<?xml version="1.0" encoding="utf-8"?>
<Schedule xmlns:html="http://www.w3.org/1999/xhtml" xmlns:math="http://www.w3.org/1998/Math/MathML" xmlns:schedule="http://www.pharmac.govt.nz/2006/07/Schedule#" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://www.pharmac.govt.nz/2006/07/Schedule#" xsi:schemaLocation="http://www.pharmac.govt.nz/2006/07/Schedule#  http://www.pharmac.govt.nz/2006/07/Schedule.xsd">
  <Front>
    <Title>Pharmaceutical Schedule</Title>
    <Country>New Zealand</Country>
    <Edition>October 2007</Edition>
    <Volume>14</Volume>
    <Number>2</Number>
    <Published>2007-10-01</Published>
  </Front>
  <Section ID="B">
    <Name>Community Pharmaceuticals</Name>
    <ATC1 ID="A01">
      <Name>Alimentary Tract and Metabolism</Name>
      <ATC2 ID="A0101">
        <Name>Antacids and Antiflatulants</Name>
        <ATC3 ID="A010102">
          <Name>Antacids and Reflux Barrier Agents</Name>
          <Chemical ID="C0101021021" Page="26">
            <Name>Alginic acid</Name>
            <Formulation ID="F010102102103" Rank="2" Units="sach" Weight="225">
              <Name>Sodium alginate 225 mg and magnesium alginate 87.5 mg per sachet</Name>
              <Brand ID="B01010210210301">
                <Name>Gaviscon Infant</Name>
                <Pack ID="P494275" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.50</Subsidy>
                  <Price>4.50</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0101021040" Page="26" Statim="Must">
            <Name>Simethicone</Name>
            <Formulation ID="F010102104002" Rank="3" Units="ml" Weight="200">
              <Name>Oral liq aluminium hydroxide 200 mg with magnesium hydroxide 200 mg and activated simethicone 20 mg per 5 ml</Name>
              <Brand ID="B01010210400225">
                <Name>Mylanta P</Name>
                <Pack ID="P2041650" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>1.50</Subsidy>
                  <Price>4.05</Price>
                  <Alternate>1.50</Alternate>
                  <Surcharge>0.00510</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0101021275" Page="26" Statim="Must">
            <Name>Calcium carbonate with aminoacetic acid</Name>
            <Formulation ID="F010102127501" Rank="1" Units="tab" Weight="420">
              <Name>Tab 420 mg with aminoacetic acid 180 mg</Name>
              <Brand ID="B01010212750101">
                <Name>Titralac</Name>
                <Pack ID="P252026">
                  <Quantity>100</Quantity>
                  <Subsidy>3.00</Subsidy>
                  <Price>6.12</Price>
                  <Alternate>3.76</Alternate>
                  <Surcharge>0.03120</Surcharge>
                </Pack>
                <Pack ID="P252050" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>30.00</Subsidy>
                  <Price>37.60</Price>
                  <Alternate>37.60</Alternate>
                  <Surcharge>0.00760</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Additional subsidy by endorsement is available for pregnant women.  The prescription must be endorsed accordingly.</p>
              </div>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0101022125" Page="26" Statim="Must">
            <Name>Sodium alginate</Name>
            <Formulation ID="F010102212501" Rank="3" Units="ml" Weight="500">
              <Name>Oral liq 500 mg with sodium bicarbonate 267 mg per 10 ml (aniseed)</Name>
              <Brand ID="B01010221250101">
                <Name>Gaviscon</Name>
                <Pack ID="P510904" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>1.50</Subsidy>
                  <Price>7.65</Price>
                  <Alternate>1.50</Alternate>
                  <Surcharge>0.01230</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010102212525" Rank="3" Units="ml">
              <Name>Oral liq 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg per 10 ml</Name>
              <Brand ID="B01010221252525">
                <Name>Acidex</Name>
                <Pack ID="P2196786" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>1.50</Subsidy>
                  <Price>4.95</Price>
                  <Alternate>1.50</Alternate>
                  <Surcharge>0.00690</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010102212526" Rank="1" Units="tab">
              <Name>Tab 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg - peppermint flavour</Name>
              <Brand ID="B01010221252625">
                <Name>Gaviscon Double Strength</Name>
                <Pack ID="P2215241" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>1.80</Subsidy>
                  <Price>7.97</Price>
                  <Alternate>1.80</Alternate>
                  <Surcharge>0.10283</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A010104">
          <Name>Phosphate Binding Agents</Name>
          <Chemical ID="C0101041038" Page="26">
            <Name>Aluminium hydroxide</Name>
            <Formulation ID="F010104103804" Rank="1" Units="tab" Weight="600">
              <Name>Tab 600 mg</Name>
              <Brand ID="B01010410380401">
                <Name>Alu-Tab</Name>
                <Pack ID="P200417" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.56</Subsidy>
                  <Price>12.56</Price>
                  <Alternate>12.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0104">
        <Name>Antidiarrhoeals</Name>
        <ATC3 ID="A010401">
          <Name>Agents Which Reduce Motility</Name>
          <Chemical ID="C0104011424" Page="27" Statim="Must">
            <Name>Diphenoxylate hydrochloride with atropine sulphate</Name>
            <Formulation ID="F010401142401" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg with atropine sulphate 25 mcg</Name>
              <Brand ID="B01040114240102" SoleSupply="true">
                <Name>Diastop</Name>
                <Pack ID="P281999" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.90</Subsidy>
                  <Price>3.90</Price>
                  <Alternate>3.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104011728" Page="27" Statim="Must">
            <Name>Loperamide hydrochloride</Name>
            <Formulation ID="F010401172802" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B01040117280225" SoleSupply="true">
                <Name>Nodia</Name>
                <Pack ID="P2184427" Specified="true">
                  <Quantity>400</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="30" Attribute="PSO"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A010404">
          <Name>Rectal and Colonic Anti-inflammatories</Name>
          <Chemical ID="C0104041168" Page="27">
            <Name>Budesonide</Name>
            <Formulation ID="F010404116809" Rank="2" Units="cap" Weight="3">
              <Name>Cap 3 mg</Name>
              <Brand ID="B01040411680901">
                <Name>Entocort CIR</Name>
                <Pack ID="P472905" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>185.00</Subsidy>
                  <Price>185.00</Price>
                  <Alternate>185.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA0698">
                <Title>
                  <range>Budesonide – Cap 3 mg Controlled Release</range>
                </Title>
                <Case When="Initial application">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Mild to moderate ileal, ileocaecal or proximal Crohn’s disease</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Diabetes</ci>
                        <ci type="logical" class="Indication">Cushingoid habitus</ci>
                        <ci type="logical" class="Indication">Osteoporosis where there is significant risk of fracture</ci>
                        <ci type="logical" class="Indication">Severe acne following treatment with conventional corticosteroid therapy</ci>
                      </apply>
                    </apply>
                  </math>
                  <Applicant>gastroenterologist</Applicant>
                  <Applicant>general surgeon</Applicant>
                  <Applicant>general physician</Applicant>
                  <Term Measure="month">3</Term>
                </Case>
                <Case When="Renewal" Form="SA0459 SA0488 SA0512 SA0698">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                  </math>
                  <Applicant>gastroenterologist</Applicant>
                  <Applicant>general surgeon</Applicant>
                  <Applicant>general physician</Applicant>
                  <Term Measure="month">3</Term>
                  <History>
                    <Term Measure="year">1</Term>
                    <Maximum>2</Maximum>
                  </History>
                </Case>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Clinical trials for Entocort CIR use beyond three months demonstrated no improvement in relapse rate.</p>
                </div>
              </Request>
              <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0698"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104041606" Page="27">
            <Name>Hydrocortisone acetate</Name>
            <Formulation ID="F010404160602" Rank="3" Units="g">
              <Name>Rectal foam 10 %, CFC-Free (14 applications)</Name>
              <Brand ID="B01040416060201" SoleSupply="true">
                <Name>Colifoam</Name>
                <Pack ID="P462829" OP="true" Specified="true">
                  <Quantity>21.1</Quantity>
                  <Subsidy>21.10</Subsidy>
                  <Price>21.10</Price>
                  <Alternate>21.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104042144" Page="27">
            <Name>Sodium cromoglycate</Name>
            <Formulation ID="F010404214406" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B01040421440601">
                <Name>Nalcrom</Name>
                <Pack ID="P259349" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>89.21</Subsidy>
                  <Price>89.21</Price>
                  <Alternate>89.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Hospital"/>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104042205" Page="27" Statim="Must">
            <Name>Sulphasalazine</Name>
            <Formulation ID="F010404220501" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B01040422050101" SoleSupply="true">
                <Name>Salazopyrin</Name>
                <Pack ID="P251615" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.42</Subsidy>
                  <Price>8.42</Price>
                  <Alternate>8.42</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010404220502" Rank="1" Units="tab" Weight="500">
              <Name>Tab EC 500 mg</Name>
              <Brand ID="B01040422050201" SoleSupply="true">
                <Name>Salazopyrin EN</Name>
                <Pack ID="P251585" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.44</Subsidy>
                  <Price>9.44</Price>
                  <Alternate>9.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010404220504" Rank="5" Units="en" Weight="3000">
              <Name>Enema 3 g per 100 ml</Name>
              <Brand ID="B01040422050401" ToBeDelisted="2008-04-01">
                <Name>Salazopyrin</Name>
                <Pack ID="P395552" Specified="true">
                  <Quantity>7</Quantity>
                  <Subsidy>37.40</Subsidy>
                  <Price>43.00</Price>
                  <Alternate>37.40</Alternate>
                  <Surcharge>0.80000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104042384" Page="27">
            <Name>Olsalazine</Name>
            <Formulation ID="F010404238401" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B01040423840101">
                <Name>Dipentum</Name>
                <Pack ID="P588679" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>31.51</Subsidy>
                  <Price>31.51</Price>
                  <Alternate>31.51</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010404238402" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B01040423840201">
                <Name>Dipentum</Name>
                <Pack ID="P426342" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>59.86</Subsidy>
                  <Price>59.86</Price>
                  <Alternate>59.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C0104042533" Page="27" Update="-Subsidy">
            <Name>Mesalazine</Name>
            <Formulation ID="F010404253302" Rank="1" Units="tab" Weight="500">
              <Name>Tab long-acting 500 mg</Name>
              <Brand ID="B01040425330201">
                <Name>Pentasa</Name>
                <Pack ID="P768618" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>69.06</Subsidy>
                  <Price>69.06</Price>
                  <Alternate>69.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F010404253303" Rank="5" Units="en">
              <Name>Enema 1 g per 100 ml</Name>
              <Brand ID="B01040425330301" SoleSupply="true">
                <Name>Pentasa</Name>
                <Pack ID="P715867" Specified="true">
                  <Quantity>7</Quantity>
                  <Subsidy>46.90</Subsidy>
                  <Price>46.90</Price>
                  <Alternate>46.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F010404253304" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B01040425330401">
                <Name>Asacol</Name>
                <Pack ID="P241113" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>49.50</Subsidy>
                  <Price>49.50</Price>
                  <Alternate>49.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F010404253305" Rank="5" Units="supp" Weight="500">
              <Name>Suppos 500 mg</Name>
              <Brand ID="B01040425330501">
                <Name>Asacol</Name>
                <Pack ID="P462543" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>25.20</Subsidy>
                  <Price>25.20</Price>
                  <Alternate>25.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010404253325" Rank="5" Units="supp" Weight="1000" Update="New Listing">
              <Name>Suppos 1 g</Name>
              <Brand ID="B01040425332525">
                <Name>Pentasa</Name>
                <Pack ID="P2111985" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>50.96</Subsidy>
                  <Price>50.96</Price>
                  <Alternate>50.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0105">
        <Name>Antihaemorrhoidals</Name>
        <ATC3 ID="A010501">
          <Name>Corticosteroids</Name>
          <Chemical ID="C0105011521" Page="28">
            <Name>Fluocortolone caproate with fluocortolone pivalate and cinchocaine</Name>
            <Formulation ID="F010501152101" Rank="5" Units="supp" Weight="630">
              <Name>Suppos 630 mcg, with fluocortolone pivalate 610 mcg, and cinchocaine hydrochloride 1 mg</Name>
              <Brand ID="B01050115210101" SoleSupply="true">
                <Name>Ultraproct</Name>
                <Pack ID="P257478" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>2.66</Subsidy>
                  <Price>2.66</Price>
                  <Alternate>2.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010501152102" Rank="3" Units="g">
              <Name>Oint 950 mcg, with fluocortolone pivalate 920 mcg, and cinchocaine hydrochloride 5 mg per g</Name>
              <Brand ID="B01050115210201" SoleSupply="true">
                <Name>Ultraproct</Name>
                <Pack ID="P257451" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.35</Subsidy>
                  <Price>6.35</Price>
                  <Alternate>6.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A010507">
          <Name>Soothing Agents</Name>
          <Chemical ID="C0105071619" Page="28">
            <Name>Zinc oxide</Name>
            <Formulation ID="F010507161901" Rank="3" Units="g">
              <Name>Oint zinc oxide with balsam peru</Name>
              <Brand ID="B01050716190101">
                <Name>Anusol</Name>
                <Pack ID="P788503" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.50</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.04000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010507161902" Rank="5" Units="supp">
              <Name>Suppos zinc oxide with balsam peru</Name>
              <Brand ID="B01050716190201">
                <Name>Anusol</Name>
                <Pack ID="P788511" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>4.47</Subsidy>
                  <Price>6.35</Price>
                  <Alternate>4.47</Alternate>
                  <Surcharge>0.15667</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0107">
        <Name>Antispasmodics and Other Agents Altering Gut Motility</Name>
        <ATC3 ID="A010701">
          <Name>Antispasmodics and Other Agents Altering Gut Motility</Name>
          <Chemical ID="C0107011097" Page="28" Statim="Must">
            <Name>Atropine sulphate</Name>
            <Formulation ID="F010701109703" Rank="4" Units="inj" Weight="600">
              <Name>Inj 600 mcg, 1 ml</Name>
              <Brand ID="B01070110970301" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P311294" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F010701109704" Rank="4" Units="inj" Weight="1200">
              <Name>Inj 1200 mcg, 1 ml</Name>
              <Brand ID="B01070110970401" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P311308" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>32.00</Subsidy>
                  <Price>32.00</Price>
                  <Alternate>32.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0107011631" Page="28" Statim="Must">
            <Name>Hyoscine N-butylbromide</Name>
            <Formulation ID="F010701163101" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B01070116310125" SoleSupply="true">
                <Name>Gastrosoothe</Name>
                <Pack ID="P2239787" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>1.33</Subsidy>
                  <Price>1.33</Price>
                  <Alternate>1.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010701163102" Rank="4" Units="inj" Weight="20">
              <Name>Inj 20 mg, 1 ml</Name>
              <Brand ID="B01070116310201" SoleSupply="true">
                <Name>Buscopan</Name>
                <Pack ID="P770833" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.15</Subsidy>
                  <Price>7.15</Price>
                  <Alternate>7.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0107012381" Page="28" Statim="Must">
            <Name>Mebeverine hydrochloride</Name>
            <Formulation ID="F010701238101" Rank="1" Units="tab" Weight="135">
              <Name>Tab 135 mg</Name>
              <Brand ID="B01070123810101">
                <Name>Colofac</Name>
                <Pack ID="P587575" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>10.72</Subsidy>
                  <Price>25.73</Price>
                  <Alternate>10.72</Alternate>
                  <Surcharge>0.16678</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0110">
        <Name>Antiulcerants</Name>
        <ATC3 ID="A011001">
          <Name>Antisecretory and Cytoprotective</Name>
          <Chemical ID="C0110012546" Page="28" Statim="Must">
            <Name>Misoprostol</Name>
            <Formulation ID="F011001254601" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mcg</Name>
              <Brand ID="B01100125460101" SoleSupply="true">
                <Name>Cytotec</Name>
                <Pack ID="P561630" Specified="true">
                  <Quantity>120</Quantity>
                  <Subsidy>52.70</Subsidy>
                  <Price>52.70</Price>
                  <Alternate>52.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011002">
          <Name>Helicobacter Pylori Eradication</Name>
          <Chemical ID="C0110021251" Page="28">
            <Name>Omeprazole, amoxycillin and clarithromycin</Name>
            <Formulation ID="F011002125101" Rank="10" Units="txpk" Weight="20">
              <Name>Omeprazole cap 20 mg x 14, amoxycillin cap 500 mg x 28 and clarithromycin tab 500 mg x 14</Name>
              <Brand ID="B01100212510102">
                <Name>Losec Hp7 OAC</Name>
                <Pack ID="P378127" OP="true" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>55.00</Subsidy>
                  <Price>55.00</Price>
                  <Alternate>55.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011003">
          <Name>H2 Antagonists</Name>
          <Chemical ID="C0110031297" Page="29" Statim="Must">
            <Name>Cimetidine</Name>
            <Formulation ID="F011003129701" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B01100312970104">
                <Name>Apo-Cimetidine</Name>
                <Pack ID="P230731" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>7.50</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.02500</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011003129702" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B01100312970204">
                <Name>Apo-Cimetidine</Name>
                <Pack ID="P230820" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>10.00</Alternate>
                  <Surcharge>0.02000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0110032080" Page="29" Statim="Must">
            <Name>Ranitidine hydrochloride</Name>
            <Formulation ID="F011003208003" Rank="3" Units="ml" Weight="15">
              <Name>Oral liq 150 mg per 10 ml</Name>
              <Brand ID="B01100320800301">
                <Name>Zantac</Name>
                <Pack ID="P615641" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>20.04</Subsidy>
                  <Price>20.04</Price>
                  <Alternate>20.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Oral liquid is subsidised only for patients:</p>
                <ol style="list-style-type: decimal">
                  <li>
                    <p>with oesophageal stricture, or</p>
                  </li>
                  <li>
                    <p>in terminal care, or</p>
                  </li>
                  <li>
                    <p>who are either too young or too old to swallow conventional tablets and the prescription is endorsed accordingly.</p>
                  </li>
                </ol>
                <p>Note: the cost of treatment with ranitidine oral liquid is more than 10 times higher than that of ranitidine tablets. Following the derestriction of access PHARMAC will be monitoring expenditure on ranitidine oral liquid more closely and may, subject to consultation and PHARMAC Board approval, restrict access again if the expenditure was to grow substantially.</p>
              </div>
            </Formulation>
            <Formulation ID="F011003208004" Rank="4" Units="inj" Weight="50">
              <Name>Inj 25 mg per ml, 2 ml</Name>
              <Brand ID="B01100320800401">
                <Name>Zantac</Name>
                <Pack ID="P316725" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>8.75</Subsidy>
                  <Price>8.75</Price>
                  <Alternate>8.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011003208005" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg</Name>
              <Brand ID="B01100320800525" SoleSupply="true">
                <Name>Arrow-Ranitidine</Name>
                <Pack ID="P2113538" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>7.99</Subsidy>
                  <Price>7.99</Price>
                  <Alternate>7.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011003208006" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B01100320800625" SoleSupply="true">
                <Name>Arrow-Ranitidine</Name>
                <Pack ID="P2113546" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>10.94</Subsidy>
                  <Price>10.94</Price>
                  <Alternate>10.94</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0110032373" Page="29" Statim="Must">
            <Name>Famotidine</Name>
            <Formulation ID="F011003237301" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B01100323730103">
                <Name>Famox</Name>
                <Pack ID="P2158639" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>9.20</Subsidy>
                  <Price>9.20</Price>
                  <Alternate>9.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011003237302" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B01100323730203">
                <Name>Famox</Name>
                <Pack ID="P2158647" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>12.90</Subsidy>
                  <Price>12.90</Price>
                  <Alternate>12.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011010">
          <Name>Proton Pump Inhibitors</Name>
          <Chemical ID="C0110101022" Page="29" Statim="Must">
            <Name>Lansoprazole</Name>
            <Formulation ID="F011010102201" Rank="2" Units="cap" Weight="30">
              <Name>Cap 30 mg</Name>
              <Brand ID="B01101010220125">
                <Name>Solox</Name>
                <Pack ID="P2043661" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>8.59</Subsidy>
                  <Price>8.59</Price>
                  <Alternate>8.59</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010102225" Rank="2" Units="cap" Weight="15">
              <Name>Cap 15 mg</Name>
              <Brand ID="B01101010222525">
                <Name>Solox</Name>
                <Pack ID="P2055163" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.30</Subsidy>
                  <Price>4.30</Price>
                  <Alternate>4.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0110101098" Page="29" Statim="Must">
            <Name>Pantoprazole</Name>
            <Formulation ID="F011010109801" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B01101010980101">
                <Name>Somac</Name>
                <Pack ID="P426350">
                  <Quantity>28</Quantity>
                  <Subsidy>4.79</Subsidy>
                  <Price>26.13</Price>
                  <Alternate>4.79</Alternate>
                  <Surcharge>0.76214</Surcharge>
                </Pack>
                <Pack ID="P479438" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.12</Subsidy>
                  <Price>28.00</Price>
                  <Alternate>5.12</Alternate>
                  <Surcharge>0.76267</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010109802" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B01101010980201">
                <Name>Somac</Name>
                <Pack ID="P493589">
                  <Quantity>28</Quantity>
                  <Subsidy>3.75</Subsidy>
                  <Price>20.53</Price>
                  <Alternate>3.75</Alternate>
                  <Surcharge>0.59929</Surcharge>
                </Pack>
                <Pack ID="P2014955" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.02</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>4.02</Alternate>
                  <Surcharge>0.59933</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0110102639" Page="29" Statim="Must">
            <Name>Omeprazole</Name>
            <Formulation ID="F011010263901" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B01101026390101">
                <Name>Losec</Name>
                <Pack ID="P726982" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>24.81</Subsidy>
                  <Price>24.81</Price>
                  <Alternate>24.81</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101026390125">
                <Name>Omezol</Name>
                <Pack ID="P2244217" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.28</Subsidy>
                  <Price>6.28</Price>
                  <Alternate>6.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101026390126" Update="New Listing">
                <Name>Dr Reddy's Omeprazole</Name>
                <Pack ID="P2265281" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.27</Subsidy>
                  <Price>4.27</Price>
                  <Alternate>4.27</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010263903" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg</Name>
              <Brand ID="B01101026390301">
                <Name>Losec</Name>
                <Pack ID="P726990" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>12.50</Subsidy>
                  <Price>12.50</Price>
                  <Alternate>12.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010263904" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B01101026390401">
                <Name>Losec</Name>
                <Pack ID="P472735" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>17.37</Subsidy>
                  <Price>17.37</Price>
                  <Alternate>17.37</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101026390425">
                <Name>Omezol</Name>
                <Pack ID="P2244225" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.28</Subsidy>
                  <Price>6.28</Price>
                  <Alternate>6.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101026390426" Update="New Listing">
                <Name>Dr Reddy's Omeprazole</Name>
                <Pack ID="P2265273" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>2.99</Subsidy>
                  <Price>2.99</Price>
                  <Alternate>2.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010263905" Rank="2" Units="cap" Weight="40">
              <Name>Cap 40 mg</Name>
              <Brand ID="B01101026390501">
                <Name>Losec</Name>
                <Pack ID="P472743" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>29.05</Subsidy>
                  <Price>29.05</Price>
                  <Alternate>29.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101026390525">
                <Name>Omezol</Name>
                <Pack ID="P2244209" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101026390526" Update="New Listing">
                <Name>Dr Reddy's Omeprazole</Name>
                <Pack ID="P2265303" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.01</Subsidy>
                  <Price>5.01</Price>
                  <Alternate>5.01</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p xlink:type="simple" xlink:href="standard-formulae">For omeprazole suspension refer</p>
            </div>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011013">
          <Name>Site Protective Agents</Name>
          <Chemical ID="C0110132191" Page="29">
            <Name>Sucralfate</Name>
            <Formulation ID="F011013219101" Rank="1" Units="tab" Weight="1000">
              <Name>Tab 1 g</Name>
              <Brand ID="B01101321910101">
                <Name>Carafate</Name>
                <Pack ID="P535273" Specified="true">
                  <Quantity>120</Quantity>
                  <Subsidy>35.50</Subsidy>
                  <Price>48.28</Price>
                  <Alternate>35.50</Alternate>
                  <Surcharge>0.10650</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0110132304" Page="29">
            <Name>Tripotassium dicitratobismuthate</Name>
            <Formulation ID="F011013230401" Rank="1" Units="tab" Weight="120">
              <Name>Tab 120 mg</Name>
              <Brand ID="B01101323040101" ToBeDelisted="2007-12-01">
                <Name>De-nol</Name>
                <Pack ID="P334405" Specified="true">
                  <Quantity>112</Quantity>
                  <Subsidy>38.00</Subsidy>
                  <Price>38.00</Price>
                  <Alternate>38.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0113">
        <Name>Diabetes</Name>
        <ATC3 ID="A011301">
          <Name>Hyperglycaemic Agents</Name>
          <Chemical ID="C0113011570" Page="30">
            <Name>Glucagon hydrochloride</Name>
            <Formulation ID="F011301157004" Rank="10" Units="txpk" Weight="1">
              <Name>Inj 1 mg syringe kit</Name>
              <Brand ID="B01130115700401">
                <Name>Glucagen Hypokit</Name>
                <Pack ID="P462519" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>27.00</Subsidy>
                  <Price>27.00</Price>
                  <Alternate>27.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011303">
          <Name>Insulin - Short-acting Preparations</Name>
          <Chemical ID="C0113031648" Page="30" Statim="May">
            <Name>Insulin neutral</Name>
            <Formulation ID="F011303164801" Rank="3" Units="ml" Weight="100">
              <Name>Inj human 100 u per ml</Name>
              <Brand ID="B01130316480101">
                <Name>Actrapid</Name>
                <Pack ID="P797103" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>25.26</Subsidy>
                  <Price>25.26</Price>
                  <Alternate>25.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130316480102">
                <Name>Humulin R</Name>
                <Pack ID="P518913" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>25.26</Subsidy>
                  <Price>25.26</Price>
                  <Alternate>25.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011303164803" Rank="4" Units="inj" Weight="300">
              <Name>Inj human 100 u per ml, 3 ml</Name>
              <Brand ID="B01130316480301">
                <Name>Actrapid Penfill</Name>
                <Pack ID="P797138" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130316480302">
                <Name>Humulin R</Name>
                <Pack ID="P282790" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011305">
          <Name>Insulin - Intermediate-acting Preparations</Name>
          <Chemical ID="C0113051649" Page="30" Statim="May">
            <Name>Insulin isophane</Name>
            <Formulation ID="F011305164903" Rank="4" Units="inj" Weight="300">
              <Name>Inj human 100 u per ml, 3 ml</Name>
              <Brand ID="B01130516490301">
                <Name>Protaphane Penfill</Name>
                <Pack ID="P797162" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>29.86</Subsidy>
                  <Price>29.86</Price>
                  <Alternate>29.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130516490325">
                <Name>Humulin NPH</Name>
                <Pack ID="P2207931" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>29.86</Subsidy>
                  <Price>29.86</Price>
                  <Alternate>29.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011305164904" Rank="3" Units="ml">
              <Name>Inj human 100 u per ml</Name>
              <Brand ID="B01130516490402">
                <Name>Protaphane</Name>
                <Pack ID="P332631" OP="true">
                  <Quantity>10</Quantity>
                  <Subsidy>17.68</Subsidy>
                  <Price>17.68</Price>
                  <Alternate>17.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P797146" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>17.68</Subsidy>
                  <Price>17.68</Price>
                  <Alternate>17.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130516490425">
                <Name>Humulin NPH</Name>
                <Pack ID="P2207923" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>17.68</Subsidy>
                  <Price>17.68</Price>
                  <Alternate>17.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011305164925" Rank="3" Units="ml" Weight="1000">
              <Name>Inj animal (pork) 100 u per ml</Name>
              <Brand ID="B01130516492503">
                <Name>Protaphane</Name>
                <Pack ID="P403490" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>25.26</Subsidy>
                  <Price>25.26</Price>
                  <Alternate>25.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113056300" Page="30" Statim="May">
            <Name>Insulin isophane with insulin neutral</Name>
            <Formulation ID="F011305630002" Rank="4" Units="inj" Weight="300">
              <Name>Inj human with neutral insulin 100 u per ml, 3 ml</Name>
              <Brand ID="B01130563000201" ToBeDelisted="2008-03-01">
                <Name>PenMix 10</Name>
                <Pack ID="P785717" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130563000202" ToBeDelisted="2008-03-01">
                <Name>PenMix 20</Name>
                <Pack ID="P785725" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130563000203">
                <Name>PenMix 30</Name>
                <Pack ID="P785733" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130563000204">
                <Name>PenMix 40</Name>
                <Pack ID="P785741" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130563000205">
                <Name>PenMix 50</Name>
                <Pack ID="P785768" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130563000225">
                <Name>Humulin 30/70</Name>
                <Pack ID="P2207915" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.66</Subsidy>
                  <Price>42.66</Price>
                  <Alternate>42.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011305630003" Rank="3" Units="ml" Weight="100">
              <Name>Inj human with neutral insulin 100 u per ml</Name>
              <Brand ID="B01130563000307">
                <Name>Mixtard 30</Name>
                <Pack ID="P797189" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>25.26</Subsidy>
                  <Price>25.26</Price>
                  <Alternate>25.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130563000308" ToBeDelisted="2008-03-01">
                <Name>Mixtard 50</Name>
                <Pack ID="P797197" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>25.26</Subsidy>
                  <Price>25.26</Price>
                  <Alternate>25.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01130563000325">
                <Name>Humulin 30/70</Name>
                <Pack ID="P2207907" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>25.26</Subsidy>
                  <Price>25.26</Price>
                  <Alternate>25.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011307">
          <Name>Insulin - Long-acting Preparations</Name>
          <Chemical ID="C0113073857" Page="31" Statim="May">
            <Name>Insulin glargine</Name>
            <Formulation ID="F011307385725" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 u per ml, 3 ml</Name>
              <Brand ID="B01130738572525">
                <Name>Lantus</Name>
                <Pack ID="P2146754" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>94.50</Subsidy>
                  <Price>94.50</Price>
                  <Alternate>94.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011307385726" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 u per ml, 10 ml</Name>
              <Brand ID="B01130738572625">
                <Name>Lantus</Name>
                <Pack ID="P2146746" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>63.00</Subsidy>
                  <Price>63.00</Price>
                  <Alternate>63.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0834">
              <Title>
                <range>Insulin Glargine</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has type 1 diabetes and has received an intensive regimen (injections at least three times a day) of an intermediate acting insulin in combination with a rapid acting insulin analogue for at least three months</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has experienced more than one unexplained severe hypoglycaemic episode in the previous 12 months (severe defined as requiring the assistance of another person)</ci>
                        <ci type="logical" class="Indication">Patient has experienced unexplained symptomatic nocturnal hypoglycaemia, biochemically documented at &lt;3.0 mmol/L, more than once a month despite optimal management</ci>
                      </apply>
                    </apply>
                    <ci type="logical" class="Indication">Patient has documented severe, or continuing, systemic or local allergic reaction to existing insulins. Note this does not include hypoglycaemic episodes</ci>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Form="SA0834">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Patient is continuing to derive benefit due to reduced hypoglycaemic events whilst maintaining similar or better glycaemic control</ci>
                    <ci type="logical" class="Indication">Patient’s allergic reaction has significantly decreased, or resolved, following the change to long-acting insulin and patient is continuing to benefit from treatment</ci>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>general practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0834"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011309">
          <Name>Insulin - Rapid Acting Insulin Analogues</Name>
          <Chemical ID="C0113091192" Page="31" Statim="May">
            <Name>Insulin lispro</Name>
            <Formulation ID="F011309119201" Rank="4" Units="inj" Weight="300">
              <Name>Inj 100 u per ml, 3 ml</Name>
              <Brand ID="B01130911920101">
                <Name>Humalog</Name>
                <Pack ID="P490865" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>59.52</Subsidy>
                  <Price>59.52</Price>
                  <Alternate>59.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011309119202" Rank="3" Units="ml">
              <Name>Inj 100 u per ml, 10 ml</Name>
              <Brand ID="B01130911920201">
                <Name>Humalog</Name>
                <Pack ID="P490857" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>34.92</Subsidy>
                  <Price>34.92</Price>
                  <Alternate>34.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113093783" Page="31" Statim="May">
            <Name>Insulin aspart</Name>
            <Formulation ID="F011309378325" Rank="4" Units="inj" Weight="300">
              <Name>Inj 100 u per ml, 3 ml</Name>
              <Brand ID="B01130937832525">
                <Name>NovoRapid Penfill</Name>
                <Pack ID="P2105098" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>53.57</Subsidy>
                  <Price>53.57</Price>
                  <Alternate>53.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011309378326" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 100 u per ml, 10 ml</Name>
              <Brand ID="B01130937832625">
                <Name>NovoRapid</Name>
                <Pack ID="P2105101" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>31.43</Subsidy>
                  <Price>31.43</Price>
                  <Alternate>31.43</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011311">
          <Name>Alpha Glucosidase Inhibitors</Name>
          <Chemical ID="C0113111247" Page="31" Statim="Must">
            <Name>Acarbose</Name>
            <Formulation ID="F011311124701" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B01131112470101">
                <Name>Glucobay</Name>
                <Pack ID="P289256" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011311124702" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B01131112470201">
                <Name>Glucobay</Name>
                <Pack ID="P289647" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>31.00</Subsidy>
                  <Price>31.00</Price>
                  <Alternate>31.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0490">
              <Title>
                <range>Acarbose</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Trial">Requires but is not able to tolerate metformin therapy</ci>
                    <ci type="logical" class="Trial">Requires metformin but metformin is contraindicated</ci>
                    <ci type="logical" class="Trial">Has not responded to or tolerated the maximum appropriate dose of metformin</ci>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0490">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0490"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011312">
          <Name>Oral Hypoglycaemic Agents</Name>
          <Chemical ID="C0113121567" Page="32" Statim="Must">
            <Name>Glibenclamide</Name>
            <Formulation ID="F011312156701" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B01131215670104">
                <Name>Gliben</Name>
                <Pack ID="P612685" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.78</Subsidy>
                  <Price>3.78</Price>
                  <Alternate>3.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011312156702" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B01131215670201">
                <Name>Gliben</Name>
                <Pack ID="P284688" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.31</Subsidy>
                  <Price>3.31</Price>
                  <Alternate>3.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113121568" Page="32" Statim="Must">
            <Name>Gliclazide</Name>
            <Formulation ID="F011312156801" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B01131215680125" SoleSupply="true">
                <Name>Apo-Gliclazide</Name>
                <Pack ID="P2090163" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>36.46</Subsidy>
                  <Price>36.46</Price>
                  <Alternate>36.46</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113121569" Page="32" Statim="Must">
            <Name>Glipizide</Name>
            <Formulation ID="F011312156901" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B01131215690102" SoleSupply="true">
                <Name>Minidiab</Name>
                <Pack ID="P2091755" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113121794" Page="32" Statim="Must">
            <Name>Metformin hydrochloride</Name>
            <Formulation ID="F011312179401" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B01131217940103" ToBeDelisted="2008-01-01">
                <Name>Metomin</Name>
                <Pack ID="P380482" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>9.75</Subsidy>
                  <Price>9.75</Price>
                  <Alternate>9.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01131217940125">
                <Name>Arrow-Metformin</Name>
                <Pack ID="P2256363" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>9.75</Subsidy>
                  <Price>9.75</Price>
                  <Alternate>9.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011312179402" Rank="1" Units="tab" Weight="850">
              <Name>Tab 850 mg</Name>
              <Brand ID="B01131217940203" ToBeDelisted="2008-01-01">
                <Name>Metomin</Name>
                <Pack ID="P380431" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01131217940226">
                <Name>Arrow-Metformin</Name>
                <Pack ID="P2256371" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113122277" Page="33" Statim="Must">
            <Name>Tolbutamide</Name>
            <Formulation ID="F011312227701" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B01131222770101">
                <Name>Diatol</Name>
                <Pack ID="P454745" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113123800" Page="32">
            <Name>Pioglitazone</Name>
            <Formulation ID="F011312380025" Rank="1" Units="tab" Weight="15">
              <Name>Tab 15 mg</Name>
              <Brand ID="B01131238002525">
                <Name>Actos</Name>
                <Pack ID="P2091240" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>61.04</Subsidy>
                  <Price>61.04</Price>
                  <Alternate>61.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011312380026" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B01131238002625">
                <Name>Actos</Name>
                <Pack ID="P2091259" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>93.90</Subsidy>
                  <Price>93.90</Price>
                  <Alternate>93.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011312380027" Rank="1" Units="tab" Weight="45">
              <Name>Tab 45 mg</Name>
              <Brand ID="B01131238002725">
                <Name>Actos</Name>
                <Pack ID="P2091267" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>119.18</Subsidy>
                  <Price>119.18</Price>
                  <Alternate>119.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0859">
              <Title>
                <range>Pioglitazone</range>
              </Title>
              <Case When="Initial application" Category="Patients with type 2 diabetes" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <mi class="heading">Monotherapy</mi>
                    <apply>
                      <and/>
                      <ci type="logical" class="Use">To be used as monotherapy for patients who after six months of diet and lifestyle changes have inadequate glycaemic control (defined as HbA1c &gt; 7.0% in tests carried out at least two months apart)</ci>
                      <ci type="logical" class="Trial">Metformin is contraindicated or not tolerated after a minimum of a four-week trial period</ci>
                      <ci type="logical" class="Trial">Sulphonylurea is contraindicated or not tolerated or the patient is obese</ci>
                    </apply>
                    <mi class="heading">In combination with sulphonylurea</mi>
                    <apply>
                      <and/>
                      <ci type="logical" class="Use">For use in combination with a sulphonylurea for patients who after diet and lifestyle changes and a six-month trial of sulphonylurea have poor glycaemic control (defined as HbA1c &gt; 7.5% measured within the last month of the six-month period)</ci>
                      <ci type="logical" class="Trial">Metformin is contraindicated or not tolerated after a minimum of a four-week trial period</ci>
                    </apply>
                    <mi class="heading">In combination with metformin</mi>
                    <apply>
                      <and/>
                      <ci type="logical" class="Use">For use in combination with metformin for patients who after diet and lifestyle changes and a six-month trial of the maximum tolerated dose of metformin have poor glycaemic control (defined as HbA1c &gt; 7.5% measured within the last month of the six-month period)</ci>
                      <ci type="logical" class="Trial">Sulphonylurea is contraindicated or not tolerated, or the patient is obese</ci>
                    </apply>
                    <mi class="heading">In combination with metformin after a trial of metformin and sulphonylurea</mi>
                    <ci type="logical" class="Use">For use in combination with metformin for patients who after diet and lifestyle changes and a six-month trial of a combination of metformin and sulphonylurea at maximum tolerated doses have poor glycaemic control (defined as HbA1c &gt; 7.5% measured within the last month of the six month period)</ci>
                    <mi class="heading">In combination with Insulin</mi>
                    <ci type="logical" class="Use">For use in combination with insulin in patients requiring more than 1.5 units per kilogram of insulin a day for at least 6 months in conjunction with metformin if tolerated</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Category="Patients with type 2 diabetes" Form="SA0738 SA0781 SA0819">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">Patient is continuing to derive benefit from treatment</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Pioglitazone is not to be used in triple oral combination (defined as a combination of metformin, sulphonylurea and pioglitazone).</p>
                <p>Pioglitazone should not be used in patients with heart failure.</p>
                <p>Liver function tests should be performed at baseline.</p>
                <p>Gastrointestinal side effects are relatively common when initiating metformin therapy. Upward titration of metformin dose over several weeks and taking metformin with food will help to minimize these side effects.</p>
                <p>Intolerance and contraindications for metformin include: serum creatinine ≥ 0.15 or creatinine clearance &lt; 60 ml/min; significant liver impairment; severe left ventricular dysfunction; and intolerable gastrointestinal side effects that persist beyond 4 weeks duration.</p>
                <p>Intolerance for sulphonylurea includes: nausea; diarrhoea; rash; blood disorders (thrombocytopenia, agranulocytosis, aplastic anaemia); erythema multiforme, exfoliative dermatitis, hepatitis; and syndrome of inappropriate antidiuretic hormone secretion (SIADH) with water retention and hyponatraemia.</p>
                <p>Maximum tolerated dose of metformin defined as: A dose up to a maximum of 3 g daily.</p>
                <p>Maximum tolerated dose of sulphonylurea defined as: A dose up to a maximum of glibenclamide 20 mg daily or glipizide 20 mg daily or gliclazide 320 mg daily.</p>
                <p>For the purposes of these criteria “obese” is defined as body mass index (BMI) greater than 33 kg/m<sup>2</sup>.</p>
                <p>However, as ethnic differences between patients may vary BMI scores, practitioners may use discretion as to whether the patient meets this criterion.</p>
                <p>It is considered that when applying, that the patient may have initiated “six months diet and lifestyle changes” from the date of diagnosis of type 2 diabetes.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0859"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0115">
        <Name>Diabetes Management</Name>
        <ATC3 ID="A011501">
          <Name>Glucose/Urine Testing</Name>
          <Chemical ID="C0115011357" Page="33" Statim="Must">
            <Name>Copper</Name>
            <Formulation ID="F011501135701" Rank="1" Units="tab">
              <Name>Tab, diagnostic</Name>
              <Brand ID="B01150113570101">
                <Name>Clinitest</Name>
                <Pack ID="P263966" OP="true" Specified="true">
                  <Quantity>36</Quantity>
                  <Subsidy>5.02</Subsidy>
                  <Price>30.25</Price>
                  <Alternate>5.02</Alternate>
                  <Surcharge>0.70083</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0115011572" Page="33">
            <Name>Glucose oxidase</Name>
            <Formulation ID="F011501157201" Rank="10" Units="strip">
              <Name>Urine diagnostic test with peroxidase</Name>
              <Brand ID="B01150115720101">
                <Name>Clinistix</Name>
                <Pack ID="P2185105" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.13</Subsidy>
                  <Price>6.05</Price>
                  <Alternate>4.13</Alternate>
                  <Surcharge>0.03840</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150115720102">
                <Name>Diastix</Name>
                <Pack ID="P2179954" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.11</Subsidy>
                  <Price>6.05</Price>
                  <Alternate>4.11</Alternate>
                  <Surcharge>0.03880</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
            <Formulation ID="F011501157202" Rank="10" Units="strip">
              <Name>Urine diagnostic test</Name>
              <Brand ID="B01150115720202">
                <Name>Diabur 5000</Name>
                <Pack ID="P325996" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.11</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>4.11</Alternate>
                  <Surcharge>0.05780</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011504">
          <Name>Glucose &amp;/or Ketones/Urine Testing</Name>
          <Chemical ID="C0115041572" Page="33">
            <Name>Glucose oxidase</Name>
            <Formulation ID="F011504157204" Rank="10" Units="strip">
              <Name>Urine diagnostic test with peroxidase, potassium iodide, sodium nitroprusside and aminoacetic acid</Name>
              <Brand ID="B01150415720401">
                <Name>Keto-Diastix</Name>
                <Pack ID="P2185113" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.53</Subsidy>
                  <Price>7.50</Price>
                  <Alternate>4.53</Alternate>
                  <Surcharge>0.05940</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
            <Formulation ID="F011504157210" Rank="10" Units="stick">
              <Name>Urine diagnostic test with peroxidase, sodium nitroprusside and aminoacetic acid</Name>
              <Brand ID="B01150415721001">
                <Name>Keto-Diabur 5000</Name>
                <Pack ID="P325988" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.53</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>4.53</Alternate>
                  <Surcharge>0.06940</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0115042158" Page="34" Statim="Must">
            <Name>Sodium nitroprusside</Name>
            <Formulation ID="F011504215801" Rank="10" Units="strip">
              <Name>Urine diagnostic strips, buffered</Name>
              <Brand ID="B01150421580101">
                <Name>Ketur-Test</Name>
                <Pack ID="P253847" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.39</Subsidy>
                  <Price>6.00</Price>
                  <Alternate>3.39</Alternate>
                  <Surcharge>0.05220</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150421580102">
                <Name>Ketostix</Name>
                <Pack ID="P2185121" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.40</Subsidy>
                  <Price>7.15</Price>
                  <Alternate>3.40</Alternate>
                  <Surcharge>0.07500</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011507">
          <Name>Glucose/Blood Testing</Name>
          <Chemical ID="C0115073802" Page="34">
            <Name>Glucose dehydrogenase</Name>
            <Formulation ID="F011507380225" Rank="10" Units="test">
              <Name>Blood/glucose test strips</Name>
              <Brand ID="B01150738022525">
                <Name>Optium</Name>
                <Pack ID="P2171546" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2184117" OP="true">
                  <Quantity>25</Quantity>
                  <Subsidy>11.00</Subsidy>
                  <Price>11.00</Price>
                  <Alternate>11.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738022526" ToBeDelisted="2008-07-01">
                <Name>Accu-Chek Advantage</Name>
                <Pack ID="P297887" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738022527">
                <Name>Accu-Chek Performa</Name>
                <Pack ID="P2247941" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>The number of test strips available on a prescription is restricted to 50 unless:</p>
              <ol style="list-style-type: decimal">
                <li>
                  <p>Prescribed with insulin or a sulphonylurea but are on a different prescription and the prescription is endorsed accordingly; or</p>
                </li>
                <li>
                  <p>Prescribed on the same prescription as insulin or a sulphonylurea in which case the prescription is deemed to be endorsed; or</p>
                </li>
                <li>
                  <p>Prescribed for a pregnant woman with diabetes and endorsed accordingly.</p>
                </li>
              </ol>
            </div>
          </Chemical>
          <Chemical ID="C0115073807" Page="34">
            <Name>Glucose blood diagnostic test meter</Name>
            <Formulation ID="F011507380725" Rank="10" Units="meter">
              <Name>Meter</Name>
              <Brand ID="B01150738072525" ToBeDelisted="2008-07-01">
                <Name>Accu-Chek Advantage</Name>
                <Pack ID="P472956" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>19.00</Subsidy>
                  <Price>19.00</Price>
                  <Alternate>19.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738072526" ToBeDelisted="2008-02-01">
                <Name>Optium</Name>
                <Pack ID="P2171554" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>9.00</Subsidy>
                  <Price>9.00</Price>
                  <Alternate>9.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738072527">
                <Name>Optium Xceed</Name>
                <Pack ID="P2211912" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>9.00</Subsidy>
                  <Price>9.00</Price>
                  <Alternate>9.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738072528">
                <Name>Accu-Chek Performa</Name>
                <Pack ID="P2247968" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>19.00</Subsidy>
                  <Price>19.00</Price>
                  <Alternate>19.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>A diagnostic blood glucose test meter is subsidised for patients who begin insulin or sulphonylurea therapy after 1 March 2005. Only one meter per patient. No further prescriptions will be subsidised. The prescription must be endorsed accordingly.</p>
            </div>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011509">
          <Name>Insulin Syringes and Needles</Name>
          <Chemical ID="C0115091110" Page="34" Statim="Must">
            <Name>Insulin pen needles</Name>
            <Formulation ID="F011509111001" Rank="10" Units="dev">
              <Name>29 g x 12.7 mm</Name>
              <Brand ID="B01150911100101">
                <Name>B-D Micro-Fine</Name>
                <Pack ID="P308218">
                  <Quantity>30</Quantity>
                  <Subsidy>3.93</Subsidy>
                  <Price>3.93</Price>
                  <Alternate>3.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2063786" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.09</Subsidy>
                  <Price>13.09</Price>
                  <Alternate>13.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509111002" Rank="10" Units="dev">
              <Name>31 g x 8 mm</Name>
              <Brand ID="B01150911100201">
                <Name>B-D Micro-Fine</Name>
                <Pack ID="P460265">
                  <Quantity>30</Quantity>
                  <Subsidy>3.93</Subsidy>
                  <Price>3.93</Price>
                  <Alternate>3.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2181835" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.09</Subsidy>
                  <Price>13.09</Price>
                  <Alternate>13.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509111025" Rank="10" Units="dev">
              <Name>31 g x 5 mm</Name>
              <Brand ID="B01150911102525">
                <Name>B-D Micro-Fine</Name>
                <Pack ID="P433802" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.09</Subsidy>
                  <Price>13.09</Price>
                  <Alternate>13.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509111026" Rank="10" Units="dev">
              <Name>31 g x 6 mm</Name>
              <Brand ID="B01150911102625">
                <Name>NovoFine</Name>
                <Pack ID="P487074" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>NovoFine pen needles 31 g × 6 mm are subsidised for children under 12 years of age.</p>
            </div>
            <Rule Type="FormMax" Value="100" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0115096307" Page="34" Statim="Must">
            <Name>Insulin syringes, disposable with attached needle</Name>
            <Formulation ID="F011509630702" Rank="10" Units="dev" Weight="3.29">
              <Name>Syringe 0.3 ml with 29 g x 12.7 mm needle</Name>
              <Brand ID="B01150963070201">
                <Name>B-D Ultra Fine</Name>
                <Pack ID="P788236" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.92</Subsidy>
                  <Price>15.92</Price>
                  <Alternate>15.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P799939">
                  <Quantity>10</Quantity>
                  <Subsidy>1.59</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.59</Alternate>
                  <Surcharge>0.04000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509630704" Rank="10" Units="dev" Weight="5.29">
              <Name>Syringe 0.5 ml with 29 g x 12.7 mm needle</Name>
              <Brand ID="B01150963070401">
                <Name>B-D Ultra Fine</Name>
                <Pack ID="P799947">
                  <Quantity>10</Quantity>
                  <Subsidy>1.59</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.59</Alternate>
                  <Surcharge>0.04000</Surcharge>
                </Pack>
                <Pack ID="P788228" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.92</Subsidy>
                  <Price>15.92</Price>
                  <Alternate>15.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509630706" Rank="10" Units="dev" Weight="10.29">
              <Name>Syringe 1 ml with 29 g x 12.7 mm needle</Name>
              <Brand ID="B01150963070601">
                <Name>B-D Ultra Fine</Name>
                <Pack ID="P788244" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.92</Subsidy>
                  <Price>15.92</Price>
                  <Alternate>15.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P799955">
                  <Quantity>10</Quantity>
                  <Subsidy>1.59</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.59</Alternate>
                  <Surcharge>0.04000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509630725" Rank="10" Units="dev" Weight="3.31">
              <Name>Syringe 0.3 ml with 31 g x 8 mm needle</Name>
              <Brand ID="B01150963072525">
                <Name>B-D Ultra Fine II</Name>
                <Pack ID="P2224216" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.92</Subsidy>
                  <Price>15.92</Price>
                  <Alternate>15.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2224348">
                  <Quantity>10</Quantity>
                  <Subsidy>1.59</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.59</Alternate>
                  <Surcharge>0.04000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509630726" Rank="10" Units="dev" Weight="5.31">
              <Name>Syringe 0.5 ml with 31 g x 8 mm needle</Name>
              <Brand ID="B01150963072625">
                <Name>B-D Ultra Fine II</Name>
                <Pack ID="P2224208" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.92</Subsidy>
                  <Price>15.92</Price>
                  <Alternate>15.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2224321">
                  <Quantity>10</Quantity>
                  <Subsidy>1.59</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.59</Alternate>
                  <Surcharge>0.04000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509630727" Rank="10" Units="dev" Weight="10.31">
              <Name>Syringe 1 ml with 31 g x 8 mm needle</Name>
              <Brand ID="B01150963072725">
                <Name>B-D Ultra Fine II</Name>
                <Pack ID="P2224224" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.92</Subsidy>
                  <Price>15.92</Price>
                  <Alternate>15.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2224356">
                  <Quantity>10</Quantity>
                  <Subsidy>1.59</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.59</Alternate>
                  <Surcharge>0.04000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="100" Attribute="Rx"/>
          </Chemical>
          <Rule Type="SubRxF"/>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p>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.</p>
          </div>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0122">
        <Name>Digestives Including Enzymes</Name>
        <ATC3 ID="A012201">
          <Name>Digestives Including Enzymes</Name>
          <Chemical ID="C0122011126" Page="35">
            <Name>Ursodeoxycholic acid</Name>
            <Formulation ID="F012201112601" Rank="2" Units="cap" Weight="300">
              <Name>Cap 300 mg</Name>
              <Brand ID="B01220111260101" SoleSupply="true">
                <Name>Actigall</Name>
                <Pack ID="P336874" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>269.98</Subsidy>
                  <Price>269.98</Price>
                  <Alternate>269.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0841">
              <Title>
                <range>Ursodeoxycholic Acid – Cap 300 mg</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Primary biliary cirrhosis confirmed by antimitochondrial antibody titre (AMA) &gt; 1:80, and raised cholestatic liver enzymes with or without raised serum IgM or, if AMA is negative, by liver biopsy</ci>
                    <ci type="logical" class="Indication">Patient not requiring a liver transplant (bilirubin &gt; 170umol/l; decompensated cirrhosis)</ci>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="month">6</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Liver biopsy is not usually required for diagnosis but is helpful to stage the disease.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0458 SA0841">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="year">2</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Actigall is not an appropriate therapy for patients requiring a liver transplant (bilirubin &gt; 170 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.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0841"/>
          </Chemical>
          <Chemical ID="C0122011925" Page="35">
            <Name>Pancreatic enzyme</Name>
            <Formulation ID="F012201192504" Rank="1" Units="tab">
              <Name>Tab EC 1,900 BP u lipase, 1,700 BP u amylase, 110 BP u protease</Name>
              <Brand ID="B01220119250401">
                <Name>Pancrex V</Name>
                <Pack ID="P296325" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>32.46</Subsidy>
                  <Price>32.46</Price>
                  <Alternate>32.46</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012201192505" Rank="1" Units="tab">
              <Name>Tab EC 5,600 BP u lipase, 5,000 BP u amylase, 330 BP u protease</Name>
              <Brand ID="B01220119250501">
                <Name>Pancrex V Forte</Name>
                <Pack ID="P266167" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>58.44</Subsidy>
                  <Price>58.44</Price>
                  <Alternate>58.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012201192506" Rank="2" Units="cap">
              <Name>Cap 8,000 BP u lipase, 9,000 BP u amylase, 430 BP u protease</Name>
              <Brand ID="B01220119250601">
                <Name>Pancrex V</Name>
                <Pack ID="P798169" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>67.26</Subsidy>
                  <Price>67.26</Price>
                  <Alternate>67.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012201192511" Rank="2" Units="cap" Weight="8000">
              <Name>Cap 8,000 USP u lipase, 30,000 USP u amylase, 30,000 USP u protease</Name>
              <Brand ID="B01220119251101">
                <Name>Cotazym ECS</Name>
                <Pack ID="P609684" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>85.00</Subsidy>
                  <Price>85.00</Price>
                  <Alternate>85.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F012201192513" Rank="2" Units="cap" Weight="25000">
              <Name>Cap EC 25,000 BP u lipase, 18,000 BP u amylase, 1,000 BP u protease</Name>
              <Brand ID="B01220119251301">
                <Name>Creon Forte</Name>
                <Pack ID="P751529" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>94.38</Subsidy>
                  <Price>94.38</Price>
                  <Alternate>94.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F012201192515" Rank="2" Units="cap" Weight="25000">
              <Name>Cap EC 25,000 BP u lipase, 22,500 BP u amylase, 1,250 BP u protease</Name>
              <Brand ID="B01220119251501">
                <Name>Panzytrat</Name>
                <Pack ID="P777021" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>94.40</Subsidy>
                  <Price>94.40</Price>
                  <Alternate>94.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F012201192525" Rank="2" Units="cap" Weight="10000">
              <Name>Cap EC 10,000 BP u lipase, 9,000 BP u amylase and 210 BP u protease</Name>
              <Brand ID="B01220119252525">
                <Name>Creon 10000</Name>
                <Pack ID="P954322" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>34.93</Subsidy>
                  <Price>34.93</Price>
                  <Alternate>34.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0125">
        <Name>Laxatives</Name>
        <ATC3 ID="A012501">
          <Name>Bulk-forming Agents</Name>
          <Chemical ID="C0125012452" Page="35" Statim="Must">
            <Name>Mucilaginous laxatives</Name>
            <Formulation ID="F012501245201" Rank="3" Units="g">
              <Name>Sugar Free</Name>
              <Brand ID="B01250124520101">
                <Name>Mucilax</Name>
                <Pack ID="P280089" OP="true" Specified="true">
                  <Quantity>275</Quantity>
                  <Subsidy>4.84</Subsidy>
                  <Price>10.60</Price>
                  <Alternate>4.84</Alternate>
                  <Surcharge>0.02095</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012501245202" Rank="3" Units="g">
              <Name>Dry</Name>
              <Brand ID="B01250124520201">
                <Name>Mucilax</Name>
                <Pack ID="P2212838" OP="true" Specified="true">
                  <Quantity>380</Quantity>
                  <Subsidy>6.69</Subsidy>
                  <Price>6.69</Price>
                  <Alternate>6.69</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01250124520202">
                <Name>Isogel</Name>
                <Pack ID="P547840" OP="true" Specified="true">
                  <Quantity>450</Quantity>
                  <Subsidy>7.92</Subsidy>
                  <Price>12.71</Price>
                  <Alternate>7.92</Alternate>
                  <Surcharge>0.01064</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01250124520205">
                <Name>Normacol</Name>
                <Pack ID="P275298" OP="true" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>8.80</Subsidy>
                  <Price>15.27</Price>
                  <Alternate>8.80</Alternate>
                  <Surcharge>0.01294</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01250124520206">
                <Name>Konsyl-D</Name>
                <Pack ID="P462756" OP="true" Specified="true">
                  <Quantity>325</Quantity>
                  <Subsidy>5.72</Subsidy>
                  <Price>5.72</Price>
                  <Alternate>5.72</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012501245209" Rank="3" Units="g">
              <Name>Dry-original flavour, regular texture only</Name>
              <Brand ID="B01250124520901">
                <Name>Metamucil</Name>
                <Pack ID="P424730" OP="true" Specified="true">
                  <Quantity>336</Quantity>
                  <Subsidy>5.91</Subsidy>
                  <Price>12.38</Price>
                  <Alternate>5.91</Alternate>
                  <Surcharge>0.01926</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125012859" Page="36" Statim="Must">
            <Name>Mucilaginous laxatives with stimulants</Name>
            <Formulation ID="F012501285910" Rank="3" Units="g">
              <Name>Dry</Name>
              <Brand ID="B01250128591001">
                <Name>Normacol Plus</Name>
                <Pack ID="P275301" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>3.52</Subsidy>
                  <Price>7.69</Price>
                  <Alternate>3.52</Alternate>
                  <Surcharge>0.02085</Surcharge>
                </Pack>
                <Pack ID="P275328" OP="true" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>8.80</Subsidy>
                  <Price>15.27</Price>
                  <Alternate>8.80</Alternate>
                  <Surcharge>0.01294</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01250128591002">
                <Name>Granocol</Name>
                <Pack ID="P250821" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>4.40</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>4.40</Alternate>
                  <Surcharge>0.03040</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A012504">
          <Name>Faecal Softeners</Name>
          <Chemical ID="C0125042429" Page="36" Statim="Must">
            <Name>Docusate sodium</Name>
            <Formulation ID="F012504242901" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B01250424290101" SoleSupply="true">
                <Name>Coloxyl</Name>
                <Pack ID="P252832" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.89</Subsidy>
                  <Price>4.89</Price>
                  <Alternate>4.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012504242902" Rank="1" Units="tab" Weight="120">
              <Name>Tab 120 mg</Name>
              <Brand ID="B01250424290201" SoleSupply="true">
                <Name>Coloxyl</Name>
                <Pack ID="P252859" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.73</Subsidy>
                  <Price>6.73</Price>
                  <Alternate>6.73</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P252867">
                  <Quantity>500</Quantity>
                  <Subsidy>24.00</Subsidy>
                  <Price>24.00</Price>
                  <Alternate>24.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012504242906" Rank="3" Units="ml" Weight="18">
              <Name>Enema conc 18%</Name>
              <Brand ID="B01250424290601">
                <Name>Coloxyl</Name>
                <Pack ID="P252824" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>5.40</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125042430" Page="36" Statim="Must">
            <Name>Poloxamer</Name>
            <Formulation ID="F012504243004" Rank="3" Units="ml">
              <Name>Oral drops 10%</Name>
              <Brand ID="B01250424300401" SoleSupply="true">
                <Name>Coloxyl</Name>
                <Pack ID="P252816" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.93</Subsidy>
                  <Price>3.93</Price>
                  <Alternate>3.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125046304" Page="36" Statim="Must">
            <Name>Docusate sodium with sennosides</Name>
            <Formulation ID="F012504630401" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg with total sennosides 8 mg</Name>
              <Brand ID="B01250463040125">
                <Name>Laxsol</Name>
                <Pack ID="P2069482" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>7.98</Subsidy>
                  <Price>7.98</Price>
                  <Alternate>7.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A012507">
          <Name>Osmotic Laxatives</Name>
          <Chemical ID="C0125071574" Page="36" Statim="Must">
            <Name>Glycerol</Name>
            <Formulation ID="F012507157403" Rank="5" Units="supp">
              <Name>Suppos 3.6 g</Name>
              <Brand ID="B01250715740301">
                <Name>PSM</Name>
                <Pack ID="P778338" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F012507157408" Rank="5" Units="supp">
              <Name>Suppos 2.55 g</Name>
              <Brand ID="B01250715740801">
                <Name>Fleet Glycerin Suppositories</Name>
                <Pack ID="P391727" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>3.12</Subsidy>
                  <Price>3.12</Price>
                  <Alternate>3.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0125072140" Page="36">
            <Name>Sodium citrate with sodium lauryl sulphoacetate</Name>
            <Formulation ID="F012507214001" Rank="5" Units="en" Weight="450">
              <Name>Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml</Name>
              <Brand ID="B01250721400101">
                <Name>Microlax</Name>
                <Pack ID="P253898" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>7.30</Subsidy>
                  <Price>7.30</Price>
                  <Alternate>7.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125072447" Page="36" Statim="Must">
            <Name>Lactulose</Name>
            <Formulation ID="F012507244701" Rank="3" Units="ml">
              <Name>Oral liq 10 g per 15 ml</Name>
              <Brand ID="B01250724470101">
                <Name>Duphalac</Name>
                <Pack ID="P2248867" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.65</Subsidy>
                  <Price>6.65</Price>
                  <Alternate>6.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01250724470102">
                <Name>Laevolac</Name>
                <Pack ID="P2149672" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.60</Subsidy>
                  <Price>6.60</Price>
                  <Alternate>6.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125072462" Page="36">
            <Name>Sodium acid phosphate</Name>
            <Formulation ID="F012507246202" Rank="5" Units="en" Weight="16">
              <Name>Enema 16% with sodium phosphate 8%</Name>
              <Brand ID="B01250724620202">
                <Name>Fleet Phosphate Enema</Name>
                <Pack ID="P267430" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>2.50</Subsidy>
                  <Price>2.50</Price>
                  <Alternate>2.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125073874" Page="34" Update="New Listing">
            <Name>Macrogol 3350</Name>
            <Formulation ID="F012507387425" Rank="2" Units="sach">
              <Name>Powder 13.125 g, sachets</Name>
              <Brand ID="B01250738742525">
                <Name>Movicol</Name>
                <Pack ID="P2194864" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>18.14</Subsidy>
                  <Price>18.14</Price>
                  <Alternate>18.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="60" Attribute="Rx"/>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0891">
              <Title>
                <range>Macrogol 3350</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">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</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Form="SA0891">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">the patient is compliant and is continuing to gain benefit from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">12</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0891"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A012510">
          <Name>Stimulant Laxatives</Name>
          <Chemical ID="C0125102461" Page="36" Statim="Must">
            <Name>Senna</Name>
            <Formulation ID="F012510246101" Rank="1" Units="tab">
              <Name>Tab, standardised</Name>
              <Brand ID="B01251024610101">
                <Name>Senokot</Name>
                <Pack ID="P267201" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.17</Subsidy>
                  <Price>6.16</Price>
                  <Alternate>2.17</Alternate>
                  <Surcharge>0.03990</Surcharge>
                </Pack>
                <Pack ID="P474436">
                  <Quantity>20</Quantity>
                  <Subsidy>0.43</Subsidy>
                  <Price>1.72</Price>
                  <Alternate>0.43</Alternate>
                  <Surcharge>0.06450</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125102482" Page="36" Statim="Must">
            <Name>Bisacodyl</Name>
            <Formulation ID="F012510248201" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B01251024820126" SoleSupply="true">
                <Name>Lax-Tabs</Name>
                <Pack ID="P2199327" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>5.09</Subsidy>
                  <Price>5.09</Price>
                  <Alternate>5.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012510248202" Rank="5" Units="supp" Weight="5">
              <Name>Suppos 5 mg</Name>
              <Brand ID="B01251024820201">
                <Name>Dulcolax</Name>
                <Pack ID="P270377" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>2.35</Subsidy>
                  <Price>3.00</Price>
                  <Alternate>2.35</Alternate>
                  <Surcharge>0.10833</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012510248203" Rank="5" Units="supp" Weight="10">
              <Name>Suppos 10 mg</Name>
              <Brand ID="B01251024820325">
                <Name>Fleet</Name>
                <Pack ID="P378224" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>3.96</Subsidy>
                  <Price>3.96</Price>
                  <Alternate>3.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0128">
        <Name>Metabolic Disorder Agents</Name>
        <ATC3 ID="A012802">
          <Name>Gaucher's Disease</Name>
          <Chemical ID="C0128021238" Page="37">
            <Name>Imiglucerase</Name>
            <Formulation ID="F012802123801" Rank="4" Units="inj" Weight="200">
              <Name>Inj 40 iu per ml, 200 iu vial</Name>
              <Brand ID="B01280212380101">
                <Name>Cerezyme</Name>
                <Pack ID="P317756" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>1072.00</Subsidy>
                  <Price>1072.00</Price>
                  <Alternate>1072.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="Gaucher's Treatment Panel" For="Subsidy" Form="SA0473" Funding="Capped">
              <Title>
                <range>Imiglucerase</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML"/>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Subject to a budgetary cap. Applications will be considered and approved subject to funding availability.</p>
                <p>Application details may be obtained from PHARMAC's website <a href="http://www.pharmac.govt.nz/">http://www.pharmac.govt.nz</a> or:</p>
                <table>
                  <tr>
                    <td>
                      <p>The Co-ordinator, Gaucher’s Treatment Panel</p>
                    </td>
                    <td>
                      <p>Phone: (04) 460 4990</p>
                    </td>
                  </tr>
                  <tr>
                    <td>
                      <p>PHARMAC, PO Box 10 254</p>
                    </td>
                    <td>
                      <p>Facsimile: (04) 916 7571</p>
                    </td>
                  </tr>
                  <tr>
                    <td>
                      <p>Wellington</p>
                    </td>
                    <td>
                      <p>Email: <a href="mailto:erin.murphy@pharmac.govt.nz">erin.murphy@pharmac.govt.nz</a></p>
                    </td>
                  </tr>
                </table>
              </div>
            </Request>
            <Rule Type="Dispensary" Attribute="HP1" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0473"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0131">
        <Name>Mouth and Throat</Name>
        <ATC3 ID="A013101">
          <Name>Agents Used in Mouth Ulceration</Name>
          <Chemical ID="C0131011132" Page="37">
            <Name>Benzydamine hydrochloride</Name>
            <Formulation ID="F013101113201" Rank="3" Units="ml">
              <Name>Soln 0.15%</Name>
              <Brand ID="B01310111320101">
                <Name>Difflam</Name>
                <Pack ID="P377937">
                  <Quantity>200</Quantity>
                  <Subsidy>3.60</Subsidy>
                  <Price>7.14</Price>
                  <Alternate>3.60</Alternate>
                  <Surcharge>0.01770</Surcharge>
                </Pack>
                <Pack ID="P538825" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>9.00</Subsidy>
                  <Price>14.91</Price>
                  <Alternate>9.00</Alternate>
                  <Surcharge>0.01182</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecOnly" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C0131011244" Page="37">
            <Name>Chlorhexidine gluconate</Name>
            <Formulation ID="F013101124426" Rank="3" Units="ml" Weight="0.2">
              <Name>Mouthwash 0.2%</Name>
              <Brand ID="B01310112442601" SoleSupply="true">
                <Name>Orion</Name>
                <Pack ID="P478547" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>3.06</Subsidy>
                  <Price>3.06</Price>
                  <Alternate>3.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131012133" Page="37">
            <Name>Sodium carboxymethylcellulose</Name>
            <Formulation ID="F013101213302" Rank="3" Units="g">
              <Name>With pectin and gelatin paste</Name>
              <Brand ID="B01310121330201">
                <Name>Orabase</Name>
                <Pack ID="P255599" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>4.55</Subsidy>
                  <Price>7.90</Price>
                  <Alternate>4.55</Alternate>
                  <Surcharge>0.22333</Surcharge>
                </Pack>
                <Pack ID="P765945" OP="true" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>1.52</Subsidy>
                  <Price>3.60</Price>
                  <Alternate>1.52</Alternate>
                  <Surcharge>0.41600</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01310121330203">
                <Name>Stomahesive</Name>
                <Pack ID="P781398" OP="true" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>17.20</Subsidy>
                  <Price>17.20</Price>
                  <Alternate>17.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013101213307" Rank="3" Units="g">
              <Name>With pectin and gelatin powder</Name>
              <Brand ID="B01310121330701">
                <Name>Stomahesive</Name>
                <Pack ID="P742570" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>8.48</Subsidy>
                  <Price>10.95</Price>
                  <Alternate>8.48</Alternate>
                  <Surcharge>0.08821</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131012389" Page="37">
            <Name>Triamcinolone acetonide</Name>
            <Formulation ID="F013101238912" Rank="3" Units="g">
              <Name>0.1% in Dental Paste USP</Name>
              <Brand ID="B01310123891201" SoleSupply="true">
                <Name>Oracort</Name>
                <Pack ID="P359009" OP="true" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>4.50</Subsidy>
                  <Price>4.50</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131016014" Page="37" Statim="Must">
            <Name>Choline salicylate with cetalkonium chloride</Name>
            <Formulation ID="F013101601401" Rank="3" Units="g">
              <Name>Adhesive gel 8.7% with cetalkonium chloride 0.01%</Name>
              <Brand ID="B01310160140101">
                <Name>Bonjela</Name>
                <Pack ID="P771473" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.06</Subsidy>
                  <Price>4.85</Price>
                  <Alternate>2.06</Alternate>
                  <Surcharge>0.18600</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013107">
          <Name>Oropharyngeal Anti-infectives</Name>
          <Chemical ID="C0131071074" Page="37">
            <Name>Amphotericin B</Name>
            <Formulation ID="F013107107401" Rank="1" Units="tab" Weight="10">
              <Name>Lozenges 10 mg</Name>
              <Brand ID="B01310710740101">
                <Name>Fungilin</Name>
                <Pack ID="P201960" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>5.86</Subsidy>
                  <Price>5.86</Price>
                  <Alternate>5.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131071825" Page="37">
            <Name>Miconazole</Name>
            <Formulation ID="F013107182501" Rank="3" Units="g">
              <Name>Oral gel 20 mg per g</Name>
              <Brand ID="B01310718250102">
                <Name>Daktarin</Name>
                <Pack ID="P283339" OP="true" Specified="true">
                  <Quantity>40</Quantity>
                  <Subsidy>8.95</Subsidy>
                  <Price>8.95</Price>
                  <Alternate>8.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131071881" Page="37">
            <Name>Nystatin</Name>
            <Formulation ID="F013107188105" Rank="3" Units="ml" Weight="100000">
              <Name>Oral liq 100,000 u per ml</Name>
              <Brand ID="B01310718810502" SoleSupply="true">
                <Name>Nilstat</Name>
                <Pack ID="P254851" OP="true" Specified="true">
                  <Quantity>24</Quantity>
                  <Subsidy>3.03</Subsidy>
                  <Price>3.03</Price>
                  <Alternate>3.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013109">
          <Name>Other Oral Agents</Name>
          <Chemical ID="C0131092262" Page="38" Statim="Must">
            <Name>Thymol glycerin</Name>
            <Formulation ID="F013109226201" Rank="3" Units="ml">
              <Name>Compound, BPC</Name>
              <Brand ID="B01310922620101">
                <Name>PSM</Name>
                <Pack ID="P731749" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>9.15</Subsidy>
                  <Price>9.15</Price>
                  <Alternate>9.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131093303" Page="38" Statim="Must">
            <Name>Hydrogen peroxide</Name>
            <Formulation ID="F013109330301" Rank="3" Units="ml">
              <Name>Solution 10 vol</Name>
              <Brand ID="B01310933030101">
                <Name>PSM</Name>
                <Pack ID="P288381" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.28</Subsidy>
                  <Price>1.28</Price>
                  <Alternate>1.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="200" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p xlink:type="simple" xlink:href="standard-formulae">For folinic mouthwash, pilocarpine oral liquid or saliva substitute formula refer</p>
          </div>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0137">
        <Name>Vitamins</Name>
        <ATC3 ID="A013701">
          <Name>Vitamin A</Name>
          <Chemical ID="C0137012322" Page="38">
            <Name>Vitamin A with vitamins D and C</Name>
            <Formulation ID="F013701232201" Rank="3" Units="ml" Weight="3">
              <Name>Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops</Name>
              <Brand ID="B01370123220101">
                <Name>Vitadol C</Name>
                <Pack ID="P527831" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>4.38</Subsidy>
                  <Price>5.51</Price>
                  <Alternate>4.38</Alternate>
                  <Surcharge>0.11300</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013704">
          <Name>Vitamin B Group</Name>
          <Chemical ID="C0137041624" Page="38" Statim="Must">
            <Name>Hydroxocobalamin</Name>
            <Formulation ID="F013704162401" Rank="4" Units="inj" Weight="1">
              <Name>Inj 1 mg per ml, 1 ml</Name>
              <Brand ID="B01370416240125" S29="true" ToBeDelisted="2008-01-01">
                <Name>Goldshield </Name>
                <Pack ID="P2246007" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>10.84</Subsidy>
                  <Price>10.84</Price>
                  <Alternate>10.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01370416240126">
                <Name>Neo-B12</Name>
                <Pack ID="P2245590" Specified="true">
                  <Quantity>3</Quantity>
                  <Subsidy>10.84</Subsidy>
                  <Price>10.84</Price>
                  <Alternate>10.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0137042071" Page="38" Statim="Must">
            <Name>Pyridoxine hydrochloride</Name>
            <Formulation ID="F013704207102" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B01370420710225">
                <Name>Healtheries</Name>
                <Pack ID="P697338" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.06</Subsidy>
                  <Price>3.06</Price>
                  <Alternate>3.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="MaxCoPayment" Value="0"/>
            </Formulation>
            <Formulation ID="F013704207103" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B01370420710302" SoleSupply="true">
                <Name>Apo-Pyridoxine</Name>
                <Pack ID="P304379" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>17.63</Subsidy>
                  <Price>17.63</Price>
                  <Alternate>17.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="DoseSWt" Value="100"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0137042250" Page="38" Statim="Must">
            <Name>Thiamine hydrochloride</Name>
            <Formulation ID="F013704225003" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B01370422500302" SoleSupply="true">
                <Name>Apo-Thiamine</Name>
                <Pack ID="P304468" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.62</Subsidy>
                  <Price>5.62</Price>
                  <Alternate>5.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0137042328" Page="38" Statim="Must">
            <Name>Vitamin B complex</Name>
            <Formulation ID="F013704232802" Rank="1" Units="tab">
              <Name>Tab, strong, BPC</Name>
              <Brand ID="B01370423280203" SoleSupply="true">
                <Name>Apo-B-Complex</Name>
                <Pack ID="P360023" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>12.10</Subsidy>
                  <Price>12.10</Price>
                  <Alternate>12.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013707">
          <Name>Vitamin C</Name>
          <Chemical ID="C0137071084" Page="38" Statim="Must">
            <Name>Ascorbic acid</Name>
            <Formulation ID="F013707108401" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B01370710840103" SoleSupply="true">
                <Name>Apo-Ascorbic Acid</Name>
                <Pack ID="P303992" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>17.25</Subsidy>
                  <Price>17.25</Price>
                  <Alternate>17.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="DoseSWt" Value="100"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0137073737" Page="38" Statim="Must">
            <Name>Ascorbic acid and sodium ascorbate</Name>
            <Formulation ID="F013707373725" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100mg</Name>
              <Brand ID="B01370737372525">
                <Name>Healtheries Vitamin C</Name>
                <Pack ID="P378690" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.60</Subsidy>
                  <Price>2.60</Price>
                  <Alternate>2.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="DoseSWt" Value="100"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013710">
          <Name>Vitamin D</Name>
          <Chemical ID="C0137101020" Page="39">
            <Name>Alfacalcidol</Name>
            <Formulation ID="F013710102001" Rank="2" Units="cap" Weight="0.25">
              <Name>Cap 0.25 mcg</Name>
              <Brand ID="B01371010200101">
                <Name>One-Alpha</Name>
                <Pack ID="P203084" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>26.32</Subsidy>
                  <Price>26.32</Price>
                  <Alternate>26.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013710102002" Rank="2" Units="cap" Weight="1">
              <Name>Cap 1 mcg</Name>
              <Brand ID="B01371010200201">
                <Name>One-Alpha</Name>
                <Pack ID="P203092" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>87.98</Subsidy>
                  <Price>87.98</Price>
                  <Alternate>87.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013710102003" Rank="3" Units="ml">
              <Name>Oral drops 2 mcg per ml</Name>
              <Brand ID="B01371010200301">
                <Name>One-Alpha</Name>
                <Pack ID="P315761" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>60.68</Subsidy>
                  <Price>60.68</Price>
                  <Alternate>60.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C0137101187" Page="39" Statim="Must">
            <Name>Cholecalciferol</Name>
            <Formulation ID="F013710118701" Rank="1" Units="tab" Weight="50000">
              <Name>Tab 1.25 mg (50,000 iu)</Name>
              <Brand ID="B01371011870125">
                <Name>Cal-d-Forte</Name>
                <Pack ID="P2193000" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>10.35</Subsidy>
                  <Price>10.35</Price>
                  <Alternate>10.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="12" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0137101189" Page="39" Statim="Must">
            <Name>Calcitriol</Name>
            <Formulation ID="F013710118901" Rank="2" Units="cap" Weight="0.25">
              <Name>Cap 0.25 mcg</Name>
              <Brand ID="B01371011890125" SoleSupply="true">
                <Name>Calcitriol-AFT</Name>
                <Pack ID="P2091038" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.45</Subsidy>
                  <Price>13.45</Price>
                  <Alternate>13.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013710118902" Rank="2" Units="cap" Weight="0.5">
              <Name>Cap 0.5 mcg</Name>
              <Brand ID="B01371011890225" SoleSupply="true">
                <Name>Calcitriol-AFT</Name>
                <Pack ID="P2091011" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>24.95</Subsidy>
                  <Price>24.95</Price>
                  <Alternate>24.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013710118903" Rank="3" Units="ml" Weight="1">
              <Name>Oral liq 1 mcg per ml</Name>
              <Brand ID="B01371011890301">
                <Name>Rocaltrol solution</Name>
                <Pack ID="P727806" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>39.40</Subsidy>
                  <Price>39.40</Price>
                  <Alternate>39.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013713">
          <Name>Vitamin E</Name>
          <Chemical ID="C0137132413" Page="39">
            <Name>Alpha tocopheryl acetate</Name>
            <Formulation ID="F013713241306" Rank="3" Units="ml" Weight="156">
              <Name>Water solubilised soln 156 iu/ml, with calibrated dropper</Name>
              <Brand ID="B01371324130601">
                <Name>Micelle E</Name>
                <Pack ID="P393991" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>13.50</Subsidy>
                  <Price>13.50</Price>
                  <Alternate>13.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0264">
              <Title>
                <range>Alpha Tocopheryl Acetate</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Cystic fibrosis patient</ci>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Infant or child with liver disease or short gut syndrome</ci>
                      <ci type="logical" class="Indication">Requires vitamin supplementation</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>respiratory specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0264">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>respiratory specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0264"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013719">
          <Name>Multivitamin Preparations</Name>
          <Chemical ID="C0137192330" Page="39" Statim="Must">
            <Name>Vitamins</Name>
            <Formulation ID="F013719233001" Rank="1" Units="tab">
              <Name>Tab (BPC cap strength)</Name>
              <Brand ID="B01371923300125" SoleSupply="true">
                <Name>Healtheries Multi-vitamin tablets</Name>
                <Pack ID="P2048779" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>14.80</Subsidy>
                  <Price>14.80</Price>
                  <Alternate>14.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0138">
        <Name>Minerals</Name>
        <ATC3 ID="A013801">
          <Name>Calcium</Name>
          <Chemical ID="C0138011191" Page="40" Statim="Must">
            <Name>Calcium carbonate</Name>
            <Formulation ID="F013801119102" Rank="1" Units="tab" Weight="1250">
              <Name>Tab 1.25 g</Name>
              <Brand ID="B01380111910225" SoleSupply="true">
                <Name>Calci-Tab 500</Name>
                <Pack ID="P2212269" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>9.18</Subsidy>
                  <Price>9.18</Price>
                  <Alternate>9.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013801119103" Rank="1" Units="tab" Weight="1500">
              <Name>Tab 1.5 g</Name>
              <Brand ID="B01380111910325" SoleSupply="true">
                <Name>Calci-Tab 600</Name>
                <Pack ID="P2212250" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>10.33</Subsidy>
                  <Price>10.33</Price>
                  <Alternate>10.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013801119125" Rank="1" Units="tab" Weight="2500">
              <Name>Tab dispersible 2.5 g</Name>
              <Brand ID="B01380111912525" SoleSupply="true">
                <Name>Calci-Tab Effervescent</Name>
                <Pack ID="P2218747" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>4.98</Subsidy>
                  <Price>4.98</Price>
                  <Alternate>4.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138011199" Page="40" Statim="Must">
            <Name>Calcium gluconate</Name>
            <Formulation ID="F013801119901" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10%, 10 ml</Name>
              <Brand ID="B01380111990101">
                <Name>Mayne</Name>
                <Pack ID="P533874" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>106.99</Subsidy>
                  <Price>106.99</Price>
                  <Alternate>106.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013802">
          <Name>Fluoride</Name>
          <Chemical ID="C0138022149" Page="40">
            <Name>Sodium fluoride</Name>
            <Formulation ID="F013802214901" Rank="1" Units="tab" Weight="1.1">
              <Name>Tab 1.1 mg</Name>
              <Brand ID="B01380221490125">
                <Name>PSM</Name>
                <Pack ID="P358827" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.00</Subsidy>
                  <Price>4.00</Price>
                  <Alternate>4.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013803">
          <Name>Iron</Name>
          <Chemical ID="C0138031501" Page="40" Statim="Must">
            <Name>Ferrous sulphate with folic acid</Name>
            <Formulation ID="F013803150101" Rank="1" Units="tab" Weight="325">
              <Name>Tab long-acting 325 mg with folic acid 350 mcg</Name>
              <Brand ID="B01380315010101">
                <Name>Ferrograd-Folic</Name>
                <Pack ID="P2190958" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.80</Subsidy>
                  <Price>3.24</Price>
                  <Alternate>1.80</Alternate>
                  <Surcharge>0.04800</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138031676" Page="40">
            <Name>Iron polymaltose</Name>
            <Formulation ID="F013803167601" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg per ml, 2 ml</Name>
              <Brand ID="B01380316760125">
                <Name>Ferrosig</Name>
                <Pack ID="P2135914" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>29.95</Subsidy>
                  <Price>29.95</Price>
                  <Alternate>29.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138033291" Page="40" Statim="Must">
            <Name>Ferrous sulphate</Name>
            <Formulation ID="F013803329105" Rank="1" Units="tab" Weight="325">
              <Name>Tab long-acting 325 mg</Name>
              <Brand ID="B01380332910501">
                <Name>Ferro-Gradumet</Name>
                <Pack ID="P209074" Specified="true">
                  <Quantity>150</Quantity>
                  <Subsidy>5.06</Subsidy>
                  <Price>13.55</Price>
                  <Alternate>5.06</Alternate>
                  <Surcharge>0.05660</Surcharge>
                </Pack>
                <Pack ID="P604321">
                  <Quantity>30</Quantity>
                  <Subsidy>1.01</Subsidy>
                  <Price>3.70</Price>
                  <Alternate>1.01</Alternate>
                  <Surcharge>0.08967</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F013803329125" Rank="3" Units="ml" Weight="30" Safety="Uncompounded">
              <Name>Oral liq 150 mg per 5 ml</Name>
              <Brand ID="B01380332912526">
                <Name>Ferro-liquid</Name>
                <Pack ID="P2179962" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>7.95</Subsidy>
                  <Price>7.95</Price>
                  <Alternate>7.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138033736" Page="40" Statim="Must">
            <Name>Ferrous gluconate with ascorbic acid</Name>
            <Formulation ID="F013803373625" Rank="1" Units="tab">
              <Name>Tab 170 mg with ascorbic acid 40 mg</Name>
              <Brand ID="B01380337362525">
                <Name>Healtheries Iron with Vitamin C</Name>
                <Pack ID="P2015277" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>12.04</Subsidy>
                  <Price>12.04</Price>
                  <Alternate>12.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138033831" Page="40">
            <Name>Ferrous fumarate</Name>
            <Formulation ID="F013803383125" Rank="1" Units="tab">
              <Name>Tab 200 mg</Name>
              <Brand ID="B01380338312525">
                <Name>Ferro-tab</Name>
                <Pack ID="P2162156" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.75</Subsidy>
                  <Price>3.75</Price>
                  <Alternate>3.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138033862" Page="40">
            <Name>Ferrous fumarate with folic acid</Name>
            <Formulation ID="F013803386225" Rank="1" Units="tab">
              <Name>Tab 310 mg with folic acid 350 mcg</Name>
              <Brand ID="B01380338622525">
                <Name>Ferro-F-Tabs</Name>
                <Pack ID="P2219476" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>3.95</Subsidy>
                  <Price>3.95</Price>
                  <Alternate>3.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013804">
          <Name>Magnesium</Name>
          <Chemical ID="C0138043329" Page="40">
            <Name>Magnesium sulphate</Name>
            <Formulation ID="F013804332903" Rank="4" Units="inj" Weight="49.3">
              <Name>Inj 49.3%</Name>
              <Brand ID="B01380433290301" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P2213613" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>26.60</Subsidy>
                  <Price>26.60</Price>
                  <Alternate>26.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p xlink:type="simple" xlink:href="standard-formulae">For magnesium hydroxide mixture refer</p>
          </div>
        </ATC3>
        <ATC3 ID="A013805">
          <Name>Zinc</Name>
          <Chemical ID="C0138052354" Page="40" Statim="Must">
            <Name>Zinc sulphate</Name>
            <Formulation ID="F013805235401" Rank="2" Units="cap" Weight="220">
              <Name>Cap 220 mg</Name>
              <Brand ID="B01380523540101" SoleSupply="true">
                <Name>Zincaps</Name>
                <Pack ID="P258253" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.00</Subsidy>
                  <Price>9.00</Price>
                  <Alternate>9.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A04" Graphic="cardiovascular.txg">
      <Name>Blood and Blood Forming Organs</Name>
      <ATC2 ID="A0401">
        <Name>Antianaemics</Name>
        <ATC3 ID="A040101">
          <Name>Hypoplastic and Haemolytic</Name>
          <Chemical ID="C0401012758" Page="41">
            <Name>Erythropoietin alpha</Name>
            <Formulation ID="F040101275805" Rank="4" Units="inj" Weight="2000">
              <Name>Inj human recombinant 2,000 u, pre-filled syringe</Name>
              <Brand ID="B04010127580501">
                <Name>Eprex</Name>
                <Pack ID="P229660" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>121.63</Subsidy>
                  <Price>325.80</Price>
                  <Alternate>121.63</Alternate>
                  <Surcharge>34.02833</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275806" Rank="4" Units="inj" Weight="3000">
              <Name>Inj human recombinant 3,000 u, pre-filled syringe</Name>
              <Brand ID="B04010127580601">
                <Name>Eprex</Name>
                <Pack ID="P229687" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>182.45</Subsidy>
                  <Price>455.34</Price>
                  <Alternate>182.45</Alternate>
                  <Surcharge>45.48167</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275807" Rank="4" Units="inj" Weight="4000">
              <Name>Inj human recombinant 4,000 u, pre-filled syringe</Name>
              <Brand ID="B04010127580701">
                <Name>Eprex</Name>
                <Pack ID="P229709" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>243.67</Subsidy>
                  <Price>572.40</Price>
                  <Alternate>243.67</Alternate>
                  <Surcharge>54.78833</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275808" Rank="4" Units="inj" Weight="10000">
              <Name>Inj human recombinant 10,000 u, pre-filled syringe</Name>
              <Brand ID="B04010127580801">
                <Name>Eprex</Name>
                <Pack ID="P229520" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>608.16</Subsidy>
                  <Price>1322.82</Price>
                  <Alternate>608.16</Alternate>
                  <Surcharge>119.11000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275825" Rank="4" Units="inj" Weight="1000">
              <Name>Inj human recombinant 1,000 u pre-filled syringe</Name>
              <Brand ID="B04010127582525">
                <Name>Eprex</Name>
                <Pack ID="P307939" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>60.82</Subsidy>
                  <Price>162.90</Price>
                  <Alternate>60.82</Alternate>
                  <Surcharge>17.01333</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0626">
              <Title>
                <range>Erythropoietin Alpha</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <mi class="heading">General Criteria:</mi>
                    <ci type="logical" class="Indication">Anaemia of end-stage renal failure (other treatable causes of anaemia being excluded)</ci>
                    <ci type="logical" class="Trial">Been on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD) for at least three months</ci>
                    <ci type="logical" class="Trial">Not under evaluation for, or awaiting, a live donor kidney transplant</ci>
                    <apply>
                      <or/>
                      <mi class="heading">Specific Criteria:</mi>
                      <ci type="logical" class="Indication">Anephric</ci>
                      <ci type="logical" class="Indication">Dependent on regular blood transfusion (1 unit each 4-8 weeks) to maintain haemoglobin &gt; 60g/L</ci>
                      <ci type="logical" class="Indication">Dependent on regular blood transfusion but cannot be transfused because of severe transfusion reactions</ci>
                      <ci type="logical" class="Indication">Transfusion induced haemosiderosis (clinical manifestations, serum ferritin &gt;1500 ug/L)</ci>
                      <apply>
                        <lt/>
                        <ci type="real" class="test">Haemoglobin</ci>
                        <cn>70<mi>g/L (mean of at least 4 haemoglobin concentrations over 4 months)</mi></cn>
                      </apply>
                      <apply>
                        <and/>
                        <apply>
                          <lt/>
                          <ci type="real" class="test">Haemoglobin</ci>
                          <cn>90<mi>g/L</mi></cn>
                        </apply>
                        <apply>
                          <or/>
                          <ci type="logical" class="Indication">Heart failure (low cardiac output, LV ejection fraction &lt;40%)</ci>
                          <ci type="logical" class="Indication">Persistent angina</ci>
                        </apply>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>renal physician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0100 SA0317 SA0626">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>renal physician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0626"/>
          </Chemical>
          <Chemical ID="C0401013771" Page="41">
            <Name>Erythropoietin beta</Name>
            <Formulation ID="F040101377125" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1,000 iu, pre-filled syringe</Name>
              <Brand ID="B04010137712525">
                <Name>Recormon</Name>
                <Pack ID="P2058898" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>76.02</Subsidy>
                  <Price>76.02</Price>
                  <Alternate>76.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377126" Rank="4" Units="inj" Weight="2000">
              <Name>Inj 2,000 iu, pre-filled syringe</Name>
              <Brand ID="B04010137712625">
                <Name>Recormon</Name>
                <Pack ID="P2058901" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>152.04</Subsidy>
                  <Price>152.04</Price>
                  <Alternate>152.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377127" Rank="4" Units="inj" Weight="3000">
              <Name>Inj 3,000 iu, pre-filled syringe</Name>
              <Brand ID="B04010137712725">
                <Name>Recormon</Name>
                <Pack ID="P2058928" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>228.06</Subsidy>
                  <Price>228.06</Price>
                  <Alternate>228.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377128" Rank="4" Units="inj" Weight="4000">
              <Name>Inj 4,000 iu, pre-filled syringe</Name>
              <Brand ID="B04010137712825">
                <Name>Recormon</Name>
                <Pack ID="P2058936" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>304.08</Subsidy>
                  <Price>304.08</Price>
                  <Alternate>304.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377129" Rank="4" Units="inj" Weight="5000">
              <Name>Inj 5,000 iu, pre-filled syringe</Name>
              <Brand ID="B04010137712925">
                <Name>Recormon</Name>
                <Pack ID="P2058944" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>380.10</Subsidy>
                  <Price>380.10</Price>
                  <Alternate>380.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377130" Rank="4" Units="inj" Weight="10000">
              <Name>Inj 10,000 iu, pre-filled syringe</Name>
              <Brand ID="B04010137713025">
                <Name>Recormon</Name>
                <Pack ID="P2058960" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>760.20</Subsidy>
                  <Price>760.20</Price>
                  <Alternate>760.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377131" Rank="4" Units="inj" Weight="6000">
              <Name>Inj 6,000 iu, pre-filled syringe</Name>
              <Brand ID="B04010137713125">
                <Name>Recormon</Name>
                <Pack ID="P2058952" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>456.12</Subsidy>
                  <Price>456.12</Price>
                  <Alternate>456.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0851">
              <Title>
                <range>Erythropoietin Beta</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">patient in chronic renal failure</ci>
                      <apply>
                        <leq/>
                        <ci type="real" class="test">Haemoglobin</ci>
                        <cn>100<mi>g/L</mi></cn>
                      </apply>
                    </apply>
                    <apply>
                      <or/>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">patient is not diabetic</ci>
                        <apply>
                          <leq/>
                          <ci type="real" class="test">glomerular filtration rate</ci>
                          <cn>30<mi>ml/min</mi></cn>
                        </apply>
                      </apply>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">patient is diabetic</ci>
                        <apply>
                          <leq/>
                          <ci type="real" class="test">glomerular filtration rate</ci>
                          <cn>45<mi>ml/min</mi></cn>
                        </apply>
                      </apply>
                      <ci type="logical" class="Indication">patient is on haemodialysis or peritoneal dialysis</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0626 SA0645 SA0646 SA0851">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>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.</p>
                <p>The Cockroft-Gault Formula may be used to estimate glomerular filtration rate (GFR) in persons 18 years and over:</p>
                <p>GFR (ml/min) (male) = (140 - age) × Ideal Body Weight (kg) / 814 × serum creatinine (mmol/l)</p>
                <p>GFR (ml/min) (female) = Estimated GFR (male) × 0.85</p>
              </div>
            </Request>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0851"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A040104">
          <Name>Megaloblastic</Name>
          <Chemical ID="C0401041498" Page="42">
            <Name>Folic acid</Name>
            <Formulation ID="F040104149801" Rank="1" Units="tab" Weight="5" Statim="Must">
              <Name>Tab 5 mg</Name>
              <Brand ID="B04010414980103" SoleSupply="true">
                <Name>Apo-Folic Acid</Name>
                <Pack ID="P304131" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.59</Subsidy>
                  <Price>6.59</Price>
                  <Alternate>6.59</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040104149803" Rank="3" Units="ml" Weight="50">
              <Name>Oral liq 50 mcg per ml</Name>
              <Brand ID="B04010414980301">
                <Name>Biomed</Name>
                <Pack ID="P344850" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>21.05</Subsidy>
                  <Price>21.05</Price>
                  <Alternate>21.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Specialist must be a paediatrician or paediatric cardiologist.</p>
              </div>
            </Formulation>
            <Formulation ID="F040104149825" Rank="1" Units="tab" Statim="Must">
              <Name>Tab 0.8 mg</Name>
              <Brand ID="B04010414982525" SoleSupply="true">
                <Name>Apo-Folic Acid</Name>
                <Pack ID="P2025736" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>16.50</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>16.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0404">
        <Name>Antifibrinolytics, Haemostatics and Local Sclerosants</Name>
        <ATC3 ID="A040401">
          <Name>Antifibrinolytics, Haemostatics and Local Sclerosants</Name>
          <Chemical ID="C0404011085" Page="42" Statim="Must">
            <Name>Aprotinin</Name>
            <Formulation ID="F040401108501" Rank="4" Units="inj" Weight="10000">
              <Name>Inj 10,000 mcg per ml 50 ml</Name>
              <Brand ID="B04040110850101">
                <Name>Trasylol</Name>
                <Pack ID="P226173" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>63.60</Subsidy>
                  <Price>73.40</Price>
                  <Alternate>63.60</Alternate>
                  <Surcharge>9.80000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C0404012164" Page="42" Statim="Must">
            <Name>Sodium tetradecyl sulphate</Name>
            <Formulation ID="F040401216401" Rank="4" Units="inj" Weight="0.5">
              <Name>Inj 0.5% 2 ml</Name>
              <Brand ID="B04040121640101">
                <Name>Fibro-vein</Name>
                <Pack ID="P786659" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>23.20</Subsidy>
                  <Price>45.52</Price>
                  <Alternate>23.20</Alternate>
                  <Surcharge>4.46400</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040401216402" Rank="4" Units="inj" Weight="1">
              <Name>Inj 1% 2 ml</Name>
              <Brand ID="B04040121640201">
                <Name>Fibro-vein</Name>
                <Pack ID="P786640" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>48.98</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>4.79600</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040401216404" Rank="4" Units="inj" Weight="3">
              <Name>Inj 3% 2 ml</Name>
              <Brand ID="B04040121640401">
                <Name>Fibro-vein</Name>
                <Pack ID="P748781" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>28.50</Subsidy>
                  <Price>55.91</Price>
                  <Alternate>28.50</Alternate>
                  <Surcharge>5.48200</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0404012505" Page="42">
            <Name>Tranexamic acid</Name>
            <Formulation ID="F040401250501" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B04040125050101">
                <Name>Cyklokapron</Name>
                <Pack ID="P461962" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>49.14</Subsidy>
                  <Price>49.14</Price>
                  <Alternate>49.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A040403">
          <Name>Vitamin K</Name>
          <Chemical ID="C0404031986" Page="42">
            <Name>Phytomenadione</Name>
            <Formulation ID="F040403198601" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04040319860101">
                <Name>Konakion</Name>
                <Pack ID="P327670" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>5.60</Subsidy>
                  <Price>5.60</Price>
                  <Alternate>5.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040403198603" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B04040319860302">
                <Name>Konakion MM</Name>
                <Pack ID="P298204" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>9.21</Subsidy>
                  <Price>9.21</Price>
                  <Alternate>9.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F040403198625" Rank="4" Units="inj" Weight="2">
              <Name>Inj 2 mg per 0.2 ml</Name>
              <Brand ID="B04040319862525">
                <Name>Konakion MM</Name>
                <Pack ID="P911828" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0404036018" Page="42" Statim="Must">
            <Name>Menadione sodium bisulphite</Name>
            <Formulation ID="F040403601801" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04040360180101">
                <Name>K-Thrombin</Name>
                <Pack ID="P259667" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.75</Subsidy>
                  <Price>4.75</Price>
                  <Alternate>4.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0407">
        <Name>Antithrombotic Agents</Name>
        <ATC3 ID="A040701">
          <Name>Antiplatelet Agents</Name>
          <Chemical ID="C0407011087" Page="43" Statim="Must">
            <Name>Aspirin</Name>
            <Formulation ID="F040701108725" Rank="1" Units="tab">
              <Name>Tab 100 mg</Name>
              <Brand ID="B04070110872525">
                <Name>Ethics Aspirin EC</Name>
                <Pack ID="P2184273" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.02</Subsidy>
                  <Price>1.02</Price>
                  <Alternate>1.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04070110872526">
                <Name>Cartia</Name>
                <Pack ID="P2207699" Specified="true">
                  <Quantity>168</Quantity>
                  <Subsidy>5.70</Subsidy>
                  <Price>5.70</Price>
                  <Alternate>5.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407011427" Page="44" Statim="Must">
            <Name>Dipyridamole</Name>
            <Formulation ID="F040701142701" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B04070114270101">
                <Name>Persantin</Name>
                <Pack ID="P208051">
                  <Quantity>100</Quantity>
                  <Subsidy>0.19</Subsidy>
                  <Price>9.95</Price>
                  <Alternate>9.95</Alternate>
                  <Surcharge>0.09760</Surcharge>
                </Pack>
                <Pack ID="P2248948" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>0.16</Subsidy>
                  <Price>8.36</Price>
                  <Alternate>8.36</Alternate>
                  <Surcharge>0.09762</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Manufacturers Price" Form="SA0648">
                <Title>
                  <range>Dipyridamole Tab 25 mg</range>
                </Title>
                <Case When="Initial application" Category="Conditions other than transient ischaemic episodes">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patients with prosthetic heart valves – as an adjunct to oral anticoagulation for prophylaxis of thromboembolism</ci>
                      <ci type="logical" class="Indication">Patients after coronary artery vein bypass graft – as an adjunct to aspirin or as monotherapy for patients who are aspirin intolerant</ci>
                    </apply>
                  </math>
                  <Applicant>cardiothoracic surgeon</Applicant>
                  <Applicant>cardiologist</Applicant>
                  <Applicant>general physician</Applicant>
                  <Term Measure="patient's lifetime"/>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising.</p>
                  </div>
                </Case>
                <Case When="Initial application" Category="Transient ischaemic episodes">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The patient continues to have transient ischaemic episodes despite aspirin therapy or has transient ischaemic episodes and is aspirin intolerant</ci>
                  </math>
                  <Applicant>neurologist</Applicant>
                  <Applicant>neuro surgeon</Applicant>
                  <Applicant>cardiologist</Applicant>
                  <Applicant>vascular surgeon</Applicant>
                  <Applicant>general physician</Applicant>
                  <Term Measure="patient's lifetime"/>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising.</p>
                  </div>
                </Case>
                <Case When="Renewal" Category="Existing 2 year approvals" Form="SA0616 SA0648">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                  </math>
                  <Applicant>general practitioner</Applicant>
                  <Applicant>relevant specialist</Applicant>
                  <Term Measure="patient's lifetime"/>
                </Case>
              </Request>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0648"/>
            </Formulation>
            <Formulation ID="F040701142704" Rank="1" Units="tab" Weight="150">
              <Name>Tab long-acting 150 mg</Name>
              <Brand ID="B04070114270401" SoleSupply="true">
                <Name>Pytazen SR</Name>
                <Pack ID="P750255" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>11.52</Subsidy>
                  <Price>11.52</Price>
                  <Alternate>11.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA0649">
                <Title>
                  <range>Dipyridamole Tab long-acting 150 mg</range>
                </Title>
                <Case When="Initial application" Category="Conditions other than transient ischaemic episodes">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patients with prosthetic heart valves – as an adjunct to oral anticoagulation for prophylaxis of thromboembolism</ci>
                      <ci type="logical" class="Indication">Patients after coronary artery vein bypass graft – as an adjunct to aspirin or as monotherapy for patients who are aspirin intolerant</ci>
                    </apply>
                  </math>
                  <Applicant>cardiothoracic surgeon</Applicant>
                  <Applicant>cardiologist</Applicant>
                  <Applicant>general physician</Applicant>
                  <Term Measure="patient's lifetime"/>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising.</p>
                  </div>
                </Case>
                <Case When="Initial application" Category="Transient ischaemic episodes">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The patient continues to have transient ischaemic episodes despite aspirin therapy or has transient ischaemic episodes and is aspirin intolerant</ci>
                  </math>
                  <Applicant>neurologist</Applicant>
                  <Applicant>neuro surgeon</Applicant>
                  <Applicant>cardiologist</Applicant>
                  <Applicant>vascular surgeon</Applicant>
                  <Applicant>general physician</Applicant>
                  <Term Measure="patient's lifetime"/>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising.</p>
                  </div>
                </Case>
                <Case When="Renewal" Category="Existing 2 year approvals" Form="SA0616 SA0649">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                  </math>
                  <Applicant>general practitioner</Applicant>
                  <Applicant>relevant specialist</Applicant>
                  <Term Measure="patient's lifetime"/>
                </Case>
              </Request>
              <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0649"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407013860" Page="43">
            <Name>Clopidogrel</Name>
            <Formulation ID="F040701386025" Rank="1" Units="tab" Weight="75">
              <Name>Tab 75 mg</Name>
              <Brand ID="B04070138602525">
                <Name>Plavix</Name>
                <Pack ID="P340405" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>73.38</Subsidy>
                  <Price>73.38</Price>
                  <Alternate>73.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0867">
              <Title>
                <range>Clopidogrel</range>
              </Title>
              <Case When="Initial application" Category="aspirin allergic patients">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">The patient is allergic to aspirin (see definition below)</ci>
                    <apply>
                      <or/>
                      <mi class="heading">The patient has:</mi>
                      <ci type="logical" class="Indication">suffered from a stroke, or transient ischaemic attack</ci>
                      <ci type="logical" class="Indication">experienced an acute myocardial infarction</ci>
                      <ci type="logical" class="Indication">experienced an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours</ci>
                      <ci type="logical" class="Indication">had a troponin T or troponin I test result greater than the upper limit of the reference range</ci>
                      <ci type="logical" class="Indication">had a revascularisation procedure</ci>
                      <ci type="logical" class="Indication">experienced symptomatic peripheral vascular disease of a severity that has required specialist consultation</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Aspirin allergy is defined as a history of anaphylaxis, urticaria or asthma within 4 hours of ingestion of aspirin, other salicylates or NSAIDs.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="aspirin tolerant patients and aspirin naive patients">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <mi class="heading">The patient has:</mi>
                    <ci type="logical" class="Indication">experienced an acute myocardial infarction</ci>
                    <ci type="logical" class="Indication">had an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours</ci>
                    <ci type="logical" class="Indication">had a troponin T or troponin I test result greater than the upper limit of the reference range</ci>
                    <ci type="logical" class="Indication">had a revascularisation procedure</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">3</Term>
              </Case>
              <Case When="Initial application" Category="patients awaiting revascularisation" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is on a waiting list or active review list for stenting, coronary artery bypass grafting, or percutaneous coronary angioplasty following acute coronary syndrome</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Initial application" Category="post stenting">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has had a stent inserted in the previous 4 weeks</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Initial application" Category="documented stent thrombosis">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis.</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <Case When="Renewal" Category="aspirin tolerant patients" Form="SA0847 SA0867">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">While on treatment with aspirin the patient has experienced an additional vascular event following the recent cessation of clopidogrel</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <Case When="Renewal" Category="acute coronary syndrome - aspirin tolerant patients and aspirin naive patients" Form="SA0847 SA0867">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <mi class="heading">The patient has:</mi>
                    <ci type="logical" class="Indication">experienced an acute myocardial infarction</ci>
                    <ci type="logical" class="Indication">had an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours</ci>
                    <ci type="logical" class="Indication">had a troponin T or troponin I test result greater than the upper limit of the reference range</ci>
                    <ci type="logical" class="Indication">had a revascularisation procedure</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">3</Term>
              </Case>
              <Case When="Renewal" Category="patients awaiting revascularisation" Break="after" Form="SA0847 SA0867">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is on a waiting list or active review list for stenting, coronary artery bypass grafting or percutaneous coronary angioplasty following acute coronary syndrome</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="post stenting" Form="SA0847 SA0867">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has had a stent inserted in the previous 4 weeks</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="documented stent thrombosis" Form="SA0847 SA0867">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0867"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A040704">
          <Name>Heparin and Antagonist Preparations</Name>
          <Chemical ID="C0407041589" Page="45">
            <Name>Heparin sodium</Name>
            <Formulation ID="F040704158901" Rank="4" Units="inj" Weight="99">
              <Name>Inj 1,000 iu per ml, 5 ml</Name>
              <Brand ID="B04070415890101">
                <Name>Mayne</Name>
                <Pack ID="P201766">
                  <Quantity>10</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P701076" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>66.80</Subsidy>
                  <Price>66.80</Price>
                  <Alternate>66.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704158902" Rank="4" Units="inj" Weight="100">
              <Name>Inj 1,000 iu per ml, 35 ml</Name>
              <Brand ID="B04070415890203">
                <Name>Mayne</Name>
                <Pack ID="P701084" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>12.10</Subsidy>
                  <Price>12.10</Price>
                  <Alternate>12.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704158903" Rank="4" Units="inj" Weight="500">
              <Name>Inj 5,000 iu per ml, 1 ml</Name>
              <Brand ID="B04070415890301">
                <Name>Mayne</Name>
                <Pack ID="P2034255" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>10.32</Subsidy>
                  <Price>10.32</Price>
                  <Alternate>10.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704158904" Rank="4" Units="inj" Weight="500">
              <Name>Inj 5,000 iu per ml, 5 ml</Name>
              <Brand ID="B04070415890402">
                <Name>Multiparin</Name>
                <Pack ID="P587583" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>27.70</Subsidy>
                  <Price>37.45</Price>
                  <Alternate>27.70</Alternate>
                  <Surcharge>0.97500</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704158906" Rank="4" Units="inj" Weight="2500">
              <Name>Inj 25,000 iu per ml, 0.2 ml</Name>
              <Brand ID="B04070415890601">
                <Name>Mayne</Name>
                <Pack ID="P333085" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.50</Subsidy>
                  <Price>7.85</Price>
                  <Alternate>7.50</Alternate>
                  <Surcharge>0.07000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Hospital"/>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407042063" Page="45" Statim="Must">
            <Name>Protamine sulphate</Name>
            <Formulation ID="F040704206301" Rank="4" Units="inj" Weight="50">
              <Name>Inj 10 mg per ml, 5 ml</Name>
              <Brand ID="B04070420630101">
                <Name>Artex</Name>
                <Pack ID="P269328" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>22.40</Subsidy>
                  <Price>76.25</Price>
                  <Alternate>22.40</Alternate>
                  <Surcharge>5.38500</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407046019" Page="45" Statim="Must">
            <Name>Heparinised saline</Name>
            <Formulation ID="F040704601901" Rank="4" Units="inj" Weight="50">
              <Name>Inj 10 iu per ml, 5 ml</Name>
              <Brand ID="B04070460190101" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P311324" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>18.00</Subsidy>
                  <Price>18.00</Price>
                  <Alternate>18.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704601902" Rank="4" Units="inj" Weight="500">
              <Name>Inj 100 iu per ml, 5 ml</Name>
              <Brand ID="B04070460190201">
                <Name>Mayne</Name>
                <Pack ID="P713244" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>103.76</Subsidy>
                  <Price>103.76</Price>
                  <Alternate>103.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A040707">
          <Name>Oral Anticoagulants</Name>
          <Chemical ID="C0407072331" Page="45" Statim="Must">
            <Name>Warfarin sodium</Name>
            <Formulation ID="F040707233101" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B04070723310101">
                <Name>Coumadin</Name>
                <Pack ID="P796824" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.46</Subsidy>
                  <Price>3.46</Price>
                  <Alternate>3.46</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04070723310102">
                <Name>Marevan</Name>
                <Pack ID="P210587" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.69</Subsidy>
                  <Price>5.69</Price>
                  <Alternate>5.69</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040707233103" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B04070723310301">
                <Name>Coumadin</Name>
                <Pack ID="P767204" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.31</Subsidy>
                  <Price>4.31</Price>
                  <Alternate>4.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040707233105" Rank="1" Units="tab" Weight="3">
              <Name>Tab 3 mg</Name>
              <Brand ID="B04070723310501">
                <Name>Marevan</Name>
                <Pack ID="P210595" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040707233106" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B04070723310601">
                <Name>Coumadin</Name>
                <Pack ID="P796832" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>5.93</Subsidy>
                  <Price>5.93</Price>
                  <Alternate>5.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04070723310602">
                <Name>Marevan</Name>
                <Pack ID="P210609" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.64</Subsidy>
                  <Price>9.64</Price>
                  <Alternate>9.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Note: Marevan and Coumadin are not interchangeable.</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0410">
        <Name>Fluids and Electrolytes</Name>
        <ATC3 ID="A041001">
          <Name>Intravenous Administration</Name>
          <Chemical ID="C0410011393" Page="45" Statim="Must">
            <Name>Dextrose</Name>
            <Formulation ID="F041001139301" Rank="4" Units="inj" Weight="10">
              <Name>Inj 50%, 10 ml</Name>
              <Brand ID="B04100113930101" ToBeDelisted="2008-04-01">
                <Name>Mayne</Name>
                <Pack ID="P500356" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>8.25</Subsidy>
                  <Price>8.25</Price>
                  <Alternate>8.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100113930125">
                <Name>Biomed</Name>
                <Pack ID="P2243296" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>27.50</Subsidy>
                  <Price>27.50</Price>
                  <Alternate>27.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001139325" Rank="4" Units="inj" Weight="90">
              <Name>Inj 50%, 90 ml</Name>
              <Brand ID="B04100113932525">
                <Name>Biomed</Name>
                <Pack ID="P2245833" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>11.25</Subsidy>
                  <Price>11.25</Price>
                  <Alternate>11.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410012016" Page="45" Statim="Must">
            <Name>Potassium chloride</Name>
            <Formulation ID="F041001201603" Rank="4" Units="inj" Weight="750">
              <Name>Inj 75 mg per ml, 10 ml</Name>
              <Brand ID="B04100120160302" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P311340" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041001201604" Rank="4" Units="inj" Weight="1500">
              <Name>Inj 150 mg per ml, 10 ml</Name>
              <Brand ID="B04100120160402" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P311359" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410012128" Page="45">
            <Name>Sodium bicarbonate</Name>
            <Formulation ID="F041001212802" Rank="4" Units="inj" Weight="8.4">
              <Name>Inj 8.4%, 100 ml</Name>
              <Brand ID="B04100121280225">
                <Name>Biomed</Name>
                <Pack ID="P2244144" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>20.50</Subsidy>
                  <Price>20.50</Price>
                  <Alternate>20.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001212826" Rank="4" Units="inj">
              <Name>Inj 8.4%, 50ml </Name>
              <Brand ID="B04100121282625">
                <Name>Biomed</Name>
                <Pack ID="P2244152" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>19.95</Subsidy>
                  <Price>19.95</Price>
                  <Alternate>19.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410012135" Page="45">
            <Name>Sodium chloride</Name>
            <Formulation ID="F041001213503" Rank="4" Units="inj" Weight="0.45">
              <Name>Inj 0.9%, 5 ml</Name>
              <Brand ID="B04100121350301" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P311251" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001213504" Rank="4" Units="inj" Weight="0.9">
              <Name>Inj 0.9%, 10 ml</Name>
              <Brand ID="B04100121350402" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P241172" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001213505" Rank="4" Units="inj" Weight="1.8">
              <Name>Inj 0.9%, 20 ml</Name>
              <Brand ID="B04100121350501">
                <Name>Pharmacia</Name>
                <Pack ID="P485926">
                  <Quantity>6</Quantity>
                  <Subsidy>4.72</Subsidy>
                  <Price>4.72</Price>
                  <Alternate>4.72</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P691976" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>23.58</Subsidy>
                  <Price>23.58</Price>
                  <Alternate>23.58</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041001213509" Rank="3" Units="ml">
              <Name>Inf 0.9%</Name>
              <Brand ID="B04100121350901">
                <Name>Baxter</Name>
                <Pack ID="P285153" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.06</Subsidy>
                  <Price>3.06</Price>
                  <Alternate>3.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P285161" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>4.06</Subsidy>
                  <Price>4.06</Price>
                  <Alternate>4.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>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)</p>
              </div>
              <Rule Type="FormMax" Value="2000" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001213525" Rank="4" Units="inj">
              <Name>Inj 23.4%, 20 ml</Name>
              <Brand ID="B04100121352525">
                <Name>Biomed</Name>
                <Pack ID="P2089432" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>26.50</Subsidy>
                  <Price>26.50</Price>
                  <Alternate>26.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410012332" Page="46">
            <Name>Water</Name>
            <Formulation ID="F041001233201" Rank="4" Units="inj" Weight="2">
              <Name>Purified for inj 2 ml</Name>
              <Brand ID="B04100123320101">
                <Name>Baxter</Name>
                <Pack ID="P347027" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>21.90</Subsidy>
                  <Price>21.90</Price>
                  <Alternate>21.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P395080">
                  <Quantity>5</Quantity>
                  <Subsidy>2.19</Subsidy>
                  <Price>2.19</Price>
                  <Alternate>2.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001233202" Rank="4" Units="inj" Weight="5">
              <Name>Purified for inj 5 ml</Name>
              <Brand ID="B04100123320202">
                <Name>AstraZeneca</Name>
                <Pack ID="P311243" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>9.31</Subsidy>
                  <Price>9.31</Price>
                  <Alternate>9.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100123320225">
                <Name>Multichem</Name>
                <Pack ID="P2208318" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>9.31</Subsidy>
                  <Price>9.31</Price>
                  <Alternate>9.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001233203" Rank="4" Units="inj" Weight="10">
              <Name>Purified for inj 10 ml</Name>
              <Brand ID="B04100123320302">
                <Name>AstraZeneca</Name>
                <Pack ID="P241180" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>10.38</Subsidy>
                  <Price>10.38</Price>
                  <Alternate>10.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100123320325">
                <Name>Multichem</Name>
                <Pack ID="P2208326" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>10.38</Subsidy>
                  <Price>10.38</Price>
                  <Alternate>10.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F041001233204" Rank="4" Units="inj" Weight="20">
              <Name>Purified for inj 20 ml</Name>
              <Brand ID="B04100123320425" SoleSupply="true">
                <Name>Multichem</Name>
                <Pack ID="P2208334" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>5.04</Subsidy>
                  <Price>5.04</Price>
                  <Alternate>5.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: decimal">
                <li>
                  <p>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</p>
                </li>
                <li>
                  <p>On a bulk supply order; or</p>
                </li>
                <li>
                  <p>When used in the extemporaneous compounding of eye drops.</p>
                </li>
              </ol>
            </div>
          </Chemical>
          <Chemical ID="C0410012808" Page="46">
            <Name>Total parental nutrition (TPN)</Name>
            <Formulation ID="F041001280801" Rank="10" Units="ea">
              <Name>Infusion</Name>
              <Brand ID="B04100128080101">
                <Name>TPN</Name>
                <Pack ID="P435031" CBS="true" OP="true" Specified="true">
                  <Quantity>1</Quantity>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="Dispensary" Attribute="HP1" NonPrinting="true"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041004">
          <Name>Oral Administration</Name>
          <Chemical ID="C0410041205" Page="46">
            <Name>Calcium polystyrene sulphonate</Name>
            <Formulation ID="F041004120501" Rank="3" Units="g">
              <Name>Powder</Name>
              <Brand ID="B04100412050101">
                <Name>Calcium Resonium</Name>
                <Pack ID="P201510" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>169.85</Subsidy>
                  <Price>169.85</Price>
                  <Alternate>169.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C0410041394" Page="46" Update="-Subsidy">
            <Name>Dextrose with electrolytes</Name>
            <Formulation ID="F041004139401" Rank="3" Units="ml">
              <Name>Soln with electrolytes</Name>
              <Brand ID="B04100413940102" ToBeDelisted="2008-01-01">
                <Name>Plasma-Lyte Oral</Name>
                <Pack ID="P330167" OP="true" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.33</Subsidy>
                  <Price>3.44</Price>
                  <Alternate>3.33</Alternate>
                  <Surcharge>0.00022</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100413940103">
                <Name>Pedialyte - Fruit</Name>
                <Pack ID="P464988" OP="true" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.66</Subsidy>
                  <Price>6.66</Price>
                  <Alternate>6.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P598518" OP="true">
                  <Quantity>946</Quantity>
                  <Subsidy>6.30</Subsidy>
                  <Price>6.66</Price>
                  <Alternate>6.30</Alternate>
                  <Surcharge>0.00038</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100413940125">
                <Name>Pedialyte - Bubblegum</Name>
                <Pack ID="P234907" OP="true" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.66</Subsidy>
                  <Price>6.66</Price>
                  <Alternate>6.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100413940126">
                <Name>Pedialyte - Plain</Name>
                <Pack ID="P440612" OP="true" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.78</Subsidy>
                  <Price>6.78</Price>
                  <Alternate>6.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410041446" Page="46">
            <Name>Compound electrolytes</Name>
            <Formulation ID="F041004144601" Rank="2" Units="sach" Weight="5">
              <Name>Powder for soln for oral use 5 g</Name>
              <Brand ID="B04100414460125" SoleSupply="true">
                <Name>Enerlyte</Name>
                <Pack ID="P2171864" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>2.86</Subsidy>
                  <Price>2.86</Price>
                  <Alternate>2.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="10" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410042013" Page="46">
            <Name>Potassium bicarbonate</Name>
            <Formulation ID="F041004201301" Rank="1" Units="tab" Weight="315">
              <Name>Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg</Name>
              <Brand ID="B04100420130101">
                <Name>Phosphate-Sandoz</Name>
                <Pack ID="P304913" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>75.00</Subsidy>
                  <Price>75.00</Price>
                  <Alternate>75.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C0410042016" Page="46" Statim="Must">
            <Name>Potassium chloride</Name>
            <Formulation ID="F041004201601" Rank="1" Units="tab" Weight="548">
              <Name>Tab eff 548 mg (14 m eq) with chloride 285 mg (8 m eq)</Name>
              <Brand ID="B04100420160101">
                <Name>Chlorvescent</Name>
                <Pack ID="P405663" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>5.26</Subsidy>
                  <Price>11.85</Price>
                  <Alternate>5.26</Alternate>
                  <Surcharge>0.10983</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041004201602" Rank="1" Units="tab" Weight="600">
              <Name>Tab long-acting 600 mg</Name>
              <Brand ID="B04100420160203" SoleSupply="true">
                <Name>Span-K</Name>
                <Pack ID="P2144468" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>5.20</Subsidy>
                  <Price>5.20</Price>
                  <Alternate>5.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410042160" Page="46">
            <Name>Sodium polystyrene sulphonate</Name>
            <Formulation ID="F041004216001" Rank="3" Units="g">
              <Name>Powder</Name>
              <Brand ID="B04100421600101">
                <Name>Resonium-A</Name>
                <Pack ID="P251089" Specified="true">
                  <Quantity>450</Quantity>
                  <Subsidy>89.10</Subsidy>
                  <Price>89.10</Price>
                  <Alternate>89.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0413">
        <Name>Lipid Modifying Agents</Name>
        <ATC3 ID="A041301">
          <Name>Fibrates</Name>
          <Chemical ID="C0413011151" Page="47" Statim="Must">
            <Name>Bezafibrate</Name>
            <Formulation ID="F041301115101" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B04130111510102" SoleSupply="true">
                <Name>Fibalip</Name>
                <Pack ID="P2095521" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>8.80</Subsidy>
                  <Price>8.80</Price>
                  <Alternate>8.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041301115102" Rank="1" Units="tab" Weight="400">
              <Name>Tab long-acting 400 mg</Name>
              <Brand ID="B04130111510201">
                <Name>Bezalip Retard</Name>
                <Pack ID="P354333" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.60</Subsidy>
                  <Price>7.60</Price>
                  <Alternate>7.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041302">
          <Name>Other Lipid Modifying Agents</Name>
          <Chemical ID="C0413021861" Page="47" Statim="Must">
            <Name>Nicotinic acid</Name>
            <Formulation ID="F041302186102" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B04130218610201" SoleSupply="true">
                <Name>Apo-Nicotinic Acid</Name>
                <Pack ID="P304247" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.08</Subsidy>
                  <Price>5.08</Price>
                  <Alternate>5.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041302186104" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B04130218610402" SoleSupply="true">
                <Name>Apo-Nicotinic Acid</Name>
                <Pack ID="P407860" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.60</Subsidy>
                  <Price>17.60</Price>
                  <Alternate>17.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0413022362" Page="47" Statim="Must">
            <Name>Acipimox</Name>
            <Formulation ID="F041302236201" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B04130223620101" SoleSupply="true">
                <Name>Olbetam</Name>
                <Pack ID="P609641" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>18.75</Subsidy>
                  <Price>18.75</Price>
                  <Alternate>18.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041303">
          <Name>Resins</Name>
          <Chemical ID="C0413031291" Page="47">
            <Name>Cholestyramine with aspartame</Name>
            <Formulation ID="F041303129101" Rank="2" Units="sach">
              <Name>Sachets 4 g with aspartame</Name>
              <Brand ID="B04130312910125">
                <Name>Questran-Lite</Name>
                <Pack ID="P776262" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>19.25</Subsidy>
                  <Price>28.88</Price>
                  <Alternate>19.25</Alternate>
                  <Surcharge>0.19260</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0413031345" Page="47" Update="+Subsidy">
            <Name>Colestipol hydrochloride</Name>
            <Formulation ID="F041303134501" Rank="2" Units="sach">
              <Name>Sachets 5 g</Name>
              <Brand ID="B04130313450101">
                <Name>Colestid</Name>
                <Pack ID="P648450" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>16.17</Subsidy>
                  <Price>16.17</Price>
                  <Alternate>16.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041304">
          <Name>HMG CoA Reductase Inhibitors (Statins)</Name>
          <Chemical ID="C0413041137" Page="47" Statim="Must">
            <Name>Atorvastatin</Name>
            <Formulation ID="F041304113701" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04130411370101">
                <Name>Lipitor</Name>
                <Pack ID="P481017" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.03</Subsidy>
                  <Price>18.32</Price>
                  <Alternate>18.32</Alternate>
                  <Surcharge>0.47633</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304113702" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B04130411370201">
                <Name>Lipitor</Name>
                <Pack ID="P481076" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.87</Subsidy>
                  <Price>26.70</Price>
                  <Alternate>26.70</Alternate>
                  <Surcharge>0.69433</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304113703" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B04130411370301">
                <Name>Lipitor</Name>
                <Pack ID="P481084" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>8.14</Subsidy>
                  <Price>37.02</Price>
                  <Alternate>37.02</Alternate>
                  <Surcharge>0.96267</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Manufacturers Price" Form="SA0788">
              <Title>
                <range>Atorvastatin</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">Patient has severe documented intolerance to simvastatin (blood tests are not required)</ci>
                      <apply>
                        <and/>
                        <ci type="logical" class="Trial">Patient has been compliant with a dose of simvastatin of 80 mg per day for at least 2 months</ci>
                        <apply>
                          <or/>
                          <apply>
                            <and/>
                            <ci type="logical" class="Indication">Patient has venous CABG</ci>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol test 1</ci>
                              <cn>2.0<mi> mmol/litre</mi></cn>
                            </apply>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol test 2</ci>
                              <cn>2.0<mi> mmol/litre (at least 1 week after test 1)</mi></cn>
                            </apply>
                          </apply>
                          <apply>
                            <and/>
                            <ci type="logical" class="Indication">Patient does not have venous CABG</ci>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol test 1</ci>
                              <cn>2.5<mi> mmol/litre</mi></cn>
                            </apply>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol test 2</ci>
                              <cn>2.5<mi> mmol/litre (at least 1 week after test 1)</mi></cn>
                            </apply>
                          </apply>
                        </apply>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>general practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>To confirm that cholesterol levels are not still improving, two lipid tests must be carried out during treatment with simvastatin 80 mg, and have results for LDL cholesterol that have reduced by &lt;10% in the second test. The tests must be carried out while the patient is in a fasted state (with the exception of patients with IDDM).</p>
                  <p>The following indications of intolerance to simvastatin, are known as class effects for all statins, and hence are likely to mean that the patient may also be intolerant of atorvastatin:</p>
                  <ul>
                    <li>Constipation, flatulence (may occur in &gt;1% of patients)</li>
                    <li>Asthenia, abdominal pain, headache (may occur in &gt;1% of patients)</li>
                    <li>Myopathy, rhabdomyolysis (may occur in &lt;3% of patients)</li>
                    <li>Elevated serum transaminase levels (may occur in &lt;1% of patients)</li>
                  </ul>
                  <p>Statins have been shown to be generally well tolerated in clinical studies, with the rate of discontinuation due to adverse reactions being less than 5%, and similar to the discontinuation rate for patients taking a placebo.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0788"/>
            <Rule Type="Guideline" xlink:href="PG0716A041304"/>
          </Chemical>
          <Chemical ID="C0413042513" Page="48" Statim="Must">
            <Name>Simvastatin</Name>
            <Formulation ID="F041304251301" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04130425130125">
                <Name>Lipex</Name>
                <Pack ID="P2022125" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>8.33</Subsidy>
                  <Price>8.33</Price>
                  <Alternate>8.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04130425130126" Update="New Listing">
                <Name>SimvaRex</Name>
                <Pack ID="P2220423" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.31</Subsidy>
                  <Price>2.31</Price>
                  <Alternate>2.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304251302" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B04130425130225">
                <Name>Lipex</Name>
                <Pack ID="P2022117" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>10.13</Subsidy>
                  <Price>10.13</Price>
                  <Alternate>10.13</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04130425130226" Update="New Listing">
                <Name>SimvaRex</Name>
                <Pack ID="P2220431" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.81</Subsidy>
                  <Price>2.81</Price>
                  <Alternate>2.81</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304251304" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B04130425130425">
                <Name>Lipex</Name>
                <Pack ID="P2062887" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>18.00</Subsidy>
                  <Price>18.00</Price>
                  <Alternate>18.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04130425130426" Update="New Listing">
                <Name>SimvaRex</Name>
                <Pack ID="P2220458" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.98</Subsidy>
                  <Price>4.98</Price>
                  <Alternate>4.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304251325" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B04130425132525">
                <Name>Lipex</Name>
                <Pack ID="P2158094" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>21.00</Subsidy>
                  <Price>21.00</Price>
                  <Alternate>21.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0716A041304"/>
          </Chemical>
          <Chemical ID="C0413042780" Page="48">
            <Name>Pravastatin</Name>
            <Formulation ID="F041304278002" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04130427800225">
                <Name>Pravachol</Name>
                <Pack ID="P2170817" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>27.46</Subsidy>
                  <Price>27.46</Price>
                  <Alternate>27.46</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304278003" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B04130427800325">
                <Name>Pravachol</Name>
                <Pack ID="P2170825" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>42.58</Subsidy>
                  <Price>42.58</Price>
                  <Alternate>42.58</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304278025" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B04130427802525">
                <Name>Pravachol</Name>
                <Pack ID="P2170833" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>65.31</Subsidy>
                  <Price>65.31</Price>
                  <Alternate>65.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0849">
              <Title>
                <range>Pravastatin</range>
              </Title>
              <Case When="Initial application" Category="Confirmed HIV/AIDS">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater</ci>
                    <ci type="logical" class="Indication">Confirmed HIV infection</ci>
                    <ci type="logical" class="Indication">Patient is being treated with an HIV protease inhibitor</ci>
                  </apply>
                </math>
                <Applicant>named specialist</Applicant>
                <Term Measure="patient's lifetime">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0849"/>
            <Rule Type="Guideline" xlink:href="PG0716A041304"/>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Guideline" id="PG0716A041304">
            <h3>Prescribing Guidelines</h3>
            <p>Treatment with HMG CoA Reductase Inhibitors (statins) is recommended for patients with dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater.</p>
          </div>
        </ATC3>
        <ATC3 ID="A041308">
          <Name>Selective Cholesterol Absorption Inhibitors</Name>
          <Chemical ID="C0413083799" Page="48">
            <Name>Ezetimibe</Name>
            <Formulation ID="F041308379925" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04130837992525">
                <Name>Ezetrol</Name>
                <Pack ID="P2121522" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>57.60</Subsidy>
                  <Price>57.60</Price>
                  <Alternate>57.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0796">
              <Title>
                <range>Ezetimibe</range>
              </Title>
              <Case When="Initial application" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Use">ezetimibe is to be used in combination with simvastatin</ci>
                      <ci type="logical" class="Use">ezetimibe is to be used without a statin</ci>
                    </apply>
                    <apply>
                      <or/>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">Patient has a calculated absolute risk of cardiovascular disease &gt;20% over 5 years</ci>
                        <ci type="logical" class="Trial">Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day</ci>
                        <apply>
                          <or/>
                          <apply>
                            <and/>
                            <ci type="logical" class="Indication">Patient has venous CABG</ci>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol</ci>
                              <cn>2.0<mi> mmol/litre (see note)</mi></cn>
                            </apply>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol</ci>
                              <cn>2.0<mi> mmol/litre (at least 1 week after test 1 – see note)</mi></cn>
                            </apply>
                          </apply>
                          <apply>
                            <and/>
                            <ci type="logical" class="Indication">Patient does not have venous CABG</ci>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol</ci>
                              <cn>2.5<mi> mmol/litre (see note)</mi></cn>
                            </apply>
                            <apply>
                              <geq/>
                              <ci type="real" class="test">LDL cholesterol</ci>
                              <cn>2.5<mi> mmol/litre (at least 1 week after test 1 – see note)</mi></cn>
                            </apply>
                          </apply>
                        </apply>
                      </apply>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia</ci>
                        <ci type="logical" class="Trial">Patient has been compliant for at least two months with maximum dose statin therapy</ci>
                        <apply>
                          <geq/>
                          <ci type="real" class="test">LDL cholesterol</ci>
                          <cn>5<mi> mmol/litre (see note)</mi></cn>
                        </apply>
                        <apply>
                          <geq/>
                          <ci type="real" class="test">LDL cholesterol</ci>
                          <cn>5<mi> mmol/litre (at least 1 week after test 1 – see note)</mi></cn>
                        </apply>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Two lipid tests are required to assess LDL cholesterol levels, the tests must be at least one week apart, and be carried out in a fasted state (other than for patients with IDDM). The results for LDL cholesterol levels in both tests must be above those specified.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0723 SA0796">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Use">ezetimibe is to be used in combination with simvastatin</ci>
                      <ci type="logical" class="Use">ezetimibe is to be used without a statin</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0796"/>
          </Chemical>
          <Chemical ID="C0413083853" Page="49">
            <Name>Ezetimibe with simvastatin</Name>
            <Formulation ID="F041308385325" Rank="1" Units="tab">
              <Name>Tab 10 mg with simvastatin 20 mg</Name>
              <Brand ID="B04130838532525">
                <Name>Vytorin</Name>
                <Pack ID="P2204614" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>75.00</Subsidy>
                  <Price>75.00</Price>
                  <Alternate>75.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041308385326" Rank="1" Units="tab">
              <Name>Tab 10 mg with simvastatin 40 mg</Name>
              <Brand ID="B04130838532625">
                <Name>Vytorin</Name>
                <Pack ID="P2204606" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>103.50</Subsidy>
                  <Price>103.50</Price>
                  <Alternate>103.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041308385327" Rank="1" Units="tab">
              <Name>Tab 10 mg with simvastatin 80 mg</Name>
              <Brand ID="B04130838532725">
                <Name>Vytorin</Name>
                <Pack ID="P2204592" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>123.00</Subsidy>
                  <Price>123.00</Price>
                  <Alternate>123.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041308385328" Rank="1" Units="tab">
              <Name>Tab 10 mg with simvastatin 10 mg</Name>
              <Brand ID="B04130838532825">
                <Name>Vytorin</Name>
                <Pack ID="P2204584" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>69.00</Subsidy>
                  <Price>69.00</Price>
                  <Alternate>69.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0826">
              <Title>
                <range>Ezetimibe with Simvastatin<instance>Vytorin</instance></range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has a calculated absolute risk of cardiovascular disease &gt;20% over 5 years</ci>
                      <ci type="logical" class="Trial">Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day</ci>
                      <apply>
                        <or/>
                        <apply>
                          <and/>
                          <ci type="logical" class="Indication">Patient has venous CABG</ci>
                          <apply>
                            <geq/>
                            <ci type="real" class="test">LDL cholesterol</ci>
                            <cn>2.0<mi> mmol/litre (see note)</mi></cn>
                          </apply>
                          <apply>
                            <geq/>
                            <ci type="real" class="test">LDL cholesterol</ci>
                            <cn>2.0<mi> mmol/litre (at least 1 week after test 1 – see note)</mi></cn>
                          </apply>
                        </apply>
                        <apply>
                          <and/>
                          <ci type="logical" class="Indication">Patient does not have venous CABG</ci>
                          <apply>
                            <geq/>
                            <ci type="real" class="test">LDL cholesterol</ci>
                            <cn>2.5<mi> mmol/litre (see note)</mi></cn>
                          </apply>
                          <apply>
                            <geq/>
                            <ci type="real" class="test">LDL cholesterol</ci>
                            <cn>2.5<mi> mmol/litre (at least 1 week after test 1 – see note)</mi></cn>
                          </apply>
                        </apply>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia</ci>
                      <ci type="logical" class="Trial">Patient has been compliant for at least two months with maximum dose statin therapy</ci>
                      <apply>
                        <geq/>
                        <ci type="real" class="test">LDL cholesterol</ci>
                        <cn>5<mi> mmol/litre (see note)</mi></cn>
                      </apply>
                      <apply>
                        <geq/>
                        <ci type="real" class="test">LDL cholesterol</ci>
                        <cn>5<mi> mmol/litre (at least 1 week after test 1 – see note)</mi></cn>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Two lipid tests are required to assess LDL cholesterol levels, the tests must be at least one week apart, and be carried out in a fasted state (other than for patients with IDDM). The results for LDL cholesterol levels in both tests must be above those specified.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0826">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0826"/>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A07">
      <Name>Cardiovascular System</Name>
      <ATC2 ID="A0704">
        <Name>Alpha Adrenoceptor Blockers</Name>
        <ATC3 ID="A070401">
          <Name>Alpha Adrenoceptor Blockers</Name>
          <Chemical ID="C0704011966" Page="55" Statim="Must">
            <Name>Phenoxybenzamine hydrochloride</Name>
            <Formulation ID="F070401196601" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B07040119660101">
                <Name>Dibenyline</Name>
                <Pack ID="P258563" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>26.05</Subsidy>
                  <Price>26.05</Price>
                  <Alternate>26.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704011971" Page="55" Statim="Must">
            <Name>Phentolamine mesylate</Name>
            <Formulation ID="F070401197101" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B07040119710101">
                <Name>Regitine</Name>
                <Pack ID="P510858" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>17.97</Subsidy>
                  <Price>27.50</Price>
                  <Alternate>17.97</Alternate>
                  <Surcharge>1.90600</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704012031" Page="55" Statim="Must">
            <Name>Prazosin hydrochloride</Name>
            <Formulation ID="F070401203101" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 0.5 mg</Name>
              <Brand ID="B07040120310101">
                <Name>Hyprosin</Name>
                <Pack ID="P352004" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401203102" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B07040120310201">
                <Name>Hyprosin</Name>
                <Pack ID="P326887" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.99</Subsidy>
                  <Price>2.99</Price>
                  <Alternate>2.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401203103" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B07040120310303">
                <Name>Hyprosin</Name>
                <Pack ID="P326895" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.00</Subsidy>
                  <Price>4.00</Price>
                  <Alternate>4.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401203104" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07040120310401">
                <Name>Hyprosin</Name>
                <Pack ID="P326909" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.50</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>6.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704012515" Page="55" Statim="Must">
            <Name>Doxazosin mesylate</Name>
            <Formulation ID="F070401251502" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B07040125150225">
                <Name>Dosan</Name>
                <Pack ID="P2031418" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>14.20</Subsidy>
                  <Price>14.20</Price>
                  <Alternate>14.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401251503" Rank="1" Units="tab" Weight="4">
              <Name>Tab 4 mg</Name>
              <Brand ID="B07040125150325">
                <Name>Dosan</Name>
                <Pack ID="P2031396" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>17.70</Subsidy>
                  <Price>17.70</Price>
                  <Alternate>17.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704012543" Page="55" Statim="Must">
            <Name>Terazosin hydrochloride</Name>
            <Formulation ID="F070401254303" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B07040125430301">
                <Name>Hytrin</Name>
                <Pack ID="P725382" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.48</Subsidy>
                  <Price>4.66</Price>
                  <Alternate>1.48</Alternate>
                  <Surcharge>0.11357</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401254305" Rank="1" Units="tab" Weight="1">
              <Name>Tab 7 x 1 mg and 7 x 2 mg</Name>
              <Brand ID="B07040125430502">
                <Name>Hytrin Starter Pack</Name>
                <Pack ID="P725374" OP="true" Specified="true">
                  <Quantity>14</Quantity>
                  <Subsidy>0.74</Subsidy>
                  <Price>0.74</Price>
                  <Alternate>0.74</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401254307" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07040125430701">
                <Name>Hytrin</Name>
                <Pack ID="P725390" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.91</Subsidy>
                  <Price>5.60</Price>
                  <Alternate>1.91</Alternate>
                  <Surcharge>0.13179</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0707">
        <Name>Agents Affecting the Renin-Angiotensin System</Name>
        <ATC3 ID="A070701">
          <Name>ACE Inhibitors</Name>
          <Chemical ID="C0707011031" Page="56" Statim="Must">
            <Name>Trandolapril</Name>
            <Formulation ID="F070701103102" Rank="2" Units="cap" Weight="1">
              <Name>Cap 1 mg</Name>
              <Brand ID="B07070110310201">
                <Name>Gopten</Name>
                <Pack ID="P311677" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>3.06</Subsidy>
                  <Price>18.67</Price>
                  <Alternate>18.67</Alternate>
                  <Surcharge>0.55750</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
            <Formulation ID="F070701103103" Rank="2" Units="cap" Weight="2">
              <Name>Cap 2 mg</Name>
              <Brand ID="B07070110310301">
                <Name>Gopten</Name>
                <Pack ID="P311774" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.43</Subsidy>
                  <Price>27.00</Price>
                  <Alternate>27.00</Alternate>
                  <Surcharge>0.80607</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012711" Page="55" Statim="Must">
            <Name>Enalapril</Name>
            <Formulation ID="F070701271101" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07070127110126" SoleSupply="true">
                <Name>m-Enalapril</Name>
                <Pack ID="P2122510" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>2.19</Subsidy>
                  <Price>2.19</Price>
                  <Alternate>2.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701271102" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07070127110226" SoleSupply="true">
                <Name>m-Enalapril</Name>
                <Pack ID="P2122502" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>2.76</Subsidy>
                  <Price>2.76</Price>
                  <Alternate>2.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701271103" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B07070127110326" SoleSupply="true">
                <Name>m-Enalapril</Name>
                <Pack ID="P2122499" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.68</Subsidy>
                  <Price>3.68</Price>
                  <Alternate>3.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012770" Page="55" Statim="Must">
            <Name>Cilazapril</Name>
            <Formulation ID="F070701277001" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 0.5 mg</Name>
              <Brand ID="B07070127700101">
                <Name>Inhibace</Name>
                <Pack ID="P754870" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.20</Subsidy>
                  <Price>2.20</Price>
                  <Alternate>2.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701277002" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07070127700201">
                <Name>Inhibace</Name>
                <Pack ID="P754889" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.39</Subsidy>
                  <Price>4.39</Price>
                  <Alternate>4.39</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701277003" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07070127700301">
                <Name>Inhibace</Name>
                <Pack ID="P754897" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.44</Subsidy>
                  <Price>6.44</Price>
                  <Alternate>6.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012772" Page="56" Statim="Must">
            <Name>Quinapril</Name>
            <Formulation ID="F070701277201" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07070127720101" SoleSupply="true">
                <Name>Accupril</Name>
                <Pack ID="P755117" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.36</Subsidy>
                  <Price>2.36</Price>
                  <Alternate>2.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701277202" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07070127720201" SoleSupply="true">
                <Name>Accupril</Name>
                <Pack ID="P755125" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.26</Subsidy>
                  <Price>3.26</Price>
                  <Alternate>3.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701277203" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B07070127720301" SoleSupply="true">
                <Name>Accupril</Name>
                <Pack ID="P755133" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.30</Subsidy>
                  <Price>4.30</Price>
                  <Alternate>4.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012797" Page="56" Statim="Must">
            <Name>Lisinopril</Name>
            <Formulation ID="F070701279701" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07070127970125" SoleSupply="true">
                <Name>Arrow-Lisinopril</Name>
                <Pack ID="P2250136" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.78</Subsidy>
                  <Price>2.78</Price>
                  <Alternate>2.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701279702" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07070127970225" SoleSupply="true">
                <Name>Arrow-Lisinopril</Name>
                <Pack ID="P2250128" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.16</Subsidy>
                  <Price>3.16</Price>
                  <Alternate>3.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701279703" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B07070127970325" SoleSupply="true">
                <Name>Arrow-Lisinopril</Name>
                <Pack ID="P2250144" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.91</Subsidy>
                  <Price>3.91</Price>
                  <Alternate>3.91</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012806" Page="56" Statim="Must">
            <Name>Perindopril</Name>
            <Formulation ID="F070701280601" Rank="1" Units="tab" Weight="4">
              <Name>Tab 4 mg</Name>
              <Brand ID="B07070128060101">
                <Name>Coversyl</Name>
                <Pack ID="P785466" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.05</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.69833</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
            <Formulation ID="F070701280602" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B07070128060201">
                <Name>Coversyl</Name>
                <Pack ID="P343048" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.00</Subsidy>
                  <Price>18.50</Price>
                  <Alternate>18.50</Alternate>
                  <Surcharge>0.51667</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012841" Page="55" Statim="Must" Update="+Subsidy">
            <Name>Captopril</Name>
            <Formulation ID="F070701284101" Rank="1" Units="tab" Weight="12.5">
              <Name>Tab 12.5 mg</Name>
              <Brand ID="B07070128410126">
                <Name>Apo-Captopril</Name>
                <Pack ID="P2149745" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>10.40</Subsidy>
                  <Price>10.40</Price>
                  <Alternate>10.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701284102" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07070128410226">
                <Name>Apo-Captopril</Name>
                <Pack ID="P2149753" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>13.40</Subsidy>
                  <Price>13.40</Price>
                  <Alternate>13.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701284103" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07070128410326">
                <Name>Apo-Captopril</Name>
                <Pack ID="P2149761" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>19.00</Subsidy>
                  <Price>19.00</Price>
                  <Alternate>19.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701284106" Rank="3" Units="ml" Weight="5" Safety="Uncompounded">
              <Name>Oral liq 5 mg per ml</Name>
              <Brand ID="B07070128410601">
                <Name>Capoten</Name>
                <Pack ID="P2055538" OP="true" Specified="true">
                  <Quantity>95</Quantity>
                  <Subsidy>51.04</Subsidy>
                  <Price>51.04</Price>
                  <Alternate>51.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Oral liquid restricted to children under 12 years of age.</p>
              </div>
            </Formulation>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p>Perindopril and trandolapril will be funded to the level of the ex-manufacturer price listed in the Schedule for patients who were taking these ACE inhibitors for the treatment of congestive heart failure prior to 1 June 1998. The prescription must be endorsed accordingly. We recommend that the words used to indicate eligibility are “certified condition” or an appropriate description of the patient such as “congestive heart failure”, “CHF”, “congestive cardiac failure” or “CCF”.</p>
            <p>
              <strong>Definition of Congestive Heart Failure</strong>
            </p>
            <p>At the request of some prescribers the PTAC Cardiovascular subcommittee has provided a definition of congestive heart failure for the purposes of the funding of the manufacturer’s surcharge: “Clinicians should use their clinical judgement. Existing patients would be eligible for the funding of the surcharge if the patient shows signs and symptoms of congestive heart failure, and requires or has in the past required concomitant treatment with a diuretic. The definition could also be considered to include patients post myocardial infarction with an ejection fraction of less than 40%.”</p>
          </div>
        </ATC3>
        <ATC3 ID="A070702">
          <Name>ACE Inhibitors with Diuretics</Name>
          <Chemical ID="C0707021127" Page="56" Statim="Must">
            <Name>Cilazapril with hydrochlorothiazide</Name>
            <Formulation ID="F070702112701" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg with hydrochlorothiazide 12.5 mg</Name>
              <Brand ID="B07070211270101">
                <Name>Inhibace Plus</Name>
                <Pack ID="P490202" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>6.30</Subsidy>
                  <Price>6.30</Price>
                  <Alternate>6.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707022708" Page="56" Statim="Must">
            <Name>Enalapril with hydrochlorothiazide</Name>
            <Formulation ID="F070702270804" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg with hydrochlorothiazide 12.5 mg</Name>
              <Brand ID="B07070227080401">
                <Name>Co-Renitec</Name>
                <Pack ID="P734128" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.32</Subsidy>
                  <Price>8.70</Price>
                  <Alternate>3.32</Alternate>
                  <Surcharge>0.17933</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707023749" Page="56" Statim="Must">
            <Name>Quinapril with hydrochlorothiazide</Name>
            <Formulation ID="F070702374925" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg with hydrochlorothiazide 12.5 mg</Name>
              <Brand ID="B07070237492525" SoleSupply="true">
                <Name>Accuretic 10</Name>
                <Pack ID="P2022923" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.37</Subsidy>
                  <Price>3.37</Price>
                  <Alternate>3.37</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070702374926" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg with hydrochlorothiazide 12.5 mg</Name>
              <Brand ID="B07070237492625" SoleSupply="true">
                <Name>Accuretic 20</Name>
                <Pack ID="P2022931" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.57</Subsidy>
                  <Price>4.57</Price>
                  <Alternate>4.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A070703">
          <Name>Angiotension II Antagonists</Name>
          <Chemical ID="C0707031061" Page="57" Statim="Must">
            <Name>Losartan</Name>
            <Formulation ID="F070703106101" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07070310610101">
                <Name>Cozaar</Name>
                <Pack ID="P285293" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>31.79</Subsidy>
                  <Price>31.79</Price>
                  <Alternate>31.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070703106102" Rank="1" Units="tab" Weight="12.5">
              <Name>Tab 12.5 mg</Name>
              <Brand ID="B07070310610201">
                <Name>Cozaar</Name>
                <Pack ID="P490091" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>23.84</Subsidy>
                  <Price>23.84</Price>
                  <Alternate>23.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070703106125" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07070310612525">
                <Name>Cozaar</Name>
                <Pack ID="P2150697" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>35.40</Subsidy>
                  <Price>35.40</Price>
                  <Alternate>35.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0862">
              <Title><range>Candesartan</range><range>Losartan</range> (Circle one)</Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient with congestive heart failure</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Trial">Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough</ci>
                        <ci type="logical" class="Trial">Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient with raised blood pressure</ci>
                      <ci type="logical" class="Trial">Use of fully funded beta blockers or diuretics are contraindicated; or not well tolerated; or insufficient to control blood pressure adequately at appropriate doses</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Trial">Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough</ci>
                        <ci type="logical" class="Trial">Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>general practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0862"/>
          </Chemical>
          <Chemical ID="C0707031254" Page="56" Statim="Must">
            <Name>Candesartan</Name>
            <Formulation ID="F070703125401" Rank="1" Units="tab" Weight="4">
              <Name>Tab 4 mg</Name>
              <Brand ID="B07070312540101">
                <Name>Atacand</Name>
                <Pack ID="P2184192" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>16.22</Subsidy>
                  <Price>16.22</Price>
                  <Alternate>16.22</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="1.5"/>
            </Formulation>
            <Formulation ID="F070703125402" Rank="1" Units="tab" Weight="8">
              <Name>Tab 8 mg</Name>
              <Brand ID="B07070312540201">
                <Name>Atacand</Name>
                <Pack ID="P2184206" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>19.30</Subsidy>
                  <Price>19.30</Price>
                  <Alternate>19.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="1.5"/>
            </Formulation>
            <Formulation ID="F070703125403" Rank="1" Units="tab" Weight="16">
              <Name>Tab 16 mg</Name>
              <Brand ID="B07070312540301">
                <Name>Atacand</Name>
                <Pack ID="P2184214" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>23.54</Subsidy>
                  <Price>23.54</Price>
                  <Alternate>23.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="1"/>
            </Formulation>
            <Formulation ID="F070703125425" Rank="1" Units="tab" Weight="16">
              <Name>Tab 32 mg</Name>
              <Brand ID="B07070312542525">
                <Name>Atacand</Name>
                <Pack ID="P2223716" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>38.50</Subsidy>
                  <Price>38.50</Price>
                  <Alternate>38.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="1"/>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0862">
              <Title><range>Candesartan</range><range>Losartan</range> (Circle one)</Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient with congestive heart failure</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Trial">Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough</ci>
                        <ci type="logical" class="Trial">Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient with raised blood pressure</ci>
                      <ci type="logical" class="Trial">Use of fully funded beta blockers or diuretics are contraindicated; or not well tolerated; or insufficient to control blood pressure adequately at appropriate doses</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Trial">Has been treated with, and cannot tolerate, two ACE inhibitors, due to persistent cough</ci>
                        <ci type="logical" class="Trial">Has experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>general practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0862"/>
          </Chemical>
          <Chemical ID="C0707033788" Page="57">
            <Name>Losartan with hydrochlorothiazide</Name>
            <Formulation ID="F070703378825" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg with hydrochlorothiazide 12.5 mg</Name>
              <Brand ID="B07070337882525">
                <Name>Hyzaar</Name>
                <Pack ID="P2150719" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>31.79</Subsidy>
                  <Price>31.79</Price>
                  <Alternate>31.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0703">
              <Title>
                <range>Losartan – Tab 50 mg with hydrochlorothiazide 12.5 mg <instance>Hyzar</instance></range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has raised blood pressure</ci>
                    <ci type="logical" class="Indication">The use of fully funded beta blockers is contraindicated, or not well tolerated; or where use of fully funded beta blockers and diuretics are insufficient to control blood pressure adequately at appropriate doses</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">Has been treated with, and cannot tolerate two ACE inhibitors, due to persistent cough</ci>
                      <ci type="logical" class="Trial">Has  experienced angioedema on an ACE inhibitor at any time in the past or who have experienced angioedema (even if not using an ACE inhibitor) in the last 2 years</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>general practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0703">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>general practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0703"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0713">
        <Name>Antiarrhythmics</Name>
        <ATC3 ID="A071301">
          <Name>Antiarrhythmics</Name>
          <Chemical ID="C0713011057" Page="58">
            <Name>Amiodarone hydrochloride</Name>
            <Formulation ID="F071301105701" Rank="1" Units="tab" Weight="100" Statim="May">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07130110570101">
                <Name>Cordarone-X</Name>
                <Pack ID="P397083" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>18.65</Subsidy>
                  <Price>18.65</Price>
                  <Alternate>18.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07130110570102">
                <Name>Aratac</Name>
                <Pack ID="P770620" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>18.65</Subsidy>
                  <Price>18.65</Price>
                  <Alternate>18.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F071301105702" Rank="1" Units="tab" Weight="200" Statim="May">
              <Name>Tab 200 mg</Name>
              <Brand ID="B07130110570201">
                <Name>Cordarone-X</Name>
                <Pack ID="P283622" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>30.52</Subsidy>
                  <Price>30.52</Price>
                  <Alternate>30.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07130110570202">
                <Name>Aratac</Name>
                <Pack ID="P770639" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>30.52</Subsidy>
                  <Price>30.52</Price>
                  <Alternate>30.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F071301105703" Rank="4" Units="inj" Weight="150">
              <Name>Inj 50 mg per ml, 3 ml</Name>
              <Brand ID="B07130110570301">
                <Name>Cordarone-X</Name>
                <Pack ID="P358312" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>60.84</Subsidy>
                  <Price>60.84</Price>
                  <Alternate>60.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0713011412" Page="58" Statim="Must" Update="+Subsidy">
            <Name>Digoxin</Name>
            <Formulation ID="F071301141201" Rank="1" Units="tab">
              <Name>Tab 62.5 mcg</Name>
              <Brand ID="B07130114120101">
                <Name>Lanoxin PG</Name>
                <Pack ID="P283118" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>6.94</Subsidy>
                  <Price>6.94</Price>
                  <Alternate>6.94</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F071301141202" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mcg</Name>
              <Brand ID="B07130114120201">
                <Name>Lanoxin</Name>
                <Pack ID="P206245" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>15.13</Subsidy>
                  <Price>15.13</Price>
                  <Alternate>15.13</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F071301141203" Rank="3" Units="ml" Weight="50" Safety="Uncompounded">
              <Name>Oral liq 50 mcg per ml</Name>
              <Brand ID="B07130114120301">
                <Name>Lanoxin</Name>
                <Pack ID="P426490" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>16.60</Subsidy>
                  <Price>16.60</Price>
                  <Alternate>16.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0713011428" Page="58" Statim="May">
            <Name>Disopyramide phosphate</Name>
            <Formulation ID="F071301142802" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B07130114280202">
                <Name>Rythmodan</Name>
                <Pack ID="P315699" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>23.87</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.08870</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071301142805" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B07130114280501">
                <Name>Rythmodan</Name>
                <Pack ID="P208590" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>26.21</Subsidy>
                  <Price>26.21</Price>
                  <Alternate>26.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0713011510" Page="58">
            <Name>Flecainide acetate</Name>
            <Formulation ID="F071301151001" Rank="1" Units="tab" Weight="50" Statim="May">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07130115100103">
                <Name>Tambocor</Name>
                <Pack ID="P724882" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>42.82</Subsidy>
                  <Price>42.82</Price>
                  <Alternate>42.82</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071301151002" Rank="1" Units="tab" Weight="100" Statim="May">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07130115100203">
                <Name>Tambocor</Name>
                <Pack ID="P359823" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>75.63</Subsidy>
                  <Price>75.63</Price>
                  <Alternate>75.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071301151003" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 15 ml</Name>
              <Brand ID="B07130115100301">
                <Name>Tambocor</Name>
                <Pack ID="P332062" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>49.02</Subsidy>
                  <Price>49.02</Price>
                  <Alternate>49.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071301151004" Rank="2" Units="cap" Weight="100" Statim="May">
              <Name>Cap long-acting 100 mg</Name>
              <Brand ID="B07130115100401">
                <Name>Tambocor CR</Name>
                <Pack ID="P234532" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>42.82</Subsidy>
                  <Price>42.82</Price>
                  <Alternate>42.82</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071301151005" Rank="2" Units="cap" Weight="200" Statim="May">
              <Name>Cap long-acting 200 mg</Name>
              <Brand ID="B07130115100501">
                <Name>Tambocor CR</Name>
                <Pack ID="P234540" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>75.63</Subsidy>
                  <Price>75.63</Price>
                  <Alternate>75.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C0713011823" Page="58" Statim="May">
            <Name>Mexiletine hydrochloride</Name>
            <Formulation ID="F071301182301" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B07130118230101" SoleSupply="true">
                <Name>Mexitil</Name>
                <Pack ID="P210838" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>23.52</Subsidy>
                  <Price>23.52</Price>
                  <Alternate>23.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071301182302" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B07130118230201" SoleSupply="true">
                <Name>Mexitil</Name>
                <Pack ID="P253820" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>55.05</Subsidy>
                  <Price>55.05</Price>
                  <Alternate>55.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0713012810" Page="58" Statim="May">
            <Name>Propafenone hydrochloride</Name>
            <Formulation ID="F071301281001" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg</Name>
              <Brand ID="B07130128100101">
                <Name>Rytmonorm</Name>
                <Pack ID="P791326" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>40.90</Subsidy>
                  <Price>40.90</Price>
                  <Alternate>40.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A220101">For lignocaine hydrochloride refer to NERVOUS SYSTEM, Anaesthetics, Local</p>
        </div>
      </ATC2>
      <ATC2 ID="A0715">
        <Name>Antihypotensives</Name>
        <ATC3 ID="A071501">
          <Name>Antihypotensives</Name>
          <Chemical ID="C0715011012" Page="58">
            <Name>Midodrine</Name>
            <Formulation ID="F071501101201" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07150110120101" SoleSupply="true">
                <Name>Gutron</Name>
                <Pack ID="P242993" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>53.00</Subsidy>
                  <Price>53.00</Price>
                  <Alternate>53.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071501101202" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07150110120201" SoleSupply="true">
                <Name>Gutron</Name>
                <Pack ID="P243000" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>79.00</Subsidy>
                  <Price>79.00</Price>
                  <Alternate>79.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0361">
              <Title>
                <range>Midodrine</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Disabling orthostatic hypotension not due to drugs</ci>
                    <ci type="logical" class="Trial">Patient has tried fludrocortisone (unless contra-indicated) with unsatisfactory results</ci>
                    <ci type="logical" class="Trial">Patient has tried non pharmacological treatments such as support hose, increased salt intake, exercise, and elevation of head and trunk at night</ci>
                  </apply>
                </math>
                <Applicant>geriatrician</Applicant>
                <Applicant>neurologist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="year">2</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Treatment should be started with small doses and titrated upwards as necessary.</p>
                  <p>Hypertension should be avoided, and the usual target is a standing systolic blood pressure of 90 mm Hg.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0361">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>geriatrician</Applicant>
                <Applicant>neurologist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0361"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0716">
        <Name>Beta Adrenoceptor Blockers</Name>
        <ATC3 ID="A071601">
          <Name>Beta Adrenoceptor Blockers</Name>
          <Chemical ID="C0716011001" Page="59" Statim="Must">
            <Name>Acebutolol</Name>
            <Formulation ID="F071601100101" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B07160110010102" ToBeDelisted="2008-03-01">
                <Name>ACB</Name>
                <Pack ID="P479217" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>27.63</Subsidy>
                  <Price>27.63</Price>
                  <Alternate>27.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601100102" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B07160110010202">
                <Name>ACB</Name>
                <Pack ID="P535427" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601100103" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B07160110010302">
                <Name>ACB</Name>
                <Pack ID="P535435" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.94</Subsidy>
                  <Price>15.94</Price>
                  <Alternate>15.94</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011094" Page="59" Statim="Must">
            <Name>Atenolol</Name>
            <Formulation ID="F071601109401" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07160110940102" SoleSupply="true">
                <Name>Loten</Name>
                <Pack ID="P2006936" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.50</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>6.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601109402" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07160110940202" SoleSupply="true">
                <Name>Loten</Name>
                <Pack ID="P2006952" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>11.30</Subsidy>
                  <Price>11.30</Price>
                  <Alternate>11.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011699" Page="59" Statim="Must">
            <Name>Labetalol</Name>
            <Formulation ID="F071601169901" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07160116990102">
                <Name>Hybloc</Name>
                <Pack ID="P589187" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.66</Subsidy>
                  <Price>8.66</Price>
                  <Alternate>8.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601169902" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07160116990202">
                <Name>Hybloc</Name>
                <Pack ID="P393584" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.59</Subsidy>
                  <Price>10.59</Price>
                  <Alternate>10.59</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601169903" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B07160116990301">
                <Name>Hybloc</Name>
                <Pack ID="P393592" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.47</Subsidy>
                  <Price>18.47</Price>
                  <Alternate>18.47</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601169904" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B07160116990403">
                <Name>Hybloc</Name>
                <Pack ID="P479209" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>34.44</Subsidy>
                  <Price>34.44</Price>
                  <Alternate>34.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601169905" Rank="4" Units="inj" Weight="100">
              <Name>Inj 5 mg per ml, 20 ml</Name>
              <Brand ID="B07160116990501">
                <Name>Trandate</Name>
                <Pack ID="P256951" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>59.06</Subsidy>
                  <Price>88.60</Price>
                  <Alternate>59.06</Alternate>
                  <Surcharge>5.90800</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601169925" Rank="4" Units="inj">
              <Name>Inj 5 mg per ml, 5 ml</Name>
              <Brand ID="B07160116992525" S29="true">
                <Name>Trandate</Name>
                <Pack ID="P2198002" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>14.77</Subsidy>
                  <Price>22.15</Price>
                  <Alternate>14.77</Alternate>
                  <Surcharge>1.47600</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011817" Page="59" Statim="Must" Update="+Price">
            <Name>Metoprolol succinate</Name>
            <Formulation ID="F071601181701" Rank="1" Units="tab" Weight="47.5">
              <Name>Tab long-acting 47.5 mg</Name>
              <Brand ID="B07160118170101">
                <Name>Betaloc CR</Name>
                <Pack ID="P599891" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.50</Subsidy>
                  <Price>7.80</Price>
                  <Alternate>7.80</Alternate>
                  <Surcharge>0.04333</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
            <Formulation ID="F071601181702" Rank="1" Units="tab" Weight="95">
              <Name>Tab long-acting 95 mg</Name>
              <Brand ID="B07160118170201">
                <Name>Betaloc CR</Name>
                <Pack ID="P527858" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>11.20</Subsidy>
                  <Price>13.20</Price>
                  <Alternate>13.20</Alternate>
                  <Surcharge>0.06667</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
            <Formulation ID="F071601181703" Rank="1" Units="tab" Weight="190">
              <Name>Tab long-acting 190 mg</Name>
              <Brand ID="B07160118170301">
                <Name>Betaloc CR</Name>
                <Pack ID="P599905" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>20.25</Subsidy>
                  <Price>21.00</Price>
                  <Alternate>21.00</Alternate>
                  <Surcharge>0.02500</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
            <Formulation ID="F071601181725" Rank="1" Units="tab">
              <Name>Tab long-acting 23.75 mg</Name>
              <Brand ID="B07160118172525">
                <Name>Betaloc CR</Name>
                <Pack ID="P2026945" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.20</Subsidy>
                  <Price>6.20</Price>
                  <Alternate>6.20</Alternate>
                  <Surcharge>0.03333</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Alternate" Attribute="Endorsement"/>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Additional subsidy by endorsement is available for patients who:</p>
              <ol style="list-style-type: decimal">
                <li>
                  <p>were being prescribed metoprolol succinate prior to 1 October 2007; or</p>
                </li>
                <li>
                  <p>have experienced a myocardial infarction.</p>
                </li>
              </ol>
              <p>The prescription must be endorsed accordingly.</p>
            </div>
            <Rule Type="Repeat" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C0716011818" Page="59" Statim="Must" Update="+Subsidy">
            <Name>Metoprolol tartrate</Name>
            <Formulation ID="F071601181801" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07160118180101">
                <Name>Lopresor</Name>
                <Pack ID="P680915" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.50</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>16.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601181802" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07160118180201">
                <Name>Lopressor</Name>
                <Pack ID="P308021">
                  <Quantity>30</Quantity>
                  <Subsidy>10.90</Subsidy>
                  <Price>10.90</Price>
                  <Alternate>10.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2104105" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>21.80</Subsidy>
                  <Price>21.80</Price>
                  <Alternate>21.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601181803" Rank="1" Units="tab" Weight="200">
              <Name>Tab long-acting 200 mg</Name>
              <Brand ID="B07160118180301" SoleSupply="true">
                <Name>Slow-Lopressor</Name>
                <Pack ID="P2108682" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>18.40</Subsidy>
                  <Price>18.40</Price>
                  <Alternate>18.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601181804" Rank="4" Units="inj" Weight="1">
              <Name>Inj 1 mg per ml 5 ml</Name>
              <Brand ID="B07160118180401">
                <Name>Betaloc</Name>
                <Pack ID="P327883" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>24.08</Subsidy>
                  <Price>34.00</Price>
                  <Alternate>24.08</Alternate>
                  <Surcharge>1.98400</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011838" Page="60" Statim="Must">
            <Name>Nadolol</Name>
            <Formulation ID="F071601183801" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07160118380102" SoleSupply="true">
                <Name>Apo-Nadolol</Name>
                <Pack ID="P787493" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>14.97</Subsidy>
                  <Price>14.97</Price>
                  <Alternate>14.97</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601183802" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B07160118380202" SoleSupply="true">
                <Name>Apo-Nadolol</Name>
                <Pack ID="P787515" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>22.19</Subsidy>
                  <Price>22.19</Price>
                  <Alternate>22.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011991" Page="60" Statim="Must">
            <Name>Pindolol</Name>
            <Formulation ID="F071601199104" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07160119910402">
                <Name>Pindol</Name>
                <Pack ID="P661864" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.50</Subsidy>
                  <Price>4.50</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601199105" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07160119910503">
                <Name>Pindol</Name>
                <Pack ID="P661872" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.35</Subsidy>
                  <Price>8.35</Price>
                  <Alternate>8.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601199106" Rank="1" Units="tab" Weight="15">
              <Name>Tab 15 mg</Name>
              <Brand ID="B07160119910603">
                <Name>Pindol</Name>
                <Pack ID="P661880" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716012060" Page="60" Statim="Must">
            <Name>Propranolol</Name>
            <Formulation ID="F071601206001" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07160120600103">
                <Name>Cardinol</Name>
                <Pack ID="P291331" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.55</Subsidy>
                  <Price>3.55</Price>
                  <Alternate>3.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601206002" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07160120600204">
                <Name>Cardinol</Name>
                <Pack ID="P291358" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.65</Subsidy>
                  <Price>4.65</Price>
                  <Alternate>4.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601206006" Rank="2" Units="cap" Weight="160">
              <Name>Cap long-acting 160 mg</Name>
              <Brand ID="B07160120600602">
                <Name>Cardinol LA</Name>
                <Pack ID="P326070" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.90</Subsidy>
                  <Price>16.90</Price>
                  <Alternate>16.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716012169" Page="60" Statim="Must">
            <Name>Sotalol</Name>
            <Formulation ID="F071601216901" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B07160121690102">
                <Name>Pacific</Name>
                <Pack ID="P2127903" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>27.50</Subsidy>
                  <Price>27.50</Price>
                  <Alternate>27.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601216902" Rank="1" Units="tab" Weight="160">
              <Name>Tab 160 mg</Name>
              <Brand ID="B07160121690202">
                <Name>Pacific</Name>
                <Pack ID="P2127911" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601216903" Rank="4" Units="inj" Weight="40">
              <Name>Inj 10 mg per ml, 4 ml</Name>
              <Brand ID="B07160121690301">
                <Name>Sotacor</Name>
                <Pack ID="P332925" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>41.34</Subsidy>
                  <Price>41.34</Price>
                  <Alternate>41.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716012266" Page="60" Statim="Must">
            <Name>Timolol maleate</Name>
            <Formulation ID="F071601226601" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07160122660104" SoleSupply="true">
                <Name>Apo-Timol</Name>
                <Pack ID="P750727" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.55</Subsidy>
                  <Price>10.55</Price>
                  <Alternate>10.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716012514" Page="59" Statim="Must">
            <Name>Celiprolol</Name>
            <Formulation ID="F071601251401" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B07160125140102">
                <Name>Celol</Name>
                <Pack ID="P2031337" Specified="true">
                  <Quantity>180</Quantity>
                  <Subsidy>19.00</Subsidy>
                  <Price>19.00</Price>
                  <Alternate>19.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716013772" Page="59">
            <Name>Carvedilol</Name>
            <Formulation ID="F071601377225" Rank="1" Units="tab" Weight="6.25">
              <Name>Tab 6.25 mg</Name>
              <Brand ID="B07160137722525">
                <Name>Dilatrend</Name>
                <Pack ID="P388548" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>21.00</Subsidy>
                  <Price>21.00</Price>
                  <Alternate>21.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601377226" Rank="1" Units="tab" Weight="12.5">
              <Name>Tab 12.5 mg</Name>
              <Brand ID="B07160137722625">
                <Name>Dilatrend</Name>
                <Pack ID="P2060221" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>27.00</Subsidy>
                  <Price>27.00</Price>
                  <Alternate>27.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601377227" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07160137722725">
                <Name>Dilatrend</Name>
                <Pack ID="P388513" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>33.75</Subsidy>
                  <Price>33.75</Price>
                  <Alternate>33.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0722">
        <Name>Calcium Channel Blockers</Name>
        <ATC3 ID="A072201">
          <Name>Dihydropyridine Calcium Channel Blockers (DHP CCBs)</Name>
          <Chemical ID="C0722011863" Page="60" Statim="Must">
            <Name>Nifedipine</Name>
            <Formulation ID="F072201186301" Rank="1" Units="tab" Weight="10">
              <Name>Tab long-acting 10 mg</Name>
              <Brand ID="B07220118630125">
                <Name>Adalat 10</Name>
                <Pack ID="P2058707" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>17.72</Subsidy>
                  <Price>17.72</Price>
                  <Alternate>17.72</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072201186302" Rank="1" Units="tab" Weight="20">
              <Name>Tab long-acting 20 mg</Name>
              <Brand ID="B07220118630203" SoleSupply="true">
                <Name>Nyefax Retard</Name>
                <Pack ID="P529435" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.30</Subsidy>
                  <Price>7.30</Price>
                  <Alternate>7.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072201186303" Rank="1" Units="tab" Weight="30">
              <Name>Tab long-acting 30 mg</Name>
              <Brand ID="B07220118630301">
                <Name>Adalat Oros</Name>
                <Pack ID="P213098" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.50</Subsidy>
                  <Price>19.90</Price>
                  <Alternate>5.50</Alternate>
                  <Surcharge>0.48000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07220118630325">
                <Name>Arrow-Nifedipine XR</Name>
                <Pack ID="P2231360" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>13.25</Subsidy>
                  <Price>13.25</Price>
                  <Alternate>13.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07220118630326">
                <Name>Adefin XL</Name>
                <Pack ID="P2222140" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>11.26</Subsidy>
                  <Price>11.26</Price>
                  <Alternate>11.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Repeat" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F072201186304" Rank="1" Units="tab" Weight="60">
              <Name>Tab long-acting 60 mg</Name>
              <Brand ID="B07220118630401">
                <Name>Adalat Oros</Name>
                <Pack ID="P213101" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>29.50</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.71667</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07220118630425">
                <Name>Arrow-Nifedipine XR</Name>
                <Pack ID="P2231379" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>19.00</Subsidy>
                  <Price>19.00</Price>
                  <Alternate>19.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07220118630426">
                <Name>Adefin XL</Name>
                <Pack ID="P2222116" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>16.15</Subsidy>
                  <Price>16.15</Price>
                  <Alternate>16.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Repeat" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0722012398" Page="60" Statim="Must">
            <Name>Felodipine</Name>
            <Formulation ID="F072201239801" Rank="1" Units="tab" Weight="5">
              <Name>Tab long-acting 5 mg</Name>
              <Brand ID="B07220123980125">
                <Name>Felo 5 ER</Name>
                <Pack ID="P2041510" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>16.50</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>16.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072201239802" Rank="1" Units="tab" Weight="10">
              <Name>Tab long-acting 10 mg</Name>
              <Brand ID="B07220123980225">
                <Name>Felo 10 ER</Name>
                <Pack ID="P2041499" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>24.00</Subsidy>
                  <Price>24.00</Price>
                  <Alternate>24.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072201239803" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab long-acting 2.5 mg</Name>
              <Brand ID="B07220123980301">
                <Name>Plendil ER</Name>
                <Pack ID="P353760" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>10.38</Subsidy>
                  <Price>10.38</Price>
                  <Alternate>10.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="1"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0722012771" Page="60">
            <Name>Isradipine</Name>
            <Formulation ID="F072201277101" Rank="2" Units="cap" Weight="2.5">
              <Name>Cap long-acting 2.5 mg</Name>
              <Brand ID="B07220127710101">
                <Name>Dynacirc-SRO</Name>
                <Pack ID="P757853" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.50</Subsidy>
                  <Price>7.50</Price>
                  <Alternate>7.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072201277102" Rank="2" Units="cap" Weight="5">
              <Name>Cap long-acting 5 mg</Name>
              <Brand ID="B07220127710201">
                <Name>Dynacirc-SRO</Name>
                <Pack ID="P757861" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.85</Subsidy>
                  <Price>7.85</Price>
                  <Alternate>7.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0722012793" Page="60" Statim="Must">
            <Name>Amlodipine</Name>
            <Formulation ID="F072201279301" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07220127930125" SoleSupply="true">
                <Name>Calvasc</Name>
                <Pack ID="P2114666" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.85</Subsidy>
                  <Price>7.85</Price>
                  <Alternate>7.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072201279302" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07220127930225" SoleSupply="true">
                <Name>Calvasc</Name>
                <Pack ID="P2114674" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>13.60</Subsidy>
                  <Price>13.60</Price>
                  <Alternate>13.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A072202">
          <Name>Other Calcium Channel Blockers</Name>
          <Chemical ID="C0722021949" Page="61" Statim="Must">
            <Name>Perhexiline maleate</Name>
            <Formulation ID="F072202194901" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07220219490125" SoleSupply="true">
                <Name>Pexsig</Name>
                <Pack ID="P352713" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>62.90</Subsidy>
                  <Price>62.90</Price>
                  <Alternate>62.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0256">
              <Title>
                <range>Perhexiline Maleate</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Refractory angina</ci>
                    <ci type="logical" class="Trial">Patient is already on maximal anti-anginal therapy</ci>
                  </apply>
                </math>
                <Applicant>cardiologist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0256">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>cardiologist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0256"/>
          </Chemical>
          <Chemical ID="C0722022317" Page="61" Statim="Must">
            <Name>Verapamil hydrochloride</Name>
            <Formulation ID="F072202231701" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07220223170104">
                <Name>Verpamil</Name>
                <Pack ID="P314846" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.75</Subsidy>
                  <Price>4.75</Price>
                  <Alternate>4.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202231702" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B07220223170202">
                <Name>Verpamil</Name>
                <Pack ID="P314854" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.00</Subsidy>
                  <Price>6.00</Price>
                  <Alternate>6.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202231707" Rank="4" Units="inj" Weight="2.5">
              <Name>Inj 2.5 mg per ml, 2 ml</Name>
              <Brand ID="B07220223170701">
                <Name>Isoptin</Name>
                <Pack ID="P253480" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.54</Subsidy>
                  <Price>7.54</Price>
                  <Alternate>7.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F072202231709" Rank="1" Units="tab" Weight="120">
              <Name>Tab long-acting 120 mg</Name>
              <Brand ID="B07220223170902" SoleSupply="true">
                <Name>Verpamil SR</Name>
                <Pack ID="P2095467" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>15.20</Subsidy>
                  <Price>15.20</Price>
                  <Alternate>15.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202231711" Rank="1" Units="tab" Weight="240">
              <Name>Tab long-acting 240 mg</Name>
              <Brand ID="B07220223171102">
                <Name>Verpamil SR</Name>
                <Pack ID="P380075" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0722022528" Page="61" Statim="Must">
            <Name>Diltiazem hydrochloride</Name>
            <Formulation ID="F072202252801" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B07220225280101">
                <Name>Dilzem</Name>
                <Pack ID="P668974" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.50</Subsidy>
                  <Price>4.50</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252802" Rank="1" Units="tab" Weight="60">
              <Name>Tab 60 mg</Name>
              <Brand ID="B07220225280203">
                <Name>Dilzem</Name>
                <Pack ID="P523836" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.50</Subsidy>
                  <Price>8.50</Price>
                  <Alternate>8.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252803" Rank="2" Units="cap" Weight="90">
              <Name>Cap long-acting 90 mg</Name>
              <Brand ID="B07220225280301">
                <Name>Dilzem SR</Name>
                <Pack ID="P749486" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>7.65</Subsidy>
                  <Price>7.65</Price>
                  <Alternate>7.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252804" Rank="2" Units="cap" Weight="120">
              <Name>Cap long-acting 120 mg (once per day)</Name>
              <Brand ID="B07220225280403">
                <Name>Cardizem CD</Name>
                <Pack ID="P344621" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.10</Subsidy>
                  <Price>5.10</Price>
                  <Alternate>5.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252805" Rank="2" Units="cap" Weight="180">
              <Name>Cap long-acting 180 mg</Name>
              <Brand ID="B07220225280501">
                <Name>Cardizem CD</Name>
                <Pack ID="P254584" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.65</Subsidy>
                  <Price>7.65</Price>
                  <Alternate>7.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252806" Rank="2" Units="cap" Weight="240">
              <Name>Cap long-acting 240 mg</Name>
              <Brand ID="B07220225280601">
                <Name>Cardizem CD</Name>
                <Pack ID="P254592" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>10.20</Subsidy>
                  <Price>10.20</Price>
                  <Alternate>10.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252807" Rank="1" Units="tab" Weight="180">
              <Name>Tab long-acting 180 mg</Name>
              <Brand ID="B07220225280701">
                <Name>Dilzem LA</Name>
                <Pack ID="P371297" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.65</Subsidy>
                  <Price>7.65</Price>
                  <Alternate>7.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252808" Rank="1" Units="tab" Weight="240">
              <Name>Tab long-acting 240 mg</Name>
              <Brand ID="B07220225280801">
                <Name>Dilzem LA</Name>
                <Pack ID="P371289" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>10.20</Subsidy>
                  <Price>10.20</Price>
                  <Alternate>10.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202252809" Rank="2" Units="cap" Weight="120">
              <Name>Cap long-acting 120 mg (twice per day)</Name>
              <Brand ID="B07220225280901">
                <Name>Dilzem SR</Name>
                <Pack ID="P2026430" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.00</Subsidy>
                  <Price>18.00</Price>
                  <Alternate>18.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0728">
        <Name>Centrally Acting Agents</Name>
        <ATC3 ID="A072801">
          <Name>Centrally Acting Agents</Name>
          <Chemical ID="C0728011317" Page="61" Statim="Must">
            <Name>Clonidine</Name>
            <Formulation ID="F072801131702" Rank="9" Units="patch" Weight="2.5">
              <Name>TDDS 2.5 mg, 100 mcg per day</Name>
              <Brand ID="B07280113170201" SoleSupply="true">
                <Name>Catapres-TTS-1</Name>
                <Pack ID="P510599" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>21.29</Subsidy>
                  <Price>21.29</Price>
                  <Alternate>21.29</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F072801131703" Rank="9" Units="patch" Weight="5">
              <Name>TDDS 5 mg, 200 mcg per day</Name>
              <Brand ID="B07280113170301" SoleSupply="true">
                <Name>Catapres-TTS-2</Name>
                <Pack ID="P510602" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>30.79</Subsidy>
                  <Price>30.79</Price>
                  <Alternate>30.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F072801131704" Rank="9" Units="patch" Weight="7.5">
              <Name>TDDS 7.5 mg, 300 mcg per day</Name>
              <Brand ID="B07280113170401" SoleSupply="true">
                <Name>Catapres-TTS-3</Name>
                <Pack ID="P510610" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>39.10</Subsidy>
                  <Price>39.10</Price>
                  <Alternate>39.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0728011318" Page="61" Statim="Must">
            <Name>Clonidine hydrochloride</Name>
            <Formulation ID="F072801131801" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mcg</Name>
              <Brand ID="B07280113180101" SoleSupply="true">
                <Name>Catapres</Name>
                <Pack ID="P202274" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>30.33</Subsidy>
                  <Price>30.33</Price>
                  <Alternate>30.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072801131805" Rank="4" Units="inj" Weight="150">
              <Name>Inj 150 mcg per ml, 1 ml</Name>
              <Brand ID="B07280113180501" SoleSupply="true">
                <Name>Catapres</Name>
                <Pack ID="P202266" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>14.00</Subsidy>
                  <Price>14.00</Price>
                  <Alternate>14.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0728011806" Page="61" Statim="Must">
            <Name>Methyldopa</Name>
            <Formulation ID="F072801180601" Rank="1" Units="tab" Weight="125">
              <Name>Tab 125 mg</Name>
              <Brand ID="B07280118060104" SoleSupply="true">
                <Name>Prodopa</Name>
                <Pack ID="P303763" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.00</Subsidy>
                  <Price>9.00</Price>
                  <Alternate>9.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072801180602" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B07280118060201" SoleSupply="true">
                <Name>Prodopa</Name>
                <Pack ID="P601160" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.80</Subsidy>
                  <Price>12.80</Price>
                  <Alternate>12.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072801180603" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B07280118060304" SoleSupply="true">
                <Name>Prodopa</Name>
                <Pack ID="P261017" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>19.50</Subsidy>
                  <Price>19.50</Price>
                  <Alternate>19.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0731">
        <Name>Diuretics</Name>
        <ATC3 ID="A073101">
          <Name>Loop Diuretics</Name>
          <Chemical ID="C0731011171" Page="62" Statim="Must">
            <Name>Bumetanide</Name>
            <Formulation ID="F073101117101" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B07310111710101">
                <Name>Burinex</Name>
                <Pack ID="P210323" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.36</Subsidy>
                  <Price>16.36</Price>
                  <Alternate>16.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073101117102" Rank="4" Units="inj" Weight="2000">
              <Name>Inj 500 mcg per ml, 4 ml</Name>
              <Brand ID="B07310111710201">
                <Name>Burinex</Name>
                <Pack ID="P704520" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.95</Subsidy>
                  <Price>7.95</Price>
                  <Alternate>7.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731011544" Page="62" Statim="Must">
            <Name>Frusemide</Name>
            <Formulation ID="F073101154401" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07310115440103">
                <Name>Diurin 40</Name>
                <Pack ID="P282014" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F073101154402" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B07310115440202">
                <Name>Diurin 500</Name>
                <Pack ID="P380539" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F073101154403" Rank="3" Units="ml" Safety="Uncompounded">
              <Name>Oral liq 10 mg per ml</Name>
              <Brand ID="B07310115440301">
                <Name>Lasix</Name>
                <Pack ID="P209945" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>10.66</Subsidy>
                  <Price>10.66</Price>
                  <Alternate>10.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073101154404" Rank="4" Units="inj" Weight="20">
              <Name>Inj 10 mg per ml, 2 ml</Name>
              <Brand ID="B07310115440401">
                <Name>Mayne</Name>
                <Pack ID="P555215" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>29.50</Subsidy>
                  <Price>29.50</Price>
                  <Alternate>29.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F073101154406" Rank="4" Units="inf" Weight="250">
              <Name>Infusion 10 mg per ml, 25 ml</Name>
              <Brand ID="B07310115440601">
                <Name>Lasix</Name>
                <Pack ID="P264547" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>48.14</Subsidy>
                  <Price>48.14</Price>
                  <Alternate>48.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A073104">
          <Name>Potassium Sparing Diuretics</Name>
          <Chemical ID="C0731041050" Page="62">
            <Name>Amiloride</Name>
            <Formulation ID="F073104105004" Rank="3" Units="ml" Safety="Uncompounded">
              <Name>Oral liq 1 mg per ml</Name>
              <Brand ID="B07310410500401">
                <Name>Biomed</Name>
                <Pack ID="P344710" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>26.20</Subsidy>
                  <Price>26.20</Price>
                  <Alternate>26.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Specialist must be a paediatrician or paediatric cardiologist.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731042176" Page="62">
            <Name>Spironolactone</Name>
            <Formulation ID="F073104217601" Rank="1" Units="tab" Weight="25" Statim="Must">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07310421760101">
                <Name>Spirotone</Name>
                <Pack ID="P796751" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.50</Subsidy>
                  <Price>8.50</Price>
                  <Alternate>8.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073104217602" Rank="1" Units="tab" Weight="100" Statim="Must">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07310421760201">
                <Name>Spirotone</Name>
                <Pack ID="P796689" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>21.70</Subsidy>
                  <Price>21.70</Price>
                  <Alternate>21.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073104217603" Rank="3" Units="ml" Safety="Uncompounded">
              <Name>Oral liq 5 mg per ml</Name>
              <Brand ID="B07310421760301">
                <Name>Biomed</Name>
                <Pack ID="P344877" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>26.80</Subsidy>
                  <Price>26.80</Price>
                  <Alternate>26.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Specialist must be a paediatrician or paediatric cardiologist.</p>
              </div>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A073107">
          <Name>Potassium Sparing Combination Diuretics</Name>
          <Chemical ID="C0731071051" Page="62" Statim="Must">
            <Name>Amiloride with frusemide</Name>
            <Formulation ID="F073107105101" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg with frusemide 40 mg</Name>
              <Brand ID="B07310710510101">
                <Name>Frumil</Name>
                <Pack ID="P2125536" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.67</Subsidy>
                  <Price>8.63</Price>
                  <Alternate>4.67</Alternate>
                  <Surcharge>0.14143</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731071053" Page="62" Statim="Must">
            <Name>Amiloride with hydrochlorothiazide</Name>
            <Formulation ID="F073107105301" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg with hydrochlorothiazide 50 mg</Name>
              <Brand ID="B07310710530101">
                <Name>Amizide</Name>
                <Pack ID="P200506" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731072293" Page="62" Statim="Must">
            <Name>Triamterene with hydrochlorothiazide</Name>
            <Formulation ID="F073107229301" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg with hydrochlorothiazide 25 mg</Name>
              <Brand ID="B07310722930102">
                <Name>Triamizide</Name>
                <Pack ID="P501409" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A073110">
          <Name>Thiazide and Related Diuretics</Name>
          <Chemical ID="C0731101116" Page="62" Statim="Must">
            <Name>Bendrofluazide</Name>
            <Formulation ID="F073110111601" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07311011160101">
                <Name>Neo-Naclex</Name>
                <Pack ID="P202967" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>13.50</Subsidy>
                  <Price>13.50</Price>
                  <Alternate>13.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>May be supplied on a PSO for reasons other than emergency.</p>
              </div>
              <Rule Type="FormMax" Value="150" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F073110111602" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07311011160201">
                <Name>Neo-Naclex</Name>
                <Pack ID="P202975" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>21.50</Subsidy>
                  <Price>21.50</Price>
                  <Alternate>21.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731101282" Page="62">
            <Name>Chlorothiazide</Name>
            <Formulation ID="F073110128202" Rank="3" Units="ml" Weight="50" Safety="Uncompounded">
              <Name>Oral liq 50 mg per ml</Name>
              <Brand ID="B07311012820201">
                <Name>Biomed</Name>
                <Pack ID="P344818" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>22.60</Subsidy>
                  <Price>22.60</Price>
                  <Alternate>22.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Specialist must be a paediatrician or paediatric cardiologist.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731101290" Page="62" Statim="Must">
            <Name>Chlorthalidone</Name>
            <Formulation ID="F073110129001" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07311012900101" SoleSupply="true">
                <Name>Hygroton</Name>
                <Pack ID="P2025779" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731101643" Page="62" Statim="Must">
            <Name>Indapamide</Name>
            <Formulation ID="F073110164301" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07311016430102" SoleSupply="true">
                <Name>Napamide</Name>
                <Pack ID="P702919" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.00</Subsidy>
                  <Price>4.00</Price>
                  <Alternate>4.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0734">
        <Name>Nitrates</Name>
        <ATC3 ID="A073401">
          <Name>Nitrates</Name>
          <Chemical ID="C0734011577" Page="63" Statim="Must">
            <Name>Glyceryl trinitrate</Name>
            <Formulation ID="F073401157701" Rank="9" Units="patch" Weight="10">
              <Name>TDDS 10 mg</Name>
              <Brand ID="B07340115770103">
                <Name>Nitroderm TTS</Name>
                <Pack ID="P750247" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>24.50</Subsidy>
                  <Price>24.50</Price>
                  <Alternate>24.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073401157705" Rank="9" Units="patch" Weight="5">
              <Name>TDDS 5 mg</Name>
              <Brand ID="B07340115770502">
                <Name>Nitroderm TTS</Name>
                <Pack ID="P716790" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>18.40</Subsidy>
                  <Price>18.40</Price>
                  <Alternate>18.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073401157706" Rank="6" Units="dose">
              <Name>Oral pump spray 400 mcg per dose</Name>
              <Brand ID="B07340115770601">
                <Name>Nitrolingual Pumpspray</Name>
                <Pack ID="P2017962" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>5.16</Subsidy>
                  <Price>5.16</Price>
                  <Alternate>5.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="250" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0734012836" Page="63" Statim="Must">
            <Name>Isosorbide mononitrate</Name>
            <Formulation ID="F073401283601" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B07340128360101">
                <Name>Ismo 20</Name>
                <Pack ID="P214833" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.00</Subsidy>
                  <Price>18.00</Price>
                  <Alternate>18.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073401283602" Rank="1" Units="tab" Weight="40">
              <Name>Tab long-acting 40 mg</Name>
              <Brand ID="B07340128360201">
                <Name>Corangin</Name>
                <Pack ID="P726958" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>14.84</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>14.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073401283603" Rank="1" Units="tab" Weight="60">
              <Name>Tab long-acting 60 mg</Name>
              <Brand ID="B07340128360304" SoleSupply="true">
                <Name>Duride</Name>
                <Pack ID="P2202964" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>4.15</Subsidy>
                  <Price>4.15</Price>
                  <Alternate>4.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0737">
        <Name>Sympathomimetics</Name>
        <ATC3 ID="A073701">
          <Name>Sympathomimetics</Name>
          <Chemical ID="C0737011015" Page="63">
            <Name>Adrenaline</Name>
            <Formulation ID="F073701101501" Rank="4" Units="inj">
              <Name>Inj 1 in 1,000, 1 ml</Name>
              <Brand ID="B07370110150101">
                <Name>Mayne</Name>
                <Pack ID="P603341" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>5.25</Subsidy>
                  <Price>5.25</Price>
                  <Alternate>5.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07370110150102" ToBeDelisted="2007-12-01">
                <Name>AstraZeneca</Name>
                <Pack ID="P726672" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>90.00</Subsidy>
                  <Price>90.00</Price>
                  <Alternate>90.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2246015" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>12.50</Subsidy>
                  <Price>12.50</Price>
                  <Alternate>12.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F073701101502" Rank="4" Units="inj">
              <Name>Inj 1 in 10,000, 10 ml</Name>
              <Brand ID="B07370110150201">
                <Name>Mayne</Name>
                <Pack ID="P534196" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>27.00</Subsidy>
                  <Price>27.00</Price>
                  <Alternate>27.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0737011682" Page="63" Statim="Must">
            <Name>Isoprenaline hydrochloride</Name>
            <Formulation ID="F073701168201" Rank="4" Units="inj" Weight="200">
              <Name>Inj 200 mcg per ml, 1 ml</Name>
              <Brand ID="B07370116820101">
                <Name>Isuprel</Name>
                <Pack ID="P221775" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>36.80</Subsidy>
                  <Price>135.00</Price>
                  <Alternate>36.80</Alternate>
                  <Surcharge>3.92800</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0740">
        <Name>Vasodilators</Name>
        <ATC3 ID="A074001">
          <Name>Vasodilators</Name>
          <Chemical ID="C0740011604" Page="63" Statim="Must">
            <Name>Hydralazine</Name>
            <Formulation ID="F074001160403" Rank="4" Units="inj" Weight="20">
              <Name>Inj 20 mg per ml, 1 ml</Name>
              <Brand ID="B07400116040301">
                <Name>Apresoline</Name>
                <Pack ID="P274550" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>25.90</Subsidy>
                  <Price>25.90</Price>
                  <Alternate>25.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0740011928" Page="60" Statim="Must">
            <Name>Papaverine hydrochloride</Name>
            <Formulation ID="F074001192801" Rank="4" Units="inj" Weight="120">
              <Name>Inj 12 mg per ml, 10 ml</Name>
              <Brand ID="B07400119280101">
                <Name>Mayne</Name>
                <Pack ID="P333328" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>73.12</Subsidy>
                  <Price>73.12</Price>
                  <Alternate>73.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0740012455" Page="63">
            <Name>Oxypentifylline</Name>
            <Formulation ID="F074001245501" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B07400124550101">
                <Name>Trental 400</Name>
                <Pack ID="P2111977" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>36.94</Subsidy>
                  <Price>42.26</Price>
                  <Alternate>36.94</Alternate>
                  <Surcharge>0.10640</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C0740016001" Page="63" Statim="Must">
            <Name>Amyl nitrite</Name>
            <Formulation ID="F074001600101" Rank="10" Units="ea">
              <Name>Ampoule, 0.3 ml crushable</Name>
              <Brand ID="B07400160010101">
                <Name>Baxter</Name>
                <Pack ID="P782793" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>62.92</Subsidy>
                  <Price>73.40</Price>
                  <Alternate>62.92</Alternate>
                  <Surcharge>0.87333</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0741">
        <Name>Smoking Cessation</Name>
        <ATC3 ID="A074101">
          <Name>Smoking Cessation</Name>
          <Chemical ID="C0741013722" Page="63">
            <Name>Nicotine</Name>
            <Formulation ID="F074101372225" Rank="9" Units="patch" Weight="21">
              <Name>Patch 21 mg</Name>
              <Brand ID="B07410137222526">
                <Name>Habitrol</Name>
                <Pack ID="P2179563" Specified="true">
                  <Quantity>7</Quantity>
                  <Subsidy>12.32</Subsidy>
                  <Price>12.32</Price>
                  <Alternate>12.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074101372226" Rank="9" Units="patch" Weight="14">
              <Name>Patch 14 mg</Name>
              <Brand ID="B07410137222626">
                <Name>Habitrol</Name>
                <Pack ID="P2179555" Specified="true">
                  <Quantity>7</Quantity>
                  <Subsidy>11.63</Subsidy>
                  <Price>11.63</Price>
                  <Alternate>11.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074101372227" Rank="9" Units="patch" Weight="7">
              <Name>Patch 7 mg</Name>
              <Brand ID="B07410137222726">
                <Name>Habitrol</Name>
                <Pack ID="P2179547" Specified="true">
                  <Quantity>7</Quantity>
                  <Subsidy>10.53</Subsidy>
                  <Price>10.53</Price>
                  <Alternate>10.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074101372228" Rank="10" Units="piece" Weight="2">
              <Name>Gum 2 mg (Fruit)</Name>
              <Brand ID="B07410137222826">
                <Name>Habitrol</Name>
                <Pack ID="P2179504" Specified="true">
                  <Quantity>96</Quantity>
                  <Subsidy>14.97</Subsidy>
                  <Price>14.97</Price>
                  <Alternate>14.97</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074101372229" Rank="10" Units="piece" Weight="4">
              <Name>Gum 4 mg (Fruit)</Name>
              <Brand ID="B07410137222926">
                <Name>Habitrol</Name>
                <Pack ID="P2179512" Specified="true">
                  <Quantity>96</Quantity>
                  <Subsidy>20.02</Subsidy>
                  <Price>20.02</Price>
                  <Alternate>20.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074101372234" Rank="10" Units="piece" Weight="2">
              <Name>Gum 2 mg (Mint)</Name>
              <Brand ID="B07410137223427">
                <Name>Habitrol</Name>
                <Pack ID="P2179520" Specified="true">
                  <Quantity>96</Quantity>
                  <Subsidy>14.97</Subsidy>
                  <Price>14.97</Price>
                  <Alternate>14.97</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074101372235" Rank="10" Units="piece" Weight="4">
              <Name>Gum 4 mg (Mint)</Name>
              <Brand ID="B07410137223527">
                <Name>Habitrol</Name>
                <Pack ID="P2179539" Specified="true">
                  <Quantity>96</Quantity>
                  <Subsidy>20.02</Subsidy>
                  <Price>20.02</Price>
                  <Alternate>20.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="QEC"/>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A10">
      <Name>Dermatologicals</Name>
      <ATC2 ID="A1001">
        <Name>Antiacne Preparations</Name>
        <ATC3 ID="A100101">
          <Name>Antiacne Preparations</Name>
          <Chemical ID="C1001011688" Page="64">
            <Name>Isotretinoin</Name>
            <Formulation ID="F100101168801" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B10010116880126" SoleSupply="true">
                <Name>Isotane 10</Name>
                <Pack ID="P2123487" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>36.00</Subsidy>
                  <Price>36.00</Price>
                  <Alternate>36.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100101168802" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B10010116880225" SoleSupply="true">
                <Name>Isotane 20</Name>
                <Pack ID="P2123495" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>47.50</Subsidy>
                  <Price>47.50</Price>
                  <Alternate>47.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="SpecOnly" Attribute="Hospital"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Specialist must be a dermatologist.</p>
            </div>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1603">For systemic antibacterials, refer to INFECTIONS, Antibacterials</p>
        </div>
      </ATC2>
      <ATC2 ID="A1004">
        <Name>Antibacterials Topical</Name>
        <ATC3 ID="A100401">
          <Name>Antibacterials Topical</Name>
          <Chemical ID="C1004011546" Page="64">
            <Name>Fusidic acid</Name>
            <Formulation ID="F100401154608" Rank="3" Units="g">
              <Name>Crm 2 %</Name>
              <Brand ID="B10040115460825" SoleSupply="true">
                <Name>Foban</Name>
                <Pack ID="P2090910" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.95</Subsidy>
                  <Price>3.95</Price>
                  <Alternate>3.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="FormMax" Value="15" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F100401154609" Rank="3" Units="g">
              <Name>Oint 2 %</Name>
              <Brand ID="B10040115460925" SoleSupply="true">
                <Name>Foban</Name>
                <Pack ID="P2090929" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.95</Subsidy>
                  <Price>3.95</Price>
                  <Alternate>3.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="FormMax" Value="15" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1004011835" Page="64">
            <Name>Mupirocin</Name>
            <Formulation ID="F100401183501" Rank="3" Units="g">
              <Name>Oint 2%</Name>
              <Brand ID="B10040118350101">
                <Name>Bactroban</Name>
                <Pack ID="P523712" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>6.60</Subsidy>
                  <Price>9.26</Price>
                  <Alternate>6.60</Alternate>
                  <Surcharge>0.17733</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1004012114" Page="64">
            <Name>Silver sulphadiazine</Name>
            <Formulation ID="F100401211401" Rank="3" Units="g">
              <Name>Crm 1% with chlorhexidine digluconate 0.2%</Name>
              <Brand ID="B10040121140101">
                <Name>Silvazine</Name>
                <Pack ID="P262943" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.04</Subsidy>
                  <Price>15.04</Price>
                  <Alternate>15.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormMax" Value="500" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1004013303" Page="64" Statim="Must">
            <Name>Hydrogen peroxide</Name>
            <Formulation ID="F100401330325" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10040133032525">
                <Name>Crystacide</Name>
                <Pack ID="P2015153" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>8.56</Subsidy>
                  <Price>8.56</Price>
                  <Alternate>8.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1603">For systemic antibacterials, refer to INFECTIONS, Antibacterials</p>
        </div>
      </ATC2>
      <ATC2 ID="A1007">
        <Name>Antifungals Topical</Name>
        <ATC3 ID="A100701">
          <Name>Antifungals Topical</Name>
          <Chemical ID="C1007011320" Page="64" Statim="Must">
            <Name>Clotrimazole</Name>
            <Formulation ID="F100701132006" Rank="3" Units="ml">
              <Name>Soln 1%</Name>
              <Brand ID="B10070113200601">
                <Name>Canesten</Name>
                <Pack ID="P202223" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>4.36</Subsidy>
                  <Price>7.55</Price>
                  <Alternate>4.36</Alternate>
                  <Surcharge>0.15950</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
            <Formulation ID="F100701132007" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10070113200725" SoleSupply="true">
                <Name>Clomazol</Name>
                <Pack ID="P2184362" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>0.55</Subsidy>
                  <Price>0.55</Price>
                  <Alternate>0.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007011443" Page="65">
            <Name>Econazole nitrate</Name>
            <Formulation ID="F100701144307" Rank="10" Units="ea">
              <Name>Foaming soln 1%, 10 ml sachets</Name>
              <Brand ID="B10070114430701">
                <Name>Pevaryl</Name>
                <Pack ID="P383872" Specified="true">
                  <Quantity>3</Quantity>
                  <Subsidy>9.89</Subsidy>
                  <Price>14.24</Price>
                  <Alternate>9.89</Alternate>
                  <Surcharge>1.45000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
            <Formulation ID="F100701144310" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10070114431002">
                <Name>Pevaryl</Name>
                <Pack ID="P2165953" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>1.00</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.27500</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10070114431003">
                <Name>Ecreme</Name>
                <Pack ID="P612650" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>1.00</Subsidy>
                  <Price>1.30</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.02000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007011620" Page="65" Statim="Must">
            <Name>Miconazole nitrate</Name>
            <Formulation ID="F100701162001" Rank="3" Units="ml">
              <Name>Lotn 2%</Name>
              <Brand ID="B10070116200101">
                <Name>Daktarin</Name>
                <Pack ID="P253278" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.36</Subsidy>
                  <Price>10.32</Price>
                  <Alternate>4.36</Alternate>
                  <Surcharge>0.19867</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
            <Formulation ID="F100701162002" Rank="3" Units="ml">
              <Name>Tincture 2%</Name>
              <Brand ID="B10070116200201">
                <Name>Daktarin</Name>
                <Pack ID="P253294" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.36</Subsidy>
                  <Price>12.46</Price>
                  <Alternate>4.36</Alternate>
                  <Surcharge>0.27000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
            <Formulation ID="F100701162003" Rank="3" Units="g">
              <Name>Crm 2%</Name>
              <Brand ID="B10070116200325" SoleSupply="true">
                <Name>Multichem</Name>
                <Pack ID="P2184354" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>0.44</Subsidy>
                  <Price>0.44</Price>
                  <Alternate>0.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007011696" Page="65">
            <Name>Ketoconazole</Name>
            <Formulation ID="F100701169602" Rank="3" Units="g">
              <Name>Crm 2%</Name>
              <Brand ID="B10070116960201">
                <Name>Nizoral</Name>
                <Pack ID="P713430" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>1.00</Subsidy>
                  <Price>10.00</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.60000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007011881" Page="65">
            <Name>Nystatin</Name>
            <Formulation ID="F100701188113" Rank="3" Units="g">
              <Name>Crm 100,000 u per g</Name>
              <Brand ID="B10070118811302">
                <Name>Mycostatin</Name>
                <Pack ID="P211044" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>1.00</Subsidy>
                  <Price>5.10</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.27333</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007012394" Page="64">
            <Name>Ciclopirox olamine</Name>
            <Formulation ID="F100701239403" Rank="3" Units="ml">
              <Name>Soln 1%</Name>
              <Brand ID="B10070123940301">
                <Name>Batrafen</Name>
                <Pack ID="P603333" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>4.36</Subsidy>
                  <Price>11.54</Price>
                  <Alternate>4.36</Alternate>
                  <Surcharge>0.35900</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100701239404" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10070123940401">
                <Name>Batrafen</Name>
                <Pack ID="P603325" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>1.00</Subsidy>
                  <Price>12.82</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.59100</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100701239405" Rank="3" Units="ml">
              <Name>Nail soln 8%</Name>
              <Brand ID="B10070123940501">
                <Name>Batrafen</Name>
                <Pack ID="P316644" OP="true" Specified="true">
                  <Quantity>3.5</Quantity>
                  <Subsidy>37.81</Subsidy>
                  <Price>42.84</Price>
                  <Alternate>37.81</Alternate>
                  <Surcharge>1.43714</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
            <Rule Type="NotCombined"/>
          </Chemical>
          <Chemical ID="C1007012832" Page="64">
            <Name>Amorolfine</Name>
            <Formulation ID="F100701283201" Rank="3" Units="ml">
              <Name>Nail soln 5%</Name>
              <Brand ID="B10070128320101">
                <Name>Loceryl</Name>
                <Pack ID="P797588" OP="true" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>37.86</Subsidy>
                  <Price>61.87</Price>
                  <Alternate>37.86</Alternate>
                  <Surcharge>4.80200</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
            <Rule Type="NotCombined"/>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1604">For systemic antifungals, refer to INFECTIONS, Antifungals</p>
        </div>
      </ATC2>
      <ATC2 ID="A1008">
        <Name>Antipruritic Preparations</Name>
        <ATC3 ID="A100801">
          <Name>Antipruritic Preparations</Name>
          <Chemical ID="C1008011179" Page="65">
            <Name>Calamine</Name>
            <Formulation ID="F100801117901" Rank="3" Units="ml">
              <Name>Crm, aqueous, BP</Name>
              <Brand ID="B10080111790125" SoleSupply="true">
                <Name>ABM</Name>
                <Pack ID="P2231913" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.02</Subsidy>
                  <Price>3.02</Price>
                  <Alternate>3.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100801117902" Rank="3" Units="ml">
              <Name>Lotn, BP</Name>
              <Brand ID="B10080111790225" SoleSupply="true">
                <Name>ABM</Name>
                <Pack ID="P2235536" Specified="true">
                  <Quantity>2000</Quantity>
                  <Subsidy>19.44</Subsidy>
                  <Price>19.44</Price>
                  <Alternate>19.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
            <Rule Type="NotCombined"/>
          </Chemical>
          <Chemical ID="C1008011363" Page="65">
            <Name>Crotamiton</Name>
            <Formulation ID="F100801136301" Rank="3" Units="g">
              <Name>Crm 10%</Name>
              <Brand ID="B10080113630101">
                <Name>Eurax</Name>
                <Pack ID="P337285" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>4.26</Subsidy>
                  <Price>4.45</Price>
                  <Alternate>4.26</Alternate>
                  <Surcharge>0.00950</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100801136302" Rank="3" Units="ml">
              <Name>Lotn 10%</Name>
              <Brand ID="B10080113630201">
                <Name>Eurax</Name>
                <Pack ID="P253197" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>7.56</Subsidy>
                  <Price>7.70</Price>
                  <Alternate>7.56</Alternate>
                  <Surcharge>0.00280</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
            <Rule Type="NotCombined"/>
          </Chemical>
          <Chemical ID="C1008013333" Page="65">
            <Name>Menthol</Name>
            <Formulation ID="F100801333301" Rank="3" Units="g">
              <Name>Crystals</Name>
              <Brand ID="B10080133330101">
                <Name>PSM</Name>
                <Pack ID="P277479" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>7.40</Subsidy>
                  <Price>7.40</Price>
                  <Alternate>7.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10080133330125">
                <Name>MidWest</Name>
                <Pack ID="P2018845" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>29.60</Subsidy>
                  <Price>29.60</Price>
                  <Alternate>29.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Combined"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>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</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1011">
        <Name>Corticosteroids Topical</Name>
        <ATC3 ID="A101101">
          <Name>Corticosteroids - Plain</Name>
          <Chemical ID="C1011011082" Page="67">
            <Name>Methylprednisolone aceponate</Name>
            <Formulation ID="F101101108201" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10110110820101" SoleSupply="true">
                <Name>Advantan</Name>
                <Pack ID="P389439" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>4.95</Subsidy>
                  <Price>4.95</Price>
                  <Alternate>4.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101108202" Rank="3" Units="g">
              <Name>Oint 0.1%</Name>
              <Brand ID="B10110110820201" SoleSupply="true">
                <Name>Advantan</Name>
                <Pack ID="P388874" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>4.95</Subsidy>
                  <Price>4.95</Price>
                  <Alternate>4.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011143" Page="66">
            <Name>Betamethasone dipropionate</Name>
            <Formulation ID="F101101114312" Rank="3" Units="g">
              <Name>Crm 0.05%</Name>
              <Brand ID="B10110111431201">
                <Name>Diprosone</Name>
                <Pack ID="P201839" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.96</Subsidy>
                  <Price>6.91</Price>
                  <Alternate>2.96</Alternate>
                  <Surcharge>0.26333</Surcharge>
                </Pack>
                <Pack ID="P210870" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.97</Subsidy>
                  <Price>18.36</Price>
                  <Alternate>8.97</Alternate>
                  <Surcharge>0.18780</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101114313" Rank="3" Units="g">
              <Name>Oint 0.05%</Name>
              <Brand ID="B10110111431301">
                <Name>Diprosone</Name>
                <Pack ID="P210889" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.96</Subsidy>
                  <Price>6.51</Price>
                  <Alternate>2.96</Alternate>
                  <Surcharge>0.23667</Surcharge>
                </Pack>
                <Pack ID="P210897" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.97</Subsidy>
                  <Price>17.11</Price>
                  <Alternate>8.97</Alternate>
                  <Surcharge>0.16280</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101114314" Rank="3" Units="g">
              <Name>Crm 0.05% in propylene glycol base</Name>
              <Brand ID="B10110111431425">
                <Name>Diprosone OV</Name>
                <Pack ID="P2063158" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.33</Subsidy>
                  <Price>13.83</Price>
                  <Alternate>4.33</Alternate>
                  <Surcharge>0.31667</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101114315" Rank="3" Units="g">
              <Name>Oint 0.05% in propylene glycol base</Name>
              <Brand ID="B10110111431525">
                <Name>Diprosone OV</Name>
                <Pack ID="P2062844" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.33</Subsidy>
                  <Price>13.83</Price>
                  <Alternate>4.33</Alternate>
                  <Surcharge>0.31667</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011309" Page="66" Statim="Must">
            <Name>Clobetasol propionate</Name>
            <Formulation ID="F101101130903" Rank="3" Units="g">
              <Name>Crm 0.05%</Name>
              <Brand ID="B10110113090301" SoleSupply="true">
                <Name>Dermol</Name>
                <Pack ID="P229059" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.35</Subsidy>
                  <Price>2.35</Price>
                  <Alternate>2.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101130904" Rank="3" Units="g">
              <Name>Oint 0.05%</Name>
              <Brand ID="B10110113090401" SoleSupply="true">
                <Name>Dermol</Name>
                <Pack ID="P229040" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.60</Subsidy>
                  <Price>1.60</Price>
                  <Alternate>1.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011310" Page="66">
            <Name>Clobetasone butyrate</Name>
            <Formulation ID="F101101131002" Rank="3" Units="g">
              <Name>Crm 0.05%</Name>
              <Brand ID="B10110113100201">
                <Name>Eumovate</Name>
                <Pack ID="P713945" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.38</Subsidy>
                  <Price>7.09</Price>
                  <Alternate>5.38</Alternate>
                  <Surcharge>0.05700</Surcharge>
                </Pack>
                <Pack ID="P713988" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.13</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>16.13</Alternate>
                  <Surcharge>0.05870</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011409" Page="66">
            <Name>Diflucortolone valerate</Name>
            <Formulation ID="F101101140903" Rank="3" Units="g">
              <Name>Oint 0.1%</Name>
              <Brand ID="B10110114090301">
                <Name>Nerisone</Name>
                <Pack ID="P207640" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.97</Subsidy>
                  <Price>15.23</Price>
                  <Alternate>8.97</Alternate>
                  <Surcharge>0.12520</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101140904" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10110114090401">
                <Name>Nerisone</Name>
                <Pack ID="P207608" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.97</Subsidy>
                  <Price>15.23</Price>
                  <Alternate>8.97</Alternate>
                  <Surcharge>0.12520</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101140905" Rank="3" Units="g">
              <Name>Fatty oint 0.1%</Name>
              <Brand ID="B10110114090501">
                <Name>Nerisone</Name>
                <Pack ID="P207624" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.97</Subsidy>
                  <Price>15.23</Price>
                  <Alternate>8.97</Alternate>
                  <Surcharge>0.12520</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011613" Page="66">
            <Name>Hydrocortisone with wool fat and mineral oil</Name>
            <Formulation ID="F101101161301" Rank="3" Units="ml">
              <Name>Lotn 1% with wool fat hydrous 3% and mineral oil</Name>
              <Brand ID="B10110116130101" SoleSupply="true">
                <Name>DP Lotn HC</Name>
                <Pack ID="P716294" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>9.95</Subsidy>
                  <Price>9.95</Price>
                  <Alternate>9.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011614" Page="67">
            <Name>Hydrocortisone butyrate</Name>
            <Formulation ID="F101101161401" Rank="3" Units="g">
              <Name>Oint 0.1%</Name>
              <Brand ID="B10110116140101">
                <Name>Locoid</Name>
                <Pack ID="P210382" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>15.00</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101161402" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10110116140201">
                <Name>Locoid</Name>
                <Pack ID="P210269" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P210277" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>15.00</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101161407" Rank="3" Units="g">
              <Name>Lipocream 0.1%</Name>
              <Brand ID="B10110116140701">
                <Name>Locoid Lipocream</Name>
                <Pack ID="P332232" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P521957" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>15.00</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101161425" Rank="3" Units="ml">
              <Name>Milky Emulsion 0.1%</Name>
              <Brand ID="B10110116142525">
                <Name>Locoid Crelo</Name>
                <Pack ID="P374741" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2017458" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>15.00</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011617" Page="66" Statim="Must">
            <Name>Hydrocortisone</Name>
            <Formulation ID="F101101161706" Rank="3" Units="g">
              <Name>Powder</Name>
              <Brand ID="B10110116170625" SoleSupply="true">
                <Name>m-Hydrocortisone</Name>
                <Pack ID="P2090562" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>37.64</Subsidy>
                  <Price>37.64</Price>
                  <Alternate>37.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Combined"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p xlink:type="simple" xlink:href="SectionC">Up to 5% in a dermatological base (not proprietary Topical Corticosteriod – Plain) with or without other dermatological galenicals. Refer</p>
              </div>
            </Formulation>
            <Formulation ID="F101101161719" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10110116171902">
                <Name>PSM</Name>
                <Pack ID="P277002" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>12.20</Subsidy>
                  <Price>14.30</Price>
                  <Alternate>12.20</Alternate>
                  <Surcharge>0.00420</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10110116171925">
                <Name>Lemnis Fatty Cream HC</Name>
                <Pack ID="P2016958" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.44</Subsidy>
                  <Price>2.44</Price>
                  <Alternate>2.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011012389" Page="67">
            <Name>Triamcinolone acetonide</Name>
            <Formulation ID="F101101238908" Rank="3" Units="g">
              <Name>Crm 0.02%</Name>
              <Brand ID="B10110123890801" SoleSupply="true">
                <Name>Aristocort</Name>
                <Pack ID="P250066" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.45</Subsidy>
                  <Price>6.45</Price>
                  <Alternate>6.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101238909" Rank="3" Units="g">
              <Name>Oint 0.02%</Name>
              <Brand ID="B10110123890901" SoleSupply="true">
                <Name>Aristocort</Name>
                <Pack ID="P250082" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.45</Subsidy>
                  <Price>6.45</Price>
                  <Alternate>6.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011012716" Page="66" Statim="Must">
            <Name>Betamethasone valerate</Name>
            <Formulation ID="F101101271608" Rank="3" Units="ml">
              <Name>Lotn 0.1%</Name>
              <Brand ID="B10110127160801">
                <Name>Betnovate</Name>
                <Pack ID="P210110" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>10.05</Subsidy>
                  <Price>10.05</Price>
                  <Alternate>10.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101271609" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10110127160925" SoleSupply="true">
                <Name>Beta Cream</Name>
                <Pack ID="P2188740" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>1.70</Subsidy>
                  <Price>1.70</Price>
                  <Alternate>1.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101271610" Rank="3" Units="g">
              <Name>Oint 0.1%</Name>
              <Brand ID="B10110127161025" SoleSupply="true">
                <Name>Beta Ointment</Name>
                <Pack ID="P2188759" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>1.70</Subsidy>
                  <Price>1.70</Price>
                  <Alternate>1.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011012837" Page="67">
            <Name>Mometasone furoate</Name>
            <Formulation ID="F101101283701" Rank="3" Units="ml">
              <Name>Lotn 0.1%</Name>
              <Brand ID="B10110128370101">
                <Name>Elocon</Name>
                <Pack ID="P2177633" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.80</Subsidy>
                  <Price>4.80</Price>
                  <Alternate>4.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101283703" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10110128370301">
                <Name>Elocon</Name>
                <Pack ID="P218375" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.96</Subsidy>
                  <Price>3.96</Price>
                  <Alternate>3.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P775916" OP="true" Specified="true">
                  <Quantity>45</Quantity>
                  <Subsidy>10.82</Subsidy>
                  <Price>10.82</Price>
                  <Alternate>10.82</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101283704" Rank="3" Units="g">
              <Name>Oint 0.1%</Name>
              <Brand ID="B10110128370401">
                <Name>Elocon</Name>
                <Pack ID="P775924" OP="true" Specified="true">
                  <Quantity>45</Quantity>
                  <Subsidy>10.82</Subsidy>
                  <Price>10.82</Price>
                  <Alternate>10.82</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P218383" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.96</Subsidy>
                  <Price>3.96</Price>
                  <Alternate>3.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A101104">
          <Name>Corticosteroids - Combination</Name>
          <Chemical ID="C1011041146" Page="67">
            <Name>Betamethasone valerate with clioquinol</Name>
            <Formulation ID="F101104114602" Rank="3" Units="g">
              <Name>Crm 0.1% with clioquinol 3%</Name>
              <Brand ID="B10110411460201">
                <Name>Betnovate-C</Name>
                <Pack ID="P209759" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>4.90</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.09400</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101104114603" Rank="3" Units="g">
              <Name>Oint 0.1% with clioquinol 3%</Name>
              <Brand ID="B10110411460301">
                <Name>Betnovate-C</Name>
                <Pack ID="P209724" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>4.90</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.09400</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1011041148" Page="67">
            <Name>Betamethasone valerate with fusidic acid</Name>
            <Formulation ID="F101104114801" Rank="3" Units="g">
              <Name>Crm 0.1% with fusidic acid 2%</Name>
              <Brand ID="B10110411480101">
                <Name>Fucicort</Name>
                <Pack ID="P629839" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>8.84</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.35667</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="FormMax" Value="15" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011041611" Page="67" Statim="Must">
            <Name>Hydrocortisone with miconazole</Name>
            <Formulation ID="F101104161101" Rank="3" Units="g">
              <Name>Crm 1% with miconazole nitrate 2%</Name>
              <Brand ID="B10110416110101">
                <Name>Micreme H</Name>
                <Pack ID="P704733" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.20</Subsidy>
                  <Price>2.20</Price>
                  <Alternate>2.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1011041612" Page="67">
            <Name>Hydrocortisone with natamycin and neomycin</Name>
            <Formulation ID="F101104161202" Rank="3" Units="g">
              <Name>Crm 1% with natamycin 1% and neomycin sulphate 0.5%</Name>
              <Brand ID="B10110416120201">
                <Name>Pimafucort</Name>
                <Pack ID="P260266" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>3.49</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101104161203" Rank="3" Units="g">
              <Name>Oint 1% with natamycin 1% and neomycin sulphate 0.5%</Name>
              <Brand ID="B10110416120301">
                <Name>Pimafucort</Name>
                <Pack ID="P260282" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>3.49</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1011041615" Page="67">
            <Name>Hydrocortisone butyrate with chlorquinaldol</Name>
            <Formulation ID="F101104161502" Rank="3" Units="g">
              <Name>Crm 0.1% with chlorquinaldol 3%</Name>
              <Brand ID="B10110416150201">
                <Name>Locoid C</Name>
                <Pack ID="P752797" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>3.49</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1011042387" Page="67">
            <Name>Triamcinolone acetonide with gramicidin, neomycin and nystatin</Name>
            <Formulation ID="F101104238703" Rank="3" Units="g">
              <Name>Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g</Name>
              <Brand ID="B10110423870325">
                <Name>Viaderm KC</Name>
                <Pack ID="P2083078" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>4.49</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.06667</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F101104238704" Rank="3" Units="g">
              <Name>Oint 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 mcg per g</Name>
              <Brand ID="B10110423870401" SoleSupply="true">
                <Name>Kenacomb</Name>
                <Pack ID="P253650" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>3.00</Subsidy>
                  <Price>3.00</Price>
                  <Alternate>3.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1407">For systemic corticosteroids, refer to CORTICOSTEROIDS AND RELATED AGENTS</p>
        </div>
      </ATC2>
      <ATC2 ID="A1013">
        <Name>Disinfecting and Cleansing Agents</Name>
        <ATC3 ID="A101301">
          <Name>Disinfecting and Cleansing Agents</Name>
          <Chemical ID="C1013011244" Page="68" Statim="Must">
            <Name>Chlorhexidine gluconate</Name>
            <Formulation ID="F101301124402" Rank="3" Units="ml">
              <Name>Soln 4%</Name>
              <Brand ID="B10130112440225" SoleSupply="true">
                <Name>Orion</Name>
                <Pack ID="P798894" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>7.20</Subsidy>
                  <Price>7.20</Price>
                  <Alternate>7.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101301124425" Rank="3" Units="ml">
              <Name>Handrub 1% with ethanol 70%</Name>
              <Brand ID="B10130112442525" SoleSupply="true">
                <Name>Orion</Name>
                <Pack ID="P2016575" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>5.40</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only if prescribed for a dialysis patient and the prescription is endorsed accordingly.</p>
            </div>
            <Rule Type="DoseMMax" Value="500"/>
          </Chemical>
          <Chemical ID="C1013012863" Page="68" Statim="Must">
            <Name>Sodium hypochlorite</Name>
            <Formulation ID="F101301286301" Rank="3" Units="ml">
              <Name>Soln</Name>
              <Brand ID="B10130128630101">
                <Name>Janola</Name>
                <Pack ID="P600334" Specified="true">
                  <Quantity>2500</Quantity>
                  <Subsidy>2.71</Subsidy>
                  <Price>2.71</Price>
                  <Alternate>2.71</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only if prescribed for a dialysis patient and the prescription is endorsed accordingly.</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1014">
        <Name>Dusting Powders</Name>
        <ATC3 ID="A101401">
          <Name>Dusting Powders</Name>
          <Chemical ID="C1014011423" Page="68">
            <Name>Diphemanil methylsulphate</Name>
            <Formulation ID="F101401142301" Rank="3" Units="g">
              <Name>Powder 2%</Name>
              <Brand ID="B10140114230101">
                <Name>Prantal</Name>
                <Pack ID="P208329" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>6.81</Subsidy>
                  <Price>13.54</Price>
                  <Alternate>6.81</Alternate>
                  <Surcharge>0.13460</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only  if prescribed for an amputee with an artificial limb, or for a paraplegic patient and the prescription endorsed accordingly.</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1015">
        <Name>Barrier Creams and Emollients</Name>
        <ATC3 ID="A101502">
          <Name>Barrier Creams</Name>
          <Chemical ID="C1015023430" Page="68">
            <Name>Zinc</Name>
            <Formulation ID="F101502343001" Rank="3" Units="g">
              <Name>Cream BP</Name>
              <Brand ID="B10150234300101">
                <Name>PSM</Name>
                <Pack ID="P306010" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.55</Subsidy>
                  <Price>9.79</Price>
                  <Alternate>6.55</Alternate>
                  <Surcharge>0.00648</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015023431" Page="68">
            <Name>Zinc and castor oil</Name>
            <Formulation ID="F101502343101" Rank="3" Units="g">
              <Name>Ointment BP</Name>
              <Brand ID="B10150234310103" SoleSupply="true">
                <Name>Multichem</Name>
                <Pack ID="P544345" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>5.11</Subsidy>
                  <Price>5.11</Price>
                  <Alternate>5.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A101504">
          <Name>Emollients</Name>
          <Chemical ID="C1015041575" Page="68" Statim="Must">
            <Name>Glycerol with paraffin and cetyl alcohol</Name>
            <Formulation ID="F101504157501" Rank="3" Units="ml">
              <Name>Lotn 5% with paraffin liq 5% and cetyl alcohol 2%</Name>
              <Brand ID="B10150415750101">
                <Name>QV</Name>
                <Pack ID="P791342" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>1.40</Subsidy>
                  <Price>8.10</Price>
                  <Alternate>1.40</Alternate>
                  <Surcharge>0.02680</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1015042312" Page="68" Statim="Must">
            <Name>Urea</Name>
            <Formulation ID="F101504231201" Rank="3" Units="g">
              <Name>Crm 10%</Name>
              <Brand ID="B10150423120103" SoleSupply="true">
                <Name>Nutraplus</Name>
                <Pack ID="P255424" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.52</Subsidy>
                  <Price>2.52</Price>
                  <Alternate>2.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015042339" Page="69" Statim="Must">
            <Name>Wool fat with mineral oil</Name>
            <Formulation ID="F101504233919" Rank="3" Units="ml">
              <Name>Lotn hydrous 3% with mineral oil</Name>
              <Brand ID="B10150423391901">
                <Name>Alpha-Keri Lotion</Name>
                <Pack ID="P268070" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>5.60</Subsidy>
                  <Price>18.43</Price>
                  <Alternate>5.60</Alternate>
                  <Surcharge>0.01283</Surcharge>
                </Pack>
                <Pack ID="P767360" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>1.12</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>1.12</Alternate>
                  <Surcharge>0.01940</Surcharge>
                </Pack>
                <Pack ID="P767379" OP="true" Specified="true">
                  <Quantity>375</Quantity>
                  <Subsidy>2.10</Subsidy>
                  <Price>9.38</Price>
                  <Alternate>2.10</Alternate>
                  <Surcharge>0.01941</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10150423391902">
                <Name>Hydroderm Lotion</Name>
                <Pack ID="P788295" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>1.40</Subsidy>
                  <Price>2.92</Price>
                  <Alternate>1.40</Alternate>
                  <Surcharge>0.00608</Surcharge>
                </Pack>
                <Pack ID="P788309" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>5.60</Subsidy>
                  <Price>9.54</Price>
                  <Alternate>5.60</Alternate>
                  <Surcharge>0.00394</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10150423391903">
                <Name>BK Lotion</Name>
                <Pack ID="P325295" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>1.40</Subsidy>
                  <Price>7.73</Price>
                  <Alternate>1.40</Alternate>
                  <Surcharge>0.02532</Surcharge>
                </Pack>
                <Pack ID="P325309" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>5.60</Subsidy>
                  <Price>23.91</Price>
                  <Alternate>5.60</Alternate>
                  <Surcharge>0.01831</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10150423391904">
                <Name>DP Lotion</Name>
                <Pack ID="P619779" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>1.40</Subsidy>
                  <Price>2.58</Price>
                  <Alternate>1.40</Alternate>
                  <Surcharge>0.00472</Surcharge>
                </Pack>
                <Pack ID="P619787" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>5.60</Subsidy>
                  <Price>9.48</Price>
                  <Alternate>5.60</Alternate>
                  <Surcharge>0.00388</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1015043213" Page="68" Statim="Must">
            <Name>Aqueous cream</Name>
            <Formulation ID="F101504321301" Rank="3" Units="g">
              <Name>Cream</Name>
              <Brand ID="B10150432130126" SoleSupply="true">
                <Name>Multichem</Name>
                <Pack ID="P2189119" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>2.37</Subsidy>
                  <Price>2.37</Price>
                  <Alternate>2.37</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015043244" Page="68" Statim="Must">
            <Name>Cetomacrogol</Name>
            <Formulation ID="F101504324401" Rank="3" Units="g">
              <Name>Cream BP</Name>
              <Brand ID="B10150432440101">
                <Name>PSM</Name>
                <Pack ID="P422452" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10150432440102" ToBeDelisted="2007-12-01">
                <Name>IPW</Name>
                <Pack ID="P786756" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>2.80</Subsidy>
                  <Price>4.35</Price>
                  <Alternate>2.80</Alternate>
                  <Surcharge>0.00310</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015043282" Page="68" Statim="Must">
            <Name>Emulsifying ointment</Name>
            <Formulation ID="F101504328201" Rank="3" Units="g">
              <Name>Ointment BP</Name>
              <Brand ID="B10150432820125" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2072246" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.83</Subsidy>
                  <Price>3.83</Price>
                  <Alternate>3.83</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015043342" Page="68" Statim="Must">
            <Name>Oily cream</Name>
            <Formulation ID="F101504334201" Rank="3" Units="g">
              <Name>Cream BP</Name>
              <Brand ID="B10150433420101">
                <Name>PSM</Name>
                <Pack ID="P290483" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>2.80</Subsidy>
                  <Price>15.40</Price>
                  <Alternate>2.80</Alternate>
                  <Surcharge>0.02520</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10150433420102">
                <Name>David Craig</Name>
                <Pack ID="P278017" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>2.80</Subsidy>
                  <Price>13.60</Price>
                  <Alternate>2.80</Alternate>
                  <Surcharge>0.02160</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015043743" Page="68" Statim="Must">
            <Name>Oil in water emulsion</Name>
            <Formulation ID="F101504374325" Rank="3" Units="g">
              <Name>Crm</Name>
              <Brand ID="B10150437432525">
                <Name>Lemnis Fatty Cream</Name>
                <Pack ID="P2016966" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>2.80</Subsidy>
                  <Price>2.80</Price>
                  <Alternate>2.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A101506">
          <Name>Other Dermatological Bases</Name>
          <Chemical ID="C1015063349" Page="68">
            <Name>Paraffin</Name>
            <Formulation ID="F101506334903" Rank="3" Units="g">
              <Name>White soft</Name>
              <Brand ID="B10150633490301">
                <Name>PSM</Name>
                <Pack ID="P221783" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.58</Subsidy>
                  <Price>8.69</Price>
                  <Alternate>3.58</Alternate>
                  <Surcharge>0.01022</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10150633490302">
                <Name>IPW</Name>
                <Pack ID="P768804">
                  <Quantity>500</Quantity>
                  <Subsidy>3.58</Subsidy>
                  <Price>7.30</Price>
                  <Alternate>3.58</Alternate>
                  <Surcharge>0.00744</Surcharge>
                </Pack>
                <Pack ID="P779679" Specified="true">
                  <Quantity>2500</Quantity>
                  <Subsidy>17.89</Subsidy>
                  <Price>17.89</Price>
                  <Alternate>17.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Combined"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only in combination with a dermatological galenical or as a diluent for a proprietary Topical Corticosteroid – Plain.</p>
              </div>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1016">
        <Name>Minor Skin Infections</Name>
        <ATC3 ID="A101601">
          <Name>Minor Skin Infections</Name>
          <Chemical ID="C1016012385" Page="68">
            <Name>Povidone iodine</Name>
            <Formulation ID="F101601238501" Rank="3" Units="g">
              <Name>Oint 10%</Name>
              <Brand ID="B10160123850101" ToBeDelisted="2008-03-01">
                <Name>Betadine</Name>
                <Pack ID="P507288" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>2.88</Subsidy>
                  <Price>2.88</Price>
                  <Alternate>2.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P507296" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.87</Subsidy>
                  <Price>7.02</Price>
                  <Alternate>6.87</Alternate>
                  <Surcharge>0.00150</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10160123850103" ToBeDelisted="2008-03-01">
                <Name>Biocil</Name>
                <Pack ID="P212741" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>2.88</Subsidy>
                  <Price>2.88</Price>
                  <Alternate>2.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="100" Attribute="Rx"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F101601238502" Rank="3" Units="ml">
              <Name>Antiseptic soln 10%</Name>
              <Brand ID="B10160123850202">
                <Name>Betadine</Name>
                <Pack ID="P510300">
                  <Quantity>4500</Quantity>
                  <Subsidy>51.06</Subsidy>
                  <Price>51.06</Price>
                  <Alternate>51.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P536970">
                  <Quantity>100</Quantity>
                  <Subsidy>1.28</Subsidy>
                  <Price>6.01</Price>
                  <Alternate>1.28</Alternate>
                  <Surcharge>0.04730</Surcharge>
                </Pack>
                <Pack ID="P507261" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.20</Subsidy>
                  <Price>6.20</Price>
                  <Alternate>6.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P510203">
                  <Quantity>15</Quantity>
                  <Subsidy>0.19</Subsidy>
                  <Price>3.27</Price>
                  <Alternate>0.19</Alternate>
                  <Surcharge>0.20533</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10160123850203" ToBeDelisted="2008-03-01">
                <Name>Biocil</Name>
                <Pack ID="P966444">
                  <Quantity>500</Quantity>
                  <Subsidy>6.42</Subsidy>
                  <Price>6.42</Price>
                  <Alternate>6.42</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P966452" Specified="true">
                  <Quantity>5000</Quantity>
                  <Subsidy>64.20</Subsidy>
                  <Price>64.20</Price>
                  <Alternate>64.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10160123850204">
                <Name>Riodine</Name>
                <Pack ID="P777447">
                  <Quantity>100</Quantity>
                  <Subsidy>1.28</Subsidy>
                  <Price>4.20</Price>
                  <Alternate>1.28</Alternate>
                  <Surcharge>0.02920</Surcharge>
                </Pack>
                <Pack ID="P994812" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.42</Subsidy>
                  <Price>7.20</Price>
                  <Alternate>6.42</Alternate>
                  <Surcharge>0.00156</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101601238504" Rank="3" Units="ml">
              <Name>Skin preparation, povidone iodine 10% with 30% alcohol</Name>
              <Brand ID="B10160123850401">
                <Name>Betadine Skin Prep</Name>
                <Pack ID="P510327">
                  <Quantity>100</Quantity>
                  <Subsidy>1.63</Subsidy>
                  <Price>3.60</Price>
                  <Alternate>1.63</Alternate>
                  <Surcharge>0.01970</Surcharge>
                </Pack>
                <Pack ID="P510335" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>8.13</Subsidy>
                  <Price>8.13</Price>
                  <Alternate>8.13</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101601238505" Rank="3" Units="ml">
              <Name>Skin preparation, povidone iodine 10% with 70% alcohol</Name>
              <Brand ID="B10160123850525">
                <Name>Orion</Name>
                <Pack ID="P2127644">
                  <Quantity>100</Quantity>
                  <Subsidy>1.63</Subsidy>
                  <Price>5.86</Price>
                  <Alternate>1.63</Alternate>
                  <Surcharge>0.04230</Surcharge>
                </Pack>
                <Pack ID="P2127652" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>8.13</Subsidy>
                  <Price>18.09</Price>
                  <Alternate>8.13</Alternate>
                  <Surcharge>0.01992</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1017">
        <Name>Parasiticidal Preparations</Name>
        <ATC3 ID="A101701">
          <Name>Parasiticidal Preparations</Name>
          <Chemical ID="C1017011101" Page="69">
            <Name>Malathion</Name>
            <Formulation ID="F101701110101" Rank="3" Units="ml">
              <Name>Liq 0.5%</Name>
              <Brand ID="B10170111010101">
                <Name>Derbac-M</Name>
                <Pack ID="P427748" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>4.99</Subsidy>
                  <Price>4.99</Price>
                  <Alternate>4.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10170111010125" ToBeDelisted="2007-12-01">
                <Name>AFT</Name>
                <Pack ID="P2090902" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>4.99</Subsidy>
                  <Price>5.80</Price>
                  <Alternate>4.99</Alternate>
                  <Surcharge>0.00405</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1017011549" Page="69">
            <Name>Gamma benzene hexachloride</Name>
            <Formulation ID="F101701154902" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10170115490201">
                <Name>Benhex</Name>
                <Pack ID="P285730" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1017011754" Page="69">
            <Name>Maldison</Name>
            <Formulation ID="F101701175425" Rank="3" Units="ml">
              <Name>Shampoo 1%</Name>
              <Brand ID="B10170117542525" SoleSupply="true">
                <Name>A-Lices</Name>
                <Pack ID="P2090937" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.83</Subsidy>
                  <Price>2.83</Price>
                  <Alternate>2.83</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1017012828" Page="69">
            <Name>Permethrin</Name>
            <Formulation ID="F101701282801" Rank="3" Units="g">
              <Name>Crm 5%</Name>
              <Brand ID="B10170128280102">
                <Name>Lyderm</Name>
                <Pack ID="P479233" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.20</Subsidy>
                  <Price>4.20</Price>
                  <Alternate>4.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101701282802" Rank="3" Units="ml">
              <Name>Lotion 5%</Name>
              <Brand ID="B10170128280201">
                <Name>Quellada-P</Name>
                <Pack ID="P427454" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.50</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.05000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: decimal">
                <li>
                  <p>Should be strictly reserved for use as second line therapy in:</p>
                  <ol style="list-style-type: decimal">
                    <li>
                      <p>patients unable to tolerate the other medications, such as infants, young children and patients with allergies or eczema;</p>
                    </li>
                    <li>
                      <p>cases of scabies which are resistent to gamma benzene hexachloride and resistant to malathion.</p>
                    </li>
                  </ol>
                </li>
                <li>
                  <p>Verification of drug resistance is dependent on the persistence of the condition after treatment. In order to establish whether there is drug resistance, the following criteria should be fulfilled:</p>
                  <ol style="list-style-type: decimal">
                    <li>
                      <p>a definite diagnosis of scabies should be made;</p>
                    </li>
                    <li>
                      <p>it should be ascertained that the medication was administered properly;</p>
                    </li>
                    <li>
                      <p>the possibility of reinfestation should have been excluded.</p>
                    </li>
                  </ol>
                </li>
              </ol>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1019">
        <Name>Psoriasis and Eczema Preparations</Name>
        <ATC3 ID="A101901">
          <Name>Psoriasis and Eczema Preparations</Name>
          <Chemical ID="C1019011324" Page="70">
            <Name>Coal tar with allantoin, menthol, phenol and sulphur</Name>
            <Formulation ID="F101901132401" Rank="3" Units="g">
              <Name>Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin crm 2.5%</Name>
              <Brand ID="B10190113240101">
                <Name>Egopsoryl TA</Name>
                <Pack ID="P201855" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.43</Subsidy>
                  <Price>4.35</Price>
                  <Alternate>3.43</Alternate>
                  <Surcharge>0.03067</Surcharge>
                </Pack>
                <Pack ID="P201863" OP="true" Specified="true">
                  <Quantity>75</Quantity>
                  <Subsidy>6.59</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>6.59</Alternate>
                  <Surcharge>0.01880</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019011800" Page="70">
            <Name>Methoxsalen</Name>
            <Formulation ID="F101901180001" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B10190118000101">
                <Name>Oxsoralen</Name>
                <Pack ID="P256366" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>11.66</Subsidy>
                  <Price>11.66</Price>
                  <Alternate>11.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1019012220" Page="71" Statim="Must">
            <Name>Tar with triethanolamine lauryl sulphate and fluorescein</Name>
            <Formulation ID="F101901222002" Rank="3" Units="ml">
              <Name>Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium</Name>
              <Brand ID="B10190122200201" SoleSupply="true">
                <Name>Pinetarsol</Name>
                <Pack ID="P307661" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>2.30</Subsidy>
                  <Price>2.30</Price>
                  <Alternate>2.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P307769">
                  <Quantity>1000</Quantity>
                  <Subsidy>4.60</Subsidy>
                  <Price>4.60</Price>
                  <Alternate>4.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1019012221" Page="71">
            <Name>Tar with cade oil</Name>
            <Formulation ID="F101901222101" Rank="3" Units="ml">
              <Name>Bath emulsion 7.5% coal tar, 2.5% cade oil, 7.5% compound</Name>
              <Brand ID="B10190122210101">
                <Name>Polytar Emollient</Name>
                <Pack ID="P389749" Specified="true">
                  <Quantity>350</Quantity>
                  <Subsidy>9.70</Subsidy>
                  <Price>29.60</Price>
                  <Alternate>9.70</Alternate>
                  <Surcharge>0.05686</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019012363" Page="70">
            <Name>Acitretin</Name>
            <Formulation ID="F101901236301" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B10190123630101" SoleSupply="true">
                <Name>Neotigason</Name>
                <Pack ID="P674389" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>94.75</Subsidy>
                  <Price>94.75</Price>
                  <Alternate>94.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101901236302" Rank="2" Units="cap" Weight="25">
              <Name>Cap 25 mg</Name>
              <Brand ID="B10190123630201" SoleSupply="true">
                <Name>Neotigason</Name>
                <Pack ID="P674397" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>203.70</Subsidy>
                  <Price>203.70</Price>
                  <Alternate>203.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="SpecOnly" Attribute="Hospital"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Specialist must be a dermatologist.</p>
            </div>
          </Chemical>
          <Chemical ID="C1019012796" Page="70">
            <Name>Calcipotriol</Name>
            <Formulation ID="F101901279603" Rank="3" Units="ml">
              <Name>Soln 50 mcg per ml</Name>
              <Brand ID="B10190127960301">
                <Name>Daivonex</Name>
                <Pack ID="P337307" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>22.47</Subsidy>
                  <Price>22.47</Price>
                  <Alternate>22.47</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P337315" OP="true" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>37.54</Subsidy>
                  <Price>37.54</Price>
                  <Alternate>37.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101901279604" Rank="3" Units="g">
              <Name>Crm 50 mcg per g</Name>
              <Brand ID="B10190127960401">
                <Name>Daivonex</Name>
                <Pack ID="P249068" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>22.44</Subsidy>
                  <Price>22.44</Price>
                  <Alternate>22.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P249076" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>62.58</Subsidy>
                  <Price>62.58</Price>
                  <Alternate>62.58</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101901279605" Rank="3" Units="g">
              <Name>Oint 50 mcg per g</Name>
              <Brand ID="B10190127960501">
                <Name>Daivonex</Name>
                <Pack ID="P760609" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>22.44</Subsidy>
                  <Price>22.44</Price>
                  <Alternate>22.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P788201" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>62.58</Subsidy>
                  <Price>62.58</Price>
                  <Alternate>62.58</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019013264" Page="70">
            <Name>Coal tar</Name>
            <Formulation ID="F101901326405" Rank="3" Units="ml">
              <Name>Solution BP</Name>
              <Brand ID="B10190132640501">
                <Name>PSM</Name>
                <Pack ID="P302414" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>36.48</Subsidy>
                  <Price>36.48</Price>
                  <Alternate>36.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10190132640502">
                <Name>David Craig</Name>
                <Pack ID="P254142" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>12.98</Subsidy>
                  <Price>16.20</Price>
                  <Alternate>12.98</Alternate>
                  <Surcharge>0.01610</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Combined"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Up to 10 %</p>
                <p xlink:type="simple" xlink:href="dermatological-base">Only in combination with a dermatological base or proprietary Topical Corticosteriod – Plain, refer</p>
                <p>With or without other dermatological galenicals.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019013280" Page="70">
            <Name>Dithranol</Name>
            <Formulation ID="F101901328025" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10190132802525">
                <Name>Micanol</Name>
                <Pack ID="P2022036" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>27.50</Subsidy>
                  <Price>27.50</Price>
                  <Alternate>27.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019013385" Page="70">
            <Name>Salicylic acid</Name>
            <Formulation ID="F101901338501" Rank="3" Units="g">
              <Name>Powder</Name>
              <Brand ID="B10190133850101">
                <Name>PSM</Name>
                <Pack ID="P245410" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>18.88</Subsidy>
                  <Price>18.88</Price>
                  <Alternate>18.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10190133850102">
                <Name>David Craig</Name>
                <Pack ID="P270989" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>29.52</Subsidy>
                  <Price>55.63</Price>
                  <Alternate>29.52</Alternate>
                  <Surcharge>0.05222</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Combined"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ol style="list-style-type: decimal">
                  <li>
                    <p xlink:type="simple" xlink:href="dermatological-base">Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain or collodion flexible, refer</p>
                  </li>
                  <li>
                    <p>With or without other dermatological galenicals.</p>
                  </li>
                  <li>
                    <p>Maximum 20 g or 20 ml per prescription when prescribed with white soft paraffin or collodion flexible.</p>
                  </li>
                </ol>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019013411" Page="71">
            <Name>Sulphur</Name>
            <Formulation ID="F101901341102" Rank="3" Units="g">
              <Name>Precipitated</Name>
              <Brand ID="B10190134110201">
                <Name>PSM</Name>
                <Pack ID="P282073" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.92</Subsidy>
                  <Price>9.25</Price>
                  <Alternate>7.92</Alternate>
                  <Surcharge>0.01330</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Combined"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ol style="list-style-type: decimal">
                  <li>
                    <p xlink:type="simple" xlink:href="dermatological-base">Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, refer</p>
                  </li>
                  <li>
                    <p>With or without other dermatological galenicals.</p>
                  </li>
                </ol>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019013776" Page="70">
            <Name>Coal tar with salicyclic acid and sulphur</Name>
            <Formulation ID="F101901377625" Rank="3" Units="g">
              <Name>Soln 12% with salicyclic acid 2% and sulphur 4% ointment</Name>
              <Brand ID="B10190137762526">
                <Name>Coco-Scalp</Name>
                <Pack ID="P2130017" OP="true" Specified="true">
                  <Quantity>40</Quantity>
                  <Subsidy>7.95</Subsidy>
                  <Price>7.95</Price>
                  <Alternate>7.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1022">
        <Name>Scalp Preparations</Name>
        <ATC3 ID="A102201">
          <Name>Scalp Preparations</Name>
          <Chemical ID="C1022011309" Page="71" Statim="Must">
            <Name>Clobetasol propionate</Name>
            <Formulation ID="F102201130902" Rank="3" Units="ml">
              <Name>Scalp app 0.05%</Name>
              <Brand ID="B10220113090202" SoleSupply="true">
                <Name>Dermol</Name>
                <Pack ID="P772755" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.20</Subsidy>
                  <Price>3.20</Price>
                  <Alternate>3.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1022011614" Page="71">
            <Name>Hydrocortisone butyrate</Name>
            <Formulation ID="F102201161406" Rank="3" Units="ml">
              <Name>Scalp lotn 0.1%</Name>
              <Brand ID="B10220116140601">
                <Name>Locoid</Name>
                <Pack ID="P210307" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.52</Subsidy>
                  <Price>7.52</Price>
                  <Alternate>7.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P210331" OP="true">
                  <Quantity>250</Quantity>
                  <Subsidy>17.90</Subsidy>
                  <Price>17.90</Price>
                  <Alternate>17.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1022011696" Page="71">
            <Name>Ketoconazole</Name>
            <Formulation ID="F102201169603" Rank="3" Units="ml">
              <Name>Shampoo 2%</Name>
              <Brand ID="B10220116960325" SoleSupply="true">
                <Name>Ketopine</Name>
                <Pack ID="P2090880" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.93</Subsidy>
                  <Price>3.93</Price>
                  <Alternate>3.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="FormMax" Value="100" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1022012716" Page="71" Statim="Must">
            <Name>Betamethasone valerate</Name>
            <Formulation ID="F102201271603" Rank="3" Units="ml">
              <Name>Scalp app 0.1%</Name>
              <Brand ID="B10220127160301" SoleSupply="true">
                <Name>Beta Scalp</Name>
                <Pack ID="P512877" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.25</Subsidy>
                  <Price>5.25</Price>
                  <Alternate>5.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1025">
        <Name>Sunscreens</Name>
        <ATC3 ID="A102501">
          <Name>Sunscreens</Name>
          <Chemical ID="C1025012213" Page="71">
            <Name>Sunscreens, proprietary</Name>
            <Formulation ID="F102501221302" Rank="3" Units="g">
              <Name>Crm</Name>
              <Brand ID="B10250122130204">
                <Name>Hamilton Sunscreen</Name>
                <Pack ID="P469149" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.39</Subsidy>
                  <Price>5.89</Price>
                  <Alternate>3.39</Alternate>
                  <Surcharge>0.02500</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10250122130225">
                <Name>Aquasun Oil Free Faces SPF30+</Name>
                <Pack ID="P2198126" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>1.74</Subsidy>
                  <Price>5.53</Price>
                  <Alternate>1.74</Alternate>
                  <Surcharge>0.07580</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F102501221304" Rank="3" Units="ml">
              <Name>Lotn</Name>
              <Brand ID="B10250122130405">
                <Name>Aquasun 30+</Name>
                <Pack ID="P455024" OP="true" Specified="true">
                  <Quantity>125</Quantity>
                  <Subsidy>4.80</Subsidy>
                  <Price>9.38</Price>
                  <Alternate>4.80</Alternate>
                  <Surcharge>0.03664</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10250122130406">
                <Name>Aquasun Sensitive SPF 30+</Name>
                <Pack ID="P455091" OP="true" Specified="true">
                  <Quantity>125</Quantity>
                  <Subsidy>4.80</Subsidy>
                  <Price>8.82</Price>
                  <Alternate>4.80</Alternate>
                  <Surcharge>0.03216</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1028">
        <Name>Wart and Corn Preparations</Name>
        <ATC3 ID="A102801">
          <Name>Wart and Corn Preparations</Name>
          <Chemical ID="C1028012516" Page="71">
            <Name>Podophyllotoxin</Name>
            <Formulation ID="F102801251601" Rank="3" Units="ml">
              <Name>Soln 0.5%</Name>
              <Brand ID="B10280125160101">
                <Name>Condyline</Name>
                <Pack ID="P701610" OP="true" Specified="true">
                  <Quantity>3.5</Quantity>
                  <Subsidy>32.00</Subsidy>
                  <Price>38.00</Price>
                  <Alternate>32.00</Alternate>
                  <Surcharge>1.71429</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="3.5" Attribute="Rx"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p xlink:type="simple" xlink:href="A1019">For salicylic acid preparations refer to PSORIASIS AND ECZEMA PREPARATIONS</p>
          </div>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1031">
        <Name>Other Skin Preparations</Name>
        <ATC3 ID="A103103">
          <Name>Antineoplastics</Name>
          <Chemical ID="C1031031529" Page="72">
            <Name>Fluorouracil sodium</Name>
            <Formulation ID="F103103152901" Rank="3" Units="g">
              <Name>Crm 5%</Name>
              <Brand ID="B10310315290101">
                <Name>Efudix</Name>
                <Pack ID="P253065" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>23.89</Subsidy>
                  <Price>28.68</Price>
                  <Alternate>23.89</Alternate>
                  <Surcharge>0.23950</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A103105">
          <Name>Topical Analgesia</Name>
          <Chemical ID="C1031053854" Page="72">
            <Name>Capsaicin</Name>
            <Formulation ID="F103105385425" Rank="3" Units="g" Weight="1">
              <Name>Crm 0.075%</Name>
              <Brand ID="B10310538542525">
                <Name>Zostrix HP</Name>
                <Pack ID="P2022710" OP="true" Specified="true">
                  <Quantity>45</Quantity>
                  <Subsidy>12.50</Subsidy>
                  <Price>12.50</Price>
                  <Alternate>12.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subsidised only if prescribed for post-herpetic neuralgia or diabetic peripheral neuropathy and the prescription is endorsed accordingly.</p>
            </div>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p xlink:type="simple" xlink:href="standard-formulae">For aspirin &amp; chloroform application refer</p>
          </div>
        </ATC3>
        <ATC3 ID="A103107">
          <Name>Wound Management Products</Name>
          <Chemical ID="C1031073303" Page="72" Statim="Must">
            <Name>Hydrogen peroxide</Name>
            <Formulation ID="F103107330302" Rank="3" Units="ml">
              <Name>Solution 20 vol</Name>
              <Brand ID="B10310733030201">
                <Name>PSM</Name>
                <Pack ID="P221570">
                  <Quantity>100</Quantity>
                  <Subsidy>0.63</Subsidy>
                  <Price>2.35</Price>
                  <Alternate>0.63</Alternate>
                  <Surcharge>0.01720</Surcharge>
                </Pack>
                <Pack ID="P277045" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.13</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>3.13</Alternate>
                  <Surcharge>0.00774</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="500" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1031073329" Page="72">
            <Name>Magnesium sulphate</Name>
            <Formulation ID="F103107332902" Rank="3" Units="g">
              <Name>Paste</Name>
              <Brand ID="B10310733290201">
                <Name>PSM</Name>
                <Pack ID="P278254" Specified="true">
                  <Quantity>80</Quantity>
                  <Subsidy>2.98</Subsidy>
                  <Price>4.90</Price>
                  <Alternate>2.98</Alternate>
                  <Surcharge>0.02400</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A13">
      <Name>Genito-Urinary System</Name>
      <ATC2 ID="A1301">
        <Name>Contraceptives - Non-hormonal</Name>
        <ATC3 ID="A130101">
          <Name>Condoms</Name>
          <Chemical ID="C1301013708" Page="73" Statim="Must">
            <Name>Condoms extra strength</Name>
            <Formulation ID="F130101370825" Rank="10" Units="dev" Weight="400">
              <Name>Condoms, proprietary</Name>
              <Brand ID="B13010137082526">
                <Name>Marquis Protecta</Name>
                <Pack ID="P2146886" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>16.21</Subsidy>
                  <Price>16.21</Price>
                  <Alternate>16.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1301016039" Page="73" Statim="Must">
            <Name>Condoms without spermicide</Name>
            <Formulation ID="F130101603901" Rank="10" Units="dev">
              <Name>Condoms, proprietary</Name>
              <Brand ID="B13010160390105">
                <Name>Gold Knight</Name>
                <Pack ID="P493163" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>14.84</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>14.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P731161">
                  <Quantity>12</Quantity>
                  <Subsidy>1.24</Subsidy>
                  <Price>1.24</Price>
                  <Alternate>1.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390107">
                <Name>R3 Superfeucht</Name>
                <Pack ID="P706663">
                  <Quantity>5</Quantity>
                  <Subsidy>0.52</Subsidy>
                  <Price>2.37</Price>
                  <Alternate>0.52</Alternate>
                  <Surcharge>0.37000</Surcharge>
                </Pack>
                <Pack ID="P697982">
                  <Quantity>6</Quantity>
                  <Subsidy>0.62</Subsidy>
                  <Price>2.85</Price>
                  <Alternate>0.62</Alternate>
                  <Surcharge>0.37167</Surcharge>
                </Pack>
                <Pack ID="P697990">
                  <Quantity>24</Quantity>
                  <Subsidy>2.47</Subsidy>
                  <Price>11.40</Price>
                  <Alternate>2.47</Alternate>
                  <Surcharge>0.37208</Surcharge>
                </Pack>
                <Pack ID="P698016" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.24</Subsidy>
                  <Price>5.70</Price>
                  <Alternate>1.24</Alternate>
                  <Surcharge>0.37167</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390111">
                <Name>Durex Confidence</Name>
                <Pack ID="P301353">
                  <Quantity>12</Quantity>
                  <Subsidy>1.24</Subsidy>
                  <Price>1.24</Price>
                  <Alternate>1.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P493171" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>14.84</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>14.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390113">
                <Name>Lifestyles Flared</Name>
                <Pack ID="P493139">
                  <Quantity>12</Quantity>
                  <Subsidy>1.24</Subsidy>
                  <Price>2.60</Price>
                  <Alternate>1.24</Alternate>
                  <Surcharge>0.11333</Surcharge>
                </Pack>
                <Pack ID="P493147" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>14.84</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>14.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390114">
                <Name>Shield Blue</Name>
                <Pack ID="P953369">
                  <Quantity>144</Quantity>
                  <Subsidy>14.84</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>14.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2144344">
                  <Quantity>12</Quantity>
                  <Subsidy>1.24</Subsidy>
                  <Price>1.24</Price>
                  <Alternate>1.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2144352" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>14.84</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>14.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390127">
                <Name>Marquis Supalite</Name>
                <Pack ID="P2146932" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>14.84</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>14.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A130105">
          <Name>Spermicidal Agents</Name>
          <Chemical ID="C1301051105" Page="73" Statim="Must">
            <Name>Applicator</Name>
            <Formulation ID="F130105110501" Rank="10" Units="dev">
              <Name>Applicator</Name>
              <Brand ID="B13010511050101" SoleSupply="true">
                <Name>Ortho</Name>
                <Pack ID="P266973" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>4.34</Subsidy>
                  <Price>4.34</Price>
                  <Alternate>4.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="1" Attribute="PSO"/>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>When ordered with a spermicide.</p>
            </div>
          </Chemical>
          <Chemical ID="C1301056008" Page="73">
            <Name>Nonoxynol-9</Name>
            <Formulation ID="F130105600825" Rank="3" Units="g">
              <Name>Jelly 2%</Name>
              <Brand ID="B13010560082525" SoleSupply="true">
                <Name>Gynol II</Name>
                <Pack ID="P2151308" OP="true" Specified="true">
                  <Quantity>108</Quantity>
                  <Subsidy>10.95</Subsidy>
                  <Price>10.95</Price>
                  <Alternate>10.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="108" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A130107">
          <Name>Contraceptive Devices</Name>
          <Chemical ID="C1301076038" Page="73" Statim="Must">
            <Name>Intra-uterine device</Name>
            <Formulation ID="F130107603802" Rank="10" Units="dev">
              <Name>IUD</Name>
              <Brand ID="B13010760380201">
                <Name>Multiload Cu 375</Name>
                <Pack ID="P752789" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>39.50</Subsidy>
                  <Price>39.50</Price>
                  <Alternate>39.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010760380202">
                <Name>Multiload Cu 375 SL</Name>
                <Pack ID="P276936" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>39.50</Subsidy>
                  <Price>39.50</Price>
                  <Alternate>39.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Distributed by Pharmaco NZ Ltd, PO Box 4079, Auckland  Ph 09 377 3336</p>
              </div>
            </Formulation>
            <Rule Type="FormReqd" Attribute="WSO"/>
          </Chemical>
          <Chemical ID="C1301076041" Page="73" Statim="Must">
            <Name>Diaphragm</Name>
            <Formulation ID="F130107604101" Rank="10" Units="dev">
              <Name>Diaphragm</Name>
              <Brand ID="B13010760410101" SoleSupply="true">
                <Name>Ortho Coil</Name>
                <Pack ID="P311693">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311707">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311723">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311731">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P305197">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311758">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311766" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311715">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010760410103" SoleSupply="true">
                <Name>Ortho All-flex</Name>
                <Pack ID="P311952" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P305200">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311871">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311898">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311901">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311928">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P311944">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>One of each size is permitted on a PSO.</p>
              </div>
              <Rule Type="FormMax" Value="1" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <Rule Type="MaxCoPayment" Value="3"/>
      </ATC2>
      <ATC2 ID="A1308">
        <Name>Contraceptives - Hormonal</Name>
        <ATC3 ID="A130802">
          <Name>Combined Oral Contraceptives</Name>
          <Chemical ID="C1308021475" Page="75" Statim="Must">
            <Name>Ethinyloestradiol with norethisterone</Name>
            <Formulation ID="F130802147508" Rank="1" Units="tab" Weight="35">
              <Name>Tab 35 mcg with norethisterone 500 mcg</Name>
              <Brand ID="B13080214750801" SoleSupply="true">
                <Name>Brevinor 21</Name>
                <Pack ID="P303518" Specified="true">
                  <Quantity>63</Quantity>
                  <Multiple>21</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="63" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130802147509" Rank="1" Units="tab" Weight="35">
              <Name>Tab 35 mcg with norethisterone 500 mcg and 7 inert tab</Name>
              <Brand ID="B13080214750902" SoleSupply="true">
                <Name>Norimin</Name>
                <Pack ID="P410691" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130802147511" Rank="1" Units="tab" Weight="35">
              <Name>Tab 35 mcg with norethisterone 1 mg</Name>
              <Brand ID="B13080214751101" SoleSupply="true">
                <Name>Brevinor 1/21</Name>
                <Pack ID="P330116" Specified="true">
                  <Quantity>63</Quantity>
                  <Multiple>21</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="63" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130802147512" Rank="1" Units="tab" Weight="35">
              <Name>Tab 35 mcg with norethisterone 1 mg and 7 inert tab</Name>
              <Brand ID="B13080214751201" SoleSupply="true">
                <Name>Brevinor 1/28</Name>
                <Pack ID="P303542" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308021477" Page="74" Statim="Must">
            <Name>Ethinyloestradiol with desogestrel</Name>
            <Formulation ID="F130802147701" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mcg with desogestrel 150 mcg</Name>
              <Brand ID="B13080214770101">
                <Name>Mercilon 21</Name>
                <Pack ID="P682047" Specified="true">
                  <Quantity>63</Quantity>
                  <Multiple>21</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.15683</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="63" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
            <Formulation ID="F130802147702" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mcg with desogestrel 150 mcg and 7 inert tab</Name>
              <Brand ID="B13080214770201">
                <Name>Mercilon 28</Name>
                <Pack ID="P682055" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.11762</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
            <Formulation ID="F130802147703" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mcg with desogestrel 150 mcg</Name>
              <Brand ID="B13080214770301">
                <Name>Marvelon 21</Name>
                <Pack ID="P310018" Specified="true">
                  <Quantity>63</Quantity>
                  <Multiple>21</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.15683</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="63" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
            <Formulation ID="F130802147704" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mcg with desogestrel 150 mcg and 7 inert tab</Name>
              <Brand ID="B13080214770401">
                <Name>Marvelon 28</Name>
                <Pack ID="P327611" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.11762</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308021479" Page="74" Statim="Must">
            <Name>Ethinyloestradiol with gestodene</Name>
            <Formulation ID="F130802147902" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mcg with gestodene 75 mcg and 7 inert tab</Name>
              <Brand ID="B13080214790201">
                <Name>Femodene 28</Name>
                <Pack ID="P608513" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>14.49</Alternate>
                  <Surcharge>0.11762</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080214790202">
                <Name>Minulet 28</Name>
                <Pack ID="P613428" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>14.49</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.09369</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308021718" Page="74" Statim="Must">
            <Name>Ethinyloestradiol with levonorgestrel</Name>
            <Formulation ID="F130802171805" Rank="1" Units="tab" Weight="50">
              <Name>Tab ethinyloestradiol 30 mcg with levonorgestrel 50 mcg (6) and tab ethinyloestradiol 40 mcg with levonorgestrel 75 mcg (5), and tab ethinyloestradiol 30 mcg with levonorgestrel 125 mcg (10) and 7 inert tab</Name>
              <Brand ID="B13080217180501">
                <Name>Triphasil 28</Name>
                <Pack ID="P251917" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>14.49</Price>
                  <Alternate>14.49</Alternate>
                  <Surcharge>0.09369</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180502">
                <Name>Triquilar ED</Name>
                <Pack ID="P589128" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>9.45</Price>
                  <Alternate>9.45</Alternate>
                  <Surcharge>0.03369</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180503">
                <Name>Trifeme</Name>
                <Pack ID="P487953" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
            <Formulation ID="F130802171807" Rank="1" Units="tab" Weight="125">
              <Name>Tab 50 mcg with levonorgestrel 125 mcg and 7 inert tab</Name>
              <Brand ID="B13080217180701">
                <Name>Microgynon 50 ED</Name>
                <Pack ID="P202827" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>9.45</Subsidy>
                  <Price>9.45</Price>
                  <Alternate>9.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130802171808" Rank="1" Units="tab" Weight="150">
              <Name>Tab 30 mcg with levonorgestrel 150 mcg</Name>
              <Brand ID="B13080217180801">
                <Name>Microgynon 30</Name>
                <Pack ID="P202770" Specified="true">
                  <Quantity>63</Quantity>
                  <Multiple>21</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.15683</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="63" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
            <Formulation ID="F130802171809" Rank="1" Units="tab" Weight="150">
              <Name>Tab 30 mcg with levonorgestrel 150 mcg and 7 inert tab</Name>
              <Brand ID="B13080217180901">
                <Name>Microgynon 30 ED</Name>
                <Pack ID="P252220" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.11762</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180902">
                <Name>Nordette 28</Name>
                <Pack ID="P203033" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>14.49</Price>
                  <Alternate>14.49</Alternate>
                  <Surcharge>0.09369</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180903">
                <Name>Monofeme</Name>
                <Pack ID="P487961" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180904">
                <Name>Levlen ED</Name>
                <Pack ID="P439118" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308021873" Page="75" Statim="Must">
            <Name>Norethisterone with mestranol</Name>
            <Formulation ID="F130802187302" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg with mestranol 50 mcg and 7 inert tab</Name>
              <Brand ID="B13080218730201">
                <Name>Norinyl-1/28</Name>
                <Pack ID="P273511" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>13.80</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.08548</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
          </Chemical>
          <Request To="HealthPAC" For="Alternate Subsidy" Form="SA0500">
            <Title><range>Combined oral contraceptives</range><range>Progestogen-only contraceptives</range> (Circle one)</Title>
            <Case When="Initial application">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <and/>
                  <apply>
                    <or/>
                    <ci type="logical" class="Target">Patient is on a Social Welfare benefit</ci>
                    <ci type="logical" class="Target">Patient has an income no greater than the benefit</ci>
                  </apply>
                  <ci type="logical" class="Trial">Has tried at least one of the fully funded options and has been unable to tolerate it</ci>
                </apply>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
            <Case When="Renewal" Form="SA0265 SA0500">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <or/>
                  <ci type="logical" class="Target">Patient is on a Social Welfare benefit</ci>
                  <ci type="logical" class="Target">Patient has an income no greater than the benefit</ci>
                </apply>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>The approval numbers of Special Authorities approved after 1 November 1999 are interchangeable between Mercilon, Marvelon, Minulet and Femodene.</p>
              <p>The additional subsidy will fund Mercilon, Marvelon, Minulet and Femodene up to the manufacturer’s price for each of these products as identified on the Schedule at 1 November 1999.</p>
              <p>Special Authorities approved before 1 November 1999 remain valid until the expiry date and can be renewed providing that women are still either:</p>
              <ul>
                <li>
                  <p>on a Social Welfare benefit; or</p>
                </li>
                <li>
                  <p>have an income no greater than the benefit.</p>
                </li>
              </ul>
              <p>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</p>
            </div>
          </Request>
        </ATC3>
        <ATC3 ID="A130803">
          <Name>Combined Oral Contraceptives - Other</Name>
          <Chemical ID="C1308031718" Page="75" Statim="Must">
            <Name>Ethinyloestradiol with levonorgestrel</Name>
            <Formulation ID="F130803171812" Rank="1" Units="tab" Weight="100">
              <Name>Tab 20 mcg with levonorgestrel 100 mcg and 7 inert tab</Name>
              <Brand ID="B13080317181201">
                <Name>Loette</Name>
                <Pack ID="P487945" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.11762</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080317181202">
                <Name>Microgynon 20 ED</Name>
                <Pack ID="P2007509" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>6.62</Alternate>
                  <Surcharge>0.11762</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A130804">
          <Name>Progestogen-only Contraceptives</Name>
          <Chemical ID="C1308041724" Page="75" Statim="Must">
            <Name>Levonorgestrel</Name>
            <Formulation ID="F130804172401" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mcg</Name>
              <Brand ID="B13080417240101">
                <Name>Microlut</Name>
                <Pack ID="P719803" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.62</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.11762</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308041766" Page="75" Statim="Must">
            <Name>Medroxyprogesterone acetate</Name>
            <Formulation ID="F130804176608" Rank="4" Units="inj" Weight="150">
              <Name>Inj 150 mg per ml, 1 ml syringe</Name>
              <Brand ID="B13080417660801">
                <Name>Depo-Provera</Name>
                <Pack ID="P271691" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>8.05</Subsidy>
                  <Price>8.05</Price>
                  <Alternate>8.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308041871" Page="75" Statim="Must">
            <Name>Norethisterone</Name>
            <Formulation ID="F130804187101" Rank="1" Units="tab">
              <Name>Tab 350 mcg</Name>
              <Brand ID="B13080418710101" SoleSupply="true">
                <Name>Noriday 28</Name>
                <Pack ID="P398322" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>7.15</Subsidy>
                  <Price>7.15</Price>
                  <Alternate>7.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Request To="HealthPAC" For="Alternate Subsidy" Form="SA0500">
            <Title><range>Combined oral contraceptives</range><range>Progestogen-only contraceptives</range> (Circle one)</Title>
            <Case When="Initial application">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <and/>
                  <apply>
                    <or/>
                    <ci type="logical" class="Target">Patient is on a Social Welfare benefit</ci>
                    <ci type="logical" class="Target">Patient has an income no greater than the benefit</ci>
                  </apply>
                  <ci type="logical" class="Trial">Has tried at least one of the fully funded options and has been unable to tolerate it</ci>
                </apply>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
            <Case When="Renewal" Form="SA0265 SA0500">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <or/>
                  <ci type="logical" class="Target">Patient is on a Social Welfare benefit</ci>
                  <ci type="logical" class="Target">Patient has an income no greater than the benefit</ci>
                </apply>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>The approval numbers of Special Authorities approved after 1 November 1999 are interchangeable between Mercilon, Marvelon, Minulet and Femodene.</p>
              <p>The additional subsidy will fund Mercilon, Marvelon, Minulet and Femodene up to the manufacturer’s price for each of these products as identified on the Schedule at 1 November 1999.</p>
              <p>Special Authorities approved before 1 November 1999 remain valid until the expiry date and can be renewed providing that women are still either:</p>
              <ul>
                <li>
                  <p>on a Social Welfare benefit; or</p>
                </li>
                <li>
                  <p>have an income no greater than the benefit.</p>
                </li>
              </ul>
              <p>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</p>
            </div>
          </Request>
        </ATC3>
        <ATC3 ID="A130805">
          <Name>Emergency Contraceptives</Name>
          <Chemical ID="C1308051724" Page="76" Statim="Must">
            <Name>Levonorgestrel</Name>
            <Formulation ID="F130805172425" Rank="1" Units="tab" Weight="750">
              <Name>Tab 750 mcg</Name>
              <Brand ID="B13080517242525">
                <Name>Postinor-2</Name>
                <Pack ID="P952788" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>8.50</Subsidy>
                  <Price>8.50</Price>
                  <Alternate>8.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="4" Attribute="Rx"/>
              <Rule Type="FormMax" Value="10" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <Rule Type="MaxCoPayment" Value="3"/>
      </ATC2>
      <ATC2 ID="A1309">
        <Name>Antiandrogen Oral Contraceptives</Name>
        <ATC3 ID="A130902">
          <Name>Antiandrogen Oral Contraceptives</Name>
          <Chemical ID="C1309022706" Page="75" Statim="Must">
            <Name>Cyproterone acetate with ethinyloestradiol</Name>
            <Formulation ID="F130902270602" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tabs</Name>
              <Brand ID="B13090227060225">
                <Name>Estelle 35</Name>
                <Pack ID="P2027682" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>6.30</Subsidy>
                  <Price>6.30</Price>
                  <Alternate>6.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p>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:</p>
            <ul>
              <li>
                <p>$3.00 prescription charge (patient co-payment) will apply.</p>
              </li>
              <li>
                <p>prescription may be written for up to six months supply.</p>
              </li>
            </ul>
            <p>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.</p>
          </div>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1310">
        <Name>Gynaecological Anti-infectives</Name>
        <ATC3 ID="A131001">
          <Name>Gynaecological Anti-infectives</Name>
          <Chemical ID="C1310011006" Page="76">
            <Name>Acetic acid with hydroxyquinoline and ricinoleic acid</Name>
            <Formulation ID="F131001100601" Rank="3" Units="g">
              <Name>Jelly with glacial acetic acid 0.94%, hydroxyquinoline sulphate 0.025%, glycerol 5% and ricinoleic acid 0.75% with applicator</Name>
              <Brand ID="B13100110060101">
                <Name>Aci-Jel</Name>
                <Pack ID="P536962" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.43</Subsidy>
                  <Price>11.32</Price>
                  <Alternate>8.43</Alternate>
                  <Surcharge>0.02890</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1310011320" Page="76" Statim="Must">
            <Name>Clotrimazole</Name>
            <Formulation ID="F131001132003" Rank="3" Units="g">
              <Name>Vaginal crm 1% with applicator(s)</Name>
              <Brand ID="B13100113200325" SoleSupply="true">
                <Name>Clomazol</Name>
                <Pack ID="P2155656" OP="true" Specified="true">
                  <Quantity>35</Quantity>
                  <Subsidy>1.45</Subsidy>
                  <Price>1.45</Price>
                  <Alternate>1.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F131001132004" Rank="3" Units="g">
              <Name>Vaginal crm 2% with applicators</Name>
              <Brand ID="B13100113200402">
                <Name>Clotrimaderm 2%</Name>
                <Pack ID="P485799" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>3.99</Subsidy>
                  <Price>3.99</Price>
                  <Alternate>3.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1310011443" Page="76">
            <Name>Econazole nitrate</Name>
            <Formulation ID="F131001144301" Rank="5" Units="pess">
              <Name>Pessaries 150 mg with applicators</Name>
              <Brand ID="B13100114430125">
                <Name>Pevaryl Ovules</Name>
                <Pack ID="P2119439" Specified="true">
                  <Quantity>3</Quantity>
                  <Subsidy>2.75</Subsidy>
                  <Price>9.71</Price>
                  <Alternate>2.75</Alternate>
                  <Surcharge>2.32000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1310011620" Page="76" Statim="Must">
            <Name>Miconazole nitrate</Name>
            <Formulation ID="F131001162006" Rank="3" Units="g">
              <Name>Vaginal crm 2% with applicator</Name>
              <Brand ID="B13100116200602">
                <Name>Micreme</Name>
                <Pack ID="P697648" OP="true" Specified="true">
                  <Quantity>40</Quantity>
                  <Subsidy>2.75</Subsidy>
                  <Price>3.70</Price>
                  <Alternate>2.75</Alternate>
                  <Surcharge>0.02375</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1310011881" Page="76">
            <Name>Nystatin</Name>
            <Formulation ID="F131001188109" Rank="3" Units="g">
              <Name>Vaginal crm 100,000 u per 5 g with applicator(s)</Name>
              <Brand ID="B13100118810901" SoleSupply="true">
                <Name>Nilstat</Name>
                <Pack ID="P254908" OP="true" Specified="true">
                  <Quantity>75</Quantity>
                  <Subsidy>4.71</Subsidy>
                  <Price>4.71</Price>
                  <Alternate>4.71</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1314">
        <Name>Myometrial and Vaginal Hormone Preparations</Name>
        <ATC3 ID="A131402">
          <Name>Myometrial and Vaginal Hormone Preparations</Name>
          <Chemical ID="C1314021456" Page="76">
            <Name>Ergometrine maleate</Name>
            <Formulation ID="F131402145601" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mcg per ml, 1 ml</Name>
              <Brand ID="B13140214560101" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P500372" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>11.60</Subsidy>
                  <Price>11.60</Price>
                  <Alternate>11.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1314021922" Page="76">
            <Name>Oxytocin</Name>
            <Formulation ID="F131402192201" Rank="4" Units="inj" Weight="5">
              <Name>Inj 5 iu per ml, 1 ml</Name>
              <Brand ID="B13140219220101" SoleSupply="true">
                <Name>Syntocinon</Name>
                <Pack ID="P256218" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>5.40</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F131402192202" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 iu per ml, 1 ml</Name>
              <Brand ID="B13140219220201" SoleSupply="true">
                <Name>Syntocinon</Name>
                <Pack ID="P256234" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>6.80</Subsidy>
                  <Price>6.80</Price>
                  <Alternate>6.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F131402192203" Rank="4" Units="inj" Weight="500">
              <Name>Inj 5 iu with ergometrine maleate 500 mcg per ml, 1 ml</Name>
              <Brand ID="B13140219220301" SoleSupply="true">
                <Name>Syntometrine</Name>
                <Pack ID="P256269" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>9.20</Subsidy>
                  <Price>9.20</Price>
                  <Alternate>9.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="5" Attribute="PSO"/>
          </Chemical>
          <Chemical ID="C1314022784" Page="76" Statim="Must">
            <Name>Oestriol</Name>
            <Formulation ID="F131402278402" Rank="3" Units="g">
              <Name>Crm 1 mg per g with applicator</Name>
              <Brand ID="B13140227840201">
                <Name>Ovestin</Name>
                <Pack ID="P767441" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>7.00</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>7.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F131402278403" Rank="5" Units="pess">
              <Name>Pessaries 500 mcg</Name>
              <Brand ID="B13140227840301">
                <Name>Ovestin</Name>
                <Pack ID="P767468" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>7.25</Subsidy>
                  <Price>7.25</Price>
                  <Alternate>7.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1316">
        <Name>Pregnancy Tests - HCG Urine</Name>
        <ATC3 ID="A131602">
          <Name>Pregnancy Tests - HCG Urine</Name>
          <Chemical ID="C1316023000" Page="77">
            <Name>Pregnancy tests - HCG urine</Name>
            <Formulation ID="F131602300002" Rank="10" Units="test">
              <Name>Cassette</Name>
              <Brand ID="B13160230000202" SoleSupply="true">
                <Name>MDS Quick Card</Name>
                <Pack ID="P431842" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>19.00</Subsidy>
                  <Price>19.00</Price>
                  <Alternate>19.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="WSO"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1319">
        <Name>Urinary Agents</Name>
        <ATC3 ID="A131904">
          <Name>Other Urinary Agents</Name>
          <Chemical ID="C1319041914" Page="77" Statim="Must" Update="+Subsidy">
            <Name>Oxybutynin</Name>
            <Formulation ID="F131904191401" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B13190419140102">
                <Name>Apo-Oxybutynin</Name>
                <Pack ID="P2110431" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>44.79</Subsidy>
                  <Price>44.79</Price>
                  <Alternate>44.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F131904191402" Rank="3" Units="ml" Weight="1">
              <Name>Oral liq 5 mg per 5 ml</Name>
              <Brand ID="B13190419140202">
                <Name>Apo-Oxybutynin</Name>
                <Pack ID="P340413" OP="true" Specified="true">
                  <Quantity>473</Quantity>
                  <Subsidy>50.40</Subsidy>
                  <Price>50.40</Price>
                  <Alternate>50.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1319042142" Page="77" Statim="Must">
            <Name>Sodium citro-tartrate</Name>
            <Formulation ID="F131904214201" Rank="2" Units="sach">
              <Name>Grans eff 4 g sachets</Name>
              <Brand ID="B13190421420102" SoleSupply="true">
                <Name>Ural</Name>
                <Pack ID="P298638" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>2.75</Subsidy>
                  <Price>2.75</Price>
                  <Alternate>2.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P709131">
                  <Quantity>8</Quantity>
                  <Subsidy>1.02</Subsidy>
                  <Price>2.40</Price>
                  <Alternate>1.02</Alternate>
                  <Surcharge>0.17250</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1622">For urinary tract Infections refer to INFECTIONS, Antibacterials</p>
        </div>
      </ATC2>
    </ATC1>
    <ATC1 ID="A14">
      <Name>Hormone Preparations - Systemic Excluding Contraceptive Hormones</Name>
      <ATC2 ID="A1401">
        <Name>Anabolic Agents</Name>
        <ATC3 ID="A140101">
          <Name>Anabolic Agents</Name>
          <Chemical ID="C1401012763" Page="78">
            <Name>Nandrolone decanoate</Name>
            <Formulation ID="F140101276302" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg per ml, 1 ml</Name>
              <Brand ID="B14010127630201">
                <Name>Deca-Durabolin Orgaject</Name>
                <Pack ID="P264121" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>21.15</Subsidy>
                  <Price>21.15</Price>
                  <Alternate>21.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1404">
        <Name>Calcium Homeostasis</Name>
        <ATC3 ID="A140402">
          <Name>Alendronate for Osteoporosis</Name>
          <Chemical ID="C1404021037" Page="78">
            <Name>Alendronate sodium</Name>
            <Formulation ID="F140402103725" Rank="1" Units="tab" Weight="70">
              <Name>Tab 70 mg</Name>
              <Brand ID="B14040210372525">
                <Name>Fosamax</Name>
                <Pack ID="P2022133" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>35.91</Subsidy>
                  <Price>35.91</Price>
                  <Alternate>35.91</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0797"/>
          </Chemical>
          <Chemical ID="C1404023868" Page="75">
            <Name>Alendronate sodium with cholecalciferol</Name>
            <Formulation ID="F140402386825" Rank="1" Units="tab" Weight="70">
              <Name>Tab 70 mg with cholecalciferol 2800 iu</Name>
              <Brand ID="B14040238682525">
                <Name>Fosamax Plus</Name>
                <Pack ID="P2255456" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>35.91</Subsidy>
                  <Price>35.91</Price>
                  <Alternate>35.91</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0797"/>
          </Chemical>
          <Request To="HealthPAC" For="Subsidy" Form="SA0797">
            <Title>
              <range>Alendronate<instance>Alendronate Tab 70 mg</instance></range>
            </Title>
            <Case When="Initial application" Category="Underlying cause -- Osteoporosis">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <or/>
                  <ci type="logical" class="Indication">History of one significant osteoporotic fracture demonstrated radiologically and documented bone mass density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5)</ci>
                  <ci type="logical" class="Indication">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</ci>
                  <ci type="logical" class="Indication">History of two significant osteoporotic fractures demonstrated radiologically</ci>
                  <ci type="logical" class="Indication">Documented T-Score ≤ -3.0</ci>
                </apply>
              </math>
              <Applicant>relevant specialist</Applicant>
              <Applicant>vocationally registered general practitioner</Applicant>
              <Term Measure="patient's lifetime"/>
            </Case>
            <Case When="Initial application" Category="Underlying cause -- glucocorticosteroid therapy">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <and/>
                  <ci type="logical" class="Indication">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 has either</ci>
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5)</ci>
                    <ci type="logical" class="Indication">history of one significant osteoporotic fracture demonstrated radiologically</ci>
                  </apply>
                </apply>
              </math>
              <Applicant>relevant specialist</Applicant>
              <Applicant>vocationally registered general practitioner</Applicant>
              <Term Measure="year">1</Term>
            </Case>
            <Case When="Renewal" Form="SA0511 SA0569 SA0614 SA0622 SA0693 SA0797">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <ci type="logical" class="Indication">The patient is continuing systemic glucocorticosteriod therapy (≥5 mg per day prednisone equivalents)</ci>
              </math>
              <Applicant>relevant specialist</Applicant>
              <Applicant>vocationally registered general practitioner</Applicant>
              <Term Measure="year">1</Term>
            </Case>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: lower-alpha">
                <li>Evidence used by National institute for Clinical Excellence (NICE) guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5, and therefore do not require BMD measurement for treatment with bisphosphonates.</li>
                <li>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.</li>
                <li>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.</li>
              </ol>
            </div>
          </Request>
        </ATC3>
        <ATC3 ID="A140404">
          <Name>Alendronate for Pagets Disease</Name>
          <Chemical ID="C1404041037" Page="79">
            <Name>Alendronate sodium</Name>
            <Formulation ID="F140404103702" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B14040410370201">
                <Name>Fosamax</Name>
                <Pack ID="P421812" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>133.00</Subsidy>
                  <Price>133.00</Price>
                  <Alternate>133.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0467"/>
          </Chemical>
          <Request To="HealthPAC" For="Subsidy" Form="SA0467">
            <Title>
              <range>Alendronate for Pagets Disease<instance>Alendronate Tab 40 mg</instance></range>
            </Title>
            <Case When="Initial application">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <and/>
                  <ci type="logical" class="Indication">Paget’s disease</ci>
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Bone or articular pain</ci>
                    <ci type="logical" class="Indication">Bone deformity</ci>
                    <ci type="logical" class="Indication">Bone, articular or neurological complications</ci>
                    <ci type="logical" class="Indication">Asymptomatic disease, but risk of complications due to site (base of skull, spine, long bones of lower limbs)</ci>
                    <ci type="logical" class="Indication">Preparation for orthopaedic surgery</ci>
                  </apply>
                </apply>
              </math>
              <Applicant>relevant specialist</Applicant>
              <Term Measure="month">6</Term>
            </Case>
            <Case When="Renewal" Form="SA0467">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
              </math>
              <Applicant>relevant specialist</Applicant>
              <Term Measure="month">6</Term>
            </Case>
          </Request>
        </ATC3>
        <ATC3 ID="A140406">
          <Name>Other Treatments</Name>
          <Chemical ID="C1404061188" Page="79" Statim="Must">
            <Name>Calcitonin</Name>
            <Formulation ID="F140406118802" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 iu per ml, 1 ml</Name>
              <Brand ID="B14040611880201">
                <Name>Miacalcic</Name>
                <Pack ID="P259012" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>100.00</Subsidy>
                  <Price>100.00</Price>
                  <Alternate>100.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C1404061487" Page="79" Statim="Must">
            <Name>Etidronate disodium</Name>
            <Formulation ID="F140406148701" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B14040614870101">
                <Name>Didronel</Name>
                <Pack ID="P319325" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>22.80</Subsidy>
                  <Price>22.80</Price>
                  <Alternate>22.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14040614870125">
                <Name>Etidrate</Name>
                <Pack ID="P2000482" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>38.00</Subsidy>
                  <Price>38.00</Price>
                  <Alternate>38.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Guideline" id="PG0650C1404061487">
              <h3>Prescribing Guidelines</h3>
              <p>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.</p>
            </div>
          </Chemical>
          <Chemical ID="C1404066033" Page="79">
            <Name>Pamidronate disodium</Name>
            <Formulation ID="F140406603301" Rank="4" Units="inj" Weight="30">
              <Name>Inj 3 mg per ml, 10 ml</Name>
              <Brand ID="B14040660330126" SoleSupply="true">
                <Name>Pamisol</Name>
                <Pack ID="P2113759" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>67.50</Subsidy>
                  <Price>67.50</Price>
                  <Alternate>67.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140406603325" Rank="4" Units="inj" Weight="15">
              <Name>Inj 3 mg per ml, 5 ml</Name>
              <Brand ID="B14040660332526" SoleSupply="true">
                <Name>Pamisol</Name>
                <Pack ID="P2113740" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>48.50</Subsidy>
                  <Price>48.50</Price>
                  <Alternate>48.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140406603326" Rank="4" Units="inj" Weight="60">
              <Name>Inj 6 mg per ml, 10 ml</Name>
              <Brand ID="B14040660332626" SoleSupply="true">
                <Name>Pamisol</Name>
                <Pack ID="P2113775" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>135.00</Subsidy>
                  <Price>135.00</Price>
                  <Alternate>135.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0091">
              <Title>
                <range>Pamidronate Disodium</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Paget’s disease</ci>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patients under hospice care</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Tumour-induced hypercalcaemia</ci>
                        <ci type="logical" class="Indication">Tumour-induced osteolysis without hypercalcaemia</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0091">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0091"/>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1407">
        <Name>Corticosteroids and Related Agents for Systemic Use</Name>
        <ATC3 ID="A140701">
          <Name>Corticosteroids and Related Agents for Systemic Use</Name>
          <Chemical ID="C1407011383" Page="80">
            <Name>Dexamethasone</Name>
            <Formulation ID="F140701138301" Rank="1" Units="tab" Weight="1" Statim="Must">
              <Name>Tab 1 mg</Name>
              <Brand ID="B14070113830101">
                <Name>Douglas</Name>
                <Pack ID="P394947" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.08</Subsidy>
                  <Price>16.08</Price>
                  <Alternate>16.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F140701138302" Rank="1" Units="tab" Weight="4" Statim="Must">
              <Name>Tab 4 mg</Name>
              <Brand ID="B14070113830201">
                <Name>Douglas</Name>
                <Pack ID="P277878" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>61.89</Subsidy>
                  <Price>61.89</Price>
                  <Alternate>61.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F140701138305" Rank="3" Units="ml">
              <Name>Oral liq 1 mg per ml</Name>
              <Brand ID="B14070113830501">
                <Name>Biomed</Name>
                <Pack ID="P344842" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>39.90</Subsidy>
                  <Price>39.90</Price>
                  <Alternate>39.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Oral liq prescriptions:</p>
                <ol style="list-style-type: decimal">
                  <li>
                    <p>Must be written by a Paediatrician or Paediatric Cardiologist; or</p>
                  </li>
                  <li>
                    <p>On the recommendation of a Paediatrician or Paediatric Cardiologist.</p>
                  </li>
                </ol>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407011385" Page="80" Statim="Must">
            <Name>Dexamethasone sodium phosphate</Name>
            <Formulation ID="F140701138501" Rank="4" Units="inj" Weight="4">
              <Name>Inj 4 mg per ml, 1 ml</Name>
              <Brand ID="B14070113850101" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P333131" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>21.50</Subsidy>
                  <Price>21.50</Price>
                  <Alternate>21.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F140701138502" Rank="4" Units="inj" Weight="8">
              <Name>Inj 4 mg per ml, 2 ml</Name>
              <Brand ID="B14070113850201" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P333158" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>31.00</Subsidy>
                  <Price>31.00</Price>
                  <Alternate>31.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407011515" Page="80" Statim="Must">
            <Name>Fludrocortisone acetate</Name>
            <Formulation ID="F140701151501" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mcg</Name>
              <Brand ID="B14070115150101">
                <Name>Florinef</Name>
                <Pack ID="P204951" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.62</Subsidy>
                  <Price>7.62</Price>
                  <Alternate>7.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407011617" Page="80" Statim="Must">
            <Name>Hydrocortisone</Name>
            <Formulation ID="F140701161701" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B14070116170101" SoleSupply="true">
                <Name>Douglas</Name>
                <Pack ID="P205621" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.95</Subsidy>
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              <Name>Tab 20 mg</Name>
              <Brand ID="B14070116170201" SoleSupply="true">
                <Name>Douglas</Name>
                <Pack ID="P205648" Specified="true">
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            <Formulation ID="F140701161716" Rank="4" Units="inj" Weight="100">
              <Name>Inj 50 mg per ml, 2 ml</Name>
              <Brand ID="B14070116171601">
                <Name>Solu-Cortef</Name>
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            <Name>Methylprednisolone acetate</Name>
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              <Name>Tab 4 mg</Name>
              <Brand ID="B14070118110101" SoleSupply="true">
                <Name>Medrol</Name>
                <Pack ID="P210692" Specified="true">
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                <Name>Medrol</Name>
                <Pack ID="P681776" Specified="true">
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            <Name>Methylprednisolone sodium succinate</Name>
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              <Name>Inj 40 mg per ml, 1 ml</Name>
              <Brand ID="B14070118120101" SoleSupply="true">
                <Name>Solu-Medrol</Name>
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            <Formulation ID="F140701181202" Rank="4" Units="inj" Weight="125">
              <Name>Inj 62.5 mg per ml, 2 ml</Name>
              <Brand ID="B14070118120201" SoleSupply="true">
                <Name>Solu-Medrol</Name>
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              <Name>Inj 500 mg</Name>
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                <Name>Solu-Medrol</Name>
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              <Name>Inj 1 g</Name>
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                <Name>Solu-Medrol</Name>
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          <Chemical ID="C1407011816" Page="80">
            <Name>Methylprednisolone acetate with lignocaine</Name>
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              <Name>Inj 40 mg per ml with lignocaine 1 ml</Name>
              <Brand ID="B14070118160601" SoleSupply="true">
                <Name>Depo-Medrol with lidocaine</Name>
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          <Chemical ID="C1407012034" Page="80" Statim="Must">
            <Name>Prednisolone sodium phosphate</Name>
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              <Name>Oral liq 5 mg per ml</Name>
              <Brand ID="B14070120342525">
                <Name>Redipred</Name>
                <Pack ID="P317659" OP="true" Specified="true">
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                <p>Restricted to children under 12 years of age.</p>
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            <Name>Prednisone</Name>
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              <Name>Tab 1 mg</Name>
              <Brand ID="B14070120380102" SoleSupply="true">
                <Name>Apo-Prednisone</Name>
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              <Brand ID="B14070120380203" SoleSupply="true">
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              <Name>Tab 5 mg</Name>
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                <Name>Apo-Prednisone</Name>
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                <Name>Apo-Prednisone</Name>
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            <Name>Tetracosactrin</Name>
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              <Name>Inj 250 mcg</Name>
              <Brand ID="B14070122390101">
                <Name>Synacthen</Name>
                <Pack ID="P379042" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>177.18</Subsidy>
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            <Formulation ID="F140701223903" Rank="4" Units="inj" Weight="1">
              <Name>Inj 1 mg per ml, 1 ml</Name>
              <Brand ID="B14070122390301">
                <Name>Synacthen Depot</Name>
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                  <Subsidy>26.88</Subsidy>
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              <Name>Inj 10 mg per ml, 1 ml</Name>
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                <Name>Kenacort-A</Name>
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            <Formulation ID="F140701238902" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 5 ml</Name>
              <Brand ID="B14070123890201">
                <Name>Kenacort-A</Name>
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              <Name>Inj 40 mg per ml, 1 ml</Name>
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                <Name>Kenacort-A40</Name>
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                  <Subsidy>28.09</Subsidy>
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              <Name>Inj 3.9 mg with betamethasone acetate 3 mg per ml, 1ml</Name>
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                <Name>Celestone Chronodose</Name>
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                  <Subsidy>19.20</Subsidy>
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          <Name>Androgen Agonists and Antagonists</Name>
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              <Name>Tab 50 mg</Name>
              <Brand ID="B14100127070125" SoleSupply="true">
                <Name>Siterone</Name>
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                  <Quantity>50</Quantity>
                  <Subsidy>23.50</Subsidy>
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            <Formulation ID="F141001270702" Rank="4" Units="inj" Weight="300">
              <Name>Inj 100 mg per ml, 3 ml</Name>
              <Brand ID="B14100127070201">
                <Name>Androcur Depot</Name>
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                  <Subsidy>196.82</Subsidy>
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            <Name>Testosterone cypionate</Name>
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              <Name>Inj long-acting 100 mg per ml, 10 ml</Name>
              <Brand ID="B14100127620101">
                <Name>Depo-Testosterone</Name>
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            <Name>Testosterone undecanoate</Name>
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              <Name>Cap 40 mg</Name>
              <Brand ID="B14100127640101">
                <Name>Panteston</Name>
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                  <Subsidy>60.71</Subsidy>
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            <Name>Testosterone esters</Name>
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              <Name>Inj 250 mg per ml, 1 ml</Name>
              <Brand ID="B14100127650125">
                <Name>Sustanon Ampoules</Name>
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              <Name>Transdermal patch 2.5 mg per day</Name>
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                <Name>Androderm</Name>
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                  <Quantity>60</Quantity>
                  <Subsidy>80.00</Subsidy>
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        <Name>Hormone Replacement Therapy - Systemic</Name>
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          <Name>Oestrogens</Name>
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            <Name>Oestradiol valerate</Name>
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              <Name>Tab 1 mg</Name>
              <Brand ID="B14110411560101">
                <Name>Progynova</Name>
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                  <Quantity>28</Quantity>
                  <Subsidy>4.12</Subsidy>
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              <Name>Tab 2 mg</Name>
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                <Name>Progynova</Name>
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                  <Quantity>28</Quantity>
                  <Subsidy>5.40</Subsidy>
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              <Name>TDDS 25 mcg per day</Name>
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                <Name>Estraderm TTS 25</Name>
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                  <Subsidy>3.01</Subsidy>
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              <Name>TDDS 50 mcg per day</Name>
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                <Name>Estraderm TTS 50</Name>
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              <Name>TDDS 100 mcg per day</Name>
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                <Name>Estraderm TTS 100</Name>
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                  <Subsidy>7.05</Subsidy>
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              <Name>TDDS 3.9 mg (releases 50 mcg of oestradiol per day)</Name>
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                <Name>Climara 50</Name>
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              <Name>TDDS 7.8 mg (releases 100 mcg of oestradiol per day)</Name>
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                <Name>Climara 100</Name>
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                  <Subsidy>7.05</Subsidy>
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              <Name>Tab 2 mg</Name>
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                <Name>Estrofem</Name>
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                  <Quantity>28</Quantity>
                  <Subsidy>5.40</Subsidy>
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              <Name>Tab 1 mg</Name>
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                <Name>Estrofem</Name>
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                  <Quantity>28</Quantity>
                  <Subsidy>4.12</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>4.12</Alternate>
                  <Surcharge>0.08500</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
          <Chemical ID="C1411041888" Page="82" Statim="Must">
            <Name>Oestrogens</Name>
            <Formulation ID="F141104188801" Rank="1" Units="tab" Weight="0.3">
              <Name>Conjugated, equine tab 300 mcg</Name>
              <Brand ID="B14110418880102">
                <Name>Premarin</Name>
                <Pack ID="P410292" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>3.01</Subsidy>
                  <Price>3.75</Price>
                  <Alternate>3.01</Alternate>
                  <Surcharge>0.02643</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141104188802" Rank="1" Units="tab" Weight="0.625">
              <Name>Conjugated, equine tab 625 mcg</Name>
              <Brand ID="B14110418880202">
                <Name>Premarin</Name>
                <Pack ID="P410284" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.12</Subsidy>
                  <Price>5.14</Price>
                  <Alternate>4.12</Alternate>
                  <Surcharge>0.03643</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A141109">
          <Name>Progestogens</Name>
          <Chemical ID="C1411091766" Page="83" Statim="Must">
            <Name>Medroxyprogesterone acetate</Name>
            <Formulation ID="F141109176605" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B14110917660501" SoleSupply="true">
                <Name>Provera</Name>
                <Pack ID="P274186" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.07</Subsidy>
                  <Price>2.07</Price>
                  <Alternate>2.07</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141109176606" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B14110917660601" SoleSupply="true">
                <Name>Provera</Name>
                <Pack ID="P261130" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.75</Subsidy>
                  <Price>13.75</Price>
                  <Alternate>13.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141109176607" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B14110917660701" SoleSupply="true">
                <Name>Provera</Name>
                <Pack ID="P274135" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.57</Subsidy>
                  <Price>7.57</Price>
                  <Alternate>7.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A141114">
          <Name>Progestogen and Oestrogen Combined Preparations</Name>
          <Chemical ID="C1411142050" Page="83" Statim="Must">
            <Name>Oestrogens with medroxyprogesterone</Name>
            <Formulation ID="F141114205003" Rank="1" Units="tab">
              <Name>Tab 625 mcg conjugated equine with 2.5 mg medroxyprogesterone acetate tab (28)</Name>
              <Brand ID="B14111420500301">
                <Name>Premia 2.5 Continuous</Name>
                <Pack ID="P474134" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>11.45</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.21607</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141114205004" Rank="1" Units="tab">
              <Name>Tab 625 mcg conjugated equine with 5 mg medroxyprogesterone acetate tab (28)</Name>
              <Brand ID="B14111420500401">
                <Name>Premia 5 Continuous</Name>
                <Pack ID="P474142" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>11.45</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.21607</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
          <Chemical ID="C1411142053" Page="83" Statim="Must">
            <Name>Oestradiol with levonorgestrel</Name>
            <Formulation ID="F141114205301" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg with 75 mcg levonorgestrel (36) and tab 2 mg oestradiol (48)</Name>
              <Brand ID="B14111420530101">
                <Name>Nuvelle</Name>
                <Pack ID="P772097" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>16.20</Subsidy>
                  <Price>16.20</Price>
                  <Alternate>16.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
          <Chemical ID="C1411142056" Page="83" Statim="Must">
            <Name>Oestradiol with norethisterone</Name>
            <Formulation ID="F141114205602" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg with 1 mg norethisterone acetate (10), and 2 mg oestradiol tab (12) and 1 mg oestradiol tab (6)</Name>
              <Brand ID="B14111420560201">
                <Name>Trisequens</Name>
                <Pack ID="P767700" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>10.00</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.16429</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141114205603" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg with 1 mg norethisterone acetate</Name>
              <Brand ID="B14111420560301">
                <Name>Kliogest</Name>
                <Pack ID="P780227" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>11.45</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.21607</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141114205604" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg with 0.5 mg norethisterone acetate</Name>
              <Brand ID="B14111420560401">
                <Name>Kliovance</Name>
                <Pack ID="P259772" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>11.45</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.21607</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
        </ATC3>
        <Request To="HealthPAC" For="Alternate Subsidy" Form="SA0312">
          <Title>
            <range>Hormone Replacement Therapy – Systemic</range>
          </Title>
          <Case When="Initial application">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <apply>
                <or/>
                <ci type="logical" class="Indication">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</ci>
                <ci type="logical" class="Indication">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</ci>
                <ci type="logical" class="Indication">hypertriglyceridaemia – documented evidence must be kept on file that triglyceride levels increased to at least 2 × normal triglyceride levels post oral oestrogens</ci>
              </apply>
            </math>
            <Applicant>obstetrician</Applicant>
            <Applicant>gynaecologist</Applicant>
            <Applicant>general practitioner</Applicant>
            <Applicant>general physician</Applicant>
            <Term Measure="year">5</Term>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>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.</p>
            </div>
          </Case>
          <Case When="Renewal" Form="SA0312">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
            </math>
            <Applicant>obstetrician</Applicant>
            <Applicant>gynaecologist</Applicant>
            <Applicant>general practitioner</Applicant>
            <Applicant>general physician</Applicant>
            <Term Measure="year">5</Term>
          </Case>
        </Request>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Guideline" id="PG0740A1411">
          <h4>Prescribing Guideline</h4>
          <p>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”.</p>
        </div>
      </ATC2>
      <ATC2 ID="A1412">
        <Name>Other Oestrogen Preparations</Name>
        <ATC3 ID="A141201">
          <Name>Other Oestrogen Preparations</Name>
          <Chemical ID="C1412011478" Page="83" Statim="Must">
            <Name>Ethinyloestradiol</Name>
            <Formulation ID="F141201147801" Rank="1" Units="tab" Weight="0.01">
              <Name>Tab 10 mcg</Name>
              <Brand ID="B14120114780101" SoleSupply="true">
                <Name>NZ Medical and Scientific</Name>
                <Pack ID="P264318" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.60</Subsidy>
                  <Price>17.60</Price>
                  <Alternate>17.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1412012784" Page="83" Statim="Must">
            <Name>Oestriol</Name>
            <Formulation ID="F141201278401" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B14120127840101">
                <Name>Ovestin</Name>
                <Pack ID="P767476" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.00</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>7.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1413">
        <Name>Other Progestogen Preparations</Name>
        <ATC3 ID="A141301">
          <Name>Other Progestogen Preparations</Name>
          <Chemical ID="C1413011441" Page="84">
            <Name>Dydrogesterone</Name>
            <Formulation ID="F141301144101" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B14130114410101">
                <Name>Duphaston</Name>
                <Pack ID="P279587">
                  <Quantity>28</Quantity>
                  <Subsidy>15.40</Subsidy>
                  <Price>16.75</Price>
                  <Alternate>15.40</Alternate>
                  <Surcharge>0.04821</Surcharge>
                </Pack>
                <Pack ID="P316970" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>27.50</Subsidy>
                  <Price>29.90</Price>
                  <Alternate>27.50</Alternate>
                  <Surcharge>0.04800</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1413011724" Page="84" Statim="Must">
            <Name>Levonorgestrel</Name>
            <Formulation ID="F141301172426" Rank="10" Units="dev">
              <Name>Levonorgestrel - releasing intrauterine system 20mcg/24 hr</Name>
              <Brand ID="B14130117242625">
                <Name>Mirena</Name>
                <Pack ID="P2013908" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>269.50</Subsidy>
                  <Price>269.50</Price>
                  <Alternate>269.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA0782">
                <Title>
                  <range>Levonorgestrel – releasing intrauterine system 20µg/24 hr</range>
                </Title>
                <Case When="Initial application" Category="No previous use">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has a clinical diagnosis of heavy menstrual bleeding</ci>
                      <ci type="logical" class="Trial">The patient has failed to respond to or is unable to tolerate other appropriate pharmaceutical therapies as per the Heavy Menstrual Bleeding Guidelines</ci>
                      <apply>
                        <or/>
                        <apply>
                          <lt/>
                          <ci type="real" class="test">serum ferritin level</ci>
                          <cn>16<mi> mg/l (within the last 12 months)</mi></cn>
                        </apply>
                        <apply>
                          <lt/>
                          <ci type="real" class="test">haemoglobin level</ci>
                          <cn>120<mi> g/l</mi></cn>
                        </apply>
                      </apply>
                    </apply>
                  </math>
                  <Applicant>relevant specialist</Applicant>
                  <Applicant>general practitioner</Applicant>
                  <Term Measure="month">6</Term>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Applications are not to be made for use in patients as contraception except where they meet the above criteria.</p>
                  </div>
                </Case>
                <Case When="Initial application" Category="Previous use before 1 October 2002">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient had a clinical diagnosis of heavy menstrual bleeding</ci>
                      <ci type="logical" class="Indication">Patient demonstrated clinical improvement of heavy menstrual bleeding</ci>
                      <ci type="text" class="details">Applicant to state date of the previous insertion</ci>
                    </apply>
                  </math>
                  <Applicant>relevant specialist</Applicant>
                  <Applicant>general practitioner</Applicant>
                  <Term Measure="month">6</Term>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Applications are not to be made for use in patients as contraception except where they meet the above criteria.</p>
                  </div>
                </Case>
                <Case When="Renewal" Form="SA0639 SA0782">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient demonstrated clinical improvement of heavy menstrual bleeding</ci>
                        <ci type="logical" class="Indication">Previous insertion was removed or expelled within 3 months of insertion</ci>
                      </apply>
                      <ci type="text" class="details">Applicant to state date of the previous insertion</ci>
                    </apply>
                  </math>
                  <Applicant>relevant specialist</Applicant>
                  <Applicant>general practitioner</Applicant>
                  <Term Measure="month">6</Term>
                </Case>
              </Request>
              <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0782"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1413011766" Page="84" Statim="Must">
            <Name>Medroxyprogesterone acetate</Name>
            <Formulation ID="F141301176601" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B14130117660101" SoleSupply="true">
                <Name>Provera</Name>
                <Pack ID="P261149" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>104.26</Subsidy>
                  <Price>104.26</Price>
                  <Alternate>104.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F141301176602" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B14130117660201" SoleSupply="true">
                <Name>Provera</Name>
                <Pack ID="P321567" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>78.06</Subsidy>
                  <Price>78.06</Price>
                  <Alternate>78.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1413011871" Page="84" Statim="Must">
            <Name>Norethisterone</Name>
            <Formulation ID="F141301187102" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B14130118710201" SoleSupply="true">
                <Name>Primolut N</Name>
                <Pack ID="P260886" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1414">
        <Name>Thyroid and Antithyroid Agents</Name>
        <ATC3 ID="A141401">
          <Name>Thyroid and Antithyroid Agents</Name>
          <Chemical ID="C1414011221" Page="85" Statim="Must">
            <Name>Carbimazole</Name>
            <Formulation ID="F141401122101" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B14140112210101">
                <Name>Neo-Mercazole</Name>
                <Pack ID="P594423" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.80</Subsidy>
                  <Price>10.80</Price>
                  <Alternate>10.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1414012263" Page="85" Statim="Must" Update="+Subsidy">
            <Name>Thyroxine</Name>
            <Formulation ID="F141401226301" Rank="1" Units="tab" Weight="0.05" Safety="Compounded">
              <Name>Tab 50 mcg</Name>
              <Brand ID="B14140122630101">
                <Name>Eltroxin</Name>
                <Pack ID="P250287" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>48.14</Subsidy>
                  <Price>48.14</Price>
                  <Alternate>48.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141401226302" Rank="1" Units="tab" Weight="0.1" Safety="Compounded">
              <Name>Tab 100 mcg</Name>
              <Brand ID="B14140122630201">
                <Name>Eltroxin</Name>
                <Pack ID="P250295" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>50.39</Subsidy>
                  <Price>50.39</Price>
                  <Alternate>50.39</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1416">
        <Name>Trophic Hormones</Name>
        <ATC3 ID="A141602">
          <Name>Growth Hormones</Name>
          <Chemical ID="C1416022510" Page="85">
            <Name>Growth hormone biosynthetic human</Name>
            <Formulation ID="F141602251009" Rank="4" Units="inj" Weight="16">
              <Name>Cartridge 16 iu per vial</Name>
              <Brand ID="B14160225100901">
                <Name>Genotropin</Name>
                <Pack ID="P689416" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>1600.00</Subsidy>
                  <Price>1600.00</Price>
                  <Alternate>1600.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2016281">
                  <Quantity>1</Quantity>
                  <Subsidy>320.00</Subsidy>
                  <Price>320.00</Price>
                  <Alternate>320.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141602251011" Rank="4" Units="inj" Weight="36">
              <Name>Cartridge 36 iu per vial</Name>
              <Brand ID="B14160225101101">
                <Name>Genotropin</Name>
                <Pack ID="P780235" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>3600.00</Subsidy>
                  <Price>3600.00</Price>
                  <Alternate>3600.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2016303">
                  <Quantity>1</Quantity>
                  <Subsidy>720.00</Subsidy>
                  <Price>720.00</Price>
                  <Alternate>720.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0755"/>
          </Chemical>
          <Chemical ID="C1416023784" Page="85">
            <Name>Recombinant human growth hormone</Name>
            <Formulation ID="F141602378425" Rank="4" Units="inj" Weight="5">
              <Name>Inj 5 mg</Name>
              <Brand ID="B14160237842525">
                <Name>Norditropin SimpleXx 5mg</Name>
                <Pack ID="P2105152" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>300.00</Subsidy>
                  <Price>300.00</Price>
                  <Alternate>300.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141602378426" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg</Name>
              <Brand ID="B14160237842625">
                <Name>Norditropin SimpleXx 10mg</Name>
                <Pack ID="P2105128" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>600.00</Subsidy>
                  <Price>600.00</Price>
                  <Alternate>600.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141602378427" Rank="4" Units="inj" Weight="15">
              <Name>Inj 15 mg</Name>
              <Brand ID="B14160237842725">
                <Name>Norditropin SimpleXx 15mg</Name>
                <Pack ID="P2105136" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>900.00</Subsidy>
                  <Price>900.00</Price>
                  <Alternate>900.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0755"/>
          </Chemical>
          <Request To="Growth Hormone Committee" For="Subsidy" Form="SA0755" Funding="Capped">
            <Title>
              <range>Growth Hormone Biosynthetic Human</range>
            </Title>
            <Case When="Initial application">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <ci type="logical" class="Indication">The patient is likely to benefit from  treatment</ci>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subject to budgetary cap. Applications will be considered and approved subject to funding availability.</p>
              <p>Applications to be made on the approved forms which are available from:</p>
              <p>Theresa Delany, Administrative Co-ordinator, Liggins Institute, Faculty of Medicine and Health Science,</p>
              <p>University of Auckland, Private Bag 92019, AUCKLAND</p>
              <p>Tel: (09) 373 7599 ext 86229, Fax: (09) 373 8763, Email: <a href="mailto:t.delany@auckland.ac.nz">t.delany@auckland.ac.nz</a></p>
            </div>
          </Request>
          <Rule Type="Dispensary" Attribute="Xpharm" NonPrinting="true"/>
        </ATC3>
        <ATC3 ID="A141603">
          <Name>GnRH Analogues</Name>
          <Chemical ID="C1416031009" Page="88">
            <Name>Leuprorelin</Name>
            <Formulation ID="F141603100901" Rank="4" Units="inj" Weight="3.75">
              <Name>Inj 3.75 mg</Name>
              <Brand ID="B14160310090101">
                <Name>Lucrin Depot</Name>
                <Pack ID="P313939" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>221.60</Subsidy>
                  <Price>221.60</Price>
                  <Alternate>221.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141603100902" Rank="4" Units="inj" Weight="11.25">
              <Name>Inj 11.25 mg</Name>
              <Brand ID="B14160310090201">
                <Name>Lucrin Depot</Name>
                <Pack ID="P494054" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>591.68</Subsidy>
                  <Price>591.68</Price>
                  <Alternate>591.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141603100925" Rank="4" Units="inj" Weight="7.5">
              <Name>Inj 7.5 mg</Name>
              <Brand ID="B14160310092525">
                <Name>Eligard</Name>
                <Pack ID="P2198525" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>184.90</Subsidy>
                  <Price>184.90</Price>
                  <Alternate>184.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141603100926" Rank="4" Units="inj" Weight="22.5">
              <Name>Inj 22.5 mg</Name>
              <Brand ID="B14160310092625">
                <Name>Eligard</Name>
                <Pack ID="P2198533" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>554.70</Subsidy>
                  <Price>554.70</Price>
                  <Alternate>554.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141603100927" Rank="4" Units="inj" Weight="30">
              <Name>Inj 30 mg</Name>
              <Brand ID="B14160310092725">
                <Name>Eligard</Name>
                <Pack ID="P2198541" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>739.60</Subsidy>
                  <Price>739.60</Price>
                  <Alternate>739.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141603100928" Rank="4" Units="inj" Weight="45">
              <Name>Inj 45 mg</Name>
              <Brand ID="B14160310092825">
                <Name>Eligard</Name>
                <Pack ID="P2245604" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>1109.40</Subsidy>
                  <Price>1109.40</Price>
                  <Alternate>1109.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0837">
              <Title>
                <range>Leuprorelin</range>
              </Title>
              <Case When="Initial application" Category="Breast cancer">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is a premenopausal woman with breast cancer</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Initial application" Category="Prostate cancer">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has advanced prostatic cancer</ci>
                </math>
                <Applicant>oncologist</Applicant>
                <Applicant>urologist</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Not to be prescribed with an anti-androgen except for a  period of three weeks,  if necessary, when GnRH analogue therapy is intiated</p>
                </div>
              </Case>
              <Case When="Initial application" Category="Endometriosis">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Endometriosis</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">6 months treatment with medroxyprogesterone acetate, danazol or dimetriose has  proven ineffective</ci>
                      <ci type="logical" class="Trial">The patient has failed to tolerate the treatment with medroxyprogesterone acetate, danazol or dimetriose for 6 months</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>gynaecologist</Applicant>
                <Term Measure="month">3</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>The maximum treatment period for a GnRH analogue is:</p>
                  <ul>
                    <li>3 months to assess whether surgery is appropriate</li>
                    <li>3 months for infertile patients after surgery</li>
                    <li>6 months for patients with symptoms of endometriosis After the first 3 months patients should be assessed to determine whether there has been a satisfactory response to the first 3 months treatment</li>
                  </ul>
                </div>
              </Case>
              <Case When="Initial application" Category="Precocious puberty" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patients is affected by gonadotropin dependent precocious puberty</ci>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Category="Breast or prostate cancer" Form="SA0837">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
              <Case When="Renewal" Category="Endometriosis" Form="SA0837">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Trial">There has been a satisfactory response to the first 3 months treatment</ci>
                      <ci type="logical" class="Trial">Surgery is inappropriate</ci>
                    </apply>
                    <ci type="logical" class="Indication">The first three months of therapy did not follow surgery for infertility</ci>
                  </apply>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="month">3</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
              <Case When="Renewal" Category="Precocious puberty" Form="SA0837">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0837"/>
          </Chemical>
          <Chemical ID="C1416032540" Page="87">
            <Name>Goserelin acetate</Name>
            <Formulation ID="F141603254001" Rank="4" Units="inj" Weight="3.6">
              <Name>Inj 3.6 mg</Name>
              <Brand ID="B14160325400101">
                <Name>Zoladex</Name>
                <Pack ID="P678066" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>221.60</Subsidy>
                  <Price>221.60</Price>
                  <Alternate>221.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141603254002" Rank="4" Units="inj" Weight="10.8">
              <Name>Inj 10.8 mg</Name>
              <Brand ID="B14160325400201">
                <Name>Zoladex</Name>
                <Pack ID="P362107" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>554.70</Subsidy>
                  <Price>554.70</Price>
                  <Alternate>554.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0839">
              <Title>
                <range>Goserelin</range>
              </Title>
              <Case When="Initial application" Category="Breast cancer">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is a premenopausal woman with breast cancer</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Initial application" Category="Prostate cancer">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Advanced prostatic cancer</ci>
                    <ci type="logical" class="Indication">Neoadjuvant or adjuvant treatment of locally advanced prostatic cancer</ci>
                  </apply>
                </math>
                <Applicant>oncologist</Applicant>
                <Applicant>urologist</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Not to be prescribed with an anti-androgen except for a  period of three weeks,  if necessary, when GnRH analogue therapy is intiated.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="Endometriosis">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Endometriosis</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">6 months treatment with medroxyprogesterone acetate, danazol or dimetriose has  proven ineffective</ci>
                      <ci type="logical" class="Trial">The patient has failed to tolerate the treatment with medroxyprogesterone acetate, danazol or dimetriose for 6 months</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>gynaecologist</Applicant>
                <Term Measure="month">3</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>The maximum treatment period for a GnRH analogue is:</p>
                  <ul>
                    <li>3 months to assess whether surgery is appropriate</li>
                    <li>3 months for infertile patients after surgery</li>
                    <li>6 months for patients with symptoms of endometriosis After the first 3 months patients should be assessed to determine whether there has been a satisfactory response to the first 3 months treatment.</li>
                  </ul>
                </div>
              </Case>
              <Case When="Initial application" Category="Precocious puberty" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is affected by gonadotropin dependent precocious puberty</ci>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Category="Breast or prostate cancer" Form="SA0836 SA0839">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
              <Case When="Renewal" Category="Endometriosis" Form="SA0836 SA0839">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Trial">There has been a satisfactory response to the first 3 months treatment</ci>
                      <ci type="logical" class="Trial">Surgery is inappropriate</ci>
                    </apply>
                    <ci type="logical" class="Indication">The first three months of therapy did not follow surgery for infertility</ci>
                  </apply>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="month">3</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
              <Case When="Renewal" Category="Precocious puberty" Form="SA0836 SA0839">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0839"/>
          </Chemical>
          <Chemical ID="C1416032679" Page="86">
            <Name>Buserelin acetate</Name>
            <Formulation ID="F141603267901" Rank="4" Units="inj" Weight="5.5">
              <Name>Inj 1 mg per ml, 5.5 ml</Name>
              <Brand ID="B14160326790101">
                <Name>Suprefact</Name>
                <Pack ID="P742082" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>195.00</Subsidy>
                  <Price>272.53</Price>
                  <Alternate>195.00</Alternate>
                  <Surcharge>38.76500</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0835">
              <Title>
                <range>Buserelin</range>
              </Title>
              <Case When="Initial application" Category="Breast cancer">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is a premenopausal woman with breast cancer</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Initial application" Category="Prostate cancer">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has advanced prostatic cancer</ci>
                </math>
                <Applicant>oncologist</Applicant>
                <Applicant>urologist</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Not to be prescribed with an anti-androgen except for a  period of three weeks,  if necessary, when GnRH analogue therapy is intiated.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="Endometriosis">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Endometriosis</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">6 months treatment with medroxyprogesterone acetate, danazol or dimetriose has  proven ineffective</ci>
                      <ci type="logical" class="Trial">The patient has failed to tolerate the treatment with medroxyprogesterone acetate, danazol or dimetriose for 6 months</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>gynaecologist</Applicant>
                <Term Measure="month">3</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>The maximum treatment period for a GnRH analogue is:</p>
                  <ul>
                    <li>3 months to assess whether surgery is appropriate</li>
                    <li>3 months for infertile patients after surgery</li>
                    <li>6 months for patients with symptoms of endometriosis After the first 3 months patients should be assessed to determine whether there has been a satisfactory response to the first 3 months treatment.</li>
                  </ul>
                </div>
              </Case>
              <Case When="Initial application" Category="Precocious puberty" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is affected by gonadotropin dependent precocious puberty</ci>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Category="Breast or prostate cancer" Form="SA0835">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
              <Case When="Renewal" Category="Endometriosis" Form="SA0835">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Trial">There has been a satisfactory response to the first 3 months treatment</ci>
                      <ci type="logical" class="Trial">Surgery is inappropriate</ci>
                    </apply>
                    <ci type="logical" class="Indication">The first three months of therapy did not follow surgery for infertility</ci>
                  </apply>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="month">3</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
              <Case When="Renewal" Category="Precocious puberty" Form="SA0835">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>paediatrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If a patient had an approval for any GnRH analogue prior to 1 July 2006 the applicant is required to submit a fresh initial application, not a renewal application.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0835"/>
          </Chemical>
          <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1419">
        <Name>Vasopressin Agonists</Name>
        <ATC3 ID="A141901">
          <Name>Vasopressin Agonists</Name>
          <Chemical ID="C1419012424" Page="89">
            <Name>Desmopressin</Name>
            <Formulation ID="F141901242402" Rank="3" Units="ml" Statim="May">
              <Name>Nasal drops 100 mcg per ml</Name>
              <Brand ID="B14190124240201">
                <Name>Minirin</Name>
                <Pack ID="P207489" OP="true" Specified="true">
                  <Quantity>2.5</Quantity>
                  <Subsidy>39.03</Subsidy>
                  <Price>39.03</Price>
                  <Alternate>39.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F141901242403" Rank="4" Units="inj" Weight="4">
              <Name>Inj 4 mcg per ml, 1 ml</Name>
              <Brand ID="B14190124240301">
                <Name>Minirin</Name>
                <Pack ID="P338192" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>67.18</Subsidy>
                  <Price>67.18</Price>
                  <Alternate>67.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA0090">
                <Title>
                  <range>Desmopressin – Inj 4 µg per ml, 1 ml</range>
                </Title>
                <Case When="Initial application">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The patient cannot use desmopressin nasal spray or nasal drops</ci>
                  </math>
                  <Applicant>relevant specialist</Applicant>
                  <Term Measure="year">2</Term>
                </Case>
                <Case When="Renewal" Form="SA0090">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                  </math>
                  <Applicant>relevant specialist</Applicant>
                  <Term Measure="year">2</Term>
                </Case>
              </Request>
              <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0090"/>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F141901242425" Rank="3" Units="ml" Weight="10" Statim="May">
              <Name>Nasal spray 10 mcg per dose</Name>
              <Brand ID="B14190124242525" SoleSupply="true">
                <Name>Desmopressin-PH&amp;T</Name>
                <Pack ID="P2198231" OP="true" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>30.30</Subsidy>
                  <Price>30.30</Price>
                  <Alternate>30.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1421">
        <Name>Other Endocrine Agents</Name>
        <ATC3 ID="A142101">
          <Name>Other Endocrine Agents</Name>
          <Chemical ID="C1421011314" Page="89">
            <Name>Clomiphene citrate</Name>
            <Formulation ID="F142101131401" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B14210113140102">
                <Name>Phenate</Name>
                <Pack ID="P262714" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>2.50</Subsidy>
                  <Price>2.50</Price>
                  <Alternate>2.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only a prescription for a female patient.</p>
            </div>
          </Chemical>
          <Chemical ID="C1421011372" Page="89">
            <Name>Danazol</Name>
            <Formulation ID="F142101137201" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B14210113720102">
                <Name>D-Zol</Name>
                <Pack ID="P752363" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>17.00</Subsidy>
                  <Price>17.00</Price>
                  <Alternate>17.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F142101137202" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B14210113720202">
                <Name>D-Zol</Name>
                <Pack ID="P752371" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1421011822" Page="89">
            <Name>Metyrapone</Name>
            <Formulation ID="F142101182201" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B14210118220101" SoleSupply="true">
                <Name>Metopirone</Name>
                <Pack ID="P388130" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>238.00</Subsidy>
                  <Price>238.00</Price>
                  <Alternate>238.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Hospital"/>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1421012816" Page="89">
            <Name>Gestrinone</Name>
            <Formulation ID="F142101281601" Rank="2" Units="cap" Weight="2.5">
              <Name>Cap 2.5 mg</Name>
              <Brand ID="B14210128160101">
                <Name>Dimetriose</Name>
                <Pack ID="P782726" OP="true" Specified="true">
                  <Quantity>8</Quantity>
                  <Subsidy>101.87</Subsidy>
                  <Price>101.87</Price>
                  <Alternate>101.87</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1421012865" Page="89">
            <Name>Cabergoline</Name>
            <Formulation ID="F142101286501" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 0.5 mg</Name>
              <Brand ID="B14210128650101">
                <Name>Dostinex</Name>
                <Pack ID="P275824">
                  <Quantity>2</Quantity>
                  <Subsidy>26.26</Subsidy>
                  <Price>26.26</Price>
                  <Alternate>26.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P275840" Specified="true">
                  <Quantity>8</Quantity>
                  <Subsidy>105.03</Subsidy>
                  <Price>105.03</Price>
                  <Alternate>105.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="2" Attribute="Rx" Waiver="Special" xlink:href="SA0175"/>
            </Formulation>
            <Request To="HealthPAC" For="Waiver of Rule" Form="SA0175">
              <Title>
                <range>Cabergoline</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has pathological hyperprolactinemia</ci>
                </math>
                <Applicant>obstetrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Applicant>gynaecologist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0175">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>obstetrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Applicant>gynaecologist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A16">
      <Name>Infections - Agents for Systemic Use</Name>
      <ATC2 ID="A1601">
        <Name>Anthelmintics</Name>
        <ATC3 ID="A160101">
          <Name>Anthelmintics</Name>
          <Chemical ID="C1601011762" Page="90">
            <Name>Mebendazole</Name>
            <Formulation ID="F160101176201" Rank="3" Units="ml" Weight="20">
              <Name>Oral liq 100 mg per 5 ml</Name>
              <Brand ID="B16010117620101">
                <Name>Vermox</Name>
                <Pack ID="P239852" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.18</Subsidy>
                  <Price>7.17</Price>
                  <Alternate>2.18</Alternate>
                  <Surcharge>0.33267</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160101176202" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16010117620202">
                <Name>Vermox</Name>
                <Pack ID="P258040" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>3.79</Subsidy>
                  <Price>7.59</Price>
                  <Alternate>3.79</Alternate>
                  <Surcharge>0.63333</Surcharge>
                </Pack>
                <Pack ID="P556009">
                  <Quantity>2</Quantity>
                  <Subsidy>1.26</Subsidy>
                  <Price>3.44</Price>
                  <Alternate>1.26</Alternate>
                  <Surcharge>1.09000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1601012068" Page="90">
            <Name>Pyrantel embonate</Name>
            <Formulation ID="F160101206801" Rank="1" Units="tab" Weight="125">
              <Name>Tab 125 mg</Name>
              <Brand ID="B16010120680101">
                <Name>Combantrin</Name>
                <Pack ID="P252905" Specified="true">
                  <Quantity>18</Quantity>
                  <Subsidy>5.31</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>5.31</Alternate>
                  <Surcharge>0.09389</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160101206802" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16010120680201">
                <Name>Combantrin</Name>
                <Pack ID="P252913" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>3.76</Subsidy>
                  <Price>4.95</Price>
                  <Alternate>3.76</Alternate>
                  <Surcharge>0.19833</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1603">
        <Name>Antibacterials</Name>
        <ATC3 ID="A160301">
          <Name>Cephalosporins and Cephamycins</Name>
          <Chemical ID="C1603011081" Page="91">
            <Name>Cefuroxime axetil</Name>
            <Formulation ID="F160301108102" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16030110810201">
                <Name>Zinnat</Name>
                <Pack ID="P682810" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>98.75</Subsidy>
                  <Price>98.75</Price>
                  <Alternate>98.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only if prescribed for prophylaxis of endocarditis and the prescription is endorsed accordingly.</p>
            </div>
          </Chemical>
          <Chemical ID="C1603011228" Page="90">
            <Name>Cefaclor monohydrate</Name>
            <Formulation ID="F160301122801" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B16030112280126" SoleSupply="true">
                <Name>Ranbaxy-Cefaclor</Name>
                <Pack ID="P2149389" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>28.90</Subsidy>
                  <Price>28.90</Price>
                  <Alternate>28.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160301122802" Rank="3" Units="ml" Weight="25">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030112280226" SoleSupply="true">
                <Name>Ranbaxy-Cefaclor</Name>
                <Pack ID="P471674" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.92</Subsidy>
                  <Price>3.92</Price>
                  <Alternate>3.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603011231" Page="90">
            <Name>Cefoxitin sodium</Name>
            <Formulation ID="F160301123101" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030112310125">
                <Name>Mayne</Name>
                <Pack ID="P299456" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>48.68</Subsidy>
                  <Price>48.68</Price>
                  <Alternate>48.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.</p>
            </div>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C1603011232" Page="91">
            <Name>Ceftriaxone sodium</Name>
            <Formulation ID="F160301123202" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030112320226" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P436461" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>3.99</Subsidy>
                  <Price>3.99</Price>
                  <Alternate>3.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160301123203" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030112320327" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P436445" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>5.40</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subsidised only if prescribed for a dialysis or cystic fibrosis patient, or the treatment of confirmed ciprofloxacin-resistant gonorrhoea, or the treatment of suspected meningitis in patients who have a known allergy to penicillin, and the prescription or PSO is endorsed accordingly.</p>
            </div>
            <Rule Type="FormMax" Value="5" Attribute="PSO"/>
          </Chemical>
          <Chemical ID="C1603011233" Page="91">
            <Name>Cefuroxime sodium</Name>
            <Formulation ID="F160301123301" Rank="4" Units="inj" Weight="250">
              <Name>Inj 250 mg</Name>
              <Brand ID="B16030112330125">
                <Name>Mayne</Name>
                <Pack ID="P2034115" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>20.97</Subsidy>
                  <Price>20.97</Price>
                  <Alternate>20.97</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="3" Attribute="Rx" Waiver="SubRxF"/>
            </Formulation>
            <Formulation ID="F160301123302" Rank="4" Units="inj" Weight="750">
              <Name>Inj 750 mg</Name>
              <Brand ID="B16030112330201">
                <Name>Zinacef</Name>
                <Pack ID="P276340" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>24.00</Subsidy>
                  <Price>24.00</Price>
                  <Alternate>24.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16030112330225">
                <Name>Mayne</Name>
                <Pack ID="P2034123" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>56.47</Subsidy>
                  <Price>56.47</Price>
                  <Alternate>56.47</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="1" Attribute="Rx" Waiver="SubRxF"/>
            </Formulation>
            <Formulation ID="F160301123303" Rank="4" Units="inj" Weight="1500">
              <Name>Inj 1.5 g</Name>
              <Brand ID="B16030112330301">
                <Name>Zinacef</Name>
                <Pack ID="P276359" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>12.36</Subsidy>
                  <Price>12.36</Price>
                  <Alternate>12.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16030112330325">
                <Name>Mayne</Name>
                <Pack ID="P2034107" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>123.55</Subsidy>
                  <Price>123.55</Price>
                  <Alternate>123.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Hospital"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.</p>
              </div>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C1603011236" Page="90">
            <Name>Cefazolin sodium</Name>
            <Formulation ID="F160301123601" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030112360127" SoleSupply="true">
                <Name>m-Cefazolin</Name>
                <Pack ID="P2204363" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>13.60</Subsidy>
                  <Price>13.60</Price>
                  <Alternate>13.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160301123602" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030112360227" SoleSupply="true">
                <Name>m-Cefazolin</Name>
                <Pack ID="P2204371" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>18.60</Subsidy>
                  <Price>18.60</Price>
                  <Alternate>18.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.</p>
            </div>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A160304">
          <Name>Macrolides</Name>
          <Chemical ID="C1603041178" Page="91">
            <Name>Azithromycin</Name>
            <Formulation ID="F160304117801" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16030411780101">
                <Name>Zithromax</Name>
                <Pack ID="P204218" OP="true" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>15.53</Subsidy>
                  <Price>15.53</Price>
                  <Alternate>15.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16030411780125">
                <Name>Arrow-Azithromycin</Name>
                <Pack ID="P2262339" OP="true" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>9.90</Subsidy>
                  <Price>9.90</Price>
                  <Alternate>9.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="2" Attribute="Rx"/>
            <Rule Type="FormMax" Value="4" Attribute="PSO"/>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subsidised only if prescribed for patients with uncomplicated urethritis or cervicitis proven or presumed to be due to chlamydia trachomatis and their sexual contacts and prescription or PSO is endorsed accordingly.</p>
            </div>
          </Chemical>
          <Chemical ID="C1603042790" Page="92">
            <Name>Roxithromycin</Name>
            <Formulation ID="F160304279001" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg</Name>
              <Brand ID="B16030427900126" SoleSupply="true">
                <Name>Arrow-Roxithromycin</Name>
                <Pack ID="P2246236" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160304279002" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B16030427900226" SoleSupply="true">
                <Name>Arrow-Roxithromycin</Name>
                <Pack ID="P2246228" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>18.00</Subsidy>
                  <Price>18.00</Price>
                  <Alternate>18.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603042809" Page="91">
            <Name>Clarithromycin</Name>
            <Formulation ID="F160304280901" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16030428090125">
                <Name>Clarac</Name>
                <Pack ID="P2201801" Specified="true">
                  <Quantity>14</Quantity>
                  <Subsidy>9.85</Subsidy>
                  <Price>9.85</Price>
                  <Alternate>9.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160304280902" Rank="3" Units="ml" Weight="25">
              <Name>Grans for oral liquid 125 mg per 5 ml</Name>
              <Brand ID="B16030428090201" SoleSupply="true">
                <Name>Klacid</Name>
                <Pack ID="P244368" Specified="true">
                  <Quantity>70</Quantity>
                  <Subsidy>23.12</Subsidy>
                  <Price>23.12</Price>
                  <Alternate>23.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
            <Request To="HealthPAC" For="Waiver of Rule" Form="SA0657">
              <Title>
                <range>Clarithromycin</range>
              </Title>
              <Case When="Initial application" Category="Helicobacter pylori infections">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Eradication of Helicobacter pylori in patient with proven infection</ci>
                    <ci type="logical" class="Indication">Peptic ulcer disease proven by endoscopy</ci>
                  </apply>
                </math>
                <Applicant>general practitioner</Applicant>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="month">6</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Maximum of two prescriptions (two courses) per patient.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="Mycobacterial infections">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Mycobacterium Avium Intracellulare Complex infections in patient with AIDS</ci>
                    <ci type="logical" class="Indication">Atypical and drug-resistant mycobacterial infection</ci>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Prophylaxis against disseminated Mycobacterium Avium Intracellulare Complex infection</ci>
                      <ci type="logical" class="Indication">HIV infection</ci>
                      <apply>
                        <leq/>
                        <ci type="real" class="test">CD4 count</ci>
                        <cn>50<mi> cells/mm³</mi></cn>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>respiratory specialist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>paediatrician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Category="Mycobacterial infections" Form="SA0070 SA0394 SA0443 SA0657">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>respiratory specialist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>paediatrician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="FormWt" Value="500" Attribute="Rx" Waiver="Special" xlink:href="SA0657"/>
          </Chemical>
          <Chemical ID="C1603046026" Page="92">
            <Name>Erythromycin ethyl succinate</Name>
            <Formulation ID="F160304602601" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16030460260102">
                <Name>E-Mycin</Name>
                <Pack ID="P243094" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.95</Subsidy>
                  <Price>18.95</Price>
                  <Alternate>18.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160304602603" Rank="3" Units="ml" Weight="40">
              <Name>Grans for oral liq 200 mg per 5 ml</Name>
              <Brand ID="B16030460260302" SoleSupply="true">
                <Name>E-Mycin</Name>
                <Pack ID="P243078" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.75</Subsidy>
                  <Price>3.75</Price>
                  <Alternate>3.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
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            <Formulation ID="F160304602605" Rank="3" Units="ml" Weight="80">
              <Name>Grans for oral liq 400 mg per 5 ml</Name>
              <Brand ID="B16030460260502" SoleSupply="true">
                <Name>E-Mycin</Name>
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              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
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          <Chemical ID="C1603046027" Page="92">
            <Name>Erythromycin stearate</Name>
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              <Name>Tab 500 mg</Name>
              <Brand ID="B16030460270202">
                <Name>ERA</Name>
                <Pack ID="P205311" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>29.90</Subsidy>
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                  <Surcharge>0.14680</Surcharge>
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            </Formulation>
            <Formulation ID="F160304602703" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16030460270301">
                <Name>ERA</Name>
                <Pack ID="P205273" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>14.95</Subsidy>
                  <Price>22.29</Price>
                  <Alternate>14.95</Alternate>
                  <Surcharge>0.07340</Surcharge>
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              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
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          <Chemical ID="C1603046028" Page="92">
            <Name>Erythromycin lactobionate</Name>
            <Formulation ID="F160304602801" Rank="4" Units="inj" Weight="300">
              <Name>Inj 300 mg</Name>
              <Brand ID="B16030460280101">
                <Name>Mayne</Name>
                <Pack ID="P788449" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>70.97</Subsidy>
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                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160304602802" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1g</Name>
              <Brand ID="B16030460280202">
                <Name>ERA</Name>
                <Pack ID="P253162" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>6.50</Subsidy>
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                  <Alternate>6.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
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        <ATC3 ID="A160307">
          <Name>Penicillins</Name>
          <Chemical ID="C1603071070" Page="93">
            <Name>Amoxycillin clavulanate</Name>
            <Formulation ID="F160307107001" Rank="1" Units="tab" Weight="500">
              <Name>Tab amoxycillin 500 mg with potassium clavulanate 125 mg</Name>
              <Brand ID="B16030710700101">
                <Name>Augmentin</Name>
                <Pack ID="P2106248" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>6.40</Subsidy>
                  <Price>6.40</Price>
                  <Alternate>6.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
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              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
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            <Formulation ID="F160307107002" Rank="3" Units="ml">
              <Name>Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml</Name>
              <Brand ID="B16030710700201">
                <Name>Augmentin</Name>
                <Pack ID="P319473" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.75</Subsidy>
                  <Price>2.75</Price>
                  <Alternate>2.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
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              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
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            <Formulation ID="F160307107003" Rank="3" Units="ml">
              <Name>Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml</Name>
              <Brand ID="B16030710700301">
                <Name>Augmentin</Name>
                <Pack ID="P319481" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.75</Subsidy>
                  <Price>4.75</Price>
                  <Alternate>4.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
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              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
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          <Chemical ID="C1603071072" Page="92">
            <Name>Amoxycillin</Name>
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              <Name>Cap 250 mg</Name>
              <Brand ID="B16030710720205" SoleSupply="true">
                <Name>Apo-Amoxi</Name>
                <Pack ID="P383015" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>17.30</Subsidy>
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              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
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            <Formulation ID="F160307107203" Rank="2" Units="cap" Weight="500">
              <Name>Cap 500 mg</Name>
              <Brand ID="B16030710720305" SoleSupply="true">
                <Name>Apo-Amoxi</Name>
                <Pack ID="P2149710" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>27.25</Subsidy>
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                  <Alternate>27.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307107204" Rank="3" Units="ml" Weight="100">
              <Name>Drops 125 mg per 1.25 ml</Name>
              <Brand ID="B16030710720401">
                <Name>Amoxil Paediatric Drops</Name>
                <Pack ID="P206512" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>7.25</Subsidy>
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                  <Alternate>7.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307107205" Rank="3" Units="ml">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030710720526" SoleSupply="true">
                <Name>Ranbaxy Amoxicillin</Name>
                <Pack ID="P2225891" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.00</Subsidy>
                  <Price>1.00</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
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              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
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            <Formulation ID="F160307107206" Rank="3" Units="ml">
              <Name>Grans for oral liq 250 mg per 5 ml</Name>
              <Brand ID="B16030710720626" SoleSupply="true">
                <Name>Ranbaxy Amoxicillin</Name>
                <Pack ID="P2225905" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.27</Subsidy>
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              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
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            <Formulation ID="F160307107208" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030710720801" SoleSupply="true">
                <Name>Ibiamox</Name>
                <Pack ID="P588326" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>11.00</Subsidy>
                  <Price>11.00</Price>
                  <Alternate>11.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
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              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
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            <Formulation ID="F160307107209" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030710720901" SoleSupply="true">
                <Name>Ibiamox</Name>
                <Pack ID="P588318" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.23</Subsidy>
                  <Price>7.23</Price>
                  <Alternate>7.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307107210" Rank="4" Units="inj" Weight="250">
              <Name>Inj 250 mg</Name>
              <Brand ID="B16030710721001" SoleSupply="true">
                <Name>Ibiamox</Name>
                <Pack ID="P588296" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>6.32</Subsidy>
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                  <Alternate>6.32</Alternate>
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          <Chemical ID="C1603071120" Page="93">
            <Name>Benzathine benzylpenicillin</Name>
            <Formulation ID="F160307112002" Rank="4" Units="inj" Weight="1200000">
              <Name>Inj 1.2 mega u per 2 ml</Name>
              <Brand ID="B16030711200202">
                <Name>Bicillin</Name>
                <Pack ID="P282561">
                  <Quantity>10</Quantity>
                  <Subsidy>160.00</Subsidy>
                  <Price>160.00</Price>
                  <Alternate>160.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
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                <Pack ID="P493252" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>16.00</Subsidy>
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                  <Surcharge>0.00000</Surcharge>
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              <Brand ID="B16030711200225">
                <Name>Bicillin LA</Name>
                <Pack ID="P2258072" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>200.00</Subsidy>
                  <Price>200.00</Price>
                  <Alternate>200.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307112025" Rank="4" Units="inj">
              <Name>Injection 1.2 mega u</Name>
              <Brand ID="B16030711202525" ToBeDelisted="2008-04-01">
                <Name>Pan Benzathine Benzylpenicillin</Name>
                <Pack ID="P2237385" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>160.00</Subsidy>
                  <Price>160.00</Price>
                  <Alternate>160.00</Alternate>
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          </Chemical>
          <Chemical ID="C1603071124" Page="93">
            <Name>Dicloxacillin</Name>
            <Formulation ID="F160307112401" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B16030711240101">
                <Name>Diclocil</Name>
                <Pack ID="P472794" Specified="true">
                  <Quantity>24</Quantity>
                  <Subsidy>2.47</Subsidy>
                  <Price>4.35</Price>
                  <Alternate>2.47</Alternate>
                  <Surcharge>0.07833</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160307112402" Rank="2" Units="cap" Weight="500">
              <Name>Cap 500 mg</Name>
              <Brand ID="B16030711240201">
                <Name>Diclocil</Name>
                <Pack ID="P472808" Specified="true">
                  <Quantity>24</Quantity>
                  <Subsidy>3.83</Subsidy>
                  <Price>8.65</Price>
                  <Alternate>3.83</Alternate>
                  <Surcharge>0.20083</Surcharge>
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              </Brand>
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            <Formulation ID="F160307112404" Rank="3" Units="ml" Weight="25">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030711240401" ToBeDelisted="2008-01-01">
                <Name>Diclocil</Name>
                <Pack ID="P472824" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.55</Subsidy>
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                  <Surcharge>0.00550</Surcharge>
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            <Formulation ID="F160307112405" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030711240501" ToBeDelisted="2008-01-01">
                <Name>Diclocil</Name>
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                  <Quantity>5</Quantity>
                  <Subsidy>5.45</Subsidy>
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                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307112406" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030711240601" ToBeDelisted="2008-01-01">
                <Name>Diclocil</Name>
                <Pack ID="P472840" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.54</Subsidy>
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                  <Alternate>7.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
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          <Chemical ID="C1603071136" Page="93">
            <Name>Benzylpenicillin sodium (penicillin G)</Name>
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              <Name>Inj 1 mega u</Name>
              <Brand ID="B16030711360101">
                <Name>Novartis</Name>
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                  <Quantity>10</Quantity>
                  <Subsidy>6.99</Subsidy>
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          <Chemical ID="C1603071512" Page="93">
            <Name>Flucloxacillin sodium</Name>
            <Formulation ID="F160307151201" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B16030715120104" SoleSupply="true">
                <Name>Staphlex</Name>
                <Pack ID="P2139006" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>18.50</Subsidy>
                  <Price>18.50</Price>
                  <Alternate>18.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307151202" Rank="2" Units="cap" Weight="500">
              <Name>Cap 500 mg</Name>
              <Brand ID="B16030715120204" SoleSupply="true">
                <Name>Staphlex</Name>
                <Pack ID="P2139014" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>57.90</Subsidy>
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                  <Alternate>57.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307151203" Rank="3" Units="ml">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030715120325" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2072270" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.05</Subsidy>
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            <Formulation ID="F160307151204" Rank="3" Units="ml">
              <Name>Grans for oral liq 250 mg per 5 ml</Name>
              <Brand ID="B16030715120425" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2072262" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.72</Subsidy>
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              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
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            <Formulation ID="F160307151205" Rank="4" Units="inj" Weight="250">
              <Name>Inj 250 mg</Name>
              <Brand ID="B16030715120502">
                <Name>Flucloxin</Name>
                <Pack ID="P742260" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>4.66</Subsidy>
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            <Formulation ID="F160307151206" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030715120602">
                <Name>Flucloxin</Name>
                <Pack ID="P742279" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>5.45</Subsidy>
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                  <Alternate>5.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
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              </Brand>
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            <Formulation ID="F160307151207" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030715120702">
                <Name>Flucloxin</Name>
                <Pack ID="P742287" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.54</Subsidy>
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                  <Surcharge>0.00000</Surcharge>
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          <Chemical ID="C1603071970" Page="93" Update="+Subsidy">
            <Name>Phenoxymethylpenicillin (Penicillin V)</Name>
            <Formulation ID="F160307197025" Rank="2" Units="cap" Weight="250">
              <Name>Cap potassium salt 250 mg</Name>
              <Brand ID="B16030719702525" SoleSupply="true">
                <Name>Cilicaine VK</Name>
                <Pack ID="P2048841" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>4.29</Subsidy>
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                  <Alternate>4.29</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307197026" Rank="2" Units="cap" Weight="500">
              <Name>Cap potassium salt 500 mg</Name>
              <Brand ID="B16030719702625" SoleSupply="true">
                <Name>Cilicaine VK</Name>
                <Pack ID="P2048868" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.15</Subsidy>
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                  <Alternate>8.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307197027" Rank="3" Units="ml" Weight="125">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
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                <Name>AFT</Name>
                <Pack ID="P2029219" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.68</Subsidy>
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                  <Alternate>1.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
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            <Formulation ID="F160307197028" Rank="3" Units="ml" Weight="250">
              <Name>Grans for oral liq 250 mg per 5 ml</Name>
              <Brand ID="B16030719702825">
                <Name>AFT</Name>
                <Pack ID="P2029227" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.82</Subsidy>
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              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
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          <Chemical ID="C1603072046" Page="93">
            <Name>Procaine penicillin</Name>
            <Formulation ID="F160307204602" Rank="4" Units="inj" Weight="1500000">
              <Name>Inj 1.5 mega u</Name>
              <Brand ID="B16030720460201" SoleSupply="true">
                <Name>Cilicaine</Name>
                <Pack ID="P252735" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>47.60</Subsidy>
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                  <Alternate>47.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
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              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
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        <ATC3 ID="A160310">
          <Name>Tetracyclines</Name>
          <Chemical ID="C1603101828" Page="93" Statim="Must">
            <Name>Minocycline hydrochloride</Name>
            <Formulation ID="F160310182801" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B16031018280101">
                <Name>Mino-tabs</Name>
                <Pack ID="P472212" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>5.79</Subsidy>
                  <Price>12.05</Price>
                  <Alternate>5.79</Alternate>
                  <Surcharge>0.10433</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160310182802" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B16031018280201">
                <Name>Minomycin</Name>
                <Pack ID="P690805" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>19.32</Subsidy>
                  <Price>52.04</Price>
                  <Alternate>19.32</Alternate>
                  <Surcharge>0.32720</Surcharge>
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            </Formulation>
          </Chemical>
          <Chemical ID="C1603102529" Page="93" Statim="Must">
            <Name>Doxycycline hydrochloride</Name>
            <Formulation ID="F160310252901" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B16031025290102">
                <Name>Doxy-50</Name>
                <Pack ID="P427802" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.90</Subsidy>
                  <Price>6.00</Price>
                  <Alternate>2.90</Alternate>
                  <Surcharge>0.10333</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160310252904" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16031025290401">
                <Name>Doxine</Name>
                <Pack ID="P380571" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>8.10</Subsidy>
                  <Price>8.10</Price>
                  <Alternate>8.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A160313">
          <Name>Other Antibiotics</Name>
          <Chemical ID="C1603131303" Page="94">
            <Name>Clindamycin</Name>
            <Formulation ID="F160313130301" Rank="2" Units="cap" Weight="150">
              <Name>Cap hydrochloride 150 mg</Name>
              <Brand ID="B16031313030101" SoleSupply="true">
                <Name>Dalacin C</Name>
                <Pack ID="P781282" Specified="true">
                  <Quantity>16</Quantity>
                  <Subsidy>11.39</Subsidy>
                  <Price>11.39</Price>
                  <Alternate>11.39</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="3" Attribute="Rx" Waiver="SpecEnd"/>
            </Formulation>
            <Formulation ID="F160313130303" Rank="4" Units="inj" Weight="150">
              <Name>Inj phosphate 150 mg per ml, 4 ml</Name>
              <Brand ID="B16031313030301" SoleSupply="true">
                <Name>Dalacin C</Name>
                <Pack ID="P210439" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>19.45</Subsidy>
                  <Price>19.45</Price>
                  <Alternate>19.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603131346" Page="94" Update="+Subsidy">
            <Name>Colistin sulphomethate</Name>
            <Formulation ID="F160313134601" Rank="4" Units="inj" Weight="150">
              <Name>Inj 150 mg</Name>
              <Brand ID="B16031313460125">
                <Name>Colistin-Link</Name>
                <Pack ID="P2245418" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>65.00</Subsidy>
                  <Price>65.00</Price>
                  <Alternate>65.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.</p>
            </div>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C1603131361" Page="94" Statim="Must">
            <Name>Co-trimoxazole</Name>
            <Formulation ID="F160313136102" Rank="1" Units="tab" Weight="80">
              <Name>Tab trimethoprim 80 mg and sulphamethoxazole 400 mg</Name>
              <Brand ID="B16031313610201" SoleSupply="true">
                <Name>Trisul</Name>
                <Pack ID="P283363" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>17.00</Subsidy>
                  <Price>17.00</Price>
                  <Alternate>17.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160313136104" Rank="3" Units="ml">
              <Name>Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml</Name>
              <Brand ID="B16031313610401" SoleSupply="true">
                <Name>Trisul</Name>
                <Pack ID="P203513" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>5.90</Subsidy>
                  <Price>5.90</Price>
                  <Alternate>5.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603131546" Page="94" Update="+Subsidy">
            <Name>Fusidic acid</Name>
            <Formulation ID="F160313154601" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16031315460101">
                <Name>Fucidin</Name>
                <Pack ID="P731706" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>43.67</Subsidy>
                  <Price>43.67</Price>
                  <Alternate>43.67</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Hospital"/>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F160313154603" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg sodium fusidate per 10 ml</Name>
              <Brand ID="B16031315460301">
                <Name>Fucidin</Name>
                <Pack ID="P283169" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>12.87</Subsidy>
                  <Price>17.80</Price>
                  <Alternate>12.87</Alternate>
                  <Surcharge>4.93000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Hospital"/>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603131554" Page="94">
            <Name>Gentamicin sulphate</Name>
            <Formulation ID="F160313155401" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B16031315540101">
                <Name>Mayne</Name>
                <Pack ID="P619272" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>8.56</Subsidy>
                  <Price>8.56</Price>
                  <Alternate>8.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed for a dialysis or cystic fibrosis patient or for prophylaxis of endocarditis and the prescription is endorsed accordingly.</p>
              </div>
            </Formulation>
            <Formulation ID="F160313155403" Rank="4" Units="inj" Weight="80">
              <Name>Inj 40 mg per ml, 2 ml</Name>
              <Brand ID="B16031315540301" SoleSupply="true">
                <Name>Pfizer</Name>
                <Pack ID="P771740" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>4.56</Subsidy>
                  <Price>4.56</Price>
                  <Alternate>4.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed for a dialysis or cystic fibrosis patient or for prophylaxis of endocarditis and the prescription is endorsed accordingly.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603132274" Page="94">
            <Name>Tobramycin</Name>
            <Formulation ID="F160313227402" Rank="4" Units="inj" Weight="80">
              <Name>Inj 40 mg per ml, 2 ml</Name>
              <Brand ID="B16031322740203">
                <Name>Mayne</Name>
                <Pack ID="P794805" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>27.50</Subsidy>
                  <Price>27.50</Price>
                  <Alternate>27.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.</p>
              </div>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603132300" Page="94" Statim="Must">
            <Name>Trimethoprim</Name>
            <Formulation ID="F160313230002" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B16031323000202" SoleSupply="true">
                <Name>TMP</Name>
                <Pack ID="P648507" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>7.90</Subsidy>
                  <Price>7.90</Price>
                  <Alternate>7.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603132314" Page="95">
            <Name>Vancomycin hydrochloride</Name>
            <Formulation ID="F160313231403" Rank="4" Units="inj" Weight="500">
              <Name>Inj 50 mg per ml, 10 ml</Name>
              <Brand ID="B16031323140325" SoleSupply="true">
                <Name>Pacific</Name>
                <Pack ID="P2195267" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>4.70</Subsidy>
                  <Price>4.70</Price>
                  <Alternate>4.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Only if prescribed for a dialysis or cystic fibrosis patient or in the treatment of pseudomembranous colitis or for prophylaxis of endocarditis and the prescription is endorsed accordingly.</p>
            </div>
          </Chemical>
          <Chemical ID="C1603132819" Page="94">
            <Name>Ciprofloxacin</Name>
            <Formulation ID="F160313281901" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16031328190125" SoleSupply="true">
                <Name>Cipflox</Name>
                <Pack ID="P2104997" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.10</Subsidy>
                  <Price>5.10</Price>
                  <Alternate>5.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160313281902" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16031328190225" SoleSupply="true">
                <Name>Cipflox</Name>
                <Pack ID="P2105004" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>8.31</Subsidy>
                  <Price>8.31</Price>
                  <Alternate>8.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160313281903" Rank="1" Units="tab" Weight="750">
              <Name>Tab 750 mg</Name>
              <Brand ID="B16031328190325" SoleSupply="true">
                <Name>Cipflox</Name>
                <Pack ID="P2105012" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>19.30</Subsidy>
                  <Price>19.30</Price>
                  <Alternate>19.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p xlink:type="simple" xlink:href="A1004">For topical antibiotics, refer to DERMATOLOGICALS</p>
          </div>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1004">For topical antibacterials, refer to DERMATOLOGICALS</p>
        </div>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A310301">For anti-infective eye preparations, refer to SENSORY ORGANS</p>
        </div>
      </ATC2>
      <ATC2 ID="A1604">
        <Name>Antifungals</Name>
        <ATC3 ID="A160401">
          <Name>Antifungals</Name>
          <Chemical ID="C1604011696" Page="95">
            <Name>Ketoconazole</Name>
            <Formulation ID="F160401169601" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16040116960101">
                <Name>Nizoral</Name>
                <Pack ID="P283347" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>38.12</Subsidy>
                  <Price>38.12</Price>
                  <Alternate>38.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1604011881" Page="95">
            <Name>Nystatin</Name>
            <Formulation ID="F160401188125" Rank="1" Units="tab" Weight="500000">
              <Name>Tab 500,000 u</Name>
              <Brand ID="B16040118812502" S29="true" SoleSupply="true">
                <Name>Nilstat</Name>
                <Pack ID="P770752" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>9.60</Subsidy>
                  <Price>9.60</Price>
                  <Alternate>9.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160401188126" Rank="2" Units="cap" Weight="500000">
              <Name>Cap 500,000 u</Name>
              <Brand ID="B16040118812601" SoleSupply="true">
                <Name>Nilstat</Name>
                <Pack ID="P648345" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>11.64</Subsidy>
                  <Price>11.64</Price>
                  <Alternate>11.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1604012709" Page="95">
            <Name>Fluconazole</Name>
            <Formulation ID="F160401270901" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B16040127090125" SoleSupply="true">
                <Name>Pacific</Name>
                <Pack ID="P2149060" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>14.50</Subsidy>
                  <Price>14.50</Price>
                  <Alternate>14.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160401270902" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B16040127090225" SoleSupply="true">
                <Name>Pacific</Name>
                <Pack ID="P2149079" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>3.90</Subsidy>
                  <Price>3.90</Price>
                  <Alternate>3.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160401270903" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16040127090325" SoleSupply="true">
                <Name>Pacific</Name>
                <Pack ID="P2149052" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>41.50</Subsidy>
                  <Price>41.50</Price>
                  <Alternate>41.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C1604012803" Page="95">
            <Name>Itraconazole</Name>
            <Formulation ID="F160401280301" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B16040128030101" SoleSupply="true">
                <Name>Sporanox</Name>
                <Pack ID="P784850" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>23.70</Subsidy>
                  <Price>23.70</Price>
                  <Alternate>23.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C1604012830" Page="95">
            <Name>Terbinafine</Name>
            <Formulation ID="F160401283001" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16040128300126" SoleSupply="true">
                <Name>Apo-Terbinafine</Name>
                <Pack ID="P2213206" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>50.00</Subsidy>
                  <Price>50.00</Price>
                  <Alternate>50.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1007">For topical antifungals refer to DERMATOLOGICALS</p>
        </div>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1310">For topical antifungals refer to GENITO URINARY</p>
        </div>
      </ATC2>
      <ATC2 ID="A1610">
        <Name>Antimalarials</Name>
        <ATC3 ID="A161001">
          <Name>Antimalarials</Name>
          <Chemical ID="C1610011625" Page="95" Statim="Must">
            <Name>Hydroxychloroquine sulphate</Name>
            <Formulation ID="F161001162501" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16100116250101">
                <Name>Plaquenil</Name>
                <Pack ID="P208264" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>31.09</Subsidy>
                  <Price>31.09</Price>
                  <Alternate>31.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1613">
        <Name>Antitrichomonal Agents</Name>
        <ATC3 ID="A161301">
          <Name>Antitrichomonal Agents</Name>
          <Chemical ID="C1613011820" Page="95">
            <Name>Metronidazole</Name>
            <Formulation ID="F161301182001" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16130118200102">
                <Name>Trichozole</Name>
                <Pack ID="P282251" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F161301182002" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16130118200202">
                <Name>Trichozole</Name>
                <Pack ID="P309923" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.50</Subsidy>
                  <Price>17.50</Price>
                  <Alternate>17.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161301182003" Rank="3" Units="ml" Weight="40">
              <Name>Oral liq benzoate 200 mg per 5 ml</Name>
              <Brand ID="B16130118200301">
                <Name>Flagyl-S</Name>
                <Pack ID="P729426" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161301182004" Rank="5" Units="supp" Weight="1000">
              <Name>Suppos 1 g</Name>
              <Brand ID="B16130118200401">
                <Name>Flagyl</Name>
                <Pack ID="P250538" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>33.31</Subsidy>
                  <Price>33.31</Price>
                  <Alternate>33.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161301182005" Rank="5" Units="supp" Weight="500">
              <Name>Suppos 500 mg</Name>
              <Brand ID="B16130118200501">
                <Name>Flagyl</Name>
                <Pack ID="P250511" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>24.48</Subsidy>
                  <Price>24.48</Price>
                  <Alternate>24.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1613011906" Page="95">
            <Name>Ornidazole</Name>
            <Formulation ID="F161301190601" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16130119060101">
                <Name>Tiberal</Name>
                <Pack ID="P303070" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>12.38</Subsidy>
                  <Price>12.38</Price>
                  <Alternate>12.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1616">
        <Name>Antituberculotics and Antileprotics</Name>
        <ATC3 ID="A161601">
          <Name>Antituberculotics and Antileprotics</Name>
          <Chemical ID="C1616011374" Page="96">
            <Name>Dapsone</Name>
            <Formulation ID="F161601137401" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16160113740101">
                <Name>Dapsone</Name>
                <Pack ID="P712914" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>110.00</Subsidy>
                  <Price>110.00</Price>
                  <Alternate>110.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161601137425" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B16160113742525">
                <Name>Dapsone</Name>
                <Pack ID="P2212226" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>95.00</Subsidy>
                  <Price>95.00</Price>
                  <Alternate>95.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C1616011679" Page="96" Statim="Must">
            <Name>Isoniazid</Name>
            <Formulation ID="F161601167901" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16160116790101">
                <Name>PSM</Name>
                <Pack ID="P267473" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>20.50</Subsidy>
                  <Price>20.50</Price>
                  <Alternate>20.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161601167902" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg with rifampicin 150 mg</Name>
              <Brand ID="B16160116790201">
                <Name>Rifinah</Name>
                <Pack ID="P251232" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>90.04</Subsidy>
                  <Price>90.04</Price>
                  <Alternate>90.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161601167903" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg with rifampicin 300 mg</Name>
              <Brand ID="B16160116790301">
                <Name>Rifinah</Name>
                <Pack ID="P251240" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>179.57</Subsidy>
                  <Price>179.57</Price>
                  <Alternate>179.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C1616012069" Page="96" Statim="Must">
            <Name>Pyrazinamide</Name>
            <Formulation ID="F161601206901" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16160120690125" S29="true">
                <Name>AFT-Pyrazinamide</Name>
                <Pack ID="P2142023" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>59.00</Subsidy>
                  <Price>59.00</Price>
                  <Alternate>59.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C1616012088" Page="96" Statim="Must">
            <Name>Rifampicin</Name>
            <Formulation ID="F161601208802" Rank="1" Units="tab" Weight="600">
              <Name>Tab 600 mg</Name>
              <Brand ID="B16160120880201">
                <Name>Rifadin</Name>
                <Pack ID="P251224" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>114.40</Subsidy>
                  <Price>114.40</Price>
                  <Alternate>114.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161601208803" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B16160120880301">
                <Name>Rifadin</Name>
                <Pack ID="P251186" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>58.66</Subsidy>
                  <Price>58.66</Price>
                  <Alternate>58.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161601208804" Rank="2" Units="cap" Weight="300">
              <Name>Cap 300 mg</Name>
              <Brand ID="B16160120880401">
                <Name>Rifadin</Name>
                <Pack ID="P251194" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>122.36</Subsidy>
                  <Price>122.36</Price>
                  <Alternate>122.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161601208805" Rank="3" Units="ml">
              <Name>Oral liq 100 mg per 5 ml</Name>
              <Brand ID="B16160120880501">
                <Name>Rifadin</Name>
                <Pack ID="P251208" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>12.66</Subsidy>
                  <Price>12.66</Price>
                  <Alternate>12.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C1616012854" Page="96" Statim="Must">
            <Name>Rifabutin</Name>
            <Formulation ID="F161601285401" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B16160128540101" SoleSupply="true">
                <Name>Mycobutin</Name>
                <Pack ID="P219924" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>213.19</Subsidy>
                  <Price>213.19</Price>
                  <Alternate>213.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C1616013865" Page="96">
            <Name>Ethambutol hydrochloride</Name>
            <Formulation ID="F161601386525" Rank="1" Units="tab" Weight="56">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16160138652525" S29="true" SoleSupply="true">
                <Name>Myambutol</Name>
                <Pack ID="P2244969" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>10.98</Subsidy>
                  <Price>10.98</Price>
                  <Alternate>10.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p>Note: There is no co-payment charge for all pharmaceuticals listed in the Antituberculotics and Antileprotics group regardless of immigration status.</p>
          </div>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1619">
        <Name>Antivirals</Name>
        <ATC3 ID="A161901">
          <Name>First Episode Genital Herpes</Name>
          <Chemical ID="C1619012483" Page="98" Statim="Must">
            <Name>Aciclovir</Name>
            <Formulation ID="F161901248306" Rank="1" Units="tab" Weight="200">
              <Name>Tab dispersible 200 mg</Name>
              <Brand ID="B16190124830602">
                <Name>Lovir</Name>
                <Pack ID="P471704" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>1.98</Subsidy>
                  <Price>1.98</Price>
                  <Alternate>1.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161901248325" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16190124832525" ToBeDelisted="2008-09-01">
                <Name>Apo-Acyclovir</Name>
                <Pack ID="P2000970" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.92</Subsidy>
                  <Price>7.92</Price>
                  <Alternate>7.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A161902">
          <Name>Recurrent Episodes of Genital Herpes</Name>
          <Chemical ID="C1619022483" Page="99" Statim="Must">
            <Name>Aciclovir</Name>
            <Formulation ID="F161902248302" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16190224830225" ToBeDelisted="2008-09-01">
                <Name>Apo-Acyclovir</Name>
                <Pack ID="P2243997" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.86</Subsidy>
                  <Price>11.86</Price>
                  <Alternate>11.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161902248307" Rank="1" Units="tab" Weight="400">
              <Name>Tab dispersible 400 mg</Name>
              <Brand ID="B16190224830702">
                <Name>Lovir</Name>
                <Pack ID="P471690" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>6.64</Subsidy>
                  <Price>6.64</Price>
                  <Alternate>6.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A161903">
          <Name>Acute Herpes Zoster</Name>
          <Chemical ID="C1619032483" Page="99" Statim="Must">
            <Name>Aciclovir</Name>
            <Formulation ID="F161903248308" Rank="1" Units="tab" Weight="800">
              <Name>Tab dispersible 800 mg</Name>
              <Brand ID="B16190324830810">
                <Name>Lovir</Name>
                <Pack ID="P471712" Specified="true">
                  <Quantity>35</Quantity>
                  <Subsidy>7.38</Subsidy>
                  <Price>7.38</Price>
                  <Alternate>7.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16190324830825">
                <Name>Acicvir</Name>
                <Pack ID="P438227">
                  <Quantity>35</Quantity>
                  <Subsidy>9.35</Subsidy>
                  <Price>9.35</Price>
                  <Alternate>9.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A161905">
          <Name>Hepatitis B Treatment</Name>
          <Chemical ID="C1619052900" Page="97">
            <Name>Lamivudine</Name>
            <Formulation ID="F161905290002" Rank="3" Units="ml">
              <Name>Oral liq 5 mg per ml</Name>
              <Brand ID="B16190529000225">
                <Name>Zeffix</Name>
                <Pack ID="P307696" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>90.00</Subsidy>
                  <Price>90.00</Price>
                  <Alternate>90.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161905290025" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100mg</Name>
              <Brand ID="B16190529002525">
                <Name>Zeffix</Name>
                <Pack ID="P307645" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>143.00</Subsidy>
                  <Price>143.00</Price>
                  <Alternate>143.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0832">
              <Title>
                <range>Lamivudine</range>
              </Title>
              <Case When="Initial application" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">HBsAg positive for more than 6 months</ci>
                        <ci type="logical" class="Indication">HBeAg positive or HBV DNA positive defined as &gt; 100,000 copies per ml by quantitative PCR at a reference laboratory</ci>
                        <ci type="logical" class="Indication">ALT greater than twice upper limit of normal or bridging fibrosis or cirrhosis (Metavir stage 3 or 4 or equivalent) on liver histology clinical/radiological evidence of cirrhosis</ci>
                      </apply>
                      <ci type="logical" class="Indication">HBV DNA positive cirrhosis prior to liver transplantation</ci>
                      <ci type="logical" class="Indication">HBsAg positive and have had a liver, kidney, heart, lung or bone marrow transplant</ci>
                      <ci type="logical" class="Indication">Hepatitis B surface antigen positive (HbsAg) patient who is receiving chemotherapy for a malignancy, or who has received such treatment within the previous two months</ci>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Trial">No continuing alcohol abuse or intravenous drug use</ci>
                      <ci type="logical" class="Indication">Not coinfected with HCV or HDV</ci>
                      <ci type="logical" class="Indication">Neither ALT nor AST greater than 10 times upper limit of normal</ci>
                      <ci type="logical" class="Trial">No history of hypersensitivity to lamivudine</ci>
                      <ci type="logical" class="Trial">No previous lamivudine therapy with genotypically proven lamivudine resistance</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>paediatrician</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Form="SA0538 SA0772 SA0832">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <mi class="heading">Renewal for patients who have maintained continuous treatment and response to lamivudine</mi>
                    <apply>
                      <and/>
                      <ci type="logical" class="Trial">Have maintained continuous treatment with lamivudine</ci>
                      <ci type="logical" class="Indication">Most recent test result shows continuing biochemical response (normal ALT)</ci>
                      <ci type="logical" class="Indication">HBV DNA &lt;100,00 copies per ml by quantitative PCR at a reference laboratory</ci>
                    </apply>
                    <mi class="heading">Renewal when given in combination with adefovir dipivoxil for patients with cirrhosis and resistance to lamivudine</mi>
                    <apply>
                      <and/>
                      <ci type="logical" class="Trial">Lamivudine to be used in combination with adefovir dipivoxil</ci>
                      <ci type="logical" class="Indication">Patient is cirrhotic</ci>
                      <mi class="heading">Documented resistance to lamivudine, defined as:</mi>
                      <ci type="logical" class="Trial">Patient has raised serum ALT (&gt; 1 × ULN)</ci>
                      <ci type="logical" class="Indication">Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir</ci>
                      <ci type="logical" class="Trial">Detection of M204I or M204V mutation</ci>
                    </apply>
                    <mi class="heading">Renewal when given in combination with adefovir dipivoxil for patients with resistance to adefovir dipivoxil</mi>
                    <apply>
                      <and/>
                      <ci type="logical" class="Trial">Lamivudine to be used in combination with adefovir dipivoxil</ci>
                      <mi class="heading">Documented resistance to adefovir, defined as:</mi>
                      <ci type="logical" class="Indication">Patient has raised serum ALT (&gt; 1 × ULN)</ci>
                      <ci type="logical" class="Trial">Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir</ci>
                      <ci type="logical" class="Indication">Detection of N236T or A181T/V mutation</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>paediatrician</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0832"/>
          </Chemical>
          <Chemical ID="C1619053855" Page="97">
            <Name>Adefovir dipivoxil</Name>
            <Formulation ID="F161905385525" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B16190538552525">
                <Name>Hepsera</Name>
                <Pack ID="P2219395" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>670.00</Subsidy>
                  <Price>670.00</Price>
                  <Alternate>670.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0829">
              <Title>
                <range>Adefovir dipivoxil</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Trial">Patient has confirmed Hepatitis B infection (HBsAg+)</ci>
                    <mi class="heading">Documented resistance to lamivudine, defined as:</mi>
                    <ci type="logical" class="Trial">Patient has raised serum ALT (&gt; 1 × ULN)</ci>
                    <ci type="logical" class="Trial">Patient has HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir</ci>
                    <ci type="logical" class="Trial">Detection of M204I or M204V mutation</ci>
                    <apply>
                      <or/>
                      <apply>
                        <and/>
                        <ci type="logical" class="Trial">Patient is cirrhotic</ci>
                        <ci type="logical" class="Trial">adefovir dipivoxil to be used in combination with lamivudine</ci>
                      </apply>
                      <apply>
                        <and/>
                        <ci type="logical" class="Trial">Patient is not cirrhotic</ci>
                        <ci type="logical" class="Trial">adefovir dipivoxil to be used as monotherapy</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Form="SA0829">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">In the opinion of the treating physician, treatment remains appropriate and patient is benefiting from treatment</ci>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Lamivudine should be added to adefovir dipivoxil if a patient develops documented resistance to adefovir dipivoxil, defined as:</p>
                <ol style="list-style-type: lower-roman">
                  <li>raised serum ALT (&gt; 1 × ULN); and</li>
                  <li>HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and</li>
                  <li>Detection of N236T or A181T/V mutation.</li>
                </ol>
                <p>Adefovir dipivoxil should be stopped 6 months following HBeAg seroconversion for patients who were HBeAg+ prior to commencing adefovir dipivoxil.</p>
                <p>The recommended dose of adefovir dipivoxil is no more than 10mg daily.</p>
                <p>In patients with renal insufficiency adefovir dipivoxil dose should be reduced in accordance with the datasheet guidelines.</p>
                <p>Adefovir dipivoxil should be avoided in pregnant women and children.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0829"/>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A310301">For eye preparations refer to Eye Preparations, Anti-Infective Preparations</p>
        </div>
      </ATC2>
      <ATC2 ID="A1620">
        <Name>Antiretrovirals</Name>
        <ATC3 ID="A162001">
          <Name>Non-nucleosides Reverse Transcriptase Inhibitors</Name>
          <Chemical ID="C1620011170" Page="101">
            <Name>Nevirapine</Name>
            <Formulation ID="F162001117001" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16200111700101">
                <Name>Viramune</Name>
                <Pack ID="P486329" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>319.80</Subsidy>
                  <Price>319.80</Price>
                  <Alternate>319.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162001117025" Rank="3" Units="ml" Weight="10">
              <Name>Oral suspension 10 mg per ml</Name>
              <Brand ID="B16200111702525" SoleSupply="true">
                <Name>Viramune Suspension</Name>
                <Pack ID="P2014947" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>134.55</Subsidy>
                  <Price>134.55</Price>
                  <Alternate>134.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620013732" Page="101">
            <Name>Efavirenz</Name>
            <Formulation ID="F162001373225" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B16200137322525">
                <Name>Stocrin</Name>
                <Pack ID="P2014548" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>158.33</Subsidy>
                  <Price>158.33</Price>
                  <Alternate>158.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162001373226" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B16200137322625">
                <Name>Stocrin</Name>
                <Pack ID="P2014556" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>158.33</Subsidy>
                  <Price>158.33</Price>
                  <Alternate>158.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162001373227" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16200137322725">
                <Name>Stocrin</Name>
                <Pack ID="P2014564" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>474.99</Subsidy>
                  <Price>474.99</Price>
                  <Alternate>474.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162001373228" Rank="1" Units="tab">
              <Name>Tab 600 mg</Name>
              <Brand ID="B16200137322825">
                <Name>Stocrin</Name>
                <Pack ID="P2060094" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>474.99</Subsidy>
                  <Price>474.99</Price>
                  <Alternate>474.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A162003">
          <Name>Nucleosides Reverse Transcriptase Inhibitors</Name>
          <Chemical ID="C1620031109" Page="101">
            <Name>Stavudine [d4T]</Name>
            <Formulation ID="F162003110902" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B16200311090201">
                <Name>Zerit</Name>
                <Pack ID="P429392" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>317.10</Subsidy>
                  <Price>317.10</Price>
                  <Alternate>317.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003110903" Rank="2" Units="cap" Weight="30">
              <Name>Cap 30 mg</Name>
              <Brand ID="B16200311090301">
                <Name>Zerit</Name>
                <Pack ID="P429376" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>377.80</Subsidy>
                  <Price>377.80</Price>
                  <Alternate>377.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003110904" Rank="2" Units="cap" Weight="40">
              <Name>Cap 40 mg</Name>
              <Brand ID="B16200311090401">
                <Name>Zerit</Name>
                <Pack ID="P429368" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>503.80</Subsidy>
                  <Price>503.80</Price>
                  <Alternate>503.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003110905" Rank="3" Units="ml">
              <Name>Powder for oral soln 1 mg per ml</Name>
              <Brand ID="B16200311090501">
                <Name>Zerit</Name>
                <Pack ID="P429414" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>100.76</Subsidy>
                  <Price>100.76</Price>
                  <Alternate>100.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620031223" Page="101">
            <Name>Zidovudine [AZT] with lamivudine</Name>
            <Formulation ID="F162003122301" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg with lamivudine 150 mg</Name>
              <Brand ID="B16200312230101">
                <Name>Combivir</Name>
                <Pack ID="P307963" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>667.20</Subsidy>
                  <Price>667.20</Price>
                  <Alternate>667.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Combivir counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority.</p>
            </div>
          </Chemical>
          <Chemical ID="C1620032464" Page="101">
            <Name>Zidovudine [AZT]</Name>
            <Formulation ID="F162003246401" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B16200324640101">
                <Name>Retrovir</Name>
                <Pack ID="P552666" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>290.00</Subsidy>
                  <Price>290.00</Price>
                  <Alternate>290.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003246402" Rank="3" Units="ml">
              <Name>Oral liq 10 mg per ml</Name>
              <Brand ID="B16200324640201">
                <Name>Retrovir</Name>
                <Pack ID="P818682" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>58.00</Subsidy>
                  <Price>58.00</Price>
                  <Alternate>58.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620032791" Page="101">
            <Name>Didanosine [DDI]</Name>
            <Formulation ID="F162003279125" Rank="2" Units="cap" Weight="125">
              <Name>Cap 125 mg</Name>
              <Brand ID="B16200327912525" SoleSupply="true">
                <Name>Videx EC</Name>
                <Pack ID="P2091461" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>115.05</Subsidy>
                  <Price>115.05</Price>
                  <Alternate>115.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003279126" Rank="2" Units="cap" Weight="400">
              <Name>Cap 400 mg</Name>
              <Brand ID="B16200327912625" SoleSupply="true">
                <Name>Videx EC</Name>
                <Pack ID="P2091518" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>368.16</Subsidy>
                  <Price>368.16</Price>
                  <Alternate>368.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003279127" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16200327912725" SoleSupply="true">
                <Name>Videx EC</Name>
                <Pack ID="P2091488" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>184.08</Subsidy>
                  <Price>184.08</Price>
                  <Alternate>184.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003279128" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B16200327912825" SoleSupply="true">
                <Name>Videx EC</Name>
                <Pack ID="P2091496" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>230.10</Subsidy>
                  <Price>230.10</Price>
                  <Alternate>230.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620032900" Page="101">
            <Name>Lamivudine</Name>
            <Formulation ID="F162003290001" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg</Name>
              <Brand ID="B16200329000101">
                <Name>3TC</Name>
                <Pack ID="P399485" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>307.20</Subsidy>
                  <Price>307.20</Price>
                  <Alternate>307.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003290026" Rank="3" Units="ml">
              <Name>Oral liq 10 mg per ml</Name>
              <Brand ID="B16200329002601">
                <Name>3TC</Name>
                <Pack ID="P474320" OP="true" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>100.00</Subsidy>
                  <Price>100.00</Price>
                  <Alternate>100.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620033731" Page="101">
            <Name>Abacavir sulphate</Name>
            <Formulation ID="F162003373125" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B16200337312525">
                <Name>Ziagen</Name>
                <Pack ID="P378038" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>458.00</Subsidy>
                  <Price>458.00</Price>
                  <Alternate>458.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162003373126" Rank="3" Units="ml">
              <Name>Oral liq 20 mg per ml</Name>
              <Brand ID="B16200337312625">
                <Name>Ziagen</Name>
                <Pack ID="P2014718" OP="true" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>100.00</Subsidy>
                  <Price>100.00</Price>
                  <Alternate>100.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620033863" Page="101">
            <Name>Abacavir sulphate with lamivudine</Name>
            <Formulation ID="F162003386325" Rank="1" Units="tab">
              <Name>Tab 600 mg with lamivudine 300 mg</Name>
              <Brand ID="B16200338632525">
                <Name>Kivexa</Name>
                <Pack ID="P2243571" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>630.00</Subsidy>
                  <Price>630.00</Price>
                  <Alternate>630.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Note: Kivexa counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority.</p>
            </div>
          </Chemical>
          <Chemical ID="C1620033866" Page="101">
            <Name>Emtricitabine</Name>
            <Formulation ID="F162003386625" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16200338662525">
                <Name>Emtriva</Name>
                <Pack ID="P2250063" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>307.20</Subsidy>
                  <Price>307.20</Price>
                  <Alternate>307.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620033867" Page="101">
            <Name>Tenofovir disoproxil fumarate</Name>
            <Formulation ID="F162003386725" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B16200338672525">
                <Name>Viread</Name>
                <Pack ID="P2222159" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>531.00</Subsidy>
                  <Price>531.00</Price>
                  <Alternate>531.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A162005">
          <Name>Protease Inhibitors</Name>
          <Chemical ID="C1620051077" Page="102">
            <Name>Saquinavir</Name>
            <Formulation ID="F162005107701" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16200510770101">
                <Name>Invirase</Name>
                <Pack ID="P369659" Specified="true">
                  <Quantity>270</Quantity>
                  <Subsidy>519.75</Subsidy>
                  <Price>519.75</Price>
                  <Alternate>519.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16200510770125">
                <Name>Fortovase</Name>
                <Pack ID="P378275" Specified="true">
                  <Quantity>180</Quantity>
                  <Subsidy>271.00</Subsidy>
                  <Price>271.00</Price>
                  <Alternate>271.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620051086" Page="102">
            <Name>Ritonavir</Name>
            <Formulation ID="F162005108601" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B16200510860101">
                <Name>Norvir</Name>
                <Pack ID="P426202" Specified="true">
                  <Quantity>168</Quantity>
                  <Subsidy>242.55</Subsidy>
                  <Price>242.55</Price>
                  <Alternate>242.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005108602" Rank="3" Units="ml" Weight="80">
              <Name>Oral liq 80 mg per ml</Name>
              <Brand ID="B16200510860201">
                <Name>Norvir</Name>
                <Pack ID="P490555" OP="true" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>277.28</Subsidy>
                  <Price>277.28</Price>
                  <Alternate>277.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620051102" Page="101">
            <Name>Indinavir</Name>
            <Formulation ID="F162005110201" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16200511020101">
                <Name>Crixivan</Name>
                <Pack ID="P354619" Specified="true">
                  <Quantity>360</Quantity>
                  <Subsidy>519.75</Subsidy>
                  <Price>519.75</Price>
                  <Alternate>519.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005110202" Rank="2" Units="cap" Weight="400">
              <Name>Cap 400 mg</Name>
              <Brand ID="B16200511020201">
                <Name>Crixivan</Name>
                <Pack ID="P354627" Specified="true">
                  <Quantity>180</Quantity>
                  <Subsidy>519.75</Subsidy>
                  <Price>519.75</Price>
                  <Alternate>519.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620051172" Page="102">
            <Name>Nelfinavir</Name>
            <Formulation ID="F162005117201" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16200511720101">
                <Name>Viracept</Name>
                <Pack ID="P485357" Specified="true">
                  <Quantity>270</Quantity>
                  <Subsidy>600.00</Subsidy>
                  <Price>600.00</Price>
                  <Alternate>600.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005117202" Rank="3" Units="g" Weight="50">
              <Name>Powder 50 mg per g</Name>
              <Brand ID="B16200511720201">
                <Name>Viracept</Name>
                <Pack ID="P485365" OP="true" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>55.44</Subsidy>
                  <Price>55.44</Price>
                  <Alternate>55.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620053798" Page="102">
            <Name>Lopinavir with ritonavir</Name>
            <Formulation ID="F162005379825" Rank="2" Units="cap">
              <Name>Cap 133.3 mg with ritonavir 33.3 mg</Name>
              <Brand ID="B16200537982525" ToBeDelisted="2008-02-01">
                <Name>Kaletra</Name>
                <Pack ID="P2146959" Specified="true">
                  <Quantity>180</Quantity>
                  <Subsidy>735.00</Subsidy>
                  <Price>735.00</Price>
                  <Alternate>735.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005379826" Rank="3" Units="ml">
              <Name>Oral liq 80 mg with ritonavir 20 mg per ml</Name>
              <Brand ID="B16200537982625">
                <Name>Kaletra</Name>
                <Pack ID="P2153904" OP="true" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>735.00</Subsidy>
                  <Price>735.00</Price>
                  <Alternate>735.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005379827" Rank="1" Units="tab">
              <Name>Tab 200 mg with ritonavir 50 mg</Name>
              <Brand ID="B16200537982725">
                <Name>Kaletra </Name>
                <Pack ID="P2243350" Specified="true">
                  <Quantity>120</Quantity>
                  <Subsidy>735.00</Subsidy>
                  <Price>735.00</Price>
                  <Alternate>735.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
          <Chemical ID="C1620053861" Page="101">
            <Name>Atazanavir sulphate</Name>
            <Formulation ID="F162005386125" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B16200538612525">
                <Name>Reyataz</Name>
                <Pack ID="P2234319" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>568.34</Subsidy>
                  <Price>568.34</Price>
                  <Alternate>568.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005386126" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16200538612625">
                <Name>Reyataz</Name>
                <Pack ID="P2234327" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>757.79</Subsidy>
                  <Price>757.79</Price>
                  <Alternate>757.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0779"/>
          </Chemical>
        </ATC3>
        <Request To="HealthPAC" For="Subsidy" Form="SA0779" Confidential="true">
          <Title>
            <range>Antiretrovirals</range>
          </Title>
          <Case When="Initial application" Category="Confirmed HIV/AIDS" Break="after">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <apply>
                <and/>
                <ci type="logical" class="Indication">Confirmed HIV infection</ci>
                <apply>
                  <or/>
                  <ci type="logical" class="Indication">Symptomatic patient</ci>
                  <ci type="logical" class="Indication">Patient aged 12 months and under</ci>
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient aged 1 to 5 years</ci>
                    <apply>
                      <or/>
                      <apply>
                        <lt/>
                        <ci type="real" class="test">CD4 counts</ci>
                        <cn>1000<mi> cells/mm³</mi></cn>
                      </apply>
                      <apply>
                        <lt/>
                        <ci type="real" class="test">CD4 counts</ci>
                        <apply>
                          <times/>
                          <cn>0.25</cn>
                          <ci type="real" class="test">total lymphocyte count</ci>
                        </apply>
                      </apply>
                      <apply>
                        <gt/>
                        <ci type="real" class="test">Viral load counts</ci>
                        <cn>100000<mi> copies per ml</mi></cn>
                      </apply>
                    </apply>
                  </apply>
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient aged 6 years and over</ci>
                    <apply>
                      <lt/>
                      <ci type="real" class="test">CD4 counts</ci>
                      <cn>350<mi> cells/mm³</mi></cn>
                    </apply>
                  </apply>
                </apply>
              </apply>
            </math>
            <Applicant>named specialist</Applicant>
            <Term Measure="patient's lifetime"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or saquinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals.</p>
            </div>
          </Case>
          <Case When="Initial application" Category="Percutaneous exposure">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <ci type="logical" class="Indication">The patient has percutaneous exposure to blood known to be HIV positive</ci>
            </math>
            <Applicant>named specialist</Applicant>
            <Term Measure="week">6</Term>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or saquinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals.</p>
            </div>
          </Case>
          <Case When="Initial application" Category="Prevention of maternal transmission">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <apply>
                <or/>
                <ci type="logical" class="Indication">Prevention of maternal foetal transmission</ci>
                <ci type="logical" class="Indication">Treatment of the newborn for up to eight weeks</ci>
              </apply>
            </math>
            <Applicant>named specialist</Applicant>
            <Term Measure="year">1</Term>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or saquinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals.</p>
              <p>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.</p>
            </div>
          </Case>
          <Case When="Renewal" Category="Confirmed HIV/AIDS" Form="SA0556 SA0575 SA0754 SA0779">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
            </math>
            <Applicant>named specialist</Applicant>
            <Term Measure="patient's lifetime"/>
          </Case>
        </Request>
        <Rule Type="Dispensary" Attribute="HP1" NonPrinting="true"/>
      </ATC2>
      <ATC2 ID="A1621">
        <Name>Antiretrovirals - Additional Therapies</Name>
        <ATC3 ID="A162103">
          <Name>HIV Fusion Inhibitors</Name>
          <Chemical ID="C1621033859" Page="102">
            <Name>Enfuvirtide</Name>
            <Formulation ID="F162103385925" Rank="10" Units="txpk" Weight="90">
              <Name>Powder for inj 90 mg per ml x 60</Name>
              <Brand ID="B16210338592525">
                <Name>Fuzeon</Name>
                <Pack ID="P2186500" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>2380.00</Subsidy>
                  <Price>2380.00</Price>
                  <Alternate>2380.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0845">
              <Title>
                <range>Enfuvirtide</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Confirmed HIV infection</ci>
                    <ci type="logical" class="Indication">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</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient has evidence of HIV replication, despite ongoing therapy</ci>
                      <ci type="logical" class="Indication">Patient has treatment-limiting toxicity to previous antiretroviral agents</ci>
                    </apply>
                    <ci type="logical" class="Indication">Previous treatment with 3 different antiretroviral regimens has failed</ci>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Previous treatment with a non-nucleoside reverse transcriptase inhibitor has failed</ci>
                      <ci type="logical" class="Indication">Previous treatment with a nucleoside reverse transcriptase inhibitor has failed</ci>
                      <ci type="logical" class="Indication">Previous treatment with a protease inhibitor has failed</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>named specialist</Applicant>
                <Term Measure="month">3</Term>
              </Case>
              <Case When="Renewal" Form="SA0845">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Trial">Evidence of at least a 10 fold reduction in viral load at 12</ci>
                    <ci type="logical" class="Trial">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                  </apply>
                </math>
                <Applicant>named specialist</Applicant>
                <Term Measure="year">1</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0845"/>
          </Chemical>
        </ATC3>
        <Rule Type="Dispensary" Attribute="HP1" NonPrinting="true"/>
      </ATC2>
      <ATC2 ID="A1622">
        <Name>Urinary Tract Infections</Name>
        <ATC3 ID="A162201">
          <Name>Urinary Tract Infections</Name>
          <Chemical ID="C1622011594" Page="102" Statim="Must">
            <Name>Hexamine hippurate</Name>
            <Formulation ID="F162201159401" Rank="1" Units="tab">
              <Name>Tab 1 g</Name>
              <Brand ID="B16220115940101">
                <Name>Hiprex</Name>
                <Pack ID="P209538" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.40</Subsidy>
                  <Price>36.99</Price>
                  <Alternate>18.40</Alternate>
                  <Surcharge>0.18590</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1622011867" Page="102" Statim="Must">
            <Name>Nitrofurantoin</Name>
            <Formulation ID="F162201186701" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B16220118670101">
                <Name>Nifuran</Name>
                <Pack ID="P254738" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.20</Subsidy>
                  <Price>17.20</Price>
                  <Alternate>17.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201186702" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16220118670201">
                <Name>Nifuran</Name>
                <Pack ID="P254754" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>29.40</Subsidy>
                  <Price>29.40</Price>
                  <Alternate>29.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1622011874" Page="102">
            <Name>Norfloxacin</Name>
            <Formulation ID="F162201187401" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16220118740125" SoleSupply="true">
                <Name>Arrow-Norfloxacin</Name>
                <Pack ID="P2204398" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>32.14</Subsidy>
                  <Price>32.14</Price>
                  <Alternate>32.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="6" Attribute="Rx" Waiver="SpecEnd"/>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1625">
        <Name>Vaccines</Name>
        <ATC3 ID="A162501">
          <Name>Influenza vaccine</Name>
          <Chemical ID="C1625013804" Page="103">
            <Name>Influenza vaccine</Name>
            <Formulation ID="F162501380425" Rank="4" Units="inj">
              <Name>Inj</Name>
              <Brand ID="B16250138042526" ToBeDelisted="2008-01-01">
                <Name>Fluvax</Name>
                <Pack ID="P788031" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>7.50</Subsidy>
                  <Price>7.50</Price>
                  <Alternate>7.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="Xpharm" NonPrinting="true"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: upper-alpha">
                <li>
                  <p>is available between 1 March and 30 June each year for patients who meet the following criteria, as set by the Ministry of Health:</p>
                  <ol style="list-style-type: lower-alpha">
                    <li>
                      <p>all people 65 years of age and over;</p>
                    </li>
                    <li>
                      <p>people under 65 years of age with:</p>
                      <ol style="list-style-type: lower-roman">
                        <li>
                          <p> the following cardiovascular disease:</p>
                          <ol style="list-style-type: decimal">
                            <li>
                              <p>ischaemic heart disease,</p>
                            </li>
                            <li>
                              <p>congestive heart disease,</p>
                            </li>
                            <li>
                              <p>rheumatic heart disease,</p>
                            </li>
                            <li>
                              <p>congenital heart disease, or</p>
                            </li>
                            <li>
                              <p>cerebo-vascular disease;</p>
                            </li>
                          </ol>
                        </li>
                        <li>
                          <p>the following chronic respiratory disease:</p>
                          <ol style="list-style-type: decimal">
                            <li>
                              <p>asthma, if on a regular preventative therapy, or</p>
                            </li>
                            <li>
                              <p>other chronic respiratory disease with impaired lung function;</p>
                            </li>
                          </ol>
                        </li>
                        <li>
                          <p>diabetes;</p>
                        </li>
                        <li>
                          <p>chronic renal disease;</p>
                        </li>
                        <li>
                          <p>any cancer, excluding basal and squamous skin cancers if not invasive;</p>
                        </li>
                        <li>
                          <p> the following other conditions:</p>
                          <ol style="list-style-type: lower-alpha">
                            <li>
                              <p>autoimmune disease,</p>
                            </li>
                            <li>
                              <p>immune suppression,</p>
                            </li>
                            <li>
                              <p>HIV,</p>
                            </li>
                            <li>
                              <p>transplant recipients,</p>
                            </li>
                            <li>
                              <p>neuromuscular and CNS diseases,</p>
                            </li>
                            <li>
                              <p>haemoglobinopathies, or</p>
                            </li>
                            <li>
                              <p>children on long term aspirin.</p>
                            </li>
                          </ol>
                        </li>
                      </ol>
                      <p>The following conditions are excluded from funding:</p>
                      <ol style="list-style-type: lower-alpha">
                        <li>
                          <p>asthma not requiring regular preventative therapy,</p>
                        </li>
                        <li>
                          <p>hypertension and/or dyslipidaemia without evidence of end-organ disease,</p>
                        </li>
                        <li>
                          <p>pregnancy in the absence of another risk factor.</p>
                        </li>
                      </ol>
                    </li>
                  </ol>
                </li>
                <li>
                  <p>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.</p>
                </li>
                <li>
                  <p>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.</p>
                </li>
                <li>
                  <p>Influenza Vaccine does not fall within the definition Community Pharmaceutical as it is not funded directly from the Pharmaceutical Budget. Pharmacists are unable to claim for the dispensing of influenza vaccine from the Funder.</p>
                </li>
              </ol>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A19">
      <Name>Musculo-skeletal System</Name>
      <ATC2 ID="A1901">
        <Name>Anticholinesterases</Name>
        <ATC3 ID="A190101">
          <Name>Anticholinesterases</Name>
          <Chemical ID="C1901011857" Page="104">
            <Name>Neostigmine</Name>
            <Formulation ID="F190101185703" Rank="4" Units="inj" Weight="2">
              <Name>Inj 2.5 mg per ml, 1 ml</Name>
              <Brand ID="B19010118570301" SoleSupply="true">
                <Name>AstraZeneca</Name>
                <Pack ID="P311316" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>20.30</Subsidy>
                  <Price>20.30</Price>
                  <Alternate>20.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1901012070" Page="104" Statim="May">
            <Name>Pyridostigmine bromide</Name>
            <Formulation ID="F190101207001" Rank="1" Units="tab" Weight="60">
              <Name>Tab 60 mg</Name>
              <Brand ID="B19010120700101">
                <Name>Mestinon</Name>
                <Pack ID="P251011" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>34.32</Subsidy>
                  <Price>34.32</Price>
                  <Alternate>34.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1904">
        <Name>Anti-inflammatory Non Steroidal Drugs (NSAIDs)</Name>
        <ATC3 ID="A190401">
          <Name>Anti-inflammatory Non Steroidal Drugs (NSAIDs)</Name>
          <Chemical ID="C1904011401" Page="104" Statim="Must">
            <Name>Diclofenac sodium</Name>
            <Formulation ID="F190401140101" Rank="1" Units="tab" Weight="25">
              <Name>Tab EC 25 mg</Name>
              <Brand ID="B19040114010103" SoleSupply="true">
                <Name>Apo-Diclo</Name>
                <Pack ID="P793116" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.51</Subsidy>
                  <Price>3.51</Price>
                  <Alternate>3.51</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
            <Formulation ID="F190401140102" Rank="1" Units="tab" Weight="50">
              <Name>Tab EC 50 mg</Name>
              <Brand ID="B19040114010203" SoleSupply="true">
                <Name>Apo-Diclo</Name>
                <Pack ID="P2025744" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>25.88</Subsidy>
                  <Price>25.88</Price>
                  <Alternate>25.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
            <Formulation ID="F190401140103" Rank="1" Units="tab" Weight="75">
              <Name>Tab long-acting 75 mg</Name>
              <Brand ID="B19040114010303" SoleSupply="true">
                <Name>Apo-Diclo SR</Name>
                <Pack ID="P2025752" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>22.78</Subsidy>
                  <Price>22.78</Price>
                  <Alternate>22.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
            <Formulation ID="F190401140105" Rank="4" Units="inj" Weight="75">
              <Name>Inj 25 mg per ml, 3 ml</Name>
              <Brand ID="B19040114010501">
                <Name>Voltaren</Name>
                <Pack ID="P263486" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F190401140106" Rank="5" Units="supp" Weight="12.5">
              <Name>Suppos 12.5 mg</Name>
              <Brand ID="B19040114010601">
                <Name>Voltaren</Name>
                <Pack ID="P645931" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.85</Subsidy>
                  <Price>1.85</Price>
                  <Alternate>1.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
            <Formulation ID="F190401140107" Rank="5" Units="supp" Weight="25">
              <Name>Suppos 25 mg</Name>
              <Brand ID="B19040114010701">
                <Name>Voltaren</Name>
                <Pack ID="P645958" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>2.22</Subsidy>
                  <Price>2.22</Price>
                  <Alternate>2.22</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
            <Formulation ID="F190401140108" Rank="5" Units="supp" Weight="50">
              <Name>Suppos 50 mg</Name>
              <Brand ID="B19040114010801">
                <Name>Voltaren</Name>
                <Pack ID="P747742" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>3.84</Subsidy>
                  <Price>3.84</Price>
                  <Alternate>3.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
              <Rule Type="FormMax" Value="10" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F190401140109" Rank="5" Units="supp" Weight="100">
              <Name>Suppos 100 mg</Name>
              <Brand ID="B19040114010901">
                <Name>Voltaren</Name>
                <Pack ID="P747750" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>6.36</Subsidy>
                  <Price>6.36</Price>
                  <Alternate>6.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
            <Formulation ID="F190401140111" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg dispersible</Name>
              <Brand ID="B19040114011101">
                <Name>Voltaren D</Name>
                <Pack ID="P269905" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>1.50</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.32500</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
            <Formulation ID="F190401140112" Rank="1" Units="tab" Weight="100">
              <Name>Tab long-acting 100 mg</Name>
              <Brand ID="B19040114011203" SoleSupply="true">
                <Name>Apo-Diclo SR</Name>
                <Pack ID="P2025760" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>34.32</Subsidy>
                  <Price>34.32</Price>
                  <Alternate>34.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1904011697" Page="104" Statim="Must">
            <Name>Ketoprofen</Name>
            <Formulation ID="F190401169703" Rank="2" Units="cap" Weight="200">
              <Name>Cap long-acting 200 mg</Name>
              <Brand ID="B19040116970303">
                <Name>Oruvail 200</Name>
                <Pack ID="P333964" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.44</Subsidy>
                  <Price>43.12</Price>
                  <Alternate>43.12</Alternate>
                  <Surcharge>0.29680</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401169708" Rank="2" Units="cap" Weight="100">
              <Name>Cap long-acting 100 mg</Name>
              <Brand ID="B19040116970801">
                <Name>Oruvail 100</Name>
                <Pack ID="P300616" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.72</Subsidy>
                  <Price>21.56</Price>
                  <Alternate>21.56</Alternate>
                  <Surcharge>0.14840</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Chemical ID="C1904011769" Page="104" Statim="Must">
            <Name>Mefenamic acid</Name>
            <Formulation ID="F190401176901" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B19040117690101">
                <Name>Ponstan</Name>
                <Pack ID="P260479" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.50</Subsidy>
                  <Price>18.33</Price>
                  <Alternate>18.33</Alternate>
                  <Surcharge>0.15830</Surcharge>
                </Pack>
                <Pack ID="P616168">
                  <Quantity>20</Quantity>
                  <Subsidy>0.50</Subsidy>
                  <Price>5.60</Price>
                  <Alternate>3.67</Alternate>
                  <Surcharge>0.25500</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Chemical ID="C1904012193" Page="105" Statim="Must">
            <Name>Sulindac</Name>
            <Formulation ID="F190401219301" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B19040121930102">
                <Name>Daclin</Name>
                <Pack ID="P589136" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.32</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.06680</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401219302" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B19040121930201">
                <Name>Daclin</Name>
                <Pack ID="P589152" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.72</Subsidy>
                  <Price>20.00</Price>
                  <Alternate>20.00</Alternate>
                  <Surcharge>0.13280</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B19040121930202">
                <Name>Clinoril</Name>
                <Pack ID="P2027933" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.36</Subsidy>
                  <Price>15.87</Price>
                  <Alternate>15.87</Alternate>
                  <Surcharge>0.25020</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Chemical ID="C1904012536" Page="105" Statim="Must">
            <Name>Tenoxicam</Name>
            <Formulation ID="F190401253601" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B19040125360101">
                <Name>Tilcotil</Name>
                <Pack ID="P729396" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>23.75</Subsidy>
                  <Price>23.75</Price>
                  <Alternate>23.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401253603" Rank="4" Units="inj" Weight="20">
              <Name>Inj 10 mg per ml, 2 ml</Name>
              <Brand ID="B19040125360301" ToBeDelisted="2008-04-01">
                <Name>Tilcotil</Name>
                <Pack ID="P711160" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>10.00</Subsidy>
                  <Price>10.00</Price>
                  <Alternate>10.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F190401253604" Rank="5" Units="supp" Weight="20">
              <Name>Suppos 20 mg</Name>
              <Brand ID="B19040125360401">
                <Name>Tilcotil</Name>
                <Pack ID="P666076" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>5.30</Subsidy>
                  <Price>5.30</Price>
                  <Alternate>5.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Chemical ID="C1904012537" Page="105" Statim="Must">
            <Name>Tiaprofenic acid</Name>
            <Formulation ID="F190401253702" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B19040125370201">
                <Name>Surgam</Name>
                <Pack ID="P2144441" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>4.03</Subsidy>
                  <Price>19.26</Price>
                  <Alternate>19.26</Alternate>
                  <Surcharge>0.25383</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401253703" Rank="2" Units="cap" Weight="300">
              <Name>Cap long-acting 300 mg</Name>
              <Brand ID="B19040125370301" ToBeDelisted="2007-11-01">
                <Name>Surgam SA</Name>
                <Pack ID="P714860" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>3.77</Subsidy>
                  <Price>17.51</Price>
                  <Alternate>17.51</Alternate>
                  <Surcharge>0.24536</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Chemical ID="C1904012782" Page="105" Statim="Must">
            <Name>Naproxen</Name>
            <Formulation ID="F190401278205" Rank="1" Units="tab" Weight="750">
              <Name>Tab long-acting 750 mg</Name>
              <Brand ID="B19040127820501" SoleSupply="true">
                <Name>Naprosyn SR 750</Name>
                <Pack ID="P767301" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>18.00</Subsidy>
                  <Price>18.00</Price>
                  <Alternate>18.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401278206" Rank="1" Units="tab" Weight="1000">
              <Name>Tab long-acting 1,000 mg</Name>
              <Brand ID="B19040127820601" SoleSupply="true">
                <Name>Naprosyn SR 1000</Name>
                <Pack ID="P767336" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>21.00</Subsidy>
                  <Price>21.00</Price>
                  <Alternate>21.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401278209" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B19040127820904" SoleSupply="true">
                <Name>Noflam 250</Name>
                <Pack ID="P319333" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>21.00</Subsidy>
                  <Price>21.00</Price>
                  <Alternate>21.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401278211" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B19040127821103" SoleSupply="true">
                <Name>Noflam 500</Name>
                <Pack ID="P323071" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>17.95</Subsidy>
                  <Price>17.95</Price>
                  <Alternate>17.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Chemical ID="C1904012783" Page="105" Statim="Must">
            <Name>Naproxen sodium</Name>
            <Formulation ID="F190401278301" Rank="1" Units="tab" Weight="275">
              <Name>Tab 275 mg</Name>
              <Brand ID="B19040127830102">
                <Name>Synflex</Name>
                <Pack ID="P2040603" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.40</Subsidy>
                  <Price>6.40</Price>
                  <Alternate>6.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401278302" Rank="1" Units="tab" Weight="550">
              <Name>Tab 550 mg</Name>
              <Brand ID="B19040127830202">
                <Name>Synflex</Name>
                <Pack ID="P2042053" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.80</Subsidy>
                  <Price>12.80</Price>
                  <Alternate>12.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Chemical ID="C1904012798" Page="104" Statim="Must">
            <Name>Ibuprofen</Name>
            <Formulation ID="F190401279801" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B19040127980125" SoleSupply="true">
                <Name>I-Profen</Name>
                <Pack ID="P2091097" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.78</Subsidy>
                  <Price>1.78</Price>
                  <Alternate>1.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401279802" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B19040127980202">
                <Name>Brufen</Name>
                <Pack ID="P2196050">
                  <Quantity>50</Quantity>
                  <Subsidy>1.78</Subsidy>
                  <Price>7.60</Price>
                  <Alternate>7.60</Alternate>
                  <Surcharge>0.11640</Surcharge>
                </Pack>
                <Pack ID="P2255510" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.07</Subsidy>
                  <Price>4.56</Price>
                  <Alternate>4.56</Alternate>
                  <Surcharge>0.11633</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401279803" Rank="1" Units="tab" Weight="600">
              <Name>Tab 600 mg</Name>
              <Brand ID="B19040127980302">
                <Name>Brufen</Name>
                <Pack ID="P329991">
                  <Quantity>100</Quantity>
                  <Subsidy>5.32</Subsidy>
                  <Price>22.80</Price>
                  <Alternate>22.80</Alternate>
                  <Surcharge>0.17480</Surcharge>
                </Pack>
                <Pack ID="P2255502" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.60</Subsidy>
                  <Price>6.84</Price>
                  <Alternate>1.60</Alternate>
                  <Surcharge>0.17467</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401279804" Rank="1" Units="tab" Weight="800">
              <Name>Tab long-acting 800 mg</Name>
              <Brand ID="B19040127980401">
                <Name>Brufen Retard</Name>
                <Pack ID="P779938">
                  <Quantity>60</Quantity>
                  <Subsidy>3.01</Subsidy>
                  <Price>18.24</Price>
                  <Alternate>18.24</Alternate>
                  <Surcharge>0.25383</Surcharge>
                </Pack>
                <Pack ID="P2255499" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.50</Subsidy>
                  <Price>9.12</Price>
                  <Alternate>9.12</Alternate>
                  <Surcharge>0.25400</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401279805" Rank="3" Units="ml" Weight="20" Safety="Uncompounded">
              <Name>Oral liq 100 mg per 5 ml</Name>
              <Brand ID="B19040127980525">
                <Name>Fenpaed</Name>
                <Pack ID="P2090864" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>3.49</Subsidy>
                  <Price>3.49</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0291"/>
          </Chemical>
          <Request To="HealthPAC" For="Manufacturers Price" Form="SA0291">
            <Title>
              <range>Anti-inflammatory Non Steroidal Drugs (NSAIDs)</range>
            </Title>
            <Case When="Initial application">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <apply>
                  <and/>
                  <ci type="logical" class="Indication">Inflammatory arthritis (including osteoarthritis with an inflammatory component)</ci>
                  <ci type="logical" class="Trial">Stabilised and are well controlled on the particular NSAID medication</ci>
                </apply>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
            <Case When="Renewal" Form="SA0291">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
          </Request>
        </ATC3>
        <ATC3 ID="A190402">
          <Name>NSAIDs Other</Name>
          <Chemical ID="C1904021645" Page="105" Statim="Must">
            <Name>Indomethacin</Name>
            <Formulation ID="F190402164501" Rank="2" Units="cap" Weight="25">
              <Name>Cap 25 mg</Name>
              <Brand ID="B19040216450103" SoleSupply="true">
                <Name>Rheumacin</Name>
                <Pack ID="P331759" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.90</Subsidy>
                  <Price>5.90</Price>
                  <Alternate>5.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190402164502" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B19040216450201" SoleSupply="true">
                <Name>Rheumacin</Name>
                <Pack ID="P282219" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.95</Subsidy>
                  <Price>6.95</Price>
                  <Alternate>6.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190402164503" Rank="2" Units="cap" Weight="75">
              <Name>Cap long-acting 75 mg</Name>
              <Brand ID="B19040216450302">
                <Name>Rheumacin SR</Name>
                <Pack ID="P317535" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.30</Subsidy>
                  <Price>13.30</Price>
                  <Alternate>13.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190402164504" Rank="5" Units="supp" Weight="100">
              <Name>Suppos 100 mg</Name>
              <Brand ID="B19040216450402">
                <Name>Arthrexin</Name>
                <Pack ID="P281964" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>14.50</Subsidy>
                  <Price>14.50</Price>
                  <Alternate>14.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1904021996" Page="105" Statim="Must">
            <Name>Piroxicam</Name>
            <Formulation ID="F190402199604" Rank="1" Units="tab" Weight="10">
              <Name>Tab dispersible 10 mg</Name>
              <Brand ID="B19040219960402">
                <Name>Piram-D</Name>
                <Pack ID="P752088" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.25</Subsidy>
                  <Price>3.25</Price>
                  <Alternate>3.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190402199606" Rank="1" Units="tab" Weight="20">
              <Name>Tab dispersible 20 mg</Name>
              <Brand ID="B19040219960602">
                <Name>Piram-D</Name>
                <Pack ID="P380342" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.50</Subsidy>
                  <Price>5.50</Price>
                  <Alternate>5.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1907">
        <Name>Antirheumatoid Agents</Name>
        <ATC3 ID="A190701">
          <Name>Antirheumatoid Agents</Name>
          <Chemical ID="C1907011099" Page="105">
            <Name>Auranofin</Name>
            <Formulation ID="F190701109901" Rank="1" Units="tab" Weight="3">
              <Name>Tab 3 mg</Name>
              <Brand ID="B19070110990101">
                <Name>Ridaura</Name>
                <Pack ID="P319562" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>68.99</Subsidy>
                  <Price>70.97</Price>
                  <Alternate>68.99</Alternate>
                  <Surcharge>0.03300</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1907011942" Page="106">
            <Name>Penicillamine</Name>
            <Formulation ID="F190701194203" Rank="1" Units="tab" Weight="125">
              <Name>Tab 125 mg</Name>
              <Brand ID="B19070119420301">
                <Name>D-Penamine</Name>
                <Pack ID="P258717">
                  <Quantity>100</Quantity>
                  <Subsidy>61.93</Subsidy>
                  <Price>61.93</Price>
                  <Alternate>61.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2125374" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>61.93</Subsidy>
                  <Price>61.93</Price>
                  <Alternate>61.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190701194204" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B19070119420401">
                <Name>D-Penamine</Name>
                <Pack ID="P258725">
                  <Quantity>100</Quantity>
                  <Subsidy>98.98</Subsidy>
                  <Price>98.98</Price>
                  <Alternate>98.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2125382" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>98.98</Subsidy>
                  <Price>98.98</Price>
                  <Alternate>98.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1907012126" Page="106">
            <Name>Sodium aurothiomalate</Name>
            <Formulation ID="F190701212601" Rank="4" Units="inj" Weight="20">
              <Name>Inj 10 mg per 0.5 ml</Name>
              <Brand ID="B19070121260101">
                <Name>Myocrisin</Name>
                <Pack ID="P254037" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>76.87</Subsidy>
                  <Price>76.87</Price>
                  <Alternate>76.87</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190701212602" Rank="4" Units="inj" Weight="40">
              <Name>Inj 20 mg per 0.5 ml</Name>
              <Brand ID="B19070121260201">
                <Name>Myocrisin</Name>
                <Pack ID="P254053" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>113.17</Subsidy>
                  <Price>113.17</Price>
                  <Alternate>113.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190701212603" Rank="4" Units="inj" Weight="100">
              <Name>Inj 50 mg per 0.5 ml</Name>
              <Brand ID="B19070121260301">
                <Name>Myocrisin</Name>
                <Pack ID="P254061" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>217.23</Subsidy>
                  <Price>217.23</Price>
                  <Alternate>217.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1907013763" Page="105">
            <Name>Leflunomide</Name>
            <Formulation ID="F190701376325" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B19070137632525">
                <Name>Arava</Name>
                <Pack ID="P369470" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>108.60</Subsidy>
                  <Price>108.60</Price>
                  <Alternate>108.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B19070137632526">
                <Name>AFT-Leflunomide</Name>
                <Pack ID="P2232731" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>97.00</Subsidy>
                  <Price>97.00</Price>
                  <Alternate>97.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190701376326" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B19070137632625">
                <Name>Arava</Name>
                <Pack ID="P306843" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>79.27</Subsidy>
                  <Price>79.27</Price>
                  <Alternate>79.27</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B19070137632626">
                <Name>AFT-Leflunomide</Name>
                <Pack ID="P2232758" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>71.00</Subsidy>
                  <Price>71.00</Price>
                  <Alternate>71.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190701376327" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B19070137632725">
                <Name>Arava</Name>
                <Pack ID="P373540" Specified="true">
                  <Quantity>3</Quantity>
                  <Subsidy>54.44</Subsidy>
                  <Price>54.44</Price>
                  <Alternate>54.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0635">
              <Title>
                <range>Leflunomide</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Rheumatoid arthritis</ci>
                    <ci type="logical" class="Indication">Patient is not a pregnant woman, or a woman of child-bearing age without adequate contraception</ci>
                    <ci type="logical" class="Trial">Patient has been unable to tolerate or has a contraindication to or has had an inadequate response to sulphasalazine and methotrexate (individually or in combination)
</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Form="SA0635">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Trial">Compliance (prescriber determined) with medication</ci>
                    <ci type="logical" class="Trial">Improved rheumatoid arthritis symptom control</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Patient should have full blood count and liver function tests regularly monitored.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0635"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A190702">
          <Name>Tumour Necrosis Factor (TNF) Inhibitors</Name>
          <Chemical ID="C1907023786" Page="107">
            <Name>Etanercept</Name>
            <Formulation ID="F190702378625" Rank="4" Units="inj" Weight="25">
              <Name>Inj 25 mg</Name>
              <Brand ID="B19070237862525">
                <Name>Enbrel</Name>
                <Pack ID="P2006561" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>949.96</Subsidy>
                  <Price>949.96</Price>
                  <Alternate>949.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0868">
              <Title>
                <range>Etanercept</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">To be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance</ci>
                    <ci type="logical" class="Indication">Patient diagnosed with Juvenile Idiopathic Arthritis (JIA)</ci>
                    <ci type="logical" class="Indication">Patient has had severe active polyarticular course JIA for 6 months duration or longer</ci>
                    <ci type="logical" class="Trial">Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-20mg/m² weekly or at the maximum tolerated dose) in combination with oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose)</ci>
                    <ci type="logical" class="Trial">Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-15mg/m² weekly or at the maximum tolerated dose) in combination with one other disease-modifying agent</ci>
                    <apply>
                      <and/>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly-controlled and active disease in at least 20 active, swollen, tender joints</ci>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly-controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip</ci>
                      </apply>
                      <ci type="logical" class="Indication">Physician’s global assessment indicating severe disease</ci>
                    </apply>
                    <ci type="logical" class="Indication">The patient or their legal guardian consents to details of their treatment being held on a central registry and has signed a consent form outlining conditions of ongoing treatment</ci>
                  </apply>
                </math>
                <Applicant>named specialist</Applicant>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">4</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>A patient declaration form <a href="http://www.pharmac.govt.nz/special_authority_forms/SA0667-declaration.pdf">http://www.pharmac.govt.nz/special_authority_forms/SA0667-declaration.pdf</a> must be signed by the legal guardian of the patient and the prescriber in the presence of a witness (over 18 years of age)</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0667 SA0868">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Following 4 months initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician’s global assessment from baseline</ci>
                      <ci type="logical" class="Indication">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</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>named specialist</Applicant>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
              </Case>
            </Request>
            <Rule Type="SpecOnly" Attribute="Retail"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0868"/>
          </Chemical>
          <Chemical ID="C1907023836" Page="106">
            <Name>Adalimumab</Name>
            <Formulation ID="F190702383625" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg per 0.8 ml prefilled syringe</Name>
              <Brand ID="B19070238362525">
                <Name>Humira</Name>
                <Pack ID="P2207354" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>1799.92</Subsidy>
                  <Price>1799.92</Price>
                  <Alternate>1799.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0812">
              <Title>
                <range>Adalimumab</range>
              </Title>
              <Case When="Initial application" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient is an adult who has had severe and active erosive Rheumatoid Arthritis for six months duration or longer</ci>
                    <ci type="logical" class="Use">Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance</ci>
                    <ci type="logical" class="Trial">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</ci>
                    <ci type="logical" class="Trial">Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with at least two of the following (triple therapy): sulphasalazine, prednisone at a dose of at least 7.5 mg per day, azathioprine, intramuscular gold, or hydroxychloroquine sulphate (at maximum tolerated doses)</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of Cyclosporin alone or in combination with another agent</ci>
                      <ci type="logical" class="Trial">Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of Leflunomide alone or in combination with another agent</ci>
                    </apply>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient has persistent symptoms of poorly-controlled and active disease in at least 20 active, swollen, tender joints</ci>
                      <ci type="logical" class="Indication">Patient has persistent symptoms of poorly-controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip</ci>
                    </apply>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">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</ci>
                      <ci type="logical" class="Indication">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</ci>
                    </apply>
                    <ci type="logical" class="Consent">The patient consents to details of their treatment being held on a central registry and has signed a consent form outlining the conditions of ongoing treatment</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>A patient declaration form <a href="http://www.pharmac.govt.nz/special_authority_forms/SA0812-declaration.pdf">http://www.pharmac.govt.nz/special_authority_forms/SA0812-declaration.pdf</a> must be signed by the legal guardian of the patient and the prescriber in the presence of a witness (over 18 years of age).</p>
                  <p>Applicants are requested to register the treatment with the New Zealand Rheumatology Association by completing the forms and questionnaire <a href="http://www.pharmac.govt.nz/special_authority_forms/SA0812-survey.pdf">http://www.pharmac.govt.nz/special_authority_forms/SA0812-survey.pdf</a>.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0812">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">Following 4 months initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician</ci>
                      <ci type="logical" class="Indication">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</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Applicant Referring="Yes">general physician</Applicant>
                <Term Measure="month">6</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0812"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1911">
        <Name>Enzymes</Name>
        <ATC3 ID="A191101">
          <Name>Enzymes</Name>
          <Chemical ID="C1911011603" Page="108">
            <Name>Hyaluronidase</Name>
            <Formulation ID="F191101160301" Rank="4" Units="inj" Weight="1500">
              <Name>Inj 1,500 iu per ml</Name>
              <Brand ID="B19110116030101">
                <Name>Hyalase</Name>
                <Pack ID="P229644" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>18.32</Subsidy>
                  <Price>194.40</Price>
                  <Alternate>18.32</Alternate>
                  <Surcharge>17.60800</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1913">
        <Name>Hyperuricaemia and Antigout</Name>
        <ATC3 ID="A191301">
          <Name>Hyperuricaemia and Antigout</Name>
          <Chemical ID="C1913011026" Page="108" Statim="Must">
            <Name>Allopurinol</Name>
            <Formulation ID="F191301102601" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B19130110260101" SoleSupply="true">
                <Name>Progout</Name>
                <Pack ID="P380636" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>11.45</Subsidy>
                  <Price>11.45</Price>
                  <Alternate>11.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F191301102602" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B19130110260203" SoleSupply="true">
                <Name>Progout</Name>
                <Pack ID="P380679" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>21.20</Subsidy>
                  <Price>21.20</Price>
                  <Alternate>21.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1913011341" Page="108" Statim="Must">
            <Name>Colchicine</Name>
            <Formulation ID="F191301134125" Rank="1" Units="tab">
              <Name>Tab 500 mcg</Name>
              <Brand ID="B19130113412525" SoleSupply="true">
                <Name>Colgout</Name>
                <Pack ID="P2200503" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.60</Subsidy>
                  <Price>9.60</Price>
                  <Alternate>9.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1913012042" Page="108" Statim="Must">
            <Name>Probenecid</Name>
            <Formulation ID="F191301204201" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B19130120420125">
                <Name>AFT</Name>
                <Pack ID="P2012499" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>55.00</Subsidy>
                  <Price>55.00</Price>
                  <Alternate>55.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1916">
        <Name>Muscle Relaxants</Name>
        <ATC3 ID="A191601">
          <Name>Muscle Relaxants</Name>
          <Chemical ID="C1916011373" Page="108" Statim="Must">
            <Name>Dantrolene sodium</Name>
            <Formulation ID="F191601137301" Rank="2" Units="cap" Weight="25">
              <Name>Cap 25 mg</Name>
              <Brand ID="B19160113730101" SoleSupply="true">
                <Name>Dantrium</Name>
                <Pack ID="P252409" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>32.96</Subsidy>
                  <Price>32.96</Price>
                  <Alternate>32.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F191601137302" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B19160113730201" SoleSupply="true">
                <Name>Dantrium</Name>
                <Pack ID="P252417" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>51.70</Subsidy>
                  <Price>51.70</Price>
                  <Alternate>51.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1916011908" Page="108">
            <Name>Orphenadrine citrate</Name>
            <Formulation ID="F191601190801" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B19160119080101">
                <Name>Norflex</Name>
                <Pack ID="P255009" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.54</Subsidy>
                  <Price>18.54</Price>
                  <Alternate>18.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F191601190802" Rank="4" Units="inj" Weight="60">
              <Name>Inj 30 mg per ml, 2 ml</Name>
              <Brand ID="B19160119080201">
                <Name>Norflex</Name>
                <Pack ID="P254991" Specified="true">
                  <Quantity>3</Quantity>
                  <Subsidy>9.60</Subsidy>
                  <Price>20.50</Price>
                  <Alternate>9.60</Alternate>
                  <Surcharge>3.63333</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1916012079" Page="108" Statim="Must">
            <Name>Quinine sulphate</Name>
            <Formulation ID="F191601207901" Rank="1" Units="tab" Weight="200" Safety="Compounded">
              <Name>Tab 200 mg</Name>
              <Brand ID="B19160120790104" SoleSupply="true">
                <Name>Q 200</Name>
                <Pack ID="P2124556" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>15.95</Subsidy>
                  <Price>15.95</Price>
                  <Alternate>15.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F191601207902" Rank="1" Units="tab" Weight="300" Safety="Compounded">
              <Name>Tab 300 mg</Name>
              <Brand ID="B19160120790205" SoleSupply="true">
                <Name>Q 300</Name>
                <Pack ID="P393118" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>34.75</Subsidy>
                  <Price>34.75</Price>
                  <Alternate>34.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1916012364" Page="108" Statim="Must">
            <Name>Baclofen</Name>
            <Formulation ID="F191601236401" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B19160123640101">
                <Name>Pacifen</Name>
                <Pack ID="P403903" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.75</Subsidy>
                  <Price>3.75</Price>
                  <Alternate>3.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A22">
      <Name>Nervous System</Name>
      <ATC2 ID="A2201">
        <Name>Anaesthetics</Name>
        <ATC3 ID="A220101">
          <Name>Local</Name>
          <Chemical ID="C2201011715" Page="109">
            <Name>Lignocaine with prilocaine</Name>
            <Formulation ID="F220101171501" Rank="3" Units="g" Weight="2.5">
              <Name>Crm 2.5% with prilocaine 2.5%</Name>
              <Brand ID="B22010117150101" SoleSupply="true">
                <Name>EMLA</Name>
                <Pack ID="P719757" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>41.00</Subsidy>
                  <Price>41.00</Price>
                  <Alternate>41.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101171502" Rank="9" Units="tube" Weight="2.5">
              <Name>Crm 2.5% with prilocaine 2.5% (5g tubes)</Name>
              <Brand ID="B22010117150201" SoleSupply="true">
                <Name>EMLA</Name>
                <Pack ID="P657697" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>41.00</Subsidy>
                  <Price>41.00</Price>
                  <Alternate>41.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0323">
              <Title>
                <range>Lignocaine with Prilocaine</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is a child receiving frequent parenteral injections (i.e. intradermal, subcutaneous, intravenous or intramuscular) requiring a 21 gauge or larger bore needle</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0323">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0323"/>
          </Chemical>
          <Chemical ID="C2201011719" Page="109">
            <Name>Lignocaine hydrochloride</Name>
            <Formulation ID="F220101171904" Rank="4" Units="inj" Weight="2">
              <Name>Inj 0.5%, 5 ml</Name>
              <Brand ID="B22010117190401" SoleSupply="true">
                <Name>Xylocaine</Name>
                <Pack ID="P311197" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>44.10</Subsidy>
                  <Price>44.10</Price>
                  <Alternate>44.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use.</p>
              </div>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220101171907" Rank="4" Units="inj" Weight="20">
              <Name>Inj 1%, 20 ml</Name>
              <Brand ID="B22010117190701" SoleSupply="true">
                <Name>Xylocaine</Name>
                <Pack ID="P728128" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>23.50</Subsidy>
                  <Price>23.50</Price>
                  <Alternate>23.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use.</p>
              </div>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220101171910" Rank="4" Units="inj" Weight="5">
              <Name>Inj 1%, 5 ml</Name>
              <Brand ID="B22010117191001" SoleSupply="true">
                <Name>Xylocaine</Name>
                <Pack ID="P311219" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>42.00</Subsidy>
                  <Price>42.00</Price>
                  <Alternate>42.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use.</p>
              </div>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201012855" Page="109">
            <Name>Bupivacaine hydrochloride</Name>
            <Formulation ID="F220101285501" Rank="4" Units="inj" Weight="0.5">
              <Name>Inj 0.5%, 8% glucose, 4 ml</Name>
              <Brand ID="B22010128550101" SoleSupply="true">
                <Name>Marcain Heavy</Name>
                <Pack ID="P513636">
                  <Quantity>5</Quantity>
                  <Subsidy>24.50</Subsidy>
                  <Price>24.50</Price>
                  <Alternate>24.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2184435" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>24.50</Subsidy>
                  <Price>24.50</Price>
                  <Alternate>24.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101285502" Rank="4" Units="inj" Weight="0.5">
              <Name>Inj 0.5%, 4 ml</Name>
              <Brand ID="B22010128550201" SoleSupply="true">
                <Name>Marcain Isobaric</Name>
                <Pack ID="P513628">
                  <Quantity>5</Quantity>
                  <Subsidy>29.35</Subsidy>
                  <Price>29.35</Price>
                  <Alternate>29.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2209284" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>29.35</Subsidy>
                  <Price>29.35</Price>
                  <Alternate>29.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
          </Chemical>
          <Chemical ID="C2201013871" Page="104">
            <Name>Lignocaine with chlorhexidine</Name>
            <Formulation ID="F220101387125" Rank="10" Units="each">
              <Name>Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringes</Name>
              <Brand ID="B22010138712525">
                <Name>Pfizer</Name>
                <Pack ID="P619841" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>43.26</Subsidy>
                  <Price>43.26</Price>
                  <Alternate>43.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A2204">
        <Name>Analgesics</Name>
        <ATC3 ID="A220404">
          <Name>Antipyretics and Non-Opioid Analgesics</Name>
          <Chemical ID="C2204041087" Page="109" Statim="Must">
            <Name>Aspirin</Name>
            <Formulation ID="F220404108701" Rank="1" Units="tab" Weight="300">
              <Name>Tab dispersible 300 mg</Name>
              <Brand ID="B22040410870125">
                <Name>Ethics Aspirin</Name>
                <Pack ID="P2184346" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>22.50</Subsidy>
                  <Price>22.50</Price>
                  <Alternate>22.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220404108705" Rank="1" Units="tab" Weight="300">
              <Name>Tab EC 300 mg</Name>
              <Brand ID="B22040410870501">
                <Name>Aspec 300</Name>
                <Pack ID="P762504" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.25</Subsidy>
                  <Price>8.10</Price>
                  <Alternate>7.25</Alternate>
                  <Surcharge>0.00850</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220404108706" Rank="1" Units="tab" Weight="650">
              <Name>Tab EC 650 mg</Name>
              <Brand ID="B22040410870601">
                <Name>Ecotrin</Name>
                <Pack ID="P359335" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.88</Subsidy>
                  <Price>6.88</Price>
                  <Alternate>6.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204041849" Page="109">
            <Name>Nefopam hydrochloride</Name>
            <Formulation ID="F220404184901" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B22040418490101">
                <Name>Acupan</Name>
                <Pack ID="P225665" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>23.40</Subsidy>
                  <Price>23.40</Price>
                  <Alternate>23.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220404184902" Rank="4" Units="inj" Weight="20">
              <Name>Inj 20 mg per ml, 1 ml</Name>
              <Brand ID="B22040418490201">
                <Name>Acupan</Name>
                <Pack ID="P2029243" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>9.10</Subsidy>
                  <Price>72.50</Price>
                  <Alternate>9.10</Alternate>
                  <Surcharge>12.68000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204041929" Page="109" Statim="Must">
            <Name>Paracetamol</Name>
            <Formulation ID="F220404192902" Rank="3" Units="ml" Weight="24" Safety="Uncompounded">
              <Name>Oral liq 120 mg per 5 ml</Name>
              <Brand ID="B22040419290225" SoleSupply="true">
                <Name>Junior Parapaed</Name>
                <Pack ID="P2108771" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.99</Subsidy>
                  <Price>6.99</Price>
                  <Alternate>6.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220404192903" Rank="3" Units="ml" Weight="50" Safety="Uncompounded">
              <Name>Oral liq 250 mg per 5 ml</Name>
              <Brand ID="B22040419290325" SoleSupply="true">
                <Name>Six Plus Parapaed</Name>
                <Pack ID="P2108798" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>7.25</Subsidy>
                  <Price>7.25</Price>
                  <Alternate>7.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormMax" Value="100" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220404192904" Rank="5" Units="supp" Weight="125">
              <Name>Suppos 125 mg</Name>
              <Brand ID="B22040419290401" SoleSupply="true">
                <Name>Panadol</Name>
                <Pack ID="P734756" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>6.51</Subsidy>
                  <Price>6.51</Price>
                  <Alternate>6.51</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220404192905" Rank="5" Units="supp" Weight="250">
              <Name>Suppos 250 mg</Name>
              <Brand ID="B22040419290501" SoleSupply="true">
                <Name>Panadol</Name>
                <Pack ID="P734764" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>12.52</Subsidy>
                  <Price>12.52</Price>
                  <Alternate>12.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220404192906" Rank="5" Units="supp" Weight="500">
              <Name>Suppos 500 mg</Name>
              <Brand ID="B22040419290625">
                <Name>Paracare</Name>
                <Pack ID="P2172127" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>20.50</Subsidy>
                  <Price>20.50</Price>
                  <Alternate>20.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220404192908" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B22040419290802" SoleSupply="true">
                <Name>Panadol</Name>
                <Pack ID="P303127" Specified="true">
                  <Quantity>1440</Quantity>
                  <Subsidy>13.23</Subsidy>
                  <Price>13.23</Price>
                  <Alternate>13.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2203081">
                  <Quantity>15000</Quantity>
                  <Subsidy>137.81</Subsidy>
                  <Price>137.81</Price>
                  <Alternate>137.81</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2212293">
                  <Quantity>150</Quantity>
                  <Subsidy>1.38</Subsidy>
                  <Price>1.38</Price>
                  <Alternate>1.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220405">
          <Name>Antipyretics with Codeine</Name>
          <Chemical ID="C2204051931" Page="110" Statim="Must">
            <Name>Paracetamol with codeine</Name>
            <Formulation ID="F220405193101" Rank="1" Units="tab" Weight="500">
              <Name>Tab paracetamol 500 mg with codeine phosphate 8 mg</Name>
              <Brand ID="B22040519310125" SoleSupply="true">
                <Name>Codalgin</Name>
                <Pack ID="P2130475" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.24</Subsidy>
                  <Price>3.24</Price>
                  <Alternate>3.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220407">
          <Name>Opioid Analgesics</Name>
          <Chemical ID="C2204071332" Page="110">
            <Name>Codeine phosphate</Name>
            <Formulation ID="F220407133201" Rank="1" Units="tab" Weight="15">
              <Name>Tab 15 mg</Name>
              <Brand ID="B22040713320102">
                <Name>PSM</Name>
                <Pack ID="P206717" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.65</Subsidy>
                  <Price>6.65</Price>
                  <Alternate>6.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407133202" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B22040713320202">
                <Name>PSM</Name>
                <Pack ID="P206733" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.75</Subsidy>
                  <Price>9.75</Price>
                  <Alternate>9.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407133203" Rank="1" Units="tab" Weight="60">
              <Name>Tab 60 mg</Name>
              <Brand ID="B22040713320302">
                <Name>PSM</Name>
                <Pack ID="P206776" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>19.65</Subsidy>
                  <Price>19.65</Price>
                  <Alternate>19.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204071392" Page="110">
            <Name>Dextropropoxyphene with paracetamol</Name>
            <Formulation ID="F220407139201" Rank="2" Units="cap" Weight="32.5">
              <Name>Cap hydrochloride 32.5 mg with paracetamol 325 mg</Name>
              <Brand ID="B22040713920101">
                <Name>Capadex</Name>
                <Pack ID="P206563">
                  <Quantity>100</Quantity>
                  <Subsidy>3.98</Subsidy>
                  <Price>4.90</Price>
                  <Alternate>3.98</Alternate>
                  <Surcharge>0.00920</Surcharge>
                </Pack>
                <Pack ID="P206571" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>19.91</Subsidy>
                  <Price>24.50</Price>
                  <Alternate>19.91</Alternate>
                  <Surcharge>0.00918</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407139202" Rank="1" Units="tab" Weight="50">
              <Name>Tab napsylate 50 mg with paracetamol 325 mg</Name>
              <Brand ID="B22040713920203">
                <Name>Paradex</Name>
                <Pack ID="P480576" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>14.50</Subsidy>
                  <Price>22.50</Price>
                  <Alternate>14.50</Alternate>
                  <Surcharge>0.01600</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204071795" Page="110">
            <Name>Methadone hydrochloride</Name>
            <Formulation ID="F220407179501" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22040717950101">
                <Name>PSM</Name>
                <Pack ID="P765503" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>2.10</Subsidy>
                  <Price>2.10</Price>
                  <Alternate>2.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22040717950102">
                <Name>Pallidone</Name>
                <Pack ID="P779725" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>2.78</Subsidy>
                  <Price>2.78</Price>
                  <Alternate>2.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407179502" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B22040717950201">
                <Name>AFT</Name>
                <Pack ID="P271454" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407179505" Rank="3" Units="ml" Weight="2" Safety="Uncompounded">
              <Name>Oral liq 2 mg per ml</Name>
              <Brand ID="B22040717950501">
                <Name>Biodone</Name>
                <Pack ID="P361372" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>6.55</Subsidy>
                  <Price>6.55</Price>
                  <Alternate>6.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407179506" Rank="3" Units="ml" Weight="5" Safety="Uncompounded">
              <Name>Oral liq 5 mg per ml</Name>
              <Brand ID="B22040717950602">
                <Name>Biodone Forte</Name>
                <Pack ID="P412341" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>6.52</Subsidy>
                  <Price>6.52</Price>
                  <Alternate>6.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407179507" Rank="3" Units="ml" Weight="10" Safety="Uncompounded">
              <Name>Oral liq 10 mg per ml</Name>
              <Brand ID="B22040717950701">
                <Name>Biodone Extra Forte</Name>
                <Pack ID="P412325" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Controlled"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets).</p>
            </div>
            <Rule Type="MaxCoPayment" Value="0"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p xlink:type="simple" xlink:href="standard-formulae">For methadone hydrochloride oral liquid refer</p>
            </div>
          </Chemical>
          <Chemical ID="C2204071830" Page="110">
            <Name>Morphine hydrochloride</Name>
            <Formulation ID="F220407183001" Rank="3" Units="ml" Weight="1" Safety="Uncompounded">
              <Name>Oral liq 1 mg per ml</Name>
              <Brand ID="B22040718300101" SoleSupply="true">
                <Name>RA-Morph</Name>
                <Pack ID="P754285" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>8.06</Subsidy>
                  <Price>8.06</Price>
                  <Alternate>8.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183002" Rank="3" Units="ml" Weight="2" Safety="Uncompounded">
              <Name>Oral liq 2 mg per ml</Name>
              <Brand ID="B22040718300201" SoleSupply="true">
                <Name>RA-Morph</Name>
                <Pack ID="P754293" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>8.56</Subsidy>
                  <Price>8.56</Price>
                  <Alternate>8.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183003" Rank="3" Units="ml" Weight="5" Safety="Uncompounded">
              <Name>Oral liq 5 mg per ml</Name>
              <Brand ID="B22040718300301" SoleSupply="true">
                <Name>RA-Morph</Name>
                <Pack ID="P754307" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>9.61</Subsidy>
                  <Price>9.61</Price>
                  <Alternate>9.61</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183004" Rank="3" Units="ml" Weight="10" Safety="Uncompounded">
              <Name>Oral liq 10 mg per ml</Name>
              <Brand ID="B22040718300401" SoleSupply="true">
                <Name>RA-Morph</Name>
                <Pack ID="P754315" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>12.56</Subsidy>
                  <Price>12.56</Price>
                  <Alternate>12.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Controlled"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C2204071831" Page="111">
            <Name>Morphine sulphate</Name>
            <Formulation ID="F220407183101" Rank="1" Units="tab" Weight="10">
              <Name>Tab long-acting 10 mg</Name>
              <Brand ID="B22040718310102">
                <Name>LA-Morph</Name>
                <Pack ID="P2155044" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.80</Subsidy>
                  <Price>1.80</Price>
                  <Alternate>1.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P346756">
                  <Quantity>10</Quantity>
                  <Subsidy>1.80</Subsidy>
                  <Price>1.80</Price>
                  <Alternate>1.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Repeat" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F220407183102" Rank="1" Units="tab" Weight="30">
              <Name>Tab long-acting 30 mg</Name>
              <Brand ID="B22040718310202">
                <Name>LA-Morph</Name>
                <Pack ID="P346764">
                  <Quantity>10</Quantity>
                  <Subsidy>3.60</Subsidy>
                  <Price>3.60</Price>
                  <Alternate>3.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2155036" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>3.60</Subsidy>
                  <Price>3.60</Price>
                  <Alternate>3.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Repeat" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F220407183103" Rank="1" Units="tab" Weight="60">
              <Name>Tab long-acting 60 mg</Name>
              <Brand ID="B22040718310302">
                <Name>LA-Morph</Name>
                <Pack ID="P346772">
                  <Quantity>10</Quantity>
                  <Subsidy>7.20</Subsidy>
                  <Price>7.20</Price>
                  <Alternate>7.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2155028" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>7.20</Subsidy>
                  <Price>7.20</Price>
                  <Alternate>7.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Repeat" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F220407183104" Rank="1" Units="tab" Weight="100">
              <Name>Tab long-acting 100 mg</Name>
              <Brand ID="B22040718310402">
                <Name>LA-Morph</Name>
                <Pack ID="P346780">
                  <Quantity>10</Quantity>
                  <Subsidy>8.50</Subsidy>
                  <Price>8.50</Price>
                  <Alternate>8.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2155001" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>8.50</Subsidy>
                  <Price>8.50</Price>
                  <Alternate>8.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Repeat" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F220407183107" Rank="4" Units="inj" Weight="5">
              <Name>Inj 5 mg per ml, 1 ml</Name>
              <Brand ID="B22040718310701" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P347930" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>5.17</Subsidy>
                  <Price>5.17</Price>
                  <Alternate>5.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220407183108" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B22040718310801">
                <Name>Mayne</Name>
                <Pack ID="P395013" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>4.75</Subsidy>
                  <Price>4.75</Price>
                  <Alternate>4.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220407183110" Rank="4" Units="inj" Weight="15">
              <Name>Inj 15 mg per ml, 1 ml</Name>
              <Brand ID="B22040718311001" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P395005" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>4.70</Subsidy>
                  <Price>4.70</Price>
                  <Alternate>4.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220407183111" Rank="4" Units="inj" Weight="30">
              <Name>Inj 30 mg per ml, 1 ml</Name>
              <Brand ID="B22040718311101">
                <Name>Mayne</Name>
                <Pack ID="P394998" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>5.16</Subsidy>
                  <Price>5.16</Price>
                  <Alternate>5.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220407183113" Rank="5" Units="supp" Weight="10">
              <Name>Suppos 10 mg</Name>
              <Brand ID="B22040718311325" S29="true">
                <Name>Martindale</Name>
                <Pack ID="P2249758" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>11.08</Subsidy>
                  <Price>11.08</Price>
                  <Alternate>11.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183114" Rank="5" Units="supp" Weight="20">
              <Name>Suppos 20 mg</Name>
              <Brand ID="B22040718311425" S29="true">
                <Name>Martindale</Name>
                <Pack ID="P2148277" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>20.31</Subsidy>
                  <Price>20.31</Price>
                  <Alternate>20.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183115" Rank="5" Units="supp" Weight="30">
              <Name>Suppos 30 mg</Name>
              <Brand ID="B22040718311525" S29="true">
                <Name>Martindale</Name>
                <Pack ID="P2148269" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>31.39</Subsidy>
                  <Price>31.39</Price>
                  <Alternate>31.39</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183119" Rank="2" Units="cap" Weight="100">
              <Name>Cap long-acting 100 mg</Name>
              <Brand ID="B22040718311925" SoleSupply="true">
                <Name>m-Eslon</Name>
                <Pack ID="P2106507" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>7.85</Subsidy>
                  <Price>7.85</Price>
                  <Alternate>7.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183120" Rank="1" Units="tab" Weight="10">
              <Name>Tab immediate release 10 mg</Name>
              <Brand ID="B22040718312001" SoleSupply="true">
                <Name>Sevredol</Name>
                <Pack ID="P242675" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>2.64</Subsidy>
                  <Price>2.64</Price>
                  <Alternate>2.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183121" Rank="1" Units="tab" Weight="20">
              <Name>Tab immediate release 20 mg</Name>
              <Brand ID="B22040718312101" SoleSupply="true">
                <Name>Sevredol</Name>
                <Pack ID="P242756" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>5.10</Subsidy>
                  <Price>5.10</Price>
                  <Alternate>5.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183122" Rank="2" Units="cap" Weight="10">
              <Name>Cap long-acting 10 mg</Name>
              <Brand ID="B22040718312225" SoleSupply="true">
                <Name>m-Eslon</Name>
                <Pack ID="P2106469" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.80</Subsidy>
                  <Price>1.80</Price>
                  <Alternate>1.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183125" Rank="2" Units="cap" Weight="200">
              <Name>Cap long-acting 200 mg</Name>
              <Brand ID="B22040718312525" SoleSupply="true">
                <Name>m-Eslon</Name>
                <Pack ID="P2106477" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>17.00</Subsidy>
                  <Price>17.00</Price>
                  <Alternate>17.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183126" Rank="2" Units="cap" Weight="30">
              <Name>Cap long-acting 30 mg</Name>
              <Brand ID="B22040718312625" SoleSupply="true">
                <Name>m-Eslon</Name>
                <Pack ID="P2106485" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>2.64</Subsidy>
                  <Price>2.64</Price>
                  <Alternate>2.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183127" Rank="2" Units="cap" Weight="60">
              <Name>Cap long-acting 60 mg</Name>
              <Brand ID="B22040718312725" SoleSupply="true">
                <Name>m-Eslon</Name>
                <Pack ID="P2106493" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>7.20</Subsidy>
                  <Price>7.20</Price>
                  <Alternate>7.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Controlled"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C2204071953" Page="111">
            <Name>Pethidine hydrochloride</Name>
            <Formulation ID="F220407195301" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22040719530101">
                <Name>PSM</Name>
                <Pack ID="P259942" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>3.00</Subsidy>
                  <Price>3.00</Price>
                  <Alternate>3.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407195302" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22040719530201">
                <Name>PSM</Name>
                <Pack ID="P259950" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>4.00</Subsidy>
                  <Price>4.00</Price>
                  <Alternate>4.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407195303" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg per ml, 1 ml</Name>
              <Brand ID="B22040719530301">
                <Name>Mayne</Name>
                <Pack ID="P500429" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>3.75</Subsidy>
                  <Price>3.75</Price>
                  <Alternate>3.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220407195304" Rank="4" Units="inj" Weight="75">
              <Name>Inj 50 mg per ml, 1.5 ml</Name>
              <Brand ID="B22040719530401">
                <Name>Mayne</Name>
                <Pack ID="P500437" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>4.35</Subsidy>
                  <Price>4.35</Price>
                  <Alternate>4.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220407195305" Rank="4" Units="inj" Weight="100">
              <Name>Inj 50 mg per ml, 2 ml</Name>
              <Brand ID="B22040719530501">
                <Name>Mayne</Name>
                <Pack ID="P394971" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>4.18</Subsidy>
                  <Price>4.18</Price>
                  <Alternate>4.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P763241">
                  <Quantity>50</Quantity>
                  <Subsidy>38.00</Subsidy>
                  <Price>38.00</Price>
                  <Alternate>38.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Rule Type="Controlled"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C2204072383" Page="111">
            <Name>Morphine tartrate</Name>
            <Formulation ID="F220407238301" Rank="4" Units="inj" Weight="120">
              <Name>Inj 80 mg per ml, 1.5 ml</Name>
              <Brand ID="B22040723830101" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P615137" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>20.20</Subsidy>
                  <Price>20.20</Price>
                  <Alternate>20.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407238302" Rank="4" Units="inj" Weight="400">
              <Name>Inj 80 mg per ml, 5 ml</Name>
              <Brand ID="B22040723830201" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P552453" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>67.37</Subsidy>
                  <Price>67.37</Price>
                  <Alternate>67.37</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Controlled"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C2204072427" Page="110">
            <Name>Dihydrocodeine tartrate</Name>
            <Formulation ID="F220407242701" Rank="1" Units="tab" Weight="60">
              <Name>Tab long-acting 60 mg</Name>
              <Brand ID="B22040724270101" SoleSupply="true">
                <Name>DHC Continus</Name>
                <Pack ID="P772887" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>30.30</Subsidy>
                  <Price>30.30</Price>
                  <Alternate>30.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204072521" Page="110">
            <Name>Buprenorphine hydrochloride</Name>
            <Formulation ID="F220407252101" Rank="4" Units="inj" Weight="0.3">
              <Name>Inj 0.3 mg per ml, 1 ml</Name>
              <Brand ID="B22040725210101">
                <Name>Temgesic</Name>
                <Pack ID="P358444" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>7.42</Subsidy>
                  <Price>9.38</Price>
                  <Alternate>7.42</Alternate>
                  <Surcharge>0.39200</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Controlled"/>
          </Chemical>
          <Chemical ID="C2204073801" Page="110">
            <Name>Fentanyl</Name>
            <Formulation ID="F220407380129" Rank="9" Units="patch" Weight="25">
              <Name>Transdermal patch, matrix 25 mcg per hour</Name>
              <Brand ID="B22040738012925">
                <Name>Durogesic</Name>
                <Pack ID="P2222914" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>55.23</Subsidy>
                  <Price>55.23</Price>
                  <Alternate>55.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407380130" Rank="9" Units="patch" Weight="50">
              <Name>Transdermal patch, matrix 50 mcg per hour</Name>
              <Brand ID="B22040738013025">
                <Name>Durogesic</Name>
                <Pack ID="P2222922" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>100.52</Subsidy>
                  <Price>100.52</Price>
                  <Alternate>100.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407380131" Rank="9" Units="patch" Weight="75">
              <Name>Transdermal patch, matrix 75 mcg per hour</Name>
              <Brand ID="B22040738013125">
                <Name>Durogesic</Name>
                <Pack ID="P2222930" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>139.18</Subsidy>
                  <Price>139.18</Price>
                  <Alternate>139.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407380132" Rank="9" Units="patch" Weight="100">
              <Name>Transdermal patch, matrix 100 mcg per hour</Name>
              <Brand ID="B22040738013225">
                <Name>Durogesic</Name>
                <Pack ID="P2222949" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>171.22</Subsidy>
                  <Price>171.22</Price>
                  <Alternate>171.22</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0743">
              <Title>
                <range>Fentanyl patches</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient is terminally ill and is opioid-responsive</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">is unable to take oral medication</ci>
                      <ci type="logical" class="Trial">is  intolerant to morphine, or morphine is contraindicated</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="month">3</Term>
              </Case>
              <Case When="Renewal" Form="SA0743">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>general practitioner</Applicant>
                <Term Measure="month">3</Term>
              </Case>
            </Request>
            <Rule Type="Controlled"/>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0743"/>
          </Chemical>
          <Chemical ID="C2204073822" Page="111">
            <Name>Oxycodone hydrochloride</Name>
            <Formulation ID="F220407382225" Rank="2" Units="cap" Weight="5">
              <Name>Cap 5 mg</Name>
              <Brand ID="B22040738222525">
                <Name>OxyNorm</Name>
                <Pack ID="P2179741" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>2.83</Subsidy>
                  <Price>2.83</Price>
                  <Alternate>2.83</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382226" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B22040738222625">
                <Name>OxyNorm</Name>
                <Pack ID="P2179768" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>5.58</Subsidy>
                  <Price>5.58</Price>
                  <Alternate>5.58</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382227" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B22040738222725">
                <Name>OxyNorm</Name>
                <Pack ID="P2179776" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>9.77</Subsidy>
                  <Price>9.77</Price>
                  <Alternate>9.77</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382228" Rank="1" Units="tab" Weight="10">
              <Name>Tab controlled-release 10 mg</Name>
              <Brand ID="B22040738222825">
                <Name>OxyContin</Name>
                <Pack ID="P2177765" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>11.14</Subsidy>
                  <Price>11.14</Price>
                  <Alternate>11.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382229" Rank="1" Units="tab" Weight="20">
              <Name>Tab controlled-release 20 mg</Name>
              <Brand ID="B22040738222925">
                <Name>OxyContin</Name>
                <Pack ID="P2177773" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>18.93</Subsidy>
                  <Price>18.93</Price>
                  <Alternate>18.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382230" Rank="1" Units="tab" Weight="40">
              <Name>Tab controlled-release 40 mg</Name>
              <Brand ID="B22040738223025">
                <Name>OxyContin</Name>
                <Pack ID="P2177781" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>33.29</Subsidy>
                  <Price>33.29</Price>
                  <Alternate>33.29</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382231" Rank="1" Units="tab" Weight="80">
              <Name>Tab controlled-release 80 mg</Name>
              <Brand ID="B22040738223125">
                <Name>OxyContin</Name>
                <Pack ID="P2177803" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>58.03</Subsidy>
                  <Price>58.03</Price>
                  <Alternate>58.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382232" Rank="1" Units="tab" Weight="5">
              <Name>Tab controlled-release 5 mg</Name>
              <Brand ID="B22040738223225">
                <Name>OxyContin</Name>
                <Pack ID="P2194767" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>7.51</Subsidy>
                  <Price>7.51</Price>
                  <Alternate>7.51</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382233" Rank="3" Units="ml" Weight="250" Safety="Uncompounded">
              <Name>Oral liq 5 mg per 5 ml</Name>
              <Brand ID="B22040738223325">
                <Name>OxyNorm</Name>
                <Pack ID="P2243687" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>11.20</Subsidy>
                  <Price>11.20</Price>
                  <Alternate>11.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382234" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B22040738223425">
                <Name>OxyNorm</Name>
                <Pack ID="P2248794" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>14.40</Subsidy>
                  <Price>14.40</Price>
                  <Alternate>14.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407382235" Rank="4" Units="inj" Weight="20">
              <Name>Inj 10 mg per ml, 2 ml</Name>
              <Brand ID="B22040738223525">
                <Name>OxyNorm</Name>
                <Pack ID="P2248786" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>28.80</Subsidy>
                  <Price>28.80</Price>
                  <Alternate>28.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Controlled"/>
            <Rule Type="MaxCoPayment" Value="0"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Guideline" id="PG0786C2204073822">
              <h3>Prescribing Guideline</h3>
              <p>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.</p>
            </div>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1904">For Anti-inflammatory NSAIDS refer to MUSCULO-SKELETAL</p>
        </div>
      </ATC2>
      <ATC2 ID="A2205">
        <Name>Antidepressants</Name>
        <ATC3 ID="A220501">
          <Name>Cyclic and Related Agents</Name>
          <Chemical ID="C2205011059" Page="112">
            <Name>Amitriptyline</Name>
            <Formulation ID="F220501105901" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050110590103" SoleSupply="true">
                <Name>Amitrip</Name>
                <Pack ID="P395633" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.00</Subsidy>
                  <Price>3.00</Price>
                  <Alternate>3.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501105902" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22050110590201" SoleSupply="true">
                <Name>Amitrip</Name>
                <Pack ID="P313661" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.40</Subsidy>
                  <Price>3.40</Price>
                  <Alternate>3.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501105903" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22050110590301" SoleSupply="true">
                <Name>Amitrip</Name>
                <Pack ID="P313696" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.20</Subsidy>
                  <Price>5.20</Price>
                  <Alternate>5.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011315" Page="112">
            <Name>Clomipramine hydrochloride</Name>
            <Formulation ID="F220501131501" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050113150125">
                <Name>Clopress</Name>
                <Pack ID="P2090686" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.00</Subsidy>
                  <Price>10.00</Price>
                  <Alternate>10.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501131502" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22050113150202">
                <Name>Clopress</Name>
                <Pack ID="P380032" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2205011437" Page="112">
            <Name>Dothiepin hydrochloride</Name>
            <Formulation ID="F220501143701" Rank="1" Units="tab" Weight="75">
              <Name>Tab 75 mg</Name>
              <Brand ID="B22050114370102">
                <Name>Dopress</Name>
                <Pack ID="P758728" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.75</Subsidy>
                  <Price>8.75</Price>
                  <Alternate>8.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501143702" Rank="2" Units="cap" Weight="25">
              <Name>Cap 25 mg</Name>
              <Brand ID="B22050114370202">
                <Name>Dopress</Name>
                <Pack ID="P758701" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.75</Subsidy>
                  <Price>4.75</Price>
                  <Alternate>4.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011438" Page="112">
            <Name>Doxepin hydrochloride</Name>
            <Formulation ID="F220501143801" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B22050114380101">
                <Name>Anten</Name>
                <Pack ID="P589209" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.99</Subsidy>
                  <Price>4.99</Price>
                  <Alternate>4.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501143802" Rank="2" Units="cap" Weight="25">
              <Name>Cap 25 mg</Name>
              <Brand ID="B22050114380202">
                <Name>Anten</Name>
                <Pack ID="P348554" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.19</Subsidy>
                  <Price>5.20</Price>
                  <Alternate>4.19</Alternate>
                  <Surcharge>0.01010</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501143803" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B22050114380301">
                <Name>Anten</Name>
                <Pack ID="P348570" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.99</Subsidy>
                  <Price>6.99</Price>
                  <Alternate>6.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501143804" Rank="2" Units="cap" Weight="75">
              <Name>Cap 75 mg</Name>
              <Brand ID="B22050114380401">
                <Name>Anten</Name>
                <Pack ID="P589225" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.99</Subsidy>
                  <Price>10.99</Price>
                  <Alternate>10.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011642" Page="112">
            <Name>Imipramine hydrochloride</Name>
            <Formulation ID="F220501164201" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050116420125" SoleSupply="true">
                <Name>Tofranil</Name>
                <Pack ID="P2015269" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>5.48</Subsidy>
                  <Price>5.48</Price>
                  <Alternate>5.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501164202" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22050116420225" SoleSupply="true">
                <Name>Tofranil</Name>
                <Pack ID="P2015250" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.80</Subsidy>
                  <Price>8.80</Price>
                  <Alternate>8.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011760" Page="112">
            <Name>Maprotiline hydrochloride</Name>
            <Formulation ID="F220501176001" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22050117600101" SoleSupply="true">
                <Name>Ludiomil</Name>
                <Pack ID="P318817" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>25.06</Subsidy>
                  <Price>25.06</Price>
                  <Alternate>25.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501176002" Rank="1" Units="tab" Weight="75">
              <Name>Tab 75 mg</Name>
              <Brand ID="B22050117600201" SoleSupply="true">
                <Name>Ludiomil</Name>
                <Pack ID="P318809" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>21.01</Subsidy>
                  <Price>21.01</Price>
                  <Alternate>21.01</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2205011824" Page="112">
            <Name>Mianserin hydrochloride</Name>
            <Formulation ID="F220501182401" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B22050118240101">
                <Name>Tolvon</Name>
                <Pack ID="P256919" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>29.25</Subsidy>
                  <Price>29.25</Price>
                  <Alternate>29.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0864">
              <Title>
                <range>Mianserin Hydrochloride</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Depression</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Co-existent bladder neck obstruction</ci>
                      <ci type="logical" class="Indication">Cardiovascular disease</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0057 SA0864">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0864"/>
          </Chemical>
          <Chemical ID="C2205011876" Page="112">
            <Name>Nortriptyline hydrochloride</Name>
            <Formulation ID="F220501187601" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050118760125" SoleSupply="true">
                <Name>Norpress</Name>
                <Pack ID="P2090678" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.10</Subsidy>
                  <Price>5.10</Price>
                  <Alternate>5.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501187602" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22050118760202" SoleSupply="true">
                <Name>Norpress</Name>
                <Pack ID="P711802" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>34.90</Subsidy>
                  <Price>34.90</Price>
                  <Alternate>34.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205012301" Page="113">
            <Name>Trimipramine maleate</Name>
            <Formulation ID="F220501230103" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B22050123010302" SoleSupply="true">
                <Name>Tripress</Name>
                <Pack ID="P519960" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.20</Subsidy>
                  <Price>10.20</Price>
                  <Alternate>10.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501230104" Rank="2" Units="cap" Weight="25">
              <Name>Cap 25 mg</Name>
              <Brand ID="B22050123010401" SoleSupply="true">
                <Name>Tripress</Name>
                <Pack ID="P519952" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.50</Subsidy>
                  <Price>5.50</Price>
                  <Alternate>5.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220504">
          <Name>Monoamine-Oxidase Inhibitors (MAOIs) - Non Selective</Name>
          <Chemical ID="C2205041955" Page="113">
            <Name>Phenelzine sulphate</Name>
            <Formulation ID="F220504195501" Rank="1" Units="tab" Weight="15">
              <Name>Tab 15 mg</Name>
              <Brand ID="B22050419550101">
                <Name>Nardil</Name>
                <Pack ID="P211389" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>95.00</Subsidy>
                  <Price>95.00</Price>
                  <Alternate>95.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205042285" Page="113">
            <Name>Tranylcypromine sulphate</Name>
            <Formulation ID="F220504228501" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050422850101">
                <Name>Parnate</Name>
                <Pack ID="P493295" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>22.94</Subsidy>
                  <Price>22.94</Price>
                  <Alternate>22.94</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220505">
          <Name>Monoamine-Oxidase Type A Inhibitors</Name>
          <Chemical ID="C2205052638" Page="113">
            <Name>Moclobemide</Name>
            <Formulation ID="F220505263802" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg</Name>
              <Brand ID="B22050526380225" SoleSupply="true">
                <Name>Apo-Moclobemide</Name>
                <Pack ID="P2129264" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>49.45</Subsidy>
                  <Price>49.45</Price>
                  <Alternate>49.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220505263803" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B22050526380325" SoleSupply="true">
                <Name>Apo-Moclobemide</Name>
                <Pack ID="P2129272" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>26.11</Subsidy>
                  <Price>26.11</Price>
                  <Alternate>26.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Note:</p>
              <p>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.</p>
            </div>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220507">
          <Name>Selective Serotonin Reuptake Inhibitors</Name>
          <Chemical ID="C2205071193" Page="113" Statim="Must">
            <Name>Citalopram hydrobromide</Name>
            <Formulation ID="F220507119301" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B22050711930125">
                <Name>Celapram</Name>
                <Pack ID="P2115786" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22050711930126">
                <Name>Arrow-Citalopram</Name>
                <Pack ID="P2146975" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22050711930127" Update="New Listing">
                <Name>Citalopram - Rex</Name>
                <Pack ID="P2220210" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205072636" Page="113" Statim="Must">
            <Name>Fluoxetine hydrochloride</Name>
            <Formulation ID="F220507263601" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B22050726360103">
                <Name>Fluox</Name>
                <Pack ID="P2031329" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>4.95</Subsidy>
                  <Price>4.95</Price>
                  <Alternate>4.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220507263602" Rank="1" Units="tab" Weight="20">
              <Name>Tab dispersible 20 mg, scored</Name>
              <Brand ID="B22050726360225">
                <Name>Fluox</Name>
                <Pack ID="P2077817" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.90</Subsidy>
                  <Price>5.90</Price>
                  <Alternate>5.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Subsidised by endorsement</p>
                <ol style="list-style-type: decimal">
                  <li>
                    <p>When prescribed for a patient who cannot swallow whole tablets or capsules and the prescription is endorsed accordingly; or</p>
                  </li>
                  <li>
                    <p>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.</p>
                  </li>
                </ol>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205076009" Page="113">
            <Name>Paroxetine hydrochloride</Name>
            <Formulation ID="F220507600901" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B22050760090125" SoleSupply="true">
                <Name>Loxamine</Name>
                <Pack ID="P2226715" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.90</Subsidy>
                  <Price>5.90</Price>
                  <Alternate>5.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220509">
          <Name>Other Antidepressants</Name>
          <Chemical ID="C2205093785" Page="114">
            <Name>Venlafaxine</Name>
            <Formulation ID="F220509378525" Rank="2" Units="cap" Weight="75">
              <Name>Cap 75 mg</Name>
              <Brand ID="B22050937852525">
                <Name>Efexor XR</Name>
                <Pack ID="P2019248" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>37.27</Subsidy>
                  <Price>37.27</Price>
                  <Alternate>37.27</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220509378526" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B22050937852625">
                <Name>Efexor XR</Name>
                <Pack ID="P2019256" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>45.68</Subsidy>
                  <Price>45.68</Price>
                  <Alternate>45.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0789">
              <Title>
                <range>Venlafaxine</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">The patient has “treatment resistant” depression</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">The patient must have had a trial of two different antidepressants and failed to respond to an adequate dose over an adequate period of time (usually at least four weeks)</ci>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">The patient is currently a hospital in-patient as a result of an acute depressive episode</ci>
                        <ci type="logical" class="Trial">The patient must have had a trial of one other antidepressant and failed to respond to an adequate dose over an adequate period of time</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Applicant>vocationally registered general practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0661 SA0789">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has a high risk of relapse (prescriber determined)</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0789"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A2207">
        <Name>Antiepilepsy Drugs</Name>
        <ATC3 ID="A220701">
          <Name>Agents for Control of Status Epilepticus</Name>
          <Chemical ID="C2207011316" Page="114">
            <Name>Clonazepam</Name>
            <Formulation ID="F220701131604" Rank="4" Units="inj" Weight="1">
              <Name>Inj 1 mg per ml, 1 ml</Name>
              <Brand ID="B22070113160401">
                <Name>Rivotril</Name>
                <Pack ID="P204471" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>9.36</Subsidy>
                  <Price>9.36</Price>
                  <Alternate>9.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207011397" Page="114">
            <Name>Diazepam</Name>
            <Formulation ID="F220701139704" Rank="5" Units="supp" Weight="5">
              <Name>Rectal tubes 5 mg</Name>
              <Brand ID="B22070113970401">
                <Name>Stesolid</Name>
                <Pack ID="P425877" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>26.50</Subsidy>
                  <Price>26.50</Price>
                  <Alternate>26.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220701139705" Rank="5" Units="supp" Weight="10">
              <Name>Rectal tubes 10 mg</Name>
              <Brand ID="B22070113970501">
                <Name>Stesolid</Name>
                <Pack ID="P425869" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>32.38</Subsidy>
                  <Price>32.38</Price>
                  <Alternate>32.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220701139706" Rank="4" Units="inj" Weight="10">
              <Name>Inj 5 mg per ml, 2 ml</Name>
              <Brand ID="B22070113970601">
                <Name>Mayne</Name>
                <Pack ID="P399019" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>9.24</Subsidy>
                  <Price>9.24</Price>
                  <Alternate>9.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>PSO must be endorsed “not for anaesthetic procedures”.</p>
              </div>
              <Rule Type="FormReqd" Attribute="PSO"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207011978" Page="114" Statim="Must">
            <Name>Phenytoin sodium</Name>
            <Formulation ID="F220701197806" Rank="4" Units="inj" Weight="100">
              <Name>Inj 50 mg per ml, 2 ml</Name>
              <Brand ID="B22070119780625">
                <Name>Mayne</Name>
                <Pack ID="P391654" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>69.24</Subsidy>
                  <Price>69.24</Price>
                  <Alternate>69.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220701197807" Rank="4" Units="inj" Weight="250">
              <Name>Inj 50 mg per ml, 5 ml</Name>
              <Brand ID="B22070119780725">
                <Name>Mayne</Name>
                <Pack ID="P391646" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>77.27</Subsidy>
                  <Price>77.27</Price>
                  <Alternate>77.27</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207012059" Page="114" Statim="Must">
            <Name>Paraldehyde</Name>
            <Formulation ID="F220701205901" Rank="4" Units="inj">
              <Name>Inj 5 ml</Name>
              <Brand ID="B22070120590101">
                <Name>AFT</Name>
                <Pack ID="P333336" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>62.37</Subsidy>
                  <Price>62.37</Price>
                  <Alternate>62.37</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220702">
          <Name>Control of Epilepsy</Name>
          <Chemical ID="C2207021002" Page="115">
            <Name>Lamotrigine</Name>
            <Formulation ID="F220702100225" Rank="1" Units="tab" Weight="5" Statim="May">
              <Name>Tab dispersible 5 mg</Name>
              <Brand ID="B22070210022501">
                <Name>Lamictal</Name>
                <Pack ID="P2056143" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>9.64</Subsidy>
                  <Price>9.64</Price>
                  <Alternate>9.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022525">
                <Name>Arrow-Lamotrigine</Name>
                <Pack ID="P2245523" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>15.00</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702100226" Rank="1" Units="tab" Weight="25" Statim="May">
              <Name>Tab dispersible 25 mg</Name>
              <Brand ID="B22070210022601">
                <Name>Lamictal</Name>
                <Pack ID="P417866" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>29.09</Subsidy>
                  <Price>29.09</Price>
                  <Alternate>29.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022625">
                <Name>Arrow-Lamotrigine</Name>
                <Pack ID="P2245515" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>25.50</Subsidy>
                  <Price>25.50</Price>
                  <Alternate>25.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022626">
                <Name>Mogine</Name>
                <Pack ID="P2237199" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>25.50</Subsidy>
                  <Price>25.50</Price>
                  <Alternate>25.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702100227" Rank="1" Units="tab" Weight="50" Statim="May">
              <Name>Tab dispersible 50 mg</Name>
              <Brand ID="B22070210022701">
                <Name>Lamictal</Name>
                <Pack ID="P418021" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>47.89</Subsidy>
                  <Price>47.89</Price>
                  <Alternate>47.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022725">
                <Name>Mogine</Name>
                <Pack ID="P2237172" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>43.40</Subsidy>
                  <Price>43.40</Price>
                  <Alternate>43.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022726">
                <Name>Arrow-Lamotrigine</Name>
                <Pack ID="P2245507" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>43.40</Subsidy>
                  <Price>43.40</Price>
                  <Alternate>43.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702100228" Rank="1" Units="tab" Weight="100" Statim="May">
              <Name>Tab dispersible 100 mg</Name>
              <Brand ID="B22070210022801">
                <Name>Lamictal</Name>
                <Pack ID="P418498" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>79.16</Subsidy>
                  <Price>79.16</Price>
                  <Alternate>79.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022825">
                <Name>Arrow-Lamotrigine</Name>
                <Pack ID="P2245493" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>74.90</Subsidy>
                  <Price>74.90</Price>
                  <Alternate>74.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022826">
                <Name>Mogine</Name>
                <Pack ID="P2237202" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>74.90</Subsidy>
                  <Price>74.90</Price>
                  <Alternate>74.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702100229" Rank="1" Units="tab" Weight="200" Statim="May">
              <Name>Tab dispersible 200 mg</Name>
              <Brand ID="B22070210022925">
                <Name>Arrow-Lamotrigine</Name>
                <Pack ID="P2245485" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>127.30</Subsidy>
                  <Price>127.30</Price>
                  <Alternate>127.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022926">
                <Name>Mogine</Name>
                <Pack ID="P2237180" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>127.30</Subsidy>
                  <Price>127.30</Price>
                  <Alternate>127.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702100230" Rank="1" Units="tab" Weight="2" Statim="May">
              <Name>Tab dispersible 2 mg</Name>
              <Brand ID="B22070210023025">
                <Name>Lamictal</Name>
                <Pack ID="P2040034" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.74</Subsidy>
                  <Price>6.74</Price>
                  <Alternate>6.74</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207021004" Page="112" Statim="May">
            <Name>Vigabatrin</Name>
            <Formulation ID="F220702100401" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B22070210040101">
                <Name>Sabril</Name>
                <Pack ID="P2144697" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>119.30</Subsidy>
                  <Price>119.30</Price>
                  <Alternate>119.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0875">
              <Title>
                <range>Vigabatrin</range>
              </Title>
              <Case When="Initial application" Category="new patients">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has epilepsy</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents</ci>
                      <ci type="logical" class="Indication">Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents</ci>
                    </apply>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient is, or will be, receiving regular automated visual field testing (ideally before starting therapy and on a 6-monthly basis thereafter)</ci>
                      <ci type="logical" class="Indication">It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual fields</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">15</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>“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.</p>
                  <p>Vigabatrin is associated with a risk of irreversible visual field defects, which may be asymptomatic in the early stages.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="patient has had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient is receiving regular automated visual field testing (ideally every 6 months) on an ongoing basis for the duration of treatment with vigabatrin</ci>
                      <ci type="logical" class="Indication">It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual fields</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>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.</p>
                  <p>Vigabatrin is associated with a risk of irreversible visual field defects, which may be asymptomatic in the early stages.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0875">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Trial">The patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient is receiving regular automated visual field testing (ideally every 6 months) on an ongoing basis for duration of treatment with vigabatrin</ci>
                      <ci type="logical" class="Indication">It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual fields</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>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.</p>
                  <p>Vigabatrin is associated with a risk of irreversible visual field defects, which may be asymptomatic in the early stages.</p>
                  <p>If the patient had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007 the applicant is required to submit a fresh initial application in the first instance, not a renewal application.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0875"/>
          </Chemical>
          <Chemical ID="C2207021062" Page="112" Statim="May">
            <Name>Gabapentin</Name>
            <Formulation ID="F220702106201" Rank="2" Units="cap" Weight="300">
              <Name>Cap 300 mg</Name>
              <Brand ID="B22070210620101">
                <Name>Neurontin</Name>
                <Pack ID="P475971" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>47.00</Subsidy>
                  <Price>47.00</Price>
                  <Alternate>47.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210620125">
                <Name>Nupentin</Name>
                <Pack ID="P2222132" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>39.76</Subsidy>
                  <Price>39.76</Price>
                  <Alternate>39.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702106202" Rank="2" Units="cap" Weight="400">
              <Name>Cap 400 mg</Name>
              <Brand ID="B22070210620201">
                <Name>Neurontin</Name>
                <Pack ID="P476986" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>62.66</Subsidy>
                  <Price>62.66</Price>
                  <Alternate>62.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210620225">
                <Name>Nupentin</Name>
                <Pack ID="P2222108" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>53.01</Subsidy>
                  <Price>53.01</Price>
                  <Alternate>53.01</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702106225" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B22070210622525">
                <Name>Neurontin</Name>
                <Pack ID="P2022141" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.67</Subsidy>
                  <Price>15.67</Price>
                  <Alternate>15.67</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210622526">
                <Name>Nupentin</Name>
                <Pack ID="P2222124" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.26</Subsidy>
                  <Price>13.26</Price>
                  <Alternate>13.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702106226" Rank="1" Units="tab">
              <Name>Tab 600 mg</Name>
              <Brand ID="B22070210622625">
                <Name>Neurontin</Name>
                <Pack ID="P2242214" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>79.79</Subsidy>
                  <Price>79.79</Price>
                  <Alternate>79.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0873">
              <Title>
                <range>Gabapentin</range>
              </Title>
              <Case When="Initial application" Category="Epilepsy - new patients">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents</ci>
                    <ci type="logical" class="Indication">Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">15</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>“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.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="Epilepsy - patient has had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">The patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>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.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="Neuropathic pain - new patients">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">The patient has tried and failed, or has been unable to tolerate, treatment with a tricyclic antidepressant AND an anticonvulsant agent</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">3</Term>
              </Case>
              <Case When="Initial application" Category="Neuropathic pain - patient has had an approval for gabapentin for neuropathic pain  prior to 1 August 2007" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">The patient has demonstrated a marked improvement in their control of pain (prescriber determined)</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Category="Epilepsy" Form="SA0873">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">The patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>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.</p>
                  <p>If the patient had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007 the applicant is required to submit a fresh initial application in the first instance, not a renewal application.</p>
                </div>
              </Case>
              <Case When="Renewal" Category="Neuropathic pain" Form="SA0873">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">The patient has demonstrated a marked improvement in their control of pain (prescriber determined)</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>If the patient had an approval for gabapentin for neuropathic pain prior to 1 August 2007 the applicant is required to submit a fresh initial application in the first instance, not a renewal application.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0873"/>
          </Chemical>
          <Chemical ID="C2207021133" Page="112" Statim="May">
            <Name>Topiramate</Name>
            <Formulation ID="F220702113301" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22070211330101">
                <Name>Topamax</Name>
                <Pack ID="P470988" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>51.50</Subsidy>
                  <Price>51.50</Price>
                  <Alternate>51.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702113302" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22070211330201">
                <Name>Topamax</Name>
                <Pack ID="P470996" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>87.54</Subsidy>
                  <Price>87.54</Price>
                  <Alternate>87.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702113303" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22070211330301">
                <Name>Topamax</Name>
                <Pack ID="P471003" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>148.83</Subsidy>
                  <Price>148.83</Price>
                  <Alternate>148.83</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702113304" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B22070211330401">
                <Name>Topamax</Name>
                <Pack ID="P471011" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>256.82</Subsidy>
                  <Price>256.82</Price>
                  <Alternate>256.82</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702113325" Rank="2" Units="cap">
              <Name>Sprinkle cap 15 mg</Name>
              <Brand ID="B22070211332525">
                <Name>Topamax</Name>
                <Pack ID="P437212" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>41.20</Subsidy>
                  <Price>41.20</Price>
                  <Alternate>41.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702113326" Rank="2" Units="cap">
              <Name>Sprinkle cap 25 mg</Name>
              <Brand ID="B22070211332625">
                <Name>Topamax</Name>
                <Pack ID="P437239" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>51.50</Subsidy>
                  <Price>51.50</Price>
                  <Alternate>51.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0874">
              <Title>
                <range>Topiramate</range>
              </Title>
              <Case When="Initial application" Category="new patients">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has epilepsy</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents</ci>
                      <ci type="logical" class="Indication">Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">15</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>“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.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="patient has had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">The patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>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.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0874">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Trial">The patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>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.</p>
                  <p>If the patient had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007 the applicant is required to submit a fresh initial application in the first instance, not a renewal application.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0874"/>
          </Chemical>
          <Chemical ID="C2207021217" Page="114" Statim="Must">
            <Name>Carbamazepine</Name>
            <Formulation ID="F220702121703" Rank="3" Units="ml" Weight="20" Safety="Uncompounded">
              <Name>Oral liq 100 mg per 5 ml</Name>
              <Brand ID="B22070212170301">
                <Name>Tegretol</Name>
                <Pack ID="P503649" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>26.37</Subsidy>
                  <Price>26.37</Price>
                  <Alternate>26.37</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702121704" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B22070212170401" ToBeDelisted="2008-01-01">
                <Name>Teril</Name>
                <Pack ID="P589179" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>14.53</Subsidy>
                  <Price>14.53</Price>
                  <Alternate>14.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070212170402">
                <Name>Tegretol</Name>
                <Pack ID="P201588" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>29.06</Subsidy>
                  <Price>29.06</Price>
                  <Alternate>29.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702121705" Rank="1" Units="tab" Weight="200">
              <Name>Tab long-acting 200 mg</Name>
              <Brand ID="B22070212170501">
                <Name>Tegretol CR</Name>
                <Pack ID="P715832" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.98</Subsidy>
                  <Price>16.98</Price>
                  <Alternate>16.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702121706" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B22070212170602">
                <Name>Tegretol</Name>
                <Pack ID="P680931" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>34.58</Subsidy>
                  <Price>34.58</Price>
                  <Alternate>34.58</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702121707" Rank="1" Units="tab" Weight="400">
              <Name>Tab long-acting 400 mg</Name>
              <Brand ID="B22070212170701">
                <Name>Tegretol CR</Name>
                <Pack ID="P715840" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>39.17</Subsidy>
                  <Price>39.17</Price>
                  <Alternate>39.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207021308" Page="115">
            <Name>Clobazam</Name>
            <Formulation ID="F220702130801" Rank="1" Units="tab" Weight="10" Safety="Compounded">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22070213080101">
                <Name>Frisium</Name>
                <Pack ID="P538620" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>9.12</Subsidy>
                  <Price>9.12</Price>
                  <Alternate>9.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207021316" Page="115">
            <Name>Clonazepam</Name>
            <Formulation ID="F220702131601" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 500 mcg</Name>
              <Brand ID="B22070213160125" SoleSupply="true">
                <Name>Paxam</Name>
                <Pack ID="P2095483" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.49</Subsidy>
                  <Price>5.49</Price>
                  <Alternate>5.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702131602" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B22070213160225" SoleSupply="true">
                <Name>Paxam</Name>
                <Pack ID="P2095491" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.95</Subsidy>
                  <Price>9.95</Price>
                  <Alternate>9.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702131603" Rank="3" Units="ml" Weight="2" Safety="Uncompounded">
              <Name>Oral drops 2.5 mg per ml</Name>
              <Brand ID="B22070213160301">
                <Name>Rivotril</Name>
                <Pack ID="P204498" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>7.38</Subsidy>
                  <Price>7.38</Price>
                  <Alternate>7.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207021481" Page="115" Statim="Must">
            <Name>Ethosuximide</Name>
            <Formulation ID="F220702148101" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B22070214810101">
                <Name>Zarontin</Name>
                <Pack ID="P208876" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>32.90</Subsidy>
                  <Price>32.90</Price>
                  <Alternate>32.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702148102" Rank="3" Units="ml" Weight="50" Safety="Uncompounded">
              <Name>Oral liq 250 mg per 5 ml</Name>
              <Brand ID="B22070214810201">
                <Name>Zarontin</Name>
                <Pack ID="P2106019" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>11.96</Subsidy>
                  <Price>11.96</Price>
                  <Alternate>11.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207021978" Page="115" Statim="Must">
            <Name>Phenytoin sodium</Name>
            <Formulation ID="F220702197801" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22070219780101">
                <Name>Dilantin Infatab</Name>
                <Pack ID="P258628" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>15.63</Subsidy>
                  <Price>15.63</Price>
                  <Alternate>15.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702197802" Rank="2" Units="cap" Weight="30">
              <Name>Cap 30 mg</Name>
              <Brand ID="B22070219780201">
                <Name>Dilantin</Name>
                <Pack ID="P258571" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>15.50</Subsidy>
                  <Price>15.50</Price>
                  <Alternate>15.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702197803" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B22070219780301">
                <Name>Dilantin</Name>
                <Pack ID="P258598" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>14.69</Subsidy>
                  <Price>14.69</Price>
                  <Alternate>14.69</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702197804" Rank="3" Units="ml" Weight="6" Safety="Uncompounded">
              <Name>Oral liq 30 mg per 5 ml</Name>
              <Brand ID="B22070219780401">
                <Name>Dilantin</Name>
                <Pack ID="P258652" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>11.19</Subsidy>
                  <Price>11.19</Price>
                  <Alternate>11.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207022041" Page="115" Statim="Must">
            <Name>Primidone</Name>
            <Formulation ID="F220702204101" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B22070220410125">
                <Name>Apo-Primidone</Name>
                <Pack ID="P2049015" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.25</Subsidy>
                  <Price>17.25</Price>
                  <Alternate>17.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207022166" Page="115" Statim="Must">
            <Name>Sodium valproate</Name>
            <Formulation ID="F220702216601" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22070221660101">
                <Name>Epilim Crushable</Name>
                <Pack ID="P539724" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.65</Subsidy>
                  <Price>13.65</Price>
                  <Alternate>13.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702216602" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg EC</Name>
              <Brand ID="B22070221660201">
                <Name>Epilim</Name>
                <Pack ID="P382175" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>27.44</Subsidy>
                  <Price>27.44</Price>
                  <Alternate>27.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702216603" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg EC</Name>
              <Brand ID="B22070221660301">
                <Name>Epilim</Name>
                <Pack ID="P316199" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>52.24</Subsidy>
                  <Price>52.24</Price>
                  <Alternate>52.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702216604" Rank="3" Units="ml" Weight="40" Safety="Uncompounded">
              <Name>Oral liq 200 mg per 5 ml</Name>
              <Brand ID="B22070221660401">
                <Name>Epilim S/F Liquid</Name>
                <Pack ID="P701017" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>20.48</Subsidy>
                  <Price>20.48</Price>
                  <Alternate>20.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070221660402">
                <Name>Epilim Syrup</Name>
                <Pack ID="P701025" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>20.48</Subsidy>
                  <Price>20.48</Price>
                  <Alternate>20.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702216605" Rank="4" Units="inj" Weight="400">
              <Name>Inj 100 mg per ml, 4 ml</Name>
              <Brand ID="B22070221660501">
                <Name>Epilim IV</Name>
                <Pack ID="P710385" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>41.50</Subsidy>
                  <Price>41.50</Price>
                  <Alternate>41.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207023354" Page="115" Statim="Must">
            <Name>Phenobarbitone</Name>
            <Formulation ID="F220702335403" Rank="1" Units="tab" Weight="15">
              <Name>Tab 15 mg</Name>
              <Brand ID="B22070233540301">
                <Name>PSM</Name>
                <Pack ID="P765481" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>23.68</Subsidy>
                  <Price>23.68</Price>
                  <Alternate>23.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702335404" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B22070233540401">
                <Name>PSM</Name>
                <Pack ID="P439886" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>24.59</Subsidy>
                  <Price>24.59</Price>
                  <Alternate>24.59</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p xlink:type="simple" xlink:href="standard-formulae">For phenobarbitone oral liquid refer</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A2213">
        <Name>Antimigraine Preparations</Name>
        <ATC3 ID="A221301">
          <Name>Acute Migraine Treatment</Name>
          <Chemical ID="C2213011462" Page="117">
            <Name>Ergotamine tartrate with caffeine</Name>
            <Formulation ID="F221301146203" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg with caffeine 100 mg</Name>
              <Brand ID="B22130114620301" SoleSupply="true">
                <Name>Cafergot</Name>
                <Pack ID="P206105" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>31.00</Subsidy>
                  <Price>31.00</Price>
                  <Alternate>31.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2213011815" Page="117">
            <Name>Metoclopramide hydrochloride with paracetamol</Name>
            <Formulation ID="F221301181501" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg with paracetamol 500 mg</Name>
              <Brand ID="B22130118150101">
                <Name>Paramax</Name>
                <Pack ID="P336025" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>3.25</Subsidy>
                  <Price>3.25</Price>
                  <Alternate>3.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2213012800" Page="117">
            <Name>Sumatriptan</Name>
            <Formulation ID="F221301280001" Rank="4" Units="inj" Weight="6">
              <Name>Inj 12 mg per ml, 0.5 ml</Name>
              <Brand ID="B22130128000101">
                <Name>Imigran</Name>
                <Pack ID="P799661" OP="true" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>80.00</Subsidy>
                  <Price>80.00</Price>
                  <Alternate>80.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Hospital"/>
              <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
              <Rule Type="FormMax" Value="10" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F221301280002" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22130128000201">
                <Name>Imigran</Name>
                <Pack ID="P316741" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22130128000225">
                <Name>Arrow-Sumatriptan</Name>
                <Pack ID="P2250152" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22130128000226">
                <Name>Sumagran</Name>
                <Pack ID="P2244233" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221301280003" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22130128000301">
                <Name>Imigran</Name>
                <Pack ID="P795135" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22130128000325">
                <Name>Arrow-Sumatriptan</Name>
                <Pack ID="P2250160" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22130128000326">
                <Name>Sumagran</Name>
                <Pack ID="P2244241" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>12.00</Subsidy>
                  <Price>12.00</Price>
                  <Alternate>12.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A221304">
          <Name>Prophylaxis of Migraine</Name>
          <Chemical ID="C2213041318" Page="117" Statim="Must">
            <Name>Clonidine hydrochloride</Name>
            <Formulation ID="F221304131808" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mcg</Name>
              <Brand ID="B22130413180801" SoleSupply="true">
                <Name>Dixarit</Name>
                <Pack ID="P203505" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.53</Subsidy>
                  <Price>17.53</Price>
                  <Alternate>17.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2213042000" Page="117" Statim="Must">
            <Name>Pizotifen</Name>
            <Formulation ID="F221304200001" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mcg</Name>
              <Brand ID="B22130420000101">
                <Name>Sandomigran</Name>
                <Pack ID="P251666" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>21.10</Subsidy>
                  <Price>24.10</Price>
                  <Alternate>21.10</Alternate>
                  <Surcharge>0.03000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
            <p xlink:type="simple" xlink:href="A0716">For Beta Adrenoceptor Blockers refer to CARDIOVASCULAR SYSTEM</p>
          </div>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A1904">For Anti-inflammatory NSAIDS refer to MUSCULO-SKELETAL</p>
        </div>
      </ATC2>
      <ATC2 ID="A2216">
        <Name>Antinausea and Vertigo Agents</Name>
        <ATC3 ID="A221601">
          <Name>Antinausea and Vertigo Agents</Name>
          <Chemical ID="C2216011107" Page="119">
            <Name>Tropisetron</Name>
            <Formulation ID="F221601110701" Rank="2" Units="cap" Weight="5">
              <Name>Cap 5 mg</Name>
              <Brand ID="B22160111070101">
                <Name>Navoban</Name>
                <Pack ID="P399930" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>77.41</Subsidy>
                  <Price>77.41</Price>
                  <Alternate>77.41</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Hospital"/>
            <Rule Type="MaxQtyDisp" Value="3"/>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Not more than one prescription per month.</p>
            </div>
            <Rule Type="FormMax" Value="6" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C2216011195" Page="117" Statim="Must">
            <Name>Betahistine dihydrochloride</Name>
            <Formulation ID="F221601119501" Rank="1" Units="tab" Weight="16">
              <Name>Tab 16 mg</Name>
              <Brand ID="B22160111950125">
                <Name>Vergo 16</Name>
                <Pack ID="P2217090" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>7.56</Subsidy>
                  <Price>7.56</Price>
                  <Alternate>7.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2216011418" Page="118" Statim="Must">
            <Name>Dimenhydrinate</Name>
            <Formulation ID="F221601141801" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22160114180101" ToBeDelisted="2008-04-01">
                <Name>Dramamine</Name>
                <Pack ID="P215112" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>0.59</Subsidy>
                  <Price>3.07</Price>
                  <Alternate>0.59</Alternate>
                  <Surcharge>0.24800</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2216011436" Page="118" Statim="Must">
            <Name>Domperidone</Name>
            <Formulation ID="F221601143601" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22160114360101">
                <Name>Motilium</Name>
                <Pack ID="P388610" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.90</Subsidy>
                  <Price>7.99</Price>
                  <Alternate>7.99</Alternate>
                  <Surcharge>0.04090</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Manufacturers Price" Form="SA0435">
              <Title>
                <range>Domperidone</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is terminally ill and requires control of nausea and vomiting</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Form="SA0435">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Price" xlink:href="SA0435"/>
          </Chemical>
          <Chemical ID="C2216011628" Page="118" Statim="Must">
            <Name>Hyoscine hydrobromide</Name>
            <Formulation ID="F221601162803" Rank="4" Units="inj" Weight="400">
              <Name>Inj 400 mcg per ml, 1 ml</Name>
              <Brand ID="B22160116280301">
                <Name>Mayne</Name>
                <Pack ID="P259144" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>6.66</Subsidy>
                  <Price>6.66</Price>
                  <Alternate>6.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2216011629" Page="118">
            <Name>Hyoscine (scopolamine)</Name>
            <Formulation ID="F221601162901" Rank="9" Units="patch">
              <Name>Patches, 1.5 mg</Name>
              <Brand ID="B22160116290101">
                <Name>Scopoderm TTS</Name>
                <Pack ID="P311472" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>9.56</Subsidy>
                  <Price>12.40</Price>
                  <Alternate>9.56</Alternate>
                  <Surcharge>1.42000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0727">
              <Title>
                <range>Hyoscine (Scopolamine)</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Control of intractable nausea, vomiting, or inability to swallow saliva in the treatment of malignancy or chronic disease</ci>
                    <ci type="logical" class="Trial">Patient cannot tolerate or does not adequately respond to oral anti-nausea agents</ci>
                    <ci type="text" class="details">The applicant must specify the underlying malignancy or chronic disease</ci>
                  </apply>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Form="SA0051 SA0727">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
            </Request>
            <Rule Type="Dispensary" Attribute="HP3" NonPrinting="true"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0727"/>
          </Chemical>
          <Chemical ID="C2216011814" Page="118" Statim="Must">
            <Name>Metoclopramide hydrochloride</Name>
            <Formulation ID="F221601181401" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22160118140102">
                <Name>Metamide</Name>
                <Pack ID="P282081" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.15</Subsidy>
                  <Price>5.15</Price>
                  <Alternate>5.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221601181403" Rank="4" Units="inj" Weight="10">
              <Name>Inj 5 mg per ml, 2 ml</Name>
              <Brand ID="B22160118140302" SoleSupply="true">
                <Name>Pfizer</Name>
                <Pack ID="P771759" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2216012054" Page="119" Statim="Must">
            <Name>Promethazine theoclate</Name>
            <Formulation ID="F221601205401" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22160120540101">
                <Name>Avomine</Name>
                <Pack ID="P212415" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.20</Subsidy>
                  <Price>6.24</Price>
                  <Alternate>1.20</Alternate>
                  <Surcharge>0.50400</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2216012710" Page="118">
            <Name>Ondansetron</Name>
            <Formulation ID="F221601271001" Rank="1" Units="tab" Weight="4">
              <Name>Tab 4 mg</Name>
              <Brand ID="B22160127100101" SoleSupply="true">
                <Name>Zofran</Name>
                <Pack ID="P256080" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>17.18</Subsidy>
                  <Price>17.18</Price>
                  <Alternate>17.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221601271003" Rank="1" Units="tab" Weight="8">
              <Name>Tab 8 mg</Name>
              <Brand ID="B22160127100302" SoleSupply="true">
                <Name>Zofran</Name>
                <Pack ID="P256099" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>33.89</Subsidy>
                  <Price>33.89</Price>
                  <Alternate>33.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221601271027" Rank="1" Units="tab" Weight="4">
              <Name>Tab disp 4 mg</Name>
              <Brand ID="B22160127102725" SoleSupply="true">
                <Name>Zofran Zydis</Name>
                <Pack ID="P2031426" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>17.18</Subsidy>
                  <Price>17.18</Price>
                  <Alternate>17.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221601271028" Rank="1" Units="tab" Weight="8">
              <Name>Tab disp 8 mg</Name>
              <Brand ID="B22160127102825" SoleSupply="true">
                <Name>Zofran Zydis</Name>
                <Pack ID="P2031442" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>20.43</Subsidy>
                  <Price>20.43</Price>
                  <Alternate>20.43</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Waiver of Rule" Form="SA0887">
              <Title>
                <range>Ondansetron</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Use">The patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment of
        malignancy</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">12</Term>
              </Case>
              <Case When="Renewal" Form="SA0887">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment
        of malignancy</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">12</Term>
              </Case>
            </Request>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <Rule Type="MaxQtyDisp" Value="6" Waiver="Special" xlink:href="SA0887"/>
            <Rule Type="FormMax" Value="12" Attribute="Rx" Waiver="Special" xlink:href="SA0887"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Not more than one prescription per month; can be waived by Special Authority see SA0887 below.</p>
            </div>
          </Chemical>
          <Chemical ID="C2216016010" Page="117">
            <Name>Cyclizine hydrochloride</Name>
            <Formulation ID="F221601601001" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22160160100125" SoleSupply="true">
                <Name>Nausicalm</Name>
                <Pack ID="P2231220" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.99</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2216016011" Page="118">
            <Name>Cyclizine lactate</Name>
            <Formulation ID="F221601601101" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg per ml, 1 ml</Name>
              <Brand ID="B22160160110125" SoleSupply="true">
                <Name>Valoid (AFT)</Name>
                <Pack ID="P2145162" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>14.95</Subsidy>
                  <Price>14.95</Price>
                  <Alternate>14.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2216016012" Page="118" Statim="Must">
            <Name>Prochlorperazine</Name>
            <Formulation ID="F221601601201" Rank="1" Units="tab" Weight="3">
              <Name>Tab 3 mg buccal</Name>
              <Brand ID="B22160160120101">
                <Name>Buccastem</Name>
                <Pack ID="P340537" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>5.97</Subsidy>
                  <Price>14.42</Price>
                  <Alternate>5.97</Alternate>
                  <Surcharge>0.16900</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221601601202" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22160160120201">
                <Name>Antinaus</Name>
                <Pack ID="P395838" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>16.85</Subsidy>
                  <Price>16.85</Price>
                  <Alternate>16.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F221601601204" Rank="5" Units="supp" Weight="5">
              <Name>Suppos 5 mg</Name>
              <Brand ID="B22160160120401">
                <Name>Stemetil</Name>
                <Pack ID="P284270" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>9.52</Subsidy>
                  <Price>18.13</Price>
                  <Alternate>9.52</Alternate>
                  <Surcharge>1.72200</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221601601205" Rank="5" Units="supp" Weight="25">
              <Name>Suppos 25 mg</Name>
              <Brand ID="B22160160120501">
                <Name>Stemetil</Name>
                <Pack ID="P284424" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>12.54</Subsidy>
                  <Price>23.87</Price>
                  <Alternate>12.54</Alternate>
                  <Surcharge>2.26600</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221601601206" Rank="4" Units="inj" Weight="12.5">
              <Name>Inj 12.5 mg per ml, 1 ml</Name>
              <Brand ID="B22160160120601">
                <Name>Stemetil</Name>
                <Pack ID="P255335" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>14.91</Subsidy>
                  <Price>25.81</Price>
                  <Alternate>14.91</Alternate>
                  <Surcharge>1.09000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p xlink:type="simple" xlink:href="A0107">For Antispasmodics refer to ALIMENTARY TRACT</p>
        </div>
      </ATC2>
      <ATC2 ID="A2219">
        <Name>Antiparkinson Agents</Name>
        <ATC3 ID="A221901">
          <Name>Dopamine Agonists and Related Agents</Name>
          <Chemical ID="C2219011024" Page="119" Statim="May">
            <Name>Apomorphine hydrochloride</Name>
            <Formulation ID="F221901102401" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B22190110240101" SoleSupply="true">
                <Name>Mayne</Name>
                <Pack ID="P299448" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>50.43</Subsidy>
                  <Price>50.43</Price>
                  <Alternate>50.43</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219011032" Page="119" Statim="May">
            <Name>Pergolide</Name>
            <Formulation ID="F221901103201" Rank="1" Units="tab" Weight="0.25">
              <Name>Tab 0.25 mg</Name>
              <Brand ID="B22190110320101" SoleSupply="true">
                <Name>Permax</Name>
                <Pack ID="P318566" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>71.00</Subsidy>
                  <Price>71.00</Price>
                  <Alternate>71.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901103202" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B22190110320201" SoleSupply="true">
                <Name>Permax</Name>
                <Pack ID="P318558" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>274.00</Subsidy>
                  <Price>274.00</Price>
                  <Alternate>274.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2219011048" Page="119" Statim="May">
            <Name>Amantadine hydrochloride</Name>
            <Formulation ID="F221901104801" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B22190110480101">
                <Name>Symmetrel</Name>
                <Pack ID="P788589" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>47.81</Subsidy>
                  <Price>47.81</Price>
                  <Alternate>47.81</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219011138" Page="120" Statim="May">
            <Name>Tolcapone</Name>
            <Formulation ID="F221901113801" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22190111380101">
                <Name>Tasmar</Name>
                <Pack ID="P487236" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>128.75</Subsidy>
                  <Price>128.75</Price>
                  <Alternate>128.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecOnly" Attribute="Retail"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Specialist must be a neurologist, geriatrician or general physician.</p>
            </div>
          </Chemical>
          <Chemical ID="C2219011167" Page="119" Statim="Must">
            <Name>Bromocriptine mesylate</Name>
            <Formulation ID="F221901116701" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B22190111670103" SoleSupply="true">
                <Name>Alpha-Bromocriptine</Name>
                <Pack ID="P352802" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>32.08</Subsidy>
                  <Price>32.08</Price>
                  <Alternate>32.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901116703" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22190111670302" SoleSupply="true">
                <Name>Alpha-Bromocriptine</Name>
                <Pack ID="P254134" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>120.86</Subsidy>
                  <Price>120.86</Price>
                  <Alternate>120.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219011717" Page="119" Statim="Must">
            <Name>Levodopa with benserazide</Name>
            <Formulation ID="F221901171702" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg with benserazide 50 mg</Name>
              <Brand ID="B22190117170201" SoleSupply="true">
                <Name>Madopar 250</Name>
                <Pack ID="P201448" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901171706" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg with benserazide 25 mg</Name>
              <Brand ID="B22190117170601" SoleSupply="true">
                <Name>Madopar 125</Name>
                <Pack ID="P201421" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.50</Subsidy>
                  <Price>12.50</Price>
                  <Alternate>12.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901171707" Rank="2" Units="cap" Weight="100">
              <Name>Cap long-acting 100 mg with benserazide 25 mg</Name>
              <Brand ID="B22190117170701" SoleSupply="true">
                <Name>Madopar HBS</Name>
                <Pack ID="P693960" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.00</Subsidy>
                  <Price>17.00</Price>
                  <Alternate>17.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F221901171708" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg with benserazide 12.5 mg</Name>
              <Brand ID="B22190117170801" SoleSupply="true">
                <Name>Madopar 62.5</Name>
                <Pack ID="P201413" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901171709" Rank="1" Units="tab" Weight="50">
              <Name>Tab dispersible 50 mg with benserazide 12.5 mg</Name>
              <Brand ID="B22190117170901" SoleSupply="true">
                <Name>Madopar Dispersible</Name>
                <Pack ID="P635960" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.00</Subsidy>
                  <Price>10.00</Price>
                  <Alternate>10.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219011723" Page="119" Statim="Must">
            <Name>Levodopa with carbidopa</Name>
            <Formulation ID="F221901172301" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg with carbidopa 25 mg</Name>
              <Brand ID="B22190117230101">
                <Name>Sindopa</Name>
                <Pack ID="P227048" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>10.00</Subsidy>
                  <Price>10.00</Price>
                  <Alternate>10.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22190117230102">
                <Name>Sinemet</Name>
                <Pack ID="P265233" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>20.00</Subsidy>
                  <Price>20.00</Price>
                  <Alternate>20.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901172302" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg with carbidopa 25 mg</Name>
              <Brand ID="B22190117230201">
                <Name>Sinemet</Name>
                <Pack ID="P204706" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>57.50</Subsidy>
                  <Price>57.50</Price>
                  <Alternate>57.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901172303" Rank="1" Units="tab" Weight="200">
              <Name>Tab long-acting 200 mg with carbidopa 50 mg</Name>
              <Brand ID="B22190117230301">
                <Name>Sinemet CR</Name>
                <Pack ID="P699624" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>70.00</Subsidy>
                  <Price>70.00</Price>
                  <Alternate>70.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219012531" Page="119" Statim="May">
            <Name>Lisuride hydrogen maleate</Name>
            <Formulation ID="F221901253101" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mcg</Name>
              <Brand ID="B22190125310101">
                <Name>Dopergin</Name>
                <Pack ID="P701572" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>27.50</Subsidy>
                  <Price>27.50</Price>
                  <Alternate>27.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219012642" Page="119" Statim="Must">
            <Name>Selegiline hydrochloride</Name>
            <Formulation ID="F221901264201" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22190126420102" SoleSupply="true">
                <Name>Apo-Selegiline</Name>
                <Pack ID="P229717" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.06</Subsidy>
                  <Price>16.06</Price>
                  <Alternate>16.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219013829" Page="119" Statim="May">
            <Name>Entacapone</Name>
            <Formulation ID="F221901382925" Rank="1" Units="tab">
              <Name>Tab 200 mg</Name>
              <Brand ID="B22190138292525">
                <Name>Comtan</Name>
                <Pack ID="P2110601" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>129.00</Subsidy>
                  <Price>129.00</Price>
                  <Alternate>129.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219013830" Page="119" Statim="May">
            <Name>Ropinirole hydrochloride</Name>
            <Formulation ID="F221901383025" Rank="1" Units="tab">
              <Name>Tab 0.25 mg</Name>
              <Brand ID="B22190138302525">
                <Name>Requip</Name>
                <Pack ID="P2114399" Specified="true">
                  <Quantity>210</Quantity>
                  <Subsidy>31.50</Subsidy>
                  <Price>31.50</Price>
                  <Alternate>31.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901383026" Rank="1" Units="tab">
              <Name>Tab 1 mg</Name>
              <Brand ID="B22190138302625">
                <Name>Requip</Name>
                <Pack ID="P2114402" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>67.20</Subsidy>
                  <Price>67.20</Price>
                  <Alternate>67.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901383027" Rank="1" Units="tab">
              <Name>Tab 2 mg</Name>
              <Brand ID="B22190138302725">
                <Name>Requip</Name>
                <Pack ID="P2114410" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>101.21</Subsidy>
                  <Price>101.21</Price>
                  <Alternate>101.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901383028" Rank="1" Units="tab">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22190138302825">
                <Name>Requip</Name>
                <Pack ID="P2114429" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>150.00</Subsidy>
                  <Price>150.00</Price>
                  <Alternate>150.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901383029" Rank="1" Units="tab">
              <Name>Tab 0.25 mg x 42, 0.5 mg x 42 and 1 mg x 21</Name>
              <Brand ID="B22190138302925">
                <Name>Requip Starter Pack</Name>
                <Pack ID="P2248603" OP="true" Specified="true">
                  <Quantity>105</Quantity>
                  <Subsidy>35.70</Subsidy>
                  <Price>35.70</Price>
                  <Alternate>35.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221901383030" Rank="1" Units="tab">
              <Name>Tab 0.5 mg x 42, 1 mg x 42 and 2 mg x 63</Name>
              <Brand ID="B22190138303025">
                <Name>Requip Follow-on Pack</Name>
                <Pack ID="P2248611" OP="true" Specified="true">
                  <Quantity>147</Quantity>
                  <Subsidy>122.11</Subsidy>
                  <Price>122.11</Price>
                  <Alternate>122.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A221904">
          <Name>Anticholinergics</Name>
          <Chemical ID="C2219041130" Page="120">
            <Name>Benztropine mesylate</Name>
            <Formulation ID="F221904113001" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B22190411300125">
                <Name>Benztrop</Name>
                <Pack ID="P2123169" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>7.25</Subsidy>
                  <Price>7.25</Price>
                  <Alternate>7.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F221904113002" Rank="4" Units="inj" Weight="2">
              <Name>Inj 1 mg per ml, 2 ml</Name>
              <Brand ID="B22190411300201">
                <Name>Cogentin</Name>
                <Pack ID="P2095033" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>36.35</Subsidy>
                  <Price>36.35</Price>
                  <Alternate>36.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="PSO"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219041909" Page="120">
            <Name>Orphenadrine hydrochloride</Name>
            <Formulation ID="F221904190901" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22190419090101">
                <Name>Disipal</Name>
                <Pack ID="P258679" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>31.93</Subsidy>
                  <Price>31.93</Price>
                  <Alternate>31.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2219042049" Page="120">
            <Name>Procyclidine hydrochloride</Name>
            <Formulation ID="F221904204901" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22190420490101">
                <Name>Kemadrin</Name>
                <Pack ID="P264962" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.40</Subsidy>
                  <Price>7.40</Price>
                  <Alternate>7.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A2222">
        <Name>Antipsychotics</Name>
        <ATC3 ID="A222201">
          <Name>General</Name>
          <Chemical ID="C2222011011" Page="121">
            <Name>Risperidone</Name>
            <Formulation ID="F222201101101" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B22220110110101">
                <Name>Risperdal</Name>
                <Pack ID="P245364" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>61.53</Subsidy>
                  <Price>61.53</Price>
                  <Alternate>61.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22220110110125">
                <Name>Ridal</Name>
                <Pack ID="P2237504" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>30.77</Subsidy>
                  <Price>30.77</Price>
                  <Alternate>30.77</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201101102" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B22220110110201">
                <Name>Risperdal</Name>
                <Pack ID="P245372" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>123.05</Subsidy>
                  <Price>123.05</Price>
                  <Alternate>123.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22220110110225">
                <Name>Ridal</Name>
                <Pack ID="P2237512" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>61.53</Subsidy>
                  <Price>61.53</Price>
                  <Alternate>61.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201101103" Rank="1" Units="tab" Weight="3">
              <Name>Tab 3 mg</Name>
              <Brand ID="B22220110110301">
                <Name>Risperdal</Name>
                <Pack ID="P245380" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>184.63</Subsidy>
                  <Price>184.63</Price>
                  <Alternate>184.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22220110110325">
                <Name>Ridal</Name>
                <Pack ID="P2237520" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>92.32</Subsidy>
                  <Price>92.32</Price>
                  <Alternate>92.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201101104" Rank="1" Units="tab" Weight="4">
              <Name>Tab 4 mg</Name>
              <Brand ID="B22220110110401">
                <Name>Risperdal</Name>
                <Pack ID="P245402" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>246.09</Subsidy>
                  <Price>246.09</Price>
                  <Alternate>246.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22220110110425">
                <Name>Ridal</Name>
                <Pack ID="P2237539" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>123.05</Subsidy>
                  <Price>123.05</Price>
                  <Alternate>123.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201101105" Rank="3" Units="ml" Weight="1">
              <Name>Oral liquid 1 mg per ml</Name>
              <Brand ID="B22220110110501">
                <Name>Risperdal</Name>
                <Pack ID="P2000725" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>45.92</Subsidy>
                  <Price>45.92</Price>
                  <Alternate>45.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201101125" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 0.5 mg</Name>
              <Brand ID="B22220110112525">
                <Name>Risperdal</Name>
                <Pack ID="P2015765" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>10.25</Subsidy>
                  <Price>10.25</Price>
                  <Alternate>10.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22220110112526">
                <Name>Ridal</Name>
                <Pack ID="P2237547" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>5.20</Subsidy>
                  <Price>5.20</Price>
                  <Alternate>5.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2222011078" Page="120">
            <Name>Clozapine</Name>
            <Formulation ID="F222201107801" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22220110780101">
                <Name>Clozaril</Name>
                <Pack ID="P454680" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22220110780125">
                <Name>Clopine</Name>
                <Pack ID="P2229773" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201107802" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22220110780201">
                <Name>Clozaril</Name>
                <Pack ID="P454699" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>57.00</Subsidy>
                  <Price>57.00</Price>
                  <Alternate>57.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22220110780225">
                <Name>Clopine</Name>
                <Pack ID="P2229811" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>57.00</Subsidy>
                  <Price>57.00</Price>
                  <Alternate>57.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201107825" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22220110782525">
                <Name>Clopine</Name>
                <Pack ID="P2229781" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>28.50</Subsidy>
                  <Price>28.50</Price>
                  <Alternate>28.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201107826" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B22220110782625">
                <Name>Clopine</Name>
                <Pack ID="P2229854" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>91.20</Subsidy>
                  <Price>91.20</Price>
                  <Alternate>91.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Dispensary" Attribute="HP4" NonPrinting="true"/>
            <Rule Type="SpecOnly" Attribute="Hospital"/>
          </Chemical>
          <Chemical ID="C2222011140" Page="121">
            <Name>Olanzapine</Name>
            <Formulation ID="F222201114001" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22220111400101">
                <Name>Zyprexa</Name>
                <Pack ID="P2243660" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>101.21</Subsidy>
                  <Price>101.21</Price>
                  <Alternate>101.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201114002" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22220111400201">
                <Name>Zyprexa</Name>
                <Pack ID="P2243679" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>204.49</Subsidy>
                  <Price>204.49</Price>
                  <Alternate>204.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201114003" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B22220111400301">
                <Name>Zyprexa</Name>
                <Pack ID="P2243652" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>51.07</Subsidy>
                  <Price>51.07</Price>
                  <Alternate>51.07</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0741">
              <Title>
                <range>Olanzapine tabs</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Patient presents with first episode schizophrenia or related psychoses</ci>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient suffering from schizophrenia and related psychoses or acute mania in bipolar disorder who is likely to benefit from antipsychotic treatment</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Trial">An effective dose of risperidone had been trialled and has been discontinued because of unacceptable side effects</ci>
                        <ci type="logical" class="Trial">An effective dose of risperidone had been trialled and has been discontinued because of inadequate clinical response after 4 weeks</ci>
                      </apply>
                    </apply>
                    <ci type="logical" class="Indication">The patient has suffered from an acute episode of schizophrenia or bipolar mania and has been treated with olanzapine short-acting intra-muscular injection</ci>
                  </apply>
                </math>
                <Applicant>psychiatrist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0350 SA0384 SA0456 SA0509 SA0741">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>psychiatrist</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Initial prescriptions to be written by psychiatrists or psychiatric registrars and subsequent prescriptions can be written by General Practitioners.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0741"/>
          </Chemical>
          <Chemical ID="C2222011183" Page="121" Update="-Subsidy">
            <Name>Quetiapine</Name>
            <Formulation ID="F222201118301" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22220111830101">
                <Name>Seroquel</Name>
                <Pack ID="P355488" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>46.20</Subsidy>
                  <Price>46.20</Price>
                  <Alternate>46.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201118302" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22220111830201">
                <Name>Seroquel</Name>
                <Pack ID="P358797" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>92.40</Subsidy>
                  <Price>92.40</Price>
                  <Alternate>92.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201118303" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B22220111830301">
                <Name>Seroquel</Name>
                <Pack ID="P358800" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>158.76</Subsidy>
                  <Price>158.76</Price>
                  <Alternate>158.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201118325" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B22220111832525">
                <Name>Seroquel</Name>
                <Pack ID="P496324" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>267.12</Subsidy>
                  <Price>267.12</Price>
                  <Alternate>267.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222011283" Page="120">
            <Name>Chlorpromazine hydrochloride</Name>
            <Formulation ID="F222201128301" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22220112830101">
                <Name>Largactil</Name>
                <Pack ID="P264539" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.36</Subsidy>
                  <Price>12.36</Price>
                  <Alternate>12.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222201128302" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22220112830201">
                <Name>Largactil</Name>
                <Pack ID="P202576" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.02</Subsidy>
                  <Price>13.02</Price>
                  <Alternate>13.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222201128304" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22220112830401">
                <Name>Largactil</Name>
                <Pack ID="P202592" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>30.61</Subsidy>
                  <Price>30.61</Price>
                  <Alternate>30.61</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222201128306" Rank="4" Units="inj" Weight="50">
              <Name>Inj 25 mg per ml, 2 ml</Name>
              <Brand ID="B22220112830601">
                <Name>Largactil</Name>
                <Pack ID="P202525" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>25.66</Subsidy>
                  <Price>25.66</Price>
                  <Alternate>25.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222011583" Page="120">
            <Name>Haloperidol</Name>
            <Formulation ID="F222201158301" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 500 mcg</Name>
              <Brand ID="B22220115830101" SoleSupply="true">
                <Name>Serenace</Name>
                <Pack ID="P254320" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.93</Subsidy>
                  <Price>4.93</Price>
                  <Alternate>4.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222201158302" Rank="1" Units="tab" Weight="1.5">
              <Name>Tab 1.5 mg</Name>
              <Brand ID="B22220115830201" SoleSupply="true">
                <Name>Serenace</Name>
                <Pack ID="P2143046" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.45</Subsidy>
                  <Price>7.45</Price>
                  <Alternate>7.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222201158303" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22220115830301" SoleSupply="true">
                <Name>Serenace</Name>
                <Pack ID="P254355" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>23.49</Subsidy>
                  <Price>23.49</Price>
                  <Alternate>23.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222201158304" Rank="3" Units="ml" Weight="2">
              <Name>Oral liq 2 mg per ml</Name>
              <Brand ID="B22220115830401" SoleSupply="true">
                <Name>Serenace</Name>
                <Pack ID="P254290" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.06</Subsidy>
                  <Price>18.06</Price>
                  <Alternate>18.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222201158306" Rank="4" Units="inj" Weight="5">
              <Name>Inj 5 mg per ml, 1 ml</Name>
              <Brand ID="B22220115830601" SoleSupply="true">
                <Name>Serenace</Name>
                <Pack ID="P254258" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>17.04</Subsidy>
                  <Price>17.04</Price>
                  <Alternate>17.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222011799" Page="120">
            <Name>Methotrimeprazine</Name>
            <Formulation ID="F222201179901" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22220117990101">
                <Name>Nozinan</Name>
                <Pack ID="P258024" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.93</Subsidy>
                  <Price>16.93</Price>
                  <Alternate>16.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201179902" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22220117990201">
                <Name>Nozinan</Name>
                <Pack ID="P258032" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>43.96</Subsidy>
                  <Price>43.96</Price>
                  <Alternate>43.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201179903" Rank="4" Units="inj" Weight="25">
              <Name>Inj 25 mg per ml, 1 ml</Name>
              <Brand ID="B22220117990301">
                <Name>Nozinan</Name>
                <Pack ID="P549142" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>73.68</Subsidy>
                  <Price>73.68</Price>
                  <Alternate>73.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222011950" Page="121">
            <Name>Pericyazine</Name>
            <Formulation ID="F222201195001" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B22220119500101">
                <Name>Neulactil</Name>
                <Pack ID="P254665" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.49</Subsidy>
                  <Price>12.49</Price>
                  <Alternate>12.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201195002" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22220119500201">
                <Name>Neulactil</Name>
                <Pack ID="P254673" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>44.45</Subsidy>
                  <Price>44.45</Price>
                  <Alternate>44.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222011990" Page="121">
            <Name>Pimozide</Name>
            <Formulation ID="F222201199025" Rank="1" Units="tab">
              <Name>Tab 4 mg</Name>
              <Brand ID="B22220119902525" S29="true" ToBeDelisted="2008-03-01">
                <Name>Orap Forte</Name>
                <Pack ID="P2243253" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>11.78</Subsidy>
                  <Price>11.78</Price>
                  <Alternate>11.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2222012255" Page="122">
            <Name>Thioridazine hydrochloride</Name>
            <Formulation ID="F222201225501" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22220122550102" ToBeDelisted="2008-01-01">
                <Name>Aldazine</Name>
                <Pack ID="P2012219" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>6.88</Subsidy>
                  <Price>6.88</Price>
                  <Alternate>6.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201225502" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22220122550202" ToBeDelisted="2008-02-01">
                <Name>Aldazine</Name>
                <Pack ID="P2012227" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>7.85</Subsidy>
                  <Price>7.85</Price>
                  <Alternate>7.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201225503" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22220122550302" ToBeDelisted="2008-04-01">
                <Name>Aldazine</Name>
                <Pack ID="P2012235" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>10.66</Subsidy>
                  <Price>10.66</Price>
                  <Alternate>10.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201225504" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22220122550401" ToBeDelisted="2007-12-01">
                <Name>Aldazine</Name>
                <Pack ID="P2012243" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>17.14</Subsidy>
                  <Price>17.14</Price>
                  <Alternate>17.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222012298" Page="122">
            <Name>Trifluoperazine hydrochloride</Name>
            <Formulation ID="F222201229801" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B22220122980101" S29="true">
                <Name>Stelazine</Name>
                <Pack ID="P255262" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.83</Subsidy>
                  <Price>10.22</Price>
                  <Alternate>9.83</Alternate>
                  <Surcharge>0.00390</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201229802" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B22220122980201" S29="true">
                <Name>Stelazine</Name>
                <Pack ID="P2243547" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.63</Subsidy>
                  <Price>15.61</Price>
                  <Alternate>13.63</Alternate>
                  <Surcharge>0.01980</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201229803" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22220122980301" S29="true">
                <Name>Stelazine</Name>
                <Pack ID="P2243555" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.79</Subsidy>
                  <Price>17.77</Price>
                  <Alternate>15.79</Alternate>
                  <Surcharge>0.01980</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201229805" Rank="3" Units="ml" Weight="1" Safety="Uncompounded">
              <Name>Oral liq 1 mg per ml</Name>
              <Brand ID="B22220122980501">
                <Name>Stelazine</Name>
                <Pack ID="P255254" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>74.80</Subsidy>
                  <Price>74.80</Price>
                  <Alternate>74.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222012466" Page="120">
            <Name>Lithium carbonate</Name>
            <Formulation ID="F222201246601" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B22220124660101">
                <Name>Lithicarb</Name>
                <Pack ID="P656445" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>25.45</Subsidy>
                  <Price>25.45</Price>
                  <Alternate>25.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201246602" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B22220124660201">
                <Name>Lithicarb</Name>
                <Pack ID="P656453" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.17</Subsidy>
                  <Price>9.17</Price>
                  <Alternate>9.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201246603" Rank="1" Units="tab" Weight="400">
              <Name>Tab long-acting 400 mg</Name>
              <Brand ID="B22220124660301">
                <Name>Priadel</Name>
                <Pack ID="P260851" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.45</Subsidy>
                  <Price>15.45</Price>
                  <Alternate>15.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201246604" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B22220124660401">
                <Name>Douglas</Name>
                <Pack ID="P733393" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.22</Subsidy>
                  <Price>7.22</Price>
                  <Alternate>7.22</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2222013873" Page="112">
            <Name>Ziprasidone </Name>
            <Formulation ID="F222201387325" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B22220138732525">
                <Name>Zeldox</Name>
                <Pack ID="P2260239" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>87.88</Subsidy>
                  <Price>87.88</Price>
                  <Alternate>87.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201387326" Rank="2" Units="cap" Weight="40">
              <Name>Cap 40 mg</Name>
              <Brand ID="B22220138732625">
                <Name>Zeldox</Name>
                <Pack ID="P2260220" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>164.78</Subsidy>
                  <Price>164.78</Price>
                  <Alternate>164.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201387327" Rank="2" Units="cap" Weight="60">
              <Name>Cap 60 mg</Name>
              <Brand ID="B22220138732725">
                <Name>Zeldox</Name>
                <Pack ID="P2260212" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>247.17</Subsidy>
                  <Price>247.17</Price>
                  <Alternate>247.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222201387328" Rank="2" Units="cap" Weight="80">
              <Name>Cap 80 mg</Name>
              <Brand ID="B22220138732825">
                <Name>Zeldox</Name>
                <Pack ID="P2260247" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>329.56</Subsidy>
                  <Price>329.56</Price>
                  <Alternate>329.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>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 because of unacceptable side effects or inadequate response, and the prescription is endorsed accordingly.</p>
            </div>
          </Chemical>
        </ATC3>
        <ATC3 ID="A222204">
          <Name>Depot Injections</Name>
          <Chemical ID="C2222041011" Page="122">
            <Name>Risperidone</Name>
            <Formulation ID="F222204101126" Rank="4" Units="inj" Weight="25">
              <Name>Microspheres for injection 25 mg</Name>
              <Brand ID="B22220410112625">
                <Name>Risperdal Consta</Name>
                <Pack ID="P2098024" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>175.00</Subsidy>
                  <Price>175.00</Price>
                  <Alternate>175.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222204101127" Rank="4" Units="inj" Weight="37">
              <Name>Microspheres for injection 37.5 mg</Name>
              <Brand ID="B22220410112725">
                <Name>Risperdal Consta</Name>
                <Pack ID="P2098032" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>230.00</Subsidy>
                  <Price>230.00</Price>
                  <Alternate>230.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F222204101128" Rank="4" Units="inj" Weight="50">
              <Name>Microspheres for injection 50 mg</Name>
              <Brand ID="B22220410112825">
                <Name>Risperdal Consta</Name>
                <Pack ID="P2098016" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>280.00</Subsidy>
                  <Price>280.00</Price>
                  <Alternate>280.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0792">
              <Title>
                <range>Risperidone microspheres</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">The patient has schizophrenia or other psychotic disorder</ci>
                    <ci type="logical" class="Trial">Has tried but failed to comply with treatment using oral atypical antipsychotic agents</ci>
                    <ci type="logical" class="Therapy">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</ci>
                  </apply>
                </math>
                <Applicant>psychiatrist</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Form="SA0792">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Therapy">The patient has had less than 12 months treatment with risperidone microspheres</ci>
                      <ci type="logical" class="Indication">There is no clinical reason to discontinue treatment</ci>
                    </apply>
                    <ci type="logical" class="Indication">The initiation of risperidone microspheres 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 microspheres</ci>
                  </apply>
                </math>
                <Applicant>psychiatrist</Applicant>
                <Term Measure="month">12</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Risperidone microspheres 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 microspheres.</p>
              </div>
            </Request>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subject to budgetary cap. Applications will be considered and approved subject to funding availability.</p>
            </div>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0792"/>
          </Chemical>
          <Chemical ID="C2222041532" Page="122">
            <Name>Flupenthixol decanoate</Name>
            <Formulation ID="F222204153201" Rank="4" Units="inj" Weight="20">
              <Name>Inj 20 mg per ml, 1 ml</Name>
              <Brand ID="B22220415320125">
                <Name>Fluanxol</Name>
                <Pack ID="P437298" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>13.14</Subsidy>
                  <Price>13.14</Price>
                  <Alternate>13.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222204153202" Rank="4" Units="inj" Weight="40">
              <Name>Inj 20 mg per ml, 2 ml</Name>
              <Brand ID="B22220415320225">
                <Name>Fluanxol</Name>
                <Pack ID="P437301" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>20.90</Subsidy>
                  <Price>20.90</Price>
                  <Alternate>20.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222204153203" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 mg per ml, 1 ml</Name>
              <Brand ID="B22220415320325">
                <Name>Fluanxol</Name>
                <Pack ID="P437271" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>40.87</Subsidy>
                  <Price>40.87</Price>
                  <Alternate>40.87</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2222041533" Page="122">
            <Name>Fluphenazine decanoate</Name>
            <Formulation ID="F222204153301" Rank="4" Units="inj" Weight="12.5">
              <Name>Inj 12.5 mg per 0.5 ml, 0.5 ml</Name>
              <Brand ID="B22220415330101" SoleSupply="true">
                <Name>Modecate</Name>
                <Pack ID="P210935" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>17.60</Subsidy>
                  <Price>17.60</Price>
                  <Alternate>17.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222204153302" Rank="4" Units="inj" Weight="25">
              <Name>Inj 25 mg per ml, 1 ml</Name>
              <Brand ID="B22220415330201" SoleSupply="true">
                <Name>Modecate</Name>
                <Pack ID="P210943" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>27.90</Subsidy>
                  <Price>27.90</Price>
                  <Alternate>27.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222204153304" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 mg per ml, 1 ml</Name>
              <Brand ID="B22220415330401" SoleSupply="true">
                <Name>Modecate</Name>
                <Pack ID="P210951" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>154.50</Subsidy>
                  <Price>154.50</Price>
                  <Alternate>154.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2222041994" Page="122">
            <Name>Pipothiazine palmitate</Name>
            <Formulation ID="F222204199401" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg per ml, 1 ml</Name>
              <Brand ID="B22220419940101">
                <Name>Piportil</Name>
                <Pack ID="P283258" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>178.48</Subsidy>
                  <Price>178.48</Price>
                  <Alternate>178.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222204199402" Rank="4" Units="inj" Weight="100">
              <Name>Inj 50 mg per ml, 2 ml</Name>
              <Brand ID="B22220419940201">
                <Name>Piportil</Name>
                <Pack ID="P283274" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>353.32</Subsidy>
                  <Price>353.32</Price>
                  <Alternate>353.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C2222042530" Page="122">
            <Name>Haloperidol decanoate</Name>
            <Formulation ID="F222204253001" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg per ml, 1 ml</Name>
              <Brand ID="B22220425300101" SoleSupply="true">
                <Name>Haldol</Name>
                <Pack ID="P714615" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>28.39</Subsidy>
                  <Price>28.39</Price>
                  <Alternate>28.39</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F222204253003" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 mg per ml, 1 ml</Name>
              <Brand ID="B22220425300301" SoleSupply="true">
                <Name>Haldol Concentrate</Name>
                <Pack ID="P768596" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>55.90</Subsidy>
                  <Price>55.90</Price>
                  <Alternate>55.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Form