<?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>June 2012</Edition>
    <Volume>19</Volume>
    <Number>1</Number>
    <Published>2012-06-01</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">
            <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" 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>4.26</Price>
                  <Alternate>1.50</Alternate>
                  <Surcharge>0.00552</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0101021275" 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" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.00</Subsidy>
                  <Price>6.30</Price>
                  <Alternate>6.30</Alternate>
                  <Surcharge>0.03300</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" Statim="Must">
            <Name>Sodium alginate</Name>
            <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>8.60</Price>
                  <Alternate>1.80</Alternate>
                  <Surcharge>0.11333</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A010104">
          <Name>Phosphate Binding Agents</Name>
          <Chemical ID="C0101041038" Statim="Must">
            <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" 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">
                <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" Statim="Must">
            <Name>Loperamide hydrochloride</Name>
            <Formulation ID="F010401172801" Rank="2" Units="cap" Weight="2">
              <Name>Cap 2 mg</Name>
              <Brand ID="B01040117280125" SoleSupply="true">
                <Name>Diamide Relief</Name>
                <Pack ID="P2365545" Specified="true">
                  <Quantity>400</Quantity>
                  <Subsidy>8.95</Subsidy>
                  <Price>8.95</Price>
                  <Alternate>8.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010401172802" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B01040117280225">
                <Name>Nodia</Name>
                <Pack ID="P2184427" Specified="true">
                  <Quantity>400</Quantity>
                  <Subsidy>8.95</Subsidy>
                  <Price>8.95</Price>
                  <Alternate>8.95</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">
            <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="P2272547" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>166.50</Subsidy>
                  <Price>166.50</Price>
                  <Alternate>166.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA1155">
                <Title>
                  <range>Budesonide - Cap 3 mg Controlled Release</range>
                </Title>
                <Case When="Initial application" Category="Crohn's disease">
                  <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>
                        <ci type="logical" class="Indication">History of severe psychiatric problems associated with corticosteroid treatment</ci>
                        <ci type="logical" class="Indication">History of major mental illness (such as bipolar affective disorder) where the risk of conventional corticosteroid treatment causing relapse is considered to be high</ci>
                        <ci type="logical" class="Indication">Relapse during pregnancy (where conventional corticosteroids are considered to be contraindicated)</ci>
                      </apply>
                    </apply>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="month">6</Term>
                </Case>
                <Case When="Initial application" Category="collagenous and lymphocytic colitis (microscopic colitis)">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">Patient has a diagnosis of microscopic colitis (collagenous or lymphocytic colitis) by colonoscopy with biopsies</ci>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="month">6</Term>
                </Case>
                <Case When="Initial application" Category="gut Graft versus Host disease" Break="after">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">Patient has a gut Graft versus Host disease following allogenic bone marrow transplantation*</ci>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="month">6</Term>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Indication marked with * is an Unapproved Indication.</p>
                  </div>
                </Case>
                <Case When="Renewal" Form="SA0459 SA0488 SA0512 SA0698 SA0913 SA1155">
                  <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="month">6</Term>
                </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="SA1155"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104041606">
            <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>23.00</Subsidy>
                  <Price>23.00</Price>
                  <Alternate>23.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104042144">
            <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>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104042205" Statim="Must">
            <Name>Sulphasalazine</Name>
            <Formulation ID="F010404220501" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B01040422050101">
                <Name>Salazopyrin</Name>
                <Pack ID="P251615" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.68</Subsidy>
                  <Price>11.68</Price>
                  <Alternate>11.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F010404220502" Rank="1" Units="tab" Weight="500">
              <Name>Tab EC 500 mg</Name>
              <Brand ID="B01040422050201">
                <Name>Salazopyrin EN</Name>
                <Pack ID="P251585" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.89</Subsidy>
                  <Price>12.89</Price>
                  <Alternate>12.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0104042384">
            <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>
          </Chemical>
          <Chemical ID="C0104042533">
            <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>59.05</Subsidy>
                  <Price>59.05</Price>
                  <Alternate>59.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </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>45.96</Subsidy>
                  <Price>45.96</Price>
                  <Alternate>45.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </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>
            </Formulation>
            <Formulation ID="F010404253305" Rank="5" Units="supp" Weight="500">
              <Name>Suppos 500 mg</Name>
              <Brand ID="B01040425330501" SoleSupply="true">
                <Name>Asacol</Name>
                <Pack ID="P462543" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>22.80</Subsidy>
                  <Price>22.80</Price>
                  <Alternate>22.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010404253325" Rank="5" Units="supp" Weight="1000">
              <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>
            <Formulation ID="F010404253326" Rank="1" Units="tab" Weight="500">
              <Name>Tab EC 500 mg</Name>
              <Brand ID="B01040425332625">
                <Name>Asamax</Name>
                <Pack ID="P2288443" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>49.50</Subsidy>
                  <Price>49.50</Price>
                  <Alternate>49.50</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">
            <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">
                <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">
                <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>
          <Chemical ID="C0105011632">
            <Name>Hydrocortisone with cinchocaine</Name>
            <Formulation ID="F010501163201" Rank="3" Units="g">
              <Name>Oint 5 mg with cinchocaine hydrochloride 5 mg per g</Name>
              <Brand ID="B01050116320101">
                <Name>Proctosedyl</Name>
                <Pack ID="P208388" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>15.00</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F010501163204" Rank="5" Units="supp" Weight="5">
              <Name>Suppos 5 mg with cinchocaine hydrochloride 5 mg per g</Name>
              <Brand ID="B01050116320401">
                <Name>Proctosedyl</Name>
                <Pack ID="P208396" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>9.90</Subsidy>
                  <Price>9.90</Price>
                  <Alternate>9.90</Alternate>
                  <Surcharge>0.00000</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" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>52.00</Subsidy>
                  <Price>52.00</Price>
                  <Alternate>52.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0107011631" 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>1.48</Subsidy>
                  <Price>1.48</Price>
                  <Alternate>1.48</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>
                  <Multiple>1</Multiple>
                  <Subsidy>9.57</Subsidy>
                  <Price>9.57</Price>
                  <Alternate>9.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0107012381" Statim="Must">
            <Name>Mebeverine hydrochloride</Name>
            <Formulation ID="F010701238101" Rank="1" Units="tab" Weight="135">
              <Name>Tab 135 mg</Name>
              <Brand ID="B01070123810101" SoleSupply="true">
                <Name>Colofac</Name>
                <Pack ID="P587575" Specified="true">
                  <Quantity>90</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="A0110">
        <Name>Antiulcerants</Name>
        <ATC3 ID="A011001">
          <Name>Antisecretory and Cytoprotective</Name>
          <Chemical ID="C0110012546" Statim="Must">
            <Name>Misoprostol</Name>
            <Formulation ID="F011001254601" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mcg</Name>
              <Brand ID="B01100125460101">
                <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>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011002">
          <Name>Helicobacter Pylori Eradication</Name>
          <Chemical ID="C0110022809">
            <Name>Clarithromycin</Name>
            <Formulation ID="F011002280925" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B01100228092526" SoleSupply="true">
                <Name>Apo-Clarithromycin</Name>
                <Pack ID="P2385511" Specified="true">
                  <Quantity>14</Quantity>
                  <Subsidy>10.95</Subsidy>
                  <Price>10.95</Price>
                  <Alternate>10.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="14" Attribute="Rx"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Subsidised only if prescribed for helicobacter pylori eradication and prescription is endorsed accordingly.</p>
                <p/>
                <p>Note: the prescription is considered endorsed if clarithromycin is prescribed in conjunction with a proton pump inhibitor and either amoxycillin or metronidazole.</p>
              </div>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011003">
          <Name>H2 Antagonists</Name>
          <Chemical ID="C0110031297" 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" 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="B01100320800325" SoleSupply="true">
                <Name>Peptisoothe</Name>
                <Pack ID="P2257319" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>5.92</Subsidy>
                  <Price>5.92</Price>
                  <Alternate>5.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </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>
                  <Multiple>1</Multiple>
                  <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>6.79</Subsidy>
                  <Price>6.79</Price>
                  <Alternate>6.79</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>9.34</Subsidy>
                  <Price>9.34</Price>
                  <Alternate>9.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0110032373" 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>8.10</Subsidy>
                  <Price>8.10</Price>
                  <Alternate>8.10</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>11.35</Subsidy>
                  <Price>11.35</Price>
                  <Alternate>11.35</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" 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>4.65</Subsidy>
                  <Price>4.65</Price>
                  <Alternate>4.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101010220126">
                <Name>Lanzol Relief</Name>
                <Pack ID="P2376474" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.34</Subsidy>
                  <Price>4.34</Price>
                  <Alternate>4.34</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>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01101010222526">
                <Name>Lanzol Relief</Name>
                <Pack ID="P2376466" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>3.27</Subsidy>
                  <Price>3.27</Price>
                  <Alternate>3.27</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0110101098" Statim="Must">
            <Name>Pantoprazole</Name>
            <Formulation ID="F011010109801" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B01101010980125" SoleSupply="true">
                <Name>Dr Reddy's Pantoprazole</Name>
                <Pack ID="P2272040" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.54</Subsidy>
                  <Price>1.54</Price>
                  <Alternate>1.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010109802" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B01101010980225" SoleSupply="true">
                <Name>Dr Reddy's Pantoprazole</Name>
                <Pack ID="P2272032" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.23</Subsidy>
                  <Price>1.23</Price>
                  <Alternate>1.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010109825" Rank="4" Units="inj">
              <Name>Inj 40 mg</Name>
              <Brand ID="B01101010982525" SoleSupply="true">
                <Name>Pantocid IV</Name>
                <Pack ID="P2311283" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>6.50</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>6.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0110102639" Statim="Must">
            <Name>Omeprazole</Name>
            <Formulation ID="F011010263901" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B01101026390127" SoleSupply="true">
                <Name>Omezol Relief</Name>
                <Pack ID="P2383438" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.78</Subsidy>
                  <Price>3.78</Price>
                  <Alternate>3.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010263903" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg</Name>
              <Brand ID="B01101026390325" SoleSupply="true">
                <Name>Dr Reddy's Omeprazole</Name>
                <Pack ID="P2310201" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>28.65</Subsidy>
                  <Price>28.65</Price>
                  <Alternate>28.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010263904" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B01101026390427" SoleSupply="true">
                <Name>Omezol Relief</Name>
                <Pack ID="P2383411" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>2.91</Subsidy>
                  <Price>2.91</Price>
                  <Alternate>2.91</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010263905" Rank="2" Units="cap" Weight="40">
              <Name>Cap 40 mg</Name>
              <Brand ID="B01101026390527" SoleSupply="true">
                <Name>Omezol Relief</Name>
                <Pack ID="P2383446" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>5.57</Subsidy>
                  <Price>5.57</Price>
                  <Alternate>5.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011010263925" Rank="3" Units="g">
              <Name>Powder</Name>
              <Brand ID="B01101026392525" SoleSupply="true">
                <Name>Midwest</Name>
                <Pack ID="P2387085" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>42.50</Subsidy>
                  <Price>42.50</Price>
                  <Alternate>42.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Combined"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Only in extemporaneously compounded omeprazole suspension.</p>
              </div>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
              <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">
            <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>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0113">
        <Name>Diabetes</Name>
        <ATC3 ID="A011301">
          <Name>Hyperglycaemic Agents</Name>
          <Chemical ID="C0113011570">
            <Name>Glucagon hydrochloride</Name>
            <Formulation ID="F011301157004" Rank="10" Units="kit" 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" 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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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" 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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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="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>
          </Chemical>
          <Chemical ID="C0113053882">
            <Name>Insulin lispro with insulin lispro protamine</Name>
            <Formulation ID="F011305388225" Rank="4" Units="inj" Statim="May">
              <Name>Inj lispro 25% with insulin lispro protamine 75% 100 u per ml, 3 ml</Name>
              <Brand ID="B01130538822525">
                <Name>Humalog Mix 25</Name>
                <Pack ID="P2011050" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>52.15</Subsidy>
                  <Price>52.15</Price>
                  <Alternate>52.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011305388226" Rank="4" Units="inj" Statim="May">
              <Name>Inj lispro 50% with insulin lispro protamine 50% 100 u per ml,3 ml</Name>
              <Brand ID="B01130538822625">
                <Name>Humalog Mix 50</Name>
                <Pack ID="P2235854" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>52.15</Subsidy>
                  <Price>52.15</Price>
                  <Alternate>52.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113056300" 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="B01130563000203">
                <Name>PenMix 30</Name>
                <Pack ID="P785733" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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="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" 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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <Subsidy>63.00</Subsidy>
                  <Price>63.00</Price>
                  <Alternate>63.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011307385727" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 u per ml, 3 ml disposable pen</Name>
              <Brand ID="B01130738572725">
                <Name>Lantus SoloStar</Name>
                <Pack ID="P2275406" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>94.50</Subsidy>
                  <Price>94.50</Price>
                  <Alternate>94.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011309">
          <Name>Insulin - Rapid Acting Preparations</Name>
          <Chemical ID="C0113091192" 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>
                  <Multiple>1</Multiple>
                  <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" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>51.19</Subsidy>
                  <Price>51.19</Price>
                  <Alternate>51.19</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>
                  <Multiple>1</Multiple>
                  <Subsidy>30.03</Subsidy>
                  <Price>30.03</Price>
                  <Alternate>30.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113093908" Statim="May">
            <Name>Insulin glulisine</Name>
            <Formulation ID="F011309390825" Rank="4" Units="inj">
              <Name>Inj 100 u per ml, 10 ml</Name>
              <Brand ID="B01130939082525">
                <Name>Apidra</Name>
                <Pack ID="P2317109" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>27.03</Subsidy>
                  <Price>27.03</Price>
                  <Alternate>27.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011309390826" Rank="4" Units="inj">
              <Name>Inj 100 u per ml, 3 ml disposable pen</Name>
              <Brand ID="B01130939082625">
                <Name>Apidra SoloStar</Name>
                <Pack ID="P2316870" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>46.07</Subsidy>
                  <Price>46.07</Price>
                  <Alternate>46.07</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011309390827" Rank="4" Units="inj">
              <Name>Inj 100 u per ml, 3 ml</Name>
              <Brand ID="B01130939082725">
                <Name>Apidra</Name>
                <Pack ID="P2361620" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>46.07</Subsidy>
                  <Price>46.07</Price>
                  <Alternate>46.07</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011311">
          <Name>Alpha Glucosidase Inhibitors</Name>
          <Chemical ID="C0113111247" Statim="Must">
            <Name>Acarbose</Name>
            <Formulation ID="F011311124701" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B01131112470101" SoleSupply="true">
                <Name>Glucobay</Name>
                <Pack ID="P289256" 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="F011311124702" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B01131112470201" SoleSupply="true">
                <Name>Glucobay</Name>
                <Pack ID="P289647" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>26.70</Subsidy>
                  <Price>26.70</Price>
                  <Alternate>26.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011312">
          <Name>Oral Hypoglycaemic Agents</Name>
          <Chemical ID="C0113121567" Statim="Must">
            <Name>Glibenclamide</Name>
            <Formulation ID="F011312156702" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B01131215670202">
                <Name>Daonil</Name>
                <Pack ID="P203106" 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>
          <Chemical ID="C0113121568" 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>17.60</Subsidy>
                  <Price>17.60</Price>
                  <Alternate>17.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113121569" Statim="Must">
            <Name>Glipizide</Name>
            <Formulation ID="F011312156901" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B01131215690102">
                <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" Statim="Must">
            <Name>Metformin hydrochloride</Name>
            <Formulation ID="F011312179401" Rank="1" Units="tab" Weight="500">
              <Name>Tab immediate-release 500 mg</Name>
              <Brand ID="B01131217940126" SoleSupply="true">
                <Name>Apotex</Name>
                <Pack ID="P2327279" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>8.09</Subsidy>
                  <Price>8.09</Price>
                  <Alternate>8.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011312179402" Rank="1" Units="tab" Weight="850">
              <Name>Tab immediate-release 850 mg</Name>
              <Brand ID="B01131217940227" SoleSupply="true">
                <Name>Apotex</Name>
                <Pack ID="P2327287" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>6.67</Subsidy>
                  <Price>6.67</Price>
                  <Alternate>6.67</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0113123800" Statim="Must">
            <Name>Pioglitazone</Name>
            <Formulation ID="F011312380025" Rank="1" Units="tab" Weight="15">
              <Name>Tab 15 mg</Name>
              <Brand ID="B01131238002526" SoleSupply="true">
                <Name>Pizaccord</Name>
                <Pack ID="P2316455" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>2.61</Subsidy>
                  <Price>2.61</Price>
                  <Alternate>2.61</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011312380026" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B01131238002626" SoleSupply="true">
                <Name>Pizaccord</Name>
                <Pack ID="P2316463" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.23</Subsidy>
                  <Price>5.23</Price>
                  <Alternate>5.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011312380027" Rank="1" Units="tab" Weight="45">
              <Name>Tab 45 mg</Name>
              <Brand ID="B01131238002726" SoleSupply="true">
                <Name>Pizaccord</Name>
                <Pack ID="P2316471" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>7.80</Subsidy>
                  <Price>7.80</Price>
                  <Alternate>7.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0959">
              <Title>
                <range>Pioglitazone</range>
              </Title>
              <Case When="Initial application" Category="Patients with type 2 diabetes">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Patient has not achieved glycaemic control on maximum doses of metformin or a sulphonylurea or where either or both are contraindicated or not tolerated</ci>
                    <ci type="logical" class="Use">Patient is on insulin</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0959"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0115">
        <Name>Diabetes Management</Name>
        <ATC3 ID="A011504">
          <Name>Ketone Testing</Name>
          <Chemical ID="C0115042158" Statim="Must">
            <Name>Sodium nitroprusside</Name>
            <Formulation ID="F011504215825" Rank="10" Units="strip">
              <Name>Test strip</Name>
              <Brand ID="B01150421582525">
                <Name>Ketostix</Name>
                <Pack ID="P2185121" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>14.14</Subsidy>
                  <Price>14.14</Price>
                  <Alternate>14.14</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150421582526" Update="New Listing">
                <Name>Accu-Chek Ketur-Test</Name>
                <Pack ID="P2399962" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>6.00</Subsidy>
                  <Price>6.00</Price>
                  <Alternate>6.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
            <Rule Type="FormMax" Value="50" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0115043888">
            <Name>Ketone blood beta-ketone electrodes</Name>
            <Formulation ID="F011504388825" Rank="10" Units="strip">
              <Name>Test strip</Name>
              <Brand ID="B01150438882525">
                <Name>Freestyle Optium Ketone </Name>
                <Pack ID="P2230984" OP="true" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>7.07</Subsidy>
                  <Price>7.07</Price>
                  <Alternate>7.07</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormBan" Attribute="BSO"/>
            </Formulation>
            <Rule Type="FormMax" Value="20" Attribute="Rx"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011507">
          <Name>Blood Glucose Testing</Name>
          <Chemical ID="C0115073802">
            <Name>Blood glucose diagnostic test strip</Name>
            <Formulation ID="F011507380225" Rank="10" Units="test">
              <Name>Blood glucose test strips</Name>
              <Brand ID="B01150738022527">
                <Name>Accu-Chek Performa</Name>
                <Pack ID="P2247941" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>21.65</Subsidy>
                  <Price>21.65</Price>
                  <Alternate>21.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738022528">
                <Name>Freestyle Optium </Name>
                <Pack ID="P2317893" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>21.65</Subsidy>
                  <Price>21.65</Price>
                  <Alternate>21.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738022529">
                <Name>SensoCard</Name>
                <Pack ID="P2328410" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>26.20</Subsidy>
                  <Price>26.20</Price>
                  <Alternate>26.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738022530">
                <Name>FreeStyle Lite</Name>
                <Pack ID="P2328046" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>21.65</Subsidy>
                  <Price>21.65</Price>
                  <Alternate>21.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011507380226" Rank="10" Units="test">
              <Name>Blood glucose test strips x 50 and lancets x 5</Name>
              <Brand ID="B01150738022625">
                <Name>CareSens</Name>
                <Pack ID="P2380579" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>19.60</Subsidy>
                  <Price>19.60</Price>
                  <Alternate>19.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738022626">
                <Name>On Call Advanced</Name>
                <Pack ID="P2380447" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>19.10</Subsidy>
                  <Price>19.10</Price>
                  <Alternate>19.10</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>
              <p>SensoCard blood glucose test strips are subsidised only if prescribed for a patient who is severely visually impaired and is using a SensoCard Plus Talking Blood Glucose Monitor.</p>
            </div>
          </Chemical>
          <Chemical ID="C0115073807">
            <Name>Blood glucose diagnostic test meter</Name>
            <Formulation ID="F011507380725" Rank="10" Units="meter">
              <Name>Meter</Name>
              <Brand ID="B01150738072527">
                <Name>Freestyle Optium </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>
              <Brand ID="B01150738072529">
                <Name>FreeStyle Lite</Name>
                <Pack ID="P2328054" 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="B01150738072530">
                <Name>CareSens POP</Name>
                <Pack ID="P2335999" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>6.00</Subsidy>
                  <Price>6.00</Price>
                  <Alternate>6.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150738072531">
                <Name>CareSens II</Name>
                <Pack ID="P2335301" 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="B01150738072532">
                <Name>On Call Advanced</Name>
                <Pack ID="P2338378" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>9.00</Subsidy>
                  <Price>9.00</Price>
                  <Alternate>9.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: decimal">
                <li>
                  <p>A diagnostic blood glucose test meter is subsidised for patients who begin insulin or sulphonylurea therapy after 1 March 2005 or is prescribed for a pregnant woman with diabetes.</p>
                </li>
                <li>
                  <p>Only one meter per patient. No further prescriptions will be subsidised. The prescription must be endorsed accordingly.</p>
                </li>
              </ol>
            </div>
            <Rule Type="FormMax" Value="1" Attribute="Rx"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A011509">
          <Name>Insulin Syringes and Needles</Name>
          <Chemical ID="C0115091110" 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" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.15</Subsidy>
                  <Price>3.15</Price>
                  <Alternate>3.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2354837" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150911100125">
                <Name>ABM</Name>
                <Pack ID="P2275392" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150911100126" ToBeDelisted="2012-12-01">
                <Name>SC Profi-Fine</Name>
                <Pack ID="P2335336" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.75</Subsidy>
                  <Price>11.75</Price>
                  <Alternate>11.75</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" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.15</Subsidy>
                  <Price>3.15</Price>
                  <Alternate>3.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2181835" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150911100226">
                <Name>ABM</Name>
                <Pack ID="P2275376" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150911100227" ToBeDelisted="2012-12-01">
                <Name>SC Profi-Fine</Name>
                <Pack ID="P2335352" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.75</Subsidy>
                  <Price>11.75</Price>
                  <Alternate>11.75</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>11.75</Subsidy>
                  <Price>11.75</Price>
                  <Alternate>11.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150911102526" ToBeDelisted="2012-12-01">
                <Name>SC Profi-Fine</Name>
                <Pack ID="P2335344" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.75</Subsidy>
                  <Price>11.75</Price>
                  <Alternate>11.75</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>10.50</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.15500</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150911102626">
                <Name>ABM</Name>
                <Pack ID="P2275384" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150911102627" ToBeDelisted="2012-12-01">
                <Name>Fine Ject</Name>
                <Pack ID="P2343592" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.75</Subsidy>
                  <Price>11.75</Price>
                  <Alternate>11.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F011509111027" Rank="10" Units="dev">
              <Name>32 g x 4 mm</Name>
              <Brand ID="B01150911102725">
                <Name>B-D Micro-Fine</Name>
                <Pack ID="P2375737" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="100" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0115096307" 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>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P799939" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.30</Alternate>
                  <Surcharge>0.06900</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963070225">
                <Name>ABM</Name>
                <Pack ID="P2275341" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963070226" ToBeDelisted="2012-12-01">
                <Name>DM Ject</Name>
                <Pack ID="P2335360" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</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="P788228" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P799947" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.30</Alternate>
                  <Surcharge>0.06900</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963070425">
                <Name>ABM</Name>
                <Pack ID="P2275368" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963070426" ToBeDelisted="2012-12-01">
                <Name>DM Ject</Name>
                <Pack ID="P2335387" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</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="P799955" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.59</Alternate>
                  <Surcharge>0.06900</Surcharge>
                </Pack>
                <Pack ID="P788244" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963070625">
                <Name>ABM</Name>
                <Pack ID="P2275333" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963070626" ToBeDelisted="2012-12-01">
                <Name>DM Ject</Name>
                <Pack ID="P2335417" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</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>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2224348" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.30</Alternate>
                  <Surcharge>0.06900</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963072526">
                <Name>ABM</Name>
                <Pack ID="P2275317" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963072527" ToBeDelisted="2012-12-01">
                <Name>DM Ject</Name>
                <Pack ID="P2335379" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</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>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2224321" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.30</Alternate>
                  <Surcharge>0.06900</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963072626">
                <Name>ABM</Name>
                <Pack ID="P2275309" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963072627" ToBeDelisted="2012-12-01">
                <Name>DM Ject</Name>
                <Pack ID="P2335409" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</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>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2224356" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.99</Price>
                  <Alternate>1.30</Alternate>
                  <Surcharge>0.06900</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963072726">
                <Name>ABM</Name>
                <Pack ID="P2275325" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B01150963072727" ToBeDelisted="2012-12-01">
                <Name>DM Ject</Name>
                <Pack ID="P2335433" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.00</Subsidy>
                  <Price>13.00</Price>
                  <Alternate>13.00</Alternate>
                  <Surcharge>0.00000</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">
            <Name>Ursodeoxycholic acid</Name>
            <Formulation ID="F012201112601" Rank="2" Units="cap" Weight="300">
              <Name>Cap 300 mg</Name>
              <Brand ID="B01220111260101" ToBeDelisted="2012-08-01">
                <Name>Actigall</Name>
                <Pack ID="P336874" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>71.50</Subsidy>
                  <Price>71.50</Price>
                  <Alternate>71.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F012201112625" Rank="10" Units="caps">
              <Name>Cap 250 mg</Name>
              <Brand ID="B01220111262525">
                <Name>Ursosan</Name>
                <Pack ID="P2397528" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>71.50</Subsidy>
                  <Price>71.50</Price>
                  <Alternate>71.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1188">
              <Title>
                <range>Ursodeoxycholic Acid</range>
              </Title>
              <Case When="Initial application" Category="Pregnancy/Cirrhosis">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Patient diagnosed with cholestasis of pregnancy</ci>
                    <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>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</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="Initial application" Category="Haematological Transplant">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient at risk of veno-occlusive disease or has hepatic impairment and is undergoing conditioning treatment prior to allogenic stem cell or bone marrow transplantation</ci>
                    <ci type="logical" class="Indication">Treatment for up to 13 weeks</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="Pregnancy/Cirrhosis" Form="SA0458 SA0841 SA0914 SA1003 SA1188">
                <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>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Ursodeoxycholic acid 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>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1188"/>
          </Chemical>
          <Chemical ID="C0122011925">
            <Name>Pancreatic enzyme</Name>
            <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>
            </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>
            </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>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0125">
        <Name>Laxatives</Name>
        <ATC3 ID="A012501">
          <Name>Bulk-forming Agents</Name>
          <Chemical ID="C0125012452" Statim="Must">
            <Name>Mucilaginous laxatives</Name>
            <Formulation ID="F012501245201" Rank="3" Units="g">
              <Name>Sugar Free</Name>
              <Brand ID="B01250124520101" ToBeDelisted="2012-09-01">
                <Name>Mucilax</Name>
                <Pack ID="P280089" OP="true" Specified="true">
                  <Quantity>275</Quantity>
                  <Subsidy>3.31</Subsidy>
                  <Price>10.60</Price>
                  <Alternate>3.31</Alternate>
                  <Surcharge>0.02651</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012501245202" Rank="3" Units="g">
              <Name>Dry</Name>
              <Brand ID="B01250124520206" SoleSupply="true">
                <Name>Konsyl-D</Name>
                <Pack ID="P2358727" OP="true" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.02</Subsidy>
                  <Price>6.02</Price>
                  <Alternate>6.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125012859" 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="P275328" OP="true" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.02</Subsidy>
                  <Price>17.32</Price>
                  <Alternate>6.02</Alternate>
                  <Surcharge>0.02260</Surcharge>
                </Pack>
                <Pack ID="P275301" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>2.41</Subsidy>
                  <Price>8.72</Price>
                  <Alternate>2.41</Alternate>
                  <Surcharge>0.03155</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A012504">
          <Name>Faecal Softeners</Name>
          <Chemical ID="C0125042429" Statim="Must">
            <Name>Docusate sodium</Name>
            <Formulation ID="F012504242903" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B01250424290325" SoleSupply="true">
                <Name>Laxofast 50</Name>
                <Pack ID="P2350394" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.57</Subsidy>
                  <Price>2.57</Price>
                  <Alternate>2.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012504242904" Rank="2" Units="cap" Weight="120">
              <Name>Cap 120 mg</Name>
              <Brand ID="B01250424290425" SoleSupply="true">
                <Name>Laxofast 120</Name>
                <Pack ID="P2350386" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.48</Subsidy>
                  <Price>3.48</Price>
                  <Alternate>3.48</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" 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>3.78</Subsidy>
                  <Price>3.78</Price>
                  <Alternate>3.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Not funded for use in the ear.</p>
            </div>
          </Chemical>
          <Chemical ID="C0125046304" 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" SoleSupply="true">
                <Name>Laxsol</Name>
                <Pack ID="P2069482" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>6.38</Subsidy>
                  <Price>6.38</Price>
                  <Alternate>6.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A012507">
          <Name>Osmotic Laxatives</Name>
          <Chemical ID="C0125071574" 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>6.00</Subsidy>
                  <Price>6.00</Price>
                  <Alternate>6.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0125072140">
            <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="B01250721400125" SoleSupply="true">
                <Name>Micolette</Name>
                <Pack ID="P2262673" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125072447" Statim="Must">
            <Name>Lactulose</Name>
            <Formulation ID="F012507244701" Rank="3" Units="ml">
              <Name>Oral liq 10 g per 15 ml</Name>
              <Brand ID="B01250724470102" SoleSupply="true">
                <Name>Laevolac</Name>
                <Pack ID="P2149672" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>7.68</Subsidy>
                  <Price>7.68</Price>
                  <Alternate>7.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125072462">
            <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">
            <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<instance>Movicol</instance></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>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" 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" Specified="true">
                  <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" 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-Tab</Name>
                <Pack ID="P2199327" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>4.99</Subsidy>
                  <Price>4.99</Price>
                  <Alternate>4.99</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>3.00</Subsidy>
                  <Price>3.00</Price>
                  <Alternate>3.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012510248203" Rank="5" Units="supp" Weight="10">
              <Name>Suppos 10 mg</Name>
              <Brand ID="B01251024820301">
                <Name>Dulcolax</Name>
                <Pack ID="P270385" Specified="true">
                  <Quantity>6</Quantity>
                  <Subsidy>3.00</Subsidy>
                  <Price>3.00</Price>
                  <Alternate>3.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0125102834">
            <Name>Danthron with poloxamer</Name>
            <Formulation ID="F012510283401" Rank="3" Units="ml" Weight="25">
              <Name>Oral liq 25 mg with poloxamer 200 mg per 5 ml</Name>
              <Brand ID="B01251028340126">
                <Name>Pinorax</Name>
                <Pack ID="P2259435" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012510283402" Rank="3" Units="ml" Weight="75">
              <Name>Oral liq 75 mg with poloxamer 1 g per 5 ml</Name>
              <Brand ID="B01251028340226">
                <Name>Pinorax Forte</Name>
                <Pack ID="P2259443" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>13.95</Subsidy>
                  <Price>13.95</Price>
                  <Alternate>13.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Note: Only for the prevention or treatment of constipation in the terminally ill.</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0128">
        <Name>Metabolic Disorder Agents</Name>
        <ATC3 ID="A012802">
          <Name>Gaucher's Disease</Name>
          <Chemical ID="C0128021238">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>1072.00</Subsidy>
                  <Price>1072.00</Price>
                  <Alternate>1072.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F012802123825" Rank="4" Units="inj" Weight="400">
              <Name>Inj 40 iu per ml, 400 iu vial</Name>
              <Brand ID="B01280212382525">
                <Name>Cerezyme</Name>
                <Pack ID="P2373165" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>2144.00</Subsidy>
                  <Price>2144.00</Price>
                  <Alternate>2144.00</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:gaucherpanel@pharmac.govt.nz">gaucherpanel@pharmac.govt.nz</a></p>
                    </td>
                  </tr>
                </table>
              </div>
            </Request>
            <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">
            <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" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>3.60</Subsidy>
                  <Price>8.50</Price>
                  <Alternate>3.60</Alternate>
                  <Surcharge>0.02450</Surcharge>
                </Pack>
                <Pack ID="P538825" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>9.00</Subsidy>
                  <Price>17.01</Price>
                  <Alternate>9.00</Alternate>
                  <Surcharge>0.01602</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131011244">
            <Name>Chlorhexidine gluconate</Name>
            <Formulation ID="F013101124426" Rank="3" Units="ml" Weight="0.2">
              <Name>Mouthwash 0.2%</Name>
              <Brand ID="B01310112442601">
                <Name>Rivacol</Name>
                <Pack ID="P478547" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>3.87</Subsidy>
                  <Price>3.87</Price>
                  <Alternate>3.87</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131012133">
            <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">
            <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>4.34</Subsidy>
                  <Price>4.34</Price>
                  <Alternate>4.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131016014" 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>5.62</Price>
                  <Alternate>2.06</Alternate>
                  <Surcharge>0.23733</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013107">
          <Name>Oropharyngeal Anti-infectives</Name>
          <Chemical ID="C0131071074">
            <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">
            <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>8.70</Subsidy>
                  <Price>8.70</Price>
                  <Alternate>8.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0131071881">
            <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>3.19</Subsidy>
                  <Price>3.19</Price>
                  <Alternate>3.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013109">
          <Name>Other Oral Agents</Name>
          <Chemical ID="C0131092262" 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" Statim="Must">
            <Name>Hydrogen peroxide</Name>
            <Formulation ID="F013109330301" Rank="3" Units="ml">
              <Name>Soln 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="Xref">
            <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" Statim="Must">
            <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>4.50</Subsidy>
                  <Price>4.50</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013704">
          <Name>Vitamin B</Name>
          <Chemical ID="C0137041624" 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="B01370416240127" SoleSupply="true">
                <Name>ABM Hydroxocobalamin</Name>
                <Pack ID="P2275902" Specified="true">
                  <Quantity>3</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>6.15</Subsidy>
                  <Price>6.15</Price>
                  <Alternate>6.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="6" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0137042071" Statim="Must">
            <Name>Pyridoxine hydrochloride</Name>
            <Formulation ID="F013704207102" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B01370420710226" SoleSupply="true">
                <Name>PyridoxADE</Name>
                <Pack ID="P2386372" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>2.20</Subsidy>
                  <Price>2.20</Price>
                  <Alternate>2.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
              <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>12.16</Subsidy>
                  <Price>12.16</Price>
                  <Alternate>12.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
            <Rule Type="DoseSWt" Value="100"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0137042250" Statim="Must">
            <Name>Thiamine hydrochloride</Name>
            <Formulation ID="F013704225003" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B01370422500302">
                <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>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C0137042328" Statim="Must">
            <Name>Vitamin B complex</Name>
            <Formulation ID="F013704232802" Rank="1" Units="tab">
              <Name>Tab, strong, BPC</Name>
              <Brand ID="B01370423280225" SoleSupply="true">
                <Name>B-PlexADE</Name>
                <Pack ID="P2360888" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>4.70</Subsidy>
                  <Price>4.70</Price>
                  <Alternate>4.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013707">
          <Name>Vitamin C</Name>
          <Chemical ID="C0137071084" Statim="Must">
            <Name>Ascorbic acid</Name>
            <Formulation ID="F013707108401" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B01370710840126" SoleSupply="true">
                <Name>Vitala-C</Name>
                <Pack ID="P2360853" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>13.80</Subsidy>
                  <Price>13.80</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
            <Rule Type="DoseSWt" Value="100"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013710">
          <Name>Vitamin D</Name>
          <Chemical ID="C0137101020" Statim="Must">
            <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>
          </Chemical>
          <Chemical ID="C0137101187" 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>7.76</Subsidy>
                  <Price>7.76</Price>
                  <Alternate>7.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="12" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0137101189" Statim="Must">
            <Name>Calcitriol</Name>
            <Formulation ID="F013710118901" Rank="2" Units="cap" Weight="0.25">
              <Name>Cap 0.25 mcg</Name>
              <Brand ID="B01371011890126" SoleSupply="true">
                <Name>Airflow</Name>
                <Pack ID="P2341255" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.03</Subsidy>
                  <Price>3.03</Price>
                  <Alternate>3.03</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="B01371011890226" SoleSupply="true">
                <Name>Airflow</Name>
                <Pack ID="P2341263" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.62</Subsidy>
                  <Price>5.62</Price>
                  <Alternate>5.62</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>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013719">
          <Name>Multivitamin Preparations</Name>
          <Chemical ID="C0137192330" Statim="Must">
            <Name>Vitamins</Name>
            <Formulation ID="F013719233001" Rank="1" Units="tab">
              <Name>Tab (BPC cap strength)</Name>
              <Brand ID="B01371923300126" SoleSupply="true">
                <Name>MultiADE</Name>
                <Pack ID="P2360861" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F013719233025" Rank="2" Units="cap">
              <Name>Cap (fat soluble vitamins A, D, E, K)</Name>
              <Brand ID="B01371923302525">
                <Name>Vitabdeck</Name>
                <Pack ID="P2253801" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>23.40</Subsidy>
                  <Price>23.40</Price>
                  <Alternate>23.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA1002">
                <Title>
                  <range>Vitabdeck</range>
                </Title>
                <Case When="Initial application">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient has cystic fibrosis with pancreatic insufficiency</ci>
                      <ci type="logical" class="Indication">Patient is an infant or child with liver disease or short gut syndrome</ci>
                    </apply>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="patient's lifetime"/>
                </Case>
              </Request>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
              <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1002"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0137192926" Statim="Must">
            <Name>Multivitamins</Name>
            <Formulation ID="F013719292602" Rank="3" Units="g">
              <Name>Powder</Name>
              <Brand ID="B01371929260201">
                <Name>Paediatric Seravit</Name>
                <Pack ID="P2361329" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>72.00</Subsidy>
                  <Price>72.00</Price>
                  <Alternate>72.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1036">
              <Title>
                <range>Multivitamins<instance>Paediatric Seravit</instance></range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has inborn errors of metabolism</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <Case When="Renewal" Form="SA0600 SA0963">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">Patient has had a previous approval for multivitamins</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1036"/>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
          <p>Alpha tocopheryl acetate is available fully subsidised for specific patients at the Medical Director of PHARMAC’s discretion. Refer to PHARMAC website www.pharmac.govt.nz for the “Alpha tocopheryl acetate information sheet and application form”.</p>
        </div>
      </ATC2>
      <ATC2 ID="A0138">
        <Name>Minerals</Name>
        <ATC3 ID="A013810">
          <Name>Calcium</Name>
          <Chemical ID="C0138101191" Statim="Must">
            <Name>Calcium carbonate</Name>
            <Formulation ID="F013810119102" Rank="1" Units="tab" Weight="1250">
              <Name>Tab 1.25 g (500 mg elemental)</Name>
              <Brand ID="B01381011910226" SoleSupply="true">
                <Name>Arrow-Calcium</Name>
                <Pack ID="P2390639" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>6.38</Subsidy>
                  <Price>6.38</Price>
                  <Alternate>6.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F013810119126" Rank="1" Units="tab" Weight="1000">
              <Name>Tab eff 1.75 g (1 g elemental)</Name>
              <Brand ID="B01381011912625" SoleSupply="true">
                <Name>Calsource</Name>
                <Pack ID="P2291819" Specified="true">
                  <Quantity>30</Quantity>
                  <Multiple>10</Multiple>
                  <Subsidy>6.21</Subsidy>
                  <Price>6.21</Price>
                  <Alternate>6.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138101199" Statim="Must">
            <Name>Calcium gluconate</Name>
            <Formulation ID="F013810119901" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10%, 10 ml</Name>
              <Brand ID="B01381011990101">
                <Name>Mayne</Name>
                <Pack ID="P2260808" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>21.40</Subsidy>
                  <Price>21.40</Price>
                  <Alternate>21.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013820">
          <Name>Fluoride</Name>
          <Chemical ID="C0138202149" Statim="Must">
            <Name>Sodium fluoride</Name>
            <Formulation ID="F013820214901" Rank="1" Units="tab" Weight="1.1">
              <Name>Tab 1.1 mg (0.5 mg elemental)</Name>
              <Brand ID="B01382021490125">
                <Name>PSM</Name>
                <Pack ID="P358827" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.00</Subsidy>
                  <Price>5.00</Price>
                  <Alternate>5.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013825">
          <Name>Iodine</Name>
          <Chemical ID="C0138253907" Statim="Must">
            <Name>Potassium iodate</Name>
            <Formulation ID="F013825390725" Rank="1" Units="tab">
              <Name>Tab 256 mcg (150 mcg elemental iodine)</Name>
              <Brand ID="B01382539072525">
                <Name>NeuroKare</Name>
                <Pack ID="P2359405" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>7.55</Subsidy>
                  <Price>7.55</Price>
                  <Alternate>7.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013830">
          <Name>Iron</Name>
          <Chemical ID="C0138301501" Statim="Must">
            <Name>Ferrous sulphate with folic acid</Name>
            <Formulation ID="F013830150101" Rank="1" Units="tab" Weight="325">
              <Name>Tab long-acting 325 mg (105 mg elemental) with folic acid 350 mcg</Name>
              <Brand ID="B01383015010101">
                <Name>Ferrograd F</Name>
                <Pack ID="P2190958" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.80</Subsidy>
                  <Price>4.29</Price>
                  <Alternate>1.80</Alternate>
                  <Surcharge>0.08300</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138301676" Statim="Must">
            <Name>Iron polymaltose</Name>
            <Formulation ID="F013830167601" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg per ml, 2 ml</Name>
              <Brand ID="B01383016760101" SoleSupply="true">
                <Name>Ferrum H</Name>
                <Pack ID="P209082" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>19.90</Subsidy>
                  <Price>19.90</Price>
                  <Alternate>19.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138303291" Statim="Must">
            <Name>Ferrous sulphate</Name>
            <Formulation ID="F013830329105" Rank="1" Units="tab" Weight="325">
              <Name>Tab long-acting 325 mg (105 mg elemental)</Name>
              <Brand ID="B01383032910501">
                <Name>Ferrograd</Name>
                <Pack ID="P209074" Specified="true">
                  <Quantity>150</Quantity>
                  <Subsidy>5.06</Subsidy>
                  <Price>15.58</Price>
                  <Alternate>5.06</Alternate>
                  <Surcharge>0.07013</Surcharge>
                </Pack>
                <Pack ID="P604321" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.01</Subsidy>
                  <Price>4.26</Price>
                  <Alternate>1.01</Alternate>
                  <Surcharge>0.10833</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F013830329125" Rank="3" Units="ml" Weight="30" Safety="Uncompounded">
              <Name>Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml)</Name>
              <Brand ID="B01383032912525" SoleSupply="true">
                <Name>Ferodan</Name>
                <Pack ID="P2259087" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>10.30</Subsidy>
                  <Price>10.30</Price>
                  <Alternate>10.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138303831" Statim="Must">
            <Name>Ferrous fumarate</Name>
            <Formulation ID="F013830383125" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg (65 mg elemental)</Name>
              <Brand ID="B01383038312525">
                <Name>Ferro-tab</Name>
                <Pack ID="P2162156" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.35</Subsidy>
                  <Price>4.35</Price>
                  <Alternate>4.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0138303862" Statim="Must">
            <Name>Ferrous fumarate with folic acid</Name>
            <Formulation ID="F013830386225" Rank="1" Units="tab">
              <Name>Tab 310 mg (100 mg elemental) with folic acid 350 mcg</Name>
              <Brand ID="B01383038622525">
                <Name>Ferro-F-Tabs</Name>
                <Pack ID="P2219476" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>4.75</Subsidy>
                  <Price>4.75</Price>
                  <Alternate>4.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A013840">
          <Name>Magnesium</Name>
          <Chemical ID="C0138403329" Statim="Must">
            <Name>Magnesium sulphate</Name>
            <Formulation ID="F013840332903" Rank="4" Units="inj" Weight="49.3">
              <Name>Inj 49.3%, 5 ml</Name>
              <Brand ID="B01384033290301">
                <Name>Mayne</Name>
                <Pack ID="P2213613" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <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="Xref">
            <p xlink:type="simple" xlink:href="standard-formulae">For magnesium hydroxide mixture refer</p>
          </div>
        </ATC3>
        <ATC3 ID="A013850">
          <Name>Zinc</Name>
          <Chemical ID="C0138502354" Statim="Must">
            <Name>Zinc sulphate</Name>
            <Formulation ID="F013850235401" Rank="2" Units="cap" Weight="137.4">
              <Name>Cap 137.4 mg (50 mg elemental)</Name>
              <Brand ID="B01385023540101" SoleSupply="true">
                <Name>Zincaps</Name>
                <Pack ID="P258253" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.00</Subsidy>
                  <Price>11.00</Price>
                  <Alternate>11.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0142">
        <Name>Agents Used in the Treatment of Poisonings</Name>
        <ATC3 ID="A014201">
          <Name>Agents Used in the Treatment of Poisonings</Name>
          <Chemical ID="C0142012132" Statim="Must">
            <Name>Sodium calcium edetate</Name>
            <Formulation ID="F014201213201" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 200 mg per ml, 5 ml</Name>
              <Brand ID="B01420121320101">
                <Name>Calcium Disodium Versenate</Name>
                <Pack ID="P252395" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>53.31</Subsidy>
                  <Price>156.71</Price>
                  <Alternate>53.31</Alternate>
                  <Surcharge>17.23333</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0142012414" Statim="Must">
            <Name>Charcoal</Name>
            <Formulation ID="F014201241425" Rank="3" Units="ml" Weight="50">
              <Name>Oral liq 50 g per 250 ml</Name>
              <Brand ID="B01420124142526">
                <Name>Carbosorb-X</Name>
                <Pack ID="P2189186" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>43.50</Subsidy>
                  <Price>43.50</Price>
                  <Alternate>43.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="PSO"/>
              <Rule Type="FormMax" Value="250" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A04">
      <Name>Blood and Blood Forming Organs</Name>
      <ATC2 ID="A0401">
        <Name>Antianaemics</Name>
        <ATC3 ID="A040101">
          <Name>Hypoplastic and Haemolytic</Name>
          <Chemical ID="C0401012758">
            <Name>Erythropoietin alpha</Name>
            <Formulation ID="F040101275805" Rank="4" Units="inj" Weight="2000">
              <Name>Inj human recombinant 2,000 iu, prefilled syringe</Name>
              <Brand ID="B04010127580501">
                <Name>Eprex</Name>
                <Pack ID="P2300311" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>120.18</Subsidy>
                  <Price>120.18</Price>
                  <Alternate>120.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275806" Rank="4" Units="inj" Weight="3000">
              <Name>Inj human recombinant 3,000 iu, prefilled syringe</Name>
              <Brand ID="B04010127580601">
                <Name>Eprex</Name>
                <Pack ID="P2300338" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>166.87</Subsidy>
                  <Price>166.87</Price>
                  <Alternate>166.87</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275807" Rank="4" Units="inj" Weight="4000">
              <Name>Inj human recombinant 4,000 iu, prefilled syringe</Name>
              <Brand ID="B04010127580701">
                <Name>Eprex</Name>
                <Pack ID="P2300346" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>193.13</Subsidy>
                  <Price>193.13</Price>
                  <Alternate>193.13</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275808" Rank="4" Units="inj" Weight="10000">
              <Name>Inj human recombinant 10,000 iu, prefilled syringe</Name>
              <Brand ID="B04010127580801">
                <Name>Eprex</Name>
                <Pack ID="P2300354" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>395.18</Subsidy>
                  <Price>395.18</Price>
                  <Alternate>395.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275825" Rank="4" Units="inj" Weight="1000">
              <Name>Inj human recombinant 1,000 iu prefilled syringe</Name>
              <Brand ID="B04010127582525">
                <Name>Eprex</Name>
                <Pack ID="P307939">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>48.68</Subsidy>
                  <Price>48.68</Price>
                  <Alternate>48.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2300303" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>48.68</Subsidy>
                  <Price>48.68</Price>
                  <Alternate>48.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275826" Rank="4" Units="inj" Weight="5000">
              <Name>Inj human recombinant 5,000 iu, prefilled syringe</Name>
              <Brand ID="B04010127582625">
                <Name>Eprex</Name>
                <Pack ID="P2294508" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>243.26</Subsidy>
                  <Price>243.26</Price>
                  <Alternate>243.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101275827" Rank="4" Units="inj" Weight="6000">
              <Name>Inj human recombinant 6,000 iu, prefilled syringe</Name>
              <Brand ID="B04010127582725">
                <Name>Eprex</Name>
                <Pack ID="P2294516" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>291.92</Subsidy>
                  <Price>291.92</Price>
                  <Alternate>291.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0922"/>
          </Chemical>
          <Chemical ID="C0401013771">
            <Name>Erythropoietin beta</Name>
            <Formulation ID="F040101377126" Rank="4" Units="inj" Weight="2000">
              <Name>Inj 2,000 iu, prefilled syringe</Name>
              <Brand ID="B04010137712625">
                <Name>NeoRecormon</Name>
                <Pack ID="P2292505" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>120.18</Subsidy>
                  <Price>120.18</Price>
                  <Alternate>120.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377127" Rank="4" Units="inj" Weight="3000">
              <Name>Inj 3,000 iu, prefilled syringe</Name>
              <Brand ID="B04010137712725">
                <Name>NeoRecormon</Name>
                <Pack ID="P2292513" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>166.87</Subsidy>
                  <Price>166.87</Price>
                  <Alternate>166.87</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377128" Rank="4" Units="inj" Weight="4000">
              <Name>Inj 4,000 iu, prefilled syringe</Name>
              <Brand ID="B04010137712825">
                <Name>NeoRecormon</Name>
                <Pack ID="P2292521" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>193.13</Subsidy>
                  <Price>193.13</Price>
                  <Alternate>193.13</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377129" Rank="4" Units="inj" Weight="5000">
              <Name>Inj 5,000 iu, prefilled syringe</Name>
              <Brand ID="B04010137712925">
                <Name>NeoRecormon</Name>
                <Pack ID="P2292548" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>243.26</Subsidy>
                  <Price>243.26</Price>
                  <Alternate>243.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377130" Rank="4" Units="inj" Weight="10000">
              <Name>Inj 10,000 iu, prefilled syringe</Name>
              <Brand ID="B04010137713025">
                <Name>NeoRecormon</Name>
                <Pack ID="P2292564" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>395.18</Subsidy>
                  <Price>395.18</Price>
                  <Alternate>395.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040101377131" Rank="4" Units="inj" Weight="6000">
              <Name>Inj 6,000 iu, prefilled syringe</Name>
              <Brand ID="B04010137713125">
                <Name>NeoRecormon</Name>
                <Pack ID="P2292556" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>291.29</Subsidy>
                  <Price>291.29</Price>
                  <Alternate>291.29</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0922"/>
          </Chemical>
          <Request To="HealthPAC" For="Subsidy" Form="SA0922">
            <Title>
              <range>Erythropoietin</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 SA0922">
              <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>
        </ATC3>
        <ATC3 ID="A040104">
          <Name>Megaloblastic</Name>
          <Chemical ID="C0401041498">
            <Name>Folic acid</Name>
            <Formulation ID="F040104149801" Rank="1" Units="tab" Weight="5" Statim="Must">
              <Name>Tab 5 mg</Name>
              <Brand ID="B04010414980103">
                <Name>Apo-Folic Acid</Name>
                <Pack ID="P304131" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>10.21</Subsidy>
                  <Price>10.21</Price>
                  <Alternate>10.21</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>24.00</Subsidy>
                  <Price>24.00</Price>
                  <Alternate>24.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040104149825" Rank="1" Units="tab" Statim="Must">
              <Name>Tab 0.8 mg</Name>
              <Brand ID="B04010414982525">
                <Name>Apo-Folic Acid</Name>
                <Pack ID="P2025736" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>19.80</Subsidy>
                  <Price>19.80</Price>
                  <Alternate>19.80</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="C0404012164" 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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <Subsidy>28.50</Subsidy>
                  <Price>55.91</Price>
                  <Alternate>28.50</Alternate>
                  <Surcharge>5.48200</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0404012505">
            <Name>Tranexamic acid</Name>
            <Formulation ID="F040401250501" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B04040125050101" SoleSupply="true">
                <Name>Cyklokapron</Name>
                <Pack ID="P461962" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>32.92</Subsidy>
                  <Price>32.92</Price>
                  <Alternate>32.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A040403">
          <Name>Vitamin K</Name>
          <Chemical ID="C0404031986">
            <Name>Phytomenadione</Name>
            <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0407">
        <Name>Antithrombotic Agents</Name>
        <ATC3 ID="A040701">
          <Name>Antiplatelet Agents</Name>
          <Chemical ID="C0407011087" Statim="Must">
            <Name>Aspirin</Name>
            <Formulation ID="F040701108725" Rank="1" Units="tab">
              <Name>Tab 100 mg</Name>
              <Brand ID="B04070110872525" SoleSupply="true">
                <Name>Ethics Aspirin EC</Name>
                <Pack ID="P2213621" Specified="true">
                  <Quantity>990</Quantity>
                  <Subsidy>14.00</Subsidy>
                  <Price>14.00</Price>
                  <Alternate>14.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407011427" 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="P2248948" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>8.36</Subsidy>
                  <Price>8.36</Price>
                  <Alternate>8.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </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>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407013860" Statim="Must">
            <Name>Clopidogrel</Name>
            <Formulation ID="F040701386025" Rank="1" Units="tab" Weight="75">
              <Name>Tab 75 mg</Name>
              <Brand ID="B04070138602526" SoleSupply="true">
                <Name>Apo-Clopidogrel</Name>
                <Pack ID="P2354896" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>16.25</Subsidy>
                  <Price>16.25</Price>
                  <Alternate>16.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407013945">
            <Name>Prasugrel</Name>
            <Formulation ID="F040701394525" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B04070139452525">
                <Name>Effient</Name>
                <Pack ID="P2351455" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>108.00</Subsidy>
                  <Price>108.00</Price>
                  <Alternate>108.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040701394526" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04070139452625">
                <Name>Effient</Name>
                <Pack ID="P2351471" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>120.00</Subsidy>
                  <Price>120.00</Price>
                  <Alternate>120.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1201">
              <Title>
                <range>Prasugrel</range>
              </Title>
              <Case When="Initial application" Category="coronary angioplasty and bare metal stent">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Treatment">The patient has undergone coronary angioplasty in the previous 4 weeks and is clopidogrel-allergic*</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Initial application" Category="drug eluting stent">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Treatment">The patient has had a drug-eluting cardiac stent inserted in the previous 4 weeks and is clopidogrel-allergic*</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">12</Term>
              </Case>
              <Case When="Initial application" Category="stent thromobosis">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Treatment">patient has experienced cardiac stent thrombosis whilst on clopidogrel</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <Case When="Renewal" Category="coronary angioplasty and bare metal stent" Form="SA1194 SA1201">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Treatment">The patient has undergone coronary angioplasty or had a bare metal cardiac stent inserted in the previous 4 weeks and is clopidogrel-allergic*</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="drug eluting stent" Form="SA1194 SA1201">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Treatment">had a drug-eluting cardiac stent inserted in the previous 4 weeks and is clopidogrel-allergic*</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">12</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>* Clopidogrel allergy is defined as a history of anaphylaxis, urticaria, generalised rash or asthma (in non-asthmatic patients) developing soon after clopidogrel is started and is considered unlikely to be caused by any other treatment.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1201"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A040704">
          <Name>Heparin and Antagonist Preparations</Name>
          <Chemical ID="C0407041589">
            <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" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <Subsidy>66.80</Subsidy>
                  <Price>66.80</Price>
                  <Alternate>66.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04070415890125">
                <Name>Pfizer</Name>
                <Pack ID="P2339897" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>46.30</Subsidy>
                  <Price>46.30</Price>
                  <Alternate>46.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2339900" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>11.44</Subsidy>
                  <Price>11.44</Price>
                  <Alternate>11.44</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>
                  <Multiple>1</Multiple>
                  <Subsidy>16.00</Subsidy>
                  <Price>16.00</Price>
                  <Alternate>16.00</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>
                  <Multiple>1</Multiple>
                  <Subsidy>14.20</Subsidy>
                  <Price>14.20</Price>
                  <Alternate>14.20</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="B04070415890425">
                <Name>Pfizer</Name>
                <Pack ID="P2339889" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>118.50</Subsidy>
                  <Price>118.50</Price>
                  <Alternate>118.50</Alternate>
                  <Surcharge>0.00000</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>
                  <Multiple>1</Multiple>
                  <Subsidy>9.50</Subsidy>
                  <Price>9.50</Price>
                  <Alternate>9.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407042063" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>22.40</Subsidy>
                  <Price>95.87</Price>
                  <Alternate>22.40</Alternate>
                  <Surcharge>7.34700</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0407043893">
            <Name>Enoxaparin sodium</Name>
            <Formulation ID="F040704389325" Rank="4" Units="inj" Weight="20">
              <Name>Inj 20 mg</Name>
              <Brand ID="B04070438932525" SoleSupply="true">
                <Name>Clexane</Name>
                <Pack ID="P795615" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>39.20</Subsidy>
                  <Price>39.20</Price>
                  <Alternate>39.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704389326" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg</Name>
              <Brand ID="B04070438932625" SoleSupply="true">
                <Name>Clexane</Name>
                <Pack ID="P795623" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>52.30</Subsidy>
                  <Price>52.30</Price>
                  <Alternate>52.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704389327" Rank="4" Units="inj" Weight="60">
              <Name>Inj 60 mg</Name>
              <Brand ID="B04070438932725" SoleSupply="true">
                <Name>Clexane</Name>
                <Pack ID="P416991" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>78.85</Subsidy>
                  <Price>78.85</Price>
                  <Alternate>78.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704389328" Rank="4" Units="inj" Weight="80">
              <Name>Inj 80 mg</Name>
              <Brand ID="B04070438932825" SoleSupply="true">
                <Name>Clexane</Name>
                <Pack ID="P417009" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>105.12</Subsidy>
                  <Price>105.12</Price>
                  <Alternate>105.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704389329" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 mg</Name>
              <Brand ID="B04070438932925" SoleSupply="true">
                <Name>Clexane</Name>
                <Pack ID="P417017" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>135.20</Subsidy>
                  <Price>135.20</Price>
                  <Alternate>135.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704389330" Rank="4" Units="inj" Weight="120">
              <Name>Inj 120 mg</Name>
              <Brand ID="B04070438933025" SoleSupply="true">
                <Name>Clexane</Name>
                <Pack ID="P389366" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>168.00</Subsidy>
                  <Price>168.00</Price>
                  <Alternate>168.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040704389331" Rank="4" Units="inj" Weight="150">
              <Name>Inj 150 mg</Name>
              <Brand ID="B04070438933125" SoleSupply="true">
                <Name>Clexane</Name>
                <Pack ID="P389390" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>192.00</Subsidy>
                  <Price>192.00</Price>
                  <Alternate>192.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1174">
              <Title>
                <range>Enoxaparin sodium</range>
              </Title>
              <Case When="Initial application" Category="Pregnancy or Malignancy">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Low molecular weight heparin treatment is required during a patients pregnancy</ci>
                    <ci type="logical" class="Treatment">For the treatment of venous thromboembolism where the patient has a malignancy</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Initial application" Category="Venous thromboembolism other than in pregnancy or malignancy">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">For the short-term treatment of venous thromboembolism prior to establishing a therapeutic INR with oral anti-coagulant treatment</ci>
                    <ci type="logical" class="Treatment">For the prophylaxis and treatment of venous thromboembolism in high risk surgery</ci>
                    <ci type="logical" class="Indication">To enable cessation/re-establishment of existing oral anticoagulant treatment pre/post surgery</ci>
                    <ci type="logical" class="Treatment">For the prophylaxis and treatment of venous thromboembolism in Acute Coronary Syndrome surgical intervention</ci>
                    <ci type="logical" class="Treatment">To be used in association with cardioversion of atrial fibrillation</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">1</Term>
              </Case>
              <Case When="Renewal" Category="Pregnancy or Malignancy" Form="SA0975 SA1174">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Low molecular weight heparin treatment is required during a patient's  pregnancy</ci>
                    <ci type="logical" class="Treatment">For the treatment of venous thromboembolism where the patient has a malignancy</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Category="Venous thromboembolism other than in pregnancy or malignancy" Form="SA0975 SA1174">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">Low molecular weight heparin treatment or prophylaxis is required for a second or subsequent event (surgery, ACS, cardioversion, or prior to oral anti-coagulation)</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">1</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1174"/>
          </Chemical>
          <Chemical ID="C0407046019" 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="B04070460190125">
                <Name>Pfizer</Name>
                <Pack ID="P2339919" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>32.50</Subsidy>
                  <Price>32.50</Price>
                  <Alternate>32.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A040707">
          <Name>Oral Anticoagulants</Name>
          <Chemical ID="C0407072331" 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>
          <Chemical ID="C0407073924">
            <Name>Rivaroxaban</Name>
            <Formulation ID="F040707392425" Rank="1" Units="tab">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04070739242525">
                <Name>Xarelto</Name>
                <Pack ID="P2336316" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>306.00</Subsidy>
                  <Price>306.00</Price>
                  <Alternate>306.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2336324" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>153.00</Subsidy>
                  <Price>153.00</Price>
                  <Alternate>153.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1066">
              <Title>
                <range>Rivaroxaban</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">For the prophylaxis of venous thromboembolism following a total hip replacement</ci>
                    <ci type="logical" class="Use">For the prophylaxis of venous thromboembolism following a total knee replacement</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="week">5</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Rivaroxaban is only currently indicated and subsidised for up to 5 weeks therapy for prophylaxis of venous thromboembolism following a total hip replacement and up to 2 weeks therapy for prophylaxis of venous thromboembolism following a total knee replacement.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA1066">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">Prophylaxis for venous thromboembolism is required for patients following a subsequent total hip or knee replacement</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="week">5</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1066"/>
          </Chemical>
          <Chemical ID="C0407073937">
            <Name>Dabigatran</Name>
            <Formulation ID="F040707393725" Rank="2" Units="cap" Weight="75">
              <Name>Cap 75 mg</Name>
              <Brand ID="B04070739372525">
                <Name>Pradaxa</Name>
                <Pack ID="P2319586" OP="true" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>148.00</Subsidy>
                  <Price>148.00</Price>
                  <Alternate>148.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="2"/>
            </Formulation>
            <Formulation ID="F040707393726" Rank="2" Units="cap" Weight="110">
              <Name>Cap 110 mg</Name>
              <Brand ID="B04070739372625">
                <Name>Pradaxa</Name>
                <Pack ID="P2319594" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>148.00</Subsidy>
                  <Price>148.00</Price>
                  <Alternate>148.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2377578" OP="true" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>148.00</Subsidy>
                  <Price>148.00</Price>
                  <Alternate>148.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F040707393727" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B04070739372725">
                <Name>Pradaxa</Name>
                <Pack ID="P2377551" OP="true" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>148.00</Subsidy>
                  <Price>148.00</Price>
                  <Alternate>148.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2389673" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>148.00</Subsidy>
                  <Price>148.00</Price>
                  <Alternate>148.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Dabigatran will not be funded Close Control in amounts less than 4 weeks of treatment.</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0410">
        <Name>Fluids and Electrolytes</Name>
        <ATC3 ID="A041001">
          <Name>Intravenous Administration</Name>
          <Chemical ID="C0410011393" Statim="Must">
            <Name>Dextrose</Name>
            <Formulation ID="F041001139301" Rank="4" Units="inj" Weight="10">
              <Name>Inj 50%, 10 ml</Name>
              <Brand ID="B04100113930125" SoleSupply="true">
                <Name>Biomed</Name>
                <Pack ID="P2243296" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>19.50</Subsidy>
                  <Price>19.50</Price>
                  <Alternate>19.50</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>
                  <Multiple>1</Multiple>
                  <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" 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">
                <Name>AstraZeneca</Name>
                <Pack ID="P311340" Specified="true">
                  <Quantity>50</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>55.00</Subsidy>
                  <Price>55.00</Price>
                  <Alternate>55.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410012128">
            <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>
                  <Multiple>1</Multiple>
                  <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%, 50 ml</Name>
              <Brand ID="B04100121282625">
                <Name>Biomed</Name>
                <Pack ID="P2244152" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>19.95</Subsidy>
                  <Price>19.95</Price>
                  <Alternate>19.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410012135">
            <Name>Sodium chloride</Name>
            <Formulation ID="F041001213503" Rank="4" Units="inj" Weight="0.45">
              <Name>Inj 0.9%, 5 ml</Name>
              <Brand ID="B04100121350302">
                <Name>Pfizer</Name>
                <Pack ID="P691941" Specified="true">
                  <Quantity>50</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>15.50</Subsidy>
                  <Price>15.50</Price>
                  <Alternate>15.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100121350325">
                <Name>Multichem</Name>
                <Pack ID="P2320541" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>10.85</Subsidy>
                  <Price>10.85</Price>
                  <Alternate>10.85</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="B04100121350401">
                <Name>Pfizer</Name>
                <Pack ID="P691968" Specified="true">
                  <Quantity>50</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>15.50</Subsidy>
                  <Price>15.50</Price>
                  <Alternate>15.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100121350425">
                <Name>Multichem</Name>
                <Pack ID="P2320568" 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" Specified="true">
                  <Quantity>6</Quantity>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <Subsidy>11.79</Subsidy>
                  <Price>11.79</Price>
                  <Alternate>11.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100121350525">
                <Name>Multichem</Name>
                <Pack ID="P2249200" Specified="true">
                  <Quantity>20</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>8.41</Subsidy>
                  <Price>8.41</Price>
                  <Alternate>8.41</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>
              <Rule Type="FormMax" Value="2000" Attribute="PSO"/>
              <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>
            </Formulation>
            <Formulation ID="F041001213525" Rank="4" Units="inj">
              <Name>Inj 23.4%, 20 ml</Name>
              <Brand ID="B04100121352525" SoleSupply="true">
                <Name>Biomed</Name>
                <Pack ID="P2089432" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>31.25</Subsidy>
                  <Price>31.25</Price>
                  <Alternate>31.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
                <p xlink:type="simple" xlink:href="standard-formulae">For Sodium chloride oral liquid formulation refer Standard Formulae</p>
              </div>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Not funded for use as a nasal drop.  Only funded for nebuliser use when in conjunction with an antibiotic intended for nebuliser use.</p>
            </div>
          </Chemical>
          <Chemical ID="C0410012332">
            <Name>Water</Name>
            <Formulation ID="F041001233202" Rank="4" Units="inj" Weight="5">
              <Name>Purified for inj, 5 ml</Name>
              <Brand ID="B04100123320225">
                <Name>Multichem</Name>
                <Pack ID="P2208318" Specified="true">
                  <Quantity>50</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>9.20</Subsidy>
                  <Price>9.20</Price>
                  <Alternate>9.20</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="B04100123320325">
                <Name>Multichem</Name>
                <Pack ID="P2208326" Specified="true">
                  <Quantity>50</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>10.20</Subsidy>
                  <Price>10.20</Price>
                  <Alternate>10.20</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">
                <Name>Multichem</Name>
                <Pack ID="P2208334" Specified="true">
                  <Quantity>20</Quantity>
                  <Multiple>1</Multiple>
                  <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>
            <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">
            <Name>Total parenteral 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="Retail"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041004">
          <Name>Oral Administration</Name>
          <Chemical ID="C0410041205">
            <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" OP="true" Specified="true">
                  <Quantity>300</Quantity>
                  <Subsidy>169.85</Subsidy>
                  <Price>169.85</Price>
                  <Alternate>169.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410041394">
            <Name>Dextrose with electrolytes</Name>
            <Formulation ID="F041004139401" Rank="3" Units="ml">
              <Name>Soln with electrolytes</Name>
              <Brand ID="B04100413940103" SoleSupply="true">
                <Name>Pedialyte - Fruit</Name>
                <Pack ID="P464988" OP="true" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.60</Subsidy>
                  <Price>6.60</Price>
                  <Alternate>6.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100413940125" SoleSupply="true">
                <Name>Pedialyte - Bubblegum</Name>
                <Pack ID="P234907" OP="true" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.60</Subsidy>
                  <Price>6.60</Price>
                  <Alternate>6.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04100413940126" SoleSupply="true">
                <Name>Pedialyte - Plain</Name>
                <Pack ID="P440612" OP="true" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.75</Subsidy>
                  <Price>6.75</Price>
                  <Alternate>6.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410041446">
            <Name>Compound electrolytes</Name>
            <Formulation ID="F041004144625" Rank="2" Units="sach" Weight="4.4">
              <Name>Powder for soln for oral use 4.4 g</Name>
              <Brand ID="B04100414462525" SoleSupply="true">
                <Name>Electral</Name>
                <Pack ID="P2381648" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>1.12</Subsidy>
                  <Price>1.12</Price>
                  <Alternate>1.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
              <Rule Type="FormMax" Value="10" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410042013">
            <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>82.50</Subsidy>
                  <Price>82.50</Price>
                  <Alternate>82.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>For phosphate supplementation</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410042016" 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>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </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>7.00</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>7.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="ProvAllow" Attribute="Dietitian" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410042128">
            <Name>Sodium bicarbonate</Name>
            <Formulation ID="F041004212827" Rank="1" Units="tab">
              <Name>Cap 840 mg</Name>
              <Brand ID="B04100421282725">
                <Name>Sodibic</Name>
                <Pack ID="P2085992" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.52</Subsidy>
                  <Price>8.52</Price>
                  <Alternate>8.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0410042160">
            <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" OP="true" Specified="true">
                  <Quantity>450</Quantity>
                  <Subsidy>89.10</Subsidy>
                  <Price>89.10</Price>
                  <Alternate>89.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0413">
        <Name>Lipid Modifying Agents</Name>
        <ATC3 ID="A041301">
          <Name>Fibrates</Name>
          <Chemical ID="C0413011151" Statim="Must">
            <Name>Bezafibrate</Name>
            <Formulation ID="F041301115101" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B04130111510102">
                <Name>Fibalip</Name>
                <Pack ID="P2095521" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>9.75</Subsidy>
                  <Price>9.75</Price>
                  <Alternate>9.75</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>5.70</Subsidy>
                  <Price>5.70</Price>
                  <Alternate>5.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0413011553" Statim="Must">
            <Name>Gemfibrozil</Name>
            <Formulation ID="F041301155325" Rank="1" Units="tab" Weight="600">
              <Name>Tab 600 mg</Name>
              <Brand ID="B04130115532525" SoleSupply="true">
                <Name>Lipazil</Name>
                <Pack ID="P472875" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>14.00</Subsidy>
                  <Price>14.00</Price>
                  <Alternate>14.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041302">
          <Name>Other Lipid Modifying Agents</Name>
          <Chemical ID="C0413021861" 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>4.17</Subsidy>
                  <Price>4.17</Price>
                  <Alternate>4.17</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>16.54</Subsidy>
                  <Price>16.54</Price>
                  <Alternate>16.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0413022362" Statim="Must">
            <Name>Acipimox</Name>
            <Formulation ID="F041302236201" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B04130223620101">
                <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>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041303">
          <Name>Resins</Name>
          <Chemical ID="C0413031291">
            <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>52.68</Price>
                  <Alternate>19.25</Alternate>
                  <Surcharge>0.66860</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0413031345">
            <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>20.00</Subsidy>
                  <Price>20.00</Price>
                  <Alternate>20.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A041304">
          <Name>HMG CoA Reductase Inhibitors (Statins)</Name>
          <Chemical ID="C0413041137" 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">
                  <Quantity>30</Quantity>
                  <Subsidy>18.32</Subsidy>
                  <Price>18.32</Price>
                  <Alternate>18.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2385244" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>18.32</Subsidy>
                  <Price>18.32</Price>
                  <Alternate>18.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04130411370126">
                <Name>Dr Reddy's Atorvastatin</Name>
                <Pack ID="P2389541" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.90</Subsidy>
                  <Price>2.90</Price>
                  <Alternate>2.90</Alternate>
                  <Surcharge>0.00000</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">
                  <Quantity>30</Quantity>
                  <Subsidy>26.70</Subsidy>
                  <Price>26.70</Price>
                  <Alternate>26.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2385252" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>26.70</Subsidy>
                  <Price>26.70</Price>
                  <Alternate>26.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04130411370226">
                <Name>Dr Reddy's Atorvastatin</Name>
                <Pack ID="P2389568" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.36</Subsidy>
                  <Price>4.36</Price>
                  <Alternate>4.36</Alternate>
                  <Surcharge>0.00000</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">
                  <Quantity>30</Quantity>
                  <Subsidy>37.02</Subsidy>
                  <Price>37.02</Price>
                  <Alternate>37.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2385260" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>37.02</Subsidy>
                  <Price>37.02</Price>
                  <Alternate>37.02</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04130411370326">
                <Name>Dr Reddy's Atorvastatin</Name>
                <Pack ID="P2389576" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.51</Subsidy>
                  <Price>6.51</Price>
                  <Alternate>6.51</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304113725" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B04130411372525">
                <Name>Lipitor</Name>
                <Pack ID="P2321793">
                  <Quantity>30</Quantity>
                  <Subsidy>110.50</Subsidy>
                  <Price>110.50</Price>
                  <Alternate>110.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2385279" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>110.50</Subsidy>
                  <Price>110.50</Price>
                  <Alternate>110.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B04130411372527">
                <Name>Dr Reddy's Atorvastatin</Name>
                <Pack ID="P2389584" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>9.67</Subsidy>
                  <Price>9.67</Price>
                  <Alternate>9.67</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0716A041304"/>
          </Chemical>
          <Chemical ID="C0413042513" Statim="Must">
            <Name>Simvastatin</Name>
            <Formulation ID="F041304251301" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B04130425130127" SoleSupply="true">
                <Name>Arrow-Simva 10mg</Name>
                <Pack ID="P2316668" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>1.40</Subsidy>
                  <Price>1.40</Price>
                  <Alternate>1.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304251302" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B04130425130227" SoleSupply="true">
                <Name>Arrow-Simva 20mg</Name>
                <Pack ID="P2316676" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>1.95</Subsidy>
                  <Price>1.95</Price>
                  <Alternate>1.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304251304" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B04130425130427" SoleSupply="true">
                <Name>Arrow-Simva 40mg</Name>
                <Pack ID="P2316684" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.18</Subsidy>
                  <Price>3.18</Price>
                  <Alternate>3.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304251325" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B04130425132527" SoleSupply="true">
                <Name>Arrow-Simva 80mg</Name>
                <Pack ID="P2316692" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>9.31</Subsidy>
                  <Price>9.31</Price>
                  <Alternate>9.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0716A041304"/>
          </Chemical>
          <Chemical ID="C0413042780" Statim="Must">
            <Name>Pravastatin</Name>
            <Formulation ID="F041304278003" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B04130427800326" SoleSupply="true">
                <Name>Cholvastin</Name>
                <Pack ID="P2362295" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.44</Subsidy>
                  <Price>5.44</Price>
                  <Alternate>5.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041304278025" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B04130427802526" SoleSupply="true">
                <Name>Cholvastin</Name>
                <Pack ID="P2362309" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>9.28</Subsidy>
                  <Price>9.28</Price>
                  <Alternate>9.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <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">
            <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>45.90</Subsidy>
                  <Price>45.90</Price>
                  <Alternate>45.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1045">
              <Title>
                <range>Ezetimibe</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 has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years</ci>
                    <ci type="logical" class="Trial">Patient's LDL cholesterol is 2.0 mmol/litre or greater</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">The patient has rhabdomyolysis (defined as muscle aches and creatine kinase more than 10 × normal) when treated with one statin</ci>
                      <ci type="logical" class="Indication">The patient is intolerant to both simvastatin and atorvastatin</ci>
                      <ci type="logical" class="Indication">The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>A patient who has failed to reduce their LDL cholesterol to &lt; 2.0 mmol/litre with the use of a less potent statin should use a more potent statin prior to consideration being given to the use of non-statin therapies.</p>
                  <p>Other treatment options including fibrates, resins and nicotinic acid should be considered after failure of statin therapy.</p>
                  <p>If a patient's LDL cholesterol cannot be calculated because the triglyceride level is too high then a repeat test should be performed and if the LDL cholesterol again cannot be calculated then it can be considered that the LDL cholesterol is greater than 2.0 mmol/litre.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0723 SA0796 SA1045">
                <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="SA1045"/>
          </Chemical>
          <Chemical ID="C0413083853">
            <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>51.60</Subsidy>
                  <Price>51.60</Price>
                  <Alternate>51.60</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>55.20</Subsidy>
                  <Price>55.20</Price>
                  <Alternate>55.20</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>60.60</Subsidy>
                  <Price>60.60</Price>
                  <Alternate>60.60</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>48.90</Subsidy>
                  <Price>48.90</Price>
                  <Alternate>48.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1046">
              <Title>
                <range>Ezetimibe with Simvastatin<instance>Vytorin</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 a calculated absolute risk of cardiovascular disease of at least 15% over 5 year</ci>
                    <ci type="logical" class="Trial">Patient's LDL cholesterol is 2.0 mmol/litre or greater</ci>
                    <ci type="logical" class="Trial">The patient has not reduced their LDL cholesterol to less than 2.0 mmol/litre with the use of the maximal tolerated dose of atorvastatin</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>A patient who has failed to reduce their LDL cholesterol to ≤ 2.0 mmol/litre with the use of a less potent statin should use a more potent statin prior to consideration being given to the use of non-statin therapies.</p>
                  <p>Other treatment options including fibrates, resins and nicotinic acid should be considered after failure of statin therapy.</p>
                  <p>If a patient's LDL cholesterol cannot be calculated because the triglyceride level is too high then a repeat test should be performed and if the LDL cholesterol again cannot be calculated then it can be considered that the LDL cholesterol is greater than 2.0 mmol/litre.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0826 SA1046">
                <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="SA1046"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0416">
        <Name>Iron Overload</Name>
        <ATC3 ID="A041601">
          <Name>Iron Overload</Name>
          <Chemical ID="C0416011378" Statim="Must">
            <Name>Desferrioxamine mesylate</Name>
            <Formulation ID="F041601137801" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B04160113780102">
                <Name>Mayne</Name>
                <Pack ID="P461598" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>99.00</Subsidy>
                  <Price>99.00</Price>
                  <Alternate>99.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0416013914">
            <Name>Deferiprone</Name>
            <Formulation ID="F041601391425" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B04160139142525">
                <Name>Ferriprox</Name>
                <Pack ID="P2369532" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>533.17</Subsidy>
                  <Price>533.17</Price>
                  <Alternate>533.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F041601391426" Rank="3" Units="ml" Weight="100">
              <Name>Oral liq 100 mg per 1 ml</Name>
              <Brand ID="B04160139142625">
                <Name>Ferriprox</Name>
                <Pack ID="P2369524" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>266.59</Subsidy>
                  <Price>266.59</Price>
                  <Alternate>266.59</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1042">
              <Title>
                <range>Deferiprone</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has been diagnosed with chronic transfusional iron overload due to congenital inherited anaemia</ci>
                </math>
                <Applicant>relevant specialist</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>For the purposes of this Special Authority, a relevant specialist is defined as a haematologist.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1042"/>
          </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" Statim="Must">
            <Name>Phenoxybenzamine hydrochloride</Name>
            <Formulation ID="F070401196601" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B07040119660101" S29="true">
                <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>
                <Pack ID="P2279053" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>7.82</Subsidy>
                  <Price>7.82</Price>
                  <Alternate>7.82</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704011971" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>17.97</Subsidy>
                  <Price>31.65</Price>
                  <Alternate>17.97</Alternate>
                  <Surcharge>2.73600</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704012031" Statim="Must">
            <Name>Prazosin hydrochloride</Name>
            <Formulation ID="F070401203102" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B07040120310225">
                <Name>Apo-Prazo</Name>
                <Pack ID="P2265397" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.53</Subsidy>
                  <Price>5.53</Price>
                  <Alternate>5.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401203103" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B07040120310325">
                <Name>Apo-Prazo</Name>
                <Pack ID="P2265389" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.00</Subsidy>
                  <Price>7.00</Price>
                  <Alternate>7.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401203104" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07040120310425">
                <Name>Apo-Prazo</Name>
                <Pack ID="P2265370" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.70</Subsidy>
                  <Price>11.70</Price>
                  <Alternate>11.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704012515" Statim="Must">
            <Name>Doxazosin mesylate</Name>
            <Formulation ID="F070401251502" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B07040125150226" SoleSupply="true">
                <Name>Apo-Doxazosin</Name>
                <Pack ID="P2261502" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>8.23</Subsidy>
                  <Price>8.23</Price>
                  <Alternate>8.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401251503" Rank="1" Units="tab" Weight="4">
              <Name>Tab 4 mg</Name>
              <Brand ID="B07040125150326" SoleSupply="true">
                <Name>Apo-Doxazosin</Name>
                <Pack ID="P2261510" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>12.40</Subsidy>
                  <Price>12.40</Price>
                  <Alternate>12.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0704012543" Statim="Must">
            <Name>Terazosin hydrochloride</Name>
            <Formulation ID="F070401254303" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B07040125430326" SoleSupply="true">
                <Name>Arrow</Name>
                <Pack ID="P2354314" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>0.80</Subsidy>
                  <Price>0.80</Price>
                  <Alternate>0.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401254307" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07040125430726" SoleSupply="true">
                <Name>Arrow</Name>
                <Pack ID="P2354292" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.00</Subsidy>
                  <Price>1.00</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070401254325" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B07040125432526" SoleSupply="true">
                <Name>Arrow</Name>
                <Pack ID="P2354306" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.50</Subsidy>
                  <Price>1.50</Price>
                  <Alternate>1.50</Alternate>
                  <Surcharge>0.00000</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" 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" Statim="Must">
            <Name>Enalapril</Name>
            <Formulation ID="F070701271101" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07070127110127" SoleSupply="true">
                <Name>Arrow-Enalapril</Name>
                <Pack ID="P2358794" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>1.98</Subsidy>
                  <Price>1.98</Price>
                  <Alternate>1.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701271102" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07070127110227" SoleSupply="true">
                <Name>Arrow-Enalapril</Name>
                <Pack ID="P2358808" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>2.44</Subsidy>
                  <Price>2.44</Price>
                  <Alternate>2.44</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701271103" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B07070127110327" SoleSupply="true">
                <Name>Arrow-Enalapril</Name>
                <Pack ID="P2358816" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.24</Subsidy>
                  <Price>3.24</Price>
                  <Alternate>3.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012770" Statim="Must">
            <Name>Cilazapril</Name>
            <Formulation ID="F070701277001" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 0.5 mg</Name>
              <Brand ID="B07070127700125" SoleSupply="true">
                <Name>Zapril</Name>
                <Pack ID="P2354330" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>0.95</Subsidy>
                  <Price>0.95</Price>
                  <Alternate>0.95</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="B07070127700225" SoleSupply="true">
                <Name>Zapril</Name>
                <Pack ID="P2379082" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>6.18</Subsidy>
                  <Price>6.18</Price>
                  <Alternate>6.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701277003" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07070127700325" SoleSupply="true">
                <Name>Zapril</Name>
                <Pack ID="P2379090" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>9.84</Subsidy>
                  <Price>9.84</Price>
                  <Alternate>9.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012772" Statim="Must">
            <Name>Quinapril</Name>
            <Formulation ID="F070701277201" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07070127720101">
                <Name>Accupril</Name>
                <Pack ID="P755117" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.60</Subsidy>
                  <Price>1.60</Price>
                  <Alternate>1.60</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">
                <Name>Accupril</Name>
                <Pack ID="P755125" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.75</Subsidy>
                  <Price>1.75</Price>
                  <Alternate>1.75</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">
                <Name>Accupril</Name>
                <Pack ID="P755133" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.35</Subsidy>
                  <Price>2.35</Price>
                  <Alternate>2.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012797" 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>2.06</Subsidy>
                  <Price>2.06</Price>
                  <Alternate>2.06</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>2.36</Subsidy>
                  <Price>2.36</Price>
                  <Alternate>2.36</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>2.87</Subsidy>
                  <Price>2.87</Price>
                  <Alternate>2.87</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707012806" 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" Statim="Must">
            <Name>Captopril</Name>
            <Formulation ID="F070701284101" Rank="1" Units="tab" Weight="12.5">
              <Name>Tab 12.5 mg</Name>
              <Brand ID="B07070128410127" SoleSupply="true">
                <Name>m-Captopril</Name>
                <Pack ID="P2356554" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.00</Subsidy>
                  <Price>2.00</Price>
                  <Alternate>2.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701284102" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07070128410227" SoleSupply="true">
                <Name>m-Captopril</Name>
                <Pack ID="P2356562" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.40</Subsidy>
                  <Price>2.40</Price>
                  <Alternate>2.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070701284103" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07070128410327" SoleSupply="true">
                <Name>m-Captopril</Name>
                <Pack ID="P2356570" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.50</Subsidy>
                  <Price>3.50</Price>
                  <Alternate>3.50</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" SoleSupply="true">
                <Name>Capoten</Name>
                <Pack ID="P2055538" OP="true" Specified="true">
                  <Quantity>95</Quantity>
                  <Subsidy>94.99</Subsidy>
                  <Price>94.99</Price>
                  <Alternate>94.99</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" 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" SoleSupply="true">
                <Name>Inhibace Plus</Name>
                <Pack ID="P490202" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>5.36</Subsidy>
                  <Price>5.36</Price>
                  <Alternate>5.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707022708" 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" 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">
                <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">
                <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">
            <Name>Losartan</Name>
            <Formulation ID="F070703106101" Rank="1" Units="tab" Weight="50" Statim="Must">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07070310610125" SoleSupply="true">
                <Name>Lostaar</Name>
                <Pack ID="P2387174" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>5.22</Subsidy>
                  <Price>5.22</Price>
                  <Alternate>5.22</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070703106102" Rank="1" Units="tab" Weight="12.5" Statim="Must">
              <Name>Tab 12.5 mg</Name>
              <Brand ID="B07070310610225" SoleSupply="true">
                <Name>Lostaar</Name>
                <Pack ID="P2387158" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>2.88</Subsidy>
                  <Price>2.88</Price>
                  <Alternate>2.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070703106105" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg with hydrochlorothiazide 12.5 mg</Name>
              <Brand ID="B07070310610526" SoleSupply="true">
                <Name>Arrow-Losartan &amp; Hydrochlorothiazide</Name>
                <Pack ID="P2390620" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.89</Subsidy>
                  <Price>4.89</Price>
                  <Alternate>4.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070703106125" Rank="1" Units="tab" Weight="100" Statim="Must">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07070310612526" SoleSupply="true">
                <Name>Lostaar</Name>
                <Pack ID="P2387182" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>8.68</Subsidy>
                  <Price>8.68</Price>
                  <Alternate>8.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F070703106126" Rank="1" Units="tab" Weight="25" Statim="Must">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07070310612626" SoleSupply="true">
                <Name>Lostaar</Name>
                <Pack ID="P2387166" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.20</Subsidy>
                  <Price>3.20</Price>
                  <Alternate>3.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0707031254" 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>
              <Brand ID="B07070312540125">
                <Name>Candestar</Name>
                <Pack ID="P2380404" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>48.66</Subsidy>
                  <Price>48.66</Price>
                  <Alternate>48.66</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>
              <Brand ID="B07070312540225">
                <Name>Candestar</Name>
                <Pack ID="P2380412" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>57.90</Subsidy>
                  <Price>57.90</Price>
                  <Alternate>57.90</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>
              <Brand ID="B07070312540325">
                <Name>Candestar</Name>
                <Pack ID="P2380420" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>70.62</Subsidy>
                  <Price>70.62</Price>
                  <Alternate>70.62</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="1"/>
            </Formulation>
            <Formulation ID="F070703125425" Rank="1" Units="tab" Weight="32">
              <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>
              <Brand ID="B07070312542526">
                <Name>Candestar</Name>
                <Pack ID="P2380439" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>115.50</Subsidy>
                  <Price>115.50</Price>
                  <Alternate>115.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseDMax" Value="1"/>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0933">
              <Title>
                <range>Candesartan</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 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>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0933"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0713">
        <Name>Antiarrhythmics</Name>
        <ATC3 ID="A071301">
          <Name>Antiarrhythmics</Name>
          <Chemical ID="C0713011057">
            <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>
                  <Multiple>1</Multiple>
                  <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" Statim="Must">
            <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="P2377012" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>6.67</Subsidy>
                  <Price>6.67</Price>
                  <Alternate>6.67</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2390957">
                  <Quantity>200</Quantity>
                  <Subsidy>5.56</Subsidy>
                  <Price>5.56</Price>
                  <Alternate>5.56</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="P2378078" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>14.52</Subsidy>
                  <Price>14.52</Price>
                  <Alternate>14.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2390965">
                  <Quantity>100</Quantity>
                  <Subsidy>6.05</Subsidy>
                  <Price>6.05</Price>
                  <Alternate>6.05</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" 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">
            <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>45.82</Subsidy>
                  <Price>45.82</Price>
                  <Alternate>45.82</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>80.92</Subsidy>
                  <Price>80.92</Price>
                  <Alternate>80.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </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>
                  <Multiple>1</Multiple>
                  <Subsidy>52.45</Subsidy>
                  <Price>52.45</Price>
                  <Alternate>52.45</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>45.82</Subsidy>
                  <Price>45.82</Price>
                  <Alternate>45.82</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>80.92</Subsidy>
                  <Price>80.92</Price>
                  <Alternate>80.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C0713012810" 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="Xref">
          <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">
            <Name>Midodrine</Name>
            <Formulation ID="F071501101201" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07150110120101">
                <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">
                <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="SA0934">
              <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>any relevant practitioner</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 SA0934">
                <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="SA0934"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A0716">
        <Name>Beta Adrenoceptor Blockers</Name>
        <ATC3 ID="A071601">
          <Name>Beta Adrenoceptor Blockers</Name>
          <Chemical ID="C0716011094" Statim="Must">
            <Name>Atenolol</Name>
            <Formulation ID="F071601109401" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07160110940125">
                <Name>Pacific Atenolol</Name>
                <Pack ID="P2279266" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.18</Subsidy>
                  <Price>6.18</Price>
                  <Alternate>6.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160110940127" SoleSupply="true" ToBeDelisted="2012-11-25">
                <Name>Atenolol Tablet USP</Name>
                <Pack ID="P2360241" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>12.36</Subsidy>
                  <Price>12.36</Price>
                  <Alternate>12.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601109402" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07160110940225">
                <Name>Pacific Atenolol</Name>
                <Pack ID="P2279274" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>10.73</Subsidy>
                  <Price>10.73</Price>
                  <Alternate>10.73</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160110940226" SoleSupply="true" ToBeDelisted="2012-11-25">
                <Name>Atenolol Tablet USP</Name>
                <Pack ID="P2360268" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>21.46</Subsidy>
                  <Price>21.46</Price>
                  <Alternate>21.46</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011699" 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>8.23</Subsidy>
                  <Price>8.23</Price>
                  <Alternate>8.23</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>10.06</Subsidy>
                  <Price>10.06</Price>
                  <Alternate>10.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </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>17.55</Subsidy>
                  <Price>17.55</Price>
                  <Alternate>17.55</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>
                  <Multiple>1</Multiple>
                  <Subsidy>59.06</Subsidy>
                  <Price>88.60</Price>
                  <Alternate>59.06</Alternate>
                  <Surcharge>5.90800</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011817" Statim="Must" Update="-Subsidy">
            <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" ToBeDelisted="2012-09-01">
                <Name>Betaloc CR</Name>
                <Pack ID="P599891" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.41</Subsidy>
                  <Price>2.74</Price>
                  <Alternate>1.41</Alternate>
                  <Surcharge>0.04433</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118170125">
                <Name>Metoprolol - AFT CR</Name>
                <Pack ID="P2304961" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.41</Subsidy>
                  <Price>1.41</Price>
                  <Alternate>1.41</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118170126" ToBeDelisted="2012-09-01">
                <Name>Myloc CR</Name>
                <Pack ID="P2376423" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.41</Subsidy>
                  <Price>1.41</Price>
                  <Alternate>1.41</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601181702" Rank="1" Units="tab" Weight="95">
              <Name>Tab long-acting 95 mg</Name>
              <Brand ID="B07160118170201" ToBeDelisted="2012-09-01">
                <Name>Betaloc CR</Name>
                <Pack ID="P527858" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.42</Subsidy>
                  <Price>4.71</Price>
                  <Alternate>2.42</Alternate>
                  <Surcharge>0.07633</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118170225">
                <Name>Metoprolol - AFT CR</Name>
                <Pack ID="P2304988" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.42</Subsidy>
                  <Price>2.42</Price>
                  <Alternate>2.42</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118170226" ToBeDelisted="2012-09-01">
                <Name>Myloc CR</Name>
                <Pack ID="P2376431" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.42</Subsidy>
                  <Price>2.42</Price>
                  <Alternate>2.42</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601181703" Rank="1" Units="tab" Weight="190">
              <Name>Tab long-acting 190 mg</Name>
              <Brand ID="B07160118170301" ToBeDelisted="2012-09-01">
                <Name>Betaloc CR</Name>
                <Pack ID="P599905" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.66</Subsidy>
                  <Price>8.51</Price>
                  <Alternate>4.66</Alternate>
                  <Surcharge>0.12833</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118170325">
                <Name>Metoprolol - AFT CR</Name>
                <Pack ID="P2304996" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.66</Subsidy>
                  <Price>4.66</Price>
                  <Alternate>4.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118170326" ToBeDelisted="2012-09-01">
                <Name>Myloc CR</Name>
                <Pack ID="P2376458" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.66</Subsidy>
                  <Price>4.66</Price>
                  <Alternate>4.66</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601181725" Rank="1" Units="tab">
              <Name>Tab long-acting 23.75 mg</Name>
              <Brand ID="B07160118172525" ToBeDelisted="2012-09-01">
                <Name>Betaloc CR</Name>
                <Pack ID="P2026945" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>0.96</Subsidy>
                  <Price>2.18</Price>
                  <Alternate>0.96</Alternate>
                  <Surcharge>0.04067</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118172526">
                <Name>Metoprolol - AFT CR</Name>
                <Pack ID="P2304953" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>0.96</Subsidy>
                  <Price>0.96</Price>
                  <Alternate>0.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118172527" ToBeDelisted="2012-09-01">
                <Name>Myloc CR</Name>
                <Pack ID="P2376415" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>0.96</Subsidy>
                  <Price>0.96</Price>
                  <Alternate>0.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011818" Statim="Must">
            <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>16.00</Subsidy>
                  <Price>16.00</Price>
                  <Alternate>16.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F071601181802" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07160118180201">
                <Name>Lopresor</Name>
                <Pack ID="P2104105" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>21.00</Subsidy>
                  <Price>21.00</Price>
                  <Alternate>21.00</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">
                <Name>Slow-Lopresor</Name>
                <Pack ID="P2108682" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>18.00</Subsidy>
                  <Price>18.00</Price>
                  <Alternate>18.00</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" ToBeDelisted="2012-08-01">
                <Name>Betaloc</Name>
                <Pack ID="P327883" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>24.00</Subsidy>
                  <Price>34.00</Price>
                  <Alternate>24.00</Alternate>
                  <Surcharge>2.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160118180425">
                <Name>Lopresor</Name>
                <Pack ID="P2395959" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>24.00</Subsidy>
                  <Price>24.00</Price>
                  <Alternate>24.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716011838" Statim="Must">
            <Name>Nadolol</Name>
            <Formulation ID="F071601183801" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07160118380102">
                <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">
                <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" Statim="Must">
            <Name>Pindolol</Name>
            <Formulation ID="F071601199104" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07160119910403" SoleSupply="true">
                <Name>Apo-Pindolol</Name>
                <Pack ID="P748366" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>5.40</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601199105" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07160119910501" SoleSupply="true">
                <Name>Apo-Pindolol</Name>
                <Pack ID="P748358" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>9.19</Subsidy>
                  <Price>9.19</Price>
                  <Alternate>9.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601199106" Rank="1" Units="tab" Weight="15">
              <Name>Tab 15 mg</Name>
              <Brand ID="B07160119910601" SoleSupply="true">
                <Name>Apo-Pindolol</Name>
                <Pack ID="P748374" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.80</Subsidy>
                  <Price>13.80</Price>
                  <Alternate>13.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716012060">
            <Name>Propranolol</Name>
            <Formulation ID="F071601206001" Rank="1" Units="tab" Weight="10" Statim="Must">
              <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>
              <Brand ID="B07160120600104" S29="true">
                <Name>Apo-Propranolol</Name>
                <Pack ID="P2400790" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.65</Subsidy>
                  <Price>3.65</Price>
                  <Alternate>3.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601206002" Rank="1" Units="tab" Weight="40" Statim="Must">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07160120600203" S29="true">
                <Name>Apo-Propranolol</Name>
                <Pack ID="P2400804" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.65</Subsidy>
                  <Price>4.65</Price>
                  <Alternate>4.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07160120600204" ToBeDelisted="2012-12-01">
                <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" Statim="Must">
              <Name>Cap long-acting 160 mg</Name>
              <Brand ID="B07160120600602">
                <Name>Cardinol LA</Name>
                <Pack ID="P326070" 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="C0716012169" Statim="Must">
            <Name>Sotalol</Name>
            <Formulation ID="F071601216901" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B07160121690102" SoleSupply="true">
                <Name>Mylan</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>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F071601216902" Rank="1" Units="tab" Weight="160">
              <Name>Tab 160 mg</Name>
              <Brand ID="B07160121690202" SoleSupply="true">
                <Name>Mylan</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>
                  <Multiple>1</Multiple>
                  <Subsidy>65.39</Subsidy>
                  <Price>65.39</Price>
                  <Alternate>65.39</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716012266" 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" 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" Statim="Must">
            <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>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0716013949">
            <Name>Bisoprolol fumarate</Name>
            <Formulation ID="F071601394925" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07160139492525" SoleSupply="true">
                <Name>Bosvate</Name>
                <Pack ID="P2392844" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.88</Subsidy>
                  <Price>3.88</Price>
                  <Alternate>3.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601394926" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07160139492625" SoleSupply="true">
                <Name>Bosvate</Name>
                <Pack ID="P2392852" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.74</Subsidy>
                  <Price>4.74</Price>
                  <Alternate>4.74</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F071601394927" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07160139492725" SoleSupply="true">
                <Name>Bosvate</Name>
                <Pack ID="P2392860" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>9.18</Subsidy>
                  <Price>9.18</Price>
                  <Alternate>9.18</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" 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">
                <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>8.56</Subsidy>
                  <Price>8.56</Price>
                  <Alternate>8.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07220118630326">
                <Name>Adefin XL</Name>
                <Pack ID="P2222140" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>8.56</Subsidy>
                  <Price>8.56</Price>
                  <Alternate>8.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </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>12.28</Subsidy>
                  <Price>12.28</Price>
                  <Alternate>12.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07220118630426">
                <Name>Adefin XL</Name>
                <Pack ID="P2222116" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>12.28</Subsidy>
                  <Price>12.28</Price>
                  <Alternate>12.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0722012398" Statim="Must">
            <Name>Felodipine</Name>
            <Formulation ID="F072201239801" Rank="1" Units="tab" Weight="5">
              <Name>Tab long-acting 5 mg</Name>
              <Brand ID="B07220123980125" SoleSupply="true">
                <Name>Felo 5 ER</Name>
                <Pack ID="P2041510" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>10.73</Subsidy>
                  <Price>10.73</Price>
                  <Alternate>10.73</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" SoleSupply="true">
                <Name>Felo 10 ER</Name>
                <Pack ID="P2041499" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>15.60</Subsidy>
                  <Price>15.60</Price>
                  <Alternate>15.60</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" Statim="Must">
            <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" Statim="Must">
            <Name>Amlodipine</Name>
            <Formulation ID="F072201279301" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07220127930126" SoleSupply="true">
                <Name>Apo-Amlodipine</Name>
                <Pack ID="P2284057" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.65</Subsidy>
                  <Price>2.65</Price>
                  <Alternate>2.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F072201279302" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07220127930226" SoleSupply="true">
                <Name>Apo-Amlodipine</Name>
                <Pack ID="P2284065" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.15</Subsidy>
                  <Price>4.15</Price>
                  <Alternate>4.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072201279325" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07220127932525" SoleSupply="true">
                <Name>Apo-Amlodipine</Name>
                <Pack ID="P2352486" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.45</Subsidy>
                  <Price>2.45</Price>
                  <Alternate>2.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A072202">
          <Name>Other Calcium Channel Blockers</Name>
          <Chemical ID="C0722021949" Statim="Must">
            <Name>Perhexiline maleate</Name>
            <Formulation ID="F072202194901" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07220219490125">
                <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="Special" Attribute="Subsidy" xlink:href="SA0256"/>
          </Chemical>
          <Chemical ID="C0722022317" Statim="Must">
            <Name>Verapamil hydrochloride</Name>
            <Formulation ID="F072202231701" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07220223170101" SoleSupply="true">
                <Name>Isoptin</Name>
                <Pack ID="P253499" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.01</Subsidy>
                  <Price>7.01</Price>
                  <Alternate>7.01</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F072202231702" Rank="1" Units="tab" Weight="80">
              <Name>Tab 80 mg</Name>
              <Brand ID="B07220223170203" SoleSupply="true">
                <Name>Isoptin</Name>
                <Pack ID="P253502" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.74</Subsidy>
                  <Price>11.74</Price>
                  <Alternate>11.74</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </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>
                  <Multiple>1</Multiple>
                  <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">
                <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" 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>4.60</Subsidy>
                  <Price>4.60</Price>
                  <Alternate>4.60</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>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F072202252804" Rank="2" Units="cap" Weight="120">
              <Name>Cap long-acting 120 mg</Name>
              <Brand ID="B07220225280403">
                <Name>Cardizem CD</Name>
                <Pack ID="P344621" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.34</Subsidy>
                  <Price>4.34</Price>
                  <Alternate>4.34</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>6.50</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>6.50</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>8.67</Subsidy>
                  <Price>8.67</Price>
                  <Alternate>8.67</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" 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>23.30</Subsidy>
                  <Price>23.30</Price>
                  <Alternate>23.30</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>32.80</Subsidy>
                  <Price>32.80</Price>
                  <Alternate>32.80</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>41.20</Subsidy>
                  <Price>41.20</Price>
                  <Alternate>41.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0728011318" 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>33.00</Subsidy>
                  <Price>33.00</Price>
                  <Alternate>33.00</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>
                  <Multiple>1</Multiple>
                  <Subsidy>15.45</Subsidy>
                  <Price>15.45</Price>
                  <Alternate>15.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0728011806" Statim="Must">
            <Name>Methyldopa</Name>
            <Formulation ID="F072801180601" Rank="1" Units="tab" Weight="125">
              <Name>Tab 125 mg</Name>
              <Brand ID="B07280118060104">
                <Name>Prodopa</Name>
                <Pack ID="P303763" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>14.25</Subsidy>
                  <Price>14.25</Price>
                  <Alternate>14.25</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">
                <Name>Prodopa</Name>
                <Pack ID="P601160" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.10</Subsidy>
                  <Price>15.10</Price>
                  <Alternate>15.10</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">
                <Name>Prodopa</Name>
                <Pack ID="P261017" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>23.15</Subsidy>
                  <Price>23.15</Price>
                  <Alternate>23.15</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" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>7.95</Subsidy>
                  <Price>7.95</Price>
                  <Alternate>7.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731011544" Statim="Must">
            <Name>Furosemide</Name>
            <Formulation ID="F073101154401" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B07310115440103" SoleSupply="true">
                <Name>Diurin 40</Name>
                <Pack ID="P282014" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>10.75</Subsidy>
                  <Price>10.75</Price>
                  <Alternate>10.75</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="B07310115440225">
                <Name>Urex Forte</Name>
                <Pack ID="P2343444" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>25.00</Subsidy>
                  <Price>25.00</Price>
                  <Alternate>25.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </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="B07310115440425" SoleSupply="true">
                <Name>Frusemide-Claris</Name>
                <Pack ID="P2325357" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.30</Price>
                  <Alternate>1.30</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>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A073104">
          <Name>Potassium Sparing Diuretics</Name>
          <Chemical ID="C0731041050">
            <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>30.00</Subsidy>
                  <Price>30.00</Price>
                  <Alternate>30.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731042176">
            <Name>Spironolactone</Name>
            <Formulation ID="F073104217601" Rank="1" Units="tab" Weight="25" Statim="Must">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07310421760101" SoleSupply="true">
                <Name>Spirotone</Name>
                <Pack ID="P796751" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.60</Subsidy>
                  <Price>4.60</Price>
                  <Alternate>4.60</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" SoleSupply="true">
                <Name>Spirotone</Name>
                <Pack ID="P796689" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.15</Subsidy>
                  <Price>15.15</Price>
                  <Alternate>15.15</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>30.00</Subsidy>
                  <Price>30.00</Price>
                  <Alternate>30.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A073107">
          <Name>Potassium Sparing Combination Diuretics</Name>
          <Chemical ID="C0731071051" 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>8.63</Subsidy>
                  <Price>8.63</Price>
                  <Alternate>8.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731071053" 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="B07310710530103">
                <Name>Moduretic</Name>
                <Pack ID="P2364433" Specified="true">
                  <Quantity>50</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" Statim="Must">
            <Name>Bendrofluazide</Name>
            <Formulation ID="F073110111601" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07311011160125" SoleSupply="true">
                <Name>Arrow-Bendrofluazide</Name>
                <Pack ID="P2351420" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>6.48</Subsidy>
                  <Price>6.48</Price>
                  <Alternate>6.48</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="B07311011160225" SoleSupply="true">
                <Name>Arrow-Bendrofluazide</Name>
                <Pack ID="P2351439" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>9.95</Subsidy>
                  <Price>9.95</Price>
                  <Alternate>9.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731101282">
            <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>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0731101290" Statim="Must">
            <Name>Chlorthalidone</Name>
            <Formulation ID="F073110129001" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07311012900101">
                <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" Statim="Must">
            <Name>Indapamide</Name>
            <Formulation ID="F073110164301" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B07311016430125" SoleSupply="true">
                <Name>Dapa-Tabs</Name>
                <Pack ID="P2356406" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>2.95</Subsidy>
                  <Price>2.95</Price>
                  <Alternate>2.95</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" Statim="Must">
            <Name>Glyceryl trinitrate</Name>
            <Formulation ID="F073401157701" Rank="9" Units="patch" Weight="10">
              <Name>TDDS 10 mg</Name>
              <Brand ID="B07340115770103" SoleSupply="true">
                <Name>Nitroderm TTS</Name>
                <Pack ID="P750247" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>19.50</Subsidy>
                  <Price>19.50</Price>
                  <Alternate>19.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073401157702" Rank="1" Units="tab" Weight="600">
              <Name>Tab 600 mcg</Name>
              <Brand ID="B07340115770225" SoleSupply="true">
                <Name>Lycinate</Name>
                <Pack ID="P2179946" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.00</Subsidy>
                  <Price>8.00</Price>
                  <Alternate>8.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="100" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F073401157705" Rank="9" Units="patch" Weight="5">
              <Name>TDDS 5 mg</Name>
              <Brand ID="B07340115770502" SoleSupply="true">
                <Name>Nitroderm TTS</Name>
                <Pack ID="P716790" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>16.56</Subsidy>
                  <Price>16.56</Price>
                  <Alternate>16.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F073401157725" Rank="6" Units="dose">
              <Name>Aerosol spray, 400 mcg per dose</Name>
              <Brand ID="B07340115772525" SoleSupply="true">
                <Name>Glytrin</Name>
                <Pack ID="P2389975" OP="true" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>4.45</Subsidy>
                  <Price>4.45</Price>
                  <Alternate>4.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="250" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0734012836" Statim="Must">
            <Name>Isosorbide mononitrate</Name>
            <Formulation ID="F073401283601" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B07340128360101" SoleSupply="true">
                <Name>Ismo 20</Name>
                <Pack ID="P214833" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>17.10</Subsidy>
                  <Price>17.10</Price>
                  <Alternate>17.10</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" SoleSupply="true">
                <Name>Corangin</Name>
                <Pack ID="P726958" 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="F073401283603" Rank="1" Units="tab" Weight="60">
              <Name>Tab long-acting 60 mg</Name>
              <Brand ID="B07340128360304">
                <Name>Duride</Name>
                <Pack ID="P2202964" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.94</Subsidy>
                  <Price>3.94</Price>
                  <Alternate>3.94</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">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>5.25</Subsidy>
                  <Price>5.25</Price>
                  <Alternate>5.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07370110150125">
                <Name>Aspen Adrenaline</Name>
                <Pack ID="P2309823" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>4.98</Subsidy>
                  <Price>4.98</Price>
                  <Alternate>4.98</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>
                  <Multiple>1</Multiple>
                  <Subsidy>27.00</Subsidy>
                  <Price>27.00</Price>
                  <Alternate>27.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B07370110150225">
                <Name>Aspen Adrenaline</Name>
                <Pack ID="P2390949" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>49.00</Subsidy>
                  <Price>49.00</Price>
                  <Alternate>49.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C0737011682" 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>
                  <Multiple>1</Multiple>
                  <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" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>25.90</Subsidy>
                  <Price>25.90</Price>
                  <Alternate>25.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0740011928" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>73.12</Subsidy>
                  <Price>73.12</Price>
                  <Alternate>73.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C0740012455">
            <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>
          </Chemical>
          <Chemical ID="C0740016001" 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>
        <ATC3 ID="A074005">
          <Name>Endothelin Receptor Antagonists</Name>
          <Chemical ID="C0740053889">
            <Name>Bosentan</Name>
            <Formulation ID="F074005388925" Rank="1" Units="tab" Weight="62">
              <Name>Tab 62.5 mg</Name>
              <Brand ID="B07400538892525">
                <Name>Tracleer</Name>
                <Pack ID="P2158612" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>4585.00</Subsidy>
                  <Price>4585.00</Price>
                  <Alternate>4585.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074005388926" Rank="1" Units="tab" Weight="125">
              <Name>Tab 125 mg</Name>
              <Brand ID="B07400538892625">
                <Name>Tracleer</Name>
                <Pack ID="P2158620" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>4585.00</Subsidy>
                  <Price>4585.00</Price>
                  <Alternate>4585.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0967"/>
          </Chemical>
          <Chemical ID="C0740053904">
            <Name>Ambrisentan</Name>
            <Formulation ID="F074005390425" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B07400539042525">
                <Name>Volibris</Name>
                <Pack ID="P2349353" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4585.00</Subsidy>
                  <Price>4585.00</Price>
                  <Alternate>4585.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074005390426" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B07400539042625">
                <Name>Volibris</Name>
                <Pack ID="P2349345" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4585.00</Subsidy>
                  <Price>4585.00</Price>
                  <Alternate>4585.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0967"/>
          </Chemical>
          <Request To="Pulmonary Arterial Hypertension Panel" For="Subsidy" Form="SA0967">
            <Title>
              <range>Endothelin Receptor Antagonists</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>Application details may be obtained from PHARMAC's website <a href="http://www.pharmac.govt.nz/">http://www.pharmac.govt.nz</a> or:</p>
              <p>The Coordinator, PAH Panel</p>
              <p>PHARMAC, PO Box 10-254, WELLINGTON</p>
              <p>Tel: (04) 916 7512, Fax: (04) 974 4858, Email: <a href="mailto:PAH@pharmac.govt.nz">PAH@pharmac.govt.nz</a></p>
            </div>
          </Request>
        </ATC3>
        <ATC3 ID="A074007">
          <Name>Phosphodiesterase Type 5 Inhibitors</Name>
          <Chemical ID="C0740073890">
            <Name>Sildenafil</Name>
            <Formulation ID="F074007389025" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B07400738902525">
                <Name>Viagra</Name>
                <Pack ID="P494712" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>39.00</Subsidy>
                  <Price>39.00</Price>
                  <Alternate>39.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074007389026" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B07400738902625">
                <Name>Viagra</Name>
                <Pack ID="P494720" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>43.50</Subsidy>
                  <Price>43.50</Price>
                  <Alternate>43.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F074007389027" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B07400738902725">
                <Name>Viagra</Name>
                <Pack ID="P494739" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>47.00</Subsidy>
                  <Price>47.00</Price>
                  <Alternate>47.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1086"/>
          </Chemical>
          <Request To="Pulmonary Arterial Hypertension Panel" For="Subsidy" Form="SA1086">
            <Title>
              <range>Sildenafil</range>
            </Title>
            <Case When="Initial application">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <mi class="heading">The Electronic Special Authority system is not available for Sildenafil</mi>
              </math>
              <Applicant>medical practitioner</Applicant>
              <Term Measure="year">2</Term>
            </Case>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <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>
              <p>The Coordinator, PAH Panel</p>
              <p>PHARMAC, PO Box 10-254, WELLINGTON</p>
              <p>Tel: (04) 916 7512, Fax: (04) 974 4858, Email: <a href="mailto:PAH@pharmac.govt.nz">PAH@pharmac.govt.nz</a></p>
            </div>
          </Request>
        </ATC3>
        <ATC3 ID="A074009">
          <Name>Prostacyclin Analogues</Name>
          <Chemical ID="C0740093891">
            <Name>Iloprost</Name>
            <Formulation ID="F074009389125" Rank="8" Units="neb" Weight="10">
              <Name>Nebuliser soln 10 mcg per ml, 2 ml</Name>
              <Brand ID="B07400938912525">
                <Name>Ventavis</Name>
                <Pack ID="P2300214" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1185.00</Subsidy>
                  <Price>1185.00</Price>
                  <Alternate>1185.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0969"/>
          </Chemical>
          <Request To="Pulmonary Arterial Hypertension Panel" For="Subsidy" Form="SA0969">
            <Title>
              <range>Iiloprost</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>Application details may be obtained from PHARMAC's website <a href="http://www.pharmac.govt.nz/">http://www.pharmac.govt.nz</a> or:</p>
              <p>The Coordinator, PAH Panel</p>
              <p>PHARMAC, PO Box 10-254, WELLINGTON</p>
              <p>Tel: (04) 916 7512, Fax: (04) 974 4858, Email: <a href="mailto:PAH@pharmac.govt.nz">PAH@pharmac.govt.nz</a></p>
            </div>
          </Request>
        </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">
            <Name>Isotretinoin</Name>
            <Formulation ID="F100101168801" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B10010116880125" SoleSupply="true">
                <Name>Oratane</Name>
                <Pack ID="P2324105" Specified="true">
                  <Quantity>180</Quantity>
                  <Subsidy>48.48</Subsidy>
                  <Price>48.48</Price>
                  <Alternate>48.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100101168802" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B10010116880202" SoleSupply="true">
                <Name>Oratane</Name>
                <Pack ID="P2324113" Specified="true">
                  <Quantity>180</Quantity>
                  <Subsidy>69.70</Subsidy>
                  <Price>69.70</Price>
                  <Alternate>69.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0955">
              <Title>
                <range>Isotretinoin</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has had an adequate trial on other available treatments and has received an inadequate response from these treatments or these are contraindicated</ci>
                    <ci type="logical" class="Indication">Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice</ci>
                    <ci type="logical" class="Indication">Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment</ci>
                      <ci type="logical" class="Indication">Patient is male</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body.</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0947 SA0955">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has had an adequate trial on other available treatments and has received an inadequate response from these treatments or these are contraindicated</ci>
                    <ci type="logical" class="Indication">Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice</ci>
                    <ci type="logical" class="Indication">Applicant has an up to date knowledge of the treatment options for acne and is aware of the safety issues around isotretinoin and is competent to prescribe isotretinoin</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient is female and has been counselled and understands the risk of teratogenicity if isotretinoin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of one month after the completion of the treatment</ci>
                      <ci type="logical" class="Indication">Patient is male</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Applicants are recommended to either have used or be familiar with using a decision support tool accredited by their professional body.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0955"/>
          </Chemical>
          <Chemical ID="C1001012286">
            <Name>Tretinoin</Name>
            <Formulation ID="F100101228626" Rank="3" Units="g">
              <Name>Crm 0.5 mg per g</Name>
              <Brand ID="B10010122862625">
                <Name>ReTrieve</Name>
                <Pack ID="P2358751" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>13.90</Subsidy>
                  <Price>13.90</Price>
                  <Alternate>13.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="50" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1001013915">
            <Name>Adapalene</Name>
            <Formulation ID="F100101391525" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10010139152525">
                <Name>Differin</Name>
                <Pack ID="P386731" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>22.89</Subsidy>
                  <Price>22.89</Price>
                  <Alternate>22.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100101391526" Rank="3" Units="g">
              <Name>Gel 0.1%</Name>
              <Brand ID="B10010139152625">
                <Name>Differin</Name>
                <Pack ID="P456160" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>22.89</Subsidy>
                  <Price>22.89</Price>
                  <Alternate>22.89</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="30" Attribute="Rx"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <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">
            <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>3.25</Subsidy>
                  <Price>3.25</Price>
                  <Alternate>3.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="FormMax" Value="15" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </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>3.25</Subsidy>
                  <Price>3.25</Price>
                  <Alternate>3.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormMax" Value="15" Attribute="Rx"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1004011835">
            <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="NotCombined"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1004012114">
            <Name>Silver sulphadiazine</Name>
            <Formulation ID="F100401211425" Rank="3" Units="g">
              <Name>Crm 1%</Name>
              <Brand ID="B10040121142525">
                <Name>Flamazine</Name>
                <Pack ID="P2343851" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>12.30</Subsidy>
                  <Price>12.30</Price>
                  <Alternate>12.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormMax" Value="250" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1004013303" 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="Xref">
          <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" 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="NotCombined"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </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>0.54</Subsidy>
                  <Price>0.54</Price>
                  <Alternate>0.54</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007011443">
            <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>17.23</Price>
                  <Alternate>9.89</Alternate>
                  <Surcharge>2.44667</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </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>7.48</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.32400</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007011620" 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>10.03</Price>
                  <Alternate>4.36</Alternate>
                  <Surcharge>0.18900</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
            <Formulation ID="F100701162002" Rank="3" Units="ml">
              <Name>Tinct 2%</Name>
              <Brand ID="B10070116200201">
                <Name>Daktarin</Name>
                <Pack ID="P253294" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.36</Subsidy>
                  <Price>12.10</Price>
                  <Alternate>4.36</Alternate>
                  <Surcharge>0.25800</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>0.46</Subsidy>
                  <Price>0.46</Price>
                  <Alternate>0.46</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="NotCombined"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007011881">
            <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>7.90</Price>
                  <Alternate>1.00</Alternate>
                  <Surcharge>0.46000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="NotCombined"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1007012394">
            <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="F100701239405" Rank="3" Units="g">
              <Name>Nail soln 8%</Name>
              <Brand ID="B10070123940501" SoleSupply="true">
                <Name>Batrafen</Name>
                <Pack ID="P316644" OP="true">
                  <Quantity>3.5</Quantity>
                  <Subsidy>19.85</Subsidy>
                  <Price>19.85</Price>
                  <Alternate>19.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2399407" OP="true" Specified="true">
                  <Quantity>3</Quantity>
                  <Subsidy>19.85</Subsidy>
                  <Price>19.85</Price>
                  <Alternate>19.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="NotCombined"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1007012832">
            <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="Xref">
          <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">
            <Name>Calamine</Name>
            <Formulation ID="F100801117901" Rank="3" Units="g">
              <Name>Crm, aqueous, BP</Name>
              <Brand ID="B10080111790126" SoleSupply="true">
                <Name>healthE</Name>
                <Pack ID="P2318628" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.78</Subsidy>
                  <Price>2.78</Price>
                  <Alternate>2.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F100801117902" Rank="3" Units="ml">
              <Name>Lotn, BP</Name>
              <Brand ID="B10080111790201" SoleSupply="true">
                <Name>API</Name>
                <Pack ID="P285994" Specified="true">
                  <Quantity>2000</Quantity>
                  <Subsidy>16.70</Subsidy>
                  <Price>16.70</Price>
                  <Alternate>16.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="NotCombined"/>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1008011363">
            <Name>Crotamiton</Name>
            <Formulation ID="F100801136301" Rank="3" Units="g">
              <Name>Crm 10%</Name>
              <Brand ID="B10080113630125" SoleSupply="true">
                <Name>Itch-Soothe</Name>
                <Pack ID="P2343614" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>3.79</Subsidy>
                  <Price>3.79</Price>
                  <Alternate>3.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
            <Rule Type="NotCombined"/>
          </Chemical>
          <Chemical ID="C1008013333">
            <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>6.50</Subsidy>
                  <Price>6.50</Price>
                  <Alternate>6.50</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>
                <Pack ID="P2377209" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>6.92</Subsidy>
                  <Price>6.92</Price>
                  <Alternate>6.92</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">
            <Name>Methylprednisolone aceponate</Name>
            <Formulation ID="F101101108201" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10110110820101">
                <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">
                <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">
            <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" 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>3.48</Subsidy>
                  <Price>3.48</Price>
                  <Alternate>3.48</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>3.48</Subsidy>
                  <Price>3.48</Price>
                  <Alternate>3.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011310">
            <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">
            <Name>Diflucortolone valerate</Name>
            <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>15.86</Price>
                  <Alternate>8.97</Alternate>
                  <Surcharge>0.13780</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>15.86</Price>
                  <Alternate>8.97</Alternate>
                  <Surcharge>0.13780</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011613">
            <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">
            <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>6.85</Subsidy>
                  <Price>6.85</Price>
                  <Alternate>6.85</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>2.30</Subsidy>
                  <Price>2.30</Price>
                  <Alternate>2.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P521957" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.85</Subsidy>
                  <Price>6.85</Price>
                  <Alternate>6.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101161425" Rank="3" Units="ml">
              <Name>Milky emul 0.1%</Name>
              <Brand ID="B10110116142525">
                <Name>Locoid Crelo</Name>
                <Pack ID="P2017458" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.85</Subsidy>
                  <Price>6.85</Price>
                  <Alternate>6.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011011617" Statim="Must">
            <Name>Hydrocortisone</Name>
            <Formulation ID="F101101161706" Rank="3" Units="g">
              <Name>Powder</Name>
              <Brand ID="B10110116170626" SoleSupply="true">
                <Name>ABM</Name>
                <Pack ID="P2322420" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>44.00</Subsidy>
                  <Price>44.00</Price>
                  <Alternate>44.00</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="B10110116171926" SoleSupply="true">
                <Name>Pharmacy Health</Name>
                <Pack ID="P277002" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>14.00</Subsidy>
                  <Price>14.00</Price>
                  <Alternate>14.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2339765">
                  <Quantity>100</Quantity>
                  <Subsidy>3.75</Subsidy>
                  <Price>3.75</Price>
                  <Alternate>3.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011012389">
            <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>6.63</Subsidy>
                  <Price>6.63</Price>
                  <Alternate>6.63</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>6.69</Subsidy>
                  <Price>6.69</Price>
                  <Alternate>6.69</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011012716" 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">
                <Name>Beta Cream</Name>
                <Pack ID="P2188740" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.20</Subsidy>
                  <Price>3.20</Price>
                  <Alternate>3.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101271610" Rank="3" Units="g">
              <Name>Oint 0.1%</Name>
              <Brand ID="B10110127161025">
                <Name>Beta Ointment</Name>
                <Pack ID="P2188759" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.20</Subsidy>
                  <Price>3.20</Price>
                  <Alternate>3.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011012837">
            <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>7.35</Subsidy>
                  <Price>7.35</Price>
                  <Alternate>7.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101283703" Rank="3" Units="g">
              <Name>Crm 0.1%</Name>
              <Brand ID="B10110128370325" SoleSupply="true">
                <Name>m-Mometasone</Name>
                <Pack ID="P2318903" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.38</Subsidy>
                  <Price>2.38</Price>
                  <Alternate>2.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2318938" OP="true" Specified="true">
                  <Quantity>45</Quantity>
                  <Subsidy>4.55</Subsidy>
                  <Price>4.55</Price>
                  <Alternate>4.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101101283704" Rank="3" Units="g">
              <Name>Oint 0.1%</Name>
              <Brand ID="B10110128370425" SoleSupply="true">
                <Name>m-Mometasone</Name>
                <Pack ID="P2318881" OP="true" Specified="true">
                  <Quantity>45</Quantity>
                  <Subsidy>4.55</Subsidy>
                  <Price>4.55</Price>
                  <Alternate>4.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2318911" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.38</Subsidy>
                  <Price>2.38</Price>
                  <Alternate>2.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A101104">
          <Name>Corticosteroids - Combination</Name>
          <Chemical ID="C1011041146">
            <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">
            <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>10.45</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.46400</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="15" Attribute="Rx"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1011041611" 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" SoleSupply="true">
                <Name>Micreme H</Name>
                <Pack ID="P704733" OP="true" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>2.10</Subsidy>
                  <Price>2.10</Price>
                  <Alternate>2.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1011041612">
            <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>2.79</Subsidy>
                  <Price>2.79</Price>
                  <Alternate>2.79</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>2.79</Subsidy>
                  <Price>2.79</Price>
                  <Alternate>2.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1011042387">
            <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>6.60</Price>
                  <Alternate>3.49</Alternate>
                  <Surcharge>0.20733</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <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" 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>5.90</Subsidy>
                  <Price>5.90</Price>
                  <Alternate>5.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101301124425" Rank="3" Units="ml">
              <Name>Handrub 1% with ethanol 70%</Name>
              <Brand ID="B10130112442526" SoleSupply="true">
                <Name>healthE</Name>
                <Pack ID="P2318679" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>4.60</Subsidy>
                  <Price>4.60</Price>
                  <Alternate>4.60</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 a dialysis patient and the prescription is endorsed accordingly.</p>
            </div>
            <Rule Type="DoseMMax" Value="500"/>
          </Chemical>
          <Chemical ID="C1013013909">
            <Name>Triclosan</Name>
            <Formulation ID="F101301390925" Rank="3" Units="ml">
              <Name>Soln 1%</Name>
              <Brand ID="B10130139092525">
                <Name>healthE</Name>
                <Pack ID="P2360128" OP="true" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>5.90</Subsidy>
                  <Price>5.90</Price>
                  <Alternate>5.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10130139092526">
                <Name>Pharmacy Health</Name>
                <Pack ID="P2366843" OP="true" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>4.50</Subsidy>
                  <Price>4.50</Price>
                  <Alternate>4.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="500" Attribute="Rx"/>
            <Rule Type="SubRxF"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: lower-alpha">
                <li>
                  <p>Only if prescribed for a patient identified with Methicillin-resistant Staphylococcus aureus (MRSA) prior to elective surgery in hospital and the prescription is endorsed accordingly; or</p>
                </li>
                <li>
                  <p>Only if prescribed for a patient with recurrent Staphylococcus aureus infection and the prescription is endorsed accordingly</p>
                </li>
              </ol>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1015">
        <Name>Barrier Creams and Emollients</Name>
        <ATC3 ID="A101502">
          <Name>Barrier Creams</Name>
          <Chemical ID="C1015023431" Statim="Must">
            <Name>Zinc and castor oil</Name>
            <Formulation ID="F101502343101" Rank="3" Units="g">
              <Name>Oint BP</Name>
              <Brand ID="B10150234310101">
                <Name>PSM</Name>
                <Pack ID="P306002" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.83</Subsidy>
                  <Price>5.11</Price>
                  <Alternate>3.83</Alternate>
                  <Surcharge>0.00256</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10150234310103">
                <Name>Multichem</Name>
                <Pack ID="P544345" 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>
        </ATC3>
        <ATC3 ID="A101504">
          <Name>Emollients</Name>
          <Chemical ID="C1015042312" Statim="Must">
            <Name>Urea</Name>
            <Formulation ID="F101504231201" Rank="3" Units="g">
              <Name>Crm 10%</Name>
              <Brand ID="B10150423120103">
                <Name>Nutraplus</Name>
                <Pack ID="P255424" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.07</Subsidy>
                  <Price>3.07</Price>
                  <Alternate>3.07</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015042339" 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>20.53</Price>
                  <Alternate>5.60</Alternate>
                  <Surcharge>0.01493</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>3.50</Price>
                  <Alternate>1.40</Alternate>
                  <Surcharge>0.00840</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>3.50</Price>
                  <Alternate>1.40</Alternate>
                  <Surcharge>0.00840</Surcharge>
                </Pack>
                <Pack ID="P619787" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>5.60</Subsidy>
                  <Price>10.90</Price>
                  <Alternate>5.60</Alternate>
                  <Surcharge>0.00530</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1015043213" Statim="Must">
            <Name>Aqueous cream</Name>
            <Formulation ID="F101504321301" Rank="3" Units="g">
              <Name>Crm</Name>
              <Brand ID="B10150432130125" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2072254" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>1.96</Subsidy>
                  <Price>1.96</Price>
                  <Alternate>1.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015043244" Statim="Must">
            <Name>Cetomacrogol</Name>
            <Formulation ID="F101504324401" Rank="3" Units="g">
              <Name>Crm BP</Name>
              <Brand ID="B10150432440101" SoleSupply="true">
                <Name>PSM</Name>
                <Pack ID="P422452" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.15</Subsidy>
                  <Price>3.15</Price>
                  <Alternate>3.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015043282" Statim="Must">
            <Name>Emulsifying ointment</Name>
            <Formulation ID="F101504328201" Rank="3" Units="g">
              <Name>Oint BP</Name>
              <Brand ID="B10150432820125" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2072246" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.04</Subsidy>
                  <Price>3.04</Price>
                  <Alternate>3.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1015043743" Statim="Must">
            <Name>Oil in water emulsion</Name>
            <Formulation ID="F101504374325" Rank="3" Units="g">
              <Name>Crm</Name>
              <Brand ID="B10150437432526">
                <Name>healthE Fatty Cream</Name>
                <Pack ID="P2329468" 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">
            <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" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>3.58</Subsidy>
                  <Price>7.78</Price>
                  <Alternate>3.58</Alternate>
                  <Surcharge>0.00840</Surcharge>
                </Pack>
                <Pack ID="P779679" Specified="true">
                  <Quantity>2500</Quantity>
                  <Subsidy>20.20</Subsidy>
                  <Price>20.20</Price>
                  <Alternate>20.20</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">
            <Name>Povidone iodine</Name>
            <Formulation ID="F101601238501" Rank="3" Units="g">
              <Name>Oint 10%</Name>
              <Brand ID="B10160123850101">
                <Name>Betadine</Name>
                <Pack ID="P507288" OP="true" Specified="true">
                  <Quantity>25</Quantity>
                  <Subsidy>3.27</Subsidy>
                  <Price>3.27</Price>
                  <Alternate>3.27</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="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" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>0.19</Subsidy>
                  <Price>4.45</Price>
                  <Alternate>0.19</Alternate>
                  <Surcharge>0.28400</Surcharge>
                </Pack>
                <Pack ID="P536970" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.28</Subsidy>
                  <Price>8.25</Price>
                  <Alternate>1.28</Alternate>
                  <Surcharge>0.06970</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10160123850204">
                <Name>Riodine</Name>
                <Pack ID="P777447" Specified="true">
                  <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>6.20</Subsidy>
                  <Price>6.20</Price>
                  <Alternate>6.20</Alternate>
                  <Surcharge>0.00000</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" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.63</Subsidy>
                  <Price>3.65</Price>
                  <Alternate>1.63</Alternate>
                  <Surcharge>0.02020</Surcharge>
                </Pack>
                <Pack ID="P510335" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>10.00</Subsidy>
                  <Price>10.00</Price>
                  <Alternate>10.00</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" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.63</Subsidy>
                  <Price>6.04</Price>
                  <Alternate>1.63</Alternate>
                  <Surcharge>0.04410</Surcharge>
                </Pack>
                <Pack ID="P2127652" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>8.13</Subsidy>
                  <Price>18.63</Price>
                  <Alternate>8.13</Alternate>
                  <Surcharge>0.02100</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1017">
        <Name>Parasiticidal Preparations</Name>
        <ATC3 ID="A101701">
          <Name>Parasiticidal Preparations</Name>
          <Chemical ID="C1017011101">
            <Name>Malathion</Name>
            <Formulation ID="F101701110101" Rank="3" Units="ml">
              <Name>Liq 0.5%</Name>
              <Brand ID="B10170111010125" SoleSupply="true">
                <Name>A-Lices</Name>
                <Pack ID="P2090902" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>3.79</Subsidy>
                  <Price>3.79</Price>
                  <Alternate>3.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101701110125" Rank="3" Units="ml">
              <Name>Shampoo 1%</Name>
              <Brand ID="B10170111012525" 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="C1017011549">
            <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="C1017012828">
            <Name>Permethrin</Name>
            <Formulation ID="F101701282801" Rank="3" Units="g">
              <Name>Crm 5%</Name>
              <Brand ID="B10170128280102" SoleSupply="true">
                <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>Lotn 5%</Name>
              <Brand ID="B10170128280225" SoleSupply="true">
                <Name>A-Scabies</Name>
                <Pack ID="P2332027" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.24</Subsidy>
                  <Price>3.24</Price>
                  <Alternate>3.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1019">
        <Name>Psoriasis and Eczema Preparations</Name>
        <ATC3 ID="A101901">
          <Name>Psoriasis and Eczema Preparations</Name>
          <Chemical ID="C1019011324">
            <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="C1019012220" 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>3.05</Subsidy>
                  <Price>3.05</Price>
                  <Alternate>3.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P307769" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>5.82</Subsidy>
                  <Price>5.82</Price>
                  <Alternate>5.82</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
          <Chemical ID="C1019012363">
            <Name>Acitretin</Name>
            <Formulation ID="F101901236301" Rank="2" Units="cap" Weight="10">
              <Name>Cap 10 mg</Name>
              <Brand ID="B10190123630101">
                <Name>Neotigason</Name>
                <Pack ID="P674389" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>75.80</Subsidy>
                  <Price>75.80</Price>
                  <Alternate>75.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10190123630125">
                <Name>Novatretin</Name>
                <Pack ID="P2384167" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>38.66</Subsidy>
                  <Price>38.66</Price>
                  <Alternate>38.66</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">
                <Name>Neotigason</Name>
                <Pack ID="P674397" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>162.96</Subsidy>
                  <Price>162.96</Price>
                  <Alternate>162.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10190123630225">
                <Name>Novatretin</Name>
                <Pack ID="P2384175" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>83.11</Subsidy>
                  <Price>83.11</Price>
                  <Alternate>83.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0954">
              <Title>
                <range>Acitretin</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice</ci>
                    <ci type="logical" class="Indication">Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment</ci>
                      <ci type="logical" class="Indication">Patient is male</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Form="SA0946 SA0954">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Applicant is a vocationally registered dermatologist, vocationally registered general practitioner, or nurse practitioner working in a relevant scope of practice</ci>
                    <ci type="logical" class="Indication">Applicant has an up to date knowledge of the treatment options for psoriasis and of disorders of keratinisation and is aware of the safety issues around acitretin and is competent to prescribe acitretin</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient is female and has been counselled and understands the risk of teratogenicity if acitretin is used during pregnancy and the applicant has ensured that the possibility of pregnancy has been excluded prior to the commencement of the treatment and that the patient is informed that she must not become pregnant during treatment and for a period of two years after the completion of the treatment</ci>
                      <ci type="logical" class="Indication">Patient is male</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0954"/>
          </Chemical>
          <Chemical ID="C1019012796">
            <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>16.00</Subsidy>
                  <Price>16.00</Price>
                  <Alternate>16.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P337315" OP="true" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>33.79</Subsidy>
                  <Price>33.79</Price>
                  <Alternate>33.79</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>16.00</Subsidy>
                  <Price>16.00</Price>
                  <Alternate>16.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P249076" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>45.00</Subsidy>
                  <Price>45.00</Price>
                  <Alternate>45.00</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>20.20</Subsidy>
                  <Price>20.20</Price>
                  <Alternate>20.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P788201" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>45.00</Subsidy>
                  <Price>45.00</Price>
                  <Alternate>45.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1019013264">
            <Name>Coal tar</Name>
            <Formulation ID="F101901326405" Rank="3" Units="ml">
              <Name>Soln BP</Name>
              <Brand ID="B10190132640525" SoleSupply="true">
                <Name>Midwest</Name>
                <Pack ID="P2361671" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>12.95</Subsidy>
                  <Price>12.95</Price>
                  <Alternate>12.95</Alternate>
                  <Surcharge>0.00000</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="C1019013385">
            <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>
              <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">
            <Name>Sulphur</Name>
            <Formulation ID="F101901341102" Rank="3" Units="g">
              <Name>Precipitated</Name>
              <Brand ID="B10190134110226">
                <Name>Midwest</Name>
                <Pack ID="P2121158" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.35</Subsidy>
                  <Price>6.35</Price>
                  <Alternate>6.35</Alternate>
                  <Surcharge>0.00000</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">
            <Name>Coal tar with salicylic acid and sulphur</Name>
            <Formulation ID="F101901377625" Rank="3" Units="g">
              <Name>Soln 12% with salicylic acid 2% and sulphur 4% oint</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>
          <Chemical ID="C1019013941">
            <Name>Betamethasone dipropionate with calcipotriol</Name>
            <Formulation ID="F101901394125" Rank="3" Units="g" Weight="550">
              <Name>Oint 500 mcg with calcipotriol 50 mcg</Name>
              <Brand ID="B10190139412525">
                <Name>Daivobet</Name>
                <Pack ID="P2170914" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>26.12</Subsidy>
                  <Price>26.12</Price>
                  <Alternate>26.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F101901394126" Rank="3" Units="g" Weight="550">
              <Name>Topical gel 500 mcg with calcipotriol 50 mcg</Name>
              <Brand ID="B10190139412625">
                <Name>Daivobet</Name>
                <Pack ID="P2392070" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>26.12</Subsidy>
                  <Price>26.12</Price>
                  <Alternate>26.12</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" 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>6.36</Subsidy>
                  <Price>6.36</Price>
                  <Alternate>6.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1022011614">
            <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>3.65</Subsidy>
                  <Price>3.65</Price>
                  <Alternate>3.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1022011696">
            <Name>Ketoconazole</Name>
            <Formulation ID="F102201169603" Rank="3" Units="ml">
              <Name>Shampoo 2%</Name>
              <Brand ID="B10220116960302" SoleSupply="true">
                <Name>Sebizole</Name>
                <Pack ID="P461504" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.08</Subsidy>
                  <Price>3.08</Price>
                  <Alternate>3.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="100" Attribute="Rx"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1022012716" 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>7.22</Subsidy>
                  <Price>7.22</Price>
                  <Alternate>7.22</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">
            <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>2.55</Subsidy>
                  <Price>5.89</Price>
                  <Alternate>2.55</Alternate>
                  <Surcharge>0.03340</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>3.19</Subsidy>
                  <Price>6.94</Price>
                  <Alternate>3.19</Alternate>
                  <Surcharge>0.03000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B10250122130425">
                <Name>Marine Blue Lotion SPF 30+</Name>
                <Pack ID="P2275945" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>5.10</Subsidy>
                  <Price>5.10</Price>
                  <Alternate>5.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2275953" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.55</Subsidy>
                  <Price>2.55</Price>
                  <Alternate>2.55</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 patient with severe photosensitivity secondary to a defined clinical condition and the prescription is endorsed accordingly.</p>
            </div>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1028">
        <Name>Wart Preparations</Name>
        <ATC3 ID="A102801">
          <Name>Wart Preparations</Name>
          <Chemical ID="C1028012516">
            <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>33.60</Subsidy>
                  <Price>33.60</Price>
                  <Alternate>33.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="3.5" Attribute="Rx"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1028013879">
            <Name>Imiquimod</Name>
            <Formulation ID="F102801387925" Rank="2" Units="sach">
              <Name>Crm 5%</Name>
              <Brand ID="B10280138792525" SoleSupply="true">
                <Name>Aldara</Name>
                <Pack ID="P481114" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>62.00</Subsidy>
                  <Price>62.00</Price>
                  <Alternate>62.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0923">
              <Title>
                <range>Imiquimod</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">The patient has external anogenital warts and podophyllotoxin has been tried and failed (or is contraindicated)</ci>
                    <ci type="logical" class="Indication">The patient has external anogenital warts and podophyllotoxin is unable to be applied accurately to the site</ci>
                    <ci type="logical" class="Indication">The patient has confirmed superficial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">4</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Superficial basal cell carcinoma</p>
                  <ul>
                    <li>
                      <p>Surgical excision remains first-line treatment for superficial basal cell carcinoma as it has a higher cure rate than imiquimod and allows histological assessment of tumour clearance.</p>
                    </li>
                    <li>
                      <p>Imiquimod has not been evaluated for the treatment of superficial basal cell carcinoma within 1 cm of the hairline, eyes, nose, mouth or ears.</p>
                    </li>
                    <li>
                      <p>Imiquimod is not indicated for recurrent, invasive, infiltrating, or nodular basal cell carcinoma.</p>
                    </li>
                  </ul>
                  <p>External anogenital warts</p>
                  <ul>
                    <li>
                      <p>Imiquimod is only indicated for external genital and perianal warts (condyloma  acuminata).</p>
                    </li>
                  </ul>
                </div>
              </Case>
              <Case When="Renewal" Form="SA0923">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Inadequate response to initial treatment for anogenital warts</ci>
                    <ci type="logical" class="Indication">New confirmed superficial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate</ci>
                    <ci type="logical" class="Indication">Inadequate response to initial treatment for superficial basal cell carcinoma</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">4</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Every effort should be made to biopsy the lesion to confirm that it is a superficial basal cell carcinoma.</p>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0923"/>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
            <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">
            <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>26.49</Subsidy>
                  <Price>26.49</Price>
                  <Alternate>26.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A103105">
          <Name>Topical Analgesia</Name>
          <Chemical ID="C1031053854">
            <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="Xref">
            <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="C1031073329" Statim="Must">
            <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="C1301016039" Statim="Must">
            <Name>Condoms</Name>
            <Formulation ID="F130101603902" Rank="10" Units="dev">
              <Name>52 mm extra strength</Name>
              <Brand ID="B13010160390202">
                <Name>Marquis Protecta</Name>
                <Pack ID="P2146886" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603903" Rank="10" Units="dev">
              <Name>53 mm</Name>
              <Brand ID="B13010160390301">
                <Name>Gold Knight</Name>
                <Pack ID="P493163" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P731161" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390302">
                <Name>Shield Blue</Name>
                <Pack ID="P2144344" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2144352" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390325">
                <Name>Marquis Titillata</Name>
                <Pack ID="P2291622" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390326">
                <Name>Marquis Black</Name>
                <Pack ID="P2291630" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603904" Rank="10" Units="dev">
              <Name>54 mm, shaped</Name>
              <Brand ID="B13010160390401">
                <Name>Lifestyles Flared</Name>
                <Pack ID="P493139" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.12</Subsidy>
                  <Price>1.24</Price>
                  <Alternate>1.12</Alternate>
                  <Surcharge>0.01000</Surcharge>
                </Pack>
                <Pack ID="P493147" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>14.84</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.01028</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603905" Rank="10" Units="dev">
              <Name>52 mm</Name>
              <Brand ID="B13010160390501">
                <Name>Marquis Supalite</Name>
                <Pack ID="P2146932" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390525">
                <Name>Marquis Selecta</Name>
                <Pack ID="P2291606" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160390526">
                <Name>Marquis Sensolite</Name>
                <Pack ID="P2291614" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603906" Rank="10" Units="dev">
              <Name>56 mm, shaped</Name>
              <Brand ID="B13010160390601">
                <Name>Durex Confidence</Name>
                <Pack ID="P301353" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P493171" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603925" Rank="10" Units="dev">
              <Name>49 mm</Name>
              <Brand ID="B13010160392525">
                <Name>Shield 49</Name>
                <Pack ID="P2099462" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160392526" ToBeDelisted="2012-10-01">
                <Name>Gold Knight</Name>
                <Pack ID="P2287765" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2287773" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160392527">
                <Name>MarquisTantiliza</Name>
                <Pack ID="P2291649" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603926" Rank="10" Units="dev">
              <Name>53 mm (chocolate)</Name>
              <Brand ID="B13010160392625">
                <Name>Gold Knight</Name>
                <Pack ID="P423351" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2287757" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603927" Rank="10" Units="dev">
              <Name>53 mm (strawberry)</Name>
              <Brand ID="B13010160392725">
                <Name>Gold Knight</Name>
                <Pack ID="P327050" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2287749" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603928" Rank="10" Units="dev">
              <Name>55 mm</Name>
              <Brand ID="B13010160392825">
                <Name>Gold Knight</Name>
                <Pack ID="P2287781" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2287803" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160392826">
                <Name>Marquis Conforma</Name>
                <Pack ID="P2291592" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603929" Rank="10" Units="dev">
              <Name>53 mm extra strength</Name>
              <Brand ID="B13010160392925">
                <Name>Gold Knight</Name>
                <Pack ID="P2287811" Specified="true">
                  <Quantity>12</Quantity>
                  <Subsidy>1.11</Subsidy>
                  <Price>1.11</Price>
                  <Alternate>1.11</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2287838" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603930" Rank="10" Units="dev">
              <Name>60 mm</Name>
              <Brand ID="B13010160393025">
                <Name>Shield XL</Name>
                <Pack ID="P2256878" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F130101603932" Rank="10" Units="dev">
              <Name>56 mm</Name>
              <Brand ID="B13010160393225">
                <Name>Durex Select Flavours</Name>
                <Pack ID="P2309459" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13010160393226">
                <Name>Durex Extra Safe</Name>
                <Pack ID="P2309440" Specified="true">
                  <Quantity>144</Quantity>
                  <Subsidy>13.36</Subsidy>
                  <Price>13.36</Price>
                  <Alternate>13.36</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="144" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A130107">
          <Name>Contraceptive Devices</Name>
          <Chemical ID="C1301076038" 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>
            </Formulation>
            <Rule Type="FormMax" Value="40" Attribute="PSO"/>
            <Rule Type="FormReqd" Attribute="PSO"/>
          </Chemical>
          <Chemical ID="C1301076041" Statim="Must">
            <Name>Diaphragm</Name>
            <Formulation ID="F130107604127" Rank="10" Units="dev" Weight="1">
              <Name>65 mm</Name>
              <Brand ID="B13010760412726">
                <Name>Ortho All-flex </Name>
                <Pack ID="P311871" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F130107604128" Rank="10" Units="dev" Weight="1">
              <Name>70 mm</Name>
              <Brand ID="B13010760412826">
                <Name>Ortho All-flex </Name>
                <Pack ID="P311898" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F130107604129" Rank="10" Units="dev" Weight="1">
              <Name>75 mm</Name>
              <Brand ID="B13010760412926">
                <Name>Ortho All-flex </Name>
                <Pack ID="P311901" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F130107604130" Rank="10" Units="dev" Weight="1">
              <Name>80 mm</Name>
              <Brand ID="B13010760413026">
                <Name>Ortho All-flex </Name>
                <Pack ID="P311928" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>42.90</Subsidy>
                  <Price>42.90</Price>
                  <Alternate>42.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <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"/>
          </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" 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">
                <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">
                <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="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Contraceptive" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F130802147511" Rank="1" Units="tab" Weight="35">
              <Name>Tab 35 mcg with norethisterone 1 mg</Name>
              <Brand ID="B13080214751101">
                <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">
                <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="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Contraceptive" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308021477" 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="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <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="FormMax" Value="84" Attribute="PSO"/>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA0500"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308021718" Statim="Must" Update="-Subsidy">
            <Name>Ethinyloestradiol with levonorgestrel</Name>
            <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="FormMax" Value="63" Attribute="PSO"/>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <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" ToBeDelisted="2012-09-01">
                <Name>Microgynon 30 ED</Name>
                <Pack ID="P252220" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>2.45</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>2.45</Alternate>
                  <Surcharge>0.16726</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180902" ToBeDelisted="2012-09-01">
                <Name>Nordette 28</Name>
                <Pack ID="P203033" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>2.45</Subsidy>
                  <Price>14.49</Price>
                  <Alternate>2.45</Alternate>
                  <Surcharge>0.14333</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180903" ToBeDelisted="2012-09-01">
                <Name>Monofeme</Name>
                <Pack ID="P487961" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>2.45</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>2.45</Alternate>
                  <Surcharge>0.04964</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180904" ToBeDelisted="2012-09-01">
                <Name>Levlen ED</Name>
                <Pack ID="P439118" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>2.45</Subsidy>
                  <Price>6.62</Price>
                  <Alternate>2.45</Alternate>
                  <Surcharge>0.04964</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B13080217180925">
                <Name>Ava 30 ED</Name>
                <Pack ID="P2395754" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>2.45</Subsidy>
                  <Price>2.45</Price>
                  <Alternate>2.45</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Contraceptive" NonPrinting="true"/>
              <Rule Type="FormMax" Value="84" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308021873" 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 and Marvelon.</p>
              <p>The additional subsidy will fund Mercilon and Marvelon up to the manufacturer’s price for each of these products as identified on the Schedule at 1 November 1999.</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" 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" 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>
            <Formulation ID="F130804172428" Rank="10" Units="pack">
              <Name>Subdermal implant (2 x 75 mg rods)</Name>
              <Brand ID="B13080417242825" SoleSupply="true">
                <Name>Jadelle</Name>
                <Pack ID="P2265532" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>133.65</Subsidy>
                  <Price>133.65</Price>
                  <Alternate>133.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308041766" 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>
                  <Multiple>1</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="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1308041871" Statim="Must">
            <Name>Norethisterone</Name>
            <Formulation ID="F130804187101" Rank="1" Units="tab" Weight="0.35">
              <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 and Marvelon.</p>
              <p>The additional subsidy will fund Mercilon and Marvelon up to the manufacturer’s price for each of these products as identified on the Schedule at 1 November 1999.</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" Statim="Must">
            <Name>Levonorgestrel</Name>
            <Formulation ID="F130805172427" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1.5 mg</Name>
              <Brand ID="B13080517242725">
                <Name>Postinor-1</Name>
                <Pack ID="P2271753" Specified="true">
                  <Quantity>1</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"/>
              <Rule Type="FormMax" Value="2" Attribute="Rx"/>
            </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" 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="B13090227060226" SoleSupply="true">
                <Name>Ginet 84</Name>
                <Pack ID="P2329050" Specified="true">
                  <Quantity>84</Quantity>
                  <Multiple>28</Multiple>
                  <Subsidy>3.89</Subsidy>
                  <Price>3.89</Price>
                  <Alternate>3.89</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">
            <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>24.00</Price>
                  <Alternate>8.43</Alternate>
                  <Surcharge>0.15570</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1310011320" Statim="Must">
            <Name>Clotrimazole</Name>
            <Formulation ID="F131001132003" Rank="3" Units="g">
              <Name>Vaginal crm 1% with applicators</Name>
              <Brand ID="B13100113200325" SoleSupply="true">
                <Name>Clomazol</Name>
                <Pack ID="P2155656" OP="true" Specified="true">
                  <Quantity>35</Quantity>
                  <Subsidy>1.30</Subsidy>
                  <Price>1.30</Price>
                  <Alternate>1.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F131001132004" Rank="3" Units="g">
              <Name>Vaginal crm 2% with applicators</Name>
              <Brand ID="B13100113200425" SoleSupply="true">
                <Name>Clomazol</Name>
                <Pack ID="P2249634" OP="true" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>2.50</Subsidy>
                  <Price>2.50</Price>
                  <Alternate>2.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1310011620" 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">
            <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">
                <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">
            <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>DBL Ergometrine</Name>
                <Pack ID="P500372" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <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="C1314021922">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>5.94</Subsidy>
                  <Price>5.94</Price>
                  <Alternate>5.94</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>
                  <Multiple>1</Multiple>
                  <Subsidy>7.48</Subsidy>
                  <Price>7.48</Price>
                  <Alternate>7.48</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>
                  <Multiple>1</Multiple>
                  <Subsidy>10.12</Subsidy>
                  <Price>10.12</Price>
                  <Alternate>10.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="5" Attribute="PSO"/>
          </Chemical>
          <Chemical ID="C1314022784" 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>6.30</Subsidy>
                  <Price>6.30</Price>
                  <Alternate>6.30</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>6.53</Subsidy>
                  <Price>6.53</Price>
                  <Alternate>6.53</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">
            <Name>Pregnancy tests - HCG urine</Name>
            <Formulation ID="F131602300002" Rank="10" Units="test">
              <Name>Cassette</Name>
              <Brand ID="B13160230000226" SoleSupply="true">
                <Name>Innovacon hCG One Step Pregnancy Test</Name>
                <Pack ID="P2349647" OP="true" Specified="true">
                  <Quantity>40</Quantity>
                  <Subsidy>22.80</Subsidy>
                  <Price>22.80</Price>
                  <Alternate>22.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="PSO"/>
            <Rule Type="FormMax" Value="200" Attribute="PSO"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1319">
        <Name>Urinary Agents</Name>
        <ATC3 ID="A131901">
          <Name>5-Alpha Reductase Inhibitors</Name>
          <Chemical ID="C1319013881" Statim="Must">
            <Name>Finasteride</Name>
            <Formulation ID="F131901388125" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B13190138812526" SoleSupply="true">
                <Name>Rex Medical</Name>
                <Pack ID="P2219883" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.10</Subsidy>
                  <Price>5.10</Price>
                  <Alternate>5.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0928">
              <Title>
                <range>Finasteride</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has symptomatic benign prostatic hyperplasia</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">The patient is intolerant of non-selective alpha blockers or these are contraindicated</ci>
                      <ci type="logical" class="Indication">Symptoms are not adequately controlled with non-selective alpha blockers</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Patients with enlarged prostates are the appropriate candidates for therapy with finasteride.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0928"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A131902">
          <Name>Alpha-1A Adrenoreceptor Blockers</Name>
          <Chemical ID="C1319023910" Statim="Must">
            <Name>Tamsulosin hydrochloride</Name>
            <Formulation ID="F131902391025" Rank="2" Units="cap">
              <Name>Cap 400 mcg</Name>
              <Brand ID="B13190239102525" SoleSupply="true">
                <Name>Tamsulosin-Rex</Name>
                <Pack ID="P2220512" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>5.98</Subsidy>
                  <Price>5.98</Price>
                  <Alternate>5.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1032">
              <Title>
                <range>Tamsulosin</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has symptomatic benign prostatic hyperplasia</ci>
                    <ci type="logical" class="Indication">The patient is intolerant of non-selective alpha blockers or these are contraindicated</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1032"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A131904">
          <Name>Other Urinary Agents</Name>
          <Chemical ID="C1319041914" Statim="Must">
            <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" 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" 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>2.71</Subsidy>
                  <Price>2.71</Price>
                  <Alternate>2.71</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1319043370">
            <Name>Potassium citrate</Name>
            <Formulation ID="F131904337025" Rank="3" Units="ml" Weight="3">
              <Name>Oral liq 3 mmol per ml</Name>
              <Brand ID="B13190433702525">
                <Name>Biomed</Name>
                <Pack ID="P2378728" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>30.00</Subsidy>
                  <Price>30.00</Price>
                  <Alternate>30.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA1083">
                <Title>
                  <range>Potassium Citrate</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 recurrent calcium oxalate urolithiasis</ci>
                      <ci type="logical" class="Trial">The patient has had more than two renal calculi in the two years prior to the application</ci>
                    </apply>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="month">12</Term>
                </Case>
                <Case When="Renewal" Form="SA1083">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <ci type="logical" class="Indication">The treatment remains appropriate and the patient is benefitting from the treatment</ci>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="year">2</Term>
                </Case>
              </Request>
              <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1083"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1319043902">
            <Name>Solifenacin succinate</Name>
            <Formulation ID="F131904390225" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B13190439022525">
                <Name>Vesicare</Name>
                <Pack ID="P2208385" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>56.50</Subsidy>
                  <Price>56.50</Price>
                  <Alternate>56.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F131904390226" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B13190439022625">
                <Name>Vesicare</Name>
                <Pack ID="P2208393" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>56.50</Subsidy>
                  <Price>56.50</Price>
                  <Alternate>56.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0998">
              <Title>
                <range>Solifenacin succinate</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has overactive bladder and a documented intolerance of oxybutynin</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0998"/>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <p xlink:type="simple" xlink:href="A1622">For urinary tract Infections refer to INFECTIONS, Antibacterials</p>
        </div>
      </ATC2>
      <ATC2 ID="A1322">
        <Name>Detection of Substances in Urine</Name>
        <ATC3 ID="A132201">
          <Name>Detection of Substances in Urine</Name>
          <Chemical ID="C1322011910" Statim="Must">
            <Name>Ortho-tolidine</Name>
            <Formulation ID="F132201191001" Rank="10" Units="test">
              <Name>Compound diagnostic sticks</Name>
              <Brand ID="B13220119100101">
                <Name>Hemastix</Name>
                <Pack ID="P250872" OP="true" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>7.50</Subsidy>
                  <Price>8.25</Price>
                  <Alternate>7.50</Alternate>
                  <Surcharge>0.01500</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1322012238" Statim="Must">
            <Name>Tetrabromophenol</Name>
            <Formulation ID="F132201223801" Rank="10" Units="test">
              <Name>Blue diagnostic strips</Name>
              <Brand ID="B13220122380102">
                <Name>Albustix</Name>
                <Pack ID="P200190" OP="true" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.02</Subsidy>
                  <Price>13.92</Price>
                  <Alternate>7.02</Alternate>
                  <Surcharge>0.06900</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </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">
            <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" S29="true">
                <Name>Deca-Durabolin Orgaject</Name>
                <Pack ID="P264121">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>21.15</Subsidy>
                  <Price>21.15</Price>
                  <Alternate>21.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2353865" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>21.16</Subsidy>
                  <Price>21.16</Price>
                  <Alternate>21.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </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" Update="-Subsidy">
            <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>5.87</Subsidy>
                  <Price>5.87</Price>
                  <Alternate>5.87</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>8.16</Subsidy>
                  <Price>8.16</Price>
                  <Alternate>8.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </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>45.00</Subsidy>
                  <Price>45.00</Price>
                  <Alternate>45.00</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" 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>Hospira</Name>
                <Pack ID="P333131" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <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>Hospira</Name>
                <Pack ID="P333158" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <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>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Dexamethasone sodium phosphate injection will not be funded for oral use.</p>
            </div>
          </Chemical>
          <Chemical ID="C1407011515" 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>14.32</Subsidy>
                  <Price>14.32</Price>
                  <Alternate>14.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407011617" 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>8.35</Subsidy>
                  <Price>8.35</Price>
                  <Alternate>8.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701161702" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B14070116170201" SoleSupply="true">
                <Name>Douglas</Name>
                <Pack ID="P205648" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>20.95</Subsidy>
                  <Price>20.95</Price>
                  <Alternate>20.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F140701161716" Rank="4" Units="inj" Weight="100">
              <Name>Inj 50 mg per ml, 2 ml</Name>
              <Brand ID="B14070116171601" SoleSupply="true">
                <Name>Solu-Cortef</Name>
                <Pack ID="P265284" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>3.99</Subsidy>
                  <Price>3.99</Price>
                  <Alternate>3.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="PSO"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407011810">
            <Name>Methylprednisolone acetate</Name>
            <Formulation ID="F140701181005" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg per ml, 1 ml</Name>
              <Brand ID="B14070118100501">
                <Name>Depo-Medrol</Name>
                <Pack ID="P284629" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>6.03</Subsidy>
                  <Price>6.03</Price>
                  <Alternate>6.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407011811" Statim="Must">
            <Name>Methylprednisolone</Name>
            <Formulation ID="F140701181101" Rank="1" Units="tab" Weight="4">
              <Name>Tab 4 mg</Name>
              <Brand ID="B14070118110101" SoleSupply="true">
                <Name>Medrol</Name>
                <Pack ID="P210692" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>48.57</Subsidy>
                  <Price>48.57</Price>
                  <Alternate>48.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701181102" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B14070118110201" SoleSupply="true">
                <Name>Medrol</Name>
                <Pack ID="P681776" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>166.52</Subsidy>
                  <Price>166.52</Price>
                  <Alternate>166.52</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1407011812">
            <Name>Methylprednisolone sodium succinate</Name>
            <Formulation ID="F140701181201" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg per ml, 1 ml</Name>
              <Brand ID="B14070118120101" SoleSupply="true">
                <Name>Solu-Medrol</Name>
                <Pack ID="P2032791" Specified="true">
                  <Quantity>25</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>151.40</Subsidy>
                  <Price>151.40</Price>
                  <Alternate>151.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2394227" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>6.06</Subsidy>
                  <Price>6.06</Price>
                  <Alternate>6.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <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>
                <Pack ID="P2032805" Specified="true">
                  <Quantity>25</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>412.59</Subsidy>
                  <Price>412.59</Price>
                  <Alternate>412.59</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2394219" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>16.50</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>16.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701181204" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B14070118120401" SoleSupply="true">
                <Name>Solu-Medrol</Name>
                <Pack ID="P265349">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>20.80</Subsidy>
                  <Price>20.80</Price>
                  <Alternate>20.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2394235" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>20.80</Subsidy>
                  <Price>20.80</Price>
                  <Alternate>20.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701181205" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B14070118120501" SoleSupply="true">
                <Name>Solu-Medrol</Name>
                <Pack ID="P265357" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>42.57</Subsidy>
                  <Price>42.57</Price>
                  <Alternate>42.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1407011816">
            <Name>Methylprednisolone acetate with lignocaine</Name>
            <Formulation ID="F140701181606" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg per ml with lignocaine 1 ml</Name>
              <Brand ID="B14070118160601">
                <Name>Depo-Medrol with Lidocaine</Name>
                <Pack ID="P264229" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>6.03</Subsidy>
                  <Price>6.03</Price>
                  <Alternate>6.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407012034" Statim="Must">
            <Name>Prednisolone sodium phosphate</Name>
            <Formulation ID="F140701203425" Rank="3" Units="ml" Weight="5">
              <Name>Oral liq 5 mg per ml</Name>
              <Brand ID="B14070120342525" SoleSupply="true">
                <Name>Redipred</Name>
                <Pack ID="P317659" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>9.95</Subsidy>
                  <Price>9.95</Price>
                  <Alternate>9.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Restricted to children under 12 years of age.</p>
              </div>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407012038" Statim="Must">
            <Name>Prednisone</Name>
            <Formulation ID="F140701203801" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B14070120380102">
                <Name>Apo-Prednisone</Name>
                <Pack ID="P665762" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>10.68</Subsidy>
                  <Price>10.68</Price>
                  <Alternate>10.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701203802" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B14070120380203">
                <Name>Apo-Prednisone</Name>
                <Pack ID="P695459" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>12.09</Subsidy>
                  <Price>12.09</Price>
                  <Alternate>12.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701203803" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B14070120380302">
                <Name>Apo-Prednisone</Name>
                <Pack ID="P304328" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>11.09</Subsidy>
                  <Price>11.09</Price>
                  <Alternate>11.09</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F140701203804" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B14070120380403">
                <Name>Apo-Prednisone</Name>
                <Pack ID="P374466" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>29.03</Subsidy>
                  <Price>29.03</Price>
                  <Alternate>29.03</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407012239" Statim="Must">
            <Name>Tetracosactrin</Name>
            <Formulation ID="F140701223901" Rank="4" Units="inj" Weight="0.25">
              <Name>Inj 250 mcg</Name>
              <Brand ID="B14070122390101" SoleSupply="true">
                <Name>Synacthen</Name>
                <Pack ID="P379042" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>177.18</Subsidy>
                  <Price>177.18</Price>
                  <Alternate>177.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701223903" Rank="4" Units="inj" Weight="1">
              <Name>Inj 1 mg per ml, 1 ml</Name>
              <Brand ID="B14070122390301" SoleSupply="true">
                <Name>Synacthen Depot</Name>
                <Pack ID="P281956" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>29.56</Subsidy>
                  <Price>29.56</Price>
                  <Alternate>29.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407012389">
            <Name>Triamcinolone acetonide</Name>
            <Formulation ID="F140701238901" Rank="4" Units="inj" Weight="10">
              <Name>Inj 10 mg per ml, 1 ml</Name>
              <Brand ID="B14070123890101" SoleSupply="true">
                <Name>Kenacort-A</Name>
                <Pack ID="P282499" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>21.90</Subsidy>
                  <Price>21.90</Price>
                  <Alternate>21.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F140701238903" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg per ml, 1 ml</Name>
              <Brand ID="B14070123890301" SoleSupply="true">
                <Name>Kenacort-A40</Name>
                <Pack ID="P253766" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>53.79</Subsidy>
                  <Price>53.79</Price>
                  <Alternate>53.79</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1407012864" Statim="Must">
            <Name>Betamethasone sodium phosphate with betamethasone acetate</Name>
            <Formulation ID="F140701286401" Rank="4" Units="inj" Weight="3.9">
              <Name>Inj 3.9 mg with betamethasone acetate 3 mg per ml, 1 ml</Name>
              <Brand ID="B14070128640101">
                <Name>Celestone Chronodose</Name>
                <Pack ID="P733970" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>19.20</Subsidy>
                  <Price>33.60</Price>
                  <Alternate>19.20</Alternate>
                  <Surcharge>2.88000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1410">
        <Name>Sex Hormones Non Contraceptive</Name>
        <ATC3 ID="A141001">
          <Name>Androgen Agonists and Antagonists</Name>
          <Chemical ID="C1410012707">
            <Name>Cyproterone acetate</Name>
            <Formulation ID="F141001270701" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B14100127070125" SoleSupply="true">
                <Name>Siterone</Name>
                <Pack ID="P2220482" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>21.10</Subsidy>
                  <Price>21.10</Price>
                  <Alternate>21.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141001270725" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B14100127072525" SoleSupply="true">
                <Name>Siterone</Name>
                <Pack ID="P2235862" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>41.50</Subsidy>
                  <Price>41.50</Price>
                  <Alternate>41.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1410012762">
            <Name>Testosterone cypionate</Name>
            <Formulation ID="F141001276201" Rank="4" Units="inj" Weight="1000">
              <Name>Inj long-acting 100 mg per ml, 10 ml</Name>
              <Brand ID="B14100127620101" SoleSupply="true">
                <Name>Depo-Testosterone</Name>
                <Pack ID="P741264" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>76.50</Subsidy>
                  <Price>76.50</Price>
                  <Alternate>76.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1410012764">
            <Name>Testosterone undecanoate</Name>
            <Formulation ID="F141001276401" Rank="2" Units="cap" Weight="40">
              <Name>Cap 40 mg</Name>
              <Brand ID="B14100127640126" SoleSupply="true">
                <Name>Arrow-Testosterone</Name>
                <Pack ID="P2346990" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>79.92</Subsidy>
                  <Price>79.92</Price>
                  <Alternate>79.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1410012765">
            <Name>Testosterone esters</Name>
            <Formulation ID="F141001276501" Rank="4" Units="inj" Weight="250">
              <Name>Inj 250 mg per ml, 1 ml</Name>
              <Brand ID="B14100127650125">
                <Name>Sustanon Ampoules</Name>
                <Pack ID="P2172011" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>12.98</Subsidy>
                  <Price>12.98</Price>
                  <Alternate>12.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1410013864">
            <Name>Testosterone</Name>
            <Formulation ID="F141001386425" Rank="9" Units="patch">
              <Name>Transdermal patch, 2.5 mg per day</Name>
              <Brand ID="B14100138642525">
                <Name>Androderm</Name>
                <Pack ID="P2198517" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>80.00</Subsidy>
                  <Price>80.00</Price>
                  <Alternate>80.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1411">
        <Name>Hormone Replacement Therapy - Systemic</Name>
        <ATC3 ID="A141104">
          <Name>Oestrogens</Name>
          <Chemical ID="C1411041156" Statim="Must">
            <Name>Oestradiol valerate</Name>
            <Formulation ID="F141104115601" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B14110411560101">
                <Name>Progynova</Name>
                <Pack ID="P358223" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>8.24</Subsidy>
                  <Price>8.24</Price>
                  <Alternate>8.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141104115602" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B14110411560201">
                <Name>Progynova</Name>
                <Pack ID="P358215" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>8.24</Subsidy>
                  <Price>8.24</Price>
                  <Alternate>8.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
          <Chemical ID="C1411041886" Statim="Must">
            <Name>Oestradiol</Name>
            <Formulation ID="F141104188605" Rank="9" Units="patch" Weight="25">
              <Name>TDDS 25 mcg per day</Name>
              <Brand ID="B14110418860525">
                <Name>Estradot</Name>
                <Pack ID="P2358840" Specified="true">
                  <Quantity>8</Quantity>
                  <Subsidy>3.01</Subsidy>
                  <Price>10.86</Price>
                  <Alternate>10.86</Alternate>
                  <Surcharge>0.98125</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseWMax" Value="2"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA1018"/>
            </Formulation>
            <Formulation ID="F141104188606" Rank="9" Units="patch" Weight="50">
              <Name>TDDS 50 mcg per day</Name>
              <Brand ID="B14110418860625">
                <Name>Estradot 50 mcg</Name>
                <Pack ID="P2358867" Specified="true">
                  <Quantity>8</Quantity>
                  <Subsidy>4.12</Subsidy>
                  <Price>13.18</Price>
                  <Alternate>13.18</Alternate>
                  <Surcharge>1.13250</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseWMax" Value="2"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA1018"/>
            </Formulation>
            <Formulation ID="F141104188607" Rank="9" Units="patch" Weight="100">
              <Name>TDDS 100 mcg per day</Name>
              <Brand ID="B14110418860725">
                <Name>Estradot</Name>
                <Pack ID="P2358883" Specified="true">
                  <Quantity>8</Quantity>
                  <Subsidy>7.05</Subsidy>
                  <Price>16.14</Price>
                  <Alternate>16.14</Alternate>
                  <Surcharge>1.13625</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseWMax" Value="2"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA1018"/>
            </Formulation>
            <Formulation ID="F141104188608" Rank="9" Units="patch" Weight="49">
              <Name>TDDS 3.9 mg (releases 50 mcg of oestradiol per day)</Name>
              <Brand ID="B14110418860802">
                <Name>Climara 50</Name>
                <Pack ID="P371114" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>4.12</Subsidy>
                  <Price>13.18</Price>
                  <Alternate>13.18</Alternate>
                  <Surcharge>2.26500</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14110418860803">
                <Name>Femtran 50</Name>
                <Pack ID="P951544" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>4.12</Subsidy>
                  <Price>32.50</Price>
                  <Alternate>13.18</Alternate>
                  <Surcharge>7.09500</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="DoseWMax" Value="1"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA1018"/>
            </Formulation>
            <Formulation ID="F141104188609" Rank="9" Units="patch" Weight="99">
              <Name>TDDS 7.8 mg (releases 100 mcg of oestradiol per day)</Name>
              <Brand ID="B14110418860902">
                <Name>Climara 100</Name>
                <Pack ID="P371122" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>7.05</Subsidy>
                  <Price>16.14</Price>
                  <Alternate>16.14</Alternate>
                  <Surcharge>2.27250</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14110418860903">
                <Name>Femtran 100</Name>
                <Pack ID="P951579" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>7.05</Subsidy>
                  <Price>35.00</Price>
                  <Alternate>16.14</Alternate>
                  <Surcharge>6.98750</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="DoseWMax" Value="1"/>
              <Rule Type="FormReqd" Attribute="Rx"/>
              <Rule Type="Alternate" Attribute="Special Authority" xlink:href="SA1018"/>
            </Formulation>
            <Formulation ID="F141104188610" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B14110418861001">
                <Name>Estrofem</Name>
                <Pack ID="P327859" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.12</Subsidy>
                  <Price>10.55</Price>
                  <Alternate>4.12</Alternate>
                  <Surcharge>0.22964</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141104188611" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B14110418861101">
                <Name>Estrofem</Name>
                <Pack ID="P258601" OP="true" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.12</Subsidy>
                  <Price>10.55</Price>
                  <Alternate>4.12</Alternate>
                  <Surcharge>0.22964</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
          <Chemical ID="C1411041888" 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>11.48</Price>
                  <Alternate>3.01</Alternate>
                  <Surcharge>0.30250</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>11.48</Price>
                  <Alternate>4.12</Alternate>
                  <Surcharge>0.26286</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A141109">
          <Name>Progestogens</Name>
          <Chemical ID="C1411091766" 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">
                <Name>Provera</Name>
                <Pack ID="P274186" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>3.09</Subsidy>
                  <Price>3.09</Price>
                  <Alternate>3.09</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">
                <Name>Provera</Name>
                <Pack ID="P261130" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>13.06</Subsidy>
                  <Price>13.06</Price>
                  <Alternate>13.06</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">
                <Name>Provera</Name>
                <Pack ID="P274135" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>6.85</Subsidy>
                  <Price>6.85</Price>
                  <Alternate>6.85</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" 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>22.96</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.62714</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>22.96</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.62714</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
          <Chemical ID="C1411142056" 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>14.52</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.32571</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>14.52</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.32571</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>14.52</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.32571</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Guideline" xlink:href="PG0740A1411"/>
          </Chemical>
        </ATC3>
        <Request To="HealthPAC" For="Alternate Subsidy" Form="SA1018">
          <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>
                <ci type="logical" class="Indication">Somatropin co-therapy - patient is being prescribed somatropin with subsidy provided under a valid approval issued under Special Authority</ci>
              </apply>
            </math>
            <Applicant>any relevant practitioner</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 SA1018">
            <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, or the patient remains on subsidised somatropin co-therapy</ci>
            </math>
            <Applicant>any relevant practitioner</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" 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" 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="C1413011724" Statim="Must">
            <Name>Levonorgestrel</Name>
            <Formulation ID="F141301172426" Rank="10" Units="dev">
              <Name>Levonorgestrel - releasing intrauterine system 20 mcg/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> µg/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" Statim="Must">
            <Name>Medroxyprogesterone acetate</Name>
            <Formulation ID="F141301176601" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B14130117660101">
                <Name>Provera</Name>
                <Pack ID="P261149" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>96.50</Subsidy>
                  <Price>96.50</Price>
                  <Alternate>96.50</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">
                <Name>Provera</Name>
                <Pack ID="P321567" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>70.50</Subsidy>
                  <Price>70.50</Price>
                  <Alternate>70.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1413011871" 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="P2307693" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>26.50</Subsidy>
                  <Price>26.50</Price>
                  <Alternate>26.50</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" 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="C1414012062">
            <Name>Propylthiouracil</Name>
            <Formulation ID="F141401206201" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B14140120620125" S29="true">
                <Name>PTU</Name>
                <Pack ID="P2010526" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>35.00</Subsidy>
                  <Price>35.00</Price>
                  <Alternate>35.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1199">
              <Title>
                <range>Propylthiouracil</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 hyperthyroidism</ci>
                    <ci type="logical" class="Indication">The patient is intolerant of carbimazole or carbimazole is contraindicated</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA1199">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">the treatment remains appropriate and the patient is benefitting from the treatment</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1199"/>
          </Chemical>
          <Chemical ID="C1414012263" Statim="Must">
            <Name>Levothyroxine</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>64.28</Subsidy>
                  <Price>64.28</Price>
                  <Alternate>64.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14140122630125">
                <Name>Goldshield</Name>
                <Pack ID="P2307766" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.71</Subsidy>
                  <Price>1.71</Price>
                  <Alternate>1.71</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14140122630126">
                <Name>Synthroid</Name>
                <Pack ID="P2309556" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>45.00</Subsidy>
                  <Price>45.00</Price>
                  <Alternate>45.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2390000" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>4.05</Subsidy>
                  <Price>4.05</Price>
                  <Alternate>4.05</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>66.78</Subsidy>
                  <Price>66.78</Price>
                  <Alternate>66.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14140122630225">
                <Name>Goldshield</Name>
                <Pack ID="P2307758" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>1.78</Subsidy>
                  <Price>1.78</Price>
                  <Alternate>1.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14140122630226">
                <Name>Synthroid</Name>
                <Pack ID="P2389460" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>4.21</Subsidy>
                  <Price>4.21</Price>
                  <Alternate>4.21</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141401226325" Rank="1" Units="tab" Weight="0.03" Safety="Compounded">
              <Name>Tab 25 mcg</Name>
              <Brand ID="B14140122632525">
                <Name>Synthroid</Name>
                <Pack ID="P2330083" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>43.24</Subsidy>
                  <Price>43.24</Price>
                  <Alternate>43.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2390019" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>3.89</Subsidy>
                  <Price>3.89</Price>
                  <Alternate>3.89</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" Statim="Must">
            <Name>Somatropin</Name>
            <Formulation ID="F141602251009" Rank="4" Units="inj" Weight="16">
              <Name>Inj cartridge 16 iu (5.3 mg)</Name>
              <Brand ID="B14160225100901" SoleSupply="true">
                <Name>Genotropin</Name>
                <Pack ID="P2016281" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>160.00</Subsidy>
                  <Price>160.00</Price>
                  <Alternate>160.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141602251011" Rank="4" Units="inj" Weight="36">
              <Name>Inj cartridge 36 iu (12 mg)</Name>
              <Brand ID="B14160225101101" SoleSupply="true">
                <Name>Genotropin</Name>
                <Pack ID="P2016303" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>360.00</Subsidy>
                  <Price>360.00</Price>
                  <Alternate>360.00</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>Application details may be obtained from PHARMAC's website <a href="http://www.pharmac.govt.nz/">http://www.pharmac.govt.nz</a> or:</p>
              <p>NZGHC Coordinator</p>
              <p>PHARMAC, PO Box 10-254, WELLINGTON</p>
              <p>Tel: 0800 808 476, Fax: (09) 929 3221, Email: <a href="mailto:growthhormone@pharmac.govt.nz">growthhormone@pharmac.govt.nz</a></p>
            </div>
          </Request>
          <Rule Type="Dispensary" Attribute="Xpharm" NonPrinting="true"/>
        </ATC3>
        <ATC3 ID="A141603">
          <Name>GnRH Analogues</Name>
          <Chemical ID="C1416031009">
            <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <Subsidy>166.20</Subsidy>
                  <Price>166.20</Price>
                  <Alternate>166.20</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>
                  <Multiple>1</Multiple>
                  <Subsidy>443.76</Subsidy>
                  <Price>443.76</Price>
                  <Alternate>443.76</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>
                  <Multiple>1</Multiple>
                  <Subsidy>591.68</Subsidy>
                  <Price>591.68</Price>
                  <Alternate>591.68</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>
                  <Multiple>1</Multiple>
                  <Subsidy>832.05</Subsidy>
                  <Price>832.05</Price>
                  <Alternate>832.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F141603100929" Rank="4" Units="inj" Weight="3.75">
              <Name>Inj 3.75 mg prefilled syringe</Name>
              <Brand ID="B14160310092925">
                <Name>Lucrin Depot PDS</Name>
                <Pack ID="P2330148" 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="F141603100930" Rank="4" Units="inj" Weight="11.25">
              <Name>Inj 11.25 mg prefilled syringe</Name>
              <Brand ID="B14160310093025">
                <Name>Lucrin Depot PDS</Name>
                <Pack ID="P2330156" 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="F141603100931" Rank="4" Units="inj" Weight="30">
              <Name>Inj 30 mg prefilled syringe</Name>
              <Brand ID="B14160310093125">
                <Name>Lucrin Depot PDS</Name>
                <Pack ID="P2330164" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>1109.40</Subsidy>
                  <Price>1109.40</Price>
                  <Alternate>1109.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1416032540">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>166.20</Subsidy>
                  <Price>166.20</Price>
                  <Alternate>166.20</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>
                  <Multiple>1</Multiple>
                  <Subsidy>443.76</Subsidy>
                  <Price>443.76</Price>
                  <Alternate>443.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1419">
        <Name>Vasopressin Agonists</Name>
        <ATC3 ID="A141901">
          <Name>Vasopressin Agonists</Name>
          <Chemical ID="C1419012424">
            <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>
                  <Multiple>1</Multiple>
                  <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"/>
            </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>27.48</Subsidy>
                  <Price>27.48</Price>
                  <Alternate>27.48</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">
            <Name>Clomiphene citrate</Name>
            <Formulation ID="F142101131401" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B14210113140103">
                <Name>Serophene</Name>
                <Pack ID="P731544" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>29.84</Subsidy>
                  <Price>29.84</Price>
                  <Alternate>29.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1421011372">
            <Name>Danazol</Name>
            <Formulation ID="F142101137201" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B14210113720125">
                <Name>Azol</Name>
                <Pack ID="P2312999" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>68.33</Subsidy>
                  <Price>68.33</Price>
                  <Alternate>68.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F142101137202" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B14210113720225">
                <Name>Azol</Name>
                <Pack ID="P2313006" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>97.83</Subsidy>
                  <Price>97.83</Price>
                  <Alternate>97.83</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1421011822">
            <Name>Metyrapone</Name>
            <Formulation ID="F142101182201" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B14210118220101">
                <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="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1421012816">
            <Name>Gestrinone</Name>
            <Formulation ID="F142101281601" Rank="2" Units="cap" Weight="2.5">
              <Name>Cap 2.5 mg</Name>
              <Brand ID="B14210128160101" ToBeDelisted="2012-12-01">
                <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">
            <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" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>16.50</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>16.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P275840" Specified="true">
                  <Quantity>8</Quantity>
                  <Subsidy>66.00</Subsidy>
                  <Price>66.00</Price>
                  <Alternate>66.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B14210128650125">
                <Name>Arrow-Cabergoline</Name>
                <Pack ID="P2328011" Specified="true">
                  <Quantity>8</Quantity>
                  <Subsidy>66.00</Subsidy>
                  <Price>66.00</Price>
                  <Alternate>66.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2328038" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>16.50</Subsidy>
                  <Price>16.50</Price>
                  <Alternate>16.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="2" Attribute="Rx" Waiver="Special" xlink:href="SA1031"/>
            </Formulation>
            <Request To="HealthPAC" For="Waiver of Rule" Form="SA1031">
              <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="patient's lifetime"/>
              </Case>
              <Case When="Renewal" Form="SA0175 SA1031">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has previously held a valid Special Authority which has expired and the treatment remains appropriate and the patient is benefiting from treatment</ci>
                </math>
                <Applicant>obstetrician</Applicant>
                <Applicant>endocrinologist</Applicant>
                <Applicant>gynaecologist</Applicant>
                <Term Measure="patient's lifetime"/>
              </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">
            <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="B16010117620225" SoleSupply="true">
                <Name>De-Worm</Name>
                <Pack ID="P2273144" Specified="true">
                  <Quantity>24</Quantity>
                  <Subsidy>24.19</Subsidy>
                  <Price>24.19</Price>
                  <Alternate>24.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormReqd" Attribute="Rx"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1603">
        <Name>Antibacterials</Name>
        <ATC3 ID="A160301">
          <Name>Cephalosporins and Cephamycins</Name>
          <Chemical ID="C1603011081">
            <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>29.40</Subsidy>
                  <Price>29.40</Price>
                  <Alternate>29.40</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 prophylaxis of endocarditis and the prescription is endorsed accordingly.</p>
            </div>
          </Chemical>
          <Chemical ID="C1603011228">
            <Name>Cefaclor monohydrate</Name>
            <Formulation ID="F160301122801" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B16030112280126">
                <Name>Ranbaxy-Cefaclor</Name>
                <Pack ID="P2149389" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>24.57</Subsidy>
                  <Price>24.57</Price>
                  <Alternate>24.57</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16030112280127" ToBeDelisted="2012-10-01">
                <Name>Cefaclor Sandoz</Name>
                <Pack ID="P2370018" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>24.57</Subsidy>
                  <Price>24.57</Price>
                  <Alternate>24.57</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>3.53</Subsidy>
                  <Price>3.53</Price>
                  <Alternate>3.53</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603011231">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>55.00</Subsidy>
                  <Price>55.00</Price>
                  <Alternate>55.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <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>
          </Chemical>
          <Chemical ID="C1603011232">
            <Name>Ceftriaxone sodium</Name>
            <Formulation ID="F160301123202" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030112320227" SoleSupply="true">
                <Name>Veracol</Name>
                <Pack ID="P2348551" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>2.70</Subsidy>
                  <Price>2.70</Price>
                  <Alternate>2.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160301123203" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030112320328" SoleSupply="true">
                <Name>Aspen Ceftriaxone</Name>
                <Pack ID="P2364425" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>10.49</Subsidy>
                  <Price>10.49</Price>
                  <Alternate>10.49</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            <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>
          </Chemical>
          <Chemical ID="C1603011233">
            <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>
                  <Multiple>1</Multiple>
                  <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"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Waiver by endorsement must state that the prescription is for dialysis or cystic fibrosis patient.</p>
              </div>
            </Formulation>
            <Formulation ID="F160301123302" Rank="4" Units="inj" Weight="750">
              <Name>Inj 750 mg</Name>
              <Brand ID="B16030112330226" SoleSupply="true">
                <Name>m-Cefuroxime</Name>
                <Pack ID="P2378140" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>6.96</Subsidy>
                  <Price>6.96</Price>
                  <Alternate>6.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Waiver by endorsement must state that the prescription is for dialysis or cystic fibrosis patient.</p>
              </div>
              <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>
                  <Multiple>1</Multiple>
                  <Subsidy>4.04</Subsidy>
                  <Price>4.04</Price>
                  <Alternate>4.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16030112330326">
                <Name>Mylan</Name>
                <Pack ID="P2390434" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>2.65</Subsidy>
                  <Price>2.65</Price>
                  <Alternate>2.65</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="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603011234">
            <Name>Cephalexin monohydrate</Name>
            <Formulation ID="F160301123403" Rank="3" Units="ml" Weight="625">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030112340325" SoleSupply="true">
                <Name>Cefalexin Sandoz</Name>
                <Pack ID="P2332817" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.50</Subsidy>
                  <Price>8.50</Price>
                  <Alternate>8.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F160301123404" Rank="3" Units="ml" Weight="1250">
              <Name>Grans for oral liq 250 mg per 5 ml</Name>
              <Brand ID="B16030112340425" SoleSupply="true">
                <Name>Cefalexin Sandoz</Name>
                <Pack ID="P2332825" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F160301123425" Rank="2" Units="cap" Weight="500">
              <Name>Cap 500 mg</Name>
              <Brand ID="B16030112342525">
                <Name>Cephalexin ABM</Name>
                <Pack ID="P2361248" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>8.90</Subsidy>
                  <Price>8.90</Price>
                  <Alternate>8.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603011236">
            <Name>Cefazolin sodium</Name>
            <Formulation ID="F160301123601" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030112360129" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2391325" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>3.99</Subsidy>
                  <Price>3.99</Price>
                  <Alternate>3.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160301123602" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030112360228" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2391317" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>3.99</Subsidy>
                  <Price>3.99</Price>
                  <Alternate>3.99</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>
          </Chemical>
        </ATC3>
        <ATC3 ID="A160304">
          <Name>Macrolides</Name>
          <Chemical ID="C1603041178">
            <Name>Azithromycin</Name>
            <Formulation ID="F160304117801" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16030411780125" SoleSupply="true">
                <Name>Arrow-Azithromycin</Name>
                <Pack ID="P2262339" OP="true" Specified="true">
                  <Quantity>2</Quantity>
                  <Subsidy>5.95</Subsidy>
                  <Price>5.95</Price>
                  <Alternate>5.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Waiver of Rule" Form="SA1130">
                <Title>
                  <range>Azithromycin</range>
                </Title>
                <Case When="Initial application" Category="Cystic Fibrosis">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The applicant is part of multidisciplinary team experienced in the management of cystic fibrosis</ci>
                      <ci type="logical" class="Indication">The patient has been definitively diagnosed with cystic fibrosis*</ci>
                      <ci type="logical" class="Indication">The patient has chronic infection with Pseudomonas aeruginosa or Pseudomonas related gram negative organisms as defined by two positive respiratory tract cultures at least three months apart*</ci>
                      <ci type="logical" class="Indication">The patient has negative cultures for non-tuberculous mycobacteria</ci>
                    </apply>
                  </math>
                  <Applicant>respiratory specialist</Applicant>
                  <Applicant>paediatrician</Applicant>
                  <Term Measure="patient's lifetime"/>
                  <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                    <p>Caution is advised if using azithromycin as an antibiotic in the treatment of cystic fibrosis patients with pneumonia.</p>
                    <p>Testing for non-tuberculosis mycobacteria should occur annually.</p>
                  </div>
                </Case>
                <Case When="Initial application" Category="bronchiolitis obliterans syndrome">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has received a lung transplant</ci>
                      <ci type="logical" class="Indication">Azithromycin is to be used for prophylaxis of bronchiolitis obliterans syndrome*</ci>
                      <ci type="logical" class="Indication">The applicant is experienced in managing patients who have received a lung transplant</ci>
                    </apply>
                  </math>
                  <Applicant>relevant specialist</Applicant>
                  <Term Measure="month">12</Term>
                </Case>
                <Case When="Renewal" Category="bronchiolitis obliterans syndrome" Form="SA1130">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient remains well and free from bronchiolits obliterans syndrome*</ci>
                      <ci type="logical" class="Indication">The applicant is experienced in managing patients who have received a lung transplant</ci>
                    </apply>
                  </math>
                  <Applicant>relevant specialist</Applicant>
                  <Term Measure="patient's lifetime"/>
                </Case>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Indications marked with * are Unapproved Indications</p>
                </div>
              </Request>
              <Rule Type="SubRxF" Waiver="Special" xlink:href="SA1130"/>
              <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; can be waived by Special Authority see SA1130.</p>
              </div>
              <Rule Type="FormMax" Value="2" Attribute="Rx" Waiver="Special" xlink:href="SA1130"/>
              <Rule Type="FormMax" Value="8" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160304117825" Rank="3" Units="ml" Weight="15" Update="New Listing">
              <Name>Grans for oral liq 200 mg per 5 ml</Name>
              <Brand ID="B16030411782525">
                <Name>Zithromax</Name>
                <Pack ID="P2144042" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>13.20</Subsidy>
                  <Price>13.20</Price>
                  <Alternate>13.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Maximum of 5 days per prescription where the patient is less than one year old; and </p>
                <p>Patient has pertussis and this has been notified to the Medical Officer of Health; or</p>
                <p>Patient has had direct contact with a notified case of pertussis and requires prophylaxis;</p>
                <p>And the prescription is endorsed accordingly (note treatment and prophylaxis of pertussis are unapproved indications).</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603042790">
            <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>8.98</Subsidy>
                  <Price>8.98</Price>
                  <Alternate>8.98</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>16.48</Subsidy>
                  <Price>16.48</Price>
                  <Alternate>16.48</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603042809">
            <Name>Clarithromycin</Name>
            <Formulation ID="F160304280901" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16030428090127" SoleSupply="true">
                <Name>Apo-Clarithromycin</Name>
                <Pack ID="P2385503" Specified="true">
                  <Quantity>14</Quantity>
                  <Subsidy>4.19</Subsidy>
                  <Price>4.19</Price>
                  <Alternate>4.19</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160304280902" Rank="3" Units="ml" Weight="25">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030428090201">
                <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="SA1131">
              <Title>
                <range>Clarithromycin</range>
              </Title>
              <Case When="Initial application" Category="Mycobacterial infections">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">Atypical mycobacterial infection</ci>
                    <ci type="logical" class="Indication">Mycobacterium tuberculosis infection where there is drug-resistance or intolerance to standard pharmaceutical agents</ci>
                  </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 SA0988 SA1131">
                <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="SA1131"/>
          </Chemical>
          <Chemical ID="C1603046026">
            <Name>Erythromycin ethyl succinate</Name>
            <Formulation ID="F160304602601" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16030460260102" SoleSupply="true">
                <Name>E-Mycin</Name>
                <Pack ID="P243094" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>16.95</Subsidy>
                  <Price>16.95</Price>
                  <Alternate>16.95</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">
                <Name>E-Mycin</Name>
                <Pack ID="P243078" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.35</Subsidy>
                  <Price>4.35</Price>
                  <Alternate>4.35</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160304602605" Rank="3" Units="ml" Weight="80">
              <Name>Grans for oral liq 400 mg per 5 ml</Name>
              <Brand ID="B16030460260502">
                <Name>E-Mycin</Name>
                <Pack ID="P243086" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.85</Subsidy>
                  <Price>5.85</Price>
                  <Alternate>5.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603046027">
            <Name>Erythromycin stearate</Name>
            <Formulation ID="F160304602702" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16030460270202">
                <Name>ERA</Name>
                <Pack ID="P205311" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>29.90</Subsidy>
                  <Price>44.58</Price>
                  <Alternate>29.90</Alternate>
                  <Surcharge>0.14680</Surcharge>
                </Pack>
              </Brand>
            </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>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603046028">
            <Name>Erythromycin lactobionate</Name>
            <Formulation ID="F160304602802" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030460280225">
                <Name>Erythrocin IV</Name>
                <Pack ID="P2270234" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>10.93</Subsidy>
                  <Price>10.93</Price>
                  <Alternate>10.93</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A160307">
          <Name>Penicillins</Name>
          <Chemical ID="C1603071070">
            <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="B16030710700103" ToBeDelisted="2012-12-01">
                <Name>Synermox</Name>
                <Pack ID="P203483" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>26.00</Subsidy>
                  <Price>26.00</Price>
                  <Alternate>26.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16030710700125">
                <Name>Curam Duo</Name>
                <Pack ID="P2396629" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.55</Subsidy>
                  <Price>12.55</Price>
                  <Alternate>12.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <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="B16030710700225" SoleSupply="true">
                <Name>Curam</Name>
                <Pack ID="P2327937" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.20</Subsidy>
                  <Price>2.20</Price>
                  <Alternate>2.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
            <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="B16030710700325" SoleSupply="true">
                <Name>Curam</Name>
                <Pack ID="P2327945" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>3.85</Subsidy>
                  <Price>3.85</Price>
                  <Alternate>3.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603071072">
            <Name>Amoxycillin</Name>
            <Formulation ID="F160307107202" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B16030710720226" SoleSupply="true">
                <Name>Alphamox</Name>
                <Pack ID="P2362716" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>16.18</Subsidy>
                  <Price>16.18</Price>
                  <Alternate>16.18</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160307107203" Rank="2" Units="cap" Weight="500">
              <Name>Cap 500 mg</Name>
              <Brand ID="B16030710720326" SoleSupply="true">
                <Name>Alphamox</Name>
                <Pack ID="P2362724" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>26.50</Subsidy>
                  <Price>26.50</Price>
                  <Alternate>26.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160307107204" Rank="3" Units="ml" Weight="100">
              <Name>Drops 125 mg per 1.25 ml</Name>
              <Brand ID="B16030710720425">
                <Name>Ospamox Paediatric Drops</Name>
                <Pack ID="P2046725" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.00</Subsidy>
                  <Price>4.00</Price>
                  <Alternate>4.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160307107205" Rank="3" Units="ml">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030710720525">
                <Name>Ospamox</Name>
                <Pack ID="P390623" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.55</Subsidy>
                  <Price>1.55</Price>
                  <Alternate>1.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160307107206" Rank="3" Units="ml">
              <Name>Grans for oral liq 250 mg per 5 ml</Name>
              <Brand ID="B16030710720625" SoleSupply="true">
                <Name>Ospamox</Name>
                <Pack ID="P390534" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.10</Subsidy>
                  <Price>1.10</Price>
                  <Alternate>1.10</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
              <Rule Type="Wastage" NonPrinting="true"/>
            </Formulation>
            <Formulation ID="F160307107208" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030710720801" SoleSupply="true">
                <Name>Ibiamox</Name>
                <Pack ID="P2272636" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>21.94</Subsidy>
                  <Price>21.94</Price>
                  <Alternate>21.94</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160307107209" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030710720901" SoleSupply="true">
                <Name>Ibiamox</Name>
                <Pack ID="P2272601" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>15.08</Subsidy>
                  <Price>15.08</Price>
                  <Alternate>15.08</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160307107210" Rank="4" Units="inj" Weight="250">
              <Name>Inj 250 mg</Name>
              <Brand ID="B16030710721001" SoleSupply="true">
                <Name>Ibiamox</Name>
                <Pack ID="P2272628" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>12.96</Subsidy>
                  <Price>12.96</Price>
                  <Alternate>12.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603071120">
            <Name>Benzathine benzylpenicillin</Name>
            <Formulation ID="F160307112002" Rank="4" Units="inj" Weight="1200000">
              <Name>Inj 1.2 mega u per 2.3 ml</Name>
              <Brand ID="B16030711200225">
                <Name>Bicillin LA</Name>
                <Pack ID="P2258072" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>315.00</Subsidy>
                  <Price>315.00</Price>
                  <Alternate>315.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603071136">
            <Name>Benzylpenicillin sodium (penicillin G)</Name>
            <Formulation ID="F160307113601" Rank="4" Units="inj" Weight="600">
              <Name>Inj 600 mg</Name>
              <Brand ID="B16030711360101" SoleSupply="true">
                <Name>Sandoz</Name>
                <Pack ID="P433748" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <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>
          </Chemical>
          <Chemical ID="C1603071512">
            <Name>Flucloxacillin sodium</Name>
            <Formulation ID="F160307151201" Rank="2" Units="cap" Weight="250">
              <Name>Cap 250 mg</Name>
              <Brand ID="B16030715120125" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2335573" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>32.00</Subsidy>
                  <Price>32.00</Price>
                  <Alternate>32.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160307151202" Rank="2" Units="cap" Weight="500">
              <Name>Cap 500 mg</Name>
              <Brand ID="B16030715120225" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2224186" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>110.00</Subsidy>
                  <Price>110.00</Price>
                  <Alternate>110.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <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>3.12</Subsidy>
                  <Price>3.12</Price>
                  <Alternate>3.12</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <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>3.55</Subsidy>
                  <Price>3.55</Price>
                  <Alternate>3.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160307151205" Rank="4" Units="inj" Weight="250">
              <Name>Inj 250 mg</Name>
              <Brand ID="B16030715120502" SoleSupply="true">
                <Name>Flucloxin</Name>
                <Pack ID="P331848" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>10.86</Subsidy>
                  <Price>10.86</Price>
                  <Alternate>10.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160307151206" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16030715120602" SoleSupply="true">
                <Name>Flucloxin</Name>
                <Pack ID="P331856" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>11.32</Subsidy>
                  <Price>11.32</Price>
                  <Alternate>11.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160307151207" Rank="4" Units="inj" Weight="1000">
              <Name>Inj 1 g</Name>
              <Brand ID="B16030715120702" SoleSupply="true">
                <Name>Flucloxin</Name>
                <Pack ID="P331929" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>14.28</Subsidy>
                  <Price>14.28</Price>
                  <Alternate>14.28</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603071970">
            <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>9.71</Subsidy>
                  <Price>9.71</Price>
                  <Alternate>9.71</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
            <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>11.70</Subsidy>
                  <Price>11.70</Price>
                  <Alternate>11.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F160307197027" Rank="3" Units="ml" Weight="125">
              <Name>Grans for oral liq 125 mg per 5 ml</Name>
              <Brand ID="B16030719702725" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2029219" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.68</Subsidy>
                  <Price>1.68</Price>
                  <Alternate>1.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160307197028" Rank="3" Units="ml" Weight="250">
              <Name>Grans for oral liq 250 mg per 5 ml</Name>
              <Brand ID="B16030719702825" SoleSupply="true">
                <Name>AFT</Name>
                <Pack ID="P2029227" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>1.78</Subsidy>
                  <Price>1.78</Price>
                  <Alternate>1.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603072046">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>123.50</Subsidy>
                  <Price>123.50</Price>
                  <Alternate>123.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A160310">
          <Name>Tetracyclines</Name>
          <Chemical ID="C1603101828" 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>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603102529" 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" SoleSupply="true">
                <Name>Doxine</Name>
                <Pack ID="P380571" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>7.95</Subsidy>
                  <Price>7.95</Price>
                  <Alternate>7.95</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">
            <Name>Clindamycin</Name>
            <Formulation ID="F160313130301" Rank="2" Units="cap" Weight="150">
              <Name>Cap hydrochloride 150 mg</Name>
              <Brand ID="B16031313030101">
                <Name>Dalacin C</Name>
                <Pack ID="P781282" Specified="true">
                  <Quantity>16</Quantity>
                  <Subsidy>9.90</Subsidy>
                  <Price>9.90</Price>
                  <Alternate>9.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16031313030125">
                <Name>Clindamycin ABM</Name>
                <Pack ID="P2397501" Specified="true">
                  <Quantity>16</Quantity>
                  <Subsidy>9.90</Subsidy>
                  <Price>9.90</Price>
                  <Alternate>9.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="4" 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">
                <Name>Dalacin C</Name>
                <Pack ID="P2387131" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>160.00</Subsidy>
                  <Price>160.00</Price>
                  <Alternate>160.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603131346">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>65.00</Subsidy>
                  <Price>65.00</Price>
                  <Alternate>65.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <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>
          </Chemical>
          <Chemical ID="C1603131361" Statim="Must">
            <Name>Co-trimoxazole</Name>
            <Formulation ID="F160313136101" Rank="3" Units="ml">
              <Name>Oral liq trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml</Name>
              <Brand ID="B16031313610125">
                <Name>Deprim</Name>
                <Pack ID="P2309718" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.15</Subsidy>
                  <Price>2.15</Price>
                  <Alternate>2.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="200" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F160313136102" Rank="1" Units="tab" Weight="80">
              <Name>Tab trimethoprim 80 mg and sulphamethoxazole 400 mg</Name>
              <Brand ID="B16031313610201">
                <Name>Trisul</Name>
                <Pack ID="P283363" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>20.97</Subsidy>
                  <Price>20.97</Price>
                  <Alternate>20.97</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603131546">
            <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>34.50</Subsidy>
                  <Price>34.50</Price>
                  <Alternate>34.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </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>
                  <Multiple>1</Multiple>
                  <Subsidy>12.87</Subsidy>
                  <Price>17.80</Price>
                  <Alternate>12.87</Alternate>
                  <Surcharge>4.93000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
              <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">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>8.56</Subsidy>
                  <Price>8.56</Price>
                  <Alternate>8.56</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 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>
                  <Multiple>1</Multiple>
                  <Subsidy>9.00</Subsidy>
                  <Price>9.00</Price>
                  <Alternate>9.00</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 a dialysis or cystic fibrosis patient or for prophylaxis of endocarditis and the prescription is endorsed accordingly.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603132274">
            <Name>Tobramycin</Name>
            <Formulation ID="F160313227402" Rank="4" Units="inj" Weight="80">
              <Name>Inj 40 mg per ml, 2 ml</Name>
              <Brand ID="B16031322740203" SoleSupply="true">
                <Name>DBL Tobramycin</Name>
                <Pack ID="P794805" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>29.32</Subsidy>
                  <Price>29.32</Price>
                  <Alternate>29.32</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>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603132300" Statim="Must">
            <Name>Trimethoprim</Name>
            <Formulation ID="F160313230002" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B16031323000202">
                <Name>TMP</Name>
                <Pack ID="P648507" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>8.94</Subsidy>
                  <Price>8.94</Price>
                  <Alternate>8.94</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603132314">
            <Name>Vancomycin hydrochloride</Name>
            <Formulation ID="F160313231403" Rank="4" Units="inj" Weight="500">
              <Name>Inj 500 mg</Name>
              <Brand ID="B16031323140325" SoleSupply="true">
                <Name>Mylan</Name>
                <Pack ID="P2195267" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>3.58</Subsidy>
                  <Price>3.58</Price>
                  <Alternate>3.58</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 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">
            <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>2.20</Subsidy>
                  <Price>2.20</Price>
                  <Alternate>2.20</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>3.00</Subsidy>
                  <Price>3.00</Price>
                  <Alternate>3.00</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>5.15</Subsidy>
                  <Price>5.15</Price>
                  <Alternate>5.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1603133925">
            <Name>Moxifloxacin</Name>
            <Formulation ID="F160313392525" Rank="1" Units="tab">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16031339252525">
                <Name>Avelox</Name>
                <Pack ID="P2022362" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>52.00</Subsidy>
                  <Price>52.00</Price>
                  <Alternate>52.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1065">
              <Title>
                <range>Moxifloxacin</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Active tuberculosis*</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Documented resistance to one or more first-line
              medications</ci>
                        <ci type="logical" class="Indication">Suspected resistance to one or more first-line
              medications (tuberculosis assumed to be contracted in an area with known resistance),
              as part of regimen containing other second-line agents</ci>
                        <ci type="logical" class="Indication">Impaired visual acuity (considered to preclude
              ethambutol use)</ci>
                        <ci type="logical" class="Indication">Significant pre-existing liver disease or
              hepatotoxicity from tuberculosis medications</ci>
                        <ci type="logical" class="Indication">Significant documented intolerance and/or side
              effects following a reasonable trial of first-line medications</ci>
                      </apply>
                    </apply>
                    <ci type="logical" class="Indication">Mycobacterium avium-intracellulare complex not
          responding to other therapy or where such therapy is contraindicated.*</ci>
                  </apply>
                </math>
                <Applicant>respiratory specialist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Term Measure="year">1</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>Indications marked with * are Unapproved Indications (refer to Section A: General Rules,
        Part I (Interpretations and Definitions) and Part IV (Miscellaneous Provisions) rule
        4.6).</p>
                </div>
              </Case>
              <Case When="Renewal" Form="SA1065">
                <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>
                <Term Measure="year">1</Term>
              </Case>
            </Request>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1065"/>
          </Chemical>
          <Chemical ID="C1603133932">
            <Name>Lincomycin</Name>
            <Formulation ID="F160313393225" Rank="4" Units="inj" Weight="300">
              <Name>Inj 300 mg per ml, 2 ml</Name>
              <Brand ID="B16031339322525">
                <Name>Lincocin</Name>
                <Pack ID="P2378620" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>80.00</Subsidy>
                  <Price>80.00</Price>
                  <Alternate>80.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
            <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="Xref">
          <p xlink:type="simple" xlink:href="A1004">For topical antibacterials, refer to DERMATOLOGICALS</p>
        </div>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <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">
            <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">
            <Name>Nystatin</Name>
            <Formulation ID="F160401188125" Rank="1" Units="tab" Weight="500000">
              <Name>Tab 500,000 u</Name>
              <Brand ID="B16040118812502" SoleSupply="true">
                <Name>Nilstat</Name>
                <Pack ID="P770752" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>14.16</Subsidy>
                  <Price>14.16</Price>
                  <Alternate>14.16</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>12.81</Subsidy>
                  <Price>12.81</Price>
                  <Alternate>12.81</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1604012709">
            <Name>Fluconazole</Name>
            <Formulation ID="F160401270901" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B16040127090126" SoleSupply="true">
                <Name>Ozole</Name>
                <Pack ID="P2388057" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.77</Subsidy>
                  <Price>4.77</Price>
                  <Alternate>4.77</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F160401270902" Rank="2" Units="cap" Weight="150">
              <Name>Cap 150 mg</Name>
              <Brand ID="B16040127090226" SoleSupply="true">
                <Name>Ozole</Name>
                <Pack ID="P2388049" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>0.91</Subsidy>
                  <Price>0.91</Price>
                  <Alternate>0.91</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SubRxF" Waiver="SpecEnd"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Patient has vaginal candida albicans and the practitioner considers that a topical imidazole (used intr-vaginally) is not recommended and the prescription is endorsed accordingly; can be waived by endorsement - Retail pharmacy - Specialist.</p>
              </div>
              <Rule Type="FormMax" Value="1" Attribute="Rx" Waiver="SpecEnd"/>
            </Formulation>
            <Formulation ID="F160401270903" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg</Name>
              <Brand ID="B16040127090326" SoleSupply="true">
                <Name>Ozole</Name>
                <Pack ID="P2388030" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>13.34</Subsidy>
                  <Price>13.34</Price>
                  <Alternate>13.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SpecEnd" Attribute="Retail"/>
            </Formulation>
            <Formulation ID="F160401270925" Rank="3" Units="ml">
              <Name>Powder for oral suspension 10 mg per ml</Name>
              <Brand ID="B16040127092525">
                <Name>Diflucan</Name>
                <Pack ID="P950289" Specified="true">
                  <Quantity>35</Quantity>
                  <Subsidy>34.56</Subsidy>
                  <Price>34.56</Price>
                  <Alternate>34.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Request To="HealthPAC" For="Subsidy" Form="SA1148">
                <Title>
                  <range>fluconazole oral liquid</range>
                </Title>
                <Case When="Initial application">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient requires prophlaxis for, or treatment of systemic candidiasis</ci>
                      <ci type="logical" class="Use">Patient is unable to swallow capsules</ci>
                    </apply>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="week">6</Term>
                </Case>
                <Case When="Renewal" Form="SA1148">
                  <math xmlns="http://www.w3.org/1998/Math/MathML">
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient requires prophlaxis for, or treatment of systemic candidiasis</ci>
                      <ci type="logical" class="Use">Patient is unable to swallow capsules</ci>
                    </apply>
                  </math>
                  <Applicant>any relevant practitioner</Applicant>
                  <Term Measure="week">6</Term>
                </Case>
              </Request>
              <Rule Type="Wastage" NonPrinting="true"/>
              <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1148"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1604012803">
            <Name>Itraconazole</Name>
            <Formulation ID="F160401280301" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B16040128030125" SoleSupply="true">
                <Name>Itrazole</Name>
                <Pack ID="P2354322" Specified="true">
                  <Quantity>15</Quantity>
                  <Subsidy>4.25</Subsidy>
                  <Price>4.25</Price>
                  <Alternate>4.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1604012830" Statim="Must">
            <Name>Terbinafine</Name>
            <Formulation ID="F160401283001" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg</Name>
              <Brand ID="B16040128300127" SoleSupply="true">
                <Name>Dr Reddy's Terbinafine</Name>
                <Pack ID="P2387735" Specified="true">
                  <Quantity>14</Quantity>
                  <Subsidy>1.78</Subsidy>
                  <Price>1.78</Price>
                  <Alternate>1.78</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <p xlink:type="simple" xlink:href="A1007">For topical antifungals refer to DERMATOLOGICALS</p>
        </div>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <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" Statim="Must">
            <Name>Hydroxychloroquine sulphate</Name>
            <Formulation ID="F161001162501" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16100116250101" SoleSupply="true">
                <Name>Plaquenil</Name>
                <Pack ID="P208264" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>22.50</Subsidy>
                  <Price>22.50</Price>
                  <Alternate>22.50</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">
            <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>10.45</Subsidy>
                  <Price>10.45</Price>
                  <Alternate>10.45</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>18.15</Subsidy>
                  <Price>18.15</Price>
                  <Alternate>18.15</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="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">
            <Name>Ornidazole</Name>
            <Formulation ID="F161301190601" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16130119060125">
                <Name>Arrow-Ornidazole</Name>
                <Pack ID="P2385325" Specified="true">
                  <Quantity>10</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="A1616">
        <Name>Antituberculotics and Antileprotics</Name>
        <ATC3 ID="A161601">
          <Name>Antituberculotics and Antileprotics</Name>
          <Chemical ID="C1616011374">
            <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" 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>20.00</Subsidy>
                  <Price>20.00</Price>
                  <Alternate>20.00</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="MaxCoPayment" Value="0"/>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1616012069" Statim="Must">
            <Name>Pyrazinamide</Name>
            <Formulation ID="F161601206901" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16160120690125">
                <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>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C1616012088" 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" 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>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="SpecEnd" Attribute="Retail"/>
          </Chemical>
          <Chemical ID="C1616013865">
            <Name>Ethambutol hydrochloride</Name>
            <Formulation ID="F161601386525" Rank="1" Units="tab" Weight="56">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16160138652525">
                <Name>Myambutol</Name>
                <Pack ID="P2244969" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>49.34</Subsidy>
                  <Price>49.34</Price>
                  <Alternate>49.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F161601386526" Rank="1" Units="tab">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16160138652625">
                <Name>Myambutol</Name>
                <Pack ID="P2343452" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>48.01</Subsidy>
                  <Price>48.01</Price>
                  <Alternate>48.01</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="A161905">
          <Name>Hepatitis B Treatment</Name>
          <Chemical ID="C1619052900">
            <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 100 mg</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">
            <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>
          <Chemical ID="C1619053895">
            <Name>Entecavir</Name>
            <Formulation ID="F161905389525" Rank="1" Units="tab">
              <Name>Tab 0.5 mg</Name>
              <Brand ID="B16190538952525">
                <Name>Baraclude</Name>
                <Pack ID="P2225972" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>400.00</Subsidy>
                  <Price>400.00</Price>
                  <Alternate>400.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0977">
              <Title>
                <range>Entecavir</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months)</ci>
                    <ci type="logical" class="Indication">Patient is Hepatitis B nucleoside analogue treatment-naive</ci>
                    <ci type="logical" class="Indication">Entecavir dose 0.5 mg/day</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">ALT greater than upper limit of normal</ci>
                      <ci type="logical" class="Indication">Bridging fibrosis or cirrhosis (Metavir stage 3 or greater) on liver histology</ci>
                    </apply>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">HBeAg positive</ci>
                      <ci type="logical" class="Indication">patient has ≥ 2,000 IU HBV DNA units per ml and fibrosis (Metavir stage 2 or greater)   on liver histology</ci>
                    </apply>
                    <ci type="logical" class="Indication">No continuing alcohol abuse or intravenous drug use</ci>
                    <ci type="logical" class="Indication">Not co-infected with HCV, HIV 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="Indication">No history of hypersensitivity to entecavir</ci>
                    <ci type="logical" class="Indication">No previous documented lamivudine resistance (either clinical or genotypic)</ci>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ul>
                  <li>Entecavir should be  continued for 6 months following documentation of complete HBeAg seroconversion (defined as loss of HBeAg plus appearance of anti-HBe plus loss of serum HBV DNA) for patients who were HBeAg positive prior to commencing this agent. This period of consolidation therapy should be extended to 12 months in patients with advanced fibrosis (Metavir Stage F3 or F4).</li>
                  <li>Entecavir should be taken on an empty stomach to improve absorption.</li>
                </ul>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0977"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A161907">
          <Name>Herpesvirus Treatments</Name>
          <Chemical ID="C1619071043">
            <Name>Valaciclovir</Name>
            <Formulation ID="F161907104301" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B16190710430101">
                <Name>Valtrex</Name>
                <Pack ID="P478369" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>102.72</Subsidy>
                  <Price>102.72</Price>
                  <Alternate>102.72</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0957">
              <Title>
                <range>Valaciclovir</range>
              </Title>
              <Case When="Initial application" Category="recurrent genital herpes">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has genital herpes with 2 or more breakthrough episodes in any 6 month period while treated with aciclovir 400 mg twice daily</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="month">12</Term>
              </Case>
              <Case When="Renewal" Category="recurrent genital herpes" Form="SA0957">
                <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">12</Term>
              </Case>
              <Case When="Initial application" Category="ophthalmic zoster">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has previous history of ophthalmic zoster and the patient is at risk of vision impairment</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <Case When="Initial application" Category="CMV prophylaxis">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">The patient has undergone organ transplantation</ci>
                </math>
                <Applicant>medical practitioner</Applicant>
                <Term Measure="month">3</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0957"/>
          </Chemical>
          <Chemical ID="C1619072483" Statim="Must">
            <Name>Aciclovir</Name>
            <Formulation ID="F161907248306" Rank="1" Units="tab" Weight="200">
              <Name>Tab dispersible 200 mg</Name>
              <Brand ID="B16190724830602" SoleSupply="true">
                <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="F161907248307" Rank="1" Units="tab" Weight="400">
              <Name>Tab dispersible 400 mg</Name>
              <Brand ID="B16190724830702" SoleSupply="true">
                <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>
            <Formulation ID="F161907248308" Rank="1" Units="tab" Weight="800">
              <Name>Tab dispersible 800 mg</Name>
              <Brand ID="B16190724830810" SoleSupply="true">
                <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>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A161911">
          <Name>Hepatitis B/ HIV/AIDS Treatment</Name>
          <Chemical ID="C1619113867">
            <Name>Tenofovir disoproxil fumarate</Name>
            <Formulation ID="F161911386725" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B16191138672525">
                <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>
            <Request To="HealthPAC" For="Waiver of Rule" Form="SA1047">
              <Title>
                <range>Tenofovir</range>
              </Title>
              <Case When="Initial application" Category="Confirmed Hepatitis B">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has confirmed Hepatitis B infection (HBsAg
            positive for more than 6 months)</ci>
                      <ci type="logical" class="Indication">Patient has had previous lamivudine, adefovir or
            entecavir therapy</ci>
                      <ci type="logical" class="Indication">HBV DNA greater than 20,000 IU/mL or increased
            ≥ 10 fold over nadir</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Lamivudine resistance - detection of M204I/V
              mutation</ci>
                        <ci type="logical" class="Indication">Adefovir resistance - detection of A181T/V or
              N236T mutation</ci>
                        <ci type="logical" class="Indication">Entecavir resistance - detection of relevant
              mutations including I169T, L180M T184S/A/I/L/G/C/M, S202C/G/I, M204V or M250I/V
              mutation</ci>
                      </apply>
                    </apply>
                    <ci type="logical" class="Indication">Patient is either listed or has undergone liver
          transplantation for HBV</ci>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <Case When="Initial application" Category="Pregnant" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient is HBsAg positive and pregnant</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">HBV DNA &gt; 20,000 IU/mL and ALT &gt; ULN</ci>
                      <ci type="logical" class="Indication">HBV DNA &gt; 100 million IU/mL and ALT normal</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="month">4</Term>
              </Case>
              <Case When="Renewal" Category="Confirmed Hepatitis B following funded tenofovir treatment for pregnancy within the previous two years" Form="SA1047">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has confirmed Hepatitis B infection (HBsAg
            positive for more than 6 months)</ci>
                      <ci type="logical" class="Indication">Patient has had previous lamivudine, adefovir or
            entecavir therapy</ci>
                      <ci type="logical" class="Indication">HBV DNA greater than 20,000 IU/mL or increased
            ≥ 10 fold over nadir</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Lamivudine resistance - detection of M204I/V
              mutation</ci>
                        <ci type="logical" class="Indication">Adefovir resistance - detection of A181T/V or
              N236T mutation</ci>
                        <ci type="logical" class="Indication">Entecavir resistance - detection of relevant
              mutations including I169T, L180M T184S/A/I/L/G/C/M, S202C/G/I, M204V or M250I/V
              mutation</ci>
                      </apply>
                    </apply>
                    <ci type="logical" class="Indication">Patient is either listed or has undergone liver
          transplantation for HBV</ci>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <Case When="Renewal" Category="Subsequent Pregnancy" Form="SA1047">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient is HBsAg positive and pregnant</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">HBV DNA &gt; 20,000 IU/mL and ALT &gt; ULN</ci>
                      <ci type="logical" class="Indication">HBV DNA &gt; 100 million IU/mL and ALT normal</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="month">4</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ul>
                  <li>
                    <p>Tenofovir disoproxil fumarate should be stopped 6 months following HBeAg seroconversion
          for patients who were HBeAg positive prior to commencing this agent and 6 months following
          HBsAg seroconversion for patients who were HBeAg negative prior to commencing this
          agent.</p>
                  </li>
                  <li>
                    <p>The recommended dose of Tenofovir disoproxil fumarate for the treatment of all three
          indications is 300 mg once daily.</p>
                  </li>
                  <li>
                    <p>In patients with renal insufficiency (calculated creatinine clearance less than
          50ml/min), Tenofovir disoproxil fumarate dose should be reduced in accordance with the
          approved Medsafe datasheet guidelines.</p>
                  </li>
                  <li>
                    <p>Tenofovir disoproxil fumarate is not approved for use in children.</p>
                  </li>
                </ul>
              </div>
            </Request>
            <Rule Type="SubRxF" Waiver="Special" xlink:href="SA1047"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Endorsement for treatment of HIV/AIDS: Prescription is deemed to be endorsed if tenofovir disoproxil fumarate is co-prescribed with another anti-retroviral subsidised under Special Authority SA1025 and the prescription is annotated accordingly by the Pharmacist or endorsed by the prescriber.</p>
              <p/>
              <p>Note:</p>
              <p xlink:type="simple" xlink:href="A1620">Tenofovir disoproxil fumarate prescribed under endorsement for the treatment of HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals for the purposes of Special Authority SA1025</p>
            </div>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <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">
            <Name>Nevirapine</Name>
            <Formulation ID="F162001117001" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16200111700101" SoleSupply="true">
                <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="SA1025"/>
          </Chemical>
          <Chemical ID="C1620013732">
            <Name>Efavirenz</Name>
            <Formulation ID="F162001373228" Rank="1" Units="tab" Weight="600">
              <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>
            <Formulation ID="F162001373229" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B16200137322925">
                <Name>Stocrin</Name>
                <Pack ID="P2292483" 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="F162001373230" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B16200137323025" S29="true">
                <Name>Stocrin</Name>
                <Pack ID="P2292475" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>158.33</Subsidy>
                  <Price>158.33</Price>
                  <Alternate>158.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
          <Chemical ID="C1620013918">
            <Name>Etravirine</Name>
            <Formulation ID="F162001391825" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16200139182525">
                <Name>Intelence</Name>
                <Pack ID="P2375672" Specified="true">
                  <Quantity>120</Quantity>
                  <Subsidy>770.00</Subsidy>
                  <Price>770.00</Price>
                  <Alternate>770.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A162003">
          <Name>Nucleosides Reverse Transcriptase Inhibitors</Name>
          <Chemical ID="C1620031109">
            <Name>Stavudine [d4T]</Name>
            <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>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
          <Chemical ID="C1620031223">
            <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="SA1025"/>
            <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">
            <Name>Zidovudine [AZT]</Name>
            <Formulation ID="F162003246401" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B16200324640101" SoleSupply="true">
                <Name>Retrovir</Name>
                <Pack ID="P552666" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>145.00</Subsidy>
                  <Price>145.00</Price>
                  <Alternate>145.00</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" SoleSupply="true">
                <Name>Retrovir</Name>
                <Pack ID="P818682" OP="true" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>29.00</Subsidy>
                  <Price>29.00</Price>
                  <Alternate>29.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
          <Chemical ID="C1620032791">
            <Name>Didanosine [DDI]</Name>
            <Formulation ID="F162003279125" Rank="2" Units="cap" Weight="125">
              <Name>Cap 125 mg</Name>
              <Brand ID="B16200327912525">
                <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">
                <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">
                <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">
                <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="SA1025"/>
          </Chemical>
          <Chemical ID="C1620032900">
            <Name>Lamivudine</Name>
            <Formulation ID="F162003290001" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg</Name>
              <Brand ID="B16200329000101" SoleSupply="true">
                <Name>3TC</Name>
                <Pack ID="P399485" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>153.60</Subsidy>
                  <Price>153.60</Price>
                  <Alternate>153.60</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" SoleSupply="true">
                <Name>3TC</Name>
                <Pack ID="P474320" OP="true" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>50.00</Subsidy>
                  <Price>50.00</Price>
                  <Alternate>50.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
          <Chemical ID="C1620033731">
            <Name>Abacavir sulphate</Name>
            <Formulation ID="F162003373125" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B16200337312525" SoleSupply="true">
                <Name>Ziagen</Name>
                <Pack ID="P378038" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>229.00</Subsidy>
                  <Price>229.00</Price>
                  <Alternate>229.00</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" SoleSupply="true">
                <Name>Ziagen</Name>
                <Pack ID="P2014718" OP="true" Specified="true">
                  <Quantity>240</Quantity>
                  <Subsidy>50.00</Subsidy>
                  <Price>50.00</Price>
                  <Alternate>50.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
          <Chemical ID="C1620033863">
            <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="SA1025"/>
            <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">
            <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="SA1025"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A162005">
          <Name>Protease Inhibitors</Name>
          <Chemical ID="C1620051086">
            <Name>Ritonavir</Name>
            <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="P2265621" OP="true" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>103.98</Subsidy>
                  <Price>103.98</Price>
                  <Alternate>103.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005108625" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16200510862525">
                <Name>Norvir</Name>
                <Pack ID="P2379317" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>43.31</Subsidy>
                  <Price>43.31</Price>
                  <Alternate>43.31</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
          <Chemical ID="C1620051102">
            <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="SA1025"/>
          </Chemical>
          <Chemical ID="C1620053798">
            <Name>Lopinavir with ritonavir</Name>
            <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" Weight="250">
              <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>
            <Formulation ID="F162005379828" Rank="1" Units="tab" Weight="125">
              <Name>Tab 100 mg with ritonavir 25 mg</Name>
              <Brand ID="B16200537982825">
                <Name>Kaletra</Name>
                <Pack ID="P2360969" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>183.75</Subsidy>
                  <Price>183.75</Price>
                  <Alternate>183.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
          <Chemical ID="C1620053861">
            <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="SA1025"/>
          </Chemical>
          <Chemical ID="C1620053919">
            <Name>Darunavir</Name>
            <Formulation ID="F162005391926" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16200539192625">
                <Name>Prezista</Name>
                <Pack ID="P2375680" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>837.50</Subsidy>
                  <Price>837.50</Price>
                  <Alternate>837.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162005391927" Rank="1" Units="tab" Weight="600">
              <Name>Tab 600 mg</Name>
              <Brand ID="B16200539192725">
                <Name>Prezista</Name>
                <Pack ID="P2375699" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>1190.00</Subsidy>
                  <Price>1190.00</Price>
                  <Alternate>1190.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
        </ATC3>
        <ATC3 ID="A162007">
          <Name>Strand Transfer Inhibitors</Name>
          <Chemical ID="C1620073900">
            <Name>Raltegravir potassium</Name>
            <Formulation ID="F162007390025" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16200739002525">
                <Name>Isentress</Name>
                <Pack ID="P2324059" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>1090.00</Subsidy>
                  <Price>1090.00</Price>
                  <Alternate>1090.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1025"/>
          </Chemical>
        </ATC3>
        <Request To="HealthPAC" For="Subsidy" Form="SA1025" Confidential="true">
          <Title>
            <range>Antiretrovirals</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">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>Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals.</p>
              <p>Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals.</p>
            </div>
          </Case>
          <Case When="Renewal" Category="Confirmed HIV/AIDS" Form="SA0556 SA0575 SA0754 SA0779 SA1021 SA1025" Break="after">
            <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>
          <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>Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals.</p>
              <p>Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals.</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="Initial application" Category="post-exposure prophylaxis following non-occupational exposure to HIV">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <apply>
                <and/>
                <ci type="logical" class="Treatment">Treatment course to be initiated within 72 hours post exposure</ci>
                <apply>
                  <or/>
                  <ci type="logical" class="Indication">Patient has had unprotected receptive anal intercourse with a known HIV positive person</ci>
                  <ci type="logical" class="Indication">Patient has shared intravenous injecting equipment with a known HIV positive person</ci>
                </apply>
              </apply>
            </math>
            <Applicant>named specialist</Applicant>
            <Term Measure="week">4</Term>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals.</p>
              <p>Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals.</p>
            </div>
          </Case>
          <Case When="Renewal" Category="second or subsequent post-exposure prophylaxis" Form="SA0556 SA0575 SA0754 SA0779 SA1021 SA1025" Break="after">
            <math xmlns="http://www.w3.org/1998/Math/MathML">
              <apply>
                <and/>
                <ci type="logical" class="Treatment">Treatment course to be initiated within 72 hours post exposure</ci>
                <apply>
                  <or/>
                  <ci type="logical" class="Indication">Patient has had unprotected receptive anal intercourse with a known HIV positive person</ci>
                  <ci type="logical" class="Indication">Patient has shared intravenous injecting equipment with a known HIV positive person</ci>
                </apply>
              </apply>
            </math>
            <Applicant>named specialist</Applicant>
            <Term Measure="week">4</Term>
          </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>Tenofovir disoproxil fumarate prescribed under endorsement for HIV/AIDS is included in the count of up to 4 subsidised antiretrovirals.</p>
              <p>Subsidies for a combination of up to four antiretroviral medications. The combination of a protease inhibitor and low-dose ritonavir given as a booster (either as part of a combination product or separately) will be counted as one protease inhibitor for the purpose of accessing funding to antiretrovirals.</p>
            </div>
          </Case>
          <Case When="Renewal" Category="Second or subsequent percutaneous exposure" Form="SA0556 SA0575 SA0754 SA0779 SA1021 SA1025">
            <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>
          </Case>
        </Request>
      </ATC2>
      <ATC2 ID="A1621">
        <Name>Antiretrovirals - Additional Therapies</Name>
        <ATC3 ID="A162103">
          <Name>HIV Fusion Inhibitors</Name>
          <Chemical ID="C1621033859">
            <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>
      </ATC2>
      <ATC2 ID="A1622">
        <Name>Immune Modulators</Name>
        <ATC3 ID="A162201">
          <Name>Immune Modulators</Name>
          <Chemical ID="C1622012445">
            <Name>Interferon alpha-2b</Name>
            <Formulation ID="F162201244514" Rank="4" Units="inj" Weight="18">
              <Name>Inj 18 m iu, 1.2 ml multidose pen</Name>
              <Brand ID="B16220124451401">
                <Name>Intron-A</Name>
                <Pack ID="P495662" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>187.92</Subsidy>
                  <Price>187.92</Price>
                  <Alternate>187.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201244515" Rank="4" Units="inj" Weight="30">
              <Name>Inj 30 m iu, 1.2 ml multidose pen</Name>
              <Brand ID="B16220124451501">
                <Name>Intron-A</Name>
                <Pack ID="P495697" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>313.20</Subsidy>
                  <Price>313.20</Price>
                  <Alternate>313.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201244516" Rank="4" Units="inj" Weight="60">
              <Name>Inj 60 m iu, 1.2 ml multidose pen</Name>
              <Brand ID="B16220124451601">
                <Name>Intron-A</Name>
                <Pack ID="P495700" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>626.40</Subsidy>
                  <Price>626.40</Price>
                  <Alternate>626.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <Rule Type="PCT"/>
            <Rule Type="Guideline" xlink:href="PG0709A162201"/>
          </Chemical>
          <Chemical ID="C1622012845">
            <Name>Interferon alpha-2a</Name>
            <Formulation ID="F162201284513" Rank="4" Units="inj" Weight="3">
              <Name>Inj 3 m iu prefilled syringe</Name>
              <Brand ID="B16220128451301">
                <Name>Roferon-A</Name>
                <Pack ID="P483206" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>31.32</Subsidy>
                  <Price>31.32</Price>
                  <Alternate>31.32</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201284514" Rank="4" Units="inj" Weight="6">
              <Name>Inj 6 m iu prefilled syringe</Name>
              <Brand ID="B16220128451401">
                <Name>Roferon-A</Name>
                <Pack ID="P483222" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>62.64</Subsidy>
                  <Price>62.64</Price>
                  <Alternate>62.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201284515" Rank="4" Units="inj" Weight="9">
              <Name>Inj 9 m iu prefilled syringe</Name>
              <Brand ID="B16220128451501">
                <Name>Roferon-A</Name>
                <Pack ID="P483230" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>93.96</Subsidy>
                  <Price>93.96</Price>
                  <Alternate>93.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="PCT"/>
            <Rule Type="SpecEnd" Attribute="Retail"/>
            <Rule Type="Guideline" xlink:href="PG0709A162201"/>
          </Chemical>
          <Chemical ID="C1622013787">
            <Name>Pegylated interferon alpha-2a</Name>
            <Formulation ID="F162201378725" Rank="4" Units="inj" Weight="135">
              <Name>Inj 135 mcg prefilled syringe</Name>
              <Brand ID="B16220137872525" SoleSupply="true">
                <Name>Pegasys</Name>
                <Pack ID="P2121093" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>362.00</Subsidy>
                  <Price>362.00</Price>
                  <Alternate>362.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2162792" Specified="true">
                  <Quantity>4</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>1448.00</Subsidy>
                  <Price>1448.00</Price>
                  <Alternate>1448.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201378726" Rank="4" Units="inj" Weight="180">
              <Name>Inj 180 mcg prefilled syringe</Name>
              <Brand ID="B16220137872625" SoleSupply="true">
                <Name>Pegasys</Name>
                <Pack ID="P2121107" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>450.00</Subsidy>
                  <Price>450.00</Price>
                  <Alternate>450.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P2162806" Specified="true">
                  <Quantity>4</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>1800.00</Subsidy>
                  <Price>1800.00</Price>
                  <Alternate>1800.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201378727" Rank="10" Units="pack" Weight="135">
              <Name>Inj 135 mcg prefilled syringe x 4 with ribavirin tab 200 mg x 112</Name>
              <Brand ID="B16220137872725" SoleSupply="true">
                <Name>Pegasys RBV Combination Pack</Name>
                <Pack ID="P2190079" OP="true" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>1799.68</Subsidy>
                  <Price>1799.68</Price>
                  <Alternate>1799.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201378728" Rank="10" Units="pack" Weight="135">
              <Name>Inj 135 mcg prefilled syringe x 4 with ribavirin tab 200 mg x 168</Name>
              <Brand ID="B16220137872825" SoleSupply="true">
                <Name>Pegasys RBV Combination Pack</Name>
                <Pack ID="P2190109" OP="true" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>1975.00</Subsidy>
                  <Price>1975.00</Price>
                  <Alternate>1975.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201378729" Rank="10" Units="pack" Weight="180">
              <Name>Inj 180 mcg prefilled syringe x 4 with ribavirin tab 200 mg x 112</Name>
              <Brand ID="B16220137872925" SoleSupply="true">
                <Name>Pegasys RBV Combination Pack</Name>
                <Pack ID="P2190117" OP="true" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>2059.84</Subsidy>
                  <Price>2059.84</Price>
                  <Alternate>2059.84</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F162201378730" Rank="10" Units="pack" Weight="180">
              <Name>Inj 180 mcg prefilled syringe x 4 with ribavirin tab 200 mg x 168</Name>
              <Brand ID="B16220137873025" SoleSupply="true">
                <Name>Pegasys RBV Combination Pack</Name>
                <Pack ID="P2190087" OP="true" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>2190.00</Subsidy>
                  <Price>2190.00</Price>
                  <Alternate>2190.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1134">
              <Title>
                <range>Pegylated Interferon alpha-2A</range>
              </Title>
              <Case When="Initial application" Category="chronic hepatitis C - genotype 1, 4, 5 or 6 infection or co-infection with HIV">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection</ci>
                      <ci type="logical" class="Indication">Patient has chronic hepatitis C and is co-infected with HIV</ci>
                    </apply>
                    <ci type="logical" class="Indication">Maximum of 48 weeks therapy</ci>
                  </apply>
                </math>
                <Applicant>any specialist</Applicant>
                <Term Measure="month">18</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <ul>
                    <li>
                      <p>Consider stopping treatment if there is absence of a virological response (defined as at least a 2-log reduction in viral load) following 12 weeks of treatment since this is predictive of treatment failure.</p>
                    </li>
                    <li>
                      <p>Consider reducing treatment to 24 weeks if serum HCV RNA level at Week 4 is undetectable by sensitive PCR assay (less than 50IU/ml) AND Baseline serum HCV RNA is  less than 400,000IU/ml</p>
                    </li>
                  </ul>
                </div>
              </Case>
              <Case When="Initial application" Category="chronic hepatitis C - genotype 2 or 3 infection without co-infection with HIV" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has chronic hepatitis C, genotype 2 or 3 infection</ci>
                    <ci type="logical" class="Indication">Maximum of 6 months therapy</ci>
                  </apply>
                </math>
                <Applicant>any specialist</Applicant>
                <Term Measure="month">12</Term>
              </Case>
              <Case When="Initial application" Category="Hepatitis B">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months)</ci>
                    <ci type="logical" class="Indication">Patient is Hepatitis B treatment-naive</ci>
                    <ci type="logical" class="Indication">ALT &gt; 2 times Upper Limit of Normal</ci>
                    <ci type="logical" class="Indication">HBV DNA &lt; 10 log10 IU/ml</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">HBeAg positive</ci>
                      <ci type="logical" class="Indication">serum HBV DNA ≥ 2,000 units/ml and significant fibrosis (≥ Metavir Stage F2)</ci>
                    </apply>
                    <ci type="logical" class="Indication">Compensated liver disease</ci>
                    <ci type="logical" class="Indication">No continuing alcohol abuse or intravenous drug use</ci>
                    <ci type="logical" class="Indication">Not co-infected with HCV, HIV or HDV</ci>
                    <ci type="logical" class="Indication">Neither ALT nor AST &gt; 10 times upper limit of normal</ci>
                    <ci type="logical" class="Indication">No history of hypersensitivity or contraindications to pegylated interferon</ci>
                    <ci type="logical" class="Indication">Maximum of 48 weeks therapy</ci>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant>infectious disease specialist</Applicant>
                <Applicant>general physician</Applicant>
                <Term Measure="month">18</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ul>
                  <li>
                    <p>Approved dose is 180 mcg once weekly.</p>
                  </li>
                  <li>
                    <p>The recommended dose of Pegylated Interferon-alpha 2a is 180 mcg once weekly.</p>
                  </li>
                  <li>
                    <p>In patients with renal insufficiency (calculated creatinine clearance less than 50ml/min), Pegylated Interferon-alpha 2a dose should be reduced to 135 mcg once weekly.</p>
                  </li>
                  <li>
                    <p>In patients with neutropaenia and thrombocytopaenia, dose should be reduced in accordance with the datasheet guidelines.</p>
                  </li>
                  <li>
                    <p>Pegylated Interferon-alpha 2a is not approved for use in children.</p>
                  </li>
                </ul>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1134"/>
            <Rule Type="Guideline" xlink:href="PG0709A162201"/>
          </Chemical>
          <div xmlns="http://www.w3.org/1999/xhtml" class="Guideline" id="PG0709A162201">
            <h4>Guidelines for the use of interferon in the treatment of hepatitis C:</h4>
            <p>Physicians considering treatment of patients with hepatitis C should discuss cases with a gastroenterologist or an infectious disease physician. All subjects undergoing treatment require careful monitoring for side effects.</p>
            <p>Patients should be otherwise fit.</p>
            <p>Hepatocellular carcinoma should be excluded by ultrasound examination and alpha-fetoprotein level.</p>
            <h4>Criteria for Treatment</h4>
            <ol style="list-style-type: decimal">
              <li>
                <p>Diagnosis</p>
                <ul>
                  <li>
                    <p>Anti-HCV positive on at least two occasions with a positive PCR for HCV-RNA and preferably confirmed by a supplementary RIBA test; or</p>
                  </li>
                  <li>
                    <p>PCR-RNA positive for HCV on at least 2 occasions if antibody negative; or</p>
                  </li>
                  <li>
                    <p>Anti-HCV positive on at least two occasions with a positive supplementary RIBA test with a negative PCR for HCV RNA but with a liver biopsy consistent with 2(b) following.</p>
                  </li>
                </ul>
              </li>
              <li>
                <p>Establishing Active Chronic Liver Disease</p>
                <ul>
                  <li>
                    <p>Confirmed HCV infection and serum ALT/AST levels measured on at least three occasions over six months averaging &gt; 1.5 × upper limit of normal. (ALT is the preferable enzyme); or</p>
                  </li>
                  <li>
                    <p>Liver biopsy showing significant inflammatory activity (active hepatitis) with or without cirrhosis. This is not a necessary requirement for those patients with coagulopathy. (Some patients have active disease on histology with normal transaminase enzymes).</p>
                  </li>
                </ul>
              </li>
            </ol>
            <h4>Exclusion Criteria</h4>
            <ol style="list-style-type: decimal">
              <li>
                <p>Autoimmune liver disease. (Interferon may exacerbate autoimmune liver disease as well as other autoimmune diseases such as thyroid disease).</p>
              </li>
              <li>
                <p>Pregnancy.</p>
              </li>
              <li>
                <p>Neutropenia (&lt;2.0 × 10<sup>9</sup>) and/or thrombocytopenia.</p>
              </li>
              <li>
                <p>Continuing alcohol abuse and/or continuing intravenous drug users.</p>
              </li>
            </ol>
            <h4>Dosage</h4>
            <p>The current recommended dosage is 3 million units of interferon alpha-2a or interferon alpha-2b administered subcutaneously 3 times a week for 52 weeks (twelve months)</p>
            <h4>Exit Criteria</h4>
            <p>The patient’s response to interferon treatment should be reviewed at either three or four months. Interferon treatment should be discontinued in patients who do not show a substantial reduction (50%) in their mean pre-treatment ALT level at this stage.</p>
          </div>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1623">
        <Name>Urinary Tract Infections</Name>
        <ATC3 ID="A162301">
          <Name>Urinary Tract Infections</Name>
          <Chemical ID="C1623011594" Statim="Must">
            <Name>Hexamine hippurate</Name>
            <Formulation ID="F162301159401" Rank="1" Units="tab">
              <Name>Tab 1 g</Name>
              <Brand ID="B16230115940101">
                <Name>Hiprex</Name>
                <Pack ID="P209538" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>18.40</Subsidy>
                  <Price>38.10</Price>
                  <Alternate>18.40</Alternate>
                  <Surcharge>0.19700</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1623011867" Statim="Must">
            <Name>Nitrofurantoin</Name>
            <Formulation ID="F162301186701" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B16230118670101">
                <Name>Nifuran</Name>
                <Pack ID="P254738" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>22.20</Subsidy>
                  <Price>22.20</Price>
                  <Alternate>22.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F162301186702" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B16230118670201">
                <Name>Nifuran</Name>
                <Pack ID="P254754" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>37.50</Subsidy>
                  <Price>37.50</Price>
                  <Alternate>37.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1623011874">
            <Name>Norfloxacin</Name>
            <Formulation ID="F162301187401" Rank="1" Units="tab" Weight="400">
              <Name>Tab 400 mg</Name>
              <Brand ID="B16230118740125" SoleSupply="true">
                <Name>Arrow-Norfloxacin</Name>
                <Pack ID="P2204398" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>15.45</Subsidy>
                  <Price>15.45</Price>
                  <Alternate>15.45</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">
            <Name>Influenza vaccine</Name>
            <Formulation ID="F162501380425" Rank="4" Units="inj">
              <Name>Inj</Name>
              <Brand ID="B16250138042526">
                <Name>Fluvax</Name>
                <Pack ID="P2353113" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>90.00</Subsidy>
                  <Price>90.00</Price>
                  <Alternate>90.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B16250138042527">
                <Name>Fluarix</Name>
                <Pack ID="P2087731" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>90.00</Subsidy>
                  <Price>90.00</Price>
                  <Alternate>90.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: upper-alpha">
                <li>
                  <p>is available 1 March until vaccine supplies are exhausted 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,</p>
                            </li>
                            <li>
                              <p>children on long term aspirin, or</p>
                            </li>
                            <li>
                              <p>pregnancy.</p>
                            </li>
                          </ol>
                        </li>
                      </ol>
                    </li>
                    <li>
                      <p>people under 18 years of age living within the boundaries of the Canterbury District Health Board.</p>
                    </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>
                  </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>
            <Rule Type="Dispensary" Attribute="Xpharm" NonPrinting="true"/>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A19">
      <Name>Musculoskeletal System</Name>
      <ATC2 ID="A1901">
        <Name>Anticholinesterases</Name>
        <ATC3 ID="A190101">
          <Name>Anticholinesterases</Name>
          <Chemical ID="C1901011857">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>140.00</Subsidy>
                  <Price>140.00</Price>
                  <Alternate>140.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1901012070" Statim="May">
            <Name>Pyridostigmine bromide</Name>
            <Formulation ID="F190101207001" Rank="1" Units="tab" Weight="60">
              <Name>Tab 60 mg</Name>
              <Brand ID="B19010120700101" SoleSupply="true">
                <Name>Mestinon</Name>
                <Pack ID="P251011" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>38.90</Subsidy>
                  <Price>38.90</Price>
                  <Alternate>38.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1904">
        <Name>Non-steroidal Anti-inflammatory Drugs (NSAIDs)</Name>
        <ATC3 ID="A190401">
          <Name>Non-steroidal Anti-inflammatory Drugs (NSAIDs)</Name>
          <Chemical ID="C1904011401" Statim="Must">
            <Name>Diclofenac sodium</Name>
            <Formulation ID="F190401140101" Rank="1" Units="tab" Weight="25">
              <Name>Tab EC 25 mg</Name>
              <Brand ID="B19040114010126" SoleSupply="true">
                <Name>Diclofenac Sandoz</Name>
                <Pack ID="P2355981" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>1.63</Subsidy>
                  <Price>1.63</Price>
                  <Alternate>1.63</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
            </Formulation>
            <Formulation ID="F190401140102" Rank="1" Units="tab" Weight="50">
              <Name>Tab EC 50 mg</Name>
              <Brand ID="B19040114010226" SoleSupply="true">
                <Name>Diclofenac Sandoz</Name>
                <Pack ID="P2356007" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>2.13</Subsidy>
                  <Price>2.13</Price>
                  <Alternate>2.13</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
            </Formulation>
            <Formulation ID="F190401140103" Rank="1" Units="tab" Weight="75">
              <Name>Tab long-acting 75 mg</Name>
              <Brand ID="B19040114010301">
                <Name>Diclax SR</Name>
                <Pack ID="P2202174" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>32.80</Subsidy>
                  <Price>32.80</Price>
                  <Alternate>32.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
            </Formulation>
            <Formulation ID="F190401140105" Rank="4" Units="inj" Weight="75">
              <Name>Inj 25 mg per ml, 3 ml</Name>
              <Brand ID="B19040114010501" SoleSupply="true">
                <Name>Voltaren</Name>
                <Pack ID="P263486" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <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="SA1038"/>
              <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" SoleSupply="true">
                <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="SA1038"/>
            </Formulation>
            <Formulation ID="F190401140107" Rank="5" Units="supp" Weight="25">
              <Name>Suppos 25 mg</Name>
              <Brand ID="B19040114010701" SoleSupply="true">
                <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="SA1038"/>
            </Formulation>
            <Formulation ID="F190401140108" Rank="5" Units="supp" Weight="50">
              <Name>Suppos 50 mg</Name>
              <Brand ID="B19040114010801" SoleSupply="true">
                <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="SA1038"/>
              <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" SoleSupply="true">
                <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="SA1038"/>
            </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="SA1038"/>
            </Formulation>
            <Formulation ID="F190401140112" Rank="1" Units="tab" Weight="100">
              <Name>Tab long-acting 100 mg</Name>
              <Brand ID="B19040114011201">
                <Name>Diclax SR</Name>
                <Pack ID="P2212846" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>63.22</Subsidy>
                  <Price>63.22</Price>
                  <Alternate>63.22</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1904011697" 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 SR</Name>
                <Pack ID="P333964" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>43.12</Subsidy>
                  <Price>43.12</Price>
                  <Alternate>43.12</Alternate>
                  <Surcharge>0.00000</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 SR</Name>
                <Pack ID="P300616" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>21.56</Subsidy>
                  <Price>21.56</Price>
                  <Alternate>21.56</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
          </Chemical>
          <Chemical ID="C1904011769" 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="P616168" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>0.50</Subsidy>
                  <Price>5.60</Price>
                  <Alternate>3.67</Alternate>
                  <Surcharge>0.25500</Surcharge>
                </Pack>
                <Pack ID="P2389444" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>1.25</Subsidy>
                  <Price>9.16</Price>
                  <Alternate>9.16</Alternate>
                  <Surcharge>0.15820</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
          </Chemical>
          <Chemical ID="C1904012193" Statim="Must">
            <Name>Sulindac</Name>
            <Formulation ID="F190401219301" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B19040121930102" ToBeDelisted="2012-07-01">
                <Name>Daclin</Name>
                <Pack ID="P589136" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>5.32</Subsidy>
                  <Price>17.10</Price>
                  <Alternate>17.10</Alternate>
                  <Surcharge>0.11780</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B19040121930125">
                <Name>Aclin</Name>
                <Pack ID="P2384221" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>2.66</Subsidy>
                  <Price>8.55</Price>
                  <Alternate>8.55</Alternate>
                  <Surcharge>0.11780</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401219302" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B19040121930201" ToBeDelisted="2012-07-01">
                <Name>Daclin</Name>
                <Pack ID="P589152" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.72</Subsidy>
                  <Price>30.20</Price>
                  <Alternate>30.20</Alternate>
                  <Surcharge>0.23480</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B19040121930225">
                <Name>Aclin</Name>
                <Pack ID="P2384248" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>3.36</Subsidy>
                  <Price>15.10</Price>
                  <Alternate>15.10</Alternate>
                  <Surcharge>0.23480</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
          </Chemical>
          <Chemical ID="C1904012536" 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="F190401253626" Rank="4" Units="inj" Weight="20">
              <Name>Inj 20 mg</Name>
              <Brand ID="B19040125362625">
                <Name>AFT</Name>
                <Pack ID="P2307022" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>9.95</Subsidy>
                  <Price>9.95</Price>
                  <Alternate>9.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
          </Chemical>
          <Chemical ID="C1904012537" 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>19.26</Subsidy>
                  <Price>19.26</Price>
                  <Alternate>19.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
          </Chemical>
          <Chemical ID="C1904012782" Statim="Must">
            <Name>Naproxen</Name>
            <Formulation ID="F190401278205" Rank="1" Units="tab" Weight="750">
              <Name>Tab long-acting 750 mg</Name>
              <Brand ID="B19040127820501">
                <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">
                <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>23.70</Subsidy>
                  <Price>23.70</Price>
                  <Alternate>23.70</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>24.88</Subsidy>
                  <Price>24.88</Price>
                  <Alternate>24.88</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
          </Chemical>
          <Chemical ID="C1904012798" Statim="Must">
            <Name>Ibuprofen</Name>
            <Formulation ID="F190401279801" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B19040127980127" SoleSupply="true">
                <Name>Arrowcare</Name>
                <Pack ID="P2390582" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>12.75</Subsidy>
                  <Price>12.75</Price>
                  <Alternate>12.75</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="P2255510" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>0.77</Subsidy>
                  <Price>4.56</Price>
                  <Alternate>4.56</Alternate>
                  <Surcharge>0.12633</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="P2255502" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.15</Subsidy>
                  <Price>6.84</Price>
                  <Alternate>6.84</Alternate>
                  <Surcharge>0.18967</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190401279804" Rank="1" Units="tab" Weight="800">
              <Name>Tab long-acting 800 mg</Name>
              <Brand ID="B19040127980401" SoleSupply="true">
                <Name>Brufen SR</Name>
                <Pack ID="P2255499" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>8.12</Subsidy>
                  <Price>8.12</Price>
                  <Alternate>8.12</Alternate>
                  <Surcharge>0.00000</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" SoleSupply="true">
                <Name>Fenpaed</Name>
                <Pack ID="P2090864" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>2.69</Subsidy>
                  <Price>2.69</Price>
                  <Alternate>2.69</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Price" xlink:href="SA1038"/>
          </Chemical>
          <Request To="PHARMAC" For="Manufacturers Price" Form="SA1038">
            <Title>
              <range>Anti-inflammatory Non Steroidal Drugs (NSAIDs)</range>
            </Title>
            <Case When="Initial application">
              <math xmlns="http://www.w3.org/1998/Math/MathML">
                <ci type="logical" class="Indication">Subsidy for patients with existing approvals prior to 1 September 2010</ci>
              </math>
              <Applicant>any relevant practitioner</Applicant>
              <Term Measure="patient's lifetime"/>
            </Case>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <p>Subsidy for patients with existing approvals prior to 1 September 2010.  Approvals valid without further renewal unless	notified.  No new approvals will be granted from 1 September 2010.</p>
            </div>
          </Request>
        </ATC3>
        <ATC3 ID="A190402">
          <Name>NSAIDs Other</Name>
          <Chemical ID="C1904021645" Statim="Must">
            <Name>Indomethacin</Name>
            <Formulation ID="F190402164504" Rank="5" Units="supp" Weight="100">
              <Name>Suppos 100 mg</Name>
              <Brand ID="B19040216450402" ToBeDelisted="2012-12-01">
                <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="C1904023912" Statim="Must">
            <Name>Meloxicam</Name>
            <Formulation ID="F190402391225" Rank="1" Units="tab" Weight="7">
              <Name>Tab 7.5 mg</Name>
              <Brand ID="B19040239122525">
                <Name>Arrow-Meloxicam</Name>
                <Pack ID="P2347253" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1034">
              <Title>
                <range>Meloxicam</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 moderate to severe haemophilia with less than or equal to 5% of normal circulating functional clotting factor</ci>
                    <ci type="logical" class="Indication">The patient has haemophilic arthropathy</ci>
                    <ci type="logical" class="Indication">Pain and inflammation associated with haemophilic arthropathy is inadequately controlled by alternative funded treatment options, or alternative funded treatment options are contraindicated</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1034"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1907">
        <Name>Antirheumatoid Agents</Name>
        <ATC3 ID="A190701">
          <Name>Antirheumatoid Agents</Name>
          <Chemical ID="C1907011099">
            <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>68.99</Price>
                  <Alternate>68.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B19070110990125" S29="true" Update="New Listing">
                <Name>Ridaura s29</Name>
                <Pack ID="P2397536" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>68.99</Subsidy>
                  <Price>68.99</Price>
                  <Alternate>68.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1907011942">
            <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="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="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>
          </Chemical>
          <Chemical ID="C1907012126">
            <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <Subsidy>217.23</Subsidy>
                  <Price>217.23</Price>
                  <Alternate>217.23</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1907013763">
            <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>76.00</Subsidy>
                  <Price>76.00</Price>
                  <Alternate>76.00</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>55.00</Subsidy>
                  <Price>55.00</Price>
                  <Alternate>55.00</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>
          </Chemical>
        </ATC3>
        <ATC3 ID="A190702">
          <Name>Tumour Necrosis Factor (TNF) Inhibitors</Name>
          <Chemical ID="C1907023786">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>949.96</Subsidy>
                  <Price>949.96</Price>
                  <Alternate>949.96</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190702378626" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg autoinjector</Name>
              <Brand ID="B19070237862625">
                <Name>Enbrel</Name>
                <Pack ID="P2375729" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>1899.92</Subsidy>
                  <Price>1899.92</Price>
                  <Alternate>1899.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190702378627" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mg prefilled syringe</Name>
              <Brand ID="B19070237862725">
                <Name>Enbrel</Name>
                <Pack ID="P2382113" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>1899.92</Subsidy>
                  <Price>1899.92</Price>
                  <Alternate>1899.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1157">
              <Title>
                <range>Etanercept</range>
              </Title>
              <Case When="Initial application" Category="juvenile idiopathic arthritis" Break="after">
                <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 10-20 mg/m² weekly or at the maximum tolerated dose) in combination with either oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose) or a full trial of serial intra-articular corticosteroid injections</ci>
                    <apply>
                      <and/>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly-controlled and active disease in at least 20 swollen, tender joints</ci>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly-controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip</ci>
                      </apply>
                      <ci type="logical" class="Indication">Physician's global assessment indicating severe disease</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>named specialist</Applicant>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">4</Term>
              </Case>
              <Case When="Initial application" Category="rheumatoid arthritis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for adalimumab for rheumatoid arthritis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from adalimumab</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for rheumatoid arthritis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer</ci>
                      <ci type="logical" class="Treatment">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 sulphasalazine and 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 of oral or parenteral methotrexate in combination with the maximum tolerated dose of cyclosporin</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 intramuscular gold</ci>
                        <ci type="logical" class="Trial">Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate</ci>
                      </apply>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least 20 swollen, tender joints</ci>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip</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>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Initial application" Category="severe chronic plaque psoriasis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for adalimumab for severe chronic plaque psoriasis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from adalimumab</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for severe chronic plaque psoriasis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has "whole body" severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis</ci>
                        <ci type="logical" class="Trial">Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis</ci>
                      </apply>
                      <ci type="logical" class="Trial">Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin</ci>
                      <ci type="logical" class="Test">A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course</ci>
                      <ci type="logical" class="Test">The most recent PASI assessment is no more than 1 month old at the time of application</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>dermatologist</Applicant>
                <Term Measure="month">4</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>"Inadequate response" is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="ankylosing spondylitis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for adalimumab for ankylosing spondylitis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from adalimumab</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for ankylosing spondylitis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has a confirmed diagnosis of ankylosing spondylitis present for more than six months</ci>
                      <ci type="logical" class="Indication">Patient has low back pain and stiffness that is relieved by exercise but not by rest</ci>
                      <ci type="logical" class="Indication">Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan</ci>
                      <ci type="logical" class="Trial">Patient's ankylosing spondylitis has not responded adequately to treatment with two or more non-steroidal anti-inflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober's test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right)</ci>
                        <ci type="logical" class="Indication">Patient has limitation of chest expansion by at least 2.5 cm below the average normal values corrected for age and gender (see Notes)</ci>
                      </apply>
                      <ci type="logical" class="Indication">A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of initial application.</p>
                  <p>Average normal chest expansion corrected for age and gender:</p>
                  <p>18-24 years - Male: 7.0 cm; Female: 5.5 cm</p>
                  <p>25-34 years - Male: 7.5 cm; Female: 5.5 cm</p>
                  <p>35-44 years - Male: 6.5 cm; Female: 4.5 cm</p>
                  <p>45-54 years - Male: 6.0 cm; Female: 5.0 cm</p>
                  <p>55-64 years - Male: 5.5 cm; Female: 4.0 cm</p>
                  <p>65-74 years - Male: 4.0 cm; Female: 4.0 cm</p>
                  <p>75+ years - Male: 3.0 cm; Female: 2.5 cm</p>
                </div>
              </Case>
              <Case When="Initial application" Category="psoriatic arthritis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for adalimumab for psoriatic arthritis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from adalimumab</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for psoriatic arthritis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has had severe active psoriatic arthritis for six 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 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 sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses)</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least 15 swollen, tender joints</ci>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip</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">Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour</ci>
                        <ci type="logical" class="Indication">ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="juvenile idiopathic arthritis" Form="SA0667 SA0868 SA1060 SA1157">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Applicant is a named specialist or rheumatologist</ci>
                      <ci type="logical" class="Indication">Applicant is a Practitioner and confirms that a named specialist or rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment</ci>
                    </apply>
                    <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 3 to 4 months' initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician's global assessment from baseline</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>
                <Applicant Referring="named specialist or rheumatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="rheumatoid arthritis" Form="SA0667 SA0868 SA1060 SA1157" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a rheumatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment</ci>
                    </apply>
                    <ci type="logical" class="Treatment">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 3 to 4 months' initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician</ci>
                      <ci type="logical" class="Trial">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>
                    <ci type="logical" class="Endorsement">Etanercept to be administered at doses no greater than 50 mg every 7 days</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Applicant Referring="rheumatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="severe chronic plaque psoriasis" Form="SA0667 SA0868 SA1060 SA1157" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a dermatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment</ci>
                    </apply>
                    <apply>
                      <or/>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">Patient had "whole body" severe chronic plaque psoriasis at the start of treatment</ci>
                        <ci type="logical" class="Indication">Following each prior etanercept treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-treatment baseline value</ci>
                      </apply>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment</ci>
                        <apply>
                          <or/>
                          <ci type="logical" class="Indication">Following each prior etanercept treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values</ci>
                          <ci type="logical" class="Indication">Following each prior etanercept treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-treatment baseline value</ci>
                        </apply>
                      </apply>
                    </apply>
                    <ci type="logical" class="Endorsement">Etanercept to be administered at doses no greater than 50 mg every 7 days</ci>
                  </apply>
                </math>
                <Applicant>dermatologist</Applicant>
                <Applicant Referring="dermatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>A treatment course is defined as a minimum of 12 weeks of etanercept treatment</p>
                </div>
              </Case>
              <Case When="Renewal" Category="ankylosing spondylitis" Form="SA0667 SA0868 SA1060 SA1157">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a rheumatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment</ci>
                    </apply>
                    <ci type="logical" class="Indication">Following 12 weeks of etanercept treatment, BASDAI has improved by 4 or more points from pre-treatment baseline on a 10 point scale, or by 50%, whichever is less</ci>
                    <ci type="logical" class="Indication">Physician considers that the patient has benefited from treatment and that continued treatment is appropriate</ci>
                    <ci type="logical" class="Endorsement">Etanercept to be administered at doses no greater than 50 mg every 7 days</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Applicant Referring="rheumatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="psoriatic arthritis" Form="SA0667 SA0868 SA1060 SA1157">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a rheumatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment</ci>
                    </apply>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Following 3 to 4 months' initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician</ci>
                      <ci type="logical" class="Indication">The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to prior etanercept treatment in the opinion of the treating physician</ci>
                    </apply>
                    <ci type="logical" class="Endorsement">Etanercept to be administered at doses no greater than 50 mg every 7 days</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Applicant Referring="rheumatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1157"/>
          </Chemical>
          <Chemical ID="C1907023836">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>1799.92</Subsidy>
                  <Price>1799.92</Price>
                  <Alternate>1799.92</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190702383626" Rank="4" Units="inj" Weight="40">
              <Name>Inj 40 mg per 0.8 ml prefilled pen</Name>
              <Brand ID="B19070238362625">
                <Name>HumiraPen</Name>
                <Pack ID="P2294397" Specified="true">
                  <Quantity>2</Quantity>
                  <Multiple>1</Multiple>
                  <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="SA1156">
              <Title>
                <range>Adalimumab</range>
              </Title>
              <Case When="Initial application" Category="rheumatoid arthritis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for etanercept for rheumatoid arthritis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from etanercept</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for rheumatoid arthritis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer</ci>
                      <ci type="logical" class="Treatment">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 sulphasalazine and 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 of oral or parenteral methotrexate in combination with the maximum tolerated dose of cyclosporin</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 intramuscular gold</ci>
                        <ci type="logical" class="Trial">Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate</ci>
                      </apply>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least 20 swollen, tender joints</ci>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip</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>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Initial application" Category="Crohn's disease" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">Patient has severe active Crohn's disease</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient has a Crohn's Disease Activity Index (CDAI) score of greater than or equal to 300</ci>
                      <ci type="logical" class="Indication">Patient has extensive small intestine disease affecting more than 50 cm of the small intestine</ci>
                      <ci type="logical" class="Indication">Patient has evidence of short gut syndrome or would be at risk of short gut syndrome with further bowel resection</ci>
                      <ci type="logical" class="Indication">Patient has an ileostomy or colostomy, and has intestinal inflammation</ci>
                    </apply>
                    <ci type="logical" class="Trial">Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses (unless contraindicated) and corticosteroids</ci>
                    <ci type="logical" class="Treatment">Surgery (or further surgery) is considered to be clinically inappropriate</ci>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Term Measure="month">3</Term>
              </Case>
              <Case When="Initial application" Category="severe chronic plaque psoriasis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for etanercept for severe chronic plaque psoriasis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from etanercept</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for severe chronic plaque psoriasis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has "whole body" severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis</ci>
                        <ci type="logical" class="Trial">Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis</ci>
                      </apply>
                      <ci type="logical" class="Trial">Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin</ci>
                      <ci type="logical" class="Test">A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course</ci>
                      <ci type="logical" class="Test">The most recent PASI assessment is no more than 1 month old at the time of application</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>dermatologist</Applicant>
                <Term Measure="month">4</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>"Inadequate response" is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment.</p>
                </div>
              </Case>
              <Case When="Initial application" Category="ankylosing spondylitis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for etanercept for ankylosing spondylitis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from etanercept</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for ankylosing spondylitis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has a confirmed diagnosis of ankylosing spondylitis for more than six months</ci>
                      <ci type="logical" class="Indication">Patient has low back pain and stiffness that is relieved by exercise but not by rest</ci>
                      <ci type="logical" class="Indication">Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan</ci>
                      <ci type="logical" class="Trial">Patient's ankylosing spondylitis has not responded adequately to treatment with two or more non-steroidal anti-inflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober's test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right)</ci>
                        <ci type="logical" class="Indication">Patient has limitation of chest expansion by at least 2.5 cm below the following average normal values corrected for age and gender (see Notes)</ci>
                      </apply>
                      <ci type="logical" class="Indication">A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of initial application.</p>
                  <p>Average normal chest expansion corrected for age and gender:</p>
                  <p/>
                  <p>18-24 years - Male: 7.0 cm; Female: 5.5 cm</p>
                  <p>25-34 years - Male: 7.5 cm; Female: 5.5 cm</p>
                  <p>35-44 years - Male: 6.5 cm; Female: 4.5 cm</p>
                  <p>45-54 years - Male: 6.0 cm; Female: 5.0 cm</p>
                  <p>55-64 years - Male: 5.5 cm; Female: 4.0 cm</p>
                  <p>65-74 years - Male: 4.0 cm; Female: 4.0 cm</p>
                  <p>75+ years - Male: 3.0 cm; Female: 2.5 cm</p>
                </div>
              </Case>
              <Case When="Initial application" Category="psoriatic arthritis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has had an initial Special Authority approval for etanercept for psoriatic arthritis</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient has experienced intolerable side effects from etanercept</ci>
                        <ci type="logical" class="Indication">The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for psoriatic arthritis</ci>
                      </apply>
                    </apply>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">Patient has had severe active psoriatic arthritis for six 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 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 sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses)</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least 15 swollen, tender joints</ci>
                        <ci type="logical" class="Indication">Patient has persistent symptoms of poorly controlled and active disease in at least four joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip</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">Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour</ci>
                        <ci type="logical" class="Indication">ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="rheumatoid arthritis" Form="SA0974 SA1026 SA1059 SA1156" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a rheumatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment</ci>
                    </apply>
                    <ci type="logical" class="Treatment">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 3 to 4 months' initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician</ci>
                      <ci type="logical" class="Trial">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>
                      <or/>
                      <ci type="logical" class="Endorsement">Adalimumab to be administered at doses no greater than 40 mg every 14 days</ci>
                      <ci type="logical" class="Endorsement">Patient cannot take concomitant methotrexate and requires doses of adalimumab higher than 40 mg every 14 days to maintain an adequate response</ci>
                    </apply>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Applicant Referring="rheumatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="Crohn's disease" Form="SA0974 SA1026 SA1059 SA1156" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a gastroenterologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a gastroenterologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment</ci>
                    </apply>
                    <apply>
                      <or/>
                      <apply>
                        <or/>
                        <ci type="logical" class="Endorsement">CDAI score has reduced by 100 points from the CDAI score when the patient was initiated on adalimumab</ci>
                        <ci type="logical" class="Endorsement">CDAI score is 150 or less</ci>
                      </apply>
                      <apply>
                        <and/>
                        <ci type="logical" class="Endorsement">The patient has demonstrated an adequate response to treatment but CDAI score cannot be assessed</ci>
                        <ci type="text" class="Endorsement">Applicant to indicate the reason that CDAI score cannot be assessed</ci>
                      </apply>
                    </apply>
                    <ci type="logical" class="Indication">Adalimumab to be administered at doses no greater than 40 mg every 14 days</ci>
                  </apply>
                </math>
                <Applicant>gastroenterologist</Applicant>
                <Applicant Referring="gastroenterologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="severe chronic plaque psoriasis" Form="SA0974 SA1026 SA1059 SA1156" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a dermatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment</ci>
                    </apply>
                    <apply>
                      <or/>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">Patient had "whole body" severe chronic plaque psoriasis at the start of treatment</ci>
                        <ci type="logical" class="Indication">Following each prior adalimumab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-adalimumab treatment baseline value</ci>
                      </apply>
                      <apply>
                        <and/>
                        <ci type="logical" class="Indication">Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment</ci>
                        <apply>
                          <or/>
                          <ci type="logical" class="Indication">Following each prior adalimumab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values</ci>
                          <ci type="logical" class="Indication">Following each prior adalimumab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre-adalimumab treatment baseline value</ci>
                        </apply>
                      </apply>
                    </apply>
                    <ci type="logical" class="Endorsement">Adalimumab to be administered at doses no greater than 40 mg every 14 days</ci>
                  </apply>
                </math>
                <Applicant>dermatologist</Applicant>
                <Applicant Referring="dermatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
                <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                  <p>A treatment course is defined as a minimum of 12 weeks adalimumab treatment</p>
                </div>
              </Case>
              <Case When="Renewal" Category="ankylosing spondylitis" Form="SA0974 SA1026 SA1059 SA1156">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a rheumatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment</ci>
                    </apply>
                    <ci type="logical" class="Indication">Following 12 weeks of adalimumab treatment, BASDAI has improved by 4 or more points from pre-adalimumab baseline on a 10 point scale, or by 50%, whichever is less</ci>
                    <ci type="logical" class="Indication">Physician considers that the patient has benefited from treatment and that continued treatment is appropriate</ci>
                    <ci type="logical" class="Endorsement">Adalimumab to be administered at doses no greater than 40 mg every 14 days</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Applicant Referring="rheumatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
              <Case When="Renewal" Category="psoriatic arthritis" Form="SA0974 SA1026 SA1059 SA1156">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Endorsement">Applicant is a rheumatologist</ci>
                      <ci type="logical" class="Endorsement">Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment</ci>
                    </apply>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Following 3 to 4 months' initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician</ci>
                      <ci type="logical" class="Indication">The patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to prior adalimumab treatment in the opinion of the treating physician</ci>
                    </apply>
                    <ci type="logical" class="Endorsement">Adalimumab to be administered at doses no greater than 40 mg every 14 days</ci>
                  </apply>
                </math>
                <Applicant>rheumatologist</Applicant>
                <Applicant Referring="rheumatologist">Practitioner</Applicant>
                <Term Measure="month">6</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1156"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A1908">
        <Name>Drugs Affecting Bone Metabolism</Name>
        <ATC3 ID="A190802">
          <Name>Alendronate for Osteoporosis</Name>
          <Chemical ID="C1908021037" Statim="Must">
            <Name>Alendronate sodium</Name>
            <Formulation ID="F190802103725" Rank="1" Units="tab" Weight="70">
              <Name>Tab 70 mg</Name>
              <Brand ID="B19080210372525">
                <Name>Fosamax</Name>
                <Pack ID="P2022133" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>22.90</Subsidy>
                  <Price>22.90</Price>
                  <Alternate>22.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1039"/>
          </Chemical>
          <Chemical ID="C1908023868" Statim="Must">
            <Name>Alendronate sodium with cholecalciferol</Name>
            <Formulation ID="F190802386826" Rank="1" Units="tab">
              <Name>Tab 70 mg with cholecalciferol 5,600 iu</Name>
              <Brand ID="B19080238682625">
                <Name>Fosamax Plus</Name>
                <Pack ID="P2337053" Specified="true">
                  <Quantity>4</Quantity>
                  <Subsidy>22.90</Subsidy>
                  <Price>22.90</Price>
                  <Alternate>22.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1039"/>
          </Chemical>
          <Request To="HealthPAC" For="Subsidy" Form="SA1039">
            <Title>
              <range>Alendronate Tab 70 mg - with or without Cholecalciferol</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 mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note)</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 (see Note)</ci>
                  <ci type="logical" class="Indication">A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note)</ci>
                  <ci type="logical" class="Indication">Patient has had a Special Authority approval for zoledronic acid (Underlying cause - Osteoporosis) or raloxifene</ci>
                </apply>
              </math>
              <Applicant>any relevant practitioner</Applicant>
              <Term Measure="patient's lifetime"/>
            </Case>
            <Case When="Initial application" Category="Underlying cause -- glucocorticosteroid therapy" Break="after">
              <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</ci>
                  <apply>
                    <or/>
                    <ci type="logical" class="Indication">The patient has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5) (see Note)</ci>
                    <ci type="logical" class="Indication">The patient has a history of one significant osteoporotic fracture demonstrated radiologically</ci>
                    <ci type="logical" class="Indication">The patient has had a Special Authority approval for zoledronic acid (Underlying cause - glucocorticosteroid therapy) or raloxifene</ci>
                  </apply>
                </apply>
              </math>
              <Applicant>any relevant practitioner</Applicant>
              <Term Measure="year">1</Term>
            </Case>
            <Case When="Renewal" Category="Underlying cause was, and remains, glucocorticosteroid therapy" Form="SA0511 SA0569 SA0614 SA0622 SA0693 SA0797 SA0948 SA0990 SA1039">
              <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>any relevant practitioner</Applicant>
              <Term Measure="year">1</Term>
            </Case>
            <Case When="Renewal" Category="Underlying cause was glucocorticosteroid therapy but patient now meets the `Underlying cause - osteoporosis' criteria" Form="SA0511 SA0569 SA0614 SA0622 SA0693 SA0797 SA0948 SA0990 SA1039">
              <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 mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note)</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 (see Note)</ci>
                  <ci type="logical" class="Indication">A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note)</ci>
                  <ci type="logical" class="Indication">Patient has had a Special Authority approval for zoledronic acid (Underlying cause was glucocorticosteroid therapy but patient now meets the `Underlying cause - Osteoporosis' criteria) or raloxifene</ci>
                </apply>
              </math>
              <Applicant>any relevant practitioner</Applicant>
              <Term Measure="patient's lifetime"/>
            </Case>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
              <ol style="list-style-type: lower-alpha">
                <li>
                  <p>BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable.</p>
                </li>
                <li>
                  <p>Evidence used by National Institute for Health and 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.</p>
                </li>
                <li>
                  <p>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.</p>
                </li>
                <li>
                  <p>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.</p>
                </li>
              </ol>
            </div>
          </Request>
        </ATC3>
        <ATC3 ID="A190804">
          <Name>Alendronate for Paget's Disease</Name>
          <Chemical ID="C1908041037" Statim="Must">
            <Name>Alendronate sodium</Name>
            <Formulation ID="F190804103702" Rank="1" Units="tab" Weight="40">
              <Name>Tab 40 mg</Name>
              <Brand ID="B19080410370201">
                <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="SA0949"/>
          </Chemical>
          <Request To="HealthPAC" For="Subsidy" Form="SA0949">
            <Title>
              <range>Alendronate for Paget's 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>any relevant practitioner</Applicant>
              <Term Measure="month">6</Term>
            </Case>
            <Case When="Renewal" Form="SA0467 SA0949">
              <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="month">6</Term>
            </Case>
          </Request>
        </ATC3>
        <ATC3 ID="A190806">
          <Name>Other Treatments</Name>
          <Chemical ID="C1908061188" Statim="Must">
            <Name>Calcitonin</Name>
            <Formulation ID="F190806118802" Rank="4" Units="inj" Weight="100">
              <Name>Inj 100 iu per ml, 1 ml</Name>
              <Brand ID="B19080611880201" SoleSupply="true">
                <Name>Miacalcic</Name>
                <Pack ID="P259012" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>110.00</Subsidy>
                  <Price>110.00</Price>
                  <Alternate>110.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1908061487" Statim="Must">
            <Name>Etidronate disodium</Name>
            <Formulation ID="F190806148701" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mg</Name>
              <Brand ID="B19080614870126" SoleSupply="true">
                <Name>Arrow-Etidronate</Name>
                <Pack ID="P2341999" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>23.95</Subsidy>
                  <Price>23.95</Price>
                  <Alternate>23.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Guideline" id="PG0650C1908061487">
              <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>
            <Rule Type="Guideline" xlink:href="PG0650C1908061487"/>
          </Chemical>
          <Chemical ID="C1908063913">
            <Name>Zoledronic acid</Name>
            <Formulation ID="F190806391325" Rank="3" Units="ml" Weight="5">
              <Name>Soln for infusion 5 mg in 100 ml</Name>
              <Brand ID="B19080639132525">
                <Name>Aclasta</Name>
                <Pack ID="P2274876" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>600.00</Subsidy>
                  <Price>600.00</Price>
                  <Alternate>600.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1187">
              <Title>
                <range>Zoledronic acid</range>
              </Title>
              <Case When="Initial application" Category="Paget's disease">
                <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</ci>
                      <ci type="logical" class="Indication">Preparation for orthopaedic surgery</ci>
                    </apply>
                    <ci type="logical" class="Indication">The patient will not be prescribed more than one infusion in the 12-month approval period</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Initial application" Category="Underlying cause - Osteoporosis" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note)</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 (see Note)</ci>
                      <ci type="logical" class="Indication">A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note)</ci>
                      <ci type="logical" class="Indication">Patient has had a Special Authority approval for alendronate (Underlying cause - Osteoporosis) or raloxifene</ci>
                    </apply>
                    <ci type="logical" class="Indication">The patient will not be prescribed more than one infusion in a 12-month period</ci>
                  </apply>
                </math>
                <Applicant>any relevant 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 glucocorticosteroid therapy (≥5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">The patient has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5) (see Note)</ci>
                      <ci type="logical" class="Indication">The patient has a history of one significant osteoporotic fracture demonstrated radiologically</ci>
                      <ci type="logical" class="Indication">The patient has had a Special Authority approval for alendronate (Underlying cause - glucocorticosteroid therapy) or raloxifene</ci>
                    </apply>
                    <ci type="logical" class="Indication">The patient will not be prescribed more than one infusion in the 12-month approval period</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
              </Case>
              <Case When="Renewal" Category="Paget's disease" Form="SA1035 SA1187">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">The patient has relapsed (based on increases in serum alkaline phosphatase)</ci>
                      <ci type="logical" class="Indication">The patient's serum alkaline phosphatase has not normalised following previous treatment with zoledronic acid</ci>
                      <ci type="logical" class="Indication">Symptomatic disease (prescriber determined)</ci>
                    </apply>
                    <ci type="logical" class="Indication">The patient will not be prescribed more than one infusion in the 12-month approval period</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
                <History>
                  <Term Measure="month">12</Term>
                  <Maximum>2</Maximum>
                </History>
              </Case>
              <Case When="Renewal" Category="Underlying cause was, and remains, glucocorticosteroid therapy" Form="SA1035 SA1187" Break="after">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <ci type="logical" class="Indication">The patient is continuing systemic glucocorticosteriod therapy (≥5 mg per day prednisone equivalents)</ci>
                    <ci type="logical" class="Indication">The patient will not be prescribed more than one infusion in the 12-month approval period</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">1</Term>
                <History>
                  <Term Measure="month">12</Term>
                  <Maximum>2</Maximum>
                </History>
              </Case>
              <Case When="Renewal" Category="Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - osteoporosis' criteria" Form="SA1035 SA1187">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note)</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 (see Note)</ci>
                      <ci type="logical" class="Indication">A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note)</ci>
                      <ci type="logical" class="Indication">Patient has had a Special Authority approval for alendronate (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - Osteoporosis' criteria) or raloxifene</ci>
                    </apply>
                    <ci type="logical" class="Indication">The patient will not be prescribed more than one infusion in a 12-month period</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ol style="list-style-type: lower-alpha">
                  <li>
                    <p>BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable.</p>
                  </li>
                  <li>
                    <p>Evidence used by National Institute for Health and 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.</p>
                  </li>
                  <li>
                    <p>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.</p>
                  </li>
                  <li>
                    <p>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.</p>
                  </li>
                </ol>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1187"/>
          </Chemical>
          <Chemical ID="C1908063938" Statim="Must">
            <Name>Raloxifene hydrochloride</Name>
            <Formulation ID="F190806393825" Rank="1" Units="tab" Weight="60">
              <Name>Tab 60 mg</Name>
              <Brand ID="B19080639382525">
                <Name>Evista</Name>
                <Pack ID="P237523" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>53.76</Subsidy>
                  <Price>53.76</Price>
                  <Alternate>53.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1138">
              <Title>
                <range>Raloxifene</range>
              </Title>
              <Case When="Initial application">
                <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 mineral density (BMD) ≥2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Notes)</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 (see Notes)</ci>
                    <ci type="logical" class="indication">A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Notes)</ci>
                    <ci type="logical" class="indication">Patient has had a prior Special Authority approval for zoledronic acid (Underlying cause - Osteoporosis) or alendronate (Underlying cause - Osteoporosis)</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ol style="list-style-type: lower-alpha">
                  <li>
                    <p>BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable.</p>
                  </li>
                  <li>
                    <p>Evidence used by the UK National Institute for Health and Clinical Excellence (NICE) in developing its 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 raloxifene funding.</p>
                  </li>
                  <li>
                    <p>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.</p>
                  </li>
                  <li>
                    <p>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.</p>
                  </li>
                </ol>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1138"/>
          </Chemical>
          <Chemical ID="C1908063939">
            <Name>Teriparatide</Name>
            <Formulation ID="F190806393925" Rank="4" Units="inj" Weight="250">
              <Name>Inj 250 mcg per ml, 2.4 ml</Name>
              <Brand ID="B19080639392525">
                <Name>Forteo</Name>
                <Pack ID="P2222906" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>490.00</Subsidy>
                  <Price>490.00</Price>
                  <Alternate>490.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1139">
              <Title>
                <range>Teriparatide</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 severe, established osteoporosis</ci>
                    <ci type="logical" class="indication">The patient has a documented T-score less than or equal to -3.0 (see Notes)</ci>
                    <ci type="logical" class="indication">The patient has had two or more fractures due to minimal trauma</ci>
                    <ci type="logical" class="indication">The patient has experienced at least one symptomatic new fracture after at least 12 months’ continuous therapy with a funded antiresorptive agent at adequate doses (see Notes)</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">18</Term>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <ol style="list-style-type: lower-alpha">
                  <li>
                    <p>The bone mineral density (BMD) measurement used to derive the T-score must be made using dual-energy x-ray absorptiometry (DXA).  Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable</p>
                  </li>
                  <li>
                    <p>Antiresorptive agents and their adequate doses for the purposes of this Special Authority are defined as: alendronate sodium tab 70 mg or tab 70 mg with cholecalciferol 5,600 iu once weekly; raloxifene hydrochloride tab 60 mg once daily; zoledronic acid 5 mg per year.  If an intolerance of a severity necessitating permanent treatment withdrawal develops during the use of one antiresorptive agent, an alternate antiresorptive agent must be trialled so that the patient achieves the minimum requirement of 12 months’ continuous therapy.</p>
                  </li>
                  <li>
                    <p>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.</p>
                  </li>
                  <li>
                    <p>A maximum of 18 months of treatment (18 cartridges) will be subsidised.</p>
                  </li>
                </ol>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1139"/>
          </Chemical>
          <Chemical ID="C1908066033">
            <Name>Pamidronate disodium</Name>
            <Formulation ID="F190806603301" Rank="4" Units="inj" Weight="30">
              <Name>Inj 3 mg per ml, 10 ml</Name>
              <Brand ID="B19080660330126">
                <Name>Pamisol</Name>
                <Pack ID="P2113759" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>37.50</Subsidy>
                  <Price>37.50</Price>
                  <Alternate>37.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190806603325" Rank="4" Units="inj" Weight="15">
              <Name>Inj 3 mg per ml, 5 ml</Name>
              <Brand ID="B19080660332526">
                <Name>Pamisol</Name>
                <Pack ID="P2113740" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>18.75</Subsidy>
                  <Price>18.75</Price>
                  <Alternate>18.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190806603326" Rank="4" Units="inj" Weight="60">
              <Name>Inj 6 mg per ml, 10 ml</Name>
              <Brand ID="B19080660332626">
                <Name>Pamisol</Name>
                <Pack ID="P2113775" Specified="true">
                  <Quantity>1</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>75.00</Subsidy>
                  <Price>75.00</Price>
                  <Alternate>75.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F190806603327" Rank="4" Units="inj" Weight="90">
              <Name>Inj 9 mg per ml, 10 ml</Name>
              <Brand ID="B19080660332725">
                <Name>Pamisol</Name>
                <Pack ID="P2034190" Specified="true">
                  <Quantity>1</Quantity>
                  <Subsidy>112.50</Subsidy>
                  <Price>112.50</Price>
                  <Alternate>112.50</Alternate>
                  <Surcharge>0.00000</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" Statim="Must">
            <Name>Allopurinol</Name>
            <Formulation ID="F191301102601" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B19130110260104" SoleSupply="true">
                <Name>Apo-Allopurinol</Name>
                <Pack ID="P2383993" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>15.90</Subsidy>
                  <Price>15.90</Price>
                  <Alternate>15.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F191301102602" Rank="1" Units="tab" Weight="300">
              <Name>Tab 300 mg</Name>
              <Brand ID="B19130110260202" SoleSupply="true">
                <Name>Apo-Allopurinol</Name>
                <Pack ID="P2383977" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>16.75</Subsidy>
                  <Price>16.75</Price>
                  <Alternate>16.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C1913011341" 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" Statim="Must">
            <Name>Probenecid</Name>
            <Formulation ID="F191301204201" Rank="1" Units="tab" Weight="500">
              <Name>Tab 500 mg</Name>
              <Brand ID="B19130120420125">
                <Name>Probenecid-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" Statim="Must">
            <Name>Dantrolene sodium</Name>
            <Formulation ID="F191601137301" Rank="2" Units="cap" Weight="25">
              <Name>Cap 25 mg</Name>
              <Brand ID="B19160113730101">
                <Name>Dantrium</Name>
                <Pack ID="P252409" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>32.96</Subsidy>
                  <Price>65.00</Price>
                  <Alternate>32.96</Alternate>
                  <Surcharge>0.32040</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F191601137302" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B19160113730201">
                <Name>Dantrium</Name>
                <Pack ID="P252417" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>51.70</Subsidy>
                  <Price>77.00</Price>
                  <Alternate>51.70</Alternate>
                  <Surcharge>0.25300</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1916011908">
            <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>
          </Chemical>
          <Chemical ID="C1916012079" Statim="Must">
            <Name>Quinine sulphate</Name>
            <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>54.06</Subsidy>
                  <Price>54.06</Price>
                  <Alternate>54.06</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C1916012364" Statim="Must">
            <Name>Baclofen</Name>
            <Formulation ID="F191601236401" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B19160123640101" SoleSupply="true">
                <Name>Pacifen</Name>
                <Pack ID="P403903" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.75</Subsidy>
                  <Price>4.75</Price>
                  <Alternate>4.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
    </ATC1>
    <ATC1 ID="A22">
      <Name>Nervous System</Name>
      <ATC2 ID="A2201">
        <Name>Agents for Parkinsonism and Related Disorders</Name>
        <ATC3 ID="A220101">
          <Name>Dopamine Agonists and Related Agents</Name>
          <Chemical ID="C2201011024" Statim="May">
            <Name>Apomorphine hydrochloride</Name>
            <Formulation ID="F220101102425" Rank="4" Units="inj">
              <Name>Inj 10 mg per ml, 2 ml</Name>
              <Brand ID="B22010110242526">
                <Name>Apomine</Name>
                <Pack ID="P2361124" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>110.00</Subsidy>
                  <Price>110.00</Price>
                  <Alternate>110.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201011032" Statim="May">
            <Name>Pergolide</Name>
            <Formulation ID="F220101103201" Rank="1" Units="tab" Weight="0.25">
              <Name>Tab 0.25 mg</Name>
              <Brand ID="B22010110320101" SoleSupply="true">
                <Name>Permax</Name>
                <Pack ID="P318566" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>48.00</Subsidy>
                  <Price>48.00</Price>
                  <Alternate>48.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101103202" Rank="1" Units="tab" Weight="1">
              <Name>Tab 1 mg</Name>
              <Brand ID="B22010110320201" SoleSupply="true">
                <Name>Permax</Name>
                <Pack ID="P318558" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>170.00</Subsidy>
                  <Price>170.00</Price>
                  <Alternate>170.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201011048" Statim="May">
            <Name>Amantadine hydrochloride</Name>
            <Formulation ID="F220101104801" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B22010110480101" SoleSupply="true">
                <Name>Symmetrel</Name>
                <Pack ID="P788589" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>38.24</Subsidy>
                  <Price>38.24</Price>
                  <Alternate>38.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201011138" Statim="May">
            <Name>Tolcapone</Name>
            <Formulation ID="F220101113801" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22010111380101" SoleSupply="true">
                <Name>Tasmar</Name>
                <Pack ID="P487236" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>126.20</Subsidy>
                  <Price>126.20</Price>
                  <Alternate>126.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201011167" Statim="Must">
            <Name>Bromocriptine mesylate</Name>
            <Formulation ID="F220101116701" Rank="1" Units="tab" Weight="2.5">
              <Name>Tab 2.5 mg</Name>
              <Brand ID="B22010111670102">
                <Name>Apo-Bromocriptine</Name>
                <Pack ID="P793086" 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="F220101116725" Rank="2" Units="cap" Weight="5">
              <Name>Cap 5 mg</Name>
              <Brand ID="B22010111672525">
                <Name>Apo-Bromocriptine</Name>
                <Pack ID="P2329492" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>60.43</Subsidy>
                  <Price>60.43</Price>
                  <Alternate>60.43</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201011717" Statim="Must">
            <Name>Levodopa with benserazide</Name>
            <Formulation ID="F220101171702" Rank="2" Units="cap" Weight="200">
              <Name>Cap 200 mg with benserazide 50 mg</Name>
              <Brand ID="B22010117170201">
                <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="F220101171706" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg with benserazide 25 mg</Name>
              <Brand ID="B22010117170601">
                <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="F220101171707" Rank="2" Units="cap" Weight="100">
              <Name>Cap long-acting 100 mg with benserazide 25 mg</Name>
              <Brand ID="B22010117170701">
                <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>
            </Formulation>
            <Formulation ID="F220101171708" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg with benserazide 12.5 mg</Name>
              <Brand ID="B22010117170801">
                <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="F220101171709" Rank="1" Units="tab" Weight="50">
              <Name>Tab dispersible 50 mg with benserazide 12.5 mg</Name>
              <Brand ID="B22010117170901">
                <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="C2201011723" Statim="Must">
            <Name>Levodopa with carbidopa</Name>
            <Formulation ID="F220101172301" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg with carbidopa 25 mg</Name>
              <Brand ID="B22010117230101">
                <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="B22010117230102">
                <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>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F220101172302" Rank="1" Units="tab" Weight="250">
              <Name>Tab 250 mg with carbidopa 25 mg</Name>
              <Brand ID="B22010117230201">
                <Name>Sinemet</Name>
                <Pack ID="P204706" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>40.00</Subsidy>
                  <Price>40.00</Price>
                  <Alternate>40.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101172303" Rank="1" Units="tab" Weight="200">
              <Name>Tab long-acting 200 mg with carbidopa 50 mg</Name>
              <Brand ID="B22010117230301">
                <Name>Sinemet CR</Name>
                <Pack ID="P699624" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>47.50</Subsidy>
                  <Price>47.50</Price>
                  <Alternate>47.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201012531" Statim="May">
            <Name>Lisuride hydrogen maleate</Name>
            <Formulation ID="F220101253101" Rank="1" Units="tab" Weight="200">
              <Name>Tab 200 mcg</Name>
              <Brand ID="B22010125310101">
                <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="C2201012642" Statim="Must">
            <Name>Selegiline hydrochloride</Name>
            <Formulation ID="F220101264201" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22010126420102" 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="C2201013829" Statim="May">
            <Name>Entacapone</Name>
            <Formulation ID="F220101382925" Rank="1" Units="tab">
              <Name>Tab 200 mg</Name>
              <Brand ID="B22010138292525" SoleSupply="true">
                <Name>Comtan</Name>
                <Pack ID="P2110601" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>116.00</Subsidy>
                  <Price>116.00</Price>
                  <Alternate>116.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201013830" Statim="May">
            <Name>Ropinirole hydrochloride</Name>
            <Formulation ID="F220101383025" Rank="1" Units="tab">
              <Name>Tab 0.25 mg</Name>
              <Brand ID="B22010138302526" SoleSupply="true">
                <Name>Ropin</Name>
                <Pack ID="P2310856" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>6.20</Subsidy>
                  <Price>6.20</Price>
                  <Alternate>6.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101383026" Rank="1" Units="tab">
              <Name>Tab 1 mg</Name>
              <Brand ID="B22010138302626" SoleSupply="true">
                <Name>Ropin</Name>
                <Pack ID="P2310864" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>15.95</Subsidy>
                  <Price>15.95</Price>
                  <Alternate>15.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101383027" Rank="1" Units="tab">
              <Name>Tab 2 mg</Name>
              <Brand ID="B22010138302726" SoleSupply="true">
                <Name>Ropin</Name>
                <Pack ID="P2310872" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>24.95</Subsidy>
                  <Price>24.95</Price>
                  <Alternate>24.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101383028" Rank="1" Units="tab">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22010138302826" SoleSupply="true">
                <Name>Ropin</Name>
                <Pack ID="P2310880" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>38.00</Subsidy>
                  <Price>38.00</Price>
                  <Alternate>38.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201013942" Statim="May">
            <Name>Pramipexole HCl</Name>
            <Formulation ID="F220101394225" Rank="1" Units="tab" Weight="125">
              <Name>Tab 0.125 mg</Name>
              <Brand ID="B22010139422525">
                <Name>Dr Reddy's Pramipexole</Name>
                <Pack ID="P2384868" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>1.95</Subsidy>
                  <Price>1.95</Price>
                  <Alternate>1.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101394226" Rank="1" Units="tab" Weight="250">
              <Name>Tab 0.25 mg</Name>
              <Brand ID="B22010139422625">
                <Name>Dr Reddy's Pramipexole</Name>
                <Pack ID="P2384841" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.40</Subsidy>
                  <Price>2.40</Price>
                  <Alternate>2.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220101394227" Rank="1" Units="tab" Weight="500">
              <Name>Tab 0.5 mg</Name>
              <Brand ID="B22010139422725">
                <Name>Dr Reddy's Pramipexole</Name>
                <Pack ID="P2384876" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>4.20</Subsidy>
                  <Price>4.20</Price>
                  <Alternate>4.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220104">
          <Name>Anticholinergics</Name>
          <Chemical ID="C2201041130">
            <Name>Benztropine mesylate</Name>
            <Formulation ID="F220104113001" Rank="1" Units="tab" Weight="2">
              <Name>Tab 2 mg</Name>
              <Brand ID="B22010411300125">
                <Name>Benztrop</Name>
                <Pack ID="P2123169" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>7.99</Subsidy>
                  <Price>7.99</Price>
                  <Alternate>7.99</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220104113002" Rank="4" Units="inj" Weight="2">
              <Name>Inj 1 mg per ml, 2 ml</Name>
              <Brand ID="B22010411300201">
                <Name>Cogentin</Name>
                <Pack ID="P2095033" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>95.00</Subsidy>
                  <Price>95.00</Price>
                  <Alternate>95.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormReqd" Attribute="PSO"/>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201041909">
            <Name>Orphenadrine hydrochloride</Name>
            <Formulation ID="F220104190901" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22010419090101">
                <Name>Disipal</Name>
                <Pack ID="P258679" Specified="true">
                  <Quantity>250</Quantity>
                  <Subsidy>35.15</Subsidy>
                  <Price>35.15</Price>
                  <Alternate>35.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2201042049">
            <Name>Procyclidine hydrochloride</Name>
            <Formulation ID="F220104204901" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22010420490101">
                <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>
        <ATC3 ID="A220107">
          <Name>Agents for Essential Tremor, Chorea and Related Disorders</Name>
          <Chemical ID="C2201072237">
            <Name>Tetrabenazine</Name>
            <Formulation ID="F220107223701" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22010722370125" ToBeDelisted="2012-08-01">
                <Name>Xenazine 25</Name>
                <Pack ID="P2024004" Specified="true">
                  <Quantity>112</Quantity>
                  <Subsidy>178.00</Subsidy>
                  <Price>178.00</Price>
                  <Alternate>178.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22010722370126">
                <Name>Motetis</Name>
                <Pack ID="P2394383" Specified="true">
                  <Quantity>112</Quantity>
                  <Subsidy>178.00</Subsidy>
                  <Price>178.00</Price>
                  <Alternate>178.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A2202">
        <Name>Anaesthetics</Name>
        <ATC3 ID="A220201">
          <Name>Local</Name>
          <Chemical ID="C2202011715">
            <Name>Lignocaine with prilocaine</Name>
            <Formulation ID="F220201171501" Rank="3" Units="g" Weight="2.5">
              <Name>Crm 2.5% with prilocaine 2.5%</Name>
              <Brand ID="B22020117150101" SoleSupply="true">
                <Name>EMLA</Name>
                <Pack ID="P719757" OP="true" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>45.00</Subsidy>
                  <Price>45.00</Price>
                  <Alternate>45.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220201171502" Rank="9" Units="tube" Weight="2.5">
              <Name>Crm 2.5% with prilocaine 2.5% (5 g tubes)</Name>
              <Brand ID="B22020117150201" SoleSupply="true">
                <Name>EMLA</Name>
                <Pack ID="P657697" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>45.00</Subsidy>
                  <Price>45.00</Price>
                  <Alternate>45.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0906">
              <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 with a chronic medical condition requiring frequent injections or venepuncture</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0323 SA0906">
                <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="SA0906"/>
          </Chemical>
          <Chemical ID="C2202011719">
            <Name>Lignocaine hydrochloride</Name>
            <Formulation ID="F220201171907" Rank="4" Units="inj" Weight="20">
              <Name>Inj 1%, 20 ml</Name>
              <Brand ID="B22020117190701" SoleSupply="true">
                <Name>Xylocaine</Name>
                <Pack ID="P728128" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>20.00</Subsidy>
                  <Price>20.00</Price>
                  <Alternate>20.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220201171910" Rank="4" Units="inj" Weight="5">
              <Name>Inj 1%, 5 ml</Name>
              <Brand ID="B22020117191001" SoleSupply="true">
                <Name>Xylocaine</Name>
                <Pack ID="P311219" Specified="true">
                  <Quantity>50</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>35.00</Subsidy>
                  <Price>35.00</Price>
                  <Alternate>35.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220201171925" Rank="4" Units="inj" Weight="10">
              <Name>Inj 2%, 5 ml</Name>
              <Brand ID="B22020117192525">
                <Name>Xylocaine</Name>
                <Pack ID="P311235" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>23.00</Subsidy>
                  <Price>23.00</Price>
                  <Alternate>23.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220201171926" Rank="4" Units="inj" Weight="40">
              <Name>Inj 2%, 20 ml</Name>
              <Brand ID="B22020117192625">
                <Name>Xylocaine</Name>
                <Pack ID="P705721" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>15.00</Subsidy>
                  <Price>15.00</Price>
                  <Alternate>15.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220201171927" Rank="3" Units="ml">
              <Name>Viscous soln 2%</Name>
              <Brand ID="B22020117192725" SoleSupply="true">
                <Name>Xylocaine Viscous</Name>
                <Pack ID="P290513" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>55.00</Subsidy>
                  <Price>55.00</Price>
                  <Alternate>55.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2202013871">
            <Name>Lignocaine with chlorhexidine</Name>
            <Formulation ID="F220201387125" Rank="10" Units="each">
              <Name>Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringes</Name>
              <Brand ID="B22020138712525">
                <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>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Subsidised only if prescribed for urethral or cervical administration and the prescription is endorsed accordingly.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C2202013905">
            <Name>Lignocaine</Name>
            <Formulation ID="F220201390525" Rank="10" Units="each">
              <Name>Gel 2%, 10 ml urethral syringe</Name>
              <Brand ID="B22020139052525">
                <Name>Pfizer</Name>
                <Pack ID="P2351277" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>43.26</Subsidy>
                  <Price>43.26</Price>
                  <Alternate>43.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Subsidised only if prescribed for urethral or cervical administration and the prescription is endorsed accordingly.</p>
              </div>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A2204">
        <Name>Analgesics</Name>
        <ATC3 ID="A220404">
          <Name>Non-opioid Analgesics</Name>
          <Chemical ID="C2204041087" Statim="Must">
            <Name>Aspirin</Name>
            <Formulation ID="F220404108701" Rank="1" Units="tab" Weight="300">
              <Name>Tab dispersible 300 mg</Name>
              <Brand ID="B22040410870125" SoleSupply="true">
                <Name>Ethics Aspirin</Name>
                <Pack ID="P2184338" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.00</Subsidy>
                  <Price>2.00</Price>
                  <Alternate>2.00</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>2.00</Subsidy>
                  <Price>8.10</Price>
                  <Alternate>2.00</Alternate>
                  <Surcharge>0.06100</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204041849">
            <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>
          </Chemical>
          <Chemical ID="C2204041929" 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="B22040419290226" SoleSupply="true">
                <Name>Ethics Paracetamol</Name>
                <Pack ID="P2371871" Specified="true">
                  <Quantity>500</Quantity>
                  <Subsidy>2.21</Subsidy>
                  <Price>2.21</Price>
                  <Alternate>2.21</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="B22040419290305" SoleSupply="true">
                <Name>Paracare Double Strength</Name>
                <Pack ID="P306088" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>6.70</Subsidy>
                  <Price>6.70</Price>
                  <Alternate>6.70</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">
                <Name>Panadol</Name>
                <Pack ID="P734756" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>7.49</Subsidy>
                  <Price>7.49</Price>
                  <Alternate>7.49</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">
                <Name>Panadol</Name>
                <Pack ID="P734764" Specified="true">
                  <Quantity>20</Quantity>
                  <Subsidy>14.40</Subsidy>
                  <Price>14.40</Price>
                  <Alternate>14.40</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="B22040419290827" SoleSupply="true">
                <Name>Parafast</Name>
                <Pack ID="P2390647" Specified="true">
                  <Quantity>1000</Quantity>
                  <Subsidy>9.38</Subsidy>
                  <Price>9.38</Price>
                  <Alternate>9.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="30" Attribute="PSO"/>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204043906">
            <Name>Tramadol hydrochloride</Name>
            <Formulation ID="F220404390625" Rank="2" Units="cap" Weight="50">
              <Name>Cap 50 mg</Name>
              <Brand ID="B22040439062525" SoleSupply="true">
                <Name>Arrow-Tramadol</Name>
                <Pack ID="P2351889" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>4.95</Subsidy>
                  <Price>4.95</Price>
                  <Alternate>4.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220407">
          <Name>Opioid Analgesics</Name>
          <Chemical ID="C2204071332">
            <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>5.39</Subsidy>
                  <Price>5.39</Price>
                  <Alternate>5.39</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>8.25</Subsidy>
                  <Price>8.25</Price>
                  <Alternate>8.25</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>17.76</Subsidy>
                  <Price>17.76</Price>
                  <Alternate>17.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204071795">
            <Name>Methadone hydrochloride</Name>
            <Formulation ID="F220407179501" Rank="1" Units="tab" Weight="5">
              <Name>Tab 5 mg</Name>
              <Brand ID="B22040717950101" SoleSupply="true">
                <Name>Methatabs</Name>
                <Pack ID="P765503" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.85</Subsidy>
                  <Price>1.85</Price>
                  <Alternate>1.85</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="P2265710" Specified="true">
                  <Quantity>10</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>61.00</Subsidy>
                  <Price>61.00</Price>
                  <Alternate>61.00</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" SoleSupply="true">
                <Name>Biodone</Name>
                <Pack ID="P361372" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>5.95</Subsidy>
                  <Price>5.95</Price>
                  <Alternate>5.95</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" SoleSupply="true">
                <Name>Biodone Forte</Name>
                <Pack ID="P412341" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>5.55</Subsidy>
                  <Price>5.55</Price>
                  <Alternate>5.55</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" SoleSupply="true">
                <Name>Biodone Extra Forte</Name>
                <Pack ID="P412325" Specified="true">
                  <Quantity>200</Quantity>
                  <Subsidy>8.95</Subsidy>
                  <Price>8.95</Price>
                  <Alternate>8.95</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
            <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="Controlled"/>
            <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
              <p xlink:type="simple" xlink:href="standard-formulae">For methadone hydrochloride oral liquid refer</p>
            </div>
          </Chemical>
          <Chemical ID="C2204071830">
            <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>8.84</Subsidy>
                  <Price>8.84</Price>
                  <Alternate>8.84</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>11.62</Subsidy>
                  <Price>11.62</Price>
                  <Alternate>11.62</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>14.65</Subsidy>
                  <Price>14.65</Price>
                  <Alternate>14.65</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>21.55</Subsidy>
                  <Price>21.55</Price>
                  <Alternate>21.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="Controlled"/>
          </Chemical>
          <Chemical ID="C2204071831">
            <Name>Morphine sulphate</Name>
            <Formulation ID="F220407183101" Rank="1" Units="tab" Weight="10">
              <Name>Tab long-acting 10 mg</Name>
              <Brand ID="B22040718310125" SoleSupply="true">
                <Name>Arrow-Morphine LA</Name>
                <Pack ID="P2383934" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>1.98</Subsidy>
                  <Price>1.98</Price>
                  <Alternate>1.98</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183102" Rank="1" Units="tab" Weight="30">
              <Name>Tab long-acting 30 mg</Name>
              <Brand ID="B22040718310225" SoleSupply="true">
                <Name>Arrow-Morphine LA</Name>
                <Pack ID="P2383942" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>3.15</Subsidy>
                  <Price>3.15</Price>
                  <Alternate>3.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183103" Rank="1" Units="tab" Weight="60">
              <Name>Tab long-acting 60 mg</Name>
              <Brand ID="B22040718310325" SoleSupply="true">
                <Name>Arrow-Morphine LA</Name>
                <Pack ID="P2383918" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>7.20</Subsidy>
                  <Price>7.20</Price>
                  <Alternate>7.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407183104" Rank="1" Units="tab" Weight="100">
              <Name>Tab long-acting 100 mg</Name>
              <Brand ID="B22040718310425" SoleSupply="true">
                <Name>Arrow-Morphine LA</Name>
                <Pack ID="P2383926" 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="F220407183107" Rank="4" Units="inj" Weight="5">
              <Name>Inj 5 mg per ml, 1 ml</Name>
              <Brand ID="B22040718310701" SoleSupply="true">
                <Name>DBL Morphine Sulphate</Name>
                <Pack ID="P347930" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>5.51</Subsidy>
                  <Price>5.51</Price>
                  <Alternate>5.51</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" SoleSupply="true">
                <Name>DBL Morphine Sulphate</Name>
                <Pack ID="P395013" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>4.79</Subsidy>
                  <Price>4.79</Price>
                  <Alternate>4.79</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>DBL Morphine Sulphate</Name>
                <Pack ID="P395005" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>5.01</Subsidy>
                  <Price>5.01</Price>
                  <Alternate>5.01</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" SoleSupply="true">
                <Name>DBL Morphine Sulphate</Name>
                <Pack ID="P394998" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>5.30</Subsidy>
                  <Price>5.30</Price>
                  <Alternate>5.30</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </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>8.05</Subsidy>
                  <Price>8.05</Price>
                  <Alternate>8.05</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>2.80</Subsidy>
                  <Price>2.80</Price>
                  <Alternate>2.80</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>5.52</Subsidy>
                  <Price>5.52</Price>
                  <Alternate>5.52</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>2.22</Subsidy>
                  <Price>2.22</Price>
                  <Alternate>2.22</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>3.20</Subsidy>
                  <Price>3.20</Price>
                  <Alternate>3.20</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>6.90</Subsidy>
                  <Price>6.90</Price>
                  <Alternate>6.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="Controlled"/>
          </Chemical>
          <Chemical ID="C2204071931" Statim="Must">
            <Name>Paracetamol with codeine</Name>
            <Formulation ID="F220407193101" Rank="1" Units="tab" Weight="500">
              <Name>Tab paracetamol 500 mg with codeine phosphate 8 mg</Name>
              <Brand ID="B22040719310127" SoleSupply="true">
                <Name>Paracetamol + Codeine (Relieve)</Name>
                <Pack ID="P2383454" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>2.70</Subsidy>
                  <Price>2.70</Price>
                  <Alternate>2.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204071953">
            <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>3.20</Subsidy>
                  <Price>3.20</Price>
                  <Alternate>3.20</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>4.20</Subsidy>
                  <Price>4.20</Price>
                  <Alternate>4.20</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" SoleSupply="true">
                <Name>DBL Pethidine Hydrochloride</Name>
                <Pack ID="P500429" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>5.51</Subsidy>
                  <Price>5.51</Price>
                  <Alternate>5.51</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" SoleSupply="true">
                <Name>DBL Pethidine Hydrochloride</Name>
                <Pack ID="P394971" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>5.83</Subsidy>
                  <Price>5.83</Price>
                  <Alternate>5.83</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
                <Pack ID="P763241">
                  <Quantity>50</Quantity>
                  <Multiple>1</Multiple>
                  <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">
            <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>Hospira</Name>
                <Pack ID="P615137" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>30.00</Subsidy>
                  <Price>30.00</Price>
                  <Alternate>30.00</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>Hospira</Name>
                <Pack ID="P552453" Specified="true">
                  <Quantity>5</Quantity>
                  <Multiple>1</Multiple>
                  <Subsidy>75.00</Subsidy>
                  <Price>75.00</Price>
                  <Alternate>75.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="Controlled"/>
          </Chemical>
          <Chemical ID="C2204072427">
            <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>27.27</Subsidy>
                  <Price>27.27</Price>
                  <Alternate>27.27</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2204073801">
            <Name>Fentanyl</Name>
            <Formulation ID="F220407380133" Rank="9" Units="patch" Weight="12">
              <Name>Transdermal patch 12.5 mcg per hour</Name>
              <Brand ID="B22040738013325" SoleSupply="true">
                <Name>Mylan Fentanyl Patch</Name>
                <Pack ID="P2351927" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>8.90</Subsidy>
                  <Price>8.90</Price>
                  <Alternate>8.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407380134" Rank="9" Units="patch" Weight="25">
              <Name>Transdermal patch 25 mcg per hour</Name>
              <Brand ID="B22040738013425" SoleSupply="true">
                <Name>Mylan Fentanyl Patch</Name>
                <Pack ID="P2351935" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>9.15</Subsidy>
                  <Price>9.15</Price>
                  <Alternate>9.15</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407380135" Rank="9" Units="patch" Weight="50">
              <Name>Transdermal patch 50 mcg per hour</Name>
              <Brand ID="B22040738013525" SoleSupply="true">
                <Name>Mylan Fentanyl Patch</Name>
                <Pack ID="P2351943" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407380136" Rank="9" Units="patch" Weight="75">
              <Name>Transdermal patch 75 mcg per hour</Name>
              <Brand ID="B22040738013625" SoleSupply="true">
                <Name>Mylan Fentanyl Patch</Name>
                <Pack ID="P2351951" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>13.60</Subsidy>
                  <Price>13.60</Price>
                  <Alternate>13.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407380137" Rank="9" Units="patch" Weight="100">
              <Name>Transdermal patch 100 mcg per hour</Name>
              <Brand ID="B22040738013725" SoleSupply="true">
                <Name>Mylan Fentanyl Patch</Name>
                <Pack ID="P2351978" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>14.50</Subsidy>
                  <Price>14.50</Price>
                  <Alternate>14.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="Controlled"/>
            <Rule Type="MaxCoPayment" Value="0"/>
          </Chemical>
          <Chemical ID="C2204073822">
            <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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <Subsidy>28.80</Subsidy>
                  <Price>28.80</Price>
                  <Alternate>28.80</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="Controlled"/>
            <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>
            <Rule Type="Guideline" xlink:href="PG0786C2204073822"/>
          </Chemical>
          <Chemical ID="C2204073896">
            <Name>Fentanyl citrate</Name>
            <Formulation ID="F220407389625" Rank="4" Units="inj" Weight="50">
              <Name>Inj 50 mcg per ml, 2 ml</Name>
              <Brand ID="B22040738962526" SoleSupply="true">
                <Name>Boucher and Muir</Name>
                <Pack ID="P2381176" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>6.43</Subsidy>
                  <Price>6.43</Price>
                  <Alternate>6.43</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220407389626" Rank="4" Units="inj" Weight="500">
              <Name>Inj 50 mcg per ml, 10 ml</Name>
              <Brand ID="B22040738962626" SoleSupply="true">
                <Name>Boucher and Muir</Name>
                <Pack ID="P2381168" Specified="true">
                  <Quantity>10</Quantity>
                  <Subsidy>16.81</Subsidy>
                  <Price>16.81</Price>
                  <Alternate>16.81</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Rule Type="MaxCoPayment" Value="0"/>
            <Rule Type="Controlled"/>
          </Chemical>
        </ATC3>
        <div xmlns="http://www.w3.org/1999/xhtml" class="Xref">
          <p xlink:type="simple" xlink:href="A1904">For Anti-inflammatory NSAIDS refer to MUSCULOSKELETAL</p>
        </div>
      </ATC2>
      <ATC2 ID="A2205">
        <Name>Antidepressants</Name>
        <ATC3 ID="A220501">
          <Name>Cyclic and Related Agents</Name>
          <Chemical ID="C2205011059">
            <Name>Amitriptyline</Name>
            <Formulation ID="F220501105901" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050110590125">
                <Name>Amirol</Name>
                <Pack ID="P2283336" Specified="true">
                  <Quantity>50</Quantity>
                  <Subsidy>2.77</Subsidy>
                  <Price>2.77</Price>
                  <Alternate>2.77</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>1.85</Subsidy>
                  <Price>1.85</Price>
                  <Alternate>1.85</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>3.60</Subsidy>
                  <Price>3.60</Price>
                  <Alternate>3.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011315">
            <Name>Clomipramine hydrochloride</Name>
            <Formulation ID="F220501131501" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050113150126">
                <Name>Apo-Clomipramine</Name>
                <Pack ID="P2289822" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.60</Subsidy>
                  <Price>12.60</Price>
                  <Alternate>12.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220501131502" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22050113150225">
                <Name>Apo-Clomipramine</Name>
                <Pack ID="P2289830" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>8.68</Subsidy>
                  <Price>8.68</Price>
                  <Alternate>8.68</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011437">
            <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>10.50</Subsidy>
                  <Price>10.50</Price>
                  <Alternate>10.50</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>6.17</Subsidy>
                  <Price>6.17</Price>
                  <Alternate>6.17</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011438">
            <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>6.30</Subsidy>
                  <Price>6.30</Price>
                  <Alternate>6.30</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>6.86</Subsidy>
                  <Price>6.86</Price>
                  <Alternate>6.86</Alternate>
                  <Surcharge>0.00000</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>8.55</Subsidy>
                  <Price>8.55</Price>
                  <Alternate>8.55</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205011642">
            <Name>Imipramine hydrochloride</Name>
            <Formulation ID="F220501164201" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050116420125">
                <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">
                <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">
            <Name>Maprotiline hydrochloride</Name>
            <Formulation ID="F220501176001" Rank="1" Units="tab" Weight="25">
              <Name>Tab 25 mg</Name>
              <Brand ID="B22050117600101">
                <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">
                <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>
          </Chemical>
          <Chemical ID="C2205011824">
            <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>24.86</Subsidy>
                  <Price>24.86</Price>
                  <Alternate>24.86</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1048">
              <Title>
                <range>Mianserin Hydrochloride</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <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>
                    <apply>
                      <and/>
                      <ci type="logical" class="Indication">The patient has a severe major depressive episode</ci>
                      <apply>
                        <or/>
                        <ci type="logical" class="Indication">The patient must have had a trial of two different antidepressants and was unable to tolerate the treatments or failed to respond to an adequate dose over an adequate period of time (usually at least four weeks)</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="Indication">The patient must have had a trial of one other antidepressant and either could not tolerate it or failed to respond to an adequate dose over an adequate period of time</ci>
                        </apply>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0057 SA0864 SA1048">
                <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="SA1048"/>
          </Chemical>
          <Chemical ID="C2205011876">
            <Name>Nortriptyline hydrochloride</Name>
            <Formulation ID="F220501187601" Rank="1" Units="tab" Weight="10">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050118760125">
                <Name>Norpress</Name>
                <Pack ID="P2090678" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.69</Subsidy>
                  <Price>6.69</Price>
                  <Alternate>6.69</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">
                <Name>Norpress</Name>
                <Pack ID="P2312441" Specified="true">
                  <Quantity>180</Quantity>
                  <Subsidy>14.77</Subsidy>
                  <Price>14.77</Price>
                  <Alternate>14.77</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220504">
          <Name>Monoamine-Oxidase Inhibitors (MAOIs) - Non Selective</Name>
          <Chemical ID="C2205041955" Statim="Must">
            <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" Statim="Must">
            <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>
                <Pack ID="P2315076">
                  <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" Statim="Must">
            <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>69.23</Subsidy>
                  <Price>69.23</Price>
                  <Alternate>69.23</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>31.33</Subsidy>
                  <Price>31.33</Price>
                  <Alternate>31.33</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <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" Statim="Must">
            <Name>Citalopram hydrobromide</Name>
            <Formulation ID="F220507119301" Rank="1" Units="tab" Weight="20">
              <Name>Tab 20 mg</Name>
              <Brand ID="B22050711930126" SoleSupply="true">
                <Name>Arrow-Citalopram</Name>
                <Pack ID="P2306980" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>2.34</Subsidy>
                  <Price>2.34</Price>
                  <Alternate>2.34</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205072636" Statim="Must">
            <Name>Fluoxetine hydrochloride</Name>
            <Formulation ID="F220507263601" Rank="2" Units="cap" Weight="20">
              <Name>Cap 20 mg</Name>
              <Brand ID="B22050726360103" SoleSupply="true">
                <Name>Fluox</Name>
                <Pack ID="P2353121" Specified="true">
                  <Quantity>84</Quantity>
                  <Subsidy>2.70</Subsidy>
                  <Price>2.70</Price>
                  <Alternate>2.70</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" SoleSupply="true">
                <Name>Fluox</Name>
                <Pack ID="P2077817" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>2.50</Subsidy>
                  <Price>2.50</Price>
                  <Alternate>2.50</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="C2205073926" Statim="Must">
            <Name>Escitalopram</Name>
            <Formulation ID="F220507392625" Rank="1" Units="tab">
              <Name>Tab 10 mg</Name>
              <Brand ID="B22050739262525" SoleSupply="true">
                <Name>Loxalate</Name>
                <Pack ID="P2347792" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>2.65</Subsidy>
                  <Price>2.65</Price>
                  <Alternate>2.65</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220507392626" Rank="1" Units="tab">
              <Name>Tab 20 mg</Name>
              <Brand ID="B22050739262625" SoleSupply="true">
                <Name>Loxalate</Name>
                <Pack ID="P2347806" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>4.20</Subsidy>
                  <Price>4.20</Price>
                  <Alternate>4.20</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205073927" Statim="Must">
            <Name>Sertraline</Name>
            <Formulation ID="F220507392725" Rank="1" Units="tab" Weight="50">
              <Name>Tab 50 mg</Name>
              <Brand ID="B22050739272525" SoleSupply="true">
                <Name>Arrow-Sertraline</Name>
                <Pack ID="P2376520" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>5.40</Subsidy>
                  <Price>5.40</Price>
                  <Alternate>5.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220507392726" Rank="1" Units="tab" Weight="100">
              <Name>Tab 100 mg</Name>
              <Brand ID="B22050739272625" SoleSupply="true">
                <Name>Arrow-Sertraline</Name>
                <Pack ID="P2376539" Specified="true">
                  <Quantity>90</Quantity>
                  <Subsidy>9.60</Subsidy>
                  <Price>9.60</Price>
                  <Alternate>9.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2205076009" Statim="Must">
            <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>2.38</Subsidy>
                  <Price>2.38</Price>
                  <Alternate>2.38</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220509">
          <Name>Other Antidepressants</Name>
          <Chemical ID="C2205093785">
            <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>
            <Formulation ID="F220509378527" Rank="2" Units="cap" Weight="37.5">
              <Name>Cap 37.5 mg</Name>
              <Brand ID="B22050937852725">
                <Name>Efexor XR</Name>
                <Pack ID="P2268140" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>18.64</Subsidy>
                  <Price>18.64</Price>
                  <Alternate>18.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220509378528" Rank="1" Units="tab" Weight="37.5">
              <Name>Tab 37.5 mg</Name>
              <Brand ID="B22050937852825">
                <Name>Arrow-Venlafaxine XR</Name>
                <Pack ID="P2387751" Specified="true">
                  <Quantity>28</Quantity>
                  <Subsidy>18.64</Subsidy>
                  <Price>18.64</Price>
                  <Alternate>18.64</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220509378529" Rank="1" Units="tab" Weight="75">
              <Name>Tab 75 mg</Name>
              <Brand ID="B22050937852925">
                <Name>Arrow-Venlafaxine XR</Name>
                <Pack ID="P2387778" 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="F220509378530" Rank="1" Units="tab" Weight="150">
              <Name>Tab 150 mg</Name>
              <Brand ID="B22050937853025">
                <Name>Arrow-Venlafaxine XR</Name>
                <Pack ID="P2387786" 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="SA1061">
              <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 have had an inadequate response from 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 have had an inadequate response from 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 SA1061">
                <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="SA1061"/>
          </Chemical>
          <Chemical ID="C2205093901">
            <Name>Mirtazapine</Name>
            <Formulation ID="F220509390125" Rank="1" Units="tab" Weight="30">
              <Name>Tab 30 mg</Name>
              <Brand ID="B22050939012525">
                <Name>Avanza</Name>
                <Pack ID="P2340410" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>22.00</Subsidy>
                  <Price>22.00</Price>
                  <Alternate>22.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220509390126" Rank="1" Units="tab" Weight="45">
              <Name>Tab 45 mg</Name>
              <Brand ID="B22050939012625">
                <Name>Avanza</Name>
                <Pack ID="P2340429" Specified="true">
                  <Quantity>30</Quantity>
                  <Subsidy>35.00</Subsidy>
                  <Price>35.00</Price>
                  <Alternate>35.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA0994">
              <Title>
                <range>Mirtazapine</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 a severe major depressive episode</ci>
                    <apply>
                      <or/>
                      <ci type="logical" class="Trial">The patient must have had a trial of two different antidepressants and was unable to tolerate the treatments or failed to respond to an adequate dose over an adequate period of time (usually at least four weeks)</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 either could not tolerate it or failed to respond to an adequate dose over an adequate period of time</ci>
                      </apply>
                    </apply>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
              <Case When="Renewal" Form="SA0994">
                <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>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0994"/>
          </Chemical>
        </ATC3>
      </ATC2>
      <ATC2 ID="A2207">
        <Name>Antiepilepsy Drugs</Name>
        <ATC3 ID="A220701">
          <Name>Agents for Control of Status Epilepticus</Name>
          <Chemical ID="C2207011316">
            <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>
                  <Multiple>1</Multiple>
                  <Subsidy>19.00</Subsidy>
                  <Price>19.00</Price>
                  <Alternate>19.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207011397">
            <Name>Diazepam</Name>
            <Formulation ID="F220701139704" Rank="9" Units="tube" Weight="5">
              <Name>Rectal tubes 5 mg</Name>
              <Brand ID="B22070113970401">
                <Name>Stesolid</Name>
                <Pack ID="P425877" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>25.05</Subsidy>
                  <Price>25.05</Price>
                  <Alternate>25.05</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
            </Formulation>
            <Formulation ID="F220701139705" Rank="9" Units="tube" Weight="10">
              <Name>Rectal tubes 10 mg</Name>
              <Brand ID="B22070113970501">
                <Name>Stesolid</Name>
                <Pack ID="P425869" Specified="true">
                  <Quantity>5</Quantity>
                  <Subsidy>30.50</Subsidy>
                  <Price>30.50</Price>
                  <Alternate>30.50</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>
                  <Multiple>1</Multiple>
                  <Subsidy>9.24</Subsidy>
                  <Price>9.24</Price>
                  <Alternate>9.24</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="FormMax" Value="5" Attribute="PSO"/>
              <Rule Type="FormReqd" Attribute="PSO"/>
              <Rule Type="SubRxF"/>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>PSO must be endorsed “not for anaesthetic procedures”.</p>
              </div>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207011978" 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>
                  <Multiple>1</Multiple>
                  <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>
                  <Multiple>1</Multiple>
                  <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" 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>
                  <Multiple>1</Multiple>
                  <Subsidy>1500.00</Subsidy>
                  <Price>1500.00</Price>
                  <Alternate>1500.00</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
        </ATC3>
        <ATC3 ID="A220702">
          <Name>Control of Epilepsy</Name>
          <Chemical ID="C2207021002">
            <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>20.40</Subsidy>
                  <Price>20.40</Price>
                  <Alternate>20.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022626">
                <Name>Mogine</Name>
                <Pack ID="P2237199" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>20.40</Subsidy>
                  <Price>20.40</Price>
                  <Alternate>20.40</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022627">
                <Name>Logem</Name>
                <Pack ID="P2271761" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>19.38</Subsidy>
                  <Price>19.38</Price>
                  <Alternate>19.38</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>34.70</Subsidy>
                  <Price>34.70</Price>
                  <Alternate>34.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022726">
                <Name>Arrow-Lamotrigine</Name>
                <Pack ID="P2245507" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>34.70</Subsidy>
                  <Price>34.70</Price>
                  <Alternate>34.70</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022727">
                <Name>Logem</Name>
                <Pack ID="P2271788" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>32.97</Subsidy>
                  <Price>32.97</Price>
                  <Alternate>32.97</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>59.90</Subsidy>
                  <Price>59.90</Price>
                  <Alternate>59.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022826">
                <Name>Mogine</Name>
                <Pack ID="P2237202" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>59.90</Subsidy>
                  <Price>59.90</Price>
                  <Alternate>59.90</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070210022827">
                <Name>Logem</Name>
                <Pack ID="P2271796" Specified="true">
                  <Quantity>56</Quantity>
                  <Subsidy>56.91</Subsidy>
                  <Price>56.91</Price>
                  <Alternate>56.91</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" 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="SA1072">
              <Title>
                <range>Vigabatrin</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <and/>
                    <apply>
                      <or/>
                      <ci type="logical" class="Indication">Patient has infantile spasms</ci>
                      <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>
                    </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="Renewal" Form="SA0875 SA0937 SA1010 SA1072">
                <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>
                </div>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1072"/>
          </Chemical>
          <Chemical ID="C2207021060" Statim="May">
            <Name>Gabapentin (Neurontin)</Name>
            <Formulation ID="F220702106001" Rank="2" Units="cap" Weight="300">
              <Name>Cap 300 mg</Name>
              <Brand ID="B22070210600101">
                <Name>Neurontin</Name>
                <Pack ID="P475971" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>39.76</Subsidy>
                  <Price>39.76</Price>
                  <Alternate>39.76</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F220702106002" Rank="2" Units="cap" Weight="400">
              <Name>Cap 400 mg</Name>
              <Brand ID="B22070210600201">
                <Name>Neurontin</Name>
                <Pack ID="P476986" 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="F220702106025" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B22070210602525">
                <Name>Neurontin</Name>
                <Pack ID="P2022141" 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="F220702106026" Rank="1" Units="tab">
              <Name>Tab 600 mg</Name>
              <Brand ID="B22070210602625">
                <Name>Neurontin</Name>
                <Pack ID="P2242214" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>67.50</Subsidy>
                  <Price>67.50</Price>
                  <Alternate>67.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="PHARMAC" For="Subsidy" Form="SA0973">
              <Title>
                <range>Neurontin</range>
              </Title>
              <Case When="Initial application">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <ci type="logical" class="Indication">Subsidy for patients pre-approved on 1 August 2009</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="patient's lifetime"/>
              </Case>
              <div xmlns="http://www.w3.org/1999/xhtml" class="Note">
                <p>Subsidy for patients pre-approved by PHARMAC on 1 August 2009.  Approvals valid without further renewal unless	notified.</p>
                <p>No new approvals will be granted from 1 August 2009.</p>
              </div>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA0973"/>
          </Chemical>
          <Chemical ID="C2207021062" Statim="May">
            <Name>Gabapentin</Name>
            <Formulation ID="F220702106201" Rank="2" Units="cap" Weight="300">
              <Name>Cap 300 mg</Name>
              <Brand ID="B22070210620125" SoleSupply="true">
                <Name>Nupentin</Name>
                <Pack ID="P2222132" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>11.50</Subsidy>
                  <Price>11.50</Price>
                  <Alternate>11.50</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Rule Type="OraProduct" xlink:href="OraProduct"/>
            </Formulation>
            <Formulation ID="F220702106202" Rank="2" Units="cap" Weight="400">
              <Name>Cap 400 mg</Name>
              <Brand ID="B22070210620225" SoleSupply="true">
                <Name>Nupentin</Name>
                <Pack ID="P2222108" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>14.75</Subsidy>
                  <Price>14.75</Price>
                  <Alternate>14.75</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Formulation ID="F220702106225" Rank="2" Units="cap" Weight="100">
              <Name>Cap 100 mg</Name>
              <Brand ID="B22070210622526" SoleSupply="true">
                <Name>Nupentin</Name>
                <Pack ID="P2222124" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>7.16</Subsidy>
                  <Price>7.16</Price>
                  <Alternate>7.16</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
            <Request To="HealthPAC" For="Subsidy" Form="SA1071">
              <Title>
                <range>Gabapentin</range>
              </Title>
              <Case When="Initial application" Category="Epilepsy">
                <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="Neuropathic pain">
                <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</ci>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="month">3</Term>
              </Case>
              <Case When="Renewal" Category="Epilepsy" Form="SA0873 SA0936 SA1009 SA1071">
                <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" Category="Neuropathic pain" Form="SA0873 SA0936 SA1009 SA1071">
                <math xmlns="http://www.w3.org/1998/Math/MathML">
                  <apply>
                    <or/>
                    <ci type="logical" class="Trial">The patient has demonstrated a marked improvement in their control of pain (prescriber determined)</ci>
                    <ci type="logical" class="Trial">The patient has previously demonstrated clinical responsiveness to gabapentin and has now developed neuropathic pain in a new site</ci>
                  </apply>
                </math>
                <Applicant>any relevant practitioner</Applicant>
                <Term Measure="year">2</Term>
              </Case>
            </Request>
            <Rule Type="Special" Attribute="Subsidy" xlink:href="SA1071"/>
          </Chemical>
          <Chemical ID="C2207021133" 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>26.04</Subsidy>
                  <Price>26.04</Price>
                  <Alternate>26.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070211330125">
                <Name>Arrow-Topiramate</Name>
                <Pack ID="P2350408" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>11.07</Subsidy>
                  <Price>11.07</Price>
                  <Alternate>11.07</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>44.26</Subsidy>
                  <Price>44.26</Price>
                  <Alternate>44.26</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070211330225">
                <Name>Arrow-Topiramate</Name>
                <Pack ID="P2350416" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>18.81</Subsidy>
                  <Price>18.81</Price>
                  <Alternate>18.81</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>75.25</Subsidy>
                  <Price>75.25</Price>
                  <Alternate>75.25</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070211330325">
                <Name>Arrow-Topiramate</Name>
                <Pack ID="P2350424" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>31.99</Subsidy>
                  <Price>31.99</Price>
                  <Alternate>31.99</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>129.85</Subsidy>
                  <Price>129.85</Price>
                  <Alternate>129.85</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
              <Brand ID="B22070211330425">
                <Name>Arrow-Topiramate</Name>
                <Pack ID="P2350432" Specified="true">
                  <Quantity>60</Quantity>
                  <Subsidy>55.19</Subsidy>
                  <Price>55.19</Price>
                  <Alternate>55.19</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>20.84</Subsidy>
                  <Price>20.84</Price>
                  <Alternate>20.84</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>26.04</Subsidy>
                  <Price>26.04</Price>
                  <Alternate>26.04</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207021217" 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="B22070212170402">
                <Name>Tegretol</Name>
                <Pack ID="P2291657" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>14.53</Subsidy>
                  <Price>14.53</Price>
                  <Alternate>14.53</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">
            <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">
            <Name>Clonazepam</Name>
            <Formulation ID="F220702131601" Rank="1" Units="tab" Weight="0.5">
              <Name>Tab 500 mcg</Name>
              <Brand ID="B22070213160125">
                <Name>Paxam</Name>
                <Pack ID="P2095483" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>6.68</Subsidy>
                  <Price>6.68</Price>
                  <Alternate>6.68</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">
                <Name>Paxam</Name>
                <Pack ID="P2095491" Specified="true">
                  <Quantity>100</Quantity>
                  <Subsidy>12.75</Subsidy>
                  <Price>12.75</Price>
                  <Alternate>12.75</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" 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>13.60</Subsidy>
                  <Price>13.60</Price>
                  <Alternate>13.60</Alternate>
                  <Surcharge>0.00000</Surcharge>
                </Pack>
              </Brand>
            </Formulation>
          </Chemical>
          <Chemical ID="C2207021978" 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>42.09</Subsidy>
                  <Price>42.09</Price>
                  <Alternate>42.09</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>19.13</Subsidy>
                  <Price>19.13</Price>
                  <Alternate>19.13</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