set MMT-390 ........................36 Quick-Set MMT-391 ........................36 Quick-Set MMT-392 ........................36 Quick-Set MMT-393 ........................36 Quinapril .........................................53 Quinapril with hydrochlorothiazide ................... 53 Quinine sulphate .............................99 -RRA-Morph .....................................126 Raloxifene hydrochloride ..............117 Raltegravir potassium ...................109 Ramipex .......................................122 Ranbaxy-Cefaclor ...........................90 Ranitidine hydrochloride .................27 Rapamune ....................................180 Reandron 1000 ...............................83 Recombinant factor IX ....................45 Recombinant factor VIIa .................45 Recombinant factor VIII ..................45 Rectogesic ......................................26 Redipred .........................................82 Refresh Night Time .......................191 Renilon 7.5 ...................................208 Resonium-A ....................................51 Resource Beneprotein ..................204 Resource Diabetic ........................205 Respigen ......................................184 Respiratory Devices .....................187 Respiratory Stimulants .................187 Retinol palmitate ...........................191 ReTrieve .........................................65 Retrovir .........................................109 Rexacrom .....................................189 Reyataz ........................................109 Ridal .............................................139 Ridaura s29 ..................................115 Rifabutin .......................................100 Rifadin ..........................................100 Rifampicin .....................................100 Rifinah ..........................................100 Rilutek ...........................................123 Riluzole .........................................123 Riodine ...........................................71 Risedronate Sandoz .....................118 Risedronate sodium ......................118 Risperdal ......................................139 Risperdal Consta ..........................141 Risperdal Quicklet ........................139 Risperidone ..........................139, 141 Risperon .......................................139 Ritalin ............................................146 Ritalin LA ......................................147 Ritalin SR ......................................146 Ritonavir .......................................109 Rituximab ......................................177 Rivaroxaban ....................................48 Rivotril ...................................130, 131 Rizamelt ........................................134 Rizatriptan ....................................134 Rocaltrol solution ............................41 Roferon-A .....................................111 Ropin ............................................123 Ropinirole hydrochloride ...............123 Roxane ...........................................56 Alimentary ..................................24 Cardiovascular ...........................56 Roxithromycin .................................92 Rubifen .........................................146 Rubifen SR ...................................146 Rythmodan .....................................54 Rytmonorm .....................................55 -SS-26 Gold Premgro .......................217 Sabril ............................................133 Salamol .........................................184 Salapin ..........................................184 Salazopyrin .....................................25 Salazopyrin EN ...............................25 Salbutamol ....................................184

245


INDEX Generic Chemicals and Brands

Salbutamol with ipratropium bromide .................................... 185 Salicylic acid ...................................74 Salmeterol ....................................183 Sandomigran ................................135 Sandostatin LAR ...........................164 Scalp Preparations .........................74 Scopoderm TTS ...........................135 Sebizole ..........................................74 Sedatives and Hypnotics ..............144 Selegiline hydrochloride ...............123 Senna .............................................39 Senokot ..........................................39 SensoCard ......................................31 Serenace ......................................137 Seretide ........................................183 Seretide Accuhaler .......................183 Serevent .......................................183 Serevent Accuhaler ......................183 Serophene ......................................88 Seroquel .......................................138 Sertraline ......................................129 Sevredol .......................................126 Sex Hormones Non Contraceptive ............................ 83 Shield 49 .........................................76 Shield Blue .....................................76 Shield XL ........................................76 Silagra ............................................63 Sildenafil .........................................63 Silhouette MMT-371 ........................34 Silhouette MMT-373 ........................34 Silver sulphadiazine ........................66 Simethicone ....................................24 Simvastatin .....................................60 Sindopa ........................................122 Sinemet ........................................122 Sinemet CR ..................................122 Singulair ........................................185 Sirolimus .......................................180 Siterone ..........................................83 Slow-Lopresor ................................56 Sodibic ............................................51 Sodium acid phosphate ..................39 Sodium alginate ..............................24 Sodium aurothiomalate .................115 Sodium bicarbonate Blood ....................................50–51 Extemporaneous ......................199 Sodium calcium edetate ...............192 Sodium carboxymethylcellulose .............. 40 Sodium chloride Blood ..........................................50 Respiratory ...............................186 Sodium citrate with sodium lauryl sulphoacetate ............................ 39 Sodium citro-tartrate .......................81 Sodium cromoglycate Alimentary ..................................25 Respiratory ...............................186 Sensory ....................................189 Sodium fluoride ..............................42 Sodium hyaluronate ......................191 Sodium nitroprusside ......................29 Sodium polystyrene sulphonate ................................. 51 Sodium tetradecyl sulphate ............45 Sodium valproate ..........................133 Sofradex .......................................188 Soframycin ....................................188 Solian ............................................136 Solifenacin succinate ......................81 Solox ...............................................27 Solu-Cortef .....................................82 Solu-Medrol ....................................82 Somatropin .....................................87 Sotacor ...........................................57 Sotalol .............................................57 Space Chamber ............................187 Space Chamber Plus ....................187 Spacer device ...............................187 Spacer device autoclavable ..........187 Span-K ............................................51 Spiractin ..........................................59 Spiriva ...........................................184 Spironolactone ................................59 Spirotone ........................................59 Sporanox ........................................97 Sprycel .........................................159 Staphlex ..........................................93 Stavudine [d4T] ............................109 Stelazine .......................................140 Stemetil .........................................136 Stesolid .........................................130 Stimulants/ADHD Treatments ............................... 145 Stiripentol .....................................133 Stocrin ..........................................108 Stomahesive ...................................40 Strattera ........................................145 Stromectol ......................................71 Suboxone .....................................148 Sucralfate .......................................27 Sulfadiazine sodium .......................96 Sulindac ........................................115 Sulphasalazine ...............................25 Sulphur ...........................................74 Sumatriptan ..................................134 Sunitinib ........................................162 Sunscreens .....................................74 Sunscreens, proprietary .................74 Suplena ........................................208 Sure-T MMT-863 .............................33 Sure-T MMT-865 .............................33 Sure-T MMT-873 .............................33 Sure-T MMT-875 .............................33 Sure-T MMT-883 .............................33 Sure-T MMT-885 .............................33 Surgam .........................................115 Sustagen Hospital Formula ..........212 Sustanon Ampoules .......................83 Sutent ...........................................162 Symbicort Turbuhaler 100/6 .........183 Symbicort Turbuhaler 200/6 .........183 Symbicort Turbuhaler 400/12 ..................................... 183 Symmetrel ....................................122 Sympathomimetics .........................61 Synacthen .......................................83 Synacthen Depot ............................83 Synflorix ........................................231 Synthroid ........................................86 Syntocinon ......................................79 Syntometrine ..................................79 Syrup (pharmaceutical grade) ...................................... 199 Systane Unit Dose ........................191 -TTacrolimus ....................................180 Tambocor ........................................54 Tambocor CR ..................................54 Tamoxifen citrate ...........................165 Tamsulosin hydrochloride ...............80 Tamsulosin-Rex ..............................80 Tap water ......................................199 Tar with triethanolamine lauryl sulphate and fluorescein ............ 74 Tarceva .........................................159 Tasmar ..........................................123 Taxotere ........................................156 Tegretol .........................................131 Tegretol CR ...................................131 Telfast ...........................................181 Temaccord ....................................158 Temazepam ..................................144 Temozolomide ..............................158 Tenofovir disoproxil fumarate .................................. 104

246


INDEX Generic Chemicals and Brands

Tenoxicam ....................................115 Tepadina .......................................152 Terazosin ........................................52 Terbinafine ......................................98 Terbutaline sulphate .....................184 Teriparatide ...................................118 Testosterone ...................................83 Testosterone cypionate ...................83 Testosterone esters ........................83 Testosterone undecanoate .............83 Tetrabenazine ...............................124 Tetrabromophenol ...........................81 Tetracosactrin .................................83 Tetracyclin Wolff .............................93 Tetracycline .....................................93 Teva ..............................................154 Thalidomide ..................................158 Thalomid .......................................158 Theophylline .................................186 Thiamine hydrochloride ..................41 THIO-TEPA ...................................152 Thioguanine ..................................154 Thiotepa ........................................152 Thymol glycerin ..............................40 Thyroid and Antithyroid Agents ....................................... 86 Tiaprofenic acid ............................115 Ticagrelor ........................................46 Tilade ............................................186 Tilcotil ...........................................115 Timolol maleate Cardiovascular ...........................57 Sensory ....................................189 Timoptol XE ..................................189 Tiotropium bromide .......................184 TMP ................................................96 Tobramycin Infection ......................................96 Sensory ....................................189 Tobrex ...........................................189 Tofranil ..........................................128 Tolcapone .....................................123 Tolterodine ......................................81 Tolvon ...........................................128 Topamax .......................................133 Topical Products for Joint and Muscular Pain .......................... 115 Topiramate ....................................133 Total parenteral nutrition (TPN) ......................................... 50 TPN ................................................50 Tracleer ...........................................63 Tramadol hydrochloride ................127 Tramal SR 100 ..............................127 Tramal SR 150 ..............................127 Tramal SR 200 ..............................127 Trandate ..........................................56 Trandolapril .....................................53 Tranexamic acid ..............................45 Tranylcypromine sulphate .............128 Trastuzumab .................................178 Travatan ........................................190 Travoprost .....................................190 Treatments for Dementia ..............148 Treatments for Substance Dependence ............................ 148 Trental 400 ......................................62 Tretinoin Dermatological ...........................65 Oncology ..................................158 Triamcinolone acetonide Alimentary ..................................40 Dermatological ...........................69 Hormone ....................................83 Triamcinolone acetonide with gramicidin, neomycin and nystatin Dermatological ...........................69 Sensory ....................................188 Triazolam ......................................145 Trichozole .......................................99 Triclosan .........................................69 Trifluoperazine hydrochloride ........................... 140 Trimeprazine tartrate ....................182 Trimethoprim ...................................96 Trisequens ......................................85 Trisul ...............................................94 Trophic Hormones ..........................87 Tropicamide ..................................190 Tropisetron ....................................136 Trusopt ..........................................190 Truvada .........................................108 Two Cal HN ...................................214 Two Cal HN RTH ..........................214 Tykerb ...........................................161 -UUltraproct ........................................26 Univent .................................184, 187 Ural .................................................81 Urea ................................................70 Urex Forte .......................................58 Urinary Agents ................................80 Urinary Tract Infections .................112 Uromitexan ...................................157 Ursodeoxycholic acid ......................37 Ursosan ..........................................37 Utrogestan ......................................86 -VVaccinations .................................230 Valaciclovir ....................................103 Valcyte ..........................................103 Valganciclovir ................................103 Vallergan Forte .............................182 Valtrex ...........................................103 Vancomycin hydrochloride ..............96 Vannair .........................................183 Varenicline tartrate .......................150 Vasodilators ....................................62 Vasopressin Agonists .....................88 Velcade .........................................154 Venlafaxine ...................................130 Ventavis ..........................................64 Ventolin .........................................184 Vepesid .........................................156 Veracol ............................................90 Verapamil hydrochloride .................58 Vergo 16 .......................................135 Vermox ...........................................90 Verpamil SR ...................................58 Vesanoid .......................................158 Vesicare ..........................................81 Vfend ..............................................98 Viaderm KC ....................................69 Victrelis .........................................105 Videx EC .......................................108 Vigabatrin .....................................133 Vimpat ..........................................132 Vinblastine sulphate .....................158 Vincristine sulphate ......................158 Vinorelbine ....................................159 Vinorelbine Ebewe ........................159 Viramune Suspension ..................108 Viread ...........................................104 Vistil ..............................................191 Vistil Forte ....................................191 VitA-POS ......................................191 Vitabdeck ........................................41 Vitadol C .........................................40 Vital HN ........................................208 Vitala-C ...........................................41 Vitamin A with vitamins D and C ................................................ 40 Vitamin B complex ..........................41 Vitamins ....................................40–41 Vivonex Pediatric ..........................218 Vivonex TEN .................................208 Volibris ............................................63 Voltaren ........................................114 Voltaren D .....................................114

247


INDEX Generic Chemicals and Brands

Voltaren Ophtha ............................189 Volumatic ......................................187 Voriconazole ...................................98 Vosol .............................................188 Votrient .........................................161 Vytorin ............................................61 -WWarfarin sodium ..............................49 Wart Preparations ...........................75 Wasp venom allergy treatment ................................. 181 Water Blood ..........................................50 Extemporaneous ......................199 Wool fat with mineral oil ..................70 -XXanax ...........................................141 Xarelto ............................................48 Xeloda ..........................................152 XMET Maxamum ..........................216 XP Maxamaid ...............................217 XP Maxamum ...............................217 Xylocaine ......................................124 Xylocaine Viscous ........................124 Xyntha ............................................45 -ZZantac .............................................27 Zapril ..............................................52 Zarator ............................................60 Zarontin ........................................131 Zaroxolyn ........................................59 Zarzio ..............................................49 Zavedos ........................................157 Zeffix .............................................102 Zeldox ...........................................140 Zerit ..............................................109 Zetlam ...........................................102 Zetop ............................................181 Ziagen ...........................................108 Zidovudine [AZT] ..........................109 Zidovudine [AZT] with lamivudine ............................... 109 Zinc and castor oil ..........................70 Zinc sulphate ..................................43 Zincaps ...........................................43 Zinnat ..............................................90 Ziprasidone ...................................140 Zithromax ........................................91 Zofran Zydis ..................................136 Zoladex ...........................................87 Zoledronic acid .............................119 Zopiclone ......................................145 Zostrix ...........................................115 Zostrix HP .....................................125 Zovirax ..........................................188 Zuclopenthixol decanoate .............141 Zuclopenthixol hydrochloride ........................... 140 Zyban ............................................149 Zypine ...........................................138 Zypine ODT ..................................138 Zyprexa .........................................138 Zyprexa Relprevv ..........................140 Zyprexa Zydis ...............................138

248


NOTES


NOTES


NOTES


NOTES


NOTES


NOTES


NOTES


NOTES


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)

Metadata

Title

Pharmaceutical Schedule - effective 1 December 2013

Abstract

Pharmaceutical Management Agency December 2013 New Zealand Pharmaceutical Schedule December 2013 Volume 20 Number 3 Editors: Kaye Wilson, Donna Jennings & Sarah Le Leu email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 9, 40 Mercer…

Page 1

icon

Note

This text has been extracted from the source PDF document.

Also available as plain text.

Please contact webmaster to discuss alternative format options.