PHARMAC Special Authority forms

PHARMAC Special Authority forms http://www.pharmac.govt.nz/healthpros/Schedule/SAForms PHARMAC Special Authority forms http://www.pharmac.govt.nz/2009/12/01/SA0925.pdf SA0925 – Acarbose 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0954.pdf SA0954 – Acitretin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0974.pdf SA0974 – Adalimumab 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0829.pdf SA0829 – Adefovir dipivoxil 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0585.pdf SA0585 – Adult Products High Calorie: Two Cal HN 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0702.pdf 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 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0949.pdf SA0949 – Alendronate for Paget's Disease: Alendronate Tab 40 mg 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0990.pdf SA0990 – Alendronate Tab 70 mg - with or without Cholecalciferol 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0915.pdf SA0915 – Alpha Tocopheryl Acetate 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0879.pdf SA0879 – Anagrelide Hydrochloride 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0291.pdf SA0291 – Anti-inflammatory Non Steroidal Drugs (NSAIDs) 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0779.pdf SA0779 – Antiretrovirals 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0987.pdf SA0987 – Aprepitant 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0920.pdf SA0920 – Aripiprazole 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0951.pdf SA0951 – Atomoxetine 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0788.pdf SA0788 – Atorvastatin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0964.pdf SA0964 – Azithromycin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0941.pdf SA0941 – Bicalutamide 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0913.pdf SA0913 – Budesonide – Cap 3 mg Controlled Release 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0835.pdf SA0835 – Buserelin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0863.pdf SA0863 – Buspirone Hydrochloride 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0175.pdf SA0175 – Cabergoline 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0933.pdf SA0933 – Candesartan 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0869.pdf SA0869 – Capecitabine 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0581.pdf SA0581 – Carbohydrate and Fat: Duocal Super Soluble Powder 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0912.pdf SA0912 – Carbohydrate: Moducal, Morrex Maltodextrin, Polycal, Polycose 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0988.pdf SA0988 – Clarithromycin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0867.pdf SA0867 – Clopidogrel 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0500.pdf SA0500 – Combined oral contraceptives; and Progestogen-only contraceptives 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0588.pdf SA0588 – CORD Products: Pulmocare 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0090.pdf SA0090 – Desmopressin – Inj 4 µg per ml, 1 ml 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0907.pdf SA0907 – Dexamphetamine Sulphate 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0594.pdf SA0594 – Diabetic Products: Diasip, Diason, Glucerna, Glucerna RTH, Resource Diabetic, Resource Diabetic RTH 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0880.pdf SA0880 – Docetaxel 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0938.pdf SA0938 – Domperidone 2009-12-01 http://www.pharmac.govt.nz/2007/07/24/SA0611.pdf SA0611 – Dornase Alfa - Entry and Stopping Criteria for Treatment 2007-07-24 http://www.pharmac.govt.nz/2009/08/06/SA0967.pdf SA0967 - Endothelian receptor antagonists - bosentan 2009-08-06 http://www.pharmac.govt.nz/2009/12/01/SA0845.pdf SA0845 – Enfuvirtide 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0975.pdf SA0975 – Enoxaparin sodium 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0977.pdf SA0977 – Entecavir 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0922.pdf SA0922 – Erythropoietin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0868.pdf SA0868 – Etanercept 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0796.pdf SA0796 – Ezetimibe 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0826.pdf SA0826 – Ezetimibe with Simvastatin: Vytorin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0615.pdf SA0615 – Fat Modified Products: Monogen 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0899.pdf SA0899 – Fat: Calogen, Liquigen, MCT oil (Nutricia) 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0935.pdf SA0935 – Fentanyl patches 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0928.pdf SA0928 – Finasteride 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0595.pdf SA0595 – Food Thickeners: Karicare Food Thickener, Resource Thicken Up 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0732.pdf SA0732 – Foods used for Homocystinuria or maple syrup urine disease: Maxamaid MSUD, Maxamum MSUD, MSUD Aid, XMET Maxamum 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0733.pdf SA0733 – Foods used for PKU: Aminogran Food Supplement, Aminogran Mineral Mix, Analog LCP, Aproten, Loprofin, Loprofin Mix, Maxamaid XP, Maxamum XP, Minaphlex, Phlexy 10 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0936.pdf SA0936 – Gabapentin 2009-12-01 http://www.pharmac.govt.nz/2009/10/21/SA0973.pdf SA0973 - Gabapentin (Neurontin) - no further approvals 2009-10-21 http://www.pharmac.govt.nz/2009/12/01/SA0877.pdf SA0877 – Gemcitabine Hydrochloride 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0722.pdf 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 2009-12-01 http://www.pharmac.govt.nz/2008/07/25/SA0755.pdf SA0755 - Growth hormone therapy guidelines and application forms 2008-07-25 http://www.pharmac.govt.nz/2009/12/01/SA0589.pdf SA0589 – High Protein Products: Fortimel 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0312.pdf SA0312 – Hormone Replacement Therapy – Systemic 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0939.pdf SA0939 – Hyoscine (Scopolamine) 2009-12-01 http://www.pharmac.govt.nz/2006/03/29/SA0643.pdf SA0643 – Imatinib mesylate for treatment of chronic myeloid leukaemia or gastrointestinal stromal tumour (GIST) 2006-03-29 http://www.pharmac.govt.nz/2008/08/06/SA0473-initial.pdf SA0473 - Imiglucerase (Cerezyme) therapy - initial application 2008-08-06 http://www.pharmac.govt.nz/2008/08/06/SA0473-renewal.pdf SA0473 - Imiglucerase (Cerezyme) therapy - renewal application 2008-08-06 http://www.pharmac.govt.nz/2009/12/01/SA0923.pdf SA0923 – Imiquimod 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0603.pdf SA0603 – Infant Formulae – For Gastrointestinal And Other Malabsorptive Problems: Neocate, Neocate Advance, Neocate LCP, Pepti Junior, Vivonex Pediatric 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0604.pdf SA0604 – Infant Formulae – For Milk Intolerance: Delact, S26 Soy, Karicare Goats Milk Infant Formula 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0602.pdf SA0602 – Infant Formulae – For Premature Infants: S26LBW, Similac Special Care 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0601.pdf SA0601 – Infant Formulae – For Williams Syndrome: Locasol 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0757.pdf SA0757 – Infant Formulae – Lactose Intolerance and Cows’ Milk Protein Intolerance: Karicare All Ages 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0958.pdf SA0958 – Inhaled Corticosteroids with Long-Acting Beta-Adrenoceptor Agonists 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0834.pdf SA0834 – Insulin Glargine 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0784.pdf SA0784 – Interferon Alpha-2A with ribavirin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0878.pdf SA0878 – Irinotecan 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0955.pdf SA0955 – Isotretinoin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0832.pdf SA0832 – Lamivudine 2009-12-01 http://www.pharmac.govt.nz/2008/08/20/SA0921.pdf SA0921 – Levetiracetam 2008-08-20 http://www.pharmac.govt.nz/2009/12/01/SA0782.pdf SA0782 – Levonorgestrel – releasing intrauterine system 20µg/24 hr 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0906.pdf SA0906 – Lignocaine with Prilocaine 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0911.pdf SA0911 – Losartan with or without hydrochlorothiazide 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0891.pdf SA0891 – Macrogol 3350 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0962.pdf SA0962 – Metabolic Mineral Mixture 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0924.pdf SA0924 – Methylphenidate Hydrochloride Extended Release: Concerta, Ritalin LA 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0908.pdf SA0908 – Methylphenidate Hydrochloride: Rubifen, Rubifen SR, Ritalin, Ritalin SR 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0864.pdf SA0864 – Mianserin Hydrochloride 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0934.pdf SA0934 – Midodrine 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0994.pdf SA0994 – Mirtazapine 2009-12-01 http://www.pharmac.govt.nz/2008/04/30/SA0855-initial.pdf SA0855 – Multiple Sclerosis treatments, Initial Application for beta-interferon or glatiramer acetate 2008-04-30 http://www.pharmac.govt.nz/2008/04/30/SA0855-renewal.pdf SA0855 – Multiple Sclerosis treatments, Renewal Application form for beta-interferon or glatiramer acetate 2008-04-30 http://www.pharmac.govt.nz/2009/12/01/SA0963.pdf SA0963 – MultivitaminsPaediatric Seravit: Ketovite, Ketovite, Paediatric Seravit 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0960.pdf SA0960 – Mycophenolate 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0909.pdf SA0909 – Naltrexone 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0563.pdf SA0563 – Octreotide (somatostatin analogue) 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0741.pdf SA0741 – Olanzapine tabs 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0739.pdf SA0739 – Olanzapine wafers 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0887.pdf SA0887 – Ondansetron 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0583.pdf SA0583 – Oral Supplements: Ensure, Nutridrink, Sustagen Hospital Formula 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0900.pdf SA0900 – Oxaliplatin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0607.pdf SA0607 – Paediatric Product For Children Awaiting Liver Transplant: Generaid Plus 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0606.pdf SA0606 – Paediatric Product For Children With Chronic Renal Failure: Kindergen Plus 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0896.pdf SA0896 – Paediatric Products: Fortini, Fortini Multifibre, Nutrini Energy RTH, Nutrini RTH, Pediasure, Pediasure RTH, Resource Just for Kids 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0952.pdf SA0952 – Pegylated Interferon alpha-2A 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0953.pdf SA0953 – Pegylated Interferon alpha-2B with Ribavirin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0256.pdf SA0256 – Perhexiline Maleate 2009-12-01 http://www.pharmac.govt.nz/2009/08/06/SA0968.pdf SA0968 - Phosphodieterase type 5 inhibitors - sildenafil 2009-08-06 http://www.pharmac.govt.nz/2009/12/01/SA0895.pdf SA0895 – Pilocarpine – Eye drops 2% single dose 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0959.pdf SA0959 – Pioglitazone 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0932.pdf SA0932 – Pravastatin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0586.pdf SA0586 – Products for Undialysed End Stage Renal Failure: Suplena 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0582.pdf SA0582 – Protein: Promod, Protifar 90 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0587.pdf SA0587 – Renal Products: Nepro (vanilla), NovaSource Renal, Nutrison Concentrated RTH, Renilon 7.5 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0926.pdf SA0926 – Risperidone microspheres 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0927.pdf SA0927 – Risperidone orally disintegrating tablets 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0961.pdf SA0961 – Rituximab 2009-12-01 http://www.pharmac.govt.nz/2009/08/03/SA0976.pdf SA0976 Dasatinib for treatment of Chronic Myeloid Leukaemia (CML) 2009-08-03 http://www.pharmac.govt.nz/2009/12/01/SA0866.pdf SA0866 – Sirolimus (Rapamune) 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0592.pdf SA0592 – Specialised And Elemental Products: Alitraq, Elemental 028 Extra, Peptisorb RTH, Vital HN, Vivonex TEN 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0669.pdf SA0669 – Tacrolimus 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0831.pdf SA0831 – Temozolomide 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0997.pdf SA0997 – Tenofovir 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0882.pdf SA0882 – Thalidomide 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0872.pdf SA0872 – Tiotropium Bromide 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0885.pdf SA0885 – Trastuzumab 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0914.pdf SA0914 – Ursodeoxycholic Acid – Cap 300 mg 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0957.pdf SA0957 – Valaciclovir 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0789.pdf SA0789 – Venlafaxine 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0937.pdf SA0937 – Vigabatrin 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0901.pdf SA0901 – Vinorelbine 2009-12-01 http://www.pharmac.govt.nz/2009/12/01/SA0053.pdf SA0053 – Wasp venom allergy treatment; and Bee Venom Allergy Treatment 2009-12-01