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Special Authority Forms

General Practitioners and specialists can download individual forms for making Special Authority applications from this page.

Alternatively, all forms are available in one indexed document, Special Authority Forms, November 2008 (157 pages, 438 KB).

Find Exceptional Circumstances (EC) forms.

Sort by Therapeutic Group or Form Title (Chemical Name)

Alimentary Tract and Metabolism

From page 25 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0925 – Acarbose (1 page, 2 KB)

• SA0915 – Alpha Tocopheryl Acetate (1 page, 2 KB)

• SA0913 – Budesonide – Cap 3 mg Controlled Release (1 page, 3 KB)

• SA0473 - Imiglucerase (Cerezyme) therapy - initial application (6 pages, 72 KB)

• SA0473 - Imiglucerase (Cerezyme) therapy - renewal application (4 pages, 67 KB)

• SA0834 – Insulin Glargine (1 page, 3 KB)

• SA0891 – Macrogol 3350 (1 page, 2 KB)

• SA0859 – Pioglitazone (2 pages, 6 KB)

• SA0914 – Ursodeoxycholic Acid – Cap 300 mg (1 page, 3 KB)

Blood and Blood Forming Organs

From page 40 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0788 – Atorvastatin (1 page, 4 KB)

• SA0867 – Clopidogrel (3 pages, 8 KB)

• SA0930 – Dipyridamole Tab 25 mg (1 page, 3 KB)

• SA0929 – Dipyridamole Tab long-acting 150 mg (1 page, 3 KB)

• SA0922 – Erythropoietin (1 page, 3 KB)

• SA0796 – Ezetimibe (2 pages, 5 KB)

• SA0826 – Ezetimibe with Simvastatin: Vytorin (1 page, 4 KB)

• SA0932 – Pravastatin (1 page, 2 KB)

Cardiovascular System

From page 53 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0933 – Candesartan (1 page, 3 KB)

• SA0911 – Losartan with or without hydrochlorothiazide (1 page, 2 KB)

• SA0934 – Midodrine (1 page, 3 KB)

• SA0256 – Perhexiline Maleate (1 page, 2 KB)

Dermatologicals

From page 62 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0923 – Imiquimod (1 page, 3 KB)

Genito-Urinary System

From page 72 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0500 – Combined oral contraceptives; and Progestogen-only contraceptives (1 page, 3 KB)

• SA0928 – Finasteride (1 page, 2 KB)

Hormone Preparations - Systemic Excluding Contraceptive Hormones

From page 78 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0467 – Alendronate for Pagets Disease: Alendronate Tab 40 mg (1 page, 2 KB)

• SA0797 – Alendronate: Alendronate Tab 70 mg (1 page, 4 KB)

• SA0835 – Buserelin (2 pages, 6 KB)

• SA0175 – Cabergoline (1 page, 2 KB)

• SA0090 – Desmopressin – Inj 4 µg per ml, 1 ml (1 page, 2 KB)

• SA0839 – Goserelin (2 pages, 6 KB)

• SA0755 - Growth hormone therapy guidelines and application forms (20 pages, 764 KB)

• SA0312 – Hormone Replacement Therapy – Systemic (1 page, 3 KB)

• SA0837 – Leuprorelin (2 pages, 6 KB)

• SA0782 – Levonorgestrel – releasing intrauterine system 20µg/24 hr (1 page, 3 KB)

• SA0091 – Pamidronate Disodium (1 page, 2 KB)

Infections - Agents for Systemic Use

From page 89 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0829 – Adefovir dipivoxil (1 page, 3 KB)

• SA0779 – Antiretrovirals (2 pages, 6 KB)

• SA0657 – Clarithromycin (1 page, 3 KB)

• SA0845 – Enfuvirtide (1 page, 3 KB)

• SA0832 – Lamivudine (2 pages, 6 KB)

Musculo-skeletal System

From page 101 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0812 – Adalimumab (2 pages, 7 KB)

• SA0291 – Anti-inflammatory Non Steroidal Drugs (NSAIDs) (1 page, 2 KB)

• SA0868 – Etanercept (1 page, 4 KB)

Nervous System

From page 106 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0920 – Aripiprazole (1 page, 2 KB)

• SA0863 – Buspirone Hydrochloride (1 page, 2 KB)

• SA0907 – Dexamphetamine Sulphate (3 pages, 8 KB)

• SA0938 – Domperidone (1 page, 2 KB)

• SA0935 – Fentanyl patches (1 page, 2 KB)

• SA0936 – Gabapentin (2 pages, 6 KB)

• SA0939 – Hyoscine (Scopolamine) (1 page, 2 KB)

• SA0921 – Levetiracetam (3 pages, 114 KB)

• SA0906 – Lignocaine with Prilocaine (1 page, 2 KB)

• SA0908 – Methylphenidate Hydrochloride (Rubifen and Rubifen SR) (3 pages, 8 KB)

• SA0924 – Methylphenidate Hydrochloride Extended Release (Concerta) (1 page, 3 KB)

• SA0864 – Mianserin Hydrochloride (1 page, 2 KB)

• SA0855 – Multiple Sclerosis treatments, Initial Application for beta-interferon or glatiramer acetate (8 pages, 188 KB)

• SA0855 – Multiple Sclerosis treatments, Renewal Application form for beta-interferon or glatiramer acetate (5 pages, 176 KB)

• SA0909 – Naltrexone (1 page, 3 KB)

• SA0741 – Olanzapine tabs (1 page, 3 KB)

• SA0739 – Olanzapine wafers (1 page, 2 KB)

• SA0887 – Ondansetron (1 page, 2 KB)

• SA0926 – Risperidone microspheres (1 page, 3 KB)

• SA0927 – Risperidone orally disintegrating tablets (1 page, 2 KB)

• SA0789 – Venlafaxine (1 page, 3 KB)

• SA0937 – Vigabatrin (2 pages, 6 KB)

Oncology Agents and Immunosuppressants

From page 131 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0879 – Anagrelide Hydrochloride (1 page, 3 KB)

• SA0810 – Anastrozole (1 page, 3 KB)

• SA0941 – Bicalutamide (1 page, 2 KB)

• SA0869 – Capecitabine (1 page, 3 KB)

• SA0470 – Cyclosporin A (2 pages, 5 KB)

• SA0880 – Docetaxel (2 pages, 4 KB)

• SA0877 – Gemcitabine Hydrochloride (1 page, 3 KB)

• SA0643 – Imatinib mesylate for treatment of chronic myeloid leukaemia or gastrointestinal stromal tumour (GIST) (3 pages, 40 KB)

• SA0784 – Interferon Alpha-2A with ribavirin (1 page, 2 KB)

• SA0878 – Irinotecan (1 page, 2 KB)

• SA0811 – Letrozole (1 page, 2 KB)

• SA0893 – Mycophenolate (1 page, 2 KB)

• SA0563 – Octreotide (somatostatin analogue) (1 page, 3 KB)

• SA0900 – Oxaliplatin (1 page, 3 KB)

• SA0802 – Pegylated Interferon Alpha-2a (1 page, 3 KB)

• SA0846 – Pegylated Interferon Alpha-2b with Ribavirin (1 page, 3 KB)

• SA0884 – Rituximab (2 pages, 4 KB)

• SA0866 – Sirolimus (Rapamune) (1 page, 2 KB)

• SA0669 – Tacrolimus (1 page, 2 KB)

• SA0831 – Temozolomide (1 page, 2 KB)

• SA0882 – Thalidomide (1 page, 3 KB)

• SA0885 – Trastuzumab (1 page, 3 KB)

• SA0901 – Vinorelbine (1 page, 3 KB)

Respiratory System and Allergies

From page 149 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0838 – Budesonide with eformoterol (Symbicort); and Fluticasone with Salmeterol (Seretide) (1 page, 3 KB)

• SA0611 – Dornase Alfa - Entry and Stopping Criteria for Treatment (17 pages, 403 KB)

• SA0872 – Tiotropium Bromide (1 page, 3 KB)

• SA0053 – Wasp venom allergy treatment; and Bee Venom Allergy Treatment (1 page, 2 KB)

Sensory Organs

From page 156 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0895 – Pilocarpine – Eye drops 2% single dose (1 page, 2 KB)

Various

From page 161 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

Extemporaneously Compounded Preparations and Galenicals

From page 166 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

Special Foods

From page 169 of the Pharmaceutical Schedule, November 2008 (224 pages, 1351 KB)

• SA0585 – Adult Products High Calorie: Two Cal HN (2 pages, 5 KB)

• SA0702 – Adult Products Standard: Ensure Plus, Ensure Plus RTH, Fibresource, Fibresource RTH, Fortisip, Fortisip Multi Fibre, Isosource 1.5, Isosource Standard, Isosource Standard RTH, Jevity RTH, Nutrison Energy Multi Fibre, Nutrison Multi Fibre, Nutrison Standard RTH, Osmolite RTH, Resource Plus (2 pages, 6 KB)

• SA0581 – Carbohydrate and Fat: Duocal Super Soluble Powder (2 pages, 4 KB)

• SA0912 – Carbohydrate: Moducal, Morrex Maltodextrin, Polycal, Polycose (2 pages, 5 KB)

• SA0588 – CORD Products: Pulmocare (1 page, 3 KB)

• SA0594 – Diabetic Products: Diasip, Diason, Glucerna, Glucerna RTH, Resource Diabetic, Resource Diabetic RTH (1 page, 3 KB)

• SA0615 – Fat Modified Products: Monogen (1 page, 2 KB)

• SA0899 – Fat: Calogen, Liquigen, MCT oil (Nutricia) (2 pages, 4 KB)

• SA0595 – Food Thickeners: Karicare Food Thickener, Resource Thicken Up (1 page, 2 KB)

• SA0732 – Foods used for Homocystinuria or maple syrup urine disease: Maxamaid MSUD, Maxamum MSUD, MSUD Aid, XMET Maxamum (1 page, 2 KB)

• SA0733 – Foods used for PKU: Aminogran Food Supplement, Aminogran Mineral Mix, Analog LCP, Aproten, Loprofin, Loprofin Mix, Maxamaid XP, Maxamum XP, Metabolic Mineral Mixture, Minaphlex, Phlexy 10 (1 page, 3 KB)

• SA0722 – Gluten Free Foods: Gluten Free Bread Mix 100% Bakels, Healtheries Wheat and Gluten Free Baking, Horleys Bread Mix, Horleys Flour, NZB Low Gluten Bread Mix, Orgran (1 page, 2 KB)

• SA0589 – High Protein Products: Fortimel (1 page, 3 KB)

• SA0603 – Infant Formulae – For Gastrointestinal And Other Malabsorptive Problems: Neocate, Neocate Advance, Neocate LCP, Pepti Junior, Vivonex Pediatric (1 page, 2 KB)

• SA0604 – Infant Formulae – For Milk Intolerance: Delact, S26 Soy, Karicare Goats Milk Infant Formula (1 page, 3 KB)

• SA0602 – Infant Formulae – For Premature Infants: S26LBW, Similac Special Care (1 page, 2 KB)

• SA0601 – Infant Formulae – For Williams Syndrome: Locasol (1 page, 2 KB)

• SA0757 – Infant Formulae – Lactose Intolerance and Cows’ Milk Protein Intolerance: Karicare All Ages (1 page, 2 KB)

• SA0600 – Multivitamin And Mineral Supplements For Inborn Errors Of Metabolism: Ketovite, Ketovite Syrup, Paediatric Seravite (1 page, 2 KB)

• SA0583 – Oral Supplements: Ensure, Nutridrink, Sustagen Hospital Formula (2 pages, 4 KB)

• SA0607 – Paediatric Product For Children Awaiting Liver Transplant: Generaid Plus (1 page, 2 KB)

• SA0606 – Paediatric Product For Children With Chronic Renal Failure: Kindergen Plus (1 page, 2 KB)

• SA0896 – Paediatric Products: Fortini, Fortini Multifibre, Nutrini Energy RTH, Nutrini RTH, Pediasure, Pediasure RTH, Resource Just for Kids (1 page, 3 KB)

• SA0586 – Products for Undialysed End Stage Renal Failure: Suplena (1 page, 3 KB)

• SA0582 – Protein: Promod, Protifar 90 (1 page, 2 KB)

• SA0587 – Renal Products: Nepro (vanilla), NovaSource Renal, Nutrison Concentrated RTH, Renilon 7.5 (1 page, 3 KB)

• SA0592 – Specialised And Elemental Products: Alitraq, Elemental 028 Extra, Peptisorb RTH, Vital HN, Vivonex TEN (1 page, 3 KB)

Data

Active Special Authority numbers for atorvastatin (Lipitor) (2 pages, 489 KB) – listing of active Special Authority approvals for atorvastatin (Lipitor) from 1 June 2004 (other than approvals under the new criteria).

Special Authority approvals for atorvastatin (Lipitor) (40 pages, 828 KB)) – from 1 June 2004 (other than approvals under the new criteria).

Page updated on 19 Nov 2008

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