Pharmaceutical Schedule - effective 1 December 2006 (text extract)

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December 2006

New Zealand Pharmaceutical Schedule

Investing in Health

Contents

IntroducIng PHArMAc .......................................... 5 PHARMAC And tHe PHARMACeutiCAl SCHedule ....6 PuRPoSe of tHe PHARMACeutiCAl SCHedule ........8 finding infoRMAtion in tHe PHARMACeutiCAl SCHedule.................................................................8 exPlAining dRug entRieS ..........................................9 example .....................................................................9 gloSSARy...................................................................10 units of Measure ......................................................10 Abbreviations ...........................................................10 PAtient CoStS ...........................................................11 SPeCiAl AutHoRity APPliCAtionS ..........................12 exCePtionAl CiRCuMStAnCeS PoliCieS .................13 HoSPitAl exCePtionAl CiRCuMStAnCeS ...............13 CAnCeR exCePtionAl CiRCuMStAnCeS ..................14 CoMMunity exCePtionAl CiRCuMStAnCeS ...........14 SEctIon A: gEnErAL ruLES .................................. 15 intRoduCtion ............................................................15 PARt i ..........................................................................15 inteRPRetAtion And definitionS ...........................15 PARt ii .........................................................................20 CoMMunity PHARMACeutiCAlS SubSidy ...............20 PARt iii ........................................................................21 PeRiod And QuAntity of SuPPly ............................21 3.1 doctors’, Midwives’, nurse Prescribers’, and optometrists’ Prescriptions (other than oral contraceptives) ..................................................21 3.2 oral Contraceptives ...........................................22 3.3 dentists’ Prescriptions........................................22 3.4 original Packs, and Certain Antibiotics................23 PARt iV ........................................................................23 MiSCellAneouS PRoViSionS....................................23 4.1 bulk Supply orders .............................................23 4.2 Practitioner’s Supply orders ...............................24 4.3 Wholesale Supply orders ...................................24 4.4 Retail Pharmacy and Hospital Pharmacy-Specialist Restriction .........................24 4.5 Pharmaceutical Cancer treatments ....................25 4.6 Amendment of Schedule ....................................25 4.7 Conflict in Provisions..........................................25 AntACidS And AntiflAtulentS...............................26 Antacids and Reflux Barrier Agents...........................26 Phosphate binding Agents........................................26 AntidiARRHoeAlS......................................................27 Agents Which Reduce Motility ..................................27 Rectal and Colonic Anti-inflammatories ....................27 AntiHAeMoRRHoidAlS ..............................................28 Corticosteroids .........................................................28 Rectal Sclerosants ...................................................28 Soothing Agents .......................................................28 AntiSPASModiCS And otHeR AgentS AlteRing gut Motility .................................................................28 AntiulCeRAntS .........................................................28 Antisecretory and Cytoprotective ..............................28

Helicobacter Pylori eradication ................................28 H2 Antagonists.........................................................29 Proton Pump inhibitors.............................................29 Site Protective Agents ..............................................29 diAbeteS.....................................................................30 Hyperglycaemic Agents............................................30 insulin – Short-acting Preparations ...........................30 insulin – intermediate-acting Preparations ................30 insulin – long-acting Preparations ...........................31 insulin – Rapid acting insulin analogues ...................31 Alpha glucosidase inhibitors .....................................31 oral Hypoglycaemic Agents .....................................32 diAbeteS MAnAgeMent ............................................33 glucose/urine testing ..............................................33 glucose &/or Ketones/urine testing .........................33 glucose/blood testing .............................................34 insulin Syringes and needles ....................................34 digeStiVeS inCluding enZyMeS ..............................35 lAxAtiVeS ...................................................................35 bulk-forming Agents.................................................35 faecal Softeners.......................................................36 osmotic laxatives ....................................................36 Stimulant laxatives ..................................................36 MetAboliC diSoRdeR AgentS .................................37 gaucher’s disease ...................................................37 MoutH And tHRoAt ..................................................37 Agents used in Mouth ulceration..............................37 oropharyngeal Anti-infectives ...................................37 other oral Agents .....................................................38 VitAMinS .....................................................................38 Vitamin A .................................................................38 Vitamin b group .......................................................38 Vitamin C .................................................................38 Vitamin d .................................................................39 Vitamin e..................................................................39 Vitamin K .................................................................39 Multivitamin Preparations .........................................39 MineRAlS ...................................................................40 Calcium....................................................................40 fluoride ....................................................................40 iron ..........................................................................40 Magnesium ..............................................................40 Zinc ..........................................................................40 BLood And BLood ForMIng orgAnS .................. 41 AntiAnAeMiCS ............................................................41 Hypoplastic and Haemolytic .....................................41 Megaloblastic ...........................................................42 AntifibRinolytiCS, HAeMoStAtiCS And loCAl SCleRoSAntS ........................................................42 Vitamin K .................................................................42 AntitHRoMbotiC AgentS .........................................43 Antiplatelet Agents....................................................43 Heparin and Antagonist Preparations ........................45 oral Anticoagulants ..................................................45 fluidS And eleCtRolyteS .......................................45 intravenous Administration .......................................45 oral Administration ...................................................46 liPid Modifying AgentS ...........................................47

fibrates ....................................................................47 other lipid modifying agents .....................................47 Resins......................................................................47 HMg CoA Reductase inhibitors (Statins) ..................47 Selective Cholesterol Absorption inhibitors ...............48 new Zealand Cardiovascular guideline group statement ..............................................................51 cArdIovAScuLAr dISEASE: BASELInE rISk And trEAtMEnt BEnEFItS ..................................... 51 cArdIovAScuLAr SYStEM .................................... 55 AlPHA AdRenoCePtoR bloCKeRS ...........................55 AgentS AffeCting tHe Renin-AngiotenSin SySteM...................................................................55 ACe inhibitors ..........................................................55 ACe inhibitors with diuretics ....................................56 Angiotensin ii Antagonists ........................................56 AntiARRHytHMiCS .....................................................58 AntiHyPotenSiVeS ....................................................58 betA AdRenoCePtoR bloCKeRS .............................59 CAlCiuM CHAnnel bloCKeRS ..................................60 dihydropyridine Calcium Channel blockers (dHP CCbs) ..........................................................60 other Calcium Channel blockers...............................61 CentRAlly ACting AgentS ......................................61 diuRetiCS ...................................................................62 loop diuretics ..........................................................62 Potassium Sparing diuretics.....................................62 Potassium Sparing Combination diuretics ................62 thiazide and Related diuretics ..................................62 nitRAteS.....................................................................63 SMoKing CeSSAtion .................................................63 SyMPAtHoMiMetiCS ..................................................63 VASodilAtoRS ...........................................................63 dErMAtoLogIcALS ................................................ 64 AntiACne PRePARAtionS..........................................64 AntibACteRiAlS toPiCAl ..........................................64 AntifungAlS toPiCAl ...............................................64 AntiPRuRitiC PRePARAtionS ...................................65 CoRtiCoSteRoidS - toPiCAl ....................................66 Corticosteroids - Plain ..............................................66 Corticosteroids - Combination ..................................67 diSinfeCting And CleAnSing AgentS ....................68 duSting PoWdeRS ....................................................68 bARRieR CReAMS And eMollientS .........................68 barrier Creams .........................................................68 emollients ................................................................68 other dermatological bases .....................................69 MinoR SKin infeCtionS.............................................69 PARASitiCidAl PRePARAtionS .................................69 PSoRiASiS And eCZeMA PRePARAtionS ..................70 SCAlP PRePARAtionS ...............................................71 SunSCReenS ..............................................................71 WARt And CoRn PRePARAtionS ..............................71 otHeR SKin PRePARAtionS ......................................72 Antineoplastics.........................................................72

topical Analgesia .....................................................72 Wound Management Products .................................72 ContRACePtiVeS – non-HoRMonAl .......................73 Condoms .................................................................73 Spermicidal Agents ..................................................73 Contraceptive devices ..............................................73 ContRACePtiVeS – HoRMonAl ................................73 Combined oral Contraceptives .................................74 Combined oral Contraceptives – other .....................75 Progestogen-only Contraceptives .............................75 emergency Contraceptives .......................................76 AntiAndRogen oRAl ContRACePtiVeS ..................76 gynAeCologiCAl Anti-infeCtiVeS ..........................76 iMPotenCe tReAtMent ............................................76 MyoMetRiAl And VAginAl HoRMone PRePARAtionS.......................................................76 PRegnAnCy teStS - HCg uRine ...............................77 uRinARy AgentS........................................................77 other urinary agents .................................................77 uRinARy tRACt infeCtionS ......................................77 HorMonE PrEPArAtIonS - SYStEMIc ExcLudIng contrAcEPtIvE HorMonES ....... 78 AnAboliC AgentS......................................................78 CAlCiuM HoMeoStASiS.............................................78 Alendronate for osteoporosis ...................................78 Alendronate for Pagets disease ................................79 other treatments......................................................79 CoRtiCoSteRoidS And RelAted AgentS foR SySteMiC uSe ........................................................80 Sex HoRMoneS non ContRACePtiVe ......................81 Androgen Agonists and Antagonists .........................81 HoRMone RePlACeMent tHeRAPy - SySteMiC ......81 oestrogens...............................................................82 Progestogens ...........................................................83 Progestogen and oestrogen combined preparations ..........................................................83 otHeR oeStRogen PRePARAtionS ..........................83 otHeR PRogeStogen PRePARAtionS .....................84 tHyRoid And AntitHyRoid AgentS .........................85 tRoPHiC HoRMoneS ..................................................85 growth Hormone......................................................85 gnRH Analogues ......................................................86 VASoPReSSin AgoniStS............................................89 otHeR endoCRine AgentS .......................................89 AntHelMintiCS ..........................................................90 AntibACteRiAlS.........................................................90 Cephalosporins and Cephamycins ...........................90 Macrolides ...............................................................91 Penicillins .................................................................92 tetracyclines ............................................................93 other Antibiotics .......................................................94 AntifungAlS ..............................................................95 AntiMAlARiAlS ..........................................................95 AntitRiCHoMonAl AgentS ......................................95 AntitubeRCulotiCS And AntilePRotiCS ...............96

AntiViRAlS .................................................................97 Hepatitis b treatment ...............................................97 HeRPeS tReAtMent ..................................................98 first episode genital herpes ......................................98 Recurrent episodes of genital herpes ........................99 Acute herpes zoster..................................................99 AntiRetRoViRAlS ....................................................100 non-nucleoside reverse transcriptase inhibitors ......101 nucleoside reverse transcriptase inhibitors .............101 Protease inhibitors..................................................101 AntiRetRoViRAlS – AdditionAl tHeRAPieS .........102 HiV fusion inhibitors ..............................................102 uRinARy tRACt infeCtionS ....................................102 VACCineS ..................................................................103 Influenza Vaccine ...................................................103 MuScuLo-SkELEtAL SYStEM .............................. 104 AntiCHolineSteRASeS............................................104 Anti-inflAMMAtoRy non SteRoidAl dRugS (nSAidS) ...............................................................104 nSAids other .........................................................105 AntiRHeuMAtoidAl AgentS...................................105 tumour necrosis factor (tnf) inhibitors ................106 enZyMeS ...................................................................108 HyPeRuRiCAeMiA And Antigout............................108 MuSCle RelAxAntS ................................................108 nErvouS SYStEM ................................................ 109 AnAeStHetiCS ..........................................................109 local ......................................................................109 AnAlgeSiCS ..............................................................109 Antipyretics and non-opioid Analgesics .................109 Antipyretics with Codeine .......................................110 opioid Analgesics...................................................110 AntidePReSSAntS ...................................................112 Cyclic and Related Agents ......................................112 Monoamine-oxidase inhibitors (MAois) non Selective ......................................................113 Monoamine-oxidase type A inhibitors ...................113 Selective Serotonin Reuptake inhibitors ..................113 other Antidepressants ............................................114 AntiePilePSy dRugS ...............................................114 Agents for Control of Status epilepticus ..................114 Control of epilepsy .................................................114 new Antiepilepsy drugs .........................................115 AntiMigRAine PRePARAtionS ................................117 Acute Migraine treatment.......................................117 Prophylaxis of Migraine ..........................................117 AntinAuSeA And VeRtigo AgentS ........................117 AntiPARKinSon AgentS..........................................119 dopamine Agonists and Related Agents .................119 Anticholinergics......................................................120 AntiPSyCHotiCS ......................................................120 general ..................................................................120 depot injections .....................................................122 orodispersible Antipsychotics ................................123 AnxiolytiCS .............................................................124

SedAtiVeS And HyPnotiCS .....................................125 otHeR CnS AgentS .................................................126 oncoLogY AgEntS And IMMunoSuPPrESSAntS ............................... 128 CHeMotHeRAPeutiC AgentS .................................128 Alkylating Agents....................................................128 Antimetabolites ......................................................129 other Cytotoxic Agents ...........................................131 Protein-tyrosine Kinase inhibitors ...........................135 endoCRine tHeRAPy ...............................................136 iMMunoSuPPReSSAntS ..........................................138 Cytotoxic immunosuppressants .............................138 immune Modulators ...............................................138 Multiple Sclerosis treatment ..................................142 other immunosuppressants ...................................144 rESPIrAtorY SYStEM And ALLErgIES .............. 146 AntiAlleRgy PRePARAtionS..................................146 AntiHiStAMineS .......................................................146 inHAled CoRtiCoSteRoidS - MeteRed doSe inHAleRS..............................................................147 low dose ...............................................................147 Medium dose .........................................................147 High dose...............................................................147 Very high dose .......................................................147 inHAled CoRtiCoSteRoidS - bReAtH ACtiVAted deViCeS ................................................................148 Medium dose .........................................................148 High dose...............................................................148 Very high dose .......................................................148 nedoCRoMil ............................................................148 SodiuM CRoMoglyCAte .........................................148 inHAled betA-AdRenoCePtoR AgoniStS - MeteRed doSe inHAleRS ....................................................148 low dose ...............................................................148 inHAled betA-AdRenoCePtoR AgoniStS - bReAtH ACtiVAted deViCeS .............................................148 High dose...............................................................148 inHAled betA-AdRenoCePtoR AgoniStS - long ACting ..................................................................149 inhaled corticosteroids with long-acting beta-adrenoceptor agonists ...................................................149 inHAled betA-AdRenoCePtoR AgoniStS nebuliSeR SolutionS ........................................150 low dose ...............................................................150 High dose...............................................................150 inHAled AntiCHolineRgiC AgentS - bReAtH ACtiVAted deViCeS .............................................150 inHAled AntiCHolineRgiC AgentS - MeteRed doSe inHAleRS..............................................................151 low dose ...............................................................151 inHAled AntiCHolineRgiC AgentS - nebuliSeR SolutionS ...........................................................151 low dose ...............................................................151 High dose...............................................................151

inHAled betA-AdRenoCePtoR AgoniSt And AntiCHolineRgiC AgentS- Mdi .........................151 inHAled betA-AdRenoCePtoR AgoniSt And AntiCHolineRgiC AgentS - nebuliSeR Solution..............................................................151 Salbutamol .............................................................151 betA-AdRenoCePtoR AgoniStS - long-ACting tAbletS................................................................151 low dose ...............................................................151 High dose...............................................................151 betA-AdRenoCePtoR AgoniStS - oRAl liQuidS..152 betA-AdRenoCePtoR AgoniStS - injeCtion ........152 tHeoPHylline deRiVAtiVeS ....................................152 CougH PRePARAtionS ............................................152 CyStiC fibRoSiS .......................................................152 nASAl PRePARAtionS .............................................153 Allergy Prophylactics ..............................................153 ReSPiRAtoRy deViCeS.............................................153 SEnSorY orgAnS ................................................ 154 eAR PRePARAtionS .................................................154 eAR/eye PRePARAtionS ..........................................154 eye PRePARAtionS ..................................................154 Anti-infective Preparations......................................154 Corticosteroids and other Anti-inflammatory Preparations ........................................................155 glaucoma Preparations – beta blockers .................155 glaucoma Preparations – Carbonic Anhydrase inhibitors .............................................................156 glaucoma Preparations – Prostaglandin Analogues 156 glaucoma Preparations – other ..............................156 Mydriatics and Cycloplegics ...................................157 Preparations for Tear Deficiency .............................158 other eye Preparations ...........................................158 vArIouS ................................................................ 159 AgentS uSed in tHe tReAtMent of PoiSoningS 159 deteCtion of SubStAnCeS in uRine .....................159 SEctIon c: ExtEMPorAnEouSLY coMPoundEd PrEPArAtIonS & gALEnIcALS ..................... 160 intRoduCtion .........................................................160 glossary.................................................................160 explanatory notes ...................................................161 Standard formulae .................................................164 nutRient ModuleS .................................................167 Carbohydrate .........................................................167 Carbohydrate and fat .............................................168 fat..........................................................................169 Protein ...................................................................170 oRAl SuPPleMentS ................................................170 oRAl SuPPleMentS/CoMPlete diet (nASogAStRiC/ gAStRoStoMy tube feed) .................................171 Respiratory Products..............................................171 diabetic Products ...................................................172 Fat Modified Products ............................................173 High Protein Products ............................................173 Paediatric Products for Children awaiting liver transplant ...........................................................174

Paediatric Products for Children with Chronic Renal failure .......................................................174 Paediatric Products ................................................175 Renal Products.......................................................176 Specialised and elemental Products .......................177 undyalised end Stage Renal failure ........................178 Adult Products Standard.........................................178 Adult Products High Calorie ....................................181 food tHiCKeneRS ....................................................182 gluten fRee foodS ................................................182 food And SuPPleMentS foR inboRn eRRoRS of MetAboliSM - otHeR.....................................184 Supplements for Homocystinuria............................184 Supplements for MSud ..........................................184 food And SuPPleMentS foR inboRn eRRoRS of MetAboliSM - PKu .........................................185 foods for PKu ........................................................185 Supplements for PKu .............................................186 Multivitamin and Mineral Supplements ...................186 MultiVitAMin SuPPleMentS foR inboRn eRRoRS of MetAboliSM ...................................................186 infAnt foRMulAe ....................................................187 for Premature infants .............................................187 for Williams Syndrome ..........................................187 for gastrointestinal and other Malabsorptive Problems ............................................................188 for Milk intolerance ................................................189 infant formulae - lactose intolerance and Cows’ Milk Protein intolerance .......................................190 SEctIon E PArt I: PrActItIonEr’S And WHoLESALE SuPPLY ordErS....................... 191 Pharmaceuticals that may be obtained on a Practitioner’s Supply order ..................................191 Pharmaceuticals that may be obtained on a Wholesale Supply order ......................................194 SEctIon E PArt II: rurAL ArEAS........................ 195 SEctIon F: coMMunItY PHArMAcEutIcAL dISPEnSIng PErIod ExEMPtIonS ................ 196 SEctIon g: SAFEtY cAP MEdIcInES .................... 198

Introducing PHArMAc

PHARMAC, the Pharmaceutical Management Agency, is a Crown entity established pursuant to the new Zealand Public Health and disability Act 2000 (the Act). the primary objective of PHARMAC is to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided. the PHARMAC board consists of up to six members appointed by the Minister of Health. All decisions relating to PHARMAC’s operation are made by or under the authority of the board. in particular, board members decide on the strategic direction of PHARMAC and may decide which community pharmaceuticals should be subsidised and at what levels, and determine national prices for some pharmaceuticals to be purchased by and used in dHb Hospitals, and whether or not special conditions are to be applied to such purchases.

Members of the PHArMAc Board

Richard Waddel gregor Coster Kura denness Karen guilliland david Moore Adrienne von tunzelmann decisions taken by the PHARMAC board members, or made under the authority of the board, incorporate a balanced view of the needs of prescribers and patients. the aim is to achieve long-term gains and efficient ways of making pharmaceuticals available to the community and for dHb Hospitals to purchase them. david Meates, Ce Wairarapa dHb, attends PHARMAC’s board meetings as an observer. the functions of PHARMAC are to perform the following, within the amount of funding provided to it in the Pharmaceutical budget or to dHbs from their own budgets for the use of pharmaceuticals in their hospitals, as applicable, and in accordance with its annual plan and any directions given by the Minister (Section 103 of the Crown entities Act): a) to maintain and manage a pharmaceutical schedule that applies consistently throughout new Zealand, including determining eligibility and criteria for the provision of subsidies; b) to manage incidental matters arising out of (a), including in exceptional circumstances providing for subsidies for the supply of pharmaceuticals not on the pharmaceutical schedule; c) to engage as it sees fit, but within its operational budget, in research to meet its objectives as set out in Section 47(a) of the Act; d) to promote the responsible use of pharmaceuticals; e) to manage the purchasing of any or all pharmaceuticals, whether used either in a hospital or outside it, on behalf of dHbs; f) any other functions given to PHARMAC by or under any enactment or authorised by the Minister.

decision criteria

PHARMAC updates the Pharmaceutical Schedule at regular intervals to notify prescribers, pharmacists, hospital managers and patients of changes to Community Pharmaceutical subsidies and the prices for Hospital Pharmaceuticals. in making decisions about amendments to the Pharmaceutical Schedule, PHARMAC is guided by its operating Policies and Procedures, as amended or supplemented from time to time. PHARMAC takes into account the following criteria when making decisions about Community Pharmaceuticals: • the health needs of all eligible people within new Zealand (eligible defined by the government’s then current rules of eligibility); • the particular health needs of Maori and Pacific peoples; • the availability and suitability of existing medicines, therapeutic medical devices and related products and related things; • the clinical benefits and risks of pharmaceuticals; • the cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health and disability support services; • the budgetary impact (in terms of the pharmaceutical budget and the government’s overall health budget) of any changes to the Pharmaceutical Schedule; • the direct cost to health service users; • the government’s priorities for health funding, as set out in any objectives notified by the Crown to PHARMAC, or in PHARMAC’s funding Agreement, or elsewhere; and • such other criteria as PHARMAC thinks fit. PHARMAC will carry out appropriate consultation when it intends to take any such “other criteria” into account. the operating Policies and Procedures, including any supplements, also describe the way in which PHARMAC determines the level of subsidy or purchase price payable for each Community Pharmaceutical or Hospital Pharmaceutical, respectively. the decision criteria for Hospital Pharmaceuticals are set out in the hospital supplement to the operating Policies and Procedures and in the introductory part of Section H of the Pharmaceutical Schedule.

Copies of PHARMAC’s operating Policies and Procedures and of any applicable supplements are available on the PHARMAC website (www.pharmac.govt.nz), or on request.

PHARMAC manages the national Pharmaceutical Schedule, which lists: • Pharmaceuticals available in the community and subsidised by the government with funding from the Pharmaceutical budget; and • some Pharmaceuticals purchased by dHbs for use in their hospitals, and includes those Hospital Pharmaceuticals for which national prices have been negotiated by PHARMAC. in the community approximately 1848 Pharmaceuticals are subsidised by the government. Most are available to all eligible people within new Zealand on prescription by a medical doctor. Some are listed with guidelines or conditions such as ‘only if prescribed for a dialysis patient’ or ‘Special Authority – Retail Pharmacy’, to ensure that Pharmaceuticals are used by those people who are most likely to benefit from them. Pharmaceuticals provided to patients for use while in dHb hospitals are not covered by Sections A to g of the Pharmaceutical Schedule. Section H of the Pharmaceutical Schedule is not a comprehensive list of Pharmaceuticals that are used within the dHb Hospitals. Section H of the Pharmaceutical Schedule includes Pharmaceuticals that can be purchased at a national price by dHbs for use in their hospitals. these are referred to as national Contract Pharmaceuticals. Section H of the Pharmaceutical Schedule also identifies new Pharmaceuticals used in hospitals, which have been or are being assessed by PHARMAC, the results of that analysis being available to dHb Hospitals via PHARMAC’s website. A list of discretionary Community Supply Pharmaceuticals, in Section H of the Pharmaceutical Schedule, identifies those products that currently are not subsidised from the Pharmaceutical budget as Community Pharmaceuticals in Sections A to g of the Pharmaceutical Schedule but which dHbs can at their discretion fund for use in the community from their own budgets without specific Hospital exceptional Circumstances approval.

PHArMAc and the Pharmaceutical Schedule:

the PHArMAc team

the PHARMAC team has a wide range of expertise in health, medicine, economics, commerce, critical analysis, and policy development and implementation. Matthew brougham Acting Chief executive Scott Metcalfe Public Health Physician jason Arnold Senior Analyst Peter Moodie Medical director Peter Alsop Manager, Corporate and external erin Murphy PtAC Secretary Relations Christina newman executive Assistant to Chief Mike bignall tender Analyst executive Stephen boxall Creative director jessica nisbet funding and Procurement Assistant Hayley bythell Medical team Assistant Project Manager/team leader jan Quin Mary Chesterfield High Cost drugs Co-ordinator Marama Parore Maori Health Manager/Acting Manager, demand Side Steffan Crausaz Manager, funding and Procurement Melanie Pemberton Communications Advisor Andrew davies Procurement initiatives Manager fisher Andrea dick Procurement initiatives Manager Matthew Perkins Procurement initiatives Manager Sean dougherty therapeutic group Manager Hospital Pharmaceuticals Analyst ginny Priest Simon england Communications Manager dilky Rasiah deputy Medical director Peter ericson database Analyst erina Rewi Project Manager, Maori Health and jackie evans therapeutic group Manager demand Side john geering it Manager brian Roulston Analyst Rachel grocott Hospital Pharmaceuticals Senior Rico Schoeler Acting Manager, Analysis and Analyst Assessment Katie Harris Hospital exceptional Circumstances liz Skelley finance Manager Panel Co-ordinator jasmin teague demand Side Assistant Karen jacobs demand Side Manager jayne Watkins Community exceptional jacquie Kean legal Counsel Circumstances Panel Co-ordinator geoff lawn database Analyst linda Wellington Schedule Analyst Adam McRae demand Side Manager tommy Wilkinson therapeutic group Manager geraldine Macgibbon therapeutic group Manager Kaye Wilson Schedule Analyst Rachel Mackay Acting Manager, Schedule and Stephen Woodruffe therapeutic group Manager Contracts

PHArMAc’s clinical advisors Pharmacology and therapeutics Advisory committee (PtAc)

PHARMAC works closely with the Pharmacology and therapeutics Advisory Committee (PtAC), an expert medical committee which provides independent advice to PHARMAC on health needs and the clinical benefits of particular pharmaceuticals for use in the community and/or in dHb Hospitals. the committee members are all senior, practising clinicians. the chair of PtAC sits with the PHARMAC board in an advisory capacity. PtAC helps decide which community pharmaceuticals are to be subsidised from public monies by making recommendations to PHARMAC. Part of the role of PtAC is to review whether Community Pharmaceuticals already listed on the Schedule should continue to receive government funds. the resources freed up can be used to subsidise other community pharmaceuticals with a greater therapeutic worth. PHARMAC may obtain clinical advice from PtAC in relation to national purchasing strategies for Hospital Pharmaceuticals. there may be additional specialist hospital representatives on PtAC subcommittees, or additional PtAC subcommittees, where PHARMAC considers this necessary.

PtAc members are:

Carl burgess ian Hosford Sisira jayathissa Peter jones jim lello Peter Pillans tom thompson Paul tomlinson Howard Wilson jim Vause Contact PTAC C/MbChb, Md, MRCP (uK), fRACP, fRCP, physician/clinical pharmacologist, Chair MbChb, fRAnZCP, psychiatrist MbbS, Md, MRCP, fAfPHM, fRCP, fRACP, physician bMedSci, MbChb, Phd, fRCP, fRACP, physician bHb, MbChb, dCH, fRnZCgP, general practitioner MbbCh, Md, fCP, fRACP, clinical pharmacologist MbChb, fRACP, physician MbChb, Md, MRCP, fRACP, bSc, paediatrician, deputy Chair bSc, Phd, Mb, bS, dip obst, fRnZCgP, general practitioner MbChb, dipgP, fRnZCgP, general practitioner PTAC Secretary Pharmaceutical Management Agency PO Box 10 254, WELLINGTON

Purpose of the Pharmaceutical Schedule

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

Finding Information in the Pharmaceutical Schedule

community Pharmaceuticals

for Community Pharmaceuticals, the Schedule is organised in a way to help the reader find Community Pharmaceuticals, which may be used to treat similar conditions. to do this, Community Pharmaceuticals are first classified anatomically, originally based on the Anatomical therapeutic Chemical (AtC) system, and then further classified under section headings structured for the new Zealand medical system. • Section A lists the general Rules in relation to Community Pharmaceuticals and related products. • Section B lists Community Pharmaceuticals and related products by anatomical classification, which are further divided into one or more therapeutic headings. Community Pharmaceuticals used to treat similar conditions are grouped together. • Section c lists the rules in relation to extemporaneously Compounded Products (eCPs) and Community Pharmaceuticals that will be subsidised when extemporaneously compounded. • Section d lists the rules in relation to Special foods and the Special foods that are subsidised. • Section E Part i lists the Community Pharmaceuticals that are subsidised on a Practitioner’s Supply order (PSo) and Wholesale Supply order (WSo). • Section E Part ii lists rural areas for the purpose of PSos. • Section F lists the Community Pharmaceuticals dispensing period exemptions. • Section g lists the Community Pharmaceuticals eligible for reimbursement of safety cap and related rules. the listings are displayed alphabetically (where practical) within each level of the classification system. each anatomical section contains a series of therapeutic headings, some of which may contain a further classification level. Where a Community Pharmaceutical is used in more than one therapeutic area, they may be cross-referenced. the therapeutic headings in the Pharmaceutical Schedule do not necessarily correspond to the therapeutic groups and therapeutic subgroups, which PHARMAC establishes for the separate purpose of determining the level of subsidy to be paid for each Community Pharmaceutical. the index located at the back of the book in which Sections A–g of the Pharmaceutical Schedule are published can be used to find page numbers for generic chemical entities, or product brand names.

Hospital Pharmaceuticals

• Section H lists Pharmaceuticals that dHbs fund from their own budgets. the Hospital Pharmaceuticals are grouped into the following Parts in Section H: - Part i lists the rules in relation to Hospital Pharmaceuticals. - Part ii lists Hospital Pharmaceuticals for which national contracts exist (national Contract Pharmaceuticals). these are listed alphabetically by generic chemical entity name and line item, the relevant Price negotiated by PHARMAC and, if applicable, an indication of whether it has Hospital Supply Status (HSS) and any associated discretionary Variance (dV) Pharmaceuticals and dV limit. - Part iii lists Assessed Pharmaceuticals, which have been or are being assessed by PHARMAC and, where such assessment is available, PHARMAC’s opinion regarding the use of the Assessed Pharmaceuticals in hospitals. dHb Hospitals are not obliged to implement those recommendations. - Part iV lists discretionary Community Supply Pharmaceuticals, which are not Community Pharmaceuticals, but which a dHb Hospital can, in its discretion, fund for use in the community from its own budget. the index located at the back of the Section H supplement can be used to find page numbers for generic chemical entities, or product brand names, for Hospital Pharmaceuticals.

Explaining drug entries

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

Example

AnAtomicAl heAding

Subsidy (Manufacturer’s Price) fully Subsidised ✓ Per brand or generic Manufacturer

$ three months supply may be dispensed at one time if endorsed tHErAPEutIc HEAdIng “certified exemption” CHeMiCAl by the prescriber. s Presentation, form and strength ............................ 10.00

100

✓ Brand A ✓ Brand B

✓ Brand c

brand or manufacturer’s name

Practitioner’s Supply order (or WSo for Wholesale Supply order) Safety cap reimbursed Conditions of and restrictions on prescribing (including Special Authority where it applies) three months or six months, as applicable, dispensed all-at once

Presentation – Availbable on a PSo ...................... 15.00

Sole subsidised supply product

‡ Presentation – Retail pharmacy-specialist ............. 18.00

a) b) Prescriptions must be written by a paediatrician or paediatric cardiologist; or on the recommendation of a paediatrician or a paediatric cardiologist.

250 ml oP

✓ Brand d

fully subsidised product original Pack - Subsidy is rounded up to a multiple of whole packs Subsidy paid on a product before markups and gSt

CHeMiCAl ❋ Presentation, form and strength ............................ 26.53 (35.27)

100 brand e

Quantity the Subsidy applies to Manuracturer’s Price if different from Subsidy

Sole Supply

✓ fully subsidised

s three months supply may be dispensed at one time if endorsed “certified exemption” by the prescriber.

glossary

units of Measure

gram .................................................................................. g kilogram............................................................................kg international unit.................................................................iu microgram ....................................................................... µg milligram......................................................................... mg millilitre .............................................................................ml millimole ......................................................................mmol unit .................................................................................... u injection ............................................................................inj linctus ..........................................................................linc liquid ..............................................................................liq long Acting ..................................................................... lA ointment ........................................................................ oint Sachet ..........................................................................Sach Solution .........................................................................Soln Suppository ..................................................................Supp tablet .............................................................................tab tincture .........................................................................tinc trans dermal delivery System ......................................tddS

Abbreviations

Ampoule ....................................................................... Amp Capsule ......................................................................... Cap Cream............................................................................Crm device ............................................................................dev dispersible .....................................................................disp effervescent ..................................................................... eff emulsion.......................................................................emul enteric Coated.................................................................. eC gelatinous....................................................................... gel granules ....................................................................... gran infusion ............................................................................inf bSo CbS

bulk Supply order. Cost brand Source. there is no set manufacturer’s price, and the government subsidises the product at the price it is obtained by pharmacy. Ce Compounded extemporaneously. CPd Cost Per dose. the funder (as defined in Part i of the general Rules) cost of a standard dose, without mark-ups or fees and excluding gSt. eCP extemporaneously Compounded Preparation HSS Hospital supply status, the status of being the brand of the relevant Hospital Pharmaceutical listed in Section H Part ii as HSS, that dHbs are obliged to purchase subject to any dV limit for that Hospital Pharmaceutical for the period of hospital supply, as awarded under an agreement between PHARMAC and the relevant pharmaceutical supplier. PSo Practitioner’s Supply order. WSo Wholesale Supply order. s three months supply may be dispensed at one time if the exempted medicine is endorsed ‘certified exemption’ by the practitioner. ❋ three months dispensed all-at-once or, in the case of oral contraceptives, six months dispensed all-at-once, unless medicine is endorsed “close control” or “cc” and the endorsement is intialled by the prescriber. ‡ Safety cap required for oral liquid formulations, including extemporaneously compounded preparations. ✓ fully subsidised brand of a given medicine. brands without the tick are not fully subsidised and may cost the patient a manufacturer’s surcharge. Sole Subsidised Supplier only brand of this medicine subsidised. this medicine is an unapproved medication supplied under Section 29 on the Medicines Act 1981 Practitioners S29 prescribing this medication should: (a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984; (b) be aware of and comply with their obligations under the Health and disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and (c) exercise their own skill, judgement, expertise and discretions, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an indication for which it is not approved. note: Where medicines supplied under Section 29 that are used for emergency situations, patient details required under Section 29 of the Medicines Act may be retrospectively provided to the supplier.

Abbrev. [HP1]

Definitions Pharmacy Services Agreement Subsidised when dispensed from pharmacies that have the Complex Medicines Variation of the Pharmacy Services Agreement Subsidised when dispensed from pharmacies that have the Pharmacy Services Agreement Subsidised when dispensed from pharmacies that have the Monitored therapy Variation (for Clozapine Services). All other Pharmacy Agreements Available from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP1] pharmaceuticals. Available from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP3] pharmaceuticals. Available from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP4] pharmaceuticals.

[HP3] [HP4]

Patient costs

community Pharmaceutical costs met by the government

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

CARbAMAZePine tab 200 mg .....................................14.53 (19.14)

✓ Fully subsidised brand Higher priced brand

community Pharmaceutical costs met by the patient

Some Community Pharmaceutical costs are met by the patient. generally a patient pays a prescription charge. in addition a patient will sometimes pay a manufacturer’s surcharge, after hours service fee and any special packaging fee.

PReSCRiPtion CHARge

the prescription charge for a three month course of a fully subsidised Community Pharmaceutical ranges up to $15.00 and represents the patient’s contribution to the cost of the Community Pharmaceutical, and a pharmacy dispensing fee. Where the cost of the Community Pharmaceutical and dispensing fee exceed the prescription charge the government pays the rest of the cost. Maximum prescription charges vary by patient status as set out below. More information about prescription charges is contained in the pamphlet, Community Services Card, available from Work and income.

Patient’s subsidy entitlement(s) Maximum prescription charge

not a low-cost PHo enrolee or no card

Low-cost PHo enrolee or care plus patient community Services card (cSc) High use Health card (HuHc) Prescription Subsidy card

for families after first 20 prescriptions since previous february* * Except prescriptions with $0 charge

Adult Child 6 - 17 Child under 6 Contraceptives no other card no other card no other card no other card With HuHC only

With CSC low-cost PHo

$15 $10 $0 $3 $3 $3 $3 $2 $2

$0 $0

MAnufACtuReR’S SuRCHARge

not all Community Pharmaceuticals are fully subsidised. Although PHARMAC endeavours to fully subsidise at least one Community Pharmaceutical in each therapeutic group, and has contracts with some suppliers to maintain the price of a particular product, manufacturers are able to set their own price to pharmacies. When these prices exceed the subsidy, the pharmacist may recoup the difference from the patient. to estimate the amount a patient will pay on top of the prescription charge, take the difference between the manufacturer’s price and the subsidy, and multiply this by 1.86. the 1.86 factor represents the pharmacy mark-up on the surcharge plus other costs such as gSt. Pharmacies charge different mark-ups so this may vary.

Manufacturer’s surcharge to patient = (price - subsidy) x 1.86

for example, a Community Pharmaceutical with a supplier (ex-manufacturer) cost of $11.00 per pack with a $10.00 subsidy will cost the patient a surcharge of $1.86 on top of the prescription charge. the most a patient should pay is therefore $16.86 – being $15.00 maximum prescription charge, plus $1.86.

Hospital Pharmaceutical and Pharmaceutical cancer treatment costs

the cost of purchasing Hospital Pharmaceuticals and Pharmaceutical Cancer treatments (for use in dHb hospitals and/or in association with outpatient services provided in dHb hospitals) is met by the funder (in particular, the relevant dHb) from its own budget. As required by section 23(7) of the Act, in performing any of their functions in relation to the supply of Pharmaceutical Cancer treatments, dHbs must not act inconsistently with the Pharmaceutical Schedule.

PHArMAc web site

PHARMAC has set up an interactive Schedule on the internet. it can be used to calculate the cost of a prescribed Community Pharmaceutical. this site at http://www.pharmac.govt.nz takes into account the quantity of Community Pharmaceutical prescribed as well as the patient’s age, whether the patient has a community services card, high use health card or prescription subsidy card, the fee for pharmacy services and prescription charges. other information about PHARMAC is also available on our website. this includes copies of the Annual Review, Annual Report and Annual Plan, as well as information such as the Pharmaceutical Schedule, Pharmaceutical Schedule updates, national Hospital Pharmaceutical Strategy, other publications and recent press releases.

Special Authority Applications

Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular person.

Subsidy

once approved, the prescriber and the patient are provided a Special Authority number which must appear on the prescription. Specialists who make an application must communicate the valid authority number to the prescriber who will be writing the prescriptions. the authority number can provide access to subsidy, increased subsidy, or waive certain restrictions otherwise present on the Community Pharmaceutical. Some approvals are dependent on the availability of funding from the Pharmaceutical budget.

criteria

the criteria for approval of Special Authority applications are included below each Community Pharmaceutical listing, and on the application forms available on PHARMAC’s website. for some Special Authority Community Pharmaceuticals, not all indications that have been approved by Medsafe are subsidised. Criteria for each Special Authority Community Pharmaceutical are updated regularly, based on the decision criteria of PHARMAC. the appropriateness of the listing of a Community Pharmaceutical in the Special Authority category will also be regularly reviewed. Applications for inclusion of further Community Pharmaceuticals in the Special Authority category will generally be made by a pharmaceutical supplier.

Special Authority Applications

Application forms can be found at www.pharmac.govt.nz. Requests for fax copies should be made to PHARMAC, phone 04 460 4990. Applications are processed by HealthPAC (Wanganui), and should be sent to: HealthPAC, Private bag 3015, WAngAnui fax: (06) 349 1983 or free fax 0800 100 131 for inquiries, phone the Call Centre, free phone 0800 CHeM no (0800 243 666). Note: HealthPAC can only provide information on Special Authority applications to prescribers and pharmacists. Each application must: • include the patients name, date of birth and nHi number (codes for AidS patients’ applications) • include the practitioner’s name, address and Medical Council registration number • Clearly indicate that the relevant criteria, have been met. • be signed by the practitioner.

Exceptional circumstances policies

the purposes of the exceptional Circumstances policies are to provide: • funding from the Community exceptional Circumstances budget for medication, to be used in the community, in circumstances where the provision of a funded community medication is appropriate, but funding from the Pharmaceutical budget is not able to be provided through the Pharmaceutical Schedule (“Community exceptional Circumstances”); or • an assessment process for dHb Hospitals to determine whether they can fund medication, to be used in the community, in circumstances where the medication is neither a Community Pharmaceutical nor a discretionary Community Supply Pharmaceutical and where the patient does not meet the criteria for Community exceptional Circumstances (“Hospital exceptional Circumstances”); or • an assessment process for dHb Hospitals to determine whether they can fund pharmaceuticals for the treatment of cancer in their dHb Hospital, or in association with outpatient services provided in their dHb hospital, in circumstances where the pharmaceutical is not identified as a Pharmaceutical Cancer treatment (“Cancer exceptional Circumstances”) in Sections A-H of the Pharmaceutical Schedule. upon receipt of an application for approval for Community exceptional Circumstances or Hospital exceptional Circumstances, the exceptional Circumstances Panel first decides whether an application will be assessed initially under the Community exceptional Circumstances criteria or the Hospital exceptional Circumstances criteria. Cancer exceptional Circumstances is a separate process.

Hospital Exceptional circumstances

if the application is first assessed but not approved under the Community exceptional Circumstances criteria, the exceptional Circumstances Panel may recommend the funding of the pharmaceutical for use in the community by a specific patient from a dHb Hospital’s own budget under Hospital exceptional Circumstances. if the application is first assessed under the Hospital exceptional Circumstances criteria, the exceptional Circumstances Panel may: a) recommend against the funding of the pharmaceutical for use in the community by a specific patient from a dHb Hospital’s own budget, in which case a dHb Hospital must not fund the pharmaceutical from its own budget; b) recommend the funding of the pharmaceutical for use in the community by a specific patient from a dHb Hospital’s own budget under Hospital exceptional Circumstances, in which case a dHb Hospital may, but is not obliged to, fund the pharmaceutical from its own budget; c) defer its decision until further assessment under the Community exceptional Circumstances criteria can be undertaken; or d) recommend interim funding of the pharmaceutical for use in the community by a specific patient from a dHb Hospital’s own budget under Hospital exceptional Circumstances until further assessment under the Community exceptional Circumstances criteria can be undertaken. Permission to fund a pharmaceutical for use in the community by a specific patient from a dHb Hospital’s own budget under Hospital exceptional Circumstances will only be granted by PHARMAC where it has been demonstrated that such funding is cost-effective for the relevant dHb in the region in which the patient resides. if the patient being treated with a pharmaceutical under Hospital exceptional Circumstances usually resides in a district other than that within the jurisdiction of the dHb initiating the treatment, then the dHb initiating the treatment must either agree to fund any on-going treatment required once the patient has returned to his/her usual dHb, or obtain written consent from the dHb or dHbs in which the patient will reside following the commencement of treatment. Applications for Hospital exceptional Circumstances should be made on the standard application form available from the PHARMAC website www.pharmac.govt.nz or the address below: the Coordinator, Hospital exceptional Circumstances Panel Phone (04) 916 7521 PHARMAC, Po box 10 254 or fax (09) 523 6870 Wellington email: ecpanel@pharmac.govt.nz

cancer Exceptional circumstances

Permission to fund a pharmaceutical for the treatment of cancer from the Hospital’s own budget under Cancer exceptional Circumstances will only be granted by PHARMAC where it has been demonstrated that the proposed use meets the criteria. if the patient being treated with a pharmaceutical under Cancer exceptional Circumstances usually resides in a district other than that within the jurisdiction of the dHb initiating the treatment, then the dHb initiating the treatment must either agree to fund any on-going treatment required once the patient has returned to his/her usual dHb, or obtain written consent from the dHb or dHbs in which the patient will reside following the commencement of treatment.

community Exceptional circumstances

in order to qualify for Community exceptional Circumstances approval one of the following entry criteria must be met: a) the condition must be rare; or b) the reaction to alternative funded treatment must be unusual; or c) an unusual combination of circumstances applies. Rare and unusual are considered to be in the order of less than 10 people nationally. Where one of the above Community exceptional Circumstances entry criteria is met, the application may then be further examined under supplementary criteria, assessing suitability of the pharmaceutical, clinical benefit, the cost effectiveness of the treatment, and the patient’s ability to pay for the treatment. Where these documented criteria are met, a subsidy sufficient to fully fund the pharmaceutical will be made available to the specific patient on whose behalf the application was made. Community exceptional Circumstances funding is only available where the criteria are met and is not available for financial reasons alone. Applications for Community exceptional Circumstances, Hospital exceptional Circumstances and Cancer exceptional Circumstances should be made on the standard application form available from the PHARMAC website www.pharmac.govt.nz or the address below: the Coordinator, Community exceptional Circumstances Panel Phone (04) 916 7553 Po box 10 254 or fax (09) 523 6870 Wellington email: ecpanel@pharmac.govt.nz

Section A: geneRAl RUleS

intRodUction

Section A contains the restrictions and other general rules that apply to Subsidies on Community Pharmaceuticals. the amounts payable by the funder to Contractors are currently determined by: • the quantities, forms, and strengths, of subsidised Community Pharmaceuticals dispensed under valid prescription by each Contractor; • the amount of the Subsidy on the Manufacturer’s Price payable for each unit of the Community Pharmaceuticals dispensed by each Contractor and; • the contractual arrangements between the Contractor and the funder for the payment of the Contractor’s dispensing services. the Pharmaceutical Schedule shows the level of subsidy payable in respect of each Community Pharmaceutical so that the amount payable by the government to Contractors, for each Community Pharmaceutical, can be calculated. the Pharmaceutical Schedule also shows the standard price (exclusive of gSt) at which a Community Pharmaceutical is supplied ex-manufacturer to wholesalers if it differs from the subsidy. the manufacturer’s surcharge to patients can be estimated using the subsidy and the standard manufacturer’s price as set out in this Schedule. the cost to government of subsidising each Community Pharmaceutical and the manufacturer’s prices may vary, in that suppliers may provide rebates to other stakeholders in the primary health care sector, including dispensers, wholesalers, and the government. Rebates are not specified in the Pharmaceutical Schedule. this Schedule is dated 1 December 2006 and is to be referred to as the Pharmaceutical Schedule Volume 13 number 3, 2006. distribution will be from 20 December 2006. this Schedule comes into force on 1 December 2006.

PARt i inteRPRetAtion And definitionS

1.1 in this Schedule, unless the context otherwise requires: “90 day Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 90 consecutive days’ treatment; “180 day Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 180 consecutive days’ treatment; “Access Exemption criteria” means the criteria under which patients may receive greater than one Month’s supply of a Community Pharmaceutical covered by Section f Part ii (b) subsidised in one lot. the specifics of these criteria are conveyed in the Ministry of Health guidelines, which are issued from time to time. the criteria the patient must meet are that they: a) have limited physical mobility; b) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; c) are relocating to another area; d) are travelling extensively and will be out of town when the repeat prescriptions are due. “Act” means the new Zealand Public Health and disability Act 2000. “Advisory committee” means the Pharmaceutical Services Advisory Committee convened by the Ministry of Health under the terms of the Advice notice issued to Contractors pursuant to Section 88 of the Act. “Alternate Subsidy” means a higher level of subsidy that the government will pay contractors for a particular community Pharmaceutical dispensed to a person who has either been granted a Special Authority for that pharmaceutical, or where the prescription is endorsed in accordance with the requirements of this Pharmaceutical Schedule. “Assessed Pharmaceuticals” means the list of Pharmaceuticals set out in Section H Part iii of the Schedule, that have been or are being assessed by PHARMAC. “Bulk Supply order” means a written order, on a form supplied by the Ministry of Health, or approved by HealthPAC, made by the licensee or manager of an institution certified to provide hospital care under the Health and disability Services (Safety) Act 2001 for the supply of such Community Pharmaceuticals as are expected to be required for the treatment of persons who are under the medical or dental supervision of such a Private Hospital or institution. “cancer Exceptional circumstances” means the policies and criteria administered by PHARMAC relating to the ability to fund, from a dHb hospital’s own budget, pharmaceuticals for the treatment of cancer that are not identified as Pharmaceutical Cancer treatments in Sections A-H of the Pharmaceutical Schedule. “class B controlled drug” means a Class b controlled drug within the meaning of the Misuse of drugs Act 1975.

Section A: geneRAl RUleS

“close control” means the dispensing of a Community Pharmaceutical, in accordance with a Prescription, in quantities less than one 90 day lot or, in the case of oral contraceptives, less than one 180 day lot for a Community Pharmaceutical referred to in Section f Part i, or in quantities less than a Monthly lot for any other Community Pharmaceutical, as applicable, where all of the following conditions are met: i) the Community Pharmaceutical is a tri-cyclic antidepressant, antipsychotic, benzodiazepine, a Class b Controlled drug, or any other Community Pharmaceutical that has been prescribed for a patient who: A) is not a resident in a Penal institution, Rest Home or Residential disability Care institution; and b) in the opinion of the prescribing doctor, Midwife or nurse Prescriber is: 1) frail; or 2) infirm; or 3) unable to manage their medication without additional support; or 4) intellectually impaired; and C) requires that Community Pharmaceutical to be dispensed in a smaller quantity than that for which it is currently funded; and ii) the prescribing doctor, Midwife or nurse Prescriber has A) endorsed each Community Pharmaceutical on the Prescription clearly with the words “close control” or “CC”; and b) initialled the endorsement in the prescribers own handwriting; and C) specified the maximum quantity or period of supply to be dispensed at any one time. “community Exceptional circumstances” means the policies and criteria administered by the exceptional Circumstances Panel relating to funding from the Community exceptional Circumstances budget for medication, to be used in the community, in circumstances where the provision of a funded community medication is appropriate, but funding from the Pharmaceutical budget is not able to be provided through the Pharmaceutical Schedule. “community Pharmaceutical” means a Pharmaceutical listed in Sections A to g of the Pharmaceutical Schedule that is subsidised by the funder from the Pharmaceutical budget for use in the community. “contractor” means a person who is entitled to receive a payment from the Crown or a dHb under a notice issued by the Crown or a dHb under Section 88 of the Act or under a contract with the Ministry of Health or a dHb for the supply of Community Pharmaceuticals. “controlled drug” means a controlled drug within the meaning of the Misuse of drugs Act 1975 (other than a controlled drug specified in Part Vi of the third Schedule to that Act). “cost, Brand, Source of Supply” means that the Community Pharmaceutical is eligible for Subsidy on the basis of the Contractor’s annotated purchase price, brand, and source of supply. “dentist” means a person registered with the dental Council, and who holds a current annual practising certificate, under the HPCA Act 2003. “dHB” means an organisation established as a district Health board by or under Section 19 of the Act. “dHB Hospital” means a dHb, including its hospital or associated provider unit that the dHb purchases Hospital Pharmaceuticals for. “discretionary community Supply Pharmaceutical” means the list of Pharmaceuticals set out in Section H Part iV of the Schedule, which may be funded by a dHb Hospital from its own budget for use in the community. “doctor” means a medical Practitioner registered with the Medical Council of new Zealand and, who holds a current annual practising certificate under the HPCA Act 2003. “dv Limit” means, for a particular Hospital Pharmaceutical with HSS, the national dV limit or the individual dV limit. “dv Pharmaceutical” means a discretionary variance Pharmaceutical, that does not have HSS and which: a) is either listed in Section H Part ii of the Schedule as being a dV Pharmaceutical in association with the relevant Hospital Pharmaceutical with HSS; or b) is the same chemical entity, at the same strength, and in the same or a similar presentation or form, as the relevant Hospital Pharmaceutical with HSS, but which is not yet listed as being a dV Pharmaceutical. “Endorsements” – unless otherwise specified, endorsements should be either handwritten or computer generated by the practitioner prescribing the medication. the endorsement can be written as “certified condition”, or state the condition of the patient, where that condition is specified for the Community Pharmaceutical in Section b of the Pharmaceutical Schedule. Where the practitioner writes “certified condition” as the endorsement, he/she is making a declaration that the patient meets the criteria as set out in Section b of the Pharmaceutical Schedule. “Exceptional circumstances Panel” means the panel of clinicians, appointed by the PHARMAC board, that is responsible

Section A: geneRAl RUleS

for administering policies in relation to Community exceptional Circumstances and Hospital exceptional Circumstances. “Funder” means the body or bodies responsible, pursuant to the Act, for the funding of pharmaceuticals listed on the Schedule (which may be one or more dHbs and/or the Ministry of Health) and their successors. “gSt” means goods and services tax under the goods and Services tax Act 1985. “Hospital care operator” means a person for the time being in charge of providing hospital care, in accordance with the Health and disability Services (Safety) Act 2001. “Hospital Exceptional circumstances” means the policies and criteria administered by the exceptional Circumstances Panel relating to the ability to fund, from a dHb Hospital’s own budget, pharmaceuticals for use in the community by a specific patient where a subsidy is not available from the Pharmaceutical budget or under Community exceptional Circumstances. “Hospital Pharmaceuticals” means national Contract Pharmaceuticals, dV Pharmaceuticals, discretionary Community Supply Pharmaceuticals and Assessed Pharmaceuticals. “Hospital Pharmacy” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the funder to dispense as a hospital pharmacy to an outpatient on the Prescription of a doctor. “Hospital Pharmacy-dermatologist” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the funder to dispense as a hospital pharmacy: a) to an outpatient; and b) on a Prescription signed by a Specialist in dermatology “Hospital Pharmacy-Specialist” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the funder to dispense as a hospital pharmacy: a) to an outpatient; and b) on a Prescription signed by a Specialist; or if the treatment of an outpatient with the Community Pharmaceutical has been recommended by a Specialist, on the Prescription of a Practitioner endorsed with the words “recommended by [name of specialist and year of authorisation]” and signed by the Practitioner. “As recommended by a Specialist” to be interpreted as: a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written; c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the specialist and the general Practitioner must keep a written record of the consultation. for the purposes of the definition it makes no difference whether or not the Specialist is employed by a hospital. “Hospital Pharmacy-Specialist Prescription” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the funder to dispense as a hospital pharmacy: a) to an outpatient; and b) on a Prescription signed by a Specialist. “HSS” means hospital supply status, the status of being the brand of the relevant Hospital Pharmaceutical listed in Section H Part ii as HSS, that dHbs are obliged to purchase subject to any dV limit for that Hospital Pharmaceutical for the period of hospital supply, as awarded under an agreement between PHARMAC and the relevant pharmaceutical supplier. “In combination” means that the Community Pharmaceutical is only subsidised when prescribed in combination with another subsidised pharmaceutical as specified in Section b or C of the Pharmaceutical Schedule. “Individual dv Limit” means, for a particular Hospital Pharmaceutical with HSS and a particular dHb Hospital, the discretionary variance limit, being the specified percentage of that dHb Hospital’s total Market Volume up to which that dHb Hospital may purchase dV Pharmaceuticals of that Hospital Pharmaceutical. “Licensed Hospital” means a place or institution that is certified to provide hospital care within the meaning of the Health and disability Services (Safety) Act 2001. “Lot” means a quantity of a Community Pharmaceutical supplied in one dispensing. “Manufacturer’s Price” means the standard price at which a Community Pharmaceutical is supplied to wholesalers (excluding gSt), as notified to PHARMAC by the supplier. “Maternity hospital” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied pursuant to a bulk Supply order to a maternity hospital certified under the Health and disability Services (Safety) Act 2001.

Section A: geneRAl RUleS

“Midwife” means a person registered as a midwife with the Midwifery Council, and who holds a current annual practising certificate under the HPCA Act 2003. “Month” means a period of 30 consecutive days. “Month restriction” means that no Subsidy is available: a) unless the Community Pharmaceutical is dispensed on the Prescription of a Practitioner; and b) for any quantity of that Community Pharmaceutical dispensed on the Prescription (whether or not dispensed as a repeat) in excess of a Monthly lot. “Monthly Lot” means the quantity of a Community Pharmaceutical required for the number of days’ treatment covered by the Prescription, being up to 30 consecutive days’ treatment; “national contract Pharmaceutical” means a Hospital Pharmaceutical for which PHARMAC has negotiated a national contract and the Price. “national dv Limit” means, for a particular Hospital Pharmaceutical with HSS, the discretionary variance limit, being the specified percentage of the total Market Volume up to which all dHb Hospitals may collectively purchase dV Pharmaceuticals of that Hospital Pharmaceutical. “not In combination” means that no Subsidy is available for any Prescription containing the Community Pharmaceutical in combination with other ingredients unless the particular combination of ingredients is separately specified in Section b or C of the Schedule, and then only to the extent specified. “nurse Prescriber” means a nurse registered with the nursing Council and who holds a current annual practicing certificate under the HPCA Act 2003 and who is approved by the nursing Council, to prescribe specified prescription medicines relating to his/her scope of practice. “optometrist” means a person registered as an optometrist with the optometrists and dispensing opticians board, who holds a current annual practising certificate under the HPCA Act 2003, and who is authorised by regulations under the Medicines Act 1981 and approved by the optometrists and dispensing opticians board to prescribe specified medicines. “outpatient”, in relation to a Community Pharmaceutical, means a person who, as part of treatment at a hospital or other institution under the control of a dHb, is prescribed the Community Pharmaceutical for consumption or use in the person’s home. “Pct” means Pharmaceutical Cancer treatment in respect of which dHb hospital pharmacies and other Contractors can claim Subsidies. “Pct only” means Pharmaceutical Cancer treatment in respect of which only dHb hospital pharmacies can claim Subsidies. “Penal Institution” means a penal institution, as that term is defined in the Penal institutions Act 1954; “PHArMAc” means the Pharmaceutical Management Agency established by Section 46 of the Act (PHARMAC). “Pharmaceutical” means a medicine, therapeutic medical device, or related product or related thing listed in Sections b to H of the Schedule. “Pharmaceutical Benefits” means the right of: a) a person; and b) any member under 16 years of age of that person’s family, to have made by the government on his or her behalf, subject to any conditions for the time being specified in the Schedule, such payment in respect of any Community Pharmaceutical supplied to that person or family member under the order of a Practitioner in the course of his or her practice. “Pharmaceutical Budget” means the pharmaceutical budget set for PHARMAC by the Crown for the subsidised supply of Community Pharmaceuticals. “Pharmaceutical cancer treatment” means Pharmaceutical for the treatment of cancer, listed in Sections A to g of the Schedule and identified therein as a “PCt” or “PCt only” Pharmaceutical that dHbs must fund, from their own budgets, for use in their hospitals, and/or in association with outpatient services provided in their dHb Hospitals, in relation to the treatment of cancers. “Practitioner” means a doctor, a dentist, a Midwife, nurse Prescriber or an optometrist as those terms are defined in the Pharmaceutical Schedule. “Practitioner’s Supply order” means a written order made by a Practitioner on a form supplied by the Ministry of Health, or approved by HealthPAC, for the supply of Community Pharmaceuticals to the Practitioner, which the Practitioner requires to ensure medical supplies are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where individual prescription is not practicable. “Prescription” means a quantity of a Community Pharmaceutical prescribed for a named person on a document signed by a Practitioner.

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“Private Hospital” means a hospital certified under the Health and disability Services (Safety) Act 2001 that is not owned or operated by a dHb. “residential disability care Institution” means premises used to provide residential disability care in accordance with the Health and disability Services (Safety) Act 2001. “rest Home” means premises used to provide rest home care in accordance with the Health and disability Services (Safety) Act 2001. “retail Pharmacy-Specialist” means that the Community Pharmaceutical is only eligible for Subsidy if it is supplied on a Prescription or Practitioner’s Supply order signed by a Specialist, or, in the case of treatment recommended by a Specialist, a Prescription or Practitioner’s Supply order and endorsed with the words “recommended by [name of Specialist and year of authorisation]” and signed by the Practitioner. “As recommended by a Specialist” to be interpreted as: a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written; c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the Specialist and the general Practitioner must keep a written record of consultation. “retail Pharmacy-Specialist Prescription” means that the Community Pharmaceutical is only eligible for Subsidy if it is supplied on a Prescription, or Practitioner’s Supply order, signed by a Specialist. “Schedule” means this Pharmaceutical Schedule and all its sections and appendices. “Section B” of this Pharmaceutical Schedule means the list of Community Pharmaceuticals eligible for Subsidies included in the Schedule. “Section c” of this Pharmaceutical Schedule means the list of community extemporaneously compounded preparations and galenicals eligible for Subsidies included in the Schedule. “Section d” of this Pharmaceutical Schedule means the list of community special foods eligible for Subsidies included in the Schedule. “Section E Part I” of this Pharmaceutical Schedule means the list of Community Pharmaceuticals eligible for Subsidies and available on a Practitioner’s Supply order or a Wholesale Supply order included in the Schedule. “Section E Part II” of this Pharmaceutical Schedule means the list of rural areas for the purpose of community Practitioner’s Supply orders included in the Schedule. “Section F Part I” of this Pharmaceutical Schedule means the part of Section f relating to the exemption from dispensing in Monthly lots, and requirement to dispense in 90 day lots or 180 day lots, as applicable, in respect of the Community Pharmaceuticals referred to in this part of Section f; “Section F Part II” of this Pharmaceutical Schedule means the part of Section f relating to the exemption from dispensing in Monthly lots in respect of the Community Pharmaceuticals referred to in this part of Section f; “Section g” of this Pharmaceutical Schedule means the list of Community Pharmaceuticals eligible for reimbursement of safety caps. “Section H” of this Pharmaceutical Schedule means the general rules for Hospital Pharmaceuticals and the lists of national Contract Pharmaceuticals and any associated dV Pharmaceuticals, of discretionary Community Supply Pharmaceuticals and Assessed Pharmaceuticals included in Section H of the Schedule. “Section H Part I” of this Pharmaceutical Schedule means the general rules for Hospital Pharmaceuticals. “Section H Part II” of this Pharmaceutical Schedule means the list of national Contract Pharmaceuticals, the relevant Price, an indication of whether the Pharmaceutical has HSS and any associated dV Pharmaceuticals and dV limit. “Section H Part III” of this Pharmaceutical Schedule means the list of Assessed Pharmaceuticals. “Section H Part Iv” of this Pharmaceutical Schedule means the list of discretionary Community Supply Pharmaceuticals. “Special Authority” means that the Community Pharmaceutical is only eligible for Subsidy or additional Subsidy for a particular person if an application meeting the criteria specified in the Schedule has been approved, and the valid Special Authority number is present on the prescription. “Specialist”, in relation to a Prescription, a doctor who holds a current annual practising certificate and who satisfies the criteria set out in paragraphs (a) or (b) or (c) or (d) below: a) i) the doctor is vocationally registered in accordance with the criteria set out by the Medical Council of new Zealand and the HPCA Act 2003 and who has written the Prescription in the course of practising in that area of medicine; and ii) the doctor’s vocational scope of practice is one of those listed below: – anaesthetics, cardiothoracic surgery,

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dermatology, diagnostic radiology, emergency medicine, general surgery, internal medicine, neurosurgery, obstetrics and gynaecology, occupational medicine, ophthalmology, oral and maxillofacial surgery otolaryngology head and neck surgery, orthopaedic surgery, paediatric surgery, paediatrics, pathology, plastic and reconstructive surgery, psychological medicine or psychiatry, public health medicine, radiation oncology, rehabilitation medicine, urology and venereology; b) the doctor is recognised by the Ministry of Health as a specialist for the purposes of this Schedule and receives remuneration from a dHb at a level which that dHb considers appropriate for specialists and who has written that Prescription in the course of practising in that area of medicine; c) the doctor is recognised by the Ministry of Health as a specialist in relation to a particular area of medicine for the purpose of writing Prescriptions and who has written the Prescription in the course of practising in that area of medicine; d) the doctor writes the Prescription on dHb stationery and is appropriately authorised by the relevant dHb to do so. “Subsidy” means the maximum amount that the government will pay Contractors for a Community Pharmaceutical dispensed to a person eligible for Pharmaceutical benefits and is different from the cost to government of subsidising that Community Pharmaceutical. for the purposes of a dHb hospital pharmacy claiming for Pharmaceutical Cancer treatments, Subsidy refers to any payment made to the dHb hospital pharmacy or service provider to which that pharmacy serves, and does not relate to a specific payment that might be made on submission of a claim. “Supply order” means a bulk Supply order, a Practitioner’s Supply order or a Wholesale Supply order. “Wholesale Supply order” means a written order by a Practitioner, on a form supplied by the Ministry of Health for the supply of certain Community Pharmaceuticals as listed in Section b and Section e Part i of the Schedule. 1.2 in addition to the above interpretations and definitions, unless the content requires otherwise, a reference in the Schedule to: a) the singular includes the plural; and b) any legislation includes a modification and re-enactment of, legislation enacted in substitution for, and a regulation, order in Council, and other instrument from time to time issued or made under that legislation, where that legislation, regulation, order in Council or other instrument has an effect on the prescribing, dispensing or subsidising of Community Pharmaceuticals.

PARt ii commUnity PhARmAceUticAlS SUbSidy

2.1 Community Pharmaceuticals eligible for Subsidy include every medicine, therapeutic medical device or related product, or related thing listed in Sections b to g of the Schedule, and every preparation (having an inert base) of any of them, is hereby declared to be a Community Pharmaceutical for the purposes of the Schedule, subject to: 2.1.1 clauses 2.2 and 2.3 of the Schedule; and 2.1.2 clauses 3.1 to 4.4 of the Schedule; and 2.1.3 the conditions (if any) specified in Sections b to g of the Schedule; 2.2 the following medicines, therapeutic medical devices, or related products or related things are not eligible for Subsidy: 2.2.1 substances, or combinations of substances, ordered for any purpose other than: a) treatment of a patient’s medical or dental condition; or b) pregnancy tests; or c) the prevention of sexually transmitted disease; or d) contraception. 2.2.2 substances and combinations of substances packed under pressure in aerosol cans or other similar devices, unless it is specified in Sections b to g of the Schedule that they may be so packed; 2.2.3 electrode jellies; 2.2.4 eye drops packed in single-dose units, unless it is specified in Sections b to g of the Schedule that they may be so packed; 2.2.5 insect repellents and similar preparations; 2.2.6 oral preparations in long-acting form, unless it is specified in Sections b to g of the Schedule that they may be in such a form; 2.2.7 substances or combinations of substances in lozenge or similar form, unless it is specified in Sections b to g of the

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Schedule that they may be in such a form; 2.2.8 machine-spread plasters; 2.2.9 preparations prescribed as foods, unless they are specified in Section d of the Schedule; 2.2.10 substances, combinations of substances, or articles, in the form of proprietary medicines or proprietary articles, unless they are deemed or declared to be Pharmaceuticals elsewhere in the Schedule; 2.2.11 shampoos, other than extemporaneously prepared medicated shampoos, or shampoos specified in Sections b to g of the Schedule intended for the treatment of a patient’s medical condition; 2.2.12 toilet preparations; 2.2.13 tooth pastes and powders; 2.2.14 lubricating jellies and catheter lubricants; 2.2.15 sterile diluents for nebulising solutions; 2.2.16 substances in a form intended to enable delivery by transdermal diffusion or osmosis or by the insertion of any solid object or substance into the eye cavity, unless it is specified in Sections b to g of the Schedule that they may be in such a form; 2.2.17 substances in a form intended for intravenous delivery (other than by injection), unless it is specified in Sections b to g of the Schedule that they may be in such a form; 2.2.18 substances packed in pre-loaded syringes known as Min-i-jets, unless it is specified in Sections b to g of the Schedule that they may be so packed; 2.2.19 Community Pharmaceuticals prescribed as cough mixtures, unless they are specified in Sections b to g of the Schedule otherwise than in combination with other ingredients; 2.2.20 vitamin preparations in capsule form, unless they are specified in Sections b to g of the Schedule; 2.2.21 substances prescribed for use as irrigating solutions, unless it is specified in Sections b to g of the Schedule that they may be prescribed for such use. 2.3 no claim by a Contractor for payment in respect of the supply of Community Pharmaceuticals will be allowed unless the Community Pharmaceuticals so supplied: 2.3.1 comply with the appropriate standards prescribed by regulations for the time being in force under the Medicines Act 1981; or 2.3.2 in the absence of any such standards, comply with the appropriate standards for the time being prescribed by the british Pharmacopoeia; or 2.3.3 in the absence of the standards prescribed in clauses 2.3.1 and 2.3.2, comply with the appropriate standards for the time being prescribed by the british Pharmaceutical Codex; or 2.3.4 in the absence of the standards prescribed in clauses 2.3.1, 2.3.2 and 2.3.3, are of a grade and quality not lower than those usually applicable to Community Pharmaceuticals intended to be used for medical purposes.

PARt iii PeRiod And QUAntity of SUPPly

3.1 doctors’, Midwives’, nurse Prescribers’, and optometrists’ Prescriptions (other than oral contraceptives) the following provisions apply to all Prescriptions, other than those for an oral contraceptive, written by a doctor, Midwife, nurse Prescriber, or optometrist: 3.1.1 for a Community Pharmaceutical other than a Class b Controlled drug, only a quantity sufficient to provide treatment for a period not exceeding three Months will be subsidised. 3.1.2 for methylphenidate hydrochloride and dexamphetamine sulphate, only a quantity sufficient to provide treatment for a period not exceeding one Month will be subsidised. 3.1.3 for a Class b Controlled drug other than methylphenidate hydrochloride and dexamphetamine sulphate, only a quantity: a) sufficient to provide treatment for a period not exceeding 10 days; and b) which has been dispensed pursuant to a Prescription sufficient to provide treatment for a period not exceeding one Month, will be subsidised. 3.1.4 Subject to clauses 3.1.3 and 3.1.7, for a doctor, Midwife or nurse Prescriber, and 3.1.7 for an optometrist, where a practitioner has prescribed a quantity of a Community Pharmaceutical sufficient to provide treatment for: a) one Month or less than one Month, but dispensed by the Contractor in quantities smaller than the quantity prescribed, the Community Pharmaceutical will only be subsidised as if that Community Pharmaceutical had

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been dispensed in a Monthly lot; b) more than one Month, the Community Pharmaceutical will be subsidised only if it is dispensed: i) in a 90 day lot, where the Community Pharmaceutical is a Pharmaceutical covered by Section f Part i of the Pharmaceutical Schedule; or ii) if the Community Pharmaceutical is not a Pharmaceutical referred to in Section f Part i of the Pharmaceutical Schedule, in Monthly lots, unless: A) the eligible person or his/her nominated representative endorses the back of the Prescription form with a statement identifying which Access exemption Criterion (Criteria) applies and signs that statement to this effect; or b) both: 1) the Practitioner endorses the Community Pharmaceutical on the Prescription with the words “certified exemption” written in the Practitioner’s own handwriting or signed or initialled by the Practitioner; and 2) every Community Pharmaceutical endorsed as “certified exemption” is covered by Section f Part ii of the Pharmaceutical Schedule. 3.1.5 A Community Pharmaceutical is only eligible for Subsidy if the Prescription under which it has been dispensed was presented to the Contractor: a) for a Class b Controlled drug, within eight days of the date on which the Prescription was written; or b) for any other Community Pharmaceutical, within three Months of the date on which the Prescription was written. 3.1.6 no subsidy will be paid for any Prescription, or part thereof, that is not fulfilled within: a) in the case of a Prescription for a total supply of from one to three Months, three Months from the date the Community Pharmaceutical was first dispensed; or b) in any other case, one Month from the date the Community Pharmaceutical was first dispensed. only that part of any Prescription that is dispensed within the time frames specified above is eligible for Subsidy. 3.1.7 if a Community Pharmaceutical: a) is stable for a limited period only, and the doctor, Midwife, nurse Prescriber, or optometrist has endorsed the Prescription with the words “unstable medicine” and has specified the maximum quantity that may be dispensed at any one time; or b) is stable for a limited period only, and the Contractor has endorsed the Prescription with the words “unstable medicine” and has specified the maximum quantity that should be dispensed at any one time in all the circumstances of the particular case; or c) is Close Control, the actual quantity dispensed will be subsidised in accordance with any such specification. 3.2 oral contraceptives the following provisions apply to all Prescriptions written by a doctor, Midwife or nurse Prescriber for an oral contraceptive: 3.2.1 the prescribing doctor, Midwife or nurse Prescriber must specify on the Prescription the period of treatment for which the Community Pharmaceutical is to be supplied. this period must not exceed: a) three Months if prescribed by a Midwife; or b) six Months if prescribed by a doctor or nurse Practitioner. 3.2.2 Where the period of treatment specified in the Prescription does not exceed six Months, the Community Pharmaceutical is to be dispensed: a) in lots as specified in the Prescription if the Community Pharmaceutical is Close Control; or b) where no lots are specified, in one lot sufficient to provide treatment for the period prescribed. 3.2.3 An oral contraceptive is only eligible for Subsidy if the Prescription under which it has been dispensed was presented to the Contractor within three Months of the date on which it was written. 3.2.4 An oral contraceptive prescribed by a Midwife is only eligible for Subsidy if the Prescription under which it has been dispensed has been written within the period of post natal care of the eligible person. 3.2.5 Where a Community Pharmaceutical in a Prescription is Close Control and a repeat on the Prescription remains unfulfilled after six Months from the date the Community Pharmaceutical was first dispensed only the actual quantity supplied by the Contractor within this time limit will be eligible for Subsidy. 3.3 dentists’ Prescriptions the following provisions apply to every Prescription written by a dentist: 3.3.1 the maximum quantity of a Community Pharmaceutical that will be subsidised is as follows:

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a) where the Community Pharmaceutical is a Controlled drug, only such quantity as is necessary to provide treatment for a period not exceeding five days; and b) in any other case, only such quantity as is necessary to provide treatment for a period not exceeding five days and, where the Prescription specifies a repeat, one further period not exceeding five days. 3.3.2 notwithstanding clause 3.3.1, if, in the opinion of the dentist, an eligible person needs extended treatment with sodium fluoride for up to three Months, the Community Pharmaceutical will be subsidised for that extended period. A Prescription for any such extended supply of sodium fluoride will be subsidised only if it is dispensed in Monthly lots, unless the eligible person or his/her nominated representative endorses the back of the Prescription form with a statement identifying which Access exemption Criterion (Criteria) applies and signs that statement to this effect. 3.3.3 A Community Pharmaceutical is only eligible for Subsidy if the Prescription under which it has been dispensed has been presented to the Contractor: a) for a Class b Controlled drug, within eight days of the date on which the Prescription was written; or b) for any other Community Pharmaceutical, within three Months of the date on which the Prescription was written. 3.3.4 no Subsidy will be paid for any Prescription, or part thereof, that is not fulfilled within: a) one Month from the date the Community Pharmaceutical was first dispensed; or b) in the case of sodium fluoride, three Months from the date the Community Pharmaceutical was first dispensed. only that part of any Prescription that is dispensed within the time frames specified above is eligible for Subsidy. 3.4 original Packs, and certain Antibiotics 3.4.1 notwithstanding clauses 3.1 and 3.3 of the Schedule, if a Practitioner prescribes or orders a Community Pharmaceutical that is identified as an original Pack (oP) on the Pharmaceutical Schedule and is packed in a container from which it is not practicable to dispense lesser amounts, every reference in those clauses to an amount or quantity eligible for Subsidy, is deemed to be a reference: a) where an amount by weight or volume of the Community Pharmaceutical is specified in the Prescription, to the smallest container of the Community Pharmaceutical, or the smallest number of containers of the Community Pharmaceutical, sufficient to provide that amount; and b) in every other case, to the amount contained in the smallest container of the Community Pharmaceutical that is manufactured in, or imported into, new Zealand. 3.4.2 if a Community Pharmaceutical is the liquid oral form of an antibiotic to which a diluent must be added by the Contractor at the time of dispensing and it is prescribed or ordered by a Practitioner in an amount that does not coincide with the amount contained in one or more standard packs of that Community Pharmaceutical, Subsidy will only be made for the amount prescribed or ordered by the Practitioner in accordance with either clause 3.1 or clause 3.3 of the Schedule, unless the Contractor satisfies the funder that he or she has not been able to dispense the balance of the pack or packs from which the Community Pharmaceutical has been dispensed. in such cases all of that pack or those packs is eligible for Subsidy.

PARt iV miScellAneoUS PRoViSionS

4.1 Bulk Supply orders the following provisions apply to the supply of Community Pharmaceuticals under bulk Supply orders: 4.1.1 no Community Pharmaceutical supplied under a bulk Supply order will be subsidised unless all the requirements in Section b, C or d of the Schedule applicable to that pharmaceutical are met. 4.1.2 the person who placed the bulk Supply order may be called upon by the Ministry of Health to justify the amount ordered. 4.1.3 Class b Controlled drugs will be subsidised only if supplied under bulk Supply orders placed by an institution certified to provide hospital care under the Health and disability Services (Safety) Act 2001. 4.1.4 Any order for a Class b Controlled drug or for buprenorphine hydrochloride must be written on a Special bulk Supply order Controlled drug form supplied by the Ministry of Health. 4.1.5 Community Pharmaceuticals listed in Part i of the first Schedule to the Medicines Regulations 1984 will be subsidised only if supplied under a bulk Supply order placed by an institution certified to provide hospital care under the Health and disability Services (Safety) Act 2001 and: a) that institution employs a registered general nurse, registered with the nursing Council and who holds a current annual practicing certificate under the HPCA Act 2003; and

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b) the bulk Supply order is supported by a written requisition signed by a Hospital Care operator. 4.1.6 no Subsidy will be paid for any quantity of a Community Pharmaceutical supplied under a bulk Supply order in excess of what is a reasonable monthly allocation for the particular institution, after taking into account stock on hand. 4.1.7 the Ministry of Health may, at any time, by public notification, declare that any approved institution within its particular region, is not entitled to obtain supplies of Community Pharmaceuticals under bulk Supply orders with effect from the date specified in that declaration. Any such notice may in like manner be revoked by the Ministry of Health at any time. 4.2 Practitioner’s Supply orders the following provisions apply to the supply of Community Pharmaceuticals to Practitioners under a Practitioner’s Supply order: 4.2.1 Subject to clause 4.2.3, a Practitioner may only order under a Practitioner’s Supply order those Community Pharmaceuticals listed in Section e Part i and only in such quantities as set out in Section e Part i that the Practitioner requires to ensure medical supplies are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where individual prescription is not practicable. 4.2.2 Any order for a Class b Controlled drug or for buprenorphine hydrochloride must be written on a Special Practitioner’s Supply order Controlled drug form supplied by the Ministry of Health. 4.2.3 A Practitioner may order such Community Pharmaceuticals as he or she expects to be required for personal administration to patients under the Practitioner’s care if: a) the Practitioner’s normal practice is in the specified areas listed in Section e Part ii of the Schedule, or if the Practitioner is a locum for a Practitioner whose normal practice is in such an area. b) the quantities ordered are reasonable for up to one Month’s supply under the conditions normally existing in the practice. (the Practitioner may be called on by the Ministry of Health to justify the amounts of Community Pharmaceuticals ordered) 4.2.4 no Community Pharmaceutical ordered under a Practitioner’s Supply order will be eligible for Subsidy unless: a) the Practitioner’s Supply order is made on a form supplied for that purpose by the Ministry of Health, or approved by HealthPAC and which: i) is personally signed and dated by the Practitioner; and ii) sets out the Practitioner’s address; and iii) sets out the Community Pharmaceuticals and quantities, and; b) all the requirements of Sections b and C of the Schedule applicable to that pharmaceutical are met. 4.2.5 the Ministry of Health may, at any time, on the recommendation of an Advisory Committee appointed by the Ministry of Health for that purpose, by public notification, declare that a Practitioner specified in such a notice is not entitled to obtain supplies of Community Pharmaceuticals under Practitioner’s Supply orders until such time as the Ministry of Health notifies otherwise. 4.3 Wholesale Supply orders the following provisions apply to the supply of Community Pharmaceuticals to Practitioners under Wholesale Supply orders: 4.3.1 notwithstanding anything contained in the Schedule, but subject nevertheless to subclause 4.3.3 of this clause, a Practitioner may obtain from a wholesaler or distributor, pursuant to a Wholesale Supply order made on a form supplied by the Ministry of Health, any Community Pharmaceutical specified in Section b and Section e Part i of the Schedule as being available on a Wholesale Supply order. 4.3.2 Subject to clause 4.3.3, Community Pharmaceuticals supplied to Practitioners under Wholesale Supply orders will be subsidised at a rate not exceeding the Manufacturer’s Price for each such Community Pharmaceutical as set out in Section b and Section e Part i of the Schedule. 4.3.3 no subsidy will be paid for any quantity of a Community Pharmaceutical supplied to a Practitioner under a Wholesale Supply order in excess of what is a reasonable monthly allocation for that particular Practitioner, after taking into account stock on hand. 4.3.4 the Ministry of Health may, at any time, on the recommendation of an Advisory Committee appointed by the Ministry of Health for that purpose, by public notification, declare that a Practitioner specified in such a notice is not entitled to obtain supplies of Community Pharmaceuticals under Wholesale Supply orders until such time as the Ministry of Health notifies otherwise. 4.4 retail Pharmacy and Hospital Pharmacy-Specialist restriction the following provisions apply to Prescriptions for Community Pharmaceuticals eligible to be subsidised as “Retail Pharmacy-Specialist” and “Hospital Pharmacy-Specialist”:

Section A: geneRAl RUleS

4.4.1 record keeping it is expected that a record will be kept by both the general Practitioner and the Specialist of the fact of consultation and enough of the clinical details to justify the recommendation. this means referral by telephone will need to be followed up by written consultation. 4.4.2 Expiry the recommendation expires at the end of two years and can be renewed by a further consultation. 4.4.3 the circulation by Specialists of the circumstances under which they are prepared to recommend a particular Community Pharmaceutical is acceptable as a guide. it must however be followed up by the procedure in subclauses 4.4.1 and 4.4.2, for the individual Patient. 4.4.4 the use of preprinted forms and named lists of Specialists (as circulated by some pharmaceutical companies) is regarded as inappropriate. 4.4.5 the Rules for Retail Pharmacy-Specialist and Hospital Pharmacy-Specialist will be audited as part of HealthPAC’s routine auditing procedures. 4.5 Pharmaceutical cancer treatments 4.5.1 dHbs must provide access to Pharmaceutical Cancer treatments for use in the treatment of cancers in their dHb hospitals, and/or in association with outpatient services provided in their dHb hospitals. 4.5.2 dHbs must only provide access to Pharmaceuticals for the treatment of cancer that are listed as Pharmaceutical Cancer treatments in Sections A to g of the Schedule, provided that dHbs may provide access to an unlisted pharmaceutical for the treatment of cancer where that unlisted pharmaceutical: (a) has Cancer exceptional Circumstances approval; (b) has Community exceptional Circumstances or Hospital exceptional Circumstances approval; (c) is being used as part of a bona fide clinical trial which has ethics Committee approval; (d) is being used and funded as part of a paediatric oncology service; or (e) was being used to treat the patient in question prior to 1 july 2005. 4.5.3 A dHb hospital pharmacy that holds a claiming agreement for Pharmaceutical Cancer treatments with the funder may claim a Subsidy for a Pharmaceutical Cancer treatment marked as “PCt” or PCt only” in Sections A to g of this Schedule subject to that Pharmaceutical Cancer treatment being dispensed in accordance with: (a) Part 1; (b) clauses 2.1 to 2.3; (b) clauses 3.1 and 3.4; and (c) clause 4.5, of Section A of the Schedule. 4.5.4 A Contractor (other than a dHb hospital pharmacy) may only claim a Subsidy for a Pharmaceutical Cancer treatment marked as “PCt” in Sections A to g of the Schedule subject to that Pharmaceutical Cancer treatment being dispensed in accordance with the rules applying to Sections A to g of the Schedule. 4.5.5 Some indications for Pharmaceutical Cancer treatments listed in the Schedule have not been approved by Medsafe, but formed part of the october 2001 direction from the Minister of Health as to pharmaceuticals and indications for which dHbs must provide funding. As far as reasonably practicable, these indications are marked in the Schedule. However, PHARMAC makes no representation and gives no guarantee as to the accuracy of this information. Practitioners prescribing Pharmaceutical Cancer treatments for such unapproved indications should: (a) be aware of and comply with their obligations under section 29 of the Medicines Act 1981 and otherwise under the Medicines Act and the Medicines Regulations 1984; (b) be aware of and comply with their obligations under the Health and disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and (c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical Cancer treatment or a Pharmaceutical Cancer treatment for an indication for which it is not approved. 4.6 Amendment of Schedule PHARMAC may amend the terms of the Schedule from time to time by notice in writing given in such manner as PHARMAC thinks fit, and in accordance with such protocols as agreed with the Pharmacy guild of new Zealand (inc) from time to time. 4.7 conflict in Provisions if any rules in Sections b–g of this Schedule conflict with the rules in Section A, the rules in Sections b–g apply.

Section b: AlimentARy tRAct And metAboliSm

Antacids and Antiflatulents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntAcidS And AntiflAtUlentS Antacids and Reflux barrier Agents

AlginiC ACid Sodium alginate 225 mg and magnesium alginate 87.5 mg per sachet .................................................................... 4.50 30 ✓ gaviscon Infant

CAlCiuM CARbonAte WitH AMinoACetiC ACid ❋ tab 420 mg and aminoacetic acid 180 mg Higher subsidy of $37.60 per 1000 with endorsement........................... 30.00 1,000 (37.60) titralac a) Additional subsidy by endorsement is available for pregnant women. b) the prescription must be endorsed accordingly. We recommend that the words used to indicate eligibilty are “certified condition” however these particular words are not a requirement. PolySiloxAne ❋ tab aluminium hydroxide 250 mg with magnesium trisil 120 mg, magnesium hydroxide 120 mg and polysiloxane 10 mg......................... 15.00 (18.70) (Gastrogel to be delisted 1 February 2007) SiMetHiCone ❋ oral liq aluminium hydroxide 200 mg with magnesium hydroxide 200 mg and activated simethicone 20 mg per 5 ml ................................. 1.50 (4.05) SodiuM AlginAte ❋ oral liq 500 mg with sodium bicarbonate 267 mg per 10 ml (aniseed) ............ 1.50 (7.50) ❋ oral liq 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg per 10 ml ............................................... 1.50 (4.95) ❋ tab 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg - peppermint flavour ................................................... 1.80 (7.81)

500 gastrogel

500 ml Mylanta P 500 ml gaviscon 500 ml 60 Acidex gaviscon double Strength

Phosphate binding Agents

AluMiniuM HydRoxide tab 600 mg .............................................................................................. 12.56 100 ✓ Alu-tab

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

AlimentARy tRAct And metAboliSm

Antidiarrhoeals

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntidiARRhoeAlS Agents Which Reduce motility

diPHenoxylAte HydRoCHloRide WitH AtRoPine SulPHAte ❋ tab 2.5 mg with atropine sulphate 25 µg .................................................... 3.90 loPeRAMide HydRoCHloRide - Available on a PSo ❋ tab 2 mg .................................................................................................. 11.75 100 400 ✓ diastop ✓ nodia

Rectal and colonic Anti-inflammatories

budeSonide - Special Authority - Retail Pharmacy Cap 3 mg................................................................................................ 185.00 100 ✓ Entocort cIr

Special Authority for Subsidy - form: SA0698 initial application only from a gastroenterologist, general surgeon or general physician. Approvals valid for 3 months for applications meeting the following criteria: both: 1 Mild to moderate ileal, ileocaecal or proximal Crohn’s disease; and 2 Any of the following: 2.1 diabetes; or 2.2 Cushingoid habitus; or 2.3 osteoporosis where there is significant risk of fracture; or 2.4 Severe acne following treatment with conventional corticosteroid therapy. Renewal only from a gastroenterologist, general surgeon or general physician. Approvals valid for 3 months where the treatment remains appropriate and the patient is benefiting from treatment. the patient has had no more than 1 prior approval in the last year. note Clinical trials for entocort CiR use beyond three months demonstrated no improvement in relapse rate. HydRoCoRtiSone ACetAte Rectal foam 10%, CfC-free ...................................................................... 21.10 MeSAlAZine tab 400 mg - Retail pharmacy-specialist .................................................. 68.40 tab long-acting 500 mg - Retail pharmacy-specialist................................ 69.06 enema 1 g per 100 ml - Retail pharmacy-specialist .................................. 46.90 Suppos 500 mg ........................................................................................ 27.95 olSAlAZine - Retail pharmacy-specialist Cap 250 mg.............................................................................................. 31.51 tab 500 mg .............................................................................................. 59.86 SodiuM CRoMoglyCAte - Hospital pharmacy [HP3]-specialist Cap 100 mg.............................................................................................. 89.21 SulPHASAlAZine ❋ tab 500 mg ................................................................................................ 8.42 ❋ tab eC 500 mg........................................................................................... 9.44 ❋ enema 3 g per 100 ml - Retail pharmacy-specialist .................................. 37.40 (43.00) 21.1 g oP 100 100 7 20 100 100 100 100 100 7 ✓ colifoam ✓ Asacol ✓ Pentasa ✓ Pentasa ✓ Asacol ✓ dipentum ✓ dipentum ✓ nalcrom ✓ Salazopyrin ✓ Salazopyrin En Salazopyrin

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

AlimentARy tRAct And metAboliSm

Antihaemorrhoidals Antispasmodics and other Agents Altering gut motility Antiulcerants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntihAemoRRhoidAlS corticosteroids

fluoCoRtolone CAPRoAte WitH fluoCoRtolone PiVAlAte And CinCHoCAine oint 950 µg, with fluocortolone pivalate 920 µg and cinchocaine hydrochloride 5 mg per g ............................................................................ 7.05 30 g oP Suppos 630 µg, with fluocortolone pivalate 610 µg, and cinchocaine hydrochloride 1 mg .......................................................... 2.95 12

✓ ultraproct ✓ ultraproct

Rectal Sclerosants

oily PHenol ❋ inj 5%, 5 ml .............................................................................................. 71.71 5 ✓ Mayne

Soothing Agents

ZinC oxide oint zinc oxide with balsam peru ................................................................. 4.50 (6.50) Suppos zinc oxide with balsam peru .......................................................... 4.47 (6.35) 50 g oP Anusol 12 Anusol

AntiSPASmodicS And otheR AgentS AlteRing gUt motility

AtRoPine SulPHAte ❋ inj 400 µg, 1 ml - Available on a PSo ....................................................... 29.95 ❋ inj 600 µg, 1 ml - Available on a PSo ....................................................... 26.00 ❋ inj 1200 µg 1 ml - Available on a PSo ...................................................... 32.00 (AstraZeneca atropine sulphate inj 400 µg, 1 ml to be delisted 1 April 2007) diCyCloMine HydRoCHloRide ❋ tab 10 mg - Available on a PSo ................................................................. 4.95 (Merbentyl tab 10 mg to be delisted 1 January 2007) HyoSCine n-butylbRoMide ❋ tab 10 mg .................................................................................................. 6.83 (10.85) ❋ inj 20 mg, 1 ml - Available on a PSo........................................................... 7.15 MebeVeRine HydRoCHloRide - Retail pharmacy-specialist ❋ tab 135 mg .............................................................................................. 10.72 (25.73) 50 50 50 ✓ AstraZeneca ✓ AstraZeneca ✓ AstraZeneca

100

✓ Merbentyl

100 5 90 Colofac buscopan ✓ Buscopan

AntiUlceRAntS Antisecretory and cytoprotective

MiSoPRoStol - Retail pharmacy-specialist ❋ tab 200 µg .............................................................................................. 52.70 120 ✓ cytotec

helicobacter Pylori eradication

oMePRAZole, AMoxyCillin And ClARitHRoMyCin omeprazole cap 20 mg x 14, amoxycillin cap 500 mg x 28, clarithromycin tab 500 mg x 14 .................................................... 55.00 1 oP ✓ Losec Hp7 oAc

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

AlimentARy tRAct And metAboliSm

Antiulcerants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

h Antagonists

CiMetidine - only on a prescription. ❋ tab 200 mg ................................................................................................ 5.00 (7.50) ❋ tab 400 mg .............................................................................................. 10.00 (12.00) fAMotidine - only on a prescription. ❋ tab 20 mg .................................................................................................. 4.66 ❋ tab 40 mg .................................................................................................. 9.98 100 Apo-Cimetidine 100 Apo-Cimetidine 250 250 ✓ Famox ✓ Famox

RAnitidine HydRoCHloRide - only on a prescription. ❋ tab 150 mg ................................................................................................ 7.99 250 ✓ Arrow-ranitidine ❋ tab 300 mg .............................................................................................. 10.94 250 ✓ Arrow-ranitidine ❋ inj 25 mg per ml, 2ml ................................................................................. 8.75 5 ✓ Zantac ❋ oral liq 150 mg per 10 ml - Subsidy by endorsement ............................... 20.04 300 ml ✓ Zantac Subsidy by endorsement: oral liquid is subsidised only for patients: - with oesophageal stricture, or - in terminal care, or - who are either too young or too old to swallow conventional tablets and the prescription is endorsed accordingly. note the cost of treatment with ranitidine oral liquid is more than 10 times higher than that of ranitidine tablets. following the derestriction of access PHARMAC will be monitoring expenditure on ranitidine oral liquid more closely and may, subject to consultation and PHARMAC board approval, restrict access again if the expenditure was to grow substantially.

Proton Pump inhibitors

lAnSoPRAZole ❋ Cap 30 mg.................................................................................................. 8.59 oMePRAZole ❋ Cap 10 mg................................................................................................ 17.37 ❋ Cap 20 mg................................................................................................ 24.81 ❋ Cap 40 mg................................................................................................ 29.05 ❋ inj 40 mg .................................................................................................. 12.50 for omeprazole suspension refer page 164 PAntoPRAZole ❋ tab 20 mg .................................................................................................. 4.02 (22.00) ❋ tab 40 mg .................................................................................................. 5.12 (28.00) 28 30 30 30 1 ✓ Solox ✓ Losec ✓ Losec ✓ Losec ✓ Losec

30 Somac 30 Somac

Site Protective Agents

SuCRAlfAte tab 1 g ..................................................................................................... 35.50 (48.28) tRiPotASSiuM diCitRAtobiSMutHAte tab 120 mg .............................................................................................. 38.00 120 Carafate 112 ✓ de-nol

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

AlimentARy tRAct And metAboliSm

diabetes

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

diAbeteS hyperglycaemic Agents

gluCAgon HydRoCHloRide - Available on PSo inj 1 mg syringe kit ................................................................................... 27.00 1 ✓ glucagen Hypokit

insulin – Short-acting Preparations

inSulin neutRAl s inj animal (pork) 100 u per ml, 10 ml ........................................................ 25.26 s inj human 100 u per ml, 3 ml .................................................................... 42.66 s inj human 100 u per ml............................................................................. 25.26 (Actrapid inj animal (pork) 100 u per ml to be delisted 1 June 2007) 10 ml oP 5 10 ml oP ✓ Actrapid ✓ Actrapid Penfill ✓ Humulin r ✓ Actrapid ✓ Humulin r

insulin – intermediate-acting Preparations

inSulin iSoPHAne s inj animal (pork) 100 u per ml, 10 ml ........................................................ 25.26 ✓ Insulatard ✓ Protaphane s inj human 100 u per ml, 3 ml .................................................................... 29.86 5 ✓ Humulin n ✓ Humulin nPH ✓ Protaphane Penfill s inj human 100 u per ml ........................................................................... 17.68 10 ml oP ✓ Humulin n ✓ Humulin nPH ✓ Protaphane (Humulin N inj human 100 u per ml, 3 ml and 100 u per ml, 10 ml OP to be delisted 1 February 2007) (Insulatard to be delisted 1 June 2007) inSulin iSoPHAne WitH inSulin neutRAl s inj animal (pork) 100 u per ml, 10 ml ........................................................ 25.26 s inj human with neutral insulin 100 u per ml, 3 ml ...................................... 42.66 ✓ Mixtard 30 ✓ Humulin 30/70 ✓ Humulin 70/30 ✓ PenMix 10 ✓ PenMix 20 ✓ PenMix 30 ✓ PenMix 40 ✓ PenMix 50 s inj human with neutral insulin 100 u per ml ............................................... 25.26 10 ml oP ✓ Humulin 30/70 ✓ Humulin 70/30 ✓ Mixtard 30 ✓ Mixtard 50 (Humulin 70/30 inj human with neutral insulin 100 u per ml, 3 ml and 100 u per ml, 10 ml OP to be delisted 1 February 2007) (Mixtard 30 inj animal (pork) 100 u per ml, 10 ml OP to be delisted 1 June 2007) 10 ml oP 5 10 ml oP

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

AlimentARy tRAct And metAboliSm

diabetes

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

insulin – long-acting Preparations

inSulin glARgine – Special Authority – Retail pharmacy s inj 100 u per ml, 3 ml ............................................................................... 94.50 s inj 100 u per ml, 10 ml ............................................................................. 63.00 5 1 ✓ Lantus ✓ Lantus

Special Authority for Subsidy – form: SA0834 initial application only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: either: 1 both: 1.1 Patient has type 1 diabetes and has received an intensive regimen (injections at least three times a day) of an intermediate acting insulin in combination with a rapid acting insulin analogue for at least three months; and 1.2 either: 1.2.1 Patient has experienced more than one unexplained severe hypoglycaemic episode in the previous 12 months (severe defined as requiring the assistance of another person); or 1.2.2 Patient has experienced unexplained symptomatic nocturnal hypoglycaemia, biochemically documented at <3.0 mmol/l, more than once a month despite optimal management; or 2 Patient has documented severe, or continuing, systemic or local allergic reaction to existing insulins. note this does not include hypoglycaemic episodes. Renewal only from a relevant specialist or general practitioner. Approvals valid for 1 year for applications meeting the following criteria: either: 3 Patient is continuing to derive benefit due to reduced hypoglycaemic events whilst maintaining similar or better glycaemic control; or 4 Patient’s allergic reaction has significantly decreased, or resolved, following the change to long-acting insulin and patient is continuing to benefit from treatment.

insulin – Rapid acting insulin analogues

inSulin ASPARt s inj 100 u per ml, 3 ml ............................................................................... 56.54 s inj 100 u per ml, 10 ml ............................................................................. 33.17 inSulin liSPRo s inj 100 u per ml, 3 ml ............................................................................... 59.52 s inj 100 u per ml, 10 ml ............................................................................. 34.92 5 1 5 10 ml oP ✓ novorapid Penfill ✓ novorapid ✓ Humalog ✓ Humalog

Alpha glucosidase inhibitors

ACARboSe - Special Authority - Retail pharmacy ❋ tab 50 mg ................................................................................................ 22.00 ❋ tab 100 mg .............................................................................................. 31.00 90 90 ✓ glucobay ✓ glucobay

Special Authority for Subsidy - form: SA0490 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 Requires but is not able to tolerate metformin therapy; or 2 Requires metformin but metformin is contraindicated; or 3 Has not responded to or tolerated the maximum appropriate dose of metformin. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

AlimentARy tRAct And metAboliSm

diabetes

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

oral hypoglycaemic Agents

glibenClAMide ❋ tab 2.5 mg ................................................................................................. 3.78 ❋ tab 5 mg .................................................................................................... 3.31 gliClAZide ❋ tab 80 mg ................................................................................................ 36.46 gliPiZide ❋ tab 5 mg .................................................................................................... 3.50 MetfoRMin HydRoCHloRide ❋ tab 500 mg .............................................................................................. 12.50 ❋ tab 850 mg ................................................................................................ 9.00 PioglitAZone - Special Authority - Retail pharmacy tab 15 mg ................................................................................................ 61.04 tab 30 mg ................................................................................................ 93.90 tab 45 mg .............................................................................................. 119.18 100 100 500 100 500 250 28 28 28 ✓ gliben ✓ gliben ✓ Apo-gliclazide ✓ Minidiab ✓ Metomin ✓ Metomin ✓ Actos ✓ Actos ✓ Actos

Special Authority for Subsidy - form: SA0819 initial application for patients with type 2 diabetes only from a relevant specialist. Approvals valid for one year for applications meeting the following criteria: Any of the following: Monotherapy 1 All of the following: 1.1 to be used as monotherapy for patients who after six months of diet and lifestyle changes have inadequate glycaemic control (defined as HbA1c > 7.0% in tests carried out at least two months apart); and 1.2 Metformin is contraindicated or not tolerated after a minimum of a four week trial period; and 1.3 Sulphonylurea is contraindicated or not tolerated or the patient’s body mass index (bMi) exceeds 33 kg/m2; or in combination with sulphonylurea 2 both: 2.1 for use in combination with a sulphonylurea for patients who after diet and lifestyle changes and a six-month trial of sulphonylurea have poor glycaemic control (defined as HbA1c > 8.0% measured within the last month of the six month period); and 2.2 Metformin is contraindicated or not tolerated after a minimum of a four-week trial period; or in combination with metformin 3 both: 3.1 for use in combination with metformin for patients who after diet and lifestyle changes and a six-month trial of the maximum tolerated dose of metformin have poor glycaemic control (defined as HbA1c > 8.0% measured within the last month of the six month period); and 3.2 Sulphonylurea is contraindicated or not tolerated or the patient’s body mass index (bMi) exceeds 33 kg/m2; or in combination with metformin after a trial of metformin and sulphonylurea 4 for use in combination with metformin for patients who after diet and lifestyle changes and a six-month trial of a combination of metformin and sulphonylurea at maximum tolerated doses have poor glycaemic control (defined as HbA1c > 8.0% measured within the last month of the six month period); or in combination with insulin 5 for use in combination with insulin in patients requiring more than 1.5 units per kilogram of insulin a day for at least 6 months in conjunction with metformin if tolerated. note Pioglitazone is not to be used in triple oral combination (defined as a combination of metformin, sulphonylurea and pioglitazone) Pioglitazone should not be used in patients with heart failure.

continued...

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

AlimentARy tRAct And metAboliSm

diabetes diabetes management

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued... liver function tests should be performed at baseline. gastrointestinal side effects are relatively common when initiating metformin therapy. upward titration of metformin dose over several weeks and taking metformin with food will help to minimize these side effects. intolerance and contraindications for metformin include: i) Serum creatinine ≥ 0.15 or creatinine clearance < 60 ml/min ii) Significant liver impairment iii) Severe left ventricular dysfunction iv) intolerable gastrointestinal side effects that persist beyond 4 weeks duration. intolerance for sulphonylurea includes: nausea; diarrhoea; rash; blood disorders (thrombocytopenia, agranulocytosis, aplastic anaemia); erythema multiforme, exfoliative dermatitis, hepatitis; and syndrome of inappropriate antidiuretic hormone secretion (SiAdH) with water retention and hyponatraemia. Maximum tolerated dose of metformin defined as: A dose up to a maximum of 3 g daily. Maximum tolerated dose of sulphonylurea defined as: A dose up to a maximum of glibenclamide 20 mg daily or glipizide 20 mg daily or gliclazide 320 mg daily. Renewal for patients with type 2 diabetes only from a relevant specialist or general practitioner. Approvals valid for one year for applications meeting the following criteria: both: 6 Patient has had two consecutive HbA1c levels tested results of < 8.0 (at least two months apart) in the last six-month period of pioglitazone treatment; and 7 either: 7.1 the patient is not on insulin combination therapy; or 7.2 following the addition of pioglitazone, there has been at least a 30% reduction in insulin dosage. tolbutAMide ❋ tab 500 mg .............................................................................................. 12.00 100 ✓ diatol

diAbeteS mAnAgement glucose/Urine testing

CoPPeR - not on a bSo ❋ tab, diagnostic ........................................................................................... 5.02 (30.25) 36 oP Clinitest

gluCoSe oxidASe - not on a bSo urine diagnostic test with peroxidase .......................................................... 4.13 50 strip oP (6.05) urine diagnostic test with peroxidase .......................................................... 4.11 50 strip oP (6.05) urine diagnostic test ................................................................................... 4.11 50 strip oP (7.00)

Clinistix diastix diabur 5000

glucose &/or Ketones/Urine testing

gluCoSe oxidASe - not on a bSo urine diagnostic test with peroxidase, sodium nitroprusside and aminoacetic acid............................................................................... 4.53 50 stick oP (8.00) urine diagnostic test with peroxidase, potassium iodide, sodium nitroprusside and aminoacetic acid ............................................. 4.53 50 strip oP (7.50)

Keto-diabur 5000 Keto-diastix

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

AlimentARy tRAct And metAboliSm

diabetes management

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer SodiuM nitRoPRuSSide - not on a bSo ❋ urine diagnostic strips, buffered.................................................................. 3.39 50 strip oP (6.00) ❋ urine diagnostic strips, buffered.................................................................. 3.40 50 strip oP (7.15)

Ketur-test Ketostix

glucose/blood testing

gluCoSe blood diAgnoStiC teSt MeteR - Subsidy by endorsement Meter ........................................................................................................ 19.00 1 ✓ Accu-chek Advantage Meter .......................................................................................................... 9.00 1 ✓ optium A diagnostic blood glucose test meter is subsidised for patients who begin insulin or sulphonylurea therapy after 1 March 2005. only one meter per patient. no further prescriptions will be subsidised. the prescription must be endorsed accordingly. gluCoSe deHydRogenASe the number of test strips available on a prescription is restricted to 50 unless: a) Prescribed with insulin or a sulphonylurea but are on a different prescription and the prescription is endorsed accordingly; or b) Prescribed on the same prescription as insulin or a sulphonylurea in which case the prescription is deemed to be endorsed; or c) Prescribed for a pregnant woman with diabetes and endorsed accordingly. blood/glucose test strips........................................................................... 11.00 25 test oP ✓ optium 22.00 50 test oP ✓ Accu-chek Advantage ✓ optium

insulin Syringes and needles

Subsidy is available for disposable insulin syringes, needles, and pen needles if prescribed on the same form as the one used for the supply of insulin or when prescribed for an insulin patient and the prescription is endorsed accordingly.

disposable supplies

inSulin SyRingeS, diSPoSAble WitH AttACHed needle Maximum of 100 dev per prescription. ❋ Syringe 0.3 ml with 29 g x 12.7 mm needle .............................................. 15.92 100 ✓ B-d ultra Fine ❋ Syringe 0.3 ml with 30 g x 8 mm needle ................................................... 15.92 100 ✓ B-d ultra Fine II 100 ✓ B-d ultra Fine II ❋ Syringe 0.3 ml with 31 g x 8 mm needle ................................................... 15.92 ❋ Syringe 0.5 ml with 29 g x 12.7 mm needle .............................................. 15.92 100 ✓ B-d ultra Fine ❋ Syringe 0.5 ml with 30 g x 8 mm needle ................................................... 15.92 100 ✓ B-d ultra Fine II ❋ Syringe 0.5 ml with 31 g x 8 mm needle ................................................... 15.92 100 ✓ B-d ultra Fine II ❋ Syringe 1 ml with 29 g x 12.7 mm needle ................................................. 15.92 100 ✓ B-d ultra Fine ❋ Syringe 1 ml with 30 g x 8 mm needle ...................................................... 15.92 100 ✓ B-d ultra Fine II ❋ Syringe 1 ml with 31 g x 8 mm needle ...................................................... 15.92 100 ✓ B-d ultra Fine II (B-D Ultra Fine II syringe 0.3 ml with 30 g x 8 mm needle, syringe 0.5 ml with 30 g x 8 mm needle and syringe 1 ml with 30 g x 8 mm needle to be delisted 1 January 2007) inSulin Pen needleS a) Subsidy by endorsement b) Maximum 100 dev per prescription. novofine pen needles 31 g x 6 mm are subsidised for children under 12 years of age. ❋ 29 g x 12.7 mm ........................................................................................ 13.09 100 ✓ B-d Micro-Fine ❋ 31 g x 8 mm ............................................................................................. 13.09 100 ✓ B-d Micro-Fine ❋ 31 g x 5 mm ............................................................................................. 13.09 100 ✓ B-d Micro-Fine ❋ 31 g x 6 mm ............................................................................................. 26.00 100 ✓ novoFine

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

AlimentARy tRAct And metAboliSm

digestives including enzymes laxatives

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

digeStiVeS inclUding enZymeS

PAnCReAtiC enZyMe tab eC 1,900 bP u lipase, 1,700 bP u amylase, 110 bP u protease ................ 32.46 tab eC 5,600 bP u lipase, 5,000 bP u amylase, 330 bP u protease ................. 58.44 Cap 8,000 bP u lipase, 9,000 bP u amylase, 430 bP u protease ............ 67.26 Cap 8,000 uSP u lipase, 30,000 uSP u amylase, 30,000 uSP u protease - Retail pharmacy-specialist.............................. 85.00 Cap eC 10,000 bP u lipase, 9,000 bP u amylase and 210 bP u protease - Retail pharmacy-specialist .............................. 34.93 Cap eC 25,000 bP u lipase, 18,000 bP u amylase, 1,000 bP u protease - Retail pharmacy-specialist .................................. 94.38 Cap eC 25,000 bP u lipase, 22,500 bP u amylase, 1,250 bP u protease - Retail pharmacy-specialist .................................. 94.40 uRSodeoxyCHoliC ACid - Special Authority - Retail pharmacy Cap 300 mg............................................................................................ 269.98 300 300 300 250 100 100 100 100 ✓ Pancrex v ✓ Pancrex v Forte ✓ Pancrex v ✓ cotazym EcS ✓ creon 10000 ✓ creon Forte ✓ Panzytrat ✓ Actigall

Special Authority for Subsidy - form: SA0841 initial application only from a gastroenterologist or general physician. Approvals valid for 6 months for applications meeting the following criteria: both: 1 Primary biliary cirrhosis confirmed by antimitochondrial antibody titre (AMA) > 1:80, and raised cholestatic liver enzymes with or without raised serum igM or, if AMA is negative, by liver biopsy; and 2 Patient not requiring a liver transplant (bilirubin > 170umol/l; decompensated cirrhosis). note liver biopsy is not usually required for diagnosis but is helpful to stage the disease Renewal only from a gastroenterologist or general physician. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. note Actigall is not an appropriate therapy for patients requiring a liver transplant (bilirubin > 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.

lAXAtiVeS bulk-forming Agents

MuCilAginouS lAxAtiVeS - only on a prescription ❋ Sugar free .................................................................................................. 4.84 (10.60) ❋ dry ............................................................................................................. 5.28 ❋ dry ............................................................................................................ 5.72 ❋ dry ............................................................................................................ 6.69 ❋ dry ............................................................................................................. 7.92 (12.71) ❋ dry - original flavour, regular texture only .................................................... 5.91 (12.38) ❋ dry ............................................................................................................. 8.80 (15.27) (Mucilax 300 g OP to be delisted 1 February 2007) 275 g oP 300 g oP 325 g oP 380 g oP 450 g oP 336 g oP Metamucil 500 g oP normacol Mucilax ✓ Mucilax ✓ konsyl-d ✓ Mucilax isogel

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

AlimentARy tRAct And metAboliSm

digestives including enzymes laxatives

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer MuCilAginouS lAxAtiVeS WitH StiMulAntS ❋ dry ............................................................................................................. 4.40 250 g oP (10.80) ❋ dry ............................................................................................................. 3.52 200 g oP (7.69) ❋ dry ............................................................................................................. 8.80 500 g oP (15.27)

granocol normacol Plus normacol Plus

faecal Softeners

doCuSAte SodiuM - only on a prescription ❋ tab 50 mg .................................................................................................. 4.89 ❋ tab 120 mg ................................................................................................ 6.73 ❋ enema conc 18%........................................................................................ 5.40 doCuSAte SodiuM WitH SennoSideS ❋ tab 50 mg with total sennosides 8 mg ....................................................... 7.98 PoloxAMeR - only on a prescription ❋ oral drops 10% ........................................................................................... 3.93 100 100 100 ml oP 200 30 ml oP ✓ coloxyl ✓ coloxyl ✓ coloxyl ✓ Laxsol ✓ coloxyl

osmotic laxatives

glyCeRol - only on a prescription ❋ Suppos 2.55 g ............................................................................................ 3.12 ❋ Suppos 3.6 g .............................................................................................. 5.00 lACtuloSe - only on a prescription ❋ oral liq 10 g per 15 ml ................................................................................ 6.60 SodiuM ACid PHoSPHAte - only on a prescription enema 16% with sodium phosphate 8% ..................................................... 2.50 12 20 1000 ml 1 ✓ Fleet glycerin Suppositories ✓ PSM ✓ Laevolac ✓ Fleet Phosphate Enema ✓ Microlax

SodiuM CitRAte WitH SodiuM lAuRyl SulPHoACetAte - only on a prescription enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml ............ 7.30 12

Stimulant laxatives

biSACodyl - only on a prescription ❋ tab 5 mg .................................................................................................... 5.55 ❋ Suppos 5 mg .............................................................................................. 2.35 (3.00) ❋ Suppos 10 mg ............................................................................................ 3.96 200 6 12 ✓ Lax-tabs dulcolax ✓ Fleet

dAntHRon WitH PoloxAMeR - only on a prescription note: danthron with poloxamer is only approved for the prevention or treatment of constipation in the terminally ill. Studies in rats have associated use of danthron with tumours. oral liq 25 mg with poloxamer 200 mg per 5 ml.......................................... 4.00 300 ml ✓ codalax oral liq 75 mg with poloxamer 1g per 5 ml.................................................. 8.30 300 ml ✓ codalax Forte (Codalax and Codalax Forte to be delisted 1 February 2007) SennA - only on a prescription ❋ tab, standardised ....................................................................................... 2.17 (6.04) 100 Senokot

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

AlimentARy tRAct And metAboliSm

metabolic disorder Agents mouth and throat

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

metAbolic diSoRdeR AgentS gaucher’s disease

iMigluCeRASe - Special Authority - Hospital pharmacy [HP1] inj 40 iu per ml, 200 iu vial...................................................................1,072.00 1 ✓ cerezyme Special Authority approved by the gaucher treatment panel. a) Subject to a budgetary cap. Applications will be considered and approved subject to funding availability. Application details may be obtained from: the Coordinator, gaucher treatment Panel Phone: (04) 460 4990 PHARMAC, Po box 10 254 facsimile: (04) 916 7571 Wellington email: erin.murphy@pharmac.govt.nz

moUth And thRoAt Agents Used in mouth Ulceration

benZydAMine HydRoCHloRide - Retail pharmacy-specialist prescription Soln 0.15% ................................................................................................. 9.00 (14.91) CHloRHexidine gluConAte Mouthwash 0.2%........................................................................................ 3.06 CHoline SAliCylAte WitH CetAlKoniuM CHloRide ❋ Adhesive gel 8.7% with cetalkonium chloride 0.01% ................................... 2.06 (4.40) SodiuM CARboxyMetHylCelluloSe With pectin and gelatin paste ...................................................................... 1.52 (3.60) With pectin and gelatin paste ..................................................................... 4.55 (7.90) With pectin and gelatin paste .................................................................... 17.20 With pectin and gelatin powder ................................................................... 8.48 (10.95) tRiAMCinolone ACetonide 0.1% in dental Paste uSP ........................................................................... 4.50 500 ml difflam 200 ml oP 15 g oP bonjela 5 g oP orabase 15 g oP 56 g oP 28 g oP 5 g oP orabase ✓ Stomahesive Stomahesive ✓ oracort ✓ orion

oropharyngeal Anti-infectives

AMPHoteRiCin b lozenges 10 mg ........................................................................................ 5.86 MiConAZole oral gel 20 mg per g ................................................................................... 8.95 nyStAtin oral liq 100,000 u per ml ............................................................................ 3.03 20 40 g oP 24 ml oP ✓ Fungilin ✓ daktarin ✓ nilstat

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

AlimentARy tRAct And metAboliSm

mouth and throat Vitamins

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

other oral Agents

for folinic mouthwash refer page 164 for pilocarpine oral liquid refer page 164 for saliva substitute formula refer page 164 HydRogen PeRoxide ❋ Soln 10 vol ................................................................................................. 0.75 (1.80) a) maximum 200 ml per prescription tHyMol glyCeRin ❋ Compound, bPC ......................................................................................... 7.30 (11.00) 100 ml PSM

500 ml PSM

VitAminS Vitamin A

VitAMin A WitH VitAMinS d And C Soln 1000 u with Vitamin d 400 u and ascorbic acid 30 mg per 10 drops ......................................................................... 4.38 10 ml oP (5.51)

Vitadol C

Vitamin b group

HydRoxoCobAlAMin ❋ inj 1 mg per ml, 1 ml ................................................................................ 10.84 PyRidoxine HydRoCHloRide a) no more than 100 mg per dose b) only on a prescription ❋ tab 25 mg – no patient co-payment payable ........................................3.06 ❋ tab 50 mg ................................................................................................ 17.63 tHiAMine HydRoCHloRide – only on a prescription ❋ tab 50 mg .................................................................................................. 5.62 VitAMin b CoMPlex ❋ tab, strong, bPC ...................................................................................... 12.10 3 ✓ neo-cytamen

90 500 100 500

✓ Healtheries ✓ Apo-Pyridoxine ✓ Apo-thiamine ✓ Apo-B-complex

Vitamin c

ASCoRbiC ACid a) no more than 100 mg per dose b) only on a prescription ❋ tab 100 mg .............................................................................................. 17.25 13.00 (17.25) (Alpha-Ascorbic Acid to be delisted 1 February 2007) ASCoRbiC ACid And SodiuM ASCoRbAte a) no more than 100 mg per dose b) only on a prescription ❋ tab 100 mg ................................................................................................ 2.60

500

✓ Apo-Ascorbic Acid Alpha Ascorbic Acid

100

✓ Healtheries vitamin c

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

AlimentARy tRAct And metAboliSm

Vitamins

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Vitamin d

AlfACAlCidol - Retail pharmacy-specialist Cap 0.25 µg ............................................................................................ 26.32 Cap 1 µg ................................................................................................. 87.98 oral drops 2 µg per ml.............................................................................. 60.68 CHoleCAlCifeRol ❋ tab 1.25 mg (50,000 iu) .......................................................................... 11.50 a) Maximum 12 tablets per prescription CAlCitRiol - Retail pharmacy-specialist ❋ Cap 0.25 µg ............................................................................................. 13.45 52.63 ❋ Cap 0.5 µg ............................................................................................... 24.95 87.98 ❋ oral liq 1 µg per ml ................................................................................... 39.40 100 100 20 ml oP 12 ✓ one-Alpha ✓ one-Alpha ✓ one-Alpha ✓ cal-d-Forte

100 100 10 ml oP

✓ calcitriol-AFt ✓ rocaltrol ✓ calcitriol-AFt ✓ rocaltrol ✓ rocaltrol solution

Vitamin e

AlPHA toCoPHeRyl ACetAte - Special Authority - Hopsital Pharmacy [HP3] Water solubilised soln 156 iu/ml, with calibrated dropper .......................... 13.50 50 ml oP ✓ Micelle E

Special Authority for Subsidy - form: SA0264 initial application only from a paediatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: either: 1 Cystic fibrosis patient; or 2 both: 2.1 infant or child with liver disease or short gut syndrome; and 2.2 Requires vitamin supplementation. Renewal only from a paediatrician or respiratory specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

Vitamin K

Refer to blood, Antifibrinolytics, page 42

multivitamin Preparations

VitAMinS ❋ tab (bPC cap strength)............................................................................. 14.80 1000 ✓ Healtheries Multi-vitamin tablets

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

AlimentARy tRAct And metAboliSm

minerals

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

mineRAlS calcium

CAlCiuM CARbonAte ❋ tab 1.25 g .................................................................................................. 9.18 ❋ tab 1.5 g .................................................................................................. 10.33 ❋ tab dispersible 2.5 g .................................................................................. 4.98 CAlCiuM gluConAte ❋ inj 10%, 10 ml ........................................................................................ 106.99 CAlCiuM lACtAte-gluConAte ❋ tab 1 g ....................................................................................................... 7.47 (Calcium-Sandoz 1000 to be delisted 1 January 2007) 250 250 20 oP 50 30 ✓ calci-tab 500 ✓ calci-tab 600 ✓ calci-tab Effervescent ✓ Mayne ✓ calcium-Sandoz 1000

fluoride

SodiuM fluoRide tab 1.1 mg ................................................................................................. 3.00 (5.00) 100 PSM

iron

feRRouS fuMARAte tab 200 mg ................................................................................................ 3.75 feRRouS gluConAte WitH ASCoRbiC ACid ❋ tab 170 mg with ascorbic acid 40 mg...................................................... 12.04 feRRouS SulPHAte ❋ tab long-acting 325 mg.............................................................................. 5.06 (13.55) ❋‡oral liq 150 mg per 5 ml ............................................................................. 7.95 feRRouS SulPHAte WitH foliC ACid ❋ tab long-acting 325 mg with folic acid 350 µg ........................................... 1.80 (3.24) iRon PolyMAltoSe inj 50 mg per ml, 2 ml .............................................................................. 29.95 100 500 ✓ Ferro-tab ✓ Healtheries Iron with vitamin c

150 250 ml 30 ferro-gradumet ✓ Ferro-liquid

ferrograd-folic ✓ Ferrosig

magnesium

for magnesium hydroxide mixture refer page 164 MAgneSiuM SulPHAte inj 49.3% .................................................................................................. 26.60 10 ✓ Mayne

Zinc

ZinC SulPHAte ❋ Cap 220 mg................................................................................................ 9.00 100 ✓ Zincaps

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

blood And blood foRming oRgAnS

Antianaemics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntiAnAemicS hypoplastic and haemolytic

eRytHRoPoietin AlPHA - Special Authority - Hospital pharmacy [HP3] inj human recombinant 1,000 u, pre-filled syringe..................................... 68.42 (162.90) inj human recombinant 2,000 u pre-filled syringe.................................... 136.84 (325.80) inj human recombinant 3,000 u pre-filled syringe.................................... 205.25 (455.34) inj human recombinant 4,000 u pre-filled syringe.................................... 273.67 (572.40) inj human recombinant 10,000 u pre-filled syringe.................................. 684.18 (1322.82) 6 eprex 6 eprex 6 eprex 6 eprex 6 eprex

Special Authority for Subsidy - form: SA0626 initial application only from a renal physician. Approvals valid for 2 years for applications meeting the following criteria: All of the following: general Criteria: 1 Anaemia of end-stage renal failure (other treatable causes of anaemia being excluded); and 2 been on haemodialysis or continuous ambulatory peritoneal dialysis (CAPd) for at least three months; and 3 not under evaluation for, or awaiting, a live donor kidney transplant; and 4 Any of the following: Specific Criteria: 4.1 Anephric; or 4.2 dependent on regular blood transfusion (1 unit each 4-8 weeks) to maintain haemoglobin > 60g/l; or 4.3 dependent on regular blood transfusion but cannot be transfused because of severe transfusion reactions; or 4.4 transfusion induced haemosiderosis (clinical manifestations, serum ferritin >1500 ug/l); or 4.5 Haemoglobin < 70 g/l (mean of at least 4 haemoglobin concentrations over 4 months); or 4.6 both: 4.6.1 Haemoglobin < 90 g/l; and 4.6.2 either: 4.6.2.1 Heart failure (low cardiac output, lV ejection fraction <40%); or 4.6.2.2 Persistent angina. Renewal only from a renal physician. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. eRytHRoPoietin betA - Special Authority - Hospital Pharmacy [HP3] inj 1,000 u, pre-filled syringe .................................................................... 76.02 6 ✓ recormon inj 2,000 u pre-filled syringe ................................................................... 152.04 6 ✓ recormon inj 3,000 u pre-filled syringe ................................................................... 228.06 6 ✓ recormon inj 4,000 u pre-filled syringe ................................................................... 304.08 6 ✓ recormon inj 5,000 u pre-filled syringe ................................................................... 380.10 6 ✓ recormon inj 6,000 u pre-filled syringe ................................................................... 456.12 6 ✓ recormon inj 10,000 u pre-filled syringe ................................................................. 760.20 6 ✓ recormon Special Authority for Subsidy - form: SA0851 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 1 both: 1.1 patient in chronic renal failure; and 1.2 Haemoglobin ≤ 100 g/L; and 2 Any of the following: continued... ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

blood And blood foRming oRgAnS

Antianaemics Antifibrinolytics, haemostatics and local Sclerosants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 2.1 both: 2.1.1 Patient is not diabetic; and 2.1.2 Glomerular filtration rate ≤ 30 ml/min; or 2.2 both: 2.2.1 Patient is diabetic; and 2.2.2 Glomerular filtration rate ≤ 45 ml/min; or 2.3 Patient is on haemodialysis or peritoneal dialysis. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. note erythropoietin beta is indicated in the treatment of anaemia associated with chronic renal failure (CRf) where no cause for anaemia other than CRf is detected and there is adequate monitoring of iron stores and iron replacement therapy. the Cockroft-gault formula may be used to estimate glomerular filtration rate (gfR) in persons 18 years and over: gfR (ml/min) (male) = (140 - age) x ideal body Weight (kg) / 814 x serum creatinine (mmol/l) gfR (ml/min) (female) = estimated gfR (male) x 0.85

megaloblastic

foliC ACid ❋ tab 0.8 mg ............................................................................................... 16.50 ❋ tab 5 mg .................................................................................................... 6.59 oral liq 50 µg per ml - Retail pharmacy-specialist ..................................... 21.05 Specialist must be a paediatrician or paediatric cardiologist. 1,000 500 25 ml oP ✓ Apo-Folic Acid ✓ Apo-Folic Acid ✓ Biomed

AntifibRinolyticS, hAemoStAticS And locAl ScleRoSAntS

APRotinin - Hospital pharmacy [HP3]-specialist ❋ inj 10,000 µg per ml 50 ml ....................................................................... 63.60 (69.90) SodiuM tetRAdeCyl SulPHAte ❋ inj 0.5% 2 ml ............................................................................................ 23.20 (45.52) ❋ inj 1% 2 ml ............................................................................................... 25.00 (48.98) ❋ inj 3% 2 ml ............................................................................................... 28.50 (55.91) tRAnexAMiC ACid tab 500 mg .............................................................................................. 49.14 1 trasylol 5 fibro-vein 5 fibro-vein 5 fibro-vein 100 ✓ cyklokapron

Vitamin K

MenAdione SodiuM biSulPHite ❋ tab 10 mg .................................................................................................. 4.75 PHytoMenAdione tab 10 mg .................................................................................................. 5.60 inj 2 mg per 0.2 ml - Available on a PSo ..................................................... 8.00 inj 10 mg per ml, 1 ml - Available on a PSo ................................................ 9.21 100 10 5 5 ✓ k-thrombin ✓ konakion ✓ konakion MM ✓ konakion MM

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

blood And blood foRming oRgAnS

Antithrombotic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntithRombotic AgentS Antiplatelet Agents

ASPiRin ❋ tab 100 mg ................................................................................................ 1.02 5.70 CloPidogRel – Special Authority – Retail pharmacy tab 75 mg .............................................................................................. 168.17 30 168 28 ✓ Ethics Aspirin Ec ✓ cartia ✓ Plavix

Special Authority for Subsidy – form: SA0847 initial application - (aspirin allergic patients) only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: both: 1 the patient is allergic to aspirin (see definition below); and 2 Any of the following: the patient has: 2.1 suffered from a stroke, or transient ischaemic attack; or 2.2 experienced an acute myocardial infarction; or 2.3 experienced an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours; or 2.4 had a troponin t or troponin i test result greater than the upper limit of the reference range; or 2.5 had a revascularisation procedure; or 2.6 experienced symptomatic peripheral vascular disease of a severity that has required specialist consultation. note Aspirin allergy is defined as a history of anaphylaxis, urticaria or asthma within 4 hours of ingestion of aspirin, other salicylates or nSAids. initial application - (aspirin tolerant patients) only from a relevant specialist or general practitioner. Approvals valid for 3 months for applications meeting the following criteria: Any of the following: While on treatment with aspirin, the patient has: 3 experienced an acute myocardial infarction; or 4 had an episode of pain at rest of greater than 20 minutes duration due to coronary disease that required admission to hospital for at least 24 hours; or 5 had a troponin t or troponin i test result greater than the upper limit of the reference range; or 6 had a revascularisation procedure. initial application - (patients awaiting revascularisation) only from a relevant specialist or general practitioner. Approvals valid for 6 months where the patient is awaiting stenting, coronary artery bypass grafting, or percutaneous coronary angioplasty following acute coronary syndrome. initial application - (post stenting (no renewals)) only from a relevant specialist or general practitioner. Approvals valid for 6 months where the patient has had a stent inserted. initial application - (documented stent thrombosis) only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified where the patient has, while on treatment with aspirin, experienced documented stent thrombosis. Renewal - (aspirin tolerant patients) only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified where the patient has experienced an additional vascular event following the recent cessation of clopidogrel. Renewal - (patients awaiting revascularisation) only from a relevant specialist or general practitioner. Approvals valid for 6 months where the patient is awaiting stenting, coronary artery bypass grafting or percutaneous coronary angioplasty following acute coronary syndrome. ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

blood And blood foRming oRgAnS

Antithrombotic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer diPyRidAMole ❋ tab 25 mg - Special Authority available ...................................................... 0.19 (9.95) 100 Persantin

Special Authority for Manufacturers Price - form: SA0648 initial application - (Conditions other than transient ischaemic episodes) only from a cardiothoracic surgeon, cardiologist or general physician. Approvals valid without further renewal unless notified for applications meeting the following criteria: either: 1 Patients with prosthetic heart valves - as an adjunct to oral anticoagulation for prophylaxis of thromboembolism; or 2 Patients after coronary artery vein bypass graft - as an adjunct to aspirin or as monotherapy for patients who are aspirin intolerant. note Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising. initial application - (transient ischaemic episodes) only from a neurologist, neuro surgeon, cardiologist, vascular surgeon or general physician. Approvals valid without further renewal unless notified where the patient continues to have transient ischaemic episodes despite aspirin therapy or has transient ischaemic episodes and is aspirin intolerant. note Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising. Renewal - (existing 2 year approvals) only from a general practitioner or relevant specialist. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment. ❋ tab long-acting 150 mg - Special Authority - Retail pharmacy .................. 11.52 60 ✓ Pytazen Sr Special Authority for Subsidy - form: SA0649 initial application - (Conditions other than transient ischaemic episodes) only from a cardiothoracic surgeon, cardiologist or general physician. Approvals valid without further renewal unless notified for applications meeting the following criteria: either: 1 Patients with prosthetic heart valves - as an adjunct to oral anticoagulation for prophylaxis of thromboembolism; or 2 Patients after coronary artery vein bypass graft - as an adjunct to aspirin or as monotherapy for patients who are aspirin intolerant. note Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising. initial application - (transient ischaemic episodes) only from a neurologist, neuro surgeon, cardiologist, vascular surgeon or general physician. Approvals valid without further renewal unless notified where the patient continues to have transient ischaemic episodes despite aspirin therapy or has transient ischaemic episodes and is aspirin intolerant. note Aspirin intolerant patients are defined as those with aspirin induced asthma, urticaria, or anaphylaxi, or those with significant aspirin induced bleeding, excluding bruising. Renewal - (existing 2 year approvals) only from a general practitioner or relevant specialist. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment.

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

blood And blood foRming oRgAnS

Antithrombotic Agents fluids and electrolytes

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

heparin and Antagonist Preparations

HePARiniSed SAline ❋ inj 10 iu per ml, 5 ml................................................................................. 18.00 ❋ inj 100 iu per ml, 5 ml............................................................................. 103.76 HePARin SodiuM inj 1,000 iu per ml, 5 ml............................................................................ 66.80 inj 1,000 iu per ml, 35 ml.......................................................................... 12.10 inj 5,000 iu per ml, 1 ml............................................................................ 10.32 inj 5,000 iu per ml, 5 ml............................................................................ 27.70 (30.67) inj 25,000 iu per ml, 0.2 ml - Hospital pharmacy [HP3]-specialist .............. 7.50 (7.85) PRotAMine SulPHAte ❋ inj 10 mg per ml, 5 ml .............................................................................. 22.40 (76.25) 50 50 50 1 5 10 5 Mayne 10 Artex ✓ AstraZeneca ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne Multiparin

oral Anticoagulants

WARfARin SodiuM ❋ tab 1 mg .................................................................................................... 3.46 ❋ tab 1 mg .................................................................................................... 5.69 ❋ tab 2 mg .................................................................................................... 4.31 ❋ tab 3 mg .................................................................................................... 8.00 ❋ tab 5 mg .................................................................................................... 5.93 ❋ tab 5 mg .................................................................................................... 9.64 note Marevan and Coumadin are not interchangeable. 50 100 50 100 50 100 ✓ coumadin ✓ Marevan ✓ coumadin ✓ Marevan ✓ coumadin ✓ Marevan

flUidS And electRolyteS intravenous Administration

dextRoSe - Available on a PSo ❋ inj 50% 10 ml ............................................................................................. 5.28 (8.25) PotASSiuM CHloRide ❋ inj 75 mg per ml, 10 ml ............................................................................ 26.00 ❋ inj 150 mg per ml, 10 ml .......................................................................... 26.00 SodiuM biCARbonAte – not in combination inj 8.4%, 10 ml ....................................................................................... 111.20 5 Mayne 50 50 10 ✓ AstraZeneca ✓ AstraZeneca ✓ Pharmalab S29

SodiuM CHloRide inf 0.9% - Available on a PSo ..................................................................... 3.06 500 ml ✓ Baxter 4.06 1,000 ml ✓ Baxter only if prescribed on a prescription for renal dialysis, maternity or post-natal care in the home of the patient or on a PSo for emergency use. (500 ml and 1,000 ml pack size) inj 0.9%, 5 ml - Available on a PSo ........................................................... 11.50 50 ✓ AstraZeneca inj 0.9%, 10 ml - Available on a PSo ......................................................... 11.50 50 ✓ AstraZeneca inj 0.9%, 20 ml ......................................................................................... 23.58 30 ✓ Pharmacia inj 23.4%, 20 ml ....................................................................................... 26.50 5 ✓ Biomed

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

blood And blood foRming oRgAnS

fluids and electrolytes

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer totAl PARenteRAl nutRition (tPn) Hospital Pharmacy [HP1] – specialist .................................................... CbS ✓

WAteR a) 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 b) on a bulk supply order, or c) When used in the extemporaneous compounding of eye drops. Purified for inj 2 ml.................................................................................... 21.90 50 ✓ Baxter Purified for inj 5 ml.................................................................................... 12.50 50 ✓ AstraZeneca Purified for inj 10 ml ................................................................................. 13.95 50 ✓ AstraZeneca Purified for inj 20 ml ................................................................................. 21.00 30 ✓ Pharmacia

oral Administration

CAlCiuM PolyStyRene SulPHonAte - Retail pharmacy-specialist Powder .................................................................................................. 169.85 CoMPound eleCtRolyteS Powder for soln for oral use 5 g - Available on a PSo ................................. 2.86 300 g 10 ✓ calcium resonium ✓ Enerlyte ✓ Plasma-Lyte oral Pedialyte fruit

dextRoSe WitH eleCtRolyteS Soln with electrolytes .................................................................................. 3.44 500 ml oP Soln with electrolytes .................................................................................. 6.66 946 ml oP (7.39) PotASSiuM biCARbonAte - Retail pharmacy-specialist tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg, ................................................................. 75.00 PotASSiuM CHloRide ❋ tab eff 548 mg (14 m eq) with chloride 285 mg (8 m eq) .......................... 5.26 (11.85) ❋ tab long-acting 600 mg.............................................................................. 5.20 SodiuM PolyStyRene SulPHonAte - Retail pharmacy-specialist Powder ..................................................................................................... 89.10

100 60 200 450 g

✓ Phosphate-Sandoz

Chlorvescent ✓ Span-k ✓ resonium-A

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

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unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

blood And blood foRming oRgAnS

lipid modifying Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

liPid modifying AgentS fibrates

beZAfibRAte ❋ tab 200 mg ................................................................................................ 8.80 ❋ tab long-acting 400 mg.............................................................................. 7.60 90 30 ✓ Fibalip ✓ Bezalip retard

other lipid modifying agents

ACiPiMox - Retail pharmacy-specialist ❋ Cap 250 mg.............................................................................................. 18.75 niCotiniC ACid ❋ tab 50 mg .................................................................................................. 5.08 ❋ tab 500 mg .............................................................................................. 17.60 16.15 (Niacin-Odan tab 500 mg to be delisted 1 March 2007) 30 100 100 ✓ olbetam ✓ Apo-nicotinic Acid ✓ Apo-nicotinic Acid ✓ niacin-odan S29

Resins

CHoleStyRAMine WitH ASPARtAMe Sachets 4 g with aspartame...................................................................... 19.25 (27.50) ColeStiPol HydRoCHloRide Sachets 5 g .............................................................................................. 11.55 50 Questran-lite 30 ✓ colestid

hmg coA Reductase inhibitors (Statins)

AtoRVAStAtin - See Prescribing guideline below or Additional subsidy by Special Authority - Retail pharmacy ❋ tab 10 mg .................................................................................................. 4.03 30 (18.32) lipitor ❋ tab 20 mg .................................................................................................. 5.87 30 (26.70) lipitor ❋ tab 40 mg .................................................................................................. 8.14 30 (37.02) lipitor Special Authority for Manufacturers Price - form: SA0788 initial application only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: both: 1 Patient has a calculated absolute risk of cardiovascular disease of at least 15% over 5 years; and 2 either: 2.1 Patient has severe documented intolerance to simvastatin (blood tests are not required); or 2.2 both: 2.2.1 Patient has been compliant with a dose of simvastatin of 80 mg per day for at least 2 months; and 2.2.2 either: 2.2.2.1 All of the following: 2.2.2.1.1 Patient has venous CAbg; and 2.2.2.1.2 ldl cholesterol test 1 ≥ 2.0 mmol/litre; and 2.2.2.1.3 ldl cholesterol test 2 ≥ 2.0 mmol/litre (at least 1 week after test 1); or 2.2.2.2 All of the following: 2.2.2.2.1 Patient does not have venous CAbg; and 2.2.2.2.2 ldl cholesterol test 1 ≥ 2.5 mmol/litre; and 2.2.2.2.3 ldl cholesterol test 2 ≥ 2.5 mmol/litre (at least 1 week after test 1). continued... ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

lipid modifying Agents

blood And blood foRming oRgAnS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… note to confirm that cholesterol levels are not still improving, two lipid tests must be carried out during treatment with simvastatin 80 mg, and have results for ldl cholesterol that have reduced by <10% in the second test. the tests must be carried out while the patient is in a fasted state (with the exception of patients with iddM). the following indications of intolerance to simvastatin, are known as class effects for all statins, and hence are likely to mean that the patient may also be intolerant of atorvastatin: - Constipation, flatulence (may occur in >1% of patients) - Asthenia, abdominal pain, headache (may occur in >1% of patients) - Myopathy, rhabdomyolysis (may occur in <3% of patients) - elevated serum transaminase levels (may occur in <1% of patients) Statins have been shown to be generally well tolerated in clinical studies, with the rate of discontinuation due to adverse reactions being less than 5%, and similar to the discontinuation rate for patients taking a placebo. PRAVAStAtin - Special Authority – Retail pharmacy tab 10 mg ................................................................................................ 27.46 30 ✓ Pravachol tab 20 mg ................................................................................................ 42.58 30 ✓ Pravachol tab 40 mg ................................................................................................ 65.31 30 ✓ Pravachol Special Authority for Subsidy - form SA0849 initial application - (Confirmed HiV/AidS) only from a named specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 Patient has dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater; and 2 Confirmed HiV infection; and 3 Patient is being treated with an HiV protease inhibitor. SiMVAStAtin - See prescribing guideline below ❋ tab 5 mg .................................................................................................... 9.30 30 ✓ Zocor ❋ tab 10 mg ................................................................................................ 11.10 30 ✓ Lipex ❋ tab 20 mg ................................................................................................ 13.50 30 ✓ Lipex ❋ tab 40 mg ................................................................................................ 24.00 30 ✓ Lipex ❋ tab 80 mg ................................................................................................ 28.00 30 ✓ Lipex Prescribing guideline treatment with HMg CoA Reductase inhibitors (statins) is recommended for patients with dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater.

Selective cholesterol Absorption inhibitors

eZetiMibe - Special Authority - Retail pharmacy tab 10 mg ................................................................................................ 57.60 30 ✓ Ezetrol

Special Authority for Subsidy - form: SA0796 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 1 either: 1.1 ezetimibe is to be used in combination with simvastatin; or 1.2 ezetimibe is to be used without a statin; and 2 either: 2.1 All of the following: 2.1.1 Patient has a calculated absolute risk of cardiovascular disease >20% over 5 years; and 2.1.2 Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day; and 2.1.3 either: 2.1.3.1 All of the following: 2.1.3.1.1 Patient has venous CAbg; and continued...

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

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unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

blood And blood foRming oRgAnS

lipid modifying Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 2.1.3.1.2 ldl cholesterol ≥ 2.0 mmol/litre (see note); and 2.1.3.1.3 ldl cholesterol ≥ 2.0 mmol/litre (at least 1 week after test 1 - see note); or 2.1.3.2 All of the following: 2.1.3.2.1 Patient does not have venous CAbg; and 2.1.3.2.2 ldl cholesterol ≥ 2.5 mmol/litre (see note); and 2.1.3.2.3 ldl cholesterol ≥ 2.5 mmol/litre (at least 1 week after test 1 - see note); or 2.2 All of the following: 2.2.1 Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia; and 2.2.2 Patient has been compliant for at least two months with maximum dose statin therapy; and 2.2.3 ldl cholesterol ≥ 5 mmol/litre (see note); and 2.2.4 ldl cholesterol ≥ 5 mmol/litre (at least 1 week after test 1 - see note). note two lipid tests are required to assess ldl cholesterol levels, the tests must be at least one week apart, and be carried out in a fasted state (other than for patients with iddM). the results for ldl cholesterol levels in both tests must be above those specified. Renewal only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 3. the treatment remains appropriate and the patient is benefiting from treatment. 4. either: 4.1 ezetimibe is to be used in combination with simvastatin; or 4.2 ezetimibe is to be used without a statin. eZetiMibe WitH SiMVAStAtin - Special Authority – Retail pharmacy tab 10 mg with simvastatin 10 mg ........................................................... 69.00 tab 10 mg with simvastatin 20mg ............................................................ 75.00 tab 10 mg with simvastatin 40 mg ......................................................... 103.50 tab 10 mg with simvastatin 80 mg ......................................................... 123.00 30 30 30 30 ✓ vytorin ✓ vytorin ✓ vytorin ✓ vytorin

Special Authority for Subsidy – form: SA0826 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: either: 1 All of the following: 1.1 Patient has a calculated absolute risk of cardiovascular disease >20% over 5 years; and 1.2 Patient cannot tolerate statin therapy at a dose of ≥ 40 mg per day; and 1.3 either: 1.3.1 All of the following: 1.3.1.1 Patient has venous CAbg; and 1.3.1.2 LDL cholesterol ≥ 2.0 mmol/litre (see note); and 1.3.1.3 LDL cholesterol ≥ 2.0 mmol/litre (at least 1 week after test 1 - see note); or 1.3.2 All of the following: 1.3.2.1 Patient does not have venous CAbg; and 1.3.2.2 LDL cholesterol ≥ 2.5 mmol/litre (see note); and 1.3.2.3 LDL cholesterol ≥ 2.5 mmol/litre (at least 1 week after test 1 - see note); or 2 All of the following: 2.1 Patient has homozygous familial hypercholesterolemia, or heterozygous familial hypercholesterolemia; and 2.2 Patient has been compliant for at least two months with maximum dose statin therapy; and 2.3 LDL cholesterol ≥ 5 mmol/litre (see note); and 2.4 LDL cholesterol ≥ 5 mmol/litre (at least 1 week after test 1 - see note). note two lipid tests are required to assess ldl cholesterol levels, the tests must be at least one week apart, and be carried out in continued... ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

lipid modifying Agents

blood And blood foRming oRgAnS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… a fasted state (other than for patients with iddM). the results for ldl cholesterol levels in both tests must be above those specified. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. For new Zealand cardiovascular group statement refer pages 51–54. For cardiovascular risk charts, refer pages 52–53.

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cARdioVAScUlAR diSeASe: bASeline RiSK And tReAtment benefitS

The Assessment and Management of Cardiovascular Risk

Absolute Cardiovascular Risk

Treatment decisions are based on the likelihood an individual will have a cardiovascular (CV) event over a given period of time. This replaces decision-making based on single risk factor levels. By knowing the risk level, an individual and their practitioner can make decisions for prevention and treatment of cardiovascular desease, including lifestyle advice, diabetes care, the prescription of lipid-modifying and blood pressure lowering medication and/or medication after myocardial infarction (MI) or ischaemic stroke. The following steps explain the actions taken at each stage.

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Step 3: Risk Assessment

Who does not need their risk calculated using the CV risk tables?

5-year CV risk is assumed clinically to be more than 20% in: • people who have had a previous cardiovascular event • people with some gentic lipid disorders (familial hypercholesterolaemia, familial defective ApoB and familial combined dyslipidaemia) • people with diabetes and overt nephropathy (albumin:creatinine ratio ≥ 30 mg/mmol) or diabetes with other renal disease.

Step 1: Select people for risk assessment

Recommended ages for starting CV risk assessment

– • Maori, Pacific peoples and people from the Indian subcontinent –age 35 years for men and age 45 years for women • People with known cardiovascular risk factors risk factors or at high risk of developing diabetes – age 35 years for men and age 45 years for women • Asymptomatic people, without known risk factors – age 45 years for men and age 55 years for women.

Where risk may be underestimated using the cardiovascular risk tables

People with isolated elevated single risk factor levels will have at least greater than 15% CV risk over 5 years. • TC greater than 8 mmol/L • TC:HDL ratio greater than 8 • Blood pressure consistently greater than 170/100 mm Hg • For age greater than 75 years the 5-year CV risk is greater than 15% in nearly all individuals. 5% may be added to CV risk for: • a family history of premature coronary heart disease or ischaemic stroke in a father or brother before the age of 55 years or mother or sister before the age of 65 years – • Maori • Pacific or Indian people • diabetes and microalbuminuria • type 2 diabetes after 10 years • type 2 diabetes with an HbA1c > 8% • the metabolic syndrome. These adjustments should be made once only for people who have more than one criteria (the maximum adjustment is 5%).

Step 2: Measure and record risk factors

A comprehensive CV risk assessment includes measuremnet and recording of: age, gender, ethnicity, smoking history, a fasting lipid profile, a fasting plasma glucose, the average of two sitting BPs, family history, waist circumference, BMI. People with diabetes will require additional tests: HbA1c, albumin: creatinine ratio, creatinine and date of diagnosis. The risk of MI and ischaemic stroke increases before diognostic levels of plasma glucose for diabetes are reached. People with IGT, IFG or the metabolic syndrome need active intervention and follow-up.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

cARdioVAScUlAR diSeASe: bASeline RiSK And tReAtment benefitS

Risk level women

NO DIABETES

Non-smoker 4 5 6 7 8

180/105 160/95 140/85 120/75

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

DIABETES

Non-smoker 4 5 6 7 8 Smoker 4 5 6 7 8

180/105

Smoker 4 5 6 7 8

AGE

160/95 140/85 120/75

180/105

Blood Pressure mm Hg

140/85 120/75

180/105 160/95 140/85 120/75

180/105

AGE

160/95 140/85 120/75

180/105 160/95 140/85 120/75

180/105

AGE

160/95 140/85 120/75

4 5 6 7 8 4 5 6 7 8 Total Cholestrol: HDL ratio 4 5 6 7 8 4 5 6 7 8 Total Cholestrol: HDL ratio

Risk Level 5 year CVD risk (non-fatal and fatal)

>33% very High 25-30% 20-25% High Moderate 15-20% 10-15% Mild 5-10% 2.5-5% <2.5%

How to use the Tables

• Identify the table relating to the person’s sex, diabetic status, smoking history and age. • Within the table choose the cell nearest to the person’s age, blood pressure and TC:HDL ratio. When the systolic and diastolic values fall in different risk levels, the higher category applies. • For example, the lower left cell contains all non-smokers without diabetes who are less than 45 years and have a TC:HDL ratio less than 4.5 and a blood pressure less than 130/80 mm Hg. People who fall exactly on a threshold between cells are placed in the cell indicating higher risk.

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fully subsidised [HP1], [HP3], [HP4] refer page 10

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unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Blood Pressure mm Hg

160/95

AGE

160/95

cARdioVAScUlAR diSeASe: bASeline RiSK And tReAtment benefitS

Risk level men

NO DIABETES

Non-smoker 4 5 6 7 8

180/105 160/95 140/85 120/75

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

DIABETES

Non-smoker 4 5 6 7 8 Smoker 4 5 6 7 8

180/105

Smoker 4 5 6 7 8

AGE

160/95 140/85 120/75

180/105

Blood Pressure mm Hg

140/85 120/75

180/105 160/95 140/85 120/75

180/105

AGE

160/95 140/85 120/75

180/105 160/95 140/85 120/75

180/105

AGE

160/95 140/85 120/75

Total Cholestrol: HDL ratio

Benefits: NNT for 5 years to prevent one event Risk level: 5-year CV risk (fatal and non-fatal) (CVD events prevented per 100 people treated for 5 years) 1 intervention (25% risk reduction) 30% 20% 15% 10% 5% 13 (7.5 per 100) 20 (5 per 100) 27 (4 per 100) 40 (2.5 per 100) 80 (1.25 per 100) 2 interventions (45% risk reduction) 7 (14 per 100) 11 (9 per 100) 15 (7 per 100) 22 (4.5 per 100) 44 (2.25 per 100) 3 interventions (55% risk reduction) 6 (16 per 100) 9 (11 per 100) 12 (8 per 100) 18 (5.5 per 100) 36 (3 per 100)

Based on the conservative estimate that each intervention: aspirin, blood pressure treatment (lowering systolic blood pressure by 10 mm Hg) or lipid modification (lowering LDL-C by 20%) reduces cardiovascular risk by about 25% over 5 years.

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

s three months supply may be dispensed at one time

Blood Pressure mm Hg

160/95

AGE

160/95

if endorsed “certified exemption” by the prescriber.

cARdioVAScUlAR diSeASe: bASeline RiSK And tReAtment benefitS

Step 4: Intervention according to(Manufacturer’s Price) Subsidised assessment cardiovascular risk generic

Cardiovascular risk Lifestyle Intensive lifestyle advice on a cardioprotective dietary pattern with a dietitian, physical activity and smoking cessation interventions. Lifestyle advise should be given simultaneously with drug treatment Intensive lifestyle advice on a cardioprotective dietary pattern with a dietitian, physical activity and smoking cessation interventions. Lifestyle advice should be given simultaneously with drug treatment Specific individualised lifestyle advice on a cardioprotective dietary pattern, physical activity and smoking cessation. This lifestyle advice should be given by the primary health care team for 3 to 6 months prior to initiating drug treatment Drug therapy

Subsidy $

fully brand or

Treatment goals

Per

✓ Manufacturer

Follow-up Cardiovascular risk assessments at least annually, risk factor monitoring every 3 to 6 months

CVD risk clinically determined more than 20%

Aspirin, if not contraindicated, a beta blocker, statin and an ACE-inhibitor (after MI) or aspirin, statin and a new or increased dose of a blood pressure lowering agent (after stroke) Aspirin and drug treatment of all modifiable risk factors (blood pressure lowering, lipid modification and glycaemic control) Aspirin and drug treatment of all modifiable risk factors (blood pressure lowering, lipid modification and glycaemic control). Drug therapy indicated for people with extreme risk factor levels Nonpharmacological approach to treating multiple risk factors

Efforts should be made to reach optimal risk factor levels

CVD risk calculated more than 20%

Risk factors treated to a level that will lower 5-year cardiovascular risk to less than 15% (by recalculating risk) Risk factors treated to a level that will lower 5-year cardiovascular risk to less than 15% (by recalculating risk)

Cardiovascular risk assessments at least annually, risk factor monitoring every 3 to 6 months

15 to 20%

Cardiovascular risk assessments at least annually, risk factor monitoring every 3 to 6 months

10 to 15%

Specific individualised lifestyle advice on a cardioprotective dietary pattern, physical activity and smoking cessation. This lifestyle advice should be given by the primary health care team General lifestlye advice on a cardioprotective dietary pattern, physical activity and smoking cessation

Lifestyle advice aimed at reducing cardiovascular risk

Further cardiovascular risk assessment in 5 years

less then 10%

Nonpharmacological approach to treating multiple risk factors

Lifestyle advice aimed at reducing cardiovascular risk

Further cardiovascular risk assessment in 5 to 10 years

Detail provided on the summary document of the evidence-based, best practice guideline, The Assessment and Mangement of Cardiovascular Risk. It is available for download at www.nzgg.org.nz – click on ‘Guidelines/ Publications’ then ‘Cardiology’.

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Alpha Adrenoceptor blockers Agents Affecting the Renin-Angiotensin System

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

cARdioVAScUlAR SyStem

AlPhA AdRenocePtoR blocKeRS

doxAZoSin MeSylAte ❋ tab 2 mg .................................................................................................. 13.23 ❋ tab 4 mg .................................................................................................. 17.05 PHenoxybenZAMine HydRoCHloRide ❋ Cap 10 mg................................................................................................ 26.05 PHentolAMine MeSylAte ❋ inj 10 mg per ml, 1 ml .............................................................................. 17.97 (27.50) PRAZoSin HydRoCHloRide ❋ tab 0.5 mg ................................................................................................. 9.50 ❋ tab 1 mg .................................................................................................... 2.99 ❋ tab 2 mg .................................................................................................... 4.00 ❋ tab 5 mg .................................................................................................... 6.50 teRAZoSin HydRoCHloRide ❋ tab 7 x 1 mg and 7 x 2 mg ......................................................................... 0.74 ❋ tab 2 mg .................................................................................................... 1.48 (4.66) ❋ tab 5 mg .................................................................................................... 1.91 (5.60) 250 250 100 5 Regitine 100 100 100 100 14 oP 28 28 Hytrin ✓ Hyprosin ✓ Hyprosin ✓ Hyprosin ✓ Hyprosin ✓ Hytrin Starter Pack Hytrin ✓ dosan ✓ dosan ✓ dibenyline

AgentS Affecting the Renin-AngiotenSin SyStem Ace inhibitors

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”. definition of Congestive Heart failure 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%.” CAPtoPRil ❋ tab 12.5 mg ............................................................................................... 9.86 ❋ tab 25 mg ................................................................................................ 12.73 ❋ tab 50 mg ................................................................................................ 17.95 ❋‡oral liq 5 mg per ml - (restricted to children under 12 years of age) ................. 51.04 CilAZAPRil ❋ tab 0.5 mg ................................................................................................. 2.20 ❋ tab 2.5 mg ................................................................................................. 4.39 ❋ tab 5 mg .................................................................................................... 6.44 enAlAPRil ❋ tab 5 mg .................................................................................................... 2.19 ❋ tab 10 mg .................................................................................................. 2.76 ❋ tab 20 mg .................................................................................................. 3.68 ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once 500 500 500 95 ml oP 30 30 30 90 90 90 ✓ Apo-captopril ✓ Apo-captopril ✓ Apo-captopril ✓ capoten ✓ Inhibace ✓ Inhibace ✓ Inhibace ✓ m-Enalapril ✓ m-Enalapril ✓ m-Enalapril

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

cARdioVAScUlAR SyStem

Agents Affecting the Renin-Angiotensin System

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer liSinoPRil ❋ tab 5 mg .................................................................................................... 4.91 ❋ tab 10 mg .................................................................................................. 7.14 ❋ tab 20 mg ................................................................................................ 10.10 PeRindoPRil ❋ tab 2 mg - Higher subsidy of $18.50 per 30 with endorsement .................. 3.00 (18.50) ❋ tab 4 mg - Higher subsidy of $25.00 per 30 with endorsement .................. 4.05 (25.00) QuinAPRil ❋ tab 5 mg .................................................................................................... 2.36 ❋ tab 10 mg .................................................................................................. 3.26 ❋ tab 20 mg .................................................................................................. 4.30 tRAndolAPRil ❋ Cap 1 mg - Higher subsidy of $18.67 per 28 with endorsement.................. 3.06 (18.67) ❋ Cap 2 mg - Higher subsidy of $27.00 per 20 with endorsement.................. 4.43 (27.00) 30 30 30 30 Coversyl 30 Coversyl 30 30 30 28 gopten 28 gopten ✓ Accupril ✓ Accupril ✓ Accupril ✓ Prinivil ✓ Prinivil ✓ Prinivil

Ace inhibitors with diuretics

CilAZAPRil WitH HydRoCHloRotHiAZide ❋ tab 5 mg with hydrochlorothiazide 12.5 mg ............................................... 6.30 enAlAPRil WitH HydRoCHloRotHiAZide ❋ tab 20 mg with hydrochlorothiazide 12.5 mg ............................................. 3.32 (8.70) QuinAPRil WitH HydRoCHloRotHiAZide ❋ tab 10 mg with hydrochlorothiazide 12.5 mg ............................................. 3.37 ❋ tab 20 mg with hydrochlorothiazide 12.5 mg ............................................. 4.57 28 30 Co-Renitec 30 30 ✓ Accuretic 10 ✓ Accuretic 20 ✓ Inhibace Plus

Angiotensin ii Antagonists

CAndeSARtAn - Special Authority - Retail pharmacy ❋ tab 4 mg .................................................................................................. 23.78 30 ✓ Atacand no more than 1.5 tabs per day ❋ tab 8 mg .................................................................................................. 28.31 30 ✓ Atacand no more than 1.5 tabs per day ❋ tab 16 mg ................................................................................................ 34.53 30 ✓ Atacand no more than 1 tab per day ❋ tab 32 mg ................................................................................................ 42.80 30 ✓ Atacand no more than 1 tab per day Special Authority for Subsidy - form: SA0706 initial application only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: either: 1 both: 1.1 Patient with congestive heart failure; and 1.2 either: 1.2.1 Has been treated with, and cannot tolerate, two ACe inhibitors, due to persistent cough; or 1.2.2 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; or continued…

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Agents Affecting the Renin-Angiotensin System

cARdioVAScUlAR SyStem

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 2 All of the following: 2.1 Patient with raised blood pressure; and 2.2 use of fully funded beta blockers or diuretics are contraindicated; or not well tolerated; or insufficient to control blood pressure adequately at appropriate doses; and 2.3 either: 2.3.1 Has been treated with, and cannot tolerate, two ACe inhibitors, due to persistent cough; or 2.3.2 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. Renewal - (Previous approval has expired) only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment. loSARtAn - Special Authority - Retail pharmacy ❋ tab 12.5 mg ............................................................................................. 23.84 30 ✓ cozaar ❋ tab 50 mg ................................................................................................ 31.79 30 ✓ cozaar ❋ tab 100 mg .............................................................................................. 35.40 30 ✓ cozaar Special Authority for Subsidy - form: SA0706 initial application only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: either: 1 both: 1.1 Patient with congestive heart failure; and 1.2 either: 1.2.1 Has been treated with, and cannot tolerate, two ACe inhibitors, due to persistent cough; or 1.2.2 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; or 2 All of the following: 2.1 Patient with raised blood pressure; and 2.2 use of fully funded beta blockers or diuretics are contraindicated; or not well tolerated; or insufficient to control blood pressure adequately at appropriate doses; and 2.3 either: 2.3.1 Has been treated with, and cannot tolerate, two ACe inhibitors, due to persistent cough; or 2.3.2 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. Renewal - (Previous approval has expired) only from a relevant specialist or general practitioner. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment. loSARtAn with HydRoCHloRotHiAZide- Special Authority - Retail pharmacy tab 50 mg with hydrochlorothiazide 12.5 mg .......................................... 31.79 30 ✓ Hyzaar Special Authority for Subsidy - form: SA0703 initial application only from a relevant specialist or general practitioner. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 Patient has raised blood pressure; and 2 the use of fully funded beta blockers is contraindicated, or not well tolerated; or where use of fully funded beta blockers and diuretics are insufficient to control blood pressure adequately at appropriate doses; and 3 either: 3.1 Has been treated with, and cannot tolerate two ACe inhibitors, due to persistent cough; or 3.2 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. Renewal only from a relevant specialist or general practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

cARdioVAScUlAR SyStem

Antiarrhythmics Antihypotensives

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntiARRhythmicS

Refer also to neRVouS SySteM, Anaesthetics, local, lignocaine Hydrochloride, page 109. AMiodARone HydRoCHloRide s tab 100 mg - Retail pharmacy-specialist ............................................... 18.65 s tab 200 mg - Retail pharmacy-specialist ............................................... 30.52 inj 50 mg per ml, 3 ml – Available on a PSo ............................................. 60.84 digoxin ❋ tab 62.5 µg - Available on a PSo ............................................................... 6.51 ❋ tab 250 µg - Available on a PSo ................................................................ 9.96 ❋‡oral liq 50 µg per ml................................................................................... 8.11 diSoPyRAMide PHoSPHAte s Cap 100 mg.............................................................................................. 15.00 (23.87) s Cap 150 mg.............................................................................................. 26.21 fleCAinide ACetAte - Retail pharmacy-specialist s tab 50 mg ................................................................................................ 42.82 s tab 100 mg .............................................................................................. 75.63 s Cap long-acting 100 mg ........................................................................... 42.82 s Cap long-acting 200 mg ........................................................................... 75.63 inj 10 mg per ml 15 ml ............................................................................. 49.02 Mexiletine HydRoCHloRide s Cap 50 mg................................................................................................ 23.52 s Cap 200 mg.............................................................................................. 55.05 PRoPAfenone HydRoCHloRide - Retail pharmacy-specialist s tab 150 mg ............................................................................................. 40.90 30 30 10 250 250 60 ml 100 100 60 60 30 30 5 100 100 50 Rythmodan ✓ rythmodan ✓ tambocor ✓ tambocor ✓ tambocor cr ✓ tambocor cr ✓ tambocor ✓ Mexitil ✓ Mexitil ✓ rytmonorm ✓ Aratac ✓ cordarone-x ✓ Aratac ✓ cordarone-x ✓ cordarone-x ✓ Lanoxin Pg ✓ Lanoxin ✓ Lanoxin

AntihyPotenSiVeS

MidodRine - Special Authority - Hospital pharmacy [HP3] tab 2.5 mg ............................................................................................... 53.00 100 ✓ gutron tab 5 mg .................................................................................................. 79.00 100 ✓ gutron Special Authority for Subsidy - form: SA0361 initial application only from a geriatrician, neurologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 disabling orthostatic hypotension not due to drugs; and 2 Patient has tried fludrocortisone (unless contra-indicated) with unsatisfactory results; and 3 Patient has tried non pharmacological treatments such as support hose, increased salt intake, exercise, and elevation of head and trunk at night. note: treatment should be started with small doses and titrated upwards as necessary. Hypertesion should be avoided, and the usual target is a standing systolic blood pressure of 90 mm Hg. Renewal only from a geriatrician, neurologist or general physician. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

cARdioVAScUlAR SyStem

beta Adrenoceptor blockers

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

betA AdRenocePtoR blocKeRS

ACebutolol ❋ Cap 100 mg................................................................................................ 9.50 ❋ Cap 200 mg.............................................................................................. 15.94 ❋ tab 400 mg .............................................................................................. 27.63 Atenolol ❋ tab 50 mg .................................................................................................. 6.50 ❋ tab 100 mg .............................................................................................. 11.30 100 100 100 500 500 ✓ AcB ✓ AcB ✓ AcB ✓ Loten ✓ Loten

CARVedilol - Special Authority - Retail pharmacy tab 6.25 mg ............................................................................................. 21.00 30 ✓ dilatrend 30 ✓ dilatrend tab 12.5 mg ............................................................................................. 27.00 30 ✓ dilatrend tab 25 mg ................................................................................................ 33.75 Special Authority for Subsidy - form: SA0633 initial application only from a general practitioner or relevant specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: both: 1 Patient is already on an ACe inhibitor or Angiotensin ii Antagonist; and 2 Any of the following: 2.1 both: 2.1.1 Symptomatic heart failure nyHA functional class ii-iii; and 2.1.2 Patient has been treated with metoprolol and is intolerant to metoprolol or has demonstrated a sub-optimal response to metoprolol; or 2.2 Symptomatic heart failure nyHA functional class iii-iV; or 2.3 Patient has left ventricular systolic dysfunction with an ejection fraction of less than 35%. note: Where possible treatment should be initiated by or on the recommendation of a specialist. CeliPRolol ❋ tab 200 mg .............................................................................................. 19.00 lAbetAlol ❋ tab 50 mg .................................................................................................. 8.66 ❋ tab 100 mg .............................................................................................. 10.59 ❋ tab 200 mg .............................................................................................. 18.47 ❋ tab 400 mg .............................................................................................. 34.44 ❋ inj 5 mg per ml, 5 ml ................................................................................ 14.77 (22.15) ❋ inj 5 mg per ml, 20 ml .............................................................................. 59.06 (88.60) MetoPRolol SuCCinAte ❋ tab long-acting 23.75 mg........................................................................... 5.20 ❋ tab long-acting 47.5 mg............................................................................. 6.50 ❋ tab long-acting 95 mg.............................................................................. 11.20 ❋ tab long-acting 190 mg............................................................................ 20.25 MetoPRolol tARtRAte ❋ tab 50 mg ................................................................................................ 15.00 (16.50) ❋ tab 100 mg .............................................................................................. 21.80 ❋ tab long-acting 200 mg............................................................................ 18.40 ❋ inj 1 mg per ml, 5 ml ................................................................................ 24.08 (34.00) ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once 180 100 100 100 100 5 5 trandate 30 30 30 30 100 60 28 5 lopresor ✓ Lopresor ✓ Slow-Lopresor betaloc ✓ Betaloc cr ✓ Betaloc cr ✓ Betaloc cr ✓ Betaloc cr ✓ celol ✓ Hybloc ✓ Hybloc ✓ Hybloc ✓ Hybloc trandate S29

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

cARdioVAScUlAR SyStem

beta Adrenoceptor blockers calcium channel blockers

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer nAdolol ❋ tab 40 mg ................................................................................................ 14.97 ❋ tab 80 mg ................................................................................................ 22.19 Pindolol ❋ tab 5 mg .................................................................................................... 4.50 ❋ tab 10 mg .................................................................................................. 8.35 ❋ tab 15 mg ................................................................................................ 12.00 PRoPRAnolol ❋ tab 10 mg .................................................................................................. 2.00 ❋ tab 40 mg .................................................................................................. 2.60 ❋ Cap long-acting 160 mg ........................................................................... 15.50 SotAlol ❋ tab 80 mg ................................................................................................ 27.50 ❋ tab 160 mg .............................................................................................. 10.50 ❋ inj 10 mg per ml, 4 ml .............................................................................. 41.34 tiMolol MAleAte ❋ tab 10 mg ................................................................................................ 10.55 100 100 100 100 100 100 100 100 500 100 5 100 ✓ Apo-nadolol ✓ Apo-nadolol ✓ Pindol ✓ Pindol ✓ Pindol ✓ cardinol ✓ cardinol ✓ cardinol LA ✓ Pacific ✓ Pacific ✓ Sotacor ✓ Apo-timol

cAlciUm chAnnel blocKeRS dihydropyridine calcium channel blockers (dhP ccbs)

AMlodiPine ❋ tab 5 mg .................................................................................................... 7.85 ❋ tab 10 mg ................................................................................................ 13.60 felodiPine ❋ tab long-acting 2.5 mg............................................................................. 10.38 no more than 1 tab per day ❋ tab long-acting 5 mg................................................................................ 16.50 ❋ tab long-acting 10 mg.............................................................................. 24.00 nifediPine ❋ tab long-acting 10 mg.............................................................................. 17.72 ❋ tab long-acting 20 mg................................................................................ 7.30 ❋ tab long-acting 30 mg.............................................................................. 11.26 13.25 5.50 (19.90) ❋ tab long-acting 60 mg.............................................................................. 16.15 19.00 8.00 (29.50) 30 30 30 90 90 60 100 30 ✓ calvasc ✓ calvasc ✓ Plendil Er ✓ Felo 5 Er ✓ Felo 10 Er ✓ Adalat 10 ✓ nyefax retard ✓ Adefin xL ✓ Arrow-nifedipine xr Adalat oros ✓ Adefin xL ✓ Arrow-nifedipine xr Adalat oros

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

cARdioVAScUlAR SyStem

calcium channel blockers centrally Acting Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

other calcium channel blockers

diltiAZeM HydRoCHloRide ❋ tab 30 mg .................................................................................................. 4.50 ❋ tab 60 mg .................................................................................................. 8.50 ❋ Cap long-acting 90 mg ............................................................................... 7.65 ❋ Cap long-acting 120 mg (once per day)...................................................... 5.10 ❋ Cap long-acting 120 mg (twice per day) ................................................... 18.00 ❋ tab long-acting 180 mg.............................................................................. 7.65 ❋ Cap long-acting 180 mg ............................................................................. 7.65 ❋ tab long-acting 240 mg............................................................................ 10.20 ❋ Cap long-acting 240 mg ........................................................................... 10.20 100 100 60 30 100 30 30 30 30 ✓ dilzem ✓ dilzem ✓ dilzem Sr ✓ cardizem cd ✓ dilzem Sr ✓ dilzem LA ✓ cardizem cd ✓ dilzem LA ✓ cardizem cd

PeRHexiline MAleAte - Special Authority - Hospital pharmacy [HP3] ❋ tab 100 mg .............................................................................................. 62.90 100 ✓ Pexsig Special Authority for Subsidy - form: SA0256 initial application only from a cardiologist or general physician. Approvals valid for 2 years for applications meeting the following criteria: both: 1 Refractory angina; and 2 Patient is already on maximal anti-anginal therapy. Renewal only from a cardiologist or general physician. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. VeRAPAMil HydRoCHloRide ❋ tab 40 mg .................................................................................................. 4.75 ❋ tab 80 mg .................................................................................................. 6.00 ❋ tab long-acting 120 mg............................................................................ 15.20 ❋ tab long-acting 240 mg............................................................................ 25.00 ❋ inj 2.5 mg per ml, 2 ml - Available on a PSo ............................................... 7.54 100 100 250 250 5 ✓ verpamil ✓ verpamil ✓ verpamil Sr ✓ verpamil Sr ✓ Isoptin

centRAlly Acting AgentS

Clonidine ❋ tddS 2.5 mg, 100 µg per day - only on a prescription ............................. 21.29 ❋ tddS 5 mg, 200 µg per day - only on a prescription ............................... 30.79 ❋ tddS 7.5 mg, 300 µg per day - only on a prescription ............................. 39.10 Clonidine HydRoCHloRide ❋ tab 150 µg .............................................................................................. 30.33 ❋ inj 150 µg per ml, 1 ml ............................................................................. 14.00 MetHyldoPA ❋ tab 125 mg ................................................................................................ 9.00 ❋ tab 250 mg .............................................................................................. 12.80 ❋ tab 500 mg .............................................................................................. 19.50 4 4 4 100 5 100 100 100 ✓ catapres-ttS-1 ✓ catapres-ttS-2 ✓ catapres-ttS-3 ✓ catapres ✓ catapres ✓ Prodopa ✓ Prodopa ✓ Prodopa

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

cARdioVAScUlAR SyStem

diuretics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

diUReticS loop diuretics

buMetAnide ❋ tab 1 mg .................................................................................................. 16.36 ❋ inj 500 µg per ml, 4 ml ............................................................................... 7.95 fRuSeMide ❋ tab 40 mg - Available on a PSo .............................................................. 11.50 ❋ tab 500 mg - Retail pharmacy-specialist .................................................. 12.00 ❋‡oral liq 10 mg per ml ................................................................................ 10.66 ❋ inj 10 mg per ml, 2 ml - Available on a PSo .............................................. 41.00 ❋ infusion 10 mg per ml, 25 ml - Retail pharmacy-specialist ........................ 48.14 100 5 1,000 100 30 ml oP 50 5 ✓ Burinex ✓ Burinex ✓ diurin 40 ✓ diurin 500 ✓ Lasix ✓ Mayne ✓ Lasix

Potassium Sparing diuretics

AMiloRide ‡oral liq 1 mg per ml - Retail pharmacy-specialist .................................... 26.20 Specialist must be a paediatrician or paediatric cardiologist. SPiRonolACtone ❋ tab 25 mg .................................................................................................. 8.50 ❋ tab 100 mg .............................................................................................. 21.70 ‡oral liq 5 mg per ml - Retail pharmacy-specialist ................................... 26.80 Specialist must be a paediatrician or paediatric cardiologist. 25 ml oP ✓ Biomed

100 100 25 ml oP

✓ Spirotone ✓ Spirotone ✓ Biomed

Potassium Sparing combination diuretics

AMiloRide WitH fRuSeMide ❋ tab 5 mg with frusemide 40 mg ................................................................. 4.67 (8.63) AMiloRide WitH HydRoCHloRotHiAZide ❋ tab 5 mg with hydrochlorothiazide 50 mg ................................................ 13.00 tRiAMteRene WitH HydRoCHloRotHiAZide ❋ tab 50 mg with hydrochlorothiazide 25 mg ................................................ 5.00 28 frumil 500 100 ✓ Amizide ✓ triamizide

thiazide and Related diuretics

bendRofluAZide ❋ tab 2.5 mg - Available on a PSo .............................................................. 13.50 ❋ tab 5 mg .................................................................................................. 21.50 CHloRotHiAZide ‡oral liq 50 mg per ml - Retail pharmacy-specialist .................................. 22.60 Specialist must be a paediatrician or paediatric cardiologist. CHloRtHAlidone ❋ tab 25 mg .................................................................................................. 8.00 indAPAMide ❋ tab 2.5 mg ................................................................................................. 4.00 500 500 25 ml oP ✓ neo-naclex ✓ neo-naclex ✓ Biomed

50 100

✓ Hygroton ✓ napamide

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

cARdioVAScUlAR SyStem

nitrates Vasodilators

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

nitRAteS

glyCeRyl tRinitRAte ❋ oral pump spray 400 µg per dose - Available on a PSo .............................. 5.16 250 dose oP ❋ tddS 5 mg............................................................................................... 18.40 30 ❋ tddS 10 mg............................................................................................. 24.50 30 iSoSoRbide MononitRAte ❋ tab 20 mg ................................................................................................ 18.00 ❋ tab long-acting 40 mg.............................................................................. 14.84 ❋ tab long-acting 60 mg................................................................................ 4.15 100 30 90 ✓ nitrolingual Pumpspray ✓ nitroderm ttS ✓ nitroderm ttS ✓ Ismo 20 ✓ corangin ✓ duride

SmoKing ceSSAtion

niCotine - only on a Quitline exchange Card Patch 7 mg ............................................................................................... 10.53 Patch 14 mg ............................................................................................. 11.63 Patch 21 mg ............................................................................................. 12.32 gum 2 mg (Mint flavour)........................................................................... 14.97 gum 2 mg (fruit flavour) .......................................................................... 14.97 gum 4 mg (Mint flavour)........................................................................... 20.02 gum 4 mg (fruit flavour) .......................................................................... 20.02 7 7 7 96 96 96 96 ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol ✓ Habitrol

SymPAthomimeticS

AdRenAline inj 1 in 1,000, 1 ml - Available on a PSo ..................................................... 5.25 inj 1 in 10,000, 10 ml - Available on a PSo ............................................... 27.00 iSoPRenAline HydRoCHloRide ❋ inj 200 µg per ml, 1 ml ............................................................................. 36.80 (135.00) 5 5 25 isuprel ✓ Mayne ✓ Mayne

VASodilAtoRS

AMyl nitRite ❋ Ampoule, 0.3 ml crushable ....................................................................... 62.92 (73.40) HydRAlAZine ❋ inj 20 mg per ml, 1 ml .............................................................................. 25.90 oxyPentifylline - Hospital pharmacy [HP3] tab 400 mg .............................................................................................. 36.94 (42.26) 12 baxter 5 50 trental 400 ✓ Apresoline

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

deRmAtologicAlS

Antiacne Preparations Antibacterials topical Antifungals topical

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntiAcne PRePARAtionS

for systemic antibacterials, refer to infeCtionS, Antibacterials, page 90 iSotRetinoin - Hospital pharmacy [HP3] - Specialist prescription Specialist must be a dermatologist Cap 10 mg................................................................................................ 36.00 Cap 20 mg................................................................................................ 47.50

100 100

✓ Isotane 10 ✓ Isotane 20

AntibActeRiAlS toPicAl

for systemic antibacterials, refer to infeCtionS, Antibacterials, page 90 fuSidiC ACid a) only on a prescription, b) not in combination, c) Maximum 15 g per prescription. Crm 2% ...................................................................................................... 4.99 oint 2%....................................................................................................... 4.99 HydRogen PeRoxide ❋ Crm 1% ...................................................................................................... 8.56 MuPiRoCin a) only on a prescription, b) not in combination. oint 2%....................................................................................................... 6.60 (9.26) SilVeR SulPHAdiAZine a) Available on a PSo, b) not in combination. Crm 1% with chlorhexidine digluconate 0.2% ............................................ 15.04

15 g oP 15 g oP 10 g oP

✓ Foban ✓ Foban ✓ crystacide

15 g oP bactroban

100 g oP

✓ Silvazine

AntifUngAlS toPicAl

for systemic antibacterials, refer to infeCtionS, Antibacterials, page 90 AMoRolfine a) not in combination and, b) only on a prescription. nail soln 5%.............................................................................................. 37.86 (61.87)

5 ml oP loceryl

CiCloPiRox olAMine a) not in combination; and b) only on a prescription. Crm 1% ...................................................................................................... 1.00 20 g oP (12.82) Soln 1% ...................................................................................................... 4.36 20 ml oP (11.54) nail soln 8% ............................................................................................. 37.81 3.5 ml oP (42.84) ClotRiMAZole a) not in combination; and b) only on a prescription. ❋ Crm 1% ...................................................................................................... 0.55 20 g oP ❋ Soln 1% ..................................................................................................... 4.36 20 ml oP (7.55)

batrafen batrafen batrafen

✓ clomazol Canesten

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Antifungals topical Antipruritic Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer eConAZole nitRAte a) not in combination; and b) only on a prescription. Crm 1% ..................................................................................................... 1.00 (1.30) 1.00 (6.50) foaming soln 1%, 10 ml sachets ................................................................ 9.89 (14.24) KetoConAZole a) not in combination; and b) only on a prescription. Crm 2% ..................................................................................................... 1.00 (10.00)

deRmAtologicAlS

15 g oP 20 g oP 3 Pevaryl ecreme Pevaryl

15 g oP nizoral

MiConAZole nitRAte a) not in combination; and b) only on a prescription. ❋ Crm 2% ...................................................................................................... 0.44 15 g oP ❋ lotn 2% ...................................................................................................... 4.36 30 ml oP (10.32) ❋ tincture 2% ................................................................................................ 4.36 30 ml oP (12.46) nyStAtin a) not in combination; and b) only on a prescription. Crm 100,000 u per g .................................................................................. 1.00 (5.10)

✓ Multichem daktarin daktarin

15 g oP Mycostatin

AntiPRURitic PRePARAtionS

CAlAMine a) not in combination; and b) only on a prescription. Crm, aqueous, bP....................................................................................... 3.02 15.10 (21.75) lotn, bP ................................................................................................... 19.44 (26.95) (PSM calamine crm aqueous, BP to be delisted 1 February 2007) (PSM calamine lotn, BP to be delisted 1 March 2007) CRotAMiton a) not in combination; and b) only on a prescription. Crm 10% .................................................................................................... 4.26 (4.45) lotn 10% .................................................................................................... 7.56 (7.70)

100 ml 500 g 2,000 ml

✓ ABM PSM ✓ ABM PSM

20 g oP eurax 50 ml eurax

MentHol - only in combination Crystals .................................................................................................... 29.60 100 g ✓ MidWest (42.40) PSM a) 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. ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

deRmAtologicAlS

corticosteroids - topical

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

coRticoSteRoidS - toPicAl

for systemic corticosteroids, refer to CoRtiCoSteRoidS And RelAted AgentS, page 80

corticosteroids - Plain

betAMetHASone diPRoPionAte Crm 0.05% ................................................................................................ 2.96 (6.28) Crm 0.05% ................................................................................................ 8.97 (18.36) Crm 0.05% in propylene glycol base ........................................................... 4.33 (12.57) oint 0.05% ................................................................................................. 2.96 (6.51) oint 0.05% ................................................................................................. 8.97 (17.11) oint 0.05% in propylene glycol base ........................................................... 4.33 (12.57) betAMetHASone VAleRAte ❋ Crm 0.1% ................................................................................................... 1.70 ❋ oint 0.1%.................................................................................................... 1.70 ❋ lotn 0.1% ................................................................................................. 10.05 ClobetASol PRoPionAte ❋ Crm 0.05% ................................................................................................ 2.35 ❋ oint 0.05% ................................................................................................. 1.60 15 g oP diprosone 50 g oP diprosone 30 g oP 15 g oP diprosone 50 g oP diprosone 30 g oP diprosone oV 50 g oP 50 g oP 50 ml oP 30 g oP 30 g oP ✓ Beta cream ✓ Beta ointment ✓ Betnovate ✓ dermol ✓ dermol diprosone oV

ClobetASone butyRAte Crm 0.05% ................................................................................................ 5.38 30 g oP (7.09) Crm 0.05% ............................................................................................... 16.13 100 g oP (22.00) difluCoRtolone VAleRAte Crm 0.1% ................................................................................................... 8.97 (13.85) fatty oint 0.1% ........................................................................................... 8.97 (13.85) oint 0.1%.................................................................................................... 8.97 (13.85) 50 g oP

eumovate eumovate

nerisone 50 g oP nerisone 50 g oP nerisone ✓ Lemnis Fatty cream Hc PSM ✓ m-Hydrocortisone

HydRoCoRtiSone - only on a prescription ❋ Crm 1% ...................................................................................................... 2.44 100 g (2.86) ❋ Powder - only in combination ................................................................. 37.64 25 g a) up to 5%; b) in a dermatological base (not proprietary topical Corticosteroid - Plain); (refer page 160) c) With or without other dermatological galenicals. HydRoCoRtiSone WitH Wool fAt And MineRAl oil - only on the prescription of a doctor lotn 1% with wool fat hydrous 3% and mineral oil ..................................... 9.95 250 ml

✓ dP Lotn Hc

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

corticosteroids - topical

deRmAtologicAlS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer HydRoCoRtiSone butyRAte Crm 0.1% ................................................................................................... 5.00 Crm 0.1% ................................................................................................. 15.00 oint 0.1%.................................................................................................. 15.00 lipocream 0.1% ......................................................................................... 5.00 lipocream 0.1% ....................................................................................... 15.00 Milky emulsion 0.1%................................................................................... 5.00 Milky emulsion 0.1%................................................................................. 15.00 MetHylPRedniSolone ACePonAte Crm 0.1% ................................................................................................... 4.95 oint 0.1%.................................................................................................... 4.95 MoMetASone fuRoAte Crm 0.1% ................................................................................................... 3.96 Crm 0.1% ................................................................................................ 10.82 oint 0.1%.................................................................................................... 3.96 oint 0.1% ................................................................................................. 10.82 lotn 0.1% ................................................................................................... 4.80 tRiAMCinolone ACetonide Crm 0.02% ................................................................................................. 6.45 oint 0.02%.................................................................................................. 6.45 30 g oP 100 g oP 100 g oP 30 g oP 100 g oP 30 g oP 100 g oP 15 g oP 15 g oP 15 g oP 45 g oP 15 g oP 45 g oP 30 ml oP 100 g oP 100 g oP ✓ Locoid ✓ Locoid ✓ Locoid ✓ Locoid Lipocream ✓ Locoid Lipocream ✓ Locoid crelo ✓ Locoid crelo ✓ Advantan ✓ Advantan ✓ Elocon ✓ Elocon ✓ Elocon ✓ Elocon ✓ Elocon ✓ Aristocort ✓ Aristocort

corticosteroids - combination

betAMetHASone VAleRAte WitH ClioQuinol - only on a prescription Crm 0.1% with clioquinol 3% ...................................................................... 3.49 (4.90) oint 0.1% with clioquinol 3%....................................................................... 3.49 (4.90) betAMetHASone VAleRAte WitH fuSidiC ACid a) only on a prescription; b) Maximum 15 g per prescription. Crm 0.1% with fusidic acid 2% ................................................................... 3.49 (8.50) HydRoCoRtiSone WitH MiConAZole - only on a prescription ❋ Crm 1% with miconazole nitrate 2% ............................................................ 1.89 15 g oP 15 g oP betnovate-C betnovate-C

15 g oP fucicort 15 g oP ✓ Micreme H ✓ Pimafucort ✓ Pimafucort ✓ Locoid c

HydRoCoRtiSone WitH nAtAMyCin And neoMyCin - only on a prescription Crm 1% with natamycin 1% and neomycin sulphate 0.5% .......................... 3.49 15 g oP oint 1% with natamycin 1% and neomycin sulphate 0.5% ........................... 3.49 15 g oP HydRoCoRtiSone butyRAte WitH CHloRQuinAldol - only on a prescription Crm 0.1% with chlorquinaldol 3% ............................................................... 3.49 15 g oP

tRiAMCinolone ACetonide WitH gRAMiCidin, neoMyCin And nyStAtin - only on a prescription Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g........................................................ 3.49 15 g oP (4.49) Viaderm KC oint 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g........................................................ 3.00 15 g oP ✓ kenacomb

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

deRmAtologicAlS

disinfecting and cleansing Agents dusting Powders barrier creams and emollients

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

diSinfecting And cleAnSing AgentS

CHloRHexidine gluConAte a) Subsidy by endorsement b) no more than 500 ml per month only if prescribed for a dialysis patient and the prescription is endorsed accordingly ❋ Soln 4% ...................................................................................................... 7.20 500 ml ❋ Handrub 1% with ethanol 70% .................................................................... 5.40 500 ml SodiuM HyPoCHloRite – Subsidy by endorsement ❋ Soln ............................................................................................................ 2.71 2,500 ml a) only if prescribed for a dialysis patient and the prescription is endorsed accordingly.

✓ orion ✓ orion ✓ Janola

dUSting PoWdeRS

diPHeMAnil MetHylSulPHAte – Subsidy by endorsement only if prescribed for an amputee with an artificial limb, or for a paraplegic patient and the prescription endorsed accordingly. Powder 2% ................................................................................................ 6.81 50 g oP (13.54) Prantal

bARRieR cReAmS And emollientS barrier creams

ZinC Cream bP ................................................................................................... 6.55 (9.79) ZinC And CAStoR oil ointment bP ...............................................................................................5.11 500 g PSM 500 g ✓ Multichem

emollients

AQueouS ❋ Cream......................................................................................................... 2.37 CetoMACRogol ❋ Cream bP ................................................................................................... 2.80 (4.35) eMulSifying ointMent bP ❋ oint ............................................................................................................ 3.83 500 g 500 g PSM iPW 500 g ✓ AFt ✓ Multichem

glyCeRol WitH PARAffin And Cetyl AlCoHol - only on the prescription of a doctor ❋ lotn 5% with paraffin liq 5% and cetyl alcohol 2% ...................................... 1.40 250 ml (8.10) oily CReAM bP ❋ Crm ............................................................................................................ 2.80 (13.60) (15.40) oil in WAteR eMulSion ❋ Crm ............................................................................................................ 2.80 uReA ❋ Crm 10% .................................................................................................. 2.52 500 g

david Craig PSM 500 g 100 g oP ✓ Lemnis Fatty cream ✓ nutraplus

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

barrier creams and emollients minor Skin infections Parasiticidal Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer Wool fAt WitH MineRAl oil - only on the prescription of a doctor lotn hydrous 3% with mineral oil ................................................................ 1.12 200 ml oP (5.00) lotn hydrous 3% with mineral oil ................................................................ 1.40 250 ml oP (2.58) (2.92) (7.73) lotn hydrous 3% with mineral oil ................................................................ 2.10 375 ml oP (9.38) lotn hydrous 3% with mineral oil ................................................................ 5.60 1,000 ml (9.48) (9.54) (18.43) (23.91)

deRmAtologicAlS

Alpha-Keri lotion dP lotion Hydroderm lotion bK lotion Alpha-Keri lotion dP lotion Hydroderm lotion Alpha-Keri lotion bK lotion

other dermatological bases

PARAffin - only in combination White soft ................................................................................................. 17.89 2,500 g ✓ IPW (43.45) PSM a) only in combination with a dermatological galenical or as a diluent for a proprietary topical Corticosteroid - Plain.

minoR SKin infectionS

PoVidone iodine Antiseptic soln 10% ................................................................................... 6.42 500 ml ✓ Betadine ✓ Biocil Riodine ✓ Betadine Skin Prep orion ✓ Biocil betadine betadine

(7.20) Alcohol skin preparation 10%...................................................................... 8.13 500 ml (17.39) oint 10% - only on a prescription, maximum 100 g per prescription ............. 2.88 25 g oP (3.27) oint 10% - only on a prescription, maximum 100 g per prescription ............. 6.87 100 g oP (7.02)

PARASiticidAl PRePARAtionS

gAMMA benZene HexACHloRide Crm 1% ...................................................................................................... 3.20 (4.00) MAlAtHion liq 0.5% ..................................................................................................... 5.80 MAldiSon Shampoo 1% .............................................................................................. 2.86 50 g oP benhex 200 ml 30 ml oP ✓ AFt ✓ A-Lices

PeRMetHRin Crm 5% ...................................................................................................... 3.80 30 g oP ✓ Lyderm lotn 5% ...................................................................................................... 4.50 50 ml oP (7.00) Quellada-P a) Should be strictly reserved for use as second line therapy in: - patients unable to tolerate the other medications, such as infants, young children and patients with allergies or eczema; - cases of scabies which are resistant to gamma benzene hexachloride and resistant to malathion. b) Verification of drug resistance is dependent on the persistence of the condition after treatment. in order to establish whether there is drug resistance, the following criteria should be fulfilled: continued… ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

deRmAtologicAlS

Parasiticidal Preparations Psoriasis and eczema Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… - a definite diagnosis of scabies should be made; - it should be ascertained that the medication was administered properly; - the possibility of reinfestation should have been excluded.

PSoRiASiS And ecZemA PRePARAtionS

ACitRetin - Hospital pharmacy [HP3]- dermatologist - Specialist prescription Specialist must be a dermatologist Cap 10 mg................................................................................................ 94.75 Cap 25 mg.............................................................................................. 203.70 CAlCiPotRiol Crm 50 µg per g ...................................................................................... 22.44 oint 50 µg per g ...................................................................................... 22.44 Crm 50 µg per g ...................................................................................... 62.58 oint 50 µg per g ...................................................................................... 62.58 Soln 50 µg per ml ..................................................................................... 22.47 Soln 50 µg per ml ..................................................................................... 37.54 100 100 30 g oP 30 g oP 100 g oP 100 g oP 30 ml oP 60 ml oP ✓ neotigason ✓ neotigason ✓ daivonex ✓ daivonex ✓ daivonex ✓ daivonex ✓ daivonex ✓ daivonex

CoAl tAR - only in combination Soln bP .................................................................................................... 32.45 500 ml (40.50) david Craig (50.55) PSM a) up to 10%; b) only in combination with a dermatological base or proprietary topical Corticosteroid - Plain; (refer page 160) c) With or without other dermatological galenicals. CoAl tAR WitH AllAntoin, MentHol, PHenol And SulPHuR Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin 2.5% crm ............................................................................ 3.43 (4.35) Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin 2.5% crm ............................................................................ 6.59 (8.00) CoAl tAR WitH SAliCyliC ACid And SulPHuR Solution 12% with salicylic acid 2% and sulphur 4% ointment ..................... 7.95 ditHRAnol Crm 1% .................................................................................................... 27.50 MetHoxSAlen - Retail pharmacy-specialist Cap 10 mg................................................................................................ 11.66

30g oP egopsoryl tA 75 g oP egopsoryl tA 40 g oP 50 g oP 25 ✓ coco-Scalp ✓ Micanol ✓ oxsoralen

SAliCyliC ACid - only in combination Powder ..................................................................................................... 29.52 500 g (46.00) PSM (55.63) david Craig a) only in combination with a dermatological base or proprietary topical Corticosteroid - Plain or collodian flexible; (refer page 160) b) With or without other dermatological galenicals. c) Maximum 20 g or 20 ml per prescription when prescribed with white soft paraffin or collodian flexible.

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Psoriasis and eczema Preparations Wart and corn Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer SulPHuR - only in combination Precipitated................................................................................................. 7.92 100 g (9.25) PSM a) only in combination with a dermatological base or proprietary topical Corticosteroid - Plain; (refer page 160) b) With or without other dermatological galenicals. tAR WitH CAde oil bath emulsion 7.5% coal tar, 2.5% cade oil, 7.5% compound ..................... 9.70 (29.60) 350 ml Polytar emollient

deRmAtologicAlS

tAR WitH tRietHAnolAMine lAuRyl SulPHAte And fluoReSCein - only on the prescription of a doctor ❋ Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium ........................................................................... 2.30 500 ml ✓ Pinetarsol

ScAlP PRePARAtionS

betAMetHASone VAleRAte ❋ Scalp app 0.1% .......................................................................................... 5.25 ClobetASol PRoPionAte ❋ Scalp app 0.05% ........................................................................................ 3.20 HydRoCoRtiSone butyRAte Scalp lotn 0.1% .......................................................................................... 7.16 Scalp lotn 0.1%......................................................................................... 17.90 KetoConAZole Shampoo 2% ............................................................................................. 3.93 Shampoo subsidised: a) only on a prescription; b) Maximum 100 ml per prescription. 100 ml oP 30 ml oP 100 ml oP 250 ml oP 100 ml oP ✓ Beta Scalp ✓ dermol ✓ Locoid ✓ Locoid ✓ ketopine

SUnScReenS

SunSCReenS, PRoPRietARy - Retail pharmacy-specialist Crm ............................................................................................................ 1.74 (5.53) 50 g oP Aquasun oil free faces SPf30+ Hamilton Sunscreen R V Paque Aquasun 30+ Aquabloc 30+

Crm ........................................................................................................... 3.39 100 g oP (5.89) oint ............................................................................................................ 5.00 14 g oP (15.00) lotn ........................................................................................................... 4.80 125 ml oP (9.38) (9.45)

WARt And coRn PRePARAtionS

for salicylic acid preparations refer to PSoRiASiS And eCZeMA PRePARAtionS, page 70 PodoPHyllotoxin Soln 0.5 % ................................................................................................ 32.00 a) only on a prescription; b) Maximum 3.5 ml per prescription. 3.5 ml oP ✓ condyline

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

other Skin Preparations

deRmAtologicAlS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

otheR SKin PRePARAtionS Antineoplastics

fluoRouRACil SodiuM - Retail pharmacy-specialist Crm 5% .................................................................................................... 23.89 (28.68) 20 g oP efudix

topical Analgesia

for aspirin & chloroform application refer page 164 CAPSAiCin – Subsidy by endorsement Crm 0.075% ............................................................................................. 12.50 45 g oP Subsidy by endorsement: a. only is prescribed for post-herpetic neuralgia or diabetic peripheral neuropathy; and b. the prescription is endorsed accordingly. ✓ Zostrix HP

Wound management Products

HydRogen PeRoxide ❋ Soln 20 vol ................................................................................................. 3.13 (7.00) a) Maximum 500 ml per prescription. MAgneSiuM SulPHAte Paste .......................................................................................................... 2.98 (4.90) 500 ml PSM

80 g PSM

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

contraceptives – non-hormonal contraceptives – hormonal

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

genito URinARy SyStem

contRAcePtiVeS – non-hoRmonAl condoms

❋ CondoMS WitHout SPeRMiCide - Available on a PSo Condoms, proprietary........................................................................... 1.24 14.84 12 144 ✓ Shield Blue ✓ durex confidence ✓ gold knight ✓ Lifestyles Flared ✓ Marquis Supalite ✓ Shield Blue R3 Superfeucht ✓ Marquis Protecta

(68.40) ❋ CondoMS extRA StRengtH - Available on a PSo Condoms, proprietary......................................................................... 16.21

144

Spermicidal Agents

❋ APPliCAtoR - when ordered with spermicide Applicator............................................................................................. 4.34 nonoxynol-9 - Available on a PSo jelly 2%................................................................................................. 10.95 1 108 g oP ✓ ortho ✓ gynol II

contraceptive devices

❋ diAPHRAgM - Available on a PSo diaphragm ......................................................................................... 42.90 ❋ intRA-uteRine deViCe - only on a WSo iud..................................................................................................... 39.50 1 oP 1 oP ✓ ortho All-flex ✓ ortho coil ✓ Multiload cu 375 ✓ Multiload cu 375SL

contRAcePtiVeS – hoRmonAl

Special Authority for Alternate Subsidy - form: SA0500 initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: both: 1 either: 1.1 Patient is on a Social Welfare benefit; or 1.2 Patient has an income no greater than the benefit; and 2 Has tried at least one of the fully funded options and has been unable to tolerate it. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: either: 3 Patient is on a Social Welfare benefit; or 4 Patient has an income no greater than the benefit. note: the approval numbers of Special Authorities approved after 1 november 1999 are interchangeable between Mercilon, Marvelon, Minulet and femodene. the additional subsidy will fund Mercilon, Marvelon, Minulet and femodene up to the manufacturer’s price for each of these products as identified on the Schedule at 1 november 1999. Special Authorities approved before 1 november 1999 remain valid until the expiry date and can be renewed providing that women are still either: - on a Social Welfare benefit; or - have an income no greater than the benefit. the approval numbers of Special Authorities approved before 1 november 1999 are interchangeable for products within the combined oral contraceptives and progestogen-only contraceptives groups, except loette, Melodene and Microgynon 20 ed. ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

genito URinARy SyStem

contraceptives – hormonal

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

combined oral contraceptives

Additional subsidy by Special Authority - Retail pharmacy – refer page 73. etHinyloeStRAdiol WitH deSogeStRel ❋ tab 20 µg with desogestrel 150 µg ............................................................ 6.62 (16.50) a) Available on a PSo b) Higher subsidy of $13.80 per 63 with Special Authority ❋ tab 20 µg with desogestrel 150 µg and 7 inert tab ..................................... 6.62 (16.50) a) Available on a PSo b) Higher subsidy of $13.80 per 84 with Special Authority ❋ tab 30 µg with desogestrel 150 µg ........................................................... 6.62 (16.50) a) Available on a PSo b) Higher subsidy of $13.80 per 63 with Special Authority ❋ tab 30 µg with desogestrel 150 µg and 7 inert tab ..................................... 6.62 (16.50) a) Available on a PSo b) Higher subsidy of $13.80 per 84 with Special Authority etHinyloeStRAdiol WitH geStodene ❋ tab 30 µg with gestodene 75 µg and 7 inert tab ......................................... 6.62 (14.49) (16.50) a) Available on a PSo b) Higher subsidy of $14.49 per 84 with Special Authority etHinyloeStRAdiol WitH leVonoRgeStRel ❋ tab 30 µg with levonorgestrel 150 µg ....................................................... 6.62 (16.50) a) Available on a PSo b) Higher subsidy of $15.00 per 63 with Special Authority ❋ tab 30 µg with levonorgestrel 150 µg and 7 inert tab ................................. 6.62 (14.49) (16.50) a) Available on a PSo b) Higher subsidy of up to $15.00 per 84 with Special Authority ❋ tab ethinyloestradiol 30 µg with levonorgestrel 50 µg (6) and tab ethinyloestradiol 40 µg with levonorgestrel 75 µg (5) and tab ethinyloestradiol 30 µg with levonorgestrel 125 µg (10) and 7 inert tab ......................................................................................... 6.62 84 (9.45) (14.49) a) Available on a PSo b) Higher subsidy of up to $14.49 per 84 with Special Authority ❋ tab 50 µg with levonorgestrel 125 µg and 7 inert tab - Available on a PSo ................................................................................ 9.45 84 63 Mercilon 21 84 Mercilon 28 63 Marvelon 21 84 Marvelon 28

84 Minulet 28 femodene 28

63 Microgynon 30 84 ✓ Levlen Ed ✓ Monofeme nordette 28 Microgynon 30 ed

✓ trifeme triquilar ed triphasil 28

✓ Microgynon 50 Ed

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

genito URinARy SyStem

contraceptives – hormonal

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer etHinyloeStRAdiol WitH noRetHiSteRone ❋ tab 35 µg with norethisterone 500 µg ....................................................... 6.62 63 (14.52) a) Available on a PSo b) Higher subsidy of $14.52 per 63 with Special Authority ❋ tab 35 µg with norethisterone 500 µg and 7 inert tab - Available on a PSo ............................................................................... 6.62 84 ❋ tab ethinyloestradiol 35 µg with norethisterone 500 µg (7) and tab ethinyloestradiol 35 µg with norethisterone 1 mg (9) and tab ethinyloestradiol 35 µg with norethisterone 500 µg (5) and 7 inert tab ...................................................................... 6.62 84 (13.80) a) Available on a PSo b) Higher subsidy of $13.80 per 84 with Special Authority ❋ tab 35 µg with norethisterone 1 mg .......................................................... 6.62 63 (14.52) a) Available on a PSo b) Higher subsidy of $14.52 per 63 with Special Authority ❋ tab 35 µg with norethisterone 1 mg and 7 inert tab .................................... 6.62 84 (14.52) a) Available on a PSo b) Higher subsidy of $14.52 per 84 with Special Authority (Synphasic 28 to be delisted 1 January 2007) noRetHiSteRone WitH MeStRAnol ❋ tab 1mg with mestranol 50 µg and 7 inert tab ............................................ 6.62 (13.80) a) Available on a PSo b) Higher subsidy of $13.80 per 84 with Special Authority 84 norinyl-1/28

brevinor 21

✓ norimin

Synphasic 28

brevinor 1/21

brevinor 1/28

combined oral contraceptives – other

Special Authority does not apply etHinyloeStRAdiol WitH leVonoRgeStRel ❋ tab 20 µg with levonorgestrel 100 µg and 7 inert tab ............................... 6.62 (16.50) 84 loette Microgynon 20 ed

Progestogen-only contraceptives

Additional subsidy by Special Authority - Retail pharmacy – refer page 73. leVonoRgeStRel ❋ tab 30 µg................................................................................................... 6.62 (16.50) a) Available on a PSo b) Higher subsidy of $13.80 per 84 with Special Authority MedRoxyPRogeSteRone ACetAte - Available on a PSo ❋ inj 150 mg per ml, 1 ml syringe .................................................................. 8.05 noRetHiSteRone - Available on a PSo ❋ tab 350 µg................................................................................................. 7.15 84 Microlut

1 84

✓ depo-Provera ✓ noriday 28

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

genito URinARy SyStem

contraceptives – hormonal myometrial and Vaginal hormone Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

emergency contraceptives

leVonoRgeStRel ❋ tab 750 µg................................................................................................. 8.50 a) Maximum of 4 tab per prescription. b) Available on a PSo 2 ✓ Postinor-2

AntiAndRogen oRAl contRAcePtiVeS

CyPRoteRone ACetAte WitH etHinyloeStRAdiol ❋ tab 2 mg with ethinyloestradiol 35 µg and 7 inert tabs ............................. 6.30 84 ✓ Estelle 35 a) 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: - $3.00 prescription charge (patient co-payment) will apply; - prescription may be written for up to six months supply. b) Prescriptions coded in any other way are subject to the non-contraceptive prescription charges, and the noncontraceptive period of supply. ie. Prescriptions may be written for up to three months supply.

gynAecologicAl Anti-infectiVeS

ACetiC ACid WitH HydRoxyQuinoline And RiCinoleiC ACid jelly with glacial acetic acid 0.94%, hydroxyquinoline sulphate 0.025%, glycerol 5% and ricinoleic acid 0.75% with applicator ................ 8.43 100 g oP (11.32) ClotRiMAZole ❋ Vaginal crm 1% with applicator(s)............................................................... 1.56 ❋ Vaginal crm 2% with applicators ................................................................. 3.99 eConAZole nitRAte Pessaries 150 mg with applicators ............................................................. 2.75 (9.71) MiConAZole nitRAte ❋ Vaginal crm 2% with applicator ................................................................... 2.75 (3.70) nyStAtin Vaginal crm 100,000 u per 5 g with applicator ............................................ 4.71 35 g oP 25 g oP

Aci-jel ✓ clomazol ✓ clotrimaderm 2%

3 Pevaryl ovules 40 g oP Micreme 75 g oP ✓ nilstat

imPotence tReAtment

PAPAVeRine HydRoCHloRide ❋ inj 12 mg per ml, 10 ml ............................................................................ 73.12 5 ✓ Mayne

myometRiAl And VAginAl hoRmone PRePARAtionS

eRgoMetRine MAleAte inj 500 µg per ml, 1 ml - Available on a PSo............................................. 11.60 oeStRiol ❋ Pessaries 500 µg ....................................................................................... 7.25 ❋ Crm 1 mg per g with applicator ................................................................... 7.00 oxytoCin - Available on a PSo inj 5 iu per ml, 1 ml ..................................................................................... 4.94 inj 10 iu per ml, 1 ml................................................................................... 6.18 inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml................................. 8.40 5 15 15 g oP 5 5 5 ✓ Mayne ✓ ovestin ✓ ovestin ✓ Syntocinon ✓ Syntocinon ✓ Syntometrine

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

genito URinARy SyStem

Pregnancy tests - hcg Urine Urinary Agents Urinary tract infections

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

PRegnAncy teStS - hcg URine

PRegnAnCy teSt - HCg uRine - only on a WSo Cassette ................................................................................................... 19.00 25 tests ✓ MdS Quick card

URinARy AgentS other urinary agents

oxybutynin ❋ tab 5 mg .................................................................................................. 44.79 ❋ oral liq 5 mg per 5 ml ............................................................................... 45.00 SodiuM CitRo-tARtRAte ❋ grans eff 4 g sachets.................................................................................. 2.75 500 473 ml oP 28 ✓ Apo-oxybutynin ✓ Apo-oxybutynin ✓ ural

URinARy tRAct infectionS

Refer also to infeCtionS, Antibacterials, page 90 and infeCtionS, urinary tract infections, page 102.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

Anabolic Agents calcium homeostasis

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AnAbolic AgentS

nAndRolone deCAnoAte - RetAil PHARMACy-SPeCiAliSt inj 50 mg per ml, 1 ml .............................................................................. 21.15 1 ✓ deca-durabolin orgaject

cAlciUm homeoStASiS Alendronate for osteoporosis

AlendRonAte SodiuM - Special Authority - Retail pharmacy tab 70 mg ................................................................................................ 35.91 Special Authority for Subsidy - form: SA0797 4 ✓ Fosamax

initial application - (underlying cause - osteoporosis) – only from a relevant Specialist or vocationally registered general Practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mass density (bMd) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. it is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0. initial application - (underlying cause – glucocorticosteroid therapy) – only from a relevant Specialist or vocationally registered general Practitioner. Approvals valid for 1 year for applications meeting the following criteria: both: 5.1 The patient is receiving systemic glucocorticosteriod therapy (≥5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for more than three months; and 5.2 either: 5.2.1 has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5); or 5.2.2 has a history of one significant osteoporotic fracture demonstrated radiologically. Renewal only from a relevant Specialist or vocationally registered general Practitioner. Approvals valid for 1 year where the patient is continuing systemic glucocorticosteriod therapy (≥5 mg per day prednisone equivalents). notes: 1. evidence used by national institute for Clinical excellence (niCe) guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5, and therefore do not require bMd measurement for treatment with bisphosphonates. 2. 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. 3. 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.

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

calcium homeostasis

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Alendronate for Pagets disease

AlendRonAte SodiuM - Special Authority - Retail pharmacy tab 40 mg .............................................................................................. 133.00 30 ✓ Fosamax Special Authority for Subsidy - form: SA0467 initial application only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: both: 1 Paget’s disease; and 2 Any of the following: 2.1 bone or articular pain; or 2.2 bone deformity; or 2.3 bone, articular or neurological complications; or 2.4 Asymptomatic disease, but risk of complications due to site (base of skull, spine, long bones of lower limbs); or 2.5 Preparation for orthopaedic surgery. Renewal only from a relevant specialist. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefiting from treatment.

other treatments

CAlCitonin - Hospital pharmacy [HP3]-specialist ❋ inj 100 iu per ml, 1 ml............................................................................. 100.00 etidRonAte diSodiuM ❋ tab 200 mg .............................................................................................. 22.80 38.00 Prescribing guideline etidronate for osteoporosis should be prescribed for 14 days (400 mg in the morning) and repeated every three months. it should not be taken at the same time of the day as any calcium supplementation (minimum dose - 500 mg per day of elemental calcium). etidronate should be taken at least 2 hours before or after any food or fluid, except water. PAMidRonAte diSodiuM - Special Authority - Hospital pharmacy [HP3] inj 3 mg per ml, 5 ml ................................................................................48.50 1 ✓ Pamisol inj 3 mg per ml, 10 ml .............................................................................. 67.50 1 ✓ Pamisol inj 6 mg per ml, 10 ml ............................................................................ 135.00 1 ✓ Pamisol Special Authority for Subsidy - form: SA0091 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: either: 1 Paget’s disease; or 2 both: 2.1 Patients under hospice care; and 2.2 either: 2.2.1 tumour-induced hypercalcaemia; or 2.2.2 tumour-induced osteolysis without hypercalcaemia. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. 5 60 100 ✓ Miacalcic ✓ didronel ✓ Etidrate

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

corticosteroids and Related Agents for Systemic Use

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

coRticoSteRoidS And RelAted AgentS foR SyStemic USe

betAMetHASone SodiuM PHoSPHAte WitH betAMetHASone ACetAte ❋ inj 3.9 mg with betamethasone acetate 3 mg per ml, 1 ml ........................ 19.20 (33.60) dexAMetHASone - Retail pharmacy-specialist ❋ tab 1 mg - Available on a PSo ................................................................. 16.08 ❋ tab 4 mg - Available on a PSo ................................................................ 61.89 oral liq 1 mg per ml .................................................................................. 39.90 oral liq prescriptions: a) Must be written by a paediatrician or paediatric cardiologist; or b) on the recommendation of a paediatrician or paediatric cardiologist. dexAMetHASone SodiuM PHoSPHAte - Available on a PSo ❋ inj 4 mg per ml, 1 ml ................................................................................ 21.50 ❋ inj 4 mg per ml, 2 ml ................................................................................ 31.00 fludRoCoRtiSone ACetAte ❋ tab 100 µg................................................................................................. 7.62 HydRoCoRtiSone ❋ tab 5 mg .................................................................................................... 7.95 ❋ tab 20 mg ................................................................................................ 19.95 ❋ inj 50 mg per ml, 2 ml - only on a PSo ....................................................... 3.72 MetHylPRedniSolone - Retail pharmacy-specialist ❋ tab 4 mg .................................................................................................. 48.57 ❋ tab 100 mg ............................................................................................ 166.52 MetHylPRedniSolone ACetAte inj 40 mg per ml, 1 ml ................................................................................ 6.03 MetHylPRedniSolone ACetAte WitH lignoCAine inj 40 mg per ml with lignocaine 1 ml ......................................................... 6.03 MetHylPRedniSolone SodiuM SuCCinAte - Retail pharmacy-specialist inj 40 mg per ml, 1 ml ............................................................................ 151.40 inj 62.5 mg per ml, 2 ml ......................................................................... 412.59 inj 500 mg ................................................................................................ 16.45 inj 1 g ....................................................................................................... 42.57 PRedniSolone SodiuM PHoSPHAte - Available on a PSo ❋ oral liq 5 mg per ml .................................................................................... 9.95 a) Restricted to children under 12 years of age. PRedniSone ❋ tab 1 mg .................................................................................................... 9.89 ❋ tab 2.5 mg ............................................................................................... 11.41 ❋ tab 5 mg - Available on a PSo ................................................................. 11.09 ❋ tab 20 mg ................................................................................................ 30.56 tetRACoSACtRin ❋ inj 250 µg ............................................................................................... 177.18 ❋ inj 1 mg per ml, 1 ml ................................................................................ 26.88 tRiAMCinolone ACetonide inj 10 mg per ml, 1 ml .............................................................................. 11.11 inj 10 mg per ml, 5 ml .............................................................................. 10.31 inj 40 mg per ml, 1 ml .............................................................................. 28.09 5 Celestone Chronodose 100 100 25 ml oP ✓ douglas ✓ douglas ✓ Biomed

5 5 100 100 100 1 100 20 1 1

✓ Mayne ✓ Mayne ✓ Florinef ✓ douglas ✓ douglas ✓ Solu-cortef ✓ Medrol ✓ Medrol ✓ depo-Medrol ✓ depo-Medrol with lidocaine ✓ Solu-Medrol ✓ Solu-Medrol ✓ Solu-Medrol ✓ Solu-Medrol ✓ redipred

25 25 1 1 30 ml oP

500 500 500 500 10 1 5 1 5

✓ Apo-Prednisone ✓ Apo-Prednisone ✓ Apo-Prednisone ✓ Apo-Prednisone ✓ Synacthen ✓ Synacthen depot ✓ kenacort-A ✓ kenacort-A ✓ kenacort-A40

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

Sex hormones non contraceptive hormone Replacement therapy - Systemic

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

SeX hoRmoneS non contRAcePtiVe Androgen Agonists and Antagonists

CyPRoteRone ACetAte - Hospital pharmacy [HP3]-specialist tab 50 mg ................................................................................................ 23.50 inj 100 mg per ml, 3 ml .......................................................................... 196.82 (Pacific Cyproterone to be delisted 1 January 2007) teStoSteRone CyPionAte - Retail pharmacy-specialist inj long-acting 100 mg per ml, 10 ml ........................................................ 61.41 teStoSteRone enAntHAte - Retail pharmacy-specialist inj long-acting 250 mg - prefilled syringe .................................................. 45.00 teStoSteRone eSteRS - Retail pharmacy-specialist inj 250 mg per ml, 1 ml ........................................................................... 12.98 teStoSteRone undeCAnoAte - Retail pharmacy-specialist Cap 40 mg................................................................................................ 60.71 50 3 ✓ Siterone ✓ Pacific cyproterone ✓ Androcur depot

1 3 1 60

✓ depo-testosterone ✓ Primoteston ✓ Sustanon Ampoules ✓ Panteston

hoRmone RePlAcement theRAPy - SyStemic

Special Authority for Alternate Subsidy - form: SA0312 initial application only from an obstetrician, gynaecologist, general practitioner or general physician. Approvals valid for 5 years for applications meeting the following criteria: Any of the following: 1 Acute or significant liver disease - a declaration must be provided from a gastroenterologist or general physician stating that oral oestrogens are contraindicated due to liver disease (details to be attached to application); or 2 oestrogen induced hypertension requiring antihypertensive therapy - documented evidence must be provided that raised blood pressure levels or inability to control blood pressure adequately occurred post oral oestrogens(details to be attached to application); or 3 Hypertriglyceridaemia - documented evidence must be provided that triglyceride levels increased to at least 2 x normal triglyceride levels post oral oestrogens (details to be attached to application). note Prescriptions with a valid Special Authority (CHeM) number will be reimbursed at the level of the lowest priced tddS product within the specified dose group. Renewal only from an obstetrician, gynaecologist, general practitioner or general physician. Approvals valid for 5 years where the treatment remains appropriate and the patient is benefiting from treatment. Prescribing guideline HRt should be taken at the lowest dose for the shortest period of time necessary to control symptoms. Patients should be reviewed 6 monthly in line with the updated nZgg “evidence-based best Practice guideline on Hormone Replacement therapy March 2004”.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

hormone Replacement therapy - Systemic

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

oestrogens

oeStRAdiol – See prescribing guideline on page 81 ❋ tab 1 mg ................................................................................................... 4.12 (6.50) ❋ tab 2 mg ................................................................................................... 5.40 (7.00) ❋ tddS 25 µg per day ................................................................................... 3.01 (10.86) a) only on a prescription; b) no more than 2 patches per week; c) Higher subsidy of $10.86 per 8 with Special Authority. ❋ tddS 50 µg per day .................................................................................. 4.12 (13.18) a) only on a prescription; b) no more than 2 patches per week; c) Higher subsidy of $11.53 per 8 with Special Authority. ❋ tddS 3.9 mg per day (releases 50 µg of oestradiol per day) ...................... 4.12 (11.53) (35.00) a) only on a prescription; b) no more than 1 patch per week; c) Higher subsidy of $11.53 per 4 with Special Authority. ❋ tddS 100 µg per day ................................................................................. 7.05 (16.14) a) only on a prescription; b) no more than 2 patches per week; c) Higher subsidy of $14.33 per 8 with Special Authority. ❋ tddS 7.8 mg per day (releases 100 µg of oestradiol per day) .................... 7.05 (14.33) (32.50) a) only on a prescription; b) no more than 1 patch per week; c) Higher subsidy of $14.33 per 4 with Special Authority. oeStRAdiol VAleRAte – See prescribing guideline on page 81 ❋ tab 1 mg .................................................................................................... 4.12 (5.40) ❋ tab 2 mg ................................................................................................... 5.40 oeStRogenS – See prescribing guideline on page 81 ❋ Conjugated, equine tab 300 µg ................................................................... 3.01 (3.75) ❋ Conjugated, equine tab 625 µg ................................................................... 4.12 (5.14) 28 oP 28 oP 8 estraderm ttS 25 estrofem estrofem

8 estraderm ttS 50

4 Climara 50 femtran 50

estraderm ttS 100

Climara 100 femtran 100

28 28 28 28 Premarin Progynova ✓ Progynova

Premarin

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

hormone Replacement therapy - Systemic other oestrogen Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Progestogens

MedRoxyPRogeSteRone ACetAte – See prescribing guideline on page 81 ❋ tab 2.5 mg ................................................................................................. 2.07 ❋ tab 5 mg .................................................................................................. 13.75 ❋ tab 10 mg .................................................................................................. 7.57 30 100 30 ✓ Provera ✓ Provera ✓ Provera

Progestogen and oestrogen combined preparations

oeStRAdiol WitH leVonoRgeStRel – See prescribing guideline on page 81 ❋ tab 2 mg with 75 µg levonorgestrel (12) and 2 mg oestradiol tab (16) ........................................................................... 5.40 oeStRAdiol WitH noRetHiSteRone – See prescribing guideline on page 81 ❋ tab 1 mg with 0.5 mg norethisterone acetate ............................................. 5.40 (11.45) ❋ tab 2 mg with 1 mg norethisterone acetate ................................................ 5.40 (11.45) ❋ tab 2 mg with 1 mg norethisterone acetate (10) and 2 mg oestradiol tab (12) and 1 mg oestradiol tab (6) ............................... 5.40 (10.00) 28 28 oP 28 oP 28 oP trisequens ✓ nuvelle

Kliovance Kliogest

oeStRogenS WitH MedRoxyPRogeSteRone – See prescribing guideline on page 81 ❋ tab 625 µg conjugated equine with 2.5 mg medroxyprogesterone acetate tab (28) .................................................... 5.40 28 oP (11.45) ❋ tab 625 µg conjugated equine with 5 mg medroxyprogesterone acetate tab (28) .................................................... 5.40 28 oP (11.45)

Premia 2.5 Continuous Premia 5 Continuous

otheR oeStRogen PRePARAtionS

etHinyloeStRAdiol ❋ tab 10 µg................................................................................................. 17.60 oeStRiol ❋ tab 2 mg .................................................................................................... 7.00 100 30 ✓ nZ Medical and Scientific ✓ ovestin

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

other Progestogen Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

otheR PRogeStogen PRePARAtionS

dydRogeSteRone tab 10 mg ................................................................................................ 27.50 (29.90) 50 duphaston

leVonoRgeStRel - Special Authority - Retail Pharmacy levonorgestrel – releasing intrauterine system ❋ 20 µg/24 hr levonorgestrel .................................................................... 269.50 1 ✓ Mirena Special Authority for Subsidy - form: SA0782 initial application - (no previous use) only from a relevant specialist or general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 the patient has a clinical diagnosis of heavy menstrual bleeding; and 2 the patient has failed to respond to or is unable to tolerate other appropriate pharmaceutical therapies as per the Heavy Menstrual bleeding guidelines; and 3 either: 3.1 serum ferritin level < 16 mg/l (within the last 12 months); or 3.2 haemoglobin level < 120 g/l. note Applications are not to be made for use in patients as contraception except where they meet the above criteria. initial application - (Previous use before 1 october 2002) only from a relevant specialist or general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 4 the patient had a clinical diagnosis of heavy menstrual bleeding; and 5 Patient demonstrated clinical improvement of heavy menstrual bleeding; and 6 Applicant to state date of the previous insertion (details to be attached to application). note Applications are not to be made for use in patients as contraception except where they meet the above criteria Renewal only from a relevant specialist or general practitioner. Approvals valid for 6 months for applications meeting the following criteria: both: 7 either: 7.1 Patient demonstrated clinical improvement of heavy menstrual bleeding; or 7.2 Previous insertion was removed or expelled within 3 months of insertion; and 8 Applicant to state date of the previous insertion (details to be attached to application). MedRoxyPRogeSteRone ACetAte - Retail pharmacy-specialist ❋ tab 100 mg ............................................................................................ 104.26 ❋ tab 200 mg .............................................................................................. 78.06 (87.82) noRetHiSteRone - Available on a PSo ❋ tab 5 mg .................................................................................................. 25.00 100 30 ✓ Provera Provera 100 ✓ Primolut n

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

thyroid and Antithyroid Agents trophic hormones

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

thyRoid And AntithyRoid AgentS

CARbiMAZole ❋ tab 5 mg .................................................................................................. 10.80 tHyRoxine ❋ tab 50 µg................................................................................................. 34.00 ❋ tab 100 µg............................................................................................... 38.00 ‡ Safety caps for extemporaneously compounded oral liquid preparations. 100 1000 1000 ✓ neo-Mercazole ✓ Eltroxin ✓ Eltroxin

tRoPhic hoRmoneS growth hormone

note Applications to be made on the approved forms which are available from: theresa delany, Administrative Co-ordinator, liggins institute, faculty of Medicine and Health Science, university of Auckland, Private bag 92019, AuCKlAnd tel: (09) 373 7599 ext 86229, fax: (09) 373 8763, email: t.delany@auckland.ac.nz gRoWtH HoRMone bioSyntHetiC HuMAn - Special Authority - Access by application Cartridge 16 iu per vial .........................................................................1,600.00 5 ✓ genotropin Cartridge 36 iu per vial .........................................................................3,600.00 5 ✓ genotropin Subject to a budgetary cap. Applications will be considered and approved subject to funding availability. ReCoMbinAnt HuMAn gRoWtH HoRMone - Special Authority - Access by application inj 5 mg .................................................................................................. 300.00 1 ✓ norditropin Simplexx 5mg inj 10 mg ................................................................................................ 600.00 1 ✓ norditropin Simplexx 10mg inj 15 mg ................................................................................................ 900.00 1 ✓ norditropin Simplexx 15mg Subject to a budgetary cap. Applications will be considered and approved subject to funding availability.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

trophic hormones

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

gnRh Analogues

buSeRelin ACetAte - Special Authority - Hospital pharmacy [HP3] inj 1 mg per ml, 5.5 ml ........................................................................... 195.00 (272.53) 2 Suprefact

Special Authority for Subsidy – form: SA0835 initial application - (breast cancer) from any medical practitioner. Approvals valid for 1 year where the patient is a premenopausal woman with breast cancer. initial application - (Prostate cancer) only from an oncologist, urologist or endocrinologist. Approvals valid for 1 year where the patient has advanced prostatic cancer. note: not to be prescribed with an anti-androgen except for a period of three weeks, if necessary, when gnRH analogue therapy is initiated. initial application - (endometriosis) only from a gynaecologist. Approvals valid for 3 months for applications meeting the following criteria: both: 1 endometriosis; and 2 either: 2.1 6 months treatment with medroxyprogesterone acetate, danazol or dimetriose has proven ineffective; or 2.2 the patient has failed to tolerate the treatment with medroxyprogesterone acetate, danazol or dimetriose for 6 months. note the maximum treatment period for a gnRH analogue is: - 3 months to assess whether surgery is appropriate - 3 months for infertile patients after surgery - 6 months for patients with symptoms of endometriosis. After the first 3 months patients should be assessed to determine whether there has been a satisfactory response to the first 3 months treatment. initial application - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the patient is affected by gonadotropin dependent precocious puberty. Renewal - (breast or prostate cancer) from any medical practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal - (endometriosis) from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: either: 3 both: 3.1 there has been a satisfactory response to the first 3 months treatment; and 3.2 Surgery is inappropriate; or 4 the first three months of therapy did not follow surgery for infertility. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application.

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

trophic hormones

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer goSeRelin ACetAte - Special Authority - Hospital pharmacy [HP3] inj 3.6 mg ............................................................................................... 277.00 inj 10.8 mg. ............................................................................................ 591.68 1 1 ✓ Zoladex ✓ Zoladex

Special Authority for Subsidy – form: SA0839 initial application - (breast cancer) from any medical practitioner. Approvals valid for 1 year where the patient is a premenopausal woman with breast cancer initial application - (Prostate cancer) only from an oncologist, urologist or endocrinologist. Approvals valid for 1 year for applications meeting the following criteria: either: 1 Advanced prostatic cancer; or 2 neoadjuvant or adjuvant treatment of locally advanced prostatic cancer. note not to be prescribed with an anti-androgen except for a period of three weeks, if necessary, when gnRH analogue therapy is initiated. initial application - (endometriosis) only from a gynaecologist. Approvals valid for 3 months for applications meeting the following criteria: both: 3 endometriosis; and 4 either: 4.1 6 months treatment with medroxyprogesterone acetate, danazol or dimetriose has proven ineffective; or 4.2 the patient has failed to tolerate the treatment with medroxyprogesterone acetate, danazol or dimetriose for 6 months. note the maximum treatment period for a gnRH analogue is: - 3 months to assess whether surgery is appropriate - 3 months for infertile patients after surgery - 6 months for patients with symptoms of endometriosis. After the first 3 months patients should be assessed to determine whether there has been a satisfactory response to the first 3 months treatment. initial application - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the patient is affected by gonadotropin dependent precocious puberty. Renewal - (breast or prostate cancer) from any medical practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal - (endometriosis) from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: either: 5 both: 5.1 there has been a satisfactory response to the first 3 months treatment; and 5.2 Surgery is inappropriate; or 6 the first three months of therapy did not follow surgery for infertility. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application. ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

trophic hormones

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer leuPRoRelin - Special Authority - Hospital pharmacy [HP3] inj 3.75 mg ............................................................................................. 221.60 inj 11.25 mg ........................................................................................... 591.68 1 1 ✓ Lucrin depot ✓ Lucrin depot

Special Authority for Subsidy – form: SA0837 initial application - (breast cancer) from any medical practitioner. Approvals valid for 1 year where the patient is a premenopausal woman with breast cancer initial application - (Prostate cancer) only from an oncologist, urologist or endocrinologist. Approvals valid for 1 year where the patient has advanced prostatic cancer note not to be prescribed with an anti-androgen except for a period of three weeks, if necessary, when gnRH analogue therapy is initiated. initial application - (endometriosis) only from a gynaecologist. Approvals valid for 3 months for applications meeting the following criteria: both: 1 endometriosis; and 2 either: 2.1 6 months treatment with medroxyprogesterone acetate, danazol or dimetriose has proven ineffective; or 2.2 the patient has failed to tolerate the treatment with medroxyprogesterone acetate, danazol or dimetriose for 6 months. note the maximum treatment period for a gnRH analogue is: - 3 months to assess whether surgery is appropriate - 3 months for infertile patients after surgery - 6 months for patients with symptoms of endometriosis. After the first 3 months patients should be assessed to determine whether there has been a satisfactory response to the first 3 months treatment. initial application - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the patient is affected by gonadotropin dependent precocious puberty. Renewal - (breast or prostate cancer) from any medical practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal - (endometriosis) from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: either: 3 both: 3.1 there has been a satisfactory response to the first 3 months treatment; and 3.2 Surgery is inappropriate; or 4 the first three months of therapy did not follow surgery for infertility. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application. Renewal - (Precocious puberty) only from a paediatrician or endocrinologist. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. note: if a patient had an approval for any gnRH analogue prior to 1 july 2006 the applicant is required to submit a fresh initial application, not a renewal application.

✓

fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

hoRmone PRePARAtionS - SyStemic excluding contraceptive hormones

Vasopressin Agonists other endocrine Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

VASoPReSSin AgoniStS

deSMoPReSSin inj 4 µg per ml, 1 ml - Special Authority - Hospital pharmacy [HP3] ............67.18 10 ✓ Minirin s nasal spray 10 µg per dose - Retail pharmacy-specialist .......................... 30.30 6 ml oP ✓ desmopressin-PH&t s nasal drops 100 µg per ml - Retail pharmacy-specialist ........................... 39.03 2.5 ml oP ✓ Minirin Special Authority for Subsidy - form: SA0090 initial application only from a relevant specialist. Approvals valid for 2 years where the patient cannot use desmopressin nasal spray or nasal drops. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

otheR endocRine AgentS

CAbeRgoline tab 0.5 mg – Maximum of 2 tab per prescription; can be waived by Special Authority...................................................... 105.03 8 ✓ dostinex Special Authority for Waiver of Rule - form: SA0175 initial application only from an obstetrician, endocrinologist or gynaecologist. Approvals valid for 2 years where the patient has pathological hyperprolactinemia. Renewal only from an obstetrician, endocrinologist or gynaecologist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. CloMiPHene CitRAte - Retail pharmacy-specialist Subsidised only on a prescription for a female patient. tab 50 mg .................................................................................................. 2.50 dAnAZol - Retail pharmacy-specialist Cap 100 mg.............................................................................................. 17.00 Cap 200 mg.............................................................................................. 25.00 geStRinone - Retail pharmacy-specialist Cap 2.5 mg............................................................................................. 101.87 MetyRAPone - Hospital pharmacy [HP3]-specialist Cap 250 mg............................................................................................ 238.00

5 30 30 8 oP 50

✓ Phenate ✓ d-Zol ✓ d-Zol ✓ dimetriose ✓ Metopirone

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

infectionS - AgentS foR SyStemic USe

Anthelmintics Antibacterials

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AnthelminticS

MebendAZole - only on a prescription tab 100 mg .............................................................................................. 3.79 (7.59) oral liq 100 mg per 5 ml ............................................................................. 2.18 (7.17) 6 Vermox 15 ml Vermox

PyRAntel eMbonAte tab 125 mg ................................................................................................ 5.31 18 (7.00) tab 250 mg ................................................................................................ 3.76 6 (4.95) oral liq 50 mg per ml .................................................................................. 2.52 15 ml (4.45) (Combantrin tab 125 mg 6 tab pack & oral liq 50 mg per ml to be delisted 1 June 2007)

Combantrin Combantrin Combantrin

AntibActeRiAlS

for topical antibacterials, refer to deRMAtologiCAlS, page 64, and SenSoRy oRgAnS page 154.

cephalosporins and cephamycins

CefACloR MonoHydRAte Cap 250 mg.............................................................................................. 28.90 grans for oral liq 125 mg per 5 ml .............................................................. 3.92 100 100 ml ✓ ranbaxy-cefaclor ✓ ranbaxy-cefaclor

CefAMAndole nAfAte a) Hospital pharmacy [HP3]-specialist b) Subsidy by endorsement only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. inj 500 mg .................................................................................................. 3.60 1 (4.30) Mandol inj 1 g ......................................................................................................... 4.30 1 ✓ Mandol (Mandol inj 500 mg and inj 1 g to be delisted 1 March 2007) CefAZolin SodiuM a) Hospital pharmacy [HP3] b) Subsidy by endorsement only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. inj 500 mg ................................................................................................ 13.60 10 ✓ m-cefazolin inj 1 g ....................................................................................................... 18.60 10 ✓ m-cefazolin Cefoxitin SodiuM a) Hospital pharmacy [HP3]-specialist b) Subsidy by endorsement only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. inj 1 g ....................................................................................................... 48.68 5 ✓ Mayne

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

infectionS - AgentS foR SyStemic USe

Antibacterials

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer CeftRiAxone SodiuM a) Hospital pharmacy [HP3] b) Subsidy by endorsement c) Available on a PSo 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. inj 250 mg .................................................................................................. 4.00 1 ✓ rocephin Iv inj 500 mg .................................................................................................. 3.99 1 ✓ AFt (7.00) Rocephin inj 1 g ......................................................................................................... 5.40 1 ✓ AFt (9.00) 1 Rocephin (Rocephin inj 500 mg and inj 1 g to be delisted 1 January 2007) CefuRoxiMe Axetil tab 250 mg - Subsidy by endorsement .................................................... 98.75 50 only if prescribed for prohylaxis of endocarditis and the prescription is endorsed accordingly. CefuRoxiMe SodiuM - Hospital pharmacy [HP3] inj 250 mg - Maximum of 3 inj per prescription; can be waived by endorsement ............................................................. 20.97 inj 750 mg - Maximum of 1 inj per prescription; can be waived by endorsement .............................................................56.47 48.00 inj 1.5 g .................................................................................................. 123.55 ✓ Zinnat

10 10 10

✓ Mayne ✓ Mayne ✓ Zinacef ✓ Mayne ✓ Zinacef

a) Specialist b) Subsidy by endorsement only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. CePHAlexin MonoHydRAte - Hospital pharmacy [HP3] Cap 250 mg................................................................................................ 6.00 (Keflex to be delisted 1 March 2007) 20 ✓ keflex

CePHRAdine - Hospital pharmacy [HP3] Cap 250 mg.............................................................................................. 14.50 24 ✓ velosef Cap 500 mg.............................................................................................. 19.85 24 ✓ velosef inj 500 mg - Subsidy by endorsement ...................................................... 16.78 5 ✓ velosef only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. inj 1 g - Subsidy by endorsement ............................................................. 31.59 5 ✓ velosef only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.

macrolides

AZitHRoMyCin tab 500 mg .............................................................................................. 15.53 2 tab oP ✓ Zithromax a) Maximum of 2 tab per prescription b) Available on a PSo c) Subsidy by endorsement 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. ClARitHRoMyCin - Maximum of 500 mg per prescription; can be waived by Special Authority tab 250 mg ................................................................................................ 9.85 14 ✓ clarac grans for oral liq 125 mg per 5 ml ........................................................... 23.12 70 ml ✓ klacid Special Authority for Subsidy - form: SA0657 ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

continued…

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

infectionS - AgentS foR SyStemic USe

Antibacterials

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… initial application - (Helicobacter pylori infections) only from a general practitioner or relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: both: 1 eradication of Helicobacter pylori in patient with proven infection; and 2 Peptic ulcer disease proven by endoscopy. note Maximum of two prescriptions (two courses) per patient. initial application - (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 3 Mycobacterium Avium intracellulare Complex infections in patient with AidS; or 4 Atypical and drug-resistant mycobacterial infection; or 5 All of the following: 5.1 Prophylaxis against disseminated Mycobacterium Avium intracellulare Complex infection; and 5.2 HiV infection; and 5.3 CD4 count ≤ 50 cells/mm3. Renewal - (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. eRytHRoMyCin etHyl SuCCinAte tab 400 mg - Available on a PSo ............................................................. 18.95 grans for oral liq 200 mg per 5 ml - Available on a PSo .............................. 3.75 grans for oral liq 400 mg per 5 ml - Available on a PSo .............................. 5.60 eRytHRoMyCin lACtobionAte inj 300 mg ................................................................................................ 70.97 inj 1 g ......................................................................................................... 6.50 eRytHRoMyCin SteARAte tab 250 mg - Available on a PSo ............................................................. 14.95 (22.29) tab 500 mg .............................................................................................. 29.90 (44.58) RoxitHRoMyCin tab 150 mg .............................................................................................. 14.95 tab 300 mg .............................................................................................. 29.90 100 100 ml 100 ml 5 1 100 100 ✓ E-Mycin ✓ E-Mycin ✓ E-Mycin ✓ Mayne ✓ ErA

eRA eRA ✓ romicin ✓ romicin

50 50

Penicillins

AMoxyCillin Cap 250 mg - Available on a PSo ............................................................. 17.33 Cap 500 mg.............................................................................................. 27.72 grans for oral liq 125 mg per 5 ml - Available on a PSo .............................. 1.00 1.08 grans for oral liq 250 mg per 5 ml - Available on a PSo .............................. 1.27 1.38 drops 125 mg per 1.25 ml ......................................................................... 7.25 4.75 inj 250 mg .................................................................................................. 6.32 inj 500 mg .................................................................................................. 7.23 inj 1 g - Available on a PSo....................................................................... 11.00 (Ospamox Paediatric Drops to be delisted 1 January 2007) 500 500 100 ml 100 ml 20 ml oP 30 ml oP 5 5 5 ✓ Apo-Amoxi ✓ Apo-Amoxi ✓ ranbaxy Amoxicillin ✓ ospamox ✓ ranbaxy Amoxicillin ✓ ospamox ✓ Amoxil Paediatric drops ✓ ospamox Paediatric drops ✓ Ibiamox ✓ Ibiamox ✓ Ibiamox

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

infectionS - AgentS foR SyStemic USe

Antibacterials

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer AMoxyCillin ClAVulAnAte - Available on a PSo tab amoxycillin 500 mg with potassium clavulanate 125 mg ...................... 6.40 grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml ................................................................... 2.75 grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml .................................................................. 4.75 benZAtHine benZylPeniCillin inj 1.2 mega u per 2 ml - Available on a PSo......................................16.00 inj 1.2 mega u - Available on a PSo .................................................160.00 benZylPeniCillin SodiuM (PeniCillin g) inj 1 mega u - Available on a PSo ............................................................... 6.99 diCloxACillin Cap 250 mg................................................................................................ 2.47 (4.35) Cap 500 mg................................................................................................ 3.83 (8.65) grans for oral liq 125 mg per 5 ml .............................................................. 3.55 (4.10) inj 500 mg .................................................................................................. 5.45 inj 1 g ......................................................................................................... 7.54 fluCloxACillin SodiuM Cap 250 mg - Available on a PSo ............................................................. 18.50 Cap 500 mg.............................................................................................. 57.90 grans for oral liq 125 mg per 5 ml - Available on a PSo ............................... 2.05 grans for oral liq 250 mg per 5 ml - Available on a PSo ............................... 2.72 inj 250 mg ................................................................................................. 4.66 inj 500 mg .................................................................................................. 5.45 inj 1 g - Available on a PSo......................................................................... 7.54 PHenoxyMetHylPeniCillin (PeniCillin V) Cap potassium salt 250 mg - Available on a PSo........................................ 4.29 Cap potassium salt 500 mg ........................................................................ 8.15 grans for oral liq benzathine 125 mg per 5 ml - Available on a PSo .................. 1.48 grans for oral liq benzathine 250 mg per 5 ml - Available on a PSo .................. 1.68 PRoCAine PeniCillin - Available on a PSo inj 1.5 mega u .......................................................................................... 47.60 20 100 ml 100 ml 1 10 ✓ Augmentin ✓ Augmentin ✓ Augmentin ✓ Bicillin ✓ Pan Benzathine Benzylpenicillin ✓ novartis

10 24 24 100 ml 5 5 250 500 100 ml 100 ml 5 5 5 50 50 100 ml 100 ml 5

diclocil diclocil diclocil ✓ diclocil ✓ diclocil ✓ Staphlex ✓ Staphlex ✓ AFt ✓ AFt ✓ Flucloxin ✓ Flucloxin ✓ Flucloxin ✓ cilicaine vk ✓ cilicaine vk ✓ AFt ✓ AFt ✓ cilicaine

tetracyclines

doxyCyCline HydRoCHloRide - Available on a PSo ❋ tab 50 mg .................................................................................................. 2.90 (6.00) ❋ tab 100 mg ................................................................................................ 8.10 MinoCyCline HydRoCHloRide ❋ tab 50 mg .................................................................................................. 5.79 (12.05) ❋ Cap 100 mg.............................................................................................. 19.32 (52.04) 30 250 60 Mino-tabs 100 Minomycin doxy-50 ✓ doxine

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

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

infectionS - AgentS foR SyStemic USe

Antibacterials

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

other Antibiotics

for topical Antibiotics, refer also to deRMAtologiCAlS, Antibactierials topical, page 64. CiPRofloxACin tab 250 mg - Available on a PSo ............................................................... 5.10 tab 500 mg - Available on a PSo ............................................................... 8.31 tab 750 mg - Retail pharmacy-specialist .................................................. 19.30 ClindAMyCin Cap hydrochloride 150 mg - Maximum of 3 cap per prescription; can be waived by endorsement - Retail pharmacy - specialist ............... 11.39 inj phosphate 150 mg per ml, 4 ml - Retail pharmacy - specialist ............ 19.45 28 28 28 ✓ cipflox ✓ cipflox ✓ cipflox

16 1

✓ dalacin c ✓ dalacin c

ColiStin SulPHoMetHAte a) Hospital pharmacy [HP3]-specialist b) Subsidy by endorsement only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. inj 150 mg ................................................................................................ 49.54 1 ✓ colymycin-M Co-tRiMoxAZole ❋ tab trimethoprim 80 mg and sulphamethoxazole 400 mg Available on a PSo ................................................................................ 17.00 ❋ oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml Available on a PSo ....................................................... 5.90

500 500 ml

✓ trisul ✓ trisul

fuSidiC ACid tab 250 mg - Hospital pharmacy [HP3]-specialist ................................ 34.50 12 ✓ Fucidin inj 500 mg sodium fusidate per 10 ml....................................................... 12.87 1 (16.95) fucidin a) Hospital pharmacy [HP3] - Specialist b) Subsidy by endorsement only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. gentAMiCin SulPHAte inj 10 mg per ml, 1 ml ................................................................................ 8.56 5 ✓ Mayne a) Hospital pharmacy [HP3] b) Subsidy by endorsment only if prescribed for a dialysis patient or cystic fibrosis patient or for prophylaxis for endocarditis and the prescription is endorsed accordingly. inj 40 mg per ml, 2 ml ................................................................................ 4.56 10 ✓ Pfizer a) Hospital pharmacy [HP3] b) Subsidy by endorsment only if prescribed for a dialysis patient or cystic fibrosis patient or for prophylaxis for endocarditis and the prescription is endorsed accordingly. tobRAMyCin inj 40 mg per ml, 2 ml .............................................................................. 27.50 5 ✓ Mayne a) Hospital pharmacy [HP3] b) Subsidy by endorsement only if prescribed for a dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. tRiMetHoPRiM ❋ tab 300 mg - Available on a PSo ............................................................... 7.90 50 ✓ tMP

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

infectionS - AgentS foR SyStemic USe

Antibacterials Antitrichomonal Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer VAnCoMyCin HydRoCHloRide a) Hospital pharmacy [HP3] b) Subsidy by endorsement 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. inj 50 mg per ml, 10 ml .............................................................................. 4.70 1 ✓ Pacific

AntifUngAlS

for topical antifungals refer to deRMAtologiCAlS page 64, genito uRinARy, page 76 fluConAZole - Hospital pharmacy [HP3]-specialist Cap 50 mg................................................................................................ 14.50 Cap 150 mg................................................................................................ 3.90 Cap 200 mg.............................................................................................. 41.50 627.59 (Diflucan cap 200 mg to be delisted 1 March 2007) itRAConAZole - Hospital pharmacy [HP3]-specialist Cap 100 mg.............................................................................................. 37.09 KetoConAZole - Retail pharmacy-specialist tab 200 mg .............................................................................................. 38.12 nyStAtin tab 500,000 u ............................................................................................ 9.60 Cap 500,000 u.......................................................................................... 11.64 teRbinAfine tab 250 mg .............................................................................................. 50.00 28 1 28 ✓ Pacific ✓ Pacific ✓ Pacific ✓ diflucan

15 30 50 50 100

✓ Sporanox ✓ nizoral ✓ nilstat ✓ nilstat ✓ Apo-terbinafine

AntimAlARiAlS

HydRoxyCHloRoQuine SulPHAte ❋ tab 200 mg .............................................................................................. 31.09 100 ✓ Plaquenil

AntitRichomonAl AgentS

MetRonidAZole tab 200 mg - Available on a PSo ............................................................... 9.50 tab 400 mg .............................................................................................. 17.50 oral liq benzoate 200 mg per 5 ml ............................................................ 17.81 (28.56) Suppos 500 mg ........................................................................................ 24.48 Suppos 1 g ............................................................................................... 33.31 oRnidAZole tab 500 mg .............................................................................................. 12.38 tinidAZole tab 500 mg .............................................................................................. 41.67 (Dyzole tab 500 mg to be delisted 1 February 2007) 100 100 100 ml 10 10 10 40 ✓ trichozole ✓ trichozole flagyl - S ✓ Flagyl ✓ Flagyl ✓ tiberal ✓ dyzole

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

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

infectionS - AgentS foR SyStemic USe

Antituberculotics and Antileprotics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntitUbeRcUloticS And AntilePRoticS

note: there is no co-payment charge for all pharmaceuticals listed in the Antituberculotics and Antileprotics group regardless of immigration status. dAPSone – no patient co-payment payable tab 25 mg ................................................................................................ 95.00 tab 100 mg ............................................................................................ 110.00 etHAMbutol - Retail pharmacy-specialist – no patient co-payment payable ❋ tab 400 mg .............................................................................................. 19.60 iSoniAZid - Retail pharmacy-specialist – no patient co-payment payable ❋ tab 100 mg .............................................................................................. 21.00 ❋ tab 100 mg with rifampicin 150 mg ......................................................... 90.04 ❋ tab 150 mg with rifampicin 300 mg ....................................................... 179.57 PyRAZinAMide - Retail pharmacy-specialist – no patient co-payment payable ❋ tab 500 mg .............................................................................................. 59.00 100 100 100 100 100 100 100 ✓ dapsone ✓ dapsone ✓ Myambutol ✓ PSM ✓ rifinah ✓ rifinah ✓ AFt-Pyrazinamide S29 ✓ Mycobutin ✓ rifadin ✓ rifadin ✓ rifadin ✓ rifadin

RifAbutin - Hospital pharmacy [HP3]-specialist – no patient co-payment payable ❋ Cap 150 mg............................................................................................ 213.19 30 RifAMPiCin - Retail pharmacy-specialist – no patient co-payment payable ❋ Cap 150 mg.............................................................................................. 58.66 ❋ Cap 300 mg............................................................................................ 122.36 ❋ tab 600 mg ............................................................................................ 114.40 ❋ oral liq 100 mg per 5 ml ........................................................................... 12.66 100 100 30 60 ml

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

infectionS - AgentS foR SyStemic USe

Antivirals

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntiViRAlS hepatitis b treatment

AdefoViR diPiVoxil - Special Authority – Retail pharmacy tab 10 mg .............................................................................................. 670.00 30 ✓ Hepsera

Special Authority for Subsidy - form: SA0829 initial application only from gastroenterologist or infectious disease specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1. Patient has confirmed Hepatitis b infection (HbsAg+); and documented resistance to lamivudine, defined as: 2. patient has raised serum Alt (> 1 x uln); and 3. patient has HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and 4. detection of M204i or M204V mutation; and 5. either 5.1.both 5.1.1.patient is cirrhotic; and 5.1.2.adefovir dipivoxil to be used in combination with lamivudine; or 5.2.both 5.2.1.patient is not cirrhotic; and 5.2.2.adefovir dipivoxil to be used as monotherapy Renewal only from a gastroenterologist or infectious disease specialist. Approvals valid for 2 years for applications where in the opinion of the treating physician, treatment remains appropriate and patient is benefiting from treatment. notes: lamivudine should be added to adefovir dipivoxil if a patient develops documented resistance to adefovir dipivoxil, defined as: i. raised serum Alt (> 1 x uln); and, ii. HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and iii. detection of n236t or A181t/V mutation. Adefovir dipivoxil should be stopped 6 months following HbeAg seroconversion for patients who were HbeAg+ prior to commencing adefovir dipivoxil. the recommended dose of adefovir dipivoxil is no more than 10 mg daily. in patients with renal insufficiency, adefovir dipivoxil dose should be reduced in accordance with the datasheet guidelines. Adefovir dipivoxil should be avoided in pregnant women and children. lAMiVudine - Special Authority - Retail pharmacy tab 100 mg ............................................................................................ 143.00 28 ✓ Zeffix oral liq 5 mg per ml .................................................................................. 90.00 240 ml ✓ Zeffix Special Authority for Subsidy – form: SA0832 initial application only from a gastroenterologist, infectious disease specialist, paediatrician or general physician. Approvals valid for 1 year for applications meeting the following criteria: both: 1 Any of the following: 1.1 All of the following: 1.1.1 HbsAg positive for more than 6 months; and 1.1.2 HbeAg positive or HbV dnA positive defined as > 100,000 copies per ml by quantitative PCR at a reference laboratory; and 1.1.3 Alt greater than twice upper limit of normal or bridging fibrosis or cirrhosis (Metavir stage 3 or 4 or equivalent) on liver histology or clinical/radiological evidence of cirrhosis; or 1.2 HbV dnA positive cirrhosis prior to liver transplantation; or 1.3 HbsAg positive and have had a liver, kidney, heart, lung or bone marrow transplant; or continued… ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

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

infectionS - AgentS foR SyStemic USe

Antivirals herpes treatment

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 1.4 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; and 2 All of the following: 2.1 no continuing alcohol abuse or intravenous drug use; and 2.2 not coinfected with HCV or HdV; and 2.3 neither Alt nor ASt greater than 10 times upper limit of normal; and 2.4 no history of hypersensitivity to lamivudine; and 2.5 no previous lamivudine therapy with genotypically proven lamivudine resistance. Renewal only from a gastroenterologist, infectious disease specialist, paediatrician or general physician. Approvals valid for 2 years for applications meeting the following criteria: Any of the following Renewal for patients who have maintained continuous treatment and response to lamivudine 3 All of the following: 3.1 Have maintained continuous treatment with lamivudine; and 3.2 Most recent test result shows continuing biochemical response (normal Alt); and 3.3 HbV dnA < 100,000 copies per ml by quantitative PCR at a reference laboratory. or: Renewal when given in combination with adefovir dipivoxil for patients with cirrhosis and resistance to lamivudine 4 All of the following 4.1 lamivudine to be used in combination with adefovir dipivoxil; and 4.2 Patient is cirrhotic; and documented resistance to lamivudine, defined as: 4.3 Patient has raised serum Alt (> 1 x uln); and 4.4 Patient has HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and 4.5 detection of M204i or M204V mutation. or: Renewal when given in combination with adefovir dipivoxil for patients with resistance to adefovir dipivoxil 5 All of the following 5.1 lamivudine to be used in combination with adefovir dipivoxil; and documented resistance to adefovir, defined as: 5.2 Patient has raised serum Alt (> 1 x uln); and 5.3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load ≥ 10 fold over nadir; and 5.4 detection of n236t or A181t/V mutation.

heRPeS tReAtment

Refer also to SenSoRy, eye Preparations, Anti-infective, page 154.

first episode genital herpes

ACiCloViR ❋ tab dispersible 200 mg .................................................................................. 1.98 7.13 48.75 10.00 VAlACiCloViR HydRoCHloRide tab 500 mg .............................................................................................. 54.63 163.80 25 90 100 10 30 ✓ Lovir ✓ Lovir ✓ Zovirax S29 ✓ Acicvir ✓ valtrex S29 ✓ valtrex S29

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

infectionS - AgentS foR SyStemic USe

herpes treatment

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Recurrent episodes of genital herpes

ACiCloViR ❋ tab dispersible 400 mg .............................................................................. 6.64 36.00 56 240 ✓ Lovir ✓ Acicvir

Acute herpes zoster

ACiCloViR ❋ tab dispersible 800 mg .............................................................................. 7.38 26.70 35 100 ✓ Lovir ✓ Acicvir

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

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

infectionS - AgentS foR SyStemic USe

Antiretrovirals

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntiRetRoViRAlS

Special Authority for Subsidy - form: SA0779 initial application - (Confirmed HiV/AidS) only from a named specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: both: 1 Confirmed HiV infection; and 2 Any of the following: 2.1 Symptomatic patient; or 2.2 Patient aged 12 months and under; or 2.3 both: 2.3.1 Patient aged 1 to 5 years; and 2.3.2 either: 2.3.2.1 Cd4 counts < 1,000 cells/mm3; or 2.3.2.2 Cd4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Patient has viral load counts > 100,000 copies per ml, or 2.4 both: 2.4.1 Patient aged 6 years and over; and 2.4.2 Cd4 counts < 350 cells/mm3. note Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or saquinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals. initial application - (Percutaneous exposure) only from a named specialist. Approvals valid for 6 weeks where the patient has percutaneous exposure to blood known to be HiV positive. note Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or saquinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals. initial application - (Prevention of maternal transmission) only from a named specialist. Approvals valid for 1 year for applications meeting the following criteria: 3 either: 3.1 Prevention of maternal foetal transmission; or 3.2 treatment of the newborn for up to eight weeks. note Subsidies for a combination of up to three anti-retroviral medications, including a maximum of two protease inhibitors. Combinations including ritonavir plus indinavir or saquinavir or atazanavir will be counted as one protease inhibitor for the purpose of accessing funding to anti-retrovirals. 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. Renewal - (Confirmed HiV/AidS) only from a named specialist. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment.

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

infectionS - AgentS foR SyStemic USe

Antiretrovirals

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

non-nucleoside reverse transcriptase inhibitors

Special Authority – anti-retrovirals refer page 100 efAViRenZ - Special Authority - Hospital pharmacy [HP1] Cap 50 mg.............................................................................................. 158.33 Cap 100 mg............................................................................................ 158.33 Cap 200 mg............................................................................................ 474.99 tab 600 mg ............................................................................................ 474.99 neViRAPine - Special Authority - Hospital pharmacy [HP1] tab 200 mg ............................................................................................ 319.80 oral suspension 10 mg per ml ................................................................ 134.55 30 30 90 30 60 240 ml ✓ Stocrin ✓ Stocrin ✓ Stocrin ✓ Stocrin ✓ viramune ✓ viramune Suspension

nucleoside reverse transcriptase inhibitors

Special Authority – anti-retrovirals refer page 100 AbACAViR SulPHAte - Special Authority - Hospital pharmacy [HP1] tab 300 mg ............................................................................................ 458.00 oral liq 20 mg per ml .............................................................................. 100.00 didAnoSine (ddi) - Special Authority - Hospital pharmacy [HP1] Cap 125 mg............................................................................................ 115.05 Cap 200 mg............................................................................................ 184.08 Cap 250 mg............................................................................................ 230.10 Cap 400 mg............................................................................................ 368.16 lAMiVudine - Special Authority - Hospital pharmacy [HP1] tab 150 mg ............................................................................................ 307.20 oral liq 10 mg per ml .............................................................................. 100.00 StAVudine (d4t) - Special Authority - Hospital pharmacy [HP1] Cap 20 mg.............................................................................................. 317.10 Cap 30 mg.............................................................................................. 377.80 Cap 40 mg.............................................................................................. 503.80 Powder for oral soln 1 mg per ml ............................................................ 100.76 ZidoVudine (AZt) - Special Authority - Hospital pharmacy [HP1] Cap 100 mg............................................................................................ 290.00 oral liq 10 mg per ml ................................................................................ 58.00 60 240 ml oP 30 30 30 30 60 240 ml oP 60 60 60 200 ml oP 100 200 ml oP ✓ Ziagen ✓ Ziagen ✓ videx Ec ✓ videx Ec ✓ videx Ec ✓ videx Ec ✓ 3tc ✓ 3tc ✓ Zerit ✓ Zerit ✓ Zerit ✓ Zerit ✓ retrovir ✓ retrovir

ZidoVudine (AZt) with lAMiVudine - Special Authority - Hospital pharmacy [HP1] tab 300 mg with lamivudine 150 mg ...................................................... 667.20 60 ✓ combivir note Combivir counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority

Protease inhibitors

Special Authority – anti-retrovirals refer page 100 AtAZAnAViR SulPHAte - Special Authority – Hospital pharmacy [HP1] Cap 150 mg ........................................................................................ 568.34 Cap 200 mg ........................................................................................ 757.79 indinAViR - Special Authority - Hospital pharmacy [HP1] Cap 200 mg............................................................................................ 519.75 Cap 400 mg............................................................................................ 519.75 60 60 360 180 ✓ reyataz ✓ reyataz ✓ crixivan ✓ crixivan

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

infectionS - AgentS foR SyStemic USe

Antiretrovirals Antiretrovirals – Additional therapies Urinary tract infections

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer loPinAViR WitH RitonAViR - Special Authority - Hospital Pharmacy [HP1] Cap 133.3 mg with ritonavir 33.3 mg...................................................... 735.00 oral liq 80 mg with ritonavir 20 mg per ml .............................................. 735.00 nelfinAViR - Special Authority - Hospital pharmacy [HP1] tab 250 mg ............................................................................................ 600.00 Powder 50 mg per g ................................................................................. 55.44 RitonAViR - Special Authority - Hospital pharmacy [HP1] Cap 100 mg............................................................................................ 242.55 oral liq 80 mg per ml .............................................................................. 277.28 SAQuinAViR - Special Authority - Hospital pharmacy [HP1] Cap 200 mg............................................................................................ 271.00 519.75 180 300 ml 270 144 g oP 168 240 ml oP 180 270 ✓ kaletra ✓ kaletra ✓ viracept ✓ viracept ✓ norvir ✓ norvir ✓ Fortovase ✓ Invirase

AntiRetRoViRAlS – AdditionAl theRAPieS hiV fusion inhibitors

enfuViRtide - Special Authority - Hospital pharmacy [HP1] Powder for inj 90 mg per ml x 60.........................................................2,380.00 1 ✓ Fuzeon Special Authority for Subsidy - form: SA0845 initial Application only from a named specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1. Confirmed HiV infection; and 2. enfuvirtide to be given in combination with optimized background therapy (including at least 1 other antiretroviral drug that the patient has never previously been exposed to) for treatment failure; and 3. either: 3.1 Patient has evidence of HiV replication, despite ongoing therapy; or 3.2 Patient has treatment-limiting toxicity to previous antiretroviral agents; and 4. Previous treatment with 3 different antiretroviral regimens has failed; and 5. All of t.he following: 5.1 Previous treatment with a non-nucleoside reverse transcriptase inhibitor has failed; and 5.2 Previous treatment with a nucleoside reverse transcriptase inhibitor has failed; and 5.3 Previous treatment with a protease inhibitor has failed. Renewal only from a named specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 6. evidence of at least a 10 fold reduction in viral load at 12 weeks; and 7. the treatment remains appropriate and the patient is benefiting from treatment.

URinARy tRAct infectionS

HexAMine HiPPuRAte ❋ tab 1 g ..................................................................................................... 18.40 (36.99) nitRofuRAntoin ❋ tab 50 mg ................................................................................................ 16.50 ❋ tab 100 mg .............................................................................................. 28.55 noRfloxACin tab 400 mg .............................................................................................. 32.14 a) Maximum of 6 tab per prescription b) Can be waived by endorsement – Retail Pharmacy – Specialist 100 Hiprex 100 100 100 ✓ nifuran ✓ nifuran ✓ Arrow-norfloxacin

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

infectionS - AgentS foR SyStemic USe

Vaccines

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

VAccineS influenza Vaccine

influenZA VACCine (a) Subsidy is available between 1 March and 30 june of each year for patients who meet the following criteria, as set by the Ministry of Health: a) all people 65 years of age and over; b) people under 65 years of age with: i) the following cardiovascular disease: 1) ischaemic heart disease, 2) congestive heart disease, 3) rheumatic heart disease, 4) congenital heart disease, or 5) cerebo-vascular disease; ii) the following chronic respiratory disease: 1) asthma, if on a regular preventative therapy, or 2) other chronic respiratory disease with impaired lung function; iii) diabetes; iv) chronic renal disease; v) any cancer, excluding basal and squamous skin cancers if not invasive; vi) the following other conditions: 1) autoimmune disease, 2) immune suppression, 3) HiV, 4) transplant recipients, 5) neuromuscular and CnS diseases, 6) haemoglobinopathies, or 7) children on long term aspirin. the following conditions are excluded from funding: i) asthma not requiring regular preventative therapy, ii) hypertension and/or dyslipidaemia without evidence of end-organ disease, iii) pregnancy in the absence of another risk factor. (b) doctors are the only Contractors entitled to claim payment from the funder for the supply of influenza vaccine to patients eligible under (a) above for subsidised immunisation and they may only do so in respect of the influenza vaccine listed in the Pharmaceutical Schedule. (c) individual dHbs may fund patients over and above the criteria in (a) above. the claiming process for these additional patients should be determined between the dHb and Contractor. (d) 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. inj .......................................................................................................... 75.00 10 ✓ Fluvax ✓ vaxigrip

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

mUScUlo-SKeletAl SyStem

Anticholinesterases Anti-inflammatory non Steroidal drugs (nSAids)

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AnticholineSteRASeS

neoStigMine inj 2.5 mg per ml, 1 ml ............................................................................. 22.50 PyRidoStigMine bRoMide s tab 60 mg ................................................................................................ 34.32 50 100 ✓ AstraZeneca ✓ Mestinon

Anti-inflAmmAtoRy non SteRoidAl dRUgS (nSAidS)

Special Authority for Manufacturers Price - form: SA0291 initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: both: 1 inflammatory arthritis (including osteoarthritis with an inflammatory component); and 2 Stabilised and are well controlled on the particular nSAid medication. Renewal from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: the treatment remains appropriate and the patient is benefiting from treatment. diClofenAC SodiuM - Special Authority available - Retail pharmacy, refer above ❋ tab eC 25 mg............................................................................................. 3.51 ❋ tab eC 50 mg........................................................................................... 25.88 ❋ tab 50 mg dispersible ................................................................................ 1.50 (3.67) ❋ tab long-acting 75 mg..............................................................................22.78 ❋ tab long-acting 100 mg............................................................................ 34.32 ❋ Suppos 12.5 mg ......................................................................................... 1.85 ❋ Suppos 25 mg ............................................................................................ 2.22 ❋ Suppos 50 mg - Available on a PSo ........................................................... 3.84 ❋ Suppos 100 mg .......................................................................................... 6.36 ❋ inj 25 mg per ml, 3 ml - Available on a PSo .............................................. 12.00 ibuPRofen - Special Authority available - Retail pharmacy, refer above ❋ tab 200 mg ................................................................................................ 1.78 ❋ tab 400 mg ................................................................................................ 1.78 (7.60) ❋ tab 600 mg ................................................................................................ 5.32 (22.80) ❋ tab long-acting 800 mg.............................................................................. 3.01 (18.24) ❋‡oral liq 100 mg per 5 ml ............................................................................. 3.49 KetoPRofen - Special Authority available - Retail pharmacy, refer above ❋ Cap long-acting 100 mg ............................................................................. 6.72 (21.56) ❋ Cap long-acting 200 mg ........................................................................... 13.44 (43.12) MefenAMiC ACid - Special Authority available - Retail pharmacy, refer above ❋ Cap 250 mg................................................................................................ 2.50 (18.33) 100 500 20 500 500 10 10 10 10 5 100 50 100 60 200 ml 100 100 ✓ Apo-diclo ✓ Apo-diclo Voltaren d ✓ Apo-diclo Sr ✓ Apo-diclo Sr ✓ voltaren ✓ voltaren ✓ voltaren ✓ voltaren ✓ voltaren ✓ I-Profen brufen brufen brufen Retard ✓ Fenpaed

oruvail 100 oruvail 200

100 Ponstan

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

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unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Anti-inflammatory non Steroidal drugs (nSAids) Antirheumatoidal Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer nAPRoxen - Special Authority available - Retail pharmacy, refer to page 104 ❋ tab 250 mg .............................................................................................. 21.00 ❋ tab 500 mg .............................................................................................. 17.95 35.90 ❋ tab long-acting 750 mg............................................................................ 18.00 ❋ tab long-acting 1000 mg.......................................................................... 21.00 (Naxen tab 250 mg & 500 mg to be delisted 1 March 2007)

mUScUlo-SKeletAl SyStem

500 250 500 90 90

✓ noflam 250 ✓ naxen ✓ noflam 500 ✓ naxen ✓ naprosyn Sr 750 ✓ naprosyn Sr 1000

nAPRoxen SodiuM - Special Authority available - Retail pharmacy, refer to page 104 ❋ tab 275 mg ................................................................................................ 6.40 100 ❋ tab 550 mg .............................................................................................. 12.80 100 SulindAC - Special Authority available - Retail pharmacy, refer to page 104 ❋ tab 100 mg ................................................................................................ 5.32 (12.00) ❋ tab 200 mg ................................................................................................ 6.72 (20.00) (31.74) tenoxiCAM - Special Authority available - Retail pharmacy, refer to page 104 ❋ tab 20 mg ................................................................................................ 23.75 ❋ Suppos 20 mg ............................................................................................ 5.30 ❋ inj 10 mg per ml, 2 ml - Available on a PSo .............................................. 10.00 100

✓ Synflex ✓ Synflex

daclin 100 daclin Clinoril 100 10 5 ✓ tilcotil ✓ tilcotil ✓ tilcotil

tiAPRofeniC ACid - Special Authority available - Retail pharmacy, refer to page 104 ❋ tab 300 mg ................................................................................................ 4.03 60 (19.26) ❋ Cap long-acting 300 mg ............................................................................. 3.77 56 (17.51)

Surgam Surgam SA

nSAids other

indoMetHACin ❋ Cap 25 mg.................................................................................................. 5.90 ❋ Cap 50 mg.................................................................................................. 6.95 ❋ Cap long-acting 75 mg ............................................................................. 12.50 ❋ Suppos 100 mg ........................................................................................ 12.00 PiRoxiCAM ❋ tab dispersible 10 mg ................................................................................ 3.25 ❋ tab dispersible 20 mg ................................................................................ 5.50 100 100 100 30 50 100 ✓ rheumacin ✓ rheumacin ✓ rheumacin Sr ✓ Arthrexin ✓ Piram-d ✓ Piram-d

AntiRheUmAtoidAl AgentS

AuRAnofin - Retail pharmacy-specialist tab 3 mg .................................................................................................. 68.99 (70.97) 60 Ridaura

leflunoMide - Special Authority - Retail pharmacy tab 10 mg .............................................................................................. 176.70 30 ✓ Arava tab 20 mg .............................................................................................. 242.10 30 ✓ Arava tab 100 mg ............................................................................................ 121.35 3 ✓ Arava Special Authority for Subsidy - form: SA0635 initial application only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Rheumatoid arthritis; and continued… ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

mUScUlo-SKeletAl SyStem

Antirheumatoidal Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 2 Patient is not a pregnant woman, or a woman of child-bearing age without adequate contraception; and 3 Patient has been unable to tolerate or has a contraindication to or has had an inadequate response to sulphasalazine and methotrexate (individually or in combination). Renewal only from a rheumatologist. Approvals valid without further renewal unless notified for applications meeting the following criteria: both: 4 Compliance (prescriber determined) with medication; and 5 improved rheumatoid arthritis symptom control. note Patient should have full blood count and liver function tests regularly monitored. PeniCillAMine - Retail pharmacy-specialist tab 125 mg .............................................................................................. 56.30 (61.93) tab 250 mg .............................................................................................. 89.98 (98.98) SodiuM AuRotHioMAlAte - Retail pharmacy-specialist inj 10 mg per 0.5 ml ................................................................................. 76.87 inj 20 mg per 0.5 ml ............................................................................... 113.17 inj 50 mg per 0.5 ml ............................................................................... 217.23 100 d-Penamine 100 d-Penamine 10 10 10 ✓ Myocrisin ✓ Myocrisin ✓ Myocrisin

tumour necrosis factor (tnf) inhibitors

AdAliMuMAb- Special Authority – Retail pharmacy inj 40 mg per 0.8 ml prefilled syringe ...................................................1,799.92 Special Authority for Subsidy – form: SA0812 initial application only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following 1 Patient is an adult who has had severe and active erosive Rheumatoid Arthritis for six months duration or longer; and 2 treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with at least two of the following (triple therapy): sulphasalazine, prednisone at a dose of at least 7.5 mg per day, azathioprine, intramuscular gold, or hydroxychloroquine sulphate (at maximum tolerated doses); and 5 Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of either: 5.1 Cyclosporin alone or in combination with another agent; or 5.2 leflunomide alone or in combination with another agent; and 6 either 6.1 Patient has persistent symptoms of poorly-controlled and active disease in at least 20 active, swollen, tender joints; or 6.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 7 either: 7.1 Patient has a C-reactive protein level greater than 15 mg/l measured no more than one month prior to the date of this application; or 7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months; 8 the patient consents to details of their treatment being held on a central registry and has signed a consent form outlining the conditions of ongoing treatment. continued… 2 ✓ Humira

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

mUScUlo-SKeletAl SyStem

Antirheumatoidal Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… Renewal only from a rheumatologist or general physician on the recommendation from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: 9 treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 10 either: 10.1 following 4 months initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 10.2 on subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of thephysician. note: A patient declaration form http://www.pharmac.govt.nz/special_authority_forms/SA0812-declaration.pdf must be signed by the legal guardian of the patient and the prescriber in the presence of a witness (over 18 years of age). Applicants are requested to register the treatment with the new Zealand Rheumatology Association by completing the forms and questionnaire http://www.pharmac.govt.nz/special_authority_forms/SA0812-survey.pdf etAneRCePt – Special Authority - Retail pharmacy - Specialist prescription inj 25 mg ................................................................................................ 899.96 4 ✓ Enbrel Special Authority for Subsidy - form: SA0667 initial application only from a named specialist. Approvals valid for 4 months for applications meeting the following criteria: All of the following: 1 to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Patient is less than 18 years of age at commencement of treatment; and 3 Patient has had severe active polyarticular course juvenile idiopathic Arthritis (jiA) for 6 months duration or longer; and 4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of 10-20mg/m2 weekly in combination with oral corticosteroids (prednisone 0.25 mg/kg); and 5 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-15mg/m2 weekly) in combination with one other disease-modifying agent; and 6 both: 6.1 either: 6.1.1 Patient has persistent symptoms of poorly-controlled and active disease in at least 20 active, swolllen, tender joints; or 6.1.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip; and 6.2 Physician’s global assessment indicating severe disease; and 7 the patient or their legal guardian consents to details of their treatment being held on a central registry and has signed a consent form outlining conditions of ongoing treatment. Renewal only from a named specialist. Approvals valid for 6 months for applications meeting the following criteria: both: 8 Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 9 either: 9.1 following 4 months initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician’s global assessment from baseline; or 9.2 on subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count and continued improvement in physician’s global assessment from baseline. note: A patient declaration form http://www.pharmac.govt.nz/special_authority_forms/SA0667-declaration.pdf must be signed by the legal guardian of the patient and the prescriber in the presence of a witness (over 18 years of age).

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

mUScUlo-SKeletAl SyStem

enzymes hyperuricaemia and Antigout muscle Relaxants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

enZymeS

HyAluRonidASe inj 1,500 iu per ml .................................................................................... 18.32 (194.40) 10 Hyalase

hyPeRURicAemiA And AntigoUt

AlloPuRinol ❋tab 100 mg ............................................................................................... 11.45 ❋tab 300 mg ............................................................................................... 21.20 ColCHiCine ❋ tab 500 µg................................................................................................. 9.60 PRobeneCid ❋ tab 500 mg ............................................................................................. 55.00 500 500 100 100 ✓ Progout ✓ Progout ✓ colgout ✓ AFt

mUScle RelAXAntS

bAClofen - Retail pharmacy-specialist ❋ tab 10 mg .................................................................................................. 3.75 dAntRolene SodiuM - Retail pharmacy-specialist ❋ Cap 25 mg................................................................................................ 32.96 ❋ Cap 50 mg................................................................................................ 51.70 oRPHenAdRine CitRAte tab 100 mg .............................................................................................. 18.54 inj 30 mg per ml, 2ml ................................................................................. 9.60 (20.50) 100 100 100 100 3 ✓ Pacifen ✓ dantrium ✓ dantrium ✓ norflex norflex ✓ Q 200 ✓ Q 300

Quinine SulPHAte ❋ tab 200 mg .............................................................................................. 15.95 250 ❋ tab 300 mg .............................................................................................. 34.75 500 ‡ Safety caps for extemporaneously compounded oral liquid preparations of quinine sulphate.

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

neRVoUS SyStem

Anaesthetics Analgesics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AnAeStheticS local

buPiVACAine HydRoCHloRide - Hospital pharmacy [HP3] inj 0.5%, 4 ml ........................................................................................... 29.95 inj 0.5%, 8% glucose, 4 ml ....................................................................... 25.00 5 5 ✓ Marcain Isobaric ✓ Marcain Heavy

lignoCAine HydRoCHloRide - Available on a PSo inj 0.5%, 5 ml .......................................................................................... 45.00 50 ✓ xylocaine 0.5% only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSo for emergency use. inj 1%, 5 ml ............................................................................................. 42.00 50 ✓ xylocaine 1.0% only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSo for emergency use. inj 1% 20 ml ............................................................................................ 23.50 5 ✓ xylocaine 1.0% only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSo for emergency use. lignoCAine WitH PRiloCAine HydRoCHloRide - Special Authority - Hospital pharmacy [HP3] Crm 2.5% with prilocaine hydrochloride 2.5% .......................................... 44.50 30 g oP ✓ Emla ✓ Emla Crm 2.5% with prilocaine hydrochloride 2.5%, 5 g ................................... 45.00 5 Special Authority for Subsidy - form: SA0323 initial application only from a relevant specialist. Approvals valid for 2 years where the patient is a child receiving frequent parenteral injections (i.e. intradermal, subcutaneous, intravenous or intramuscular) requiring a 21 gauge or larger bore needle. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

AnAlgeSicS

Refer also to MuSCulo-SKeletAl, Anti-inflammatory, nSAids, page 104.

Antipyretics and non-opioid Analgesics

ASPiRin ❋ tab 300 mg, eC.......................................................................................... 7.25 (8.10) ❋ tab 650 mg, eC.......................................................................................... 6.88 ❋ tab, dispersible 300 mg - Available on a PSo ........................................... 22.50 nefoPAM HydRoCHloRide tab 30 mg ................................................................................................ 23.40 inj 20 mg per ml, 1 ml ................................................................................ 9.10 (72.50) PARACetAMol ❋ tab 500 mg - Available on a PSo ............................................................. 13.23 ❋‡oral liq 120 mg per 5 ml ............................................................................. 6.99 a) Available on a PSo b) not in combination ❋‡oral liq 250 mg per 5 ml ............................................................................. 7.25 a) Available on a PSo b) not in combination ❋ Suppos 125 mg .......................................................................................... 6.51 ❋ Suppos 250 mg ........................................................................................ 12.52 ❋ Suppos 500 mg ........................................................................................ 19.50 100 100 1000 90 5 Aspec 300 ✓ Ecotrin ✓ Ethics Aspirin ✓ Acupan Acupan 1,440 1,000 ml 1,000 ml 20 20 50 ✓ Panadol ✓ Junior Parapaed ✓ Six Plus Parapaed ✓ Panadol ✓ Panadol ✓ Paracare

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

109

neRVoUS SyStem

Analgesics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Antipyretics with codeine

PARACetAMol WitH Codeine ❋ tab paracetamol 500 mg with codeine phosphate 8 mg ............................ 3.24 100 ✓ codalgin

opioid Analgesics

buPRenoRPHine HydRoCHloRide - only on a controlled drug form inj 0.3 mg per ml, 1 ml ............................................................................... 7.42 (9.38) Codeine PHoSPHAte tab 15 mg .................................................................................................. 7.00 tab 30 mg ................................................................................................ 10.00 tab 60 mg ................................................................................................ 20.00 dextRoPRoPoxyPHene WitH PARACetAMol tab napsylate 50 mg with paracetamol 325 mg........................................ 14.50 (22.50) Cap hydrochloride 32.5 mg with paracetamol 325 mg .............................. 19.91 (24.50) diHydRoCodeine tARtRAte tab long-acting 60 mg.............................................................................. 30.30 5 temgesic 100 100 100 500 Paradex 500 Capadex 60 ✓ dHc continus ✓ PSM ✓ PSM ✓ PSM

fentAnyl - only on a controlled drug form - Special Authority - Retail pharmacy – no patient co-payment payable transdermal patch 2.5 mg, 25 µg per hour............................................... 55.23 5 ✓ durogesic transdermal patch 5 mg, 50 µg per hour................................................ 100.52 5 ✓ durogesic transdermal patch 7.5 mg, 75 µg per hour............................................. 139.18 5 ✓ durogesic transdermal patch 10 mg, 100 µg per hour............................................ 171.22 5 ✓ durogesic Special Authority for Subsidy - form: SA0743 initial application only from a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: both: 1 Patient is terminally ill and is opioid-responsive; and 2 either: 2.1 is unable to take oral medication; or 2.2 is intolerant to morphine, or morphine is contraindicated. Renewal only from a relevant specialist or general practitioner. Approvals valid for 3 months where the treatment remains appropriate and the patient is benefiting from treatment. MetHAdone HydRoCHloRide – no patient co-payment payable a) only on a controlled drug form. tab 5 mg .................................................................................................... 2.78 ‡ oral liq 2 mg per ml .................................................................................... 6.55 ‡ oral liq 5 mg per ml .................................................................................... 6.52 ‡ oral liq 10 mg per ml .................................................................................. 9.50 inj 10 mg per ml, 1 ml .............................................................................. 26.00 for methadone hydrochloride oral liquid refer page 164

10 200 ml 200 ml 200 ml 5

✓ Pallidone ✓ Biodone ✓ Biodone Forte ✓ Biodone Extra Forte ✓ Mayne

MoRPHine HydRoCHloRide - only on a controlled drug form – no patient co-payment payable ‡ oral liq 1 mg per ml .................................................................................... 8.06 200 ml ✓ rA-Morph ‡ oral liq 2 mg per ml .................................................................................... 8.56 200 ml ✓ rA-Morph ‡ oral liq 5 mg per ml .................................................................................... 9.61 200 ml ✓ rA-Morph ‡ oral liq 10 mg per ml ................................................................................ 12.56 200 ml ✓ rA-Morph

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

neRVoUS SyStem

Analgesics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer MoRPHine SulPHAte - only on a controlled drug form – no patient co-payment payable tab immediate release 10 mg ..................................................................... 2.64 10 Cap long-acting 10 mg ............................................................................... 1.80 10 tab long-acting 10 mg................................................................................ 1.80 10 tab immediate release 20 mg ..................................................................... 5.10 10 tab long-acting 30 mg................................................................................ 3.60 10 Cap long-acting 30 mg ............................................................................... 2.64 10 tab long-acting 60 mg................................................................................ 7.20 10 Cap long-acting 60 mg ............................................................................... 7.20 10 tab long-acting 100 mg.............................................................................. 8.50 10 Cap long-acting 100 mg ............................................................................. 7.85 10 Cap long-acting 200 mg ........................................................................... 17.00 10 Suppos 5 mg ........................................................................................... 17.74 12 Suppos 10 mg .......................................................................................... 19.14 12 Suppos 20 mg .......................................................................................... 20.31 12 Suppos 30 mg .......................................................................................... 31.39 inj 5 mg per ml, 1 ml - Available on a PSo .................................................. 5.17 inj 10 mg per ml, 1 ml - Available on a PSo ................................................ 4.75 inj 15 mg per ml, 1 ml - Available on a PSo ................................................ 4.70 inj 30 mg per ml, 1 ml - Available on a PSo ................................................ 5.16 12 5 5 5 5 ✓ Sevredol ✓ m-Eslon ✓ LA-Morph ✓ Sevredol ✓ LA-Morph ✓ m-Eslon ✓ LA-Morph ✓ m-Eslon ✓ LA-Morph ✓ m-Eslon ✓ m-Eslon ✓ rMS ✓ rMS ✓ Martindale S29 ✓ rMS ✓ Martindale S29 ✓ rMS ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne

MoRPHine tARtRAte - only on a controlled drug form – no patient co-payment payable inj 80 mg per ml, 1.5 ml ........................................................................... 20.20 5 inj 80 mg per ml, 5 ml .............................................................................. 67.37 5

oxyCodone HydRoCHloRide - only on a controlled drug form – See prescribing guideline below – no patient co-payment payable Cap 5 mg.................................................................................................... 2.83 20 ✓ oxynorm Cap 10 mg.................................................................................................. 5.58 20 ✓ oxynorm Cap 20 mg.................................................................................................. 9.77 20 ✓ oxynorm tab controlled-release 5 mg ....................................................................... 7.51 20 ✓ oxycontin tab controlled-release 10 mg ................................................................... 11.14 20 ✓ oxycontin tab controlled-release 20 mg ................................................................... 18.93 20 ✓ oxycontin tab controlled-release 40 mg ................................................................... 33.29 20 ✓ oxycontin tab controlled-release 80 mg ................................................................... 58.03 20 ✓ oxycontin Prescribing guideline Prescribers should note that oxycodone is significantly more expensive than long-acting morphine sulphate and clinical advice suggests that it is reasonable to consider this as a second-line agent to be used after morphine. PetHidine HydRoCHloRide - only on a controlled drug form – no patient co-payment payable tab 50 mg .................................................................................................. 3.50 10 ✓ PSM tab 100 mg ................................................................................................ 4.35 10 ✓ PSM inj 50 mg per ml, 1 ml - Available on a PSo ................................................ 3.75 5 ✓ Mayne inj 50 mg per ml, 1.5 ml - Available on a PSo ............................................. 4.35 5 ✓ Mayne inj 50 mg per ml, 2 ml - Available on a PSo ................................................ 4.18 5 ✓ Mayne

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

111

neRVoUS SyStem

Antidepressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntidePReSSAntS cyclic and Related Agents

AMitRiPtyline tab 10 mg .................................................................................................. 3.00 tab 25 mg .................................................................................................. 3.40 tab 50 mg .................................................................................................. 5.20 CloMiPRAMine HydRoCHloRide - Retail pharmacy-specialist tab 10 mg ................................................................................................ 10.00 tab 25 mg ................................................................................................ 26.00 deSiPRAMine HydRoCHloRide - Hospital pharmacy [HP3] tab 25 mg ................................................................................................ 32.32 (36.62) (Pertofran to be delisted 1 June 2007) dotHiePin HydRoCHloRide Cap 25 mg.................................................................................................. 4.50 tab 75 mg .................................................................................................. 8.75 doxePin HydRoCHloRide Cap 10 mg.................................................................................................. 4.99 Cap 25 mg.................................................................................................. 4.19 (5.20) Cap 50 mg.................................................................................................. 6.99 Cap 75 mg................................................................................................ 10.99 iMiPRAMine HydRoCHloRide tab 10 mg .................................................................................................. 5.48 tab 25 mg .................................................................................................. 8.80 MAPRotiline HydRoCHloRide - Retail pharmacy-specialist tab 25 mg ................................................................................................ 25.06 tab 75 mg ................................................................................................ 21.01 100 100 100 100 500 50 Pertofran ✓ Amitrip ✓ Amitrip ✓ Amitrip ✓ clopress ✓ clopress

100 100 100 100 100 100 50 50 100 30

✓ dopress ✓ dopress ✓ Anten Anten ✓ Anten ✓ Anten ✓ tofranil ✓ tofranil ✓ Ludiomil ✓ Ludiomil

MiAnSeRin HydRoCHloRide - Special Authority - Hospital pharmacy [HP3]- specialist prescription Specialist must be a psychiatrist. tab 30 mg ................................................................................................ 29.25 30 ✓ tolvon Special Authority for Subsidy - form: SA0057 initial application only from a psychiatrist. Approvals valid for 2 years for applications meeting the following criteria: both: 1 depression; and 2 Any of the following: 2.1 both: 2.1.1 failed trials with other antidepressants; and 2.1.2 Patient has been maintained on mianserin prior to december 1993; or 2.2 Co-existent bladder neck obstruction; or 2.3 Cardiovascular disease. Renewal only from a psychiatrist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. noRtRiPtyline HydRoCHloRide tab 10 mg .................................................................................................. 5.10 tab 25 mg ................................................................................................ 34.90 100 500 ✓ norpress ✓ norpress

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

neRVoUS SyStem

Antidepressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer tRiMiPRAMine MAleAte Cap 25 mg.................................................................................................. 5.50 Cap 50 mg................................................................................................ 10.20 100 100 ✓ tripress ✓ tripress

monoamine-oxidase inhibitors (mAois) - non Selective

PHenelZine SulPHAte tab 15 mg ................................................................................................ 95.00 tRAnylCyPRoMine SulPHAte tab 10 mg ................................................................................................ 22.94 100 50 ✓ nardil ✓ Parnate

monoamine-oxidase type A inhibitors

MoClobeMide - Retail pharmacy-specialist tab 150 mg .............................................................................................. 49.45 500 ✓ Apo-Moclobemide tab 300 mg .............................................................................................. 26.11 100 ✓ Apo-Moclobemide note there is a significant cost differential between moclobemide and fluoxetine (moclobemide being about three times more expensive). for depressive syndromes it is therefore more cost-effective to start treatment with fluoxetine first before considering prescribing moclobemide.

Selective Serotonin Reuptake inhibitors

CitAloPRAM HydRobRoMide ❋ tab 20 mg .................................................................................................. 3.50 28 ✓ Arrow-citalopram

fluoxetine HydRoCHloRide ❋ Cap 20 mg.................................................................................................. 4.75 90 ✓ Fluox ❋ tab disp 20 mg, scored - Subsidy by endorsement .................................... 5.90 30 ✓ Fluox • When prescribed for a patient who cannot swallow whole tablets or capsules and the prescription is endorsed accordingly; or • 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. PARoxetine HydRoCHloRide tab 20 mg - Higher subsidy of $35.02 per 30 wtih endorsement ................ 1.90 30 (35.02) Aropax Additional subsidy by endorsement is available for patients who: • were taking paroxetine hydrochloride on february 2001; or • have previously responded to treatment with paroxetine hydrochloride; or • have had a trial of fluoxetine and have had to discontinue due to - inability to tolerate the drug due to side effects; or - failed to respond to an adequate dose and duration of treatment; or • have contraindications to fluoxetine (eg pre-existing significant levels of nausea, breastfeeding, potential drug interactions). the prescription must be endorsed accordingly.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

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Antidepressants Antiepilepsy drugs

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

other Antidepressants

VenlAfAxine - Special Authority - Retail pharmacy Cap 75 mg................................................................................................ 37.27 Cap 150 mg.............................................................................................. 45.68 28 28 ✓ Efexor xr ✓ Efexor xr

Special Authority for Subsidy - form: SA0789 initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 2 years for applications meeting the following criteria: both: 1 the patient has “treatment resistant” depression; and 2 either: 2.1 the patient must have had a trial of two different antidepressants and failed to respond to an adequate dose over an adequate period of time (usually at least four weeks); or 2.2 both: 2.2.1 the patient is currently a hospital in-patient as a result of an acute depressive episode; and 2.2.2 the patient must have had a trial of one other antidepressant and failed to respond to an adequate dose over an adequate period of time. Renewal from any medical practitioner. Approvals valid for 2 years where the patient has a high risk of relapse (prescriber determined).

AntiePilePSy dRUgS Agents for control of Status epilepticus

ClonAZePAM inj 1 mg per ml, 1 ml .................................................................................. 9.36 diAZePAM Rectal tubes 5 mg - Available on a PSo .................................................... 26.50 Rectal tubes 10 mg - Available on a PSo .................................................. 32.38 inj 5 mg per ml, 2 ml ................................................................................. 9.24 8.32 (16.95) a) Subsidy by endorsement b) only on a PSo PSo must be endorsed “not for anaesthetic procedures”. PARAldeHyde ❋ inj 5 ml ..................................................................................................... 58.00 (62.37) PHenytoin SodiuM - Available on a PSo ❋ inj 50 mg per ml, 2 ml .............................................................................. 69.24 ❋ inj 50 mg per ml, 5 ml .............................................................................. 77.27 5 5 5 5 ✓ rivotril ✓ Stesolid ✓ Stesolid ✓ Mayne diazemuls

5 Mayne 5 5 ✓ Mayne ✓ Mayne

control of epilepsy

CARbAMAZePine ❋ tab 200 mg .............................................................................................. 14.53 ❋ tab long-acting 200 mg............................................................................ 16.98 ❋ tab 400 mg .............................................................................................. 34.58 ❋ tab long-acting 400 mg............................................................................ 39.17 ❋‡oral liq 100 mg per 5 ml ........................................................................... 26.37 ✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

100 100 100 100 250 ml

✓ tegretol ✓ teril ✓ tegretol cr ✓ tegretol ✓ tegretol cr ✓ tegretol

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

neRVoUS SyStem

Antiepilepsy drugs

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer ClobAZAM - Retail pharmacy-specialist tab 10 mg .................................................................................................. 9.12 ‡ Safety caps for extemporaneously compounded oral liquid preparations. ClonAZePAM tab 500 µg................................................................................................. 5.49 tab 2 mg .................................................................................................... 9.95 ‡ oral drops 2.5 mg per ml ............................................................................ 7.38 etHoSuxiMide ❋ Cap 250 mg.............................................................................................. 32.90 ❋‡oral liq 250 mg per 5 ml ........................................................................... 11.96 PHenobARbitone ❋ tab 15 mg ................................................................................................ 23.68 ❋ tab 30 mg ................................................................................................ 24.59 for phenobarbitone oral liquid refer page 164 PHenytoin SodiuM ❋ Cap 30 mg................................................................................................ 15.50 ❋ tab 50 mg ................................................................................................ 15.63 ❋ Cap 100 mg.............................................................................................. 14.69 ❋‡oral liq 30 mg per 5 ml ............................................................................. 11.19 PRiMidone ❋ tab 250 mg .............................................................................................. 17.25 SodiuM VAlPRoAte ❋ tab 100 mg .............................................................................................. 13.65 ❋ tab 200 mg eC......................................................................................... 27.44 ❋ tab 500 mg eC......................................................................................... 52.24 ❋‡oral liq 200 mg per 5 ml ........................................................................... 20.48 ❋ inj 100 mg per ml, 4 ml ............................................................................ 41.50 50 ✓ Frisium

100 100 10 ml oP 200 200 ml 500 500

✓ Paxam ✓ Paxam ✓ rivotril ✓ Zarontin ✓ Zarontin ✓ PSM ✓ PSM

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

✓ dilantin ✓ dilantin Infatab ✓ dilantin ✓ dilantin ✓ Apo-Primidone ✓ Epilim crushable ✓ Epilim ✓ Epilim ✓ Epilim S/F Liquid ✓ Epilim Syrup ✓ Epilim Iv

new Antiepilepsy drugs

Special Authority for Subsidy - form: SA0780 initial application - (Single nAed therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 15 months for applications meeting the following criteria: Any of the following: 1 Was on nAed therapy before 1 September 2000; or 2 Seizures are not adequately controlled with optimal older anti-epilepsy drug treatment; or 3 Seizures are controlled adequately but who experience unacceptable side effects from older anti-epilepsy drug treatment. note “optimal older anti-epilepsy drug therapy” is defined as treatment with those older anti-epilepsy drugs which are indicated and clinically appropriate for the patient, given singly and in combination in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. initial application - (dual nAed therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 18 months for applications meeting the following criteria: either: 4 Stabilised on two nAeds on or before 31 july 2000; or 5 both: 5.1 A second nAed has been added; and 5.2 An attempt to withdraw one nAed has been made and was unsuccessful. continued… ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

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Antiepilepsy drugs

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… initial application - (neuropathic pain - gabapentin only) only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 2 months where the patient has tried and failed, or has been unable to tolerate, treatment with a tricyclic antidepressant And an anticonvulsant agent. note gabapentin is not interchangeable with other nAeds when used for treating neuropathic pain. Vocationally registered general practitioners are a relevant specialist when recommending gabapentin for neuropathic pain. Renewal - (Single or dual nAed therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 18 months for applications meeting the following criteria: either: 6 both: 6.1 Patient has been prescribed adequate doses of gabapentin, lamotrigine, topiramate or vigabatrin; and 6.2 Patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life ; or 7 Patient has had a previous approval but has not yet trialed monotherapy with all available nAeds. note As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anti-convulsant therapy and have assessed quality of life from the patient’s perspective. Renewal - (triple nAed therapy) only from a paediatrician, neurologist or general physician. Approvals valid for 6 months for applications meeting the following criteria: both: 8 Patient is on dual therapy; and 9 Patient switching from vigabatrin to another nAed. Renewal - (neuropathic pain - gabapentin only) only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 2 years where the patient has demonstrated a marked improvement in their control of pain (prescriber determined). note gabapentin is not interchangeable with other nAeds when used for treating neuropathic pain. Vocationally registered general practitioners are a relevant specialist when recommending gabapentin for neuropathic pain. note: Special Authority applications and reapplications for nAeds (for use in epilepsy) must be made by a neurologist or paediatric neurologist. Applications from a general physician or paediatrician will be accepted if access to neurology or paediatric neurology services is limited in the locality in which they practice. gAbAPentin - Special Authority - Retail pharmacy s Cap 100 mg.............................................................................................. 29.46 13.26 s Cap 300 mg.............................................................................................. 88.36 39.76 s Cap 400 mg............................................................................................ 117.81 53.01 s tab 600 mg ............................................................................................ 150.00 lAMotRigine - Special Authority - Retail pharmacy s tab 5 mg dispersible .................................................................................. 9.64 s tab 25 mg dispersible .............................................................................. 51.07 s tab 50 mg dispersible .............................................................................. 86.82 s tab 100 mg dispersible .......................................................................... 149.81 100 100 100 100 30 56 56 56 ✓ neurontin ✓ nupentin ✓ neurontin ✓ nupentin ✓ neurontin ✓ nupentin ✓ neurontin ✓ Lamictal ✓ Lamictal ✓ Lamictal ✓ Lamictal

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Antiepilepsy drugs Antimigraine Preparations Antinausea and Vertigo Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer toPiRAMAte - Special Authority - Retail pharmacy s Sprinkle cap 15 mg................................................................................... 41.20 s Sprinkle cap 25 mg................................................................................... 51.50 s tab 25 mg ................................................................................................ 51.50 s tab 50 mg ................................................................................................ 87.54 s tab 100 mg ............................................................................................ 148.83 s tab 200 mg ............................................................................................ 256.82 VigAbAtRin - Special Authority - Retail Pharmacy s tab 500 mg ............................................................................................ 119.30 60 60 60 60 60 60 100 ✓ topamax ✓ topamax ✓ topamax ✓ topamax ✓ topamax ✓ topamax ✓ Sabril

neRVoUS SyStem

AntimigRAine PRePARAtionS Acute migraine treatment

Refer also to MuSCulo-SKeletAl, Anti-inflammatory nSAidS, page 104 eRgotAMine tARtRAte WitH CAffeine tab 1 mg with caffeine 100 mg ................................................................ 31.00 MetoCloPRAMide HydRoCHloRide WitH PARACetAMol tab 5 mg with paracetamol 500 mg ........................................................... 3.25 SuMAtRiPtAn tab 50 mg ................................................................................................ 34.00 tab 100 mg .............................................................................................. 32.00 inj 12 mg per ml, 0.5 ml .......................................................................... 80.00 a) Hospital pharmacy [HP3] - Specialist b) Maximum of 10 inj per prescription. 100 60 4 2 2 inj oP ✓ cafergot ✓ Paramax ✓ Imigran ✓ Imigran ✓ Imigran

Prophylaxis of migraine

Refer also to Cardiovascular System, beta Adrenoceptor blockers, page 59 Clonidine HydRoCHloRide ❋ tab 25 µg................................................................................................. 17.53 PiZotifen ❋ tab 500 µg............................................................................................... 21.10 (24.10) 100 100 Sandomigran ✓ dixarit

AntinAUSeA And VeRtigo AgentS

Refer also to AliMentARy tRACt, Antispasmodics, page 28 betAHiStine diHydRoCHloRide - Retail pharmacy-specialist ❋ tab 16 mg .................................................................................................. 7.56 9.00 (Vergo 16 100 tab pack to be delisted 1 June 2007) 84 100 ✓ vergo 16 ✓ vergo 16

CyCliZine HydRoCHloRide - Special Authority available - Retail pharmacy tab 50 mg .................................................................................................. 1.99 10 ✓ nausicalm 1.26 10 Marzine (4.05) Special Authority for Manufacturers Price - form: SA0178 initial application from any medical practitioner. Approvals valid for 6 months where the patient is terminally ill and requires control of nausea and vomiting. Renewal from any medical practitioner. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefiting from treatment. ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

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Antinausea and Vertigo Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer CyCliZine lACtAte inj 50 mg per ml, 1 ml .............................................................................. 14.95 diMenHydRinAte ❋ tab 50 mg .................................................................................................. 0.59 (3.07) doMPeRidone - Special Authority available - Retail pharmacy ❋ tab 10 mg .................................................................................................. 3.90 (7.99) 5 10 dramamine 100 Motilium ✓ valoid (AFt)

Special Authority for Manufacturers Price - form: SA0435 initial application from any medical practitioner. Approvals valid for 6 months where the patient is terminally ill and requires control of nausea and vomiting. Renewal from any medical practitioner. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefiting from treatment. HyoSCine HydRobRoMide ❋ inj 400 µg per ml, 1 ml ............................................................................... 6.66 5 ✓ Mayne

HyoSCine (SCoPolAMine) - Special Authority - Hospital pharmacy [HP3] Patches, 1.5 mg ......................................................................................... 9.56 2 (12.40) Scopoderm ttS Special Authority for Subsidy - form: SA0727 initial application from any medical practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Control of intractable nausea, vomiting, or inability to swallow saliva in the treatment of malignancy or chronic disease; and 2 Patient cannot tolerate or does not adequately respond to oral anti-nausea agents; and 3 the applicant must specify the underlying malignancy or chronic disease (details to be attached to application). Renewal from any medical practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment. MetoCloPRAMide HydRoCHloRide ❋ tab 10 mg .................................................................................................. 5.15 ❋‡oral liq 5 mg per 5 ml ................................................................................. 2.74 (5.20) ❋ inj 5 mg per ml, 2 ml - Available on a PSo ..................................................5.00 (Maxolon oral liq 5 mg per 5 ml to be delisted 1 June 2007) ondAnSetRon a) Hospital pharmacy [HP3]-specialist b) Maximum of 6 tab per dispensing c) Maximum of 12 tab per prescription. not more than one prescription per month. tab 4 mg .................................................................................................. 32.25 tab disp 4 mg .......................................................................................... 86.00 tab 8 mg .................................................................................................. 92.85 tab disp 8 mg ........................................................................................ 123.80 PRoCHloRPeRAZine ❋ tab 3 mg buccal......................................................................................... 5.97 (14.42) ❋ tab 5 mg - Available on a PSo ................................................................. 16.85 ❋ Suppos 5 mg .............................................................................................. 9.52 (18.13) ❋ Suppos 25 mg .......................................................................................... 12.54 (23.87) ❋ inj 12.5 mg per ml, 1 ml - Available on a PSo ........................................... 14.91 (25.81) 100 100 ml 10 ✓ Metamide Maxolon ✓ Pfizer

10 10 20 10 50 500 5 5

✓ Zofran ✓ Zofran Zydis ✓ Zofran ✓ Zofran Zydis

buccastem ✓ Antinaus Stemetil Stemetil

10 Stemetil

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Antinausea and Vertigo Agents AntiParkinson Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer PRoMetHAZine tHeoClAte ❋ tab 25 mg .................................................................................................. 1.20 (6.24) tRoPiSetRon - Hospital pharmacy [HP3]-specialist a) Maximum of 3 cap per dispensing b) Maximum of 6 cap per prescription. not more than one prescription per month. Cap 5 mg.................................................................................................. 77.41 10 Avomine

neRVoUS SyStem

✓ navoban

AntiPARKinSon AgentS dopamine Agonists and Related Agents

AMAntAdine HydRoCHloRide - Retail pharmacy-specialist s Cap 100 mg.............................................................................................. 47.81 APoMoRPHine HydRoCHloRide - Hospital pharmacy [HP3] - specialist s inj 10 mg per ml, 1 ml .............................................................................. 50.43 bRoMoCRiPtine MeSylAte ❋ tab 2.5 mg ............................................................................................... 32.08 ❋ tab 10 mg .............................................................................................. 120.86 entACAPone – Retail pharmacy-specialist s tab 200 mg ............................................................................................ 129.00 leVodoPA WitH benSeRAZide ❋ Cap 50 mg with benserazide 12.5 mg......................................................... 8.00 ❋ tab dispersible 50 mg with benserazide 12.5 mg ..................................... 10.00 ❋ Cap 100 mg with benserazide 25 mg........................................................ 12.50 ❋ Cap long acting 100 mg with benserazide 25 mg - Retail pharmacy-specialist............................. 17.00 ❋ Cap 200 mg with benserazide 50 mg........................................................ 25.00 leVodoPA WitH CARbidoPA ❋ tab 100 mg with carbidopa 25 mg .......................................................... 20.00 ❋ tab 250 mg with carbidopa 25 mg ........................................................... 57.50 ❋ tab long-acting 200 mg with carbidopa 50 mg - Retail pharmacy-specialist ....................................... 70.00 liSuRide HydRogen MAleAte s tab 200 µg............................................................................................... 27.50 PeRgolide - Retail pharmacy-specialist s tab 0.25 mg ............................................................................................. 71.00 s tab 1 mg ................................................................................................ 274.00 RoPiniRole HydRoCHloRide – Retail pharmacy-specialist s tab 0.25 mg ............................................................................................. 31.50 s tab 1 mg .................................................................................................. 67.20 s tab 2 mg ................................................................................................ 101.21 s tab 5 mg ................................................................................................ 150.00 60 5 100 100 100 100 100 100 100 100 100 100 100 30 100 100 210 84 84 84 ✓ Symmetrel ✓ Mayne ✓ Alpha-Bromocriptine ✓ Alpha-Bromocriptine ✓ comtan ✓ Madopar 62.5 ✓ Madopar dispersible ✓ Madopar 125 ✓ Madopar HBS ✓ Madopar 250 ✓ Sindopa ✓ Sinemet ✓ Sinemet ✓ Sinemet cr ✓ dopergin ✓ Permax ✓ Permax ✓ requip ✓ requip ✓ requip ✓ requip

Selegiline HydRoCHloRide - Retail pharmacy-specialist ❋ tab 5 mg .................................................................................................. 16.06 100 ✓ Apo-Selegiline note: due to uncertainty around the long term effects of Selegiline it is not recommended as a first line agent.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

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AntiParkinson Agents Antipsychotics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer tolCAPone - Retail pharmacy-specialist prescription s tab 100 mg ............................................................................................ 128.75 Specialist must be a neurologist, geriatrician or general physician. 100 ✓ tasmar

Anticholinergics

benZtRoPine MeSylAte tab 2 mg .................................................................................................... 7.25 inj 1 mg per ml, 2 ml - only on a PSo ....................................................... 36.35 oRPHenAdRine HydRoCHloRide tab 50 mg ................................................................................................ 31.93 PRoCyClidine HydRoCHloRide tab 5 mg .................................................................................................... 7.40 60 5 250 100 ✓ Benztrop ✓ cogentin ✓ disipal ✓ kemadrin

AntiPSychoticS

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

general

CHloRPRoMAZine HydRoCHloRide - Available on a PSo tab 10 mg ................................................................................................ 12.36 tab 25 mg ................................................................................................ 13.02 tab 100 mg .............................................................................................. 30.61 inj 25 mg per ml, 2 ml .............................................................................. 25.66 CloZAPine - Hospital pharmacy [HP4]-specialist prescription tab 25 mg ................................................................................................ 22.00 tab 100 mg .............................................................................................. 57.00 HAloPeRidol tab 500 µg - Available on a PSo ................................................................ 4.93 tab 1.5 mg - Available on a PSo ................................................................ 7.45 tab 5 mg - Available on a PSo ................................................................. 23.49 oral liq 2 mg per ml - Available on a PSo .................................................. 18.06 inj 5 mg per ml, 1 ml - Available on a PSo ................................................ 17.04 litHiuM CARbonAte tab 250 mg .............................................................................................. 25.45 Cap 250 mg................................................................................................ 6.38 tab 400 mg ................................................................................................ 9.17 tab long-acting 400 mg............................................................................ 14.85 MetHotRiMePRAZine tab 25 mg ................................................................................................ 16.93 tab 100 mg .............................................................................................. 43.96 inj 25 mg per ml, 1 ml .............................................................................. 73.68 ✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

100 100 100 10 50 50

✓ Largactil ✓ Largactil ✓ Largactil ✓ Largactil ✓ clopine ✓ clozaril ✓ clopine ✓ clozaril ✓ Serenace ✓ Serenace ✓ Serenace ✓ Serenace ✓ Serenace ✓ Lithicarb ✓ douglas ✓ Lithicarb ✓ Priadel ✓ nozinan ✓ nozinan ✓ nozinan

100 100 100 100 ml 10 500 100 100 100 100 100 10

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

neRVoUS SyStem

Antipsychotics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer olAnZAPine - Special Authority - Retail pharmacy tab 2.5 mg ............................................................................................... 54.72 tab 5 mg ................................................................................................ 108.44 tab 10 mg .............................................................................................. 219.10 30 30 30 ✓ Zyprexa ✓ Zyprexa ✓ Zyprexa

Special Authority for Subsidy - form: SA0741 initial application only from a psychiatrist. Approvals valid for two years for applications meeting the following criteria: Any of the following: 1 Patients presenting with first episode schizophrenia or related psychoses; 2 both 2.1 Patients suffering from schizophrenia and related psychoses or acute mania in bipolar disorder who are likely to benefit from anti-psychotic treatment and 2.2 either 2.2.1 An effective dose of risperidone had been trialled and has been discontinued because of unacceptable side effects; or 2.2.2.An effective dose of risperidone had been trialled and has been discontinued because of inadequate clinical response after four weeks; or 3 the patient has suffered from an acute episode of schizophrenia or bipolar mania and has been treated with olanzapine short-acting intra-muscular injection. Renewal only from a psychiatrist. Approvals valid for two years where the treatment remains appropriate and the patient is benefiting from treatment. note initial prescriptions to be written by psychiatrists or psychiatric registrars and subsequent prescriptions can be written by general Practitioners. PeRiCyAZine tab 2.5 mg ............................................................................................... 12.49 tab 10 mg ................................................................................................ 44.45 PiMoZide - Retail pharmacy-specialist tab 2 mg .................................................................................................. 14.72 100 100 50 ✓ neulactil ✓ neulactil ✓ orap

QuetiAPine - Subsidy by endorsement tab 25 mg ................................................................................................ 55.00 60 ✓ Seroquel tab 100 mg ............................................................................................ 110.00 60 ✓ Seroquel tab 200 mg ............................................................................................ 189.00 60 ✓ Seroquel tab 300 mg ............................................................................................ 318.00 60 ✓ Seroquel a) Subsidised for: i) Patients presenting with first episode schizophrenia or related psychoses, or manic episodes associated with bipolar disorder; and ii) Patients suffering from schizophrenia or related psychoses, or manic episodes associated with bipolar disorder, after a trial of an effective dose of risperidone that has been discontinued because of unacceptable side effects or inadequate response. b) initial prescription must be written by a relevant specialist. c) Subsequent prescriptions may be written by a general practitioner. d) the prescription must be endorsed “certified condition”. RiSPeRidone - Retail pharmacy-specialist tab 0.5 mg ............................................................................................... 10.25 tab 1 mg .................................................................................................. 61.53 tab 2 mg ................................................................................................ 123.05 tab 3 mg ................................................................................................ 184.63 tab 4 mg ................................................................................................ 246.09 oral liq 1 mg per ml .................................................................................. 45.92 20 60 60 60 60 30 ml ✓ risperdal ✓ risperdal ✓ risperdal ✓ risperdal ✓ risperdal ✓ risperdal

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

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Antipsychotics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer tHioRidAZine HydRoCHloRide tab 10 mg .................................................................................................. 6.88 tab 25 mg .................................................................................................. 7.85 tab 50 mg ................................................................................................ 10.66 tab 100 mg .............................................................................................. 17.14 tRifluoPeRAZine HydRoCHloRide tab 1 mg .................................................................................................... 9.83 (10.22) (10.22) tab 2 mg .................................................................................................. 13.63 (15.61) tab 5 mg .................................................................................................. 15.79 (17.77) (17.77) ‡ oral liq 1 mg per ml .................................................................................. 74.80 90 90 90 90 100 112 100 100 112 1,000 ml Stelazine Stelazine Section 29 S29 ✓ Stelazine Stelazine Stelazine Section 29 S29 Stelazine ✓ Aldazine ✓ Aldazine ✓ Aldazine ✓ Aldazine

depot injections

fluPentHixol deCAnoAte - Retail pharmacy-specialist inj 20 mg per ml, 1 ml - Available on a PSo .............................................. 13.14 inj 20 mg per ml, 2 ml - Available on a PSo .............................................. 20.90 inj 100 mg per ml, 1 ml - Available on a PSo ............................................ 40.87 fluPHenAZine deCAnoAte - Retail pharmacy-specialist inj 12.5 mg per 0.5 ml, 0.5 ml - Available on a PSo .................................. 17.60 inj 25 mg per ml, 1 ml - Available on a PSo .............................................. 27.90 inj 25 mg per ml, 2 ml - Available on a PSo .............................................. 97.50 inj 100 mg per ml, 1 ml - Available on a PSo .......................................... 154.50 (Mayne inj 25 mg per ml, 2 ml to be delisted 1 February 2007) HAloPeRidol deCAnoAte - Retail pharmacy-specialist inj 50 mg per ml, 1 ml - Available on a PSo .............................................. 28.39 inj 100 mg per ml, 1 ml - Available on a PSo ............................................ 55.90 PiPotHiAZine PAlMitAte - Retail pharmacy-specialist inj 50 mg per ml, 1 ml - Available on a PSo ............................................ 178.48 inj 50 mg per ml, 2 ml - Available on a PSo ............................................ 353.32 RiSPeRidone - Special Authority - Retail pharmacy Microspheres for injection 25 mg............................................................ 175.00 Microspheres for injection 37.5 mg ........................................................ 230.00 Microspheres for injection 50 mg............................................................ 280.00 5 5 5 5 5 5 5 ✓ Fluanxol ✓ Fluanxol ✓ Fluanxol ✓ Modecate ✓ Modecate ✓ Mayne ✓ Modecate

5 5 10 10 1 1 1

✓ Haldol ✓ Haldol concentrate ✓ Piportil ✓ Piportil ✓ risperdal consta ✓ risperdal consta ✓ risperdal consta

Subject to a budgetary cap. Applications will be considered and approved subject to funding availability. Special Authority for Subsidy - form: SA0792 initial application only from a psychiatrist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 the patient has schizophrenia or other psychotic disorder; and 2 Has tried but failed to comply with treatment using oral atypical anti-psychotic agents; and 3 Has been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment for 30 days or more in last 12 months. Renewal only from a psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: either: 4 both: 4.1 the patient has had less than 12 months treatment with risperidone microspheres; and 4.2 there is no clinical reason to discontinue treatment; or

continued…

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

neRVoUS SyStem

Antipsychotics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

continued…

5 the initiation of risperidone microspheres has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of risperidone microspheres. note Risperidone microspheres should ideally be used as monotherapy (i.e. without concurrent use of any other anti-psychotic medication). in some cases, it may be clinically appropriate to attempt to treat a patient with typical anti-psychotic agents in depot injectable form before trialing risperidone microspheres. ZuCloPentHixol deCAnoAte - Retail pharmacy - specialist inj 200 mg per ml, 1 ml - Available on a PSo ............................................ 19.80 5 ✓ clopixol

orodispersible Antipsychotics

olAnZAPine - Special Authority - Retail pharmacy Wafer 5 mg............................................................................................. 102.19 Wafer 10 mg........................................................................................... 204.37 28 28 ✓ Zyprexa Zydis ✓ Zyprexa Zydis

Special Authority for Subsidy - form: SA0739 initial application only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 the patient meets the current criteria for standard olanzapine tablets; and 2 the patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; or the patient is non-adherent to oral therapy with standard olanzapine tablets; and 3 the patient is under direct supervision for administration of medicine. Renewal only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: both: 4 the patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; and 5 the patient is under direct supervision for administration of medicine. note initial prescriptions to be written by psychiatrists and subsequent prescriptions can be written by psychiatric registrars or general Practitioners. RiSPeRidone - Special Authority - Retail pharmacy orally-disintegrating tablets 0.5 mg ........................................................... 21.42 orally-disintegrating tablets 1 mg .............................................................. 42.84 orally-disintegrating tablets 2 mg .............................................................. 85.71 28 28 28 ✓ risperdal Quicklet ✓ risperdal Quicklet ✓ risperdal Quicklet

Special Authority for Subsidy - form: SA0794 initial application - (Acute situations) only from a psychiatrist. Approvals valid for 6 weeks for applications meeting the following criteria: both: 1 for a non-adherent patient on oral therapy with standard risperidone tablets or risperidone oral liquid; and 2 the patient is under direct supervision for administration of medicine. initial application - (Chronic situations) only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: both: 3 the patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 4 the patient is under direct supervision for administration of medicine. Renewal only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: both: 5 the patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 6 the patient is under direct supervision for administration of medicine.

continued…

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

123

neRVoUS SyStem

Antipsychotics Anxiolytics

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

continued…

note initial prescriptions to be written by psychiatrists and subsequent prescriptions can be written by psychiatric registrars or general Practitioner. Risperdal Quicklets cost significantly more than Risperdal tablets and should only be used where necessary.

AnXiolyticS

AlPRAZolAM a) Retail pharmacy-specialist b) Month restriction tab 250 µg................................................................................................. 4.77 (8.11) tab 500 µg................................................................................................. 9.54 (16.26) tab 1 mg .................................................................................................. 19.08 (32.51) ‡ Safety caps for extemporaneously compounded oral liquid preparations. buSPiRone HydRoCHloRide a) Month restriction b) Special Authority - Hospital pharmacy [HP3] tab 5 mg .................................................................................................... 7.00 tab 10 mg .................................................................................................. 7.00

100 xanax 100 xanax 100 xanax

100 100

✓ Pacific Buspirone ✓ Pacific Buspirone

Special Authority for Subsidy - form: SA0055 initial application only from a psychiatrist, geriatrician or respiratory specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 1 for use only as an anxiolytic; and 2 other agents are contraindicated or have failed. Renewal only from a psychiatrist, geriatrician or respiratory specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. diAZePAM - Month restriction tab 2 mg .................................................................................................... 8.40 tab 5 mg .................................................................................................... 5.00 tab 10 mg .................................................................................................. 3.45 ‡ Safety caps for extemporaneously compounded oral liquid preparations. loRAZePAM - Month restriction tab 1 mg .................................................................................................... 6.28 tab 2.5 mg ................................................................................................. 4.12 ‡ Safety caps for extemporaneously compounded oral liquid preparations. oxAZePAM - Month restriction tab 10 mg .................................................................................................. 1.98 (4.90) tab 15 mg .................................................................................................. 2.45 (6.90) ‡ Safety caps for extemporaneously compounded oral liquid preparations. 500 250 100 ✓ Pro-Pam ✓ Pro-Pam ✓ Pro-Pam

250 100

✓ Ativan ✓ Ativan

100 ox-Pam 100 ox-Pam

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Sedatives and hypnotics

neRVoUS SyStem

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

SedAtiVeS And hyPnoticS

loRMetAZePAM - Month restriction tab 1 mg .................................................................................................... 3.11 (23.50) ‡ Safety caps for extemporaneously compounded oral liquid preparations. MidAZolAM tab 7.5 mg - Month restriction ................................................................. 10.38 (12.00) inj 1 mg per ml, 5 ml - Special Authority - Hospital pharmacy [HP3] ........... 12.65 inj 5 mg per ml, 3 ml - Special Authority - Hospital pharmacy [HP3]...........14.00 ‡ Safety caps for extemporaneously compounded oral liquid preparations. 30 noctamid

100 10 5 Hypnovel ✓ Hypnovel ✓ Hypnovel

Special Authority for Subsidy - form: SA0050 initial application only from a relevant specialist. Approvals valid for 2 years where the patient is terminally ill. Renewal only from a relevant specialist. Approvals valid for 2 years where the patient is terminally ill. nitRAZePAM - Month restriction tab 5 mg .................................................................................................... 2.00 (3.90) (4.05) ‡ Safety caps for extemporaneously compounded oral liquid preparations. teMAZePAM - Month restriction tab 10 mg .................................................................................................. 0.79 ‡ Safety caps for extemporaneously compounded oral liquid preparations. tRiAZolAM - Month restriction tab 125 µg................................................................................................. 5.10 tab 250 µg................................................................................................. 4.10 ‡ Safety caps for extemporaneously compounded oral liquid preparations. ZoPiClone - Month restriction tab 7.5 mg ............................................................................................... 22.13 100 insoma nitrados

✓ normison

100 100

✓ Hypam ✓ Hypam

500

✓ Apo-Zopiclone

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

125

neRVoUS SyStem

other cnS Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

otheR cnS AgentS

dexAMPHetAMine SulPHAte a) Special Authority - Retail pharmacy b) Controlled drug form tab 5 mg .................................................................................................. 19.00

100

✓ PSM

Special Authority for Subsidy - form: SA0696 initial application (narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. initial application (AdHd in patients 5 or over) only from a paediatrician, psychiatrist or general practitioner on the recommendation of such a specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 AdHd (Attention deficit and Hyperactivity disorder) patients aged 5 years or over; and 2 diagnosed according to dSM-iV or iCd 10 criteria; and 3 either: 3.1 Applicant is a specialist; or 3.2 both: 3.2.1 Applicant is a gP and a specialist has recommended treatment; and 3.2.2 Provide name of specialist (details to be attached to application). initial application (AdHd in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: both: 4 AdHd (Attention deficit and Hyperactivity disorder) patients under 5 years of age; and 5 diagnosed according to dSM-iV or iCd 10 criteria. Renewal (narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal (AdHd in patients 5 or over) only from a paediatrician, psychiatrist or general practitioner. Approvals valid for 24 months for applications meeting the following criteria: either: 6 Applicant is a specialist; or 7 both: 7.1 Applicant is a gP and a specialist has recommended treatment; and 7.2 Provide name of specialist (details to be attached to application). Renewal - (AdHd in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. MetHylPHenidAte HydRoCHloRide a) Special Authority - Retail pharmacy b) Controlled drug form tab 5 mg.............................................................................................3.20 tab 10 mg .................................................................................................. 4.29 tab 20 mg .................................................................................................. 7.85 tab long-acting 20 mg..............................................................................10.95 75.00

30 30 30 30 100

✓ rubifen ✓ rubifen ✓ rubifen ✓ rubifen Sr ✓ ritalin Sr

S29

continued…

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

neRVoUS SyStem

other cnS Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

continued…

2 diagnosed according to dSM-iV or iCd 10 criteria; and 3 either: 3.1 Applicant is a specialist; or 3.2 both: 3.2.1 Applicant is a gP and a specialist has recommended treatment; and 3.2.2 Provide name of specialist (details to be attached to application). initial application (AdHd in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: both: 4 AdHd (Attention deficit and Hyperactivity disorder) patients under 5 years of age; and 5 diagnosed according to dSM-iV or iCd 10 criteria. Renewal (narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal (AdHd in patients 5 or over) only from a paediatrician, psychiatrist or general practitioner. Approvals valid for 24 months for applications meeting the following criteria: either: 6 Applicant is a specialist; or 7 both: 7.1 Applicant is a gP and a specialist has recommended treatment; and 7.2 Provide name of specialist (details to be attached to application). Renewal - (AdHd in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. diSulfiRAM tab 200 mg .............................................................................................. 24.30 nAltRexone HydRoCHloRide – Special Authority - Retail pharmacy tab 50 mg .............................................................................................. 180.00 100 30 ✓ Antabuse ✓ revia

Special Authority for Subsidy - form: SA0714 initial application from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient is currently enrolled in a recognised comprehensive treatment programme for alcohol dependence in a service accredited against the new Zealand Alcohol and other drug Sector Standard or the national Mental Health Sector Standard; and 2 Applicant works in an Alcohol & drug Service; and 3 Applicant must include the address of the service (details to be attached to application). Renewal from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: both: 4 Compliance with the medication (prescriber determined); and 5 Any of the following: 5.1 Patient is still unstable and requires further treatment; or 5.2 Patient achieved significant improvement but requires further treatment; or 5.3 Patient is well controlled but requires maintenance therapy. Maximum of 2 approvals per 12 months. tetRAbenAZine tab 25 mg .............................................................................................. 243.00 112 ✓ xenazine 25

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

127

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

chemotheRAPeUtic AgentS Alkylating Agents

buSulPHAn - Retail pharmacy-specialist - PCt tab 2 mg .................................................................................................. 47.89 CARboPlAtin – PCt only - specialist inj 1 mg for eCP ......................................................................................... 0.14 inj 10 mg per ml, 5 ml .............................................................................. 12.00 inj 10 mg per ml, 15 ml ............................................................................ 18.70 30.00 inj 10 mg per ml, 45 ml ............................................................................ 55.50 75.00 (Mayne carboplatin inj 10 mg per ml, 15 ml and 45 ml to be delisted 1 May 2007) 100 1 mg 1 1 1 1 1 ✓ Myleran ✓ Baxter ✓ carboplatin Ebewe ✓ carboplatin Ebewe ✓ Mayne ✓ carboplatin Ebewe ✓ Mayne

CARMuStine – PCt only – specialist inj 100 mg .............................................................................................. 204.13 1 inj 100 mg for eCP ................................................................................. 214.34 100 mg oP CHloRAMbuCil- Retail pharmacy-specialist - PCt tab 2 mg .................................................................................................. 22.35 CiSPlAtin – PCt only – specialist inj 1 mg for eCP ......................................................................................... 1.44 inj 1 mg per ml, 50 ml .............................................................................. 59.20 inj 1 mg per ml, 100 ml .......................................................................... 116.00 CyCloPHoSPHAMide tab 50 mg - Retail pharmacy-specialist - PCt ....................................... 25.71 inj 1 mg for eCP – PCt only – specialist ..................................................... 0.03 inj 1 g - Retail pharmacy-specialist - PCt ............................................ 127.80 inj 1 g – PCt only – specialist ................................................................... 21.51 inj 2 g – PCt only – specialist ................................................................... 43.00 ifoSfAMide – PCt only – specialist inj 1 mg for eCP ......................................................................................... 0.10 inj 1 g ....................................................................................................... 87.26 inj 2 g ..................................................................................................... 162.80 loMuStine – PCt only – specialist Cap 10 mg.............................................................................................. 132.59 Cap 40 mg.............................................................................................. 399.15 MelPHAlAn tab 2 mg – Retail pharmacy-specialist – PCt ........................................ 31.31 inj 50 mg – PCt only – specialist.............................................................. 52.15 25 1 mg 1 1 50 1 mg 6 1 1 1 mg 1 1 20 20 25 1

✓ Bicnu ✓ Baxter ✓ Leukeran Fc ✓ Baxter ✓ Mayne ✓ Mayne ✓ cycloblastin ✓ Baxter ✓ cytoxan ✓ Endoxan ✓ Endoxan ✓ Baxter ✓ Holoxan ✓ Holoxan ✓ ceenu ✓ ceenu ✓ Alkeran ✓ Alkeran

oxAliPlAtin – PCt only –specialist –– Special Authority inj 1 mg for eCP ......................................................................................... 8.80 1 mg ✓ Baxter inj 50 mg ................................................................................................ 410.00 1 ✓ Eloxatin inj 100 mg .............................................................................................. 800.00 1 ✓ Eloxatin Special Authority for Subsidy – form: SA0808 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 1 the patient has metastatic colorectal cancer; and 2 to be used for first or second line use as part of a combination chemotherapy regimen. Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 3 the patient requires continued therapy; or 4 the tumour has relapsed and requires re-treatment.

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Antimetabolites

CAlCiuM folinAte tab 15 mg - Hospital pharmacy [HP3] - specialist - PCt .......................... 63.89 38.90 (55.60) inj 1 mg for eCP - PCt only - specialist ...................................................... 0.17 inj 3 mg per ml, 1 ml - Hospital pharmacy [HP1] - specialist - PCt........... 17.10 inj 15 mg - Hospital pharmacy [HP1] - specialist - PCt ............................ 57.20 inj 50 mg - Hospital pharmacy [HP1] - specialist - PCt ............................ 38.00 inj 100 mg – PCt only – specialist............................................................ 15.00 inj 300 mg – PCt only – specialist............................................................ 45.00 inj 1 g – PCt only – specialist ................................................................. 152.00 (Leucovorin Calcium inj 15 mg to be delisted 1 January 2007) CAPeCitAbine – PCt only – specialist – Special Authority tab 150 mg ............................................................................................ 115.00 tab 500 mg ............................................................................................ 705.00 10 1 mg 5 5 5 1 1 1 ✓ Mayne leucovorin ✓ Baxter ✓ Mayne ✓ Leucovorin calcium ✓ calcium Folinate Ebewe ✓ calcium Folinate Ebewe ✓ calcium Folinate Ebewe ✓ calcium Folinate Ebewe

60 120

✓ xeloda ✓ xeloda

Special Authority for Subsidy - form: SA0774 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 the patient has advanced gastrointestinal malignancy; or 2 the patient has metastatic breast cancer*; or 3 both: 3.1 the patient has poor venous access or needle phobia*; and 3.2 the patient requires a substitute for single agent fluoropyrimidine*. Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 4 the patient requires continued therapy; or 5 the tumour has relapsed and requires re-treatment. note indications marked with * are unapproved indications. ClAdRibine – PCt only – specialist inj 1 mg per ml, 10 ml .........................................................................5,249.72 inj 10 mg for eCP ................................................................................... 787.46 7 10 mg oP ✓ Leustatin ✓ Baxter ✓ Baxter ✓ Baxter ✓ Mayne ✓ Pharmacia ✓ Mayne ✓ Mayne ✓ Mayne ✓ Baxter ✓ Fludara ✓ Fludara

CytARAbine inj 1 mg for eCP – PCt only – specialist ..................................................... 0.10 1 mg inj 100 mg intrathecal syringe for eCP – PCt only – specialist .................. 70.00 100 mg oP inj 100 mg - Retail pharmacy-specialist - PCt ....................................... 80.00 5 inj 500 mg - Retail pharmacy-specialist - PCt ....................................... 67.00 inj 1 g - Retail pharmacy-specialist - PCt ............................................ 118.00 inj 100 mg per ml, 20 ml - PCt only – specialist..................................... 118.00 fludARAbine PHoSPHAte - PCt only – specialist inj 50 mg for eCP ................................................................................... 312.00 inj 50 mg .............................................................................................1,496.25 tab 10 mg .............................................................................................. 637.50 1 1 1 50 mg oP 5 15

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer fluoRouRACil SodiuM inj 1 mg for eCP – PCt only – specialist ..................................................... 0.01 inj 25 mg per ml, 100 ml – PCt only – specialist ...................................... 14.12 inj 50 mg per ml, 20 ml – PCt only – specialist ........................................ 52.31 inj 50 mg per ml, 50 ml – PCt only – specialist ........................................ 26.16 inj 500 mg per 10 ml – Retail pharmacy-specialist – PCt ...................... 28.75 inj 500 mg per 20 ml – Retail pharmacy-specialist – PCt ...................... 55.60 1 mg 1 5 1 5 10 ✓ Baxter ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne ✓ Mayne

geMCitAbine HydRoCHloRide – PCt only – specialist – Special Authority inj 200 mg ................................................................................................ 78.00 1 ✓ gemzar inj 1 g ..................................................................................................... 349.20 1 ✓ gemzar inj 1 mg for eCP ......................................................................................... 0.38 1 mg ✓ Baxter Special Authority for Subsidy - form: SA0833 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 the patient has non small cell lung carcinoma (stage illa, or above); or 2 the patient has advanced malignant mesothelioma*; or 3 the patient has advanced pancreatic carcinoma; or 4 the patient has ovarian, fallopian tube* or primary peritoneal carcinoma*. 5 the patient has advanced transitional cell carcinoma of the urothelial tract (locally advanced or metastatic). Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: both: 6 the patient requires continued therapy; or 7 the tumour has relapsed and requires re-treatment. note indications marked with a * are unapproved indications. iRinoteCAn - PCt only – specialist – Special Authority inj 1 mg for eCP ......................................................................................... 3.35 inj 20 mg per ml, 2 ml ............................................................................ 124.00 inj 20 mg per ml, 5 ml ............................................................................ 310.00 Special Authority for Subsidy - form: SA0775 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: both: 1 the patient has metastatic colorectal cancer; and 2 either: 2.1 to be used for first or second line use as part of a combination chemotherapy regimen; or 2.2 As single agent chemotherapy in fluropyrimidine-relapsed disease. Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 3 the patient requires continued therapy; or 4 the tumour has relapsed and requires re-treatment. MeRCAPtoPuRine - Retail pharmacy-specialist - PCt tab 50 mg ................................................................................................ 47.06 25 ✓ Purinethol 1 mg 1 1 ✓ Baxter ✓ camptosar ✓ camptosar

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer MetHotRexAte ❋ tab 2.5 mg - Hospital pharmacy [HP3] - specialist - PCt ........................... 5.80 ❋ tab 10 mg - Hospital pharmacy [HP3] - specialist - PCt ......................... 40.93 ❋ inj 1 mg for eCP – PCt only – specialist ..................................................... 0.19 ❋ inj 5 mg intrathecal syringe for eCP – PCt only – specialist ........................ 4.92 ❋ inj 2.5 mg per ml, 2 ml - Hospital pharmacy [HP1] - specialist - PCt........ 23.65 ❋ inj 25 mg per ml, 2 ml - Hospital pharmacy [HP1] - specialist - PCt......... 46.10 ❋ inj 25 mg per ml, 20 ml - Hospital pharmacy [HP1] - specialist - PCt ...... 80.25 ❋ inj 100 mg per ml, 5 ml - Hospital pharmacy [HP1] - specialist - PCt ...... 18.00 ❋ inj 100 mg per ml, 10 ml - Hospital pharmacy [HP1] - specialist - PCt .... 33.00 ❋ inj 100 mg per ml, 50 ml - Hospital pharmacy [HP1] - specialist - PCt .. 150.00 tHioguAnine - Hospital pharmacy [HP3]-specialist - PCt tab 40 mg ................................................................................................ 97.16 30 50 1 mg 5 mg oP 5 5 1 1 1 1 25 ✓ Methoblastin ✓ Methoblastin ✓ Baxter ✓ Baxter ✓ Mayne ✓ Mayne ✓ Mayne ✓ Methotrexate Ebewe ✓ Methotrexate Ebewe ✓ Methotrexate Ebewe ✓ Lanvis

other cytotoxic Agents

AnAgRelide HydRoCHloRide – PCt only – specialist – Special Authority Cap 0.5 mg............................................................................................ CbS 100 ✓ Agrylin S29 Special Authority for Subsidy - form: SA0814 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: both: 1 the patient has primary thrombocythaemia; and 2 either: 2.1 is at high risk (previous thromboembolic disease, bleeding or platelet count >1500/ml); or 2.2 is intolerant or refractory to hydroxyurea or interferon. Renewal only from a relevant specialist. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. note it is recommended that treatment with anagrelide be initiated only on the recommendation of a haematologist. ARSeniC tRioxide – PCt only – specialist inj 10 mg ................................................................................................ 943.00 bleoMyCin SulPHAte - PCt only – specialist inj 1,000 iu for eCP..................................................................................... 5.48 inj 15,000 iu ........................................................................................... 680.00 10 1,000 iu 10 ✓ AFt S29 ✓ Baxter ✓ Blenoxane ✓ Leunase ✓ Baxter ✓ Baxter ✓ Mayne ✓ cosmegen ✓ Baxter ✓ Mayne ✓ Baxter

ColASPASe (l-ASPARAginASe) – PCt only – specialist inj 10,000 iu ........................................................................................... 102.32 1 inj 10,000 iu for eCP............................................................................... 107.44 10,000 iu oP dACARbAZine – PCt only – specialist inj 200 mg for eCP ................................................................................... 45.66 200 mg oP inj 200 mg ................................................................................................ 43.86 1 dACtinoMyCin (ACtinoMyCin d) – PCt only – specialist inj 0.5 mg ................................................................................................. 13.52 inj 0.5 mg for eCP .................................................................................... 14.20 dAunoRubiCin – PCt only – specialist inj 5 mg per ml, 4 ml ................................................................................ 99.00 inj 20 mg for eCP ................................................................................... 104.00 1 0.5 mg oP 1 20 mg oP

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer doCetAxel – PCt only – specialist – Special Authority inj 20 mg ................................................................................................ 460.00 1 ✓ taxotere inj 80 mg ..............................................................................................1650.00 1 ✓ taxotere inj 1 mg for eCP ....................................................................................... 24.82 1 mg ✓ Baxter Special Authority for Subsidy - form: SA0809 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 both: 1.1 the patient has ovarian*, fallopian* or primary peritoneal cancer*; and 1.2 either: 1.2.1 Has not received prior chemotherapy; or 1.2.2 Has received prior chemotherapy but has not previously been treated with taxanes; or 2 the patient has metastatic breast cancer; or 3 both: 3.1 the patient has non small-cell lung cancer; and 3.2 either: 3.2.1 Has advanced disease (stage iiia or above); or 3.2.2 is receiving combined chemotherapy and radiotherapy; or 4 both: 4.1 the patient has small-cell lung cancer*; and 4.2 docetaxel is to be used as second-line therapy. Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 5 the patient has metastatic breast cancer, non small-cell lung cancer, or small-cell lung cancer* and 5.1 the patient requires continued therapy; or 5.2 the tumour has relapsed and requires re-treatment. note indications marked with * are unapproved indications. doxoRubiCin - PCt only – specialist inj 1 mg for eCP ......................................................................................... 0.97 inj 10 mg .................................................................................................... 8.80 inj 50 mg ..................................................................................................39.40 49.95 inj 100 mg ................................................................................................ 81.00 inj 200 mg.......................................................................................162.00 (Mayne doxorubicin inj 50 mg to be delisted 1 January 2007) ePiRubiCin - PCt only – specialist inj 1 mg for eCP ......................................................................................... 2.87 inj 2 mg per ml, 5 ml ................................................................................ 24.70 29.00 inj 2 mg per ml, 25 ml ............................................................................ 123.50 136.50 inj 2 mg per ml, 50 ml ............................................................................ 247.00 inj 2 mg per ml, 100 ml .......................................................................... 494.00 (Pharmorubicin inj 2 mg per ml, 5 ml and inj 25 ml to be delisted 1 January 2007) etoPoSide inj 1 mg for eCP – PCt only – specialist ..................................................... 0.49 Cap 50 mg - Hospital pharmacy [HP3] - specialist - PCt....................... 340.73 Cap 100 mg - Hospital pharmacy [HP3] - specialist - PCt..................... 340.73 inj 20 mg per ml, 5 ml - Hospital pharmacy [HP1] - specialist - PCt........ 39.95 61.22 1 mg 1 1 1 1 1 ✓ Baxter ✓ doxorubicin Ebewe ✓ doxorubicin Ebewe ✓ Mayne ✓ doxorubicin Ebewe ✓ doxorubicin Ebewe

1 mg 1 1 1 1

✓ Baxter ✓ Epirubicin Ebewe ✓ Pharmorubicin ✓ Epirubicin Ebewe ✓ Pharmorubicin ✓ Epirubicin Ebewe ✓ Epirubicin Ebewe

1 mg 20 10 1

✓ Baxter ✓ vepesid ✓ vepesid ✓ Mayne ✓ vepesid

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer etoPoSide PHoSPHAte – PCt only – specialist inj 100 mg (of etoposide base) ................................................................. 40.00 inj 1 mg (of etoposide base) for eCP .......................................................... 0.49 HydRoxyuReA - Retail pharmacy-specialist - PCt Cap 500 mg.............................................................................................. 31.76 idARubiCin HydRoCHloRide – PCt only – specialist Cap 5 mg.................................................................................................. 80.75 Cap 10 mg.............................................................................................. 144.50 inj 5 mg .................................................................................................. 170.00 inj 10 mg ................................................................................................ 340.00 inj 1 mg for eCP ....................................................................................... 39.44 MeSnA – PCt only – specialist inj 100 mg per ml, 4 ml .......................................................................... 109.63 inj 100 mg per ml, 10 ml ........................................................................ 251.73 tab 400 mg ............................................................................................ 168.30 tab 600 mg ............................................................................................ 251.35 MitoMyCin C – PCt only – specialist inj 2 mg .................................................................................................... 28.30 inj 10 mg ................................................................................................ 106.26 inj 1 mg for eCP ....................................................................................... 11.37 MitoZAntRone – PCt only – specialist inj 1 mg for eCP ....................................................................................... 19.47 inj 2 mg per ml, 10 ml ............................................................................ 330.00 inj 2 mg per ml, 12.5 ml ......................................................................... 407.50 1 1 mg 100 1 1 1 1 1 mg 15 15 50 50 1 1 1 mg 1 mg 1 1 ✓ Etopophos ✓ Baxter ✓ Hydrea ✓ Zavedos ✓ Zavedos ✓ Zavedos ✓ Zavedos ✓ Baxter ✓ uromitexan ✓ uromitexan ✓ uromitexan ✓ uromitexan ✓ Mitomycin-c kyowa ✓ Mitomycin-c kyowa ✓ Baxter ✓ Baxter ✓ onkotrone ✓ onkotrone

PAClitAxel - PCt only – specialist – Special Authority inj 1 mg for eCP ......................................................................................... 3.65 1 mg ✓ Baxter inj 30 mg ................................................................................................ 100.00 1 ✓ taxol inj 100 mg .............................................................................................. 333.00 1 ✓ taxol inj 150 mg .............................................................................................. 486.00 1 ✓ Paclitaxel Ebewe inj 300 mg .............................................................................................. 943.00 1 ✓ Paclitaxel Ebewe Special Authority for Subsidy - form: SA0842 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 both: 1.1 the patient has ovarian, fallopian* or primary peritoneal cancer*; and 1.2 either: 1.2.1 Has not received prior chemotherapy; or 1.2.2 Has received prior chemotherapy but have not previously been treated with taxanes; or 2 the patient has metastatic breast cancer; or 3 the patient has node-positive early breast cancer; or 4 both: 4.1 the patient has non small-cell lung cancer; and 4.2 either: 4.2.1 Has advanced disease (stage iiia or above); or 4.2.2 is receiving combined chemotherapy and radiotherapy; or 5 both: 5.1 the patient has small-cell lung cancer*; and 5.2 Paclitaxel is to be used as second-line therapy. Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 6 the patient has metastatic breast cancer, non small-cell lung cancer, or small-cell lung cancer* and continued… ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 6.1 the patient requires continued therapy; or 6.2 the tumour has relapsed and requires re-treatment. note indications marked with * are unapproved indications. PentoStAtin (deoxyCofoRMyCin) – PCt only – specialist inj 10 mg .............................................................................................1,695.00 PRoCARbAZine HydRoCHloRide – PCt only - specialist Cap 50 mg.............................................................................................. 133.00 teMoZoloMide - Special Authority - Hospital pharmacy [HP3] Cap 5 mg.................................................................................................. 50.00 Cap 20 mg.............................................................................................. 170.00 Cap 100 mg............................................................................................ 840.00 Cap 250 mg.........................................................................................2,100.00 1 50 5 5 5 5 ✓ nipent S29 ✓ natulan S29 ✓ temodal ✓ temodal ✓ temodal ✓ temodal

Special Authority for Subsidy - form: SA0831 Application only from a relevant specialist. Approvals valid for 10 months for applications meeting the following criteria: 1. Patient has newly diagnosed glioblastoma multiforme; and 2. temozolomide is to be (or has been) given concomitantly with radiotherapy; and 3. following concomitant treatment temozolomide is to be used for a maximum of six cycles of 5 days treatment, at a maximum dose of 200 mg/m2. note: temozolomide is not subsidised for the treatment of relapsed glioblastoma multiforme. Reapplications will not be approved. Studies of temozolomide show that its benefit is predominantly in those patients with a good performance status (WHo grade 0 or 1 or Karnofsky score >80), and in patients who have had at least a partial resection of the tumour. teniPoSide – PCt only – specialist inj 10 mg per ml, 5 ml ............................................................................ 845.11 inj 50 mg for eCP ..................................................................................... 88.74 tHAlidoMide a) PCt only – specialist – Special Authority b) only on a Controlled drug form Cap 50 mg.............................................................................................. 490.00 10 50 mg oP ✓ vumon ✓ Baxter

Special Authority for Subsidy - form: SA0817 initial application (for new patients) only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: both: 1 the patient has refractory, progressive or relapsed multiple myeloma; and 2 the patient has received prior chemotherapy. initial application (for patients receiving thalidomide prior to 1 january 2006) only from a relevant specialist. Approvals valid without further renewal where the patient was receiving treatment with thalidomide for multiple myeloma on or before 31 december 2005. Renewal only from a relevant specialist. Approvals valid without further renewal where the patient has obtained a response from treatment during the initial approval period. note: Prescription must be written by registered prescriber in the thalidomide risk management programme operated by the supplier. Maximum dose of 400 mg daily as monotherapy or in a combination therapy regimen. tRetinoin – PCt only – specialist Cap 10 mg.............................................................................................. 435.90 100 ✓ vesanoid

✓ thalidomide Pharmion

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

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Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer VinblAStine SulPHAte inj 1 mg for eCP – PCt only – specialist ..................................................... 3.19 inj 10 mg - Retail pharmacy-specialist - PCt ....................................... 137.50 VinCRiStine SulPHAte inj 1 mg for eCP – PCt only – specialist ................................................... 23.68 inj 1 mg per ml, 1 ml - Retail pharmacy-specialist - PCt........................ 99.00 inj 1 mg per ml, 2 ml - Retail pharmacy-specialist - PCt...................... 199.00 VinoRelbine - PCt only – specialist – Special Authority inj 1 mg for eCP ......................................................................................... 4.96 inj 10 mg per ml, 1 ml .............................................................................. 42.00 141.00 inj 10 mg per ml, 5 ml ............................................................................ 210.00 560.00 (Navelbine inj 10 mg per ml, 1 ml and 5 ml to be delisted 1 May 2007) 1 mg 5 1 mg 5 5 1 mg 1 1 1 1 ✓ Baxter ✓ Mayne ✓ Baxter ✓ Mayne ✓ Mayne ✓ Baxter ✓ vinorelbine Ebewe ✓ navelbine ✓ vinorelbine Ebewe ✓ navelbine

Special Authority - form SA0799 initial application only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: either: 1 the patient has metastatic breast cancer; or 2 the patient has non-small cell lung cancer (stage illa, or above). Renewal only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 3 the patient requires continued therapy; or 4 the tumour has relapsed and requires re-treatment.

Protein-tyrosine Kinase inhibitors

iMAtinib MeSylAte - Special Authority - access by application tab 100 mg .........................................................................................2,400.00 60 ✓ glivec

Special Authority criteria and guidelines for glivec: Application forms are available from, and prescriptions should be sent to: the glivec Coordinator tel: (04) 460 4990 fax: (04) 916 7571 email: mary.chesterfield@pharmac.govt.nz PHARMAC, Po box 10 254, Wellington Special Authority criteria for cML - access by application a) funded for patients with diagnosis (confirmed by a haematologist) of a chronic myeloid leukaemia (CMl) in blast crisis, accelerated phase, or in chronic phase. b) Maximum dose of 600 mg/day for accelerated or blast phase, and 400 mg/day for chronic phase CMl. c) Subsidised for use as monotherapy only. d) initial approvals valid seven months. e) Subsequent approval(s) are granted on application and are valid for six months. the first re-application (after seven months) should provide details of the haematological response. the third re-application should provide details of the cytogenetic response after 14–18 months from initiating therapy. All other re-applications should provide details of haematological response, and cytogenetic response if such data is available. Applications to be made and subsequent prescriptions can be written by a haematologist or an oncologist. guideline on discontinuation of treatment for patients with cML a) Prescribers should consider discontinuation of treatment if after 6 months from initiating therapy a patient did not obtain a haematological response as defined as any one of the following three levels of response: - complete haematologic response (as characterised by an absolute neutrophil count (AnC) > 1.5 x 109/l, platelets > 100 x 109/l, absence of peripheral blood (Pb) blasts, bone marrow (bM) blasts < 5% (or fiSH Ph+ 0–35% metaphases), and absence of extramedullary disease); or continued… ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

chemotherapeutic Agents endocrine therapy

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… no evidence of leukaemia (as characterised by an absolute neutrophil count (AnC) > 1.0 x 109/l, platelets > 20 x 109/l, absence of peripheral blood (Pb) blasts, bone marrow (bM) blasts < 5% (or fiSH Ph+ 0-35% metaphases), and absence of extramedullary disease); or - return to chronic phase (as characterised by bM and Pb blasts < 15%, bM and Pb blasts and promyelocytes < 30%, Pb basophils < 20% and absence of extramedullary disease other than spleen and liver). b) Prescribers should consider discontinuation of treatment if after 18 months from initiating therapy a patient did not obtain a major cytogenetic response defined as 0–35% Ph+ metaphases. Special Authority criteria for gISt - access by application a) funded for patients: - with a diagnosis (confirmed by an oncologist) of unresectable and/or metastatic malignant gastrointestinal stromal tumour (giSt); and - who have immunohistochemical documentation of c-kit (Cd117) expression by the tumour. b) Maximum dose of 400 mg/day. c) Applications to be made and subsequent prescriptions can be written by an oncologist. d) initial and subsequent applications are valid for one year. the re-application criterion is an adequate clinical response to the treatment with imatinib (prescriber determined). -

endocRine theRAPy

gnRH AnAlogueS - refer to HoRMone PRePARAtionS, trophic Hormones, page 85. AnAStRoZole - Special Authority available - Retail pharmacy tab 1 mg – Higher subsidy of $240.00 per 30 with Special Authority ................................................. 146.46 (240.00)

30 Arimidex

Special Authority for Alternate Subsidy – form: SA0810 initial application only from a relevant specialist. Approvals valid for 5 years for applications meeting the following criteria: All of the following: 1. Patient is a postmenopausal woman; and 2. Patient has hormone receptor positive breast cancer; and 3. Any of the following 3.1 the cancer is advanced (Stage iiib, or metastatic Stage iV); or 3.2 the patient has a very clear history of intolerance to tamoxifen; or 3.3 the use of tamoxifen is contraindicated due to a history of thromboembolic disease. Renewal only from a relevant specialist. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment. flutAMide tab 250 mg - Hospital pharmacy [HP3]-specialist .................................... 39.50 letRoZole - Special Authority available - Retail pharmacy tab 2.5 mg – Higher subsidy of $200.00 per 30 with Special Authority ................................................. 146.46 (200.00) 100 ✓ Flutamin

30 femara

Special Authority for Alternate Subsidy – form: SA0811 initial application only from a relevant specialist. Approvals valid for 5 years for applications meeting the following criteria: All of the following: 1. Patient is a postmenopausal woman; and 2. Patient has hormone receptor positive breast cancer; and 3 Any of the following 3.1 the cancer is advanced (Stage iiib, or metastatic Stage iV); or 3.2 the patient has a very clear history of intolerance to tamoxifen; or continued…

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

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endocrine therapy

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 3.3 the use of tamoxifen is contraindicated due to a history of thromboembolic disease. Renewal only from a relevant specialist. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefiting from treatment. MegeStRol ACetAte - Retail pharmacy-specialist tab 160 mg .............................................................................................. 74.25 oCtReotide (somatostatin analogue) - Special Authority - Hospital pharmacy [HP3] inj 50 µg per ml, 1 ml ............................................................................... 43.50 inj 100 µg per ml, 1 ml ............................................................................. 81.00 inj 500 µg per ml, 1 ml ........................................................................... 399.00 lAR 10 mg pre-filled syringe ................................................................1772.50 lAR 20 mg pre-filled syringe ................................................................2358.75 lAR 30 mg pre-filled syringe ................................................................2951.25 30 5 5 5 1 1 1 ✓ Megace ✓ Sandostatin ✓ Sandostatin ✓ Sandostatin ✓ Sandostatin LAr ✓ Sandostatin LAr ✓ Sandostatin LAr

Special Authority for Subsidy - form: SA0563 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 both: 1.1 Acromegaly; and 1.2 Patient has failed surgery, radiotherapy, bromocriptine and other oral therapies; or 2 ViPomas and glucagonomas - for patients who are seriously ill in order to improve their clinical state prior to definitive surgery; or 3 both: 3.1 gastrinoma; and 3.2 either: 3.2.1 Patient has failed surgery; or 3.2.2 Patient in metastatic disease after H2 antagonists (or proton pump inhibitors) have failed; or 4 both: 4.1 insulinomas; and 4.2 Surgery is contraindicated or has failed; or 5 for pre-operative control of hypoglycaemia and for maintenance therapy; or 6 both: 6.1 Carcinoid syndrome (diagnosed by tissue pathology and/or urinary 5HiAA analysis); and 6.2 disabling symptoms not controlled by maximal medical therapy. note the use of octretide in patients with fistulae, oesophageal varices, miscellaneous diarrhoea and hypotension will not be funded as a Special Authority item. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. tAMoxifen CitRAte ❋ tab 10 mg .................................................................................................. 9.00 ❋ tab 20 mg .................................................................................................. 9.25 100 100 ✓ genox ✓ genox

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

immunosuppressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

immUnoSUPPReSSAntS cytotoxic immunosuppressants

AZAtHioPRine - Retail pharmacy-specialist ❋ tab 50 mg ................................................................................................ 25.00 (34.90) ❋ inj 50 mg .................................................................................................. 46.33 (47.72) MyCoPHenolAte Mofetil - Special Authority - Hospital pharmacy [HP3] Cap 250 mg............................................................................................ 206.66 tab 500 mg ............................................................................................ 206.66 Powder for oral liq 1g per 5 ml - Subsidy by endorsement ...................... 285.00 100 1 imuran 100 50 165 ml oP ✓ cellcept ✓ cellcept ✓ cellcept ✓ thioprine ✓ Azamun imuran

Mycophenolate powder for oral liquid is subsidised only for patients unable to swallow tablets and capsules, and when the prescription is endorsed accordingly. Special Authority for Subsidy - form: SA0798 initial application only from a relevant specialist. Approvals valid without further renewal for applications meeting the following criteria: Any of the following: 1. Renal transplant recipient; or 2. Heart transplant recipient; or 3. Patient has an organ transplant and has severe tophaceous gout making azathioprine unsuitable. Renewal only from a relevant specialist. Approvals valid without further renewal where the patient had a previous Special Authority approval and was receiving mycophenolate prior to 1 october 2005.

immune modulators

guidelines for the use of interferon in the treatment of hepatitis c: Physicians considering treatment of patients with hepatitis C should discuss cases with a gastroenterologist or an infectious disease physician. All subjects undergoing treatment require careful monitoring for side effects. Patients should be otherwise fit. Hepatocellular carcinoma should be excluded by ultrasound examination and alpha-fetoprotein level. criteria for treatment a) diagnosis - Anti-HCV positive on at least two occasions with a positive PCR for HCV-RnA and preferably confirmed by a supplementary RibA test; or - PCR-RnA positive for HCV on at least 2 occasions if antibody negative; or - 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. b) establishing Active Chronic liver disease - Confirmed HCV infection and serum Alt/ASt levels measured on at least three occasions over six months averaging > 1.5 x upper limit of normal. (Alt is the preferable enzyme); or - 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). Exclusion criteria a) Autoimmune liver disease. (interferon may exacerbate autoimmune liver disease as well as other autoimmune diseases such as thyroid disease). b) Pregnancy. c) neutropenia (<2.0 x 109) and/or thrombocytopenia. d) Continuing alcohol abuse and/or continuing intravenous drug users. continued… ✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

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Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… dosage the current recommended dosage is 3 million units of interferon alpha-2a or interferon alpha-2b administered subcutaneously three times a week for 52 weeks (twelve months). Exit criteria the patient’s response to interferon treatment should be reviewed at either three or four months. interferon treatment should be discontinued in patients who do not show a substantial reduction (50%) in their mean pre-treatment Alt level at this stage. AntitHyMoCyte globulin (eQuine) – PCt only – specialist inj 50 mg per ml, 5 ml .........................................................................2,137.50 5 ✓ AtgAM ✓ roferon-A ✓ roferon-A ✓ roferon-A ✓ roferon-A ✓ roferon-A ✓ roferon-A

inteRfeRon AlPHA-2A - Hospital pharmacy [HP3] – PCt – specialist inj 3 m iu prefilled syringe ......................................................................... 31.32 1 inj 4.5 m iu prefilled syringe ...................................................................... 46.98 1 inj 6 m iu prefilled syringe ......................................................................... 62.64 1 inj 9 m iu prefilled syringe ......................................................................... 93.96 1 inj 18 m iu multidose cartridge ................................................................ 187.92 1 inj 18 m iu multidose cartridge x 2 starter pack .......................................375.84 1 only one multidose cartridge starter pack to be prescribed and dispensed per patient. (Roferon-A inj 18 m iu multidose cartridge starter pack to be delisted 1 April 2007) inteRfeRon AlPHA-2A WitH RibAViRin – Special Authority – Hospital Pharmacy [HP3] inj 18 m iu multidose cartridge x 2 with ribavirin tab 200 mg x 168 ................................................................1,375.84 1 oP inj 18 m iu multidose cartridge x 2 with pen and needles with ribavirin tab 200 mg x 168 .....................................1,375.84 1 oP

✓ roferon rBv combination Pack ✓ roferon rBv combination Pack Starter kit

Special Authority for Subsidy - form: SA0784 initial application from any specialist. Approvals valid for 12 months where patient has chronic hepatitis C (all genotypes). inteRfeRon AlPHA-2b - Hospital pharmacy [HP3] – PCt – Specialist inj 18 m iu, 1.2 ml multidose pen............................................................ 187.92 inj 30 m iu, 1.2 ml multidose pen............................................................ 313.20 inj 60 m iu, 1.2 ml multidose pen............................................................ 626.40 1 1 1 ✓ Intron-A ✓ Intron-A ✓ Intron-A ✓ Pegasys ✓ Pegasys rBv combination Pack ✓ Pegasys rBv combination Pack ✓ Pegasys ✓ Pegasys rBv combination Pack ✓ Pegasys rBv combination Pack

PegylAted inteRfeRon AlPHA-2A – Special Authority - Hospital pharmacy [HP3] inj 135 µg prefilled syringe...................................................................... 362.00 1 inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 ................................................................1,799.68 1 oP inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 ................................................................1,975.00 inj 180 µg prefilled syringe...................................................................... 450.00 inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 ................................................................2,059.84 inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 ................................................................2,190.00 Special Authority for Subsidy - form: SA0802 1 oP 1 1 oP 1 oP

initial application – (genotype 1, 4, 5 or 6 infection or co-infection with HiV) from any specialist. Approvals valid for 11 months for applications meeting the following criteria: continued… ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

immunosuppressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… either: 1. Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection; or 2. Patient has chronic hepatitis C and is co-infected with HiV. note: 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. initial application – (genotype 2 or 3 infection without co-infection with HiV) from any specialist. Approvals valid for 6 months for applications meeting the following criteria: 3. Patient has chronic hepatitis C, genotype 2 or 3 infection; and either: 3.1 has bridging fibrosis or cirrhosis (Metavir stage 3 or 4 or equivalent); or 3.2 is unsuitable for liver biopsy due to coagulopathy. PegylAted inteRfeRon AlPHA-2b WitH RibAViRin – Special Authority - Hospital pharmacy [HP3] inj 50 µg x 4 with ribavirin cap 200 mg x 84 ........................................... 976.80 1 oP ✓ Pegatron combination therapy ✓ Pegatron combination inj 50 µg x 4 with ribavirin cap 200 mg x 112 ......................................1,080.40 1 oP therapy inj 80 µg x 4 with ribavirin cap 200 mg x 84 ........................................1,376.40 1 oP ✓ Pegatron combination therapy inj 80 µg x 4 with ribavirin cap 200 mg x 140 ......................................1,583.60 1 oP ✓ Pegatron combination therapy inj 80 µg x 4 with ribavirin cap 200 mg x 168 ......................................1,687.20 1 oP ✓ Pegatron combination therapy inj 100 µg x 4 with ribavirin cap 200 mg x 84 ......................................1,642.80 1 oP ✓ Pegatron combination therapy inj 100 µg x 4 with ribavirin cap 200 mg x 112 ....................................1,746.40 1 oP ✓ Pegatron combination therapy inj 120 µg x 4 with ribavirin cap 200 mg x 84 ......................................1,909.20 1 oP ✓ Pegatron combination therapy inj 120 µg x 4 with ribavirin cap 200 mg x 140 ....................................2,116.40 1 oP ✓ Pegatron combination therapy inj 150 µg x 4 with ribavirin cap 200 mg x 84 ......................................2,308.80 1 oP ✓ Pegatron combination therapy inj 150 µg x 4 with ribavirin cap 200 mg x 140 ....................................2,516.00 1 oP ✓ Pegatron combination therapy inj 150 µg x 4 with ribavirin cap 200 mg x 168 ....................................2,619.60 1 oP ✓ Pegatron combination therapy Special Authority for Subsidy - form: SA0846 initial application from any specialist. Approvals valid for 11 months for applications meeting the following criteria: either: 1 Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection; or 2 both 2.1 Patient has chronic hepatitis C, genotype 2 or 3 infection; and 2.2 either: 2.2.1 has bridging fibrosis or cirrhosis (Metavir stage 3 or 4 or equivalent); or 2.2.2 is unsuitable for liver biospy due to coagulopathy. note: 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.

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

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immunosuppressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer RituxiMAb - PCt only – specialist – Special Authority inj 1 mg for eCP ......................................................................................... 6.39 inj 100 mg per 10 ml vial .....................................................................1,195.00 inj 500 mg per 50 ml vial .....................................................................2,987.00 Special Authority for Subsidy - form: SA0777 initial application - (Post-transplant) only from a relevant specialist. Approvals valid for 6 months where the patient has b-cell post-transplant lymphoproliferative disorder* note for no more than 8 cycles initial application - (low-grade lymphomas) only from a relevant specialist. Approvals valid for 6 months where the patient has low grade nHl - relapsed disease following prior chemotherapy. note for no more than 4 treatment cycles. initial application - (large cell lymphomas) only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: both: 1 the patient has treatment naïve large b-cell nHl; and 2 to be used with CHoP (or alternative anthracycline containing multi-agent chemotherapy regime given with curative intent). note for no more than 8 treatment cycles. Renewal - (low-grade lymphomas) only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: both: 3 the patient has had a treatment-free interval of 6 months or more; and 4 either: 4.1 Has b-cell post-transplant lymphoproliferative disorder*; or 4.2 Has low grade nHl - relapsed disease following prior chemotherapy. note for no more than 4 treatment cycles for low grade nHl. indications marked with * are unapproved indications. tRAStuZuMAb - PCt only – specialist – Special Authority inj 1 mg for eCP ......................................................................................... 9.99 inj 150 mg vial .....................................................................................1,350.00 inj 440 mg vial .....................................................................................3,875.00 Special Authority for Subsidy - form: SA0778 initial application only from a relevant specialist. Approvals valid for 12 months where the patient has metastatic breast cancer expressing HeR-2 3+ or fiSH+. Renewal only from a relevant specialist. Approvals valid for 12 months where the cancer has not progressed. 1 mg 1 1 ✓ Baxter ✓ Herceptin ✓ Herceptin 1 mg 2 1 ✓ Baxter ✓ Mabthera ✓ Mabthera

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

immunosuppressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

multiple Sclerosis treatment

glAtiRAMeR ACetAte – Access by application inj 20 mg pre-filled syringe ..................................................................1,089.25 inteRfeRon betA-1-AlPHA - Access by application inj 6 million iu per vial ..........................................................................1,152.30 28 ✓ copaxone

✓ Avonex

inteRfeRon betA-1-betA - Access by application inj 8 million iu per 1 ml .......................................................................1,202.99 15 ✓ Betaferon Access by application a) budget managed by appointed clinicians on the Multiple Sclerosis treatment Assessments Committee (MStAC). b) Applications will be considered by MStAC at its regular meetings and approved subject to eligibility according to the entry and Stopping criteria (below). c) Applications to be made on the approved forms which are available from the co-ordinator for MStAC: the Co-ordinator Phone: (04) 460 4990 Multiple Sclerosis treatment Assessments Committee facsimile: (04) 916 7571 PHARMAC, Po box 10 254 email: silvia.valsenti@pharmac.govt.nz Wellington d) Completed application forms must be sent to the co-ordinator for MStAC and will be considered by MStAC at the next practicable opportunity. e) notification of MStAC’s decision will be sent to the patient, the applying clinician and the patient’s gP (if specified). f) these agents will not be subsidised if dispensed from a community or hospital pharmacy. Regular supplies will be distributed to all approved patients or their clinicians by courier. g) Prescribers must fax quarterly prescriptions for approved patients to the MStAC co-ordinator. h) only prescriptions for 6 million iu of interferon beta-1-alpha per week or 8 million iu of interferon beta-1-beta every other day will be subsidised. i) Appeals against MStAC’s decision and/or the processing of any application may be lodged with the MStAC co-ordinator. Concerns that cannot be or have not been adequately addressed by MStAC will be forwarded to a separate Appeal Committee if necessary. j) entry and Stopping criteria Entry criteria • diagnosis of multiple sclerosis (MS) must be confirmed by a neurologist. diagnosis should as a rule include MRi confirmation. for patients diagnosed before MRi was widely utilised in new Zealand, confirmation of diagnosis via clinical assessment and laboratory/ancillary data must be provided; and • patients must have active relapsing MS (confirmed by MR scan where necessary) with or without underlying progression; and • patients must have either: 1. edSS score 2.5 - 5.5 with 2+ relapses: experienced at least 2 significant relapses of MS in the previous 12 months, and an edSS score of between 2.5 and 5.5 inclusive; or 2. edSS score 2.0 with 3+ relapses: experienced at least 3 significant relapses of MS in the previous 12 months, and an edSS score of 2.0; and • each relapse must: - be confirmed by a neurologist or general physician (the patient may not necessarily have been seen during the relapse but the neurologist/physician must be satisfied that the clinical features were characteristic and met the specified criteria); - be associated with characteristic new symptom(s)/sign(s) or substantial worsening of previously experienced symptom(s)/sign(s); - last at least one week; - follow a period of stability of at least one month; - be severe enough to change either the edSS or at least one of the Kurtzke functional systems scores by at least 1 point; continued…

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

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oncology AgentS And immUnoSUPPReSSAntS

immunosuppressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… - be distinguishable from the effects of general fatigue; and - not be associated with a fever (t>37.5°C); and • applications must be made at least four weeks after the date of the onset of the last known relapse; and • patients must have no previous history of lack of response to beta-interferon and glatiramer acetate (see criteria for stopping beta-interferon). • applications must be submitted to the Multiple Sclerosis treatment Assessment Committee (MStAC) by the patient’s neurologist or a general physician; and • patients must agree (via informed consent) to co-operate if as a result of their meeting the stopping criteria, funding is withdrawn. Patients must agree to the collection of clinical data relating to their MS and use of those data by PHARMAC; and • patients must agree to allow clinical data to be collected and reviewed by MStAC annually for each year in which they receive funding for beta-interferon or glatiramer acetate. Stopping criteria • Confirmed progression of disability that is sustained for three months after a minimum of one year of treatment. Progression of disability is defined as either an increase of 1 edSS point from the starting edSS or an increase in edSS score to 6.0 or more; or • stable or increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment); or • pregnancy and/or lactation; or • intolerance to interferon beta-1-alpha, interferon beta-1-beta and glatiramer acetate; or • non-compliance with treatment, including refusal to undergo annual assessment or refusal to allow the results of the assessment to be submitted to MStAC; or • patients may, subject to conclusions drawn from published evidence available at the time, be excluded if they develop a high titre of neutralising anti-bodies to beta-interferon or glatiramer acetate.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

oncology AgentS And immUnoSUPPReSSAntS

immunosuppressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

other immunosuppressants

CyCloSPoRin A - Special Authority - Hospital pharmacy [HP3] Cap 25 mg................................................................................................ 85.00 Cap 50 mg.............................................................................................. 169.34 Cap 100 mg............................................................................................ 338.69 oral liq 100 mg per ml ............................................................................ 377.38 50 50 50 50 ml oP ✓ neoral ✓ neoral ✓ neoral ✓ neoral

Special Authority for Subsidy - form: SA0470 initial application - (organ transplant) only from a relevant specialist. Approvals valid without further renewal unless notified where the patient is an organ transplant recipient. initial application - (bone marrow transplant or graft v host disease) only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: either: 1 bone marrow transplant; or 2 graft v host disease. initial application - (Psoriasis) only from a dermatologist. Approvals valid for 2 years for applications meeting the following criteria: both: 3 Psoriasis; and 4 Applicant must state which systemic and topical therapies have failed. initial application - (Severe atopic dermatitis) only from a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: both: 5 Severe atopic dermatitis; and 6 not responsive to topical therapy, oral antihistamines and other commonly used orthodox therapies. initial application - (nephrotic Syndrome) only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 7 nephrotic Syndrome; and 8 Corticosteroid dependent patients who have failed on cytotoxic therapy. initial application - (endogenous uveitis) only from a relevant specialist. Approvals valid for 2 years where the patient suffers from endogenous uveitis. initial application - (Severe rheumatoid arthritis) only from a rheumatologist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 9 Severe rheumatoid arthritis; and 10 the patient must be either unresponsive to or unable to tolerate, both sulphasalazine and methotrexate; and 11 Patients must have 2 serum creatinine test results within the normal range within the three months prior to initiation of therapy. Renewal - (Severe atopic dermatitis) only from a dermatologist. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal - (indications other than severe atopic dermatitis) only from a dermatologist, rheumatologist or relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. guidelines for use of cyclosporin A in rheumatoid arthritis Monitoring: All patients require frequent monitoring for creatinine levels and blood pressure: • fortnightly, in the first three months of therapy and then monthly, if results are stable; • if dose is increased or there is a rise in serum creatinine or blood pressure, then more frequent monitoring is required. Cyclosporin A is contraindicated in patients with the following conditions: • current or past malignancy; • uncontrolled hypertension; • renal dysfunction (abnormal serum creatinine for age and sex); • immunodeficiency and neutropenia; • abnormally low white blood cell count or platelet count; or continued…

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

oncology AgentS And immUnoSUPPReSSAntS

immunosuppressants

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… • liver function tests more than twice the upper limit of normal. Caution in use: • age above 65 years; • controlled hypertension; • use of anti-epileptic medication; • use of ketoconazole, fluconazole, trimethoprim, erythromycin, verapamil, and diltiazem; • concurrent or previous use of alkylating agents such as cyclophosphamide; • use of any experimental drug within the past three months; • premalignant conditions such as leukoplakia, monoclonal paraprotoinaemia, myelodysplastic syndrome and dysplastic naevi; • active infection may necessitate temporary discontinuation; • pregnancy and lactation. therapy should be discontinued if there has been no improvement after 6 months with the patient on the maximum tolerated dose. for further information please consult the data sheet. tACRoliMuS - Special Authority - Hospital pharmacy [HP3] Cap 0.5 mg............................................................................................. 214.00 Cap 1 mg................................................................................................ 428.00 Cap 5 mg.............................................................................................1,070.00 100 100 50 ✓ Prograf ✓ Prograf ✓ Prograf

Special Authority for Subsidy - form: SA0669 initial application only from a relevant specialist. Approvals valid without further renewal unless notified where the patient is an organ transplant recipient. note Subsidy applies for either primary or rescue therapy.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

ReSPiRAtoRy SyStem And AlleRgieS

Antiallergy Preparations Antihistamines

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

AntiAlleRgy PRePARAtionS

bee VenoM AlleRgy tReAtMent - Special Authority - Hospital Pharmacy [HP3] treatment kit - 1 vial 550 µg freeze dried venom, 1 diluent 9 ml, 3 diluent 1.8 ml ............................................................ 154.30 1 oP Maintenance kit - 6 vials 120 µg freeze dried venom, 6 diluent 1.8 ml ................................................................................... 154.30 1 oP ✓ Albay ✓ Albay

Special Authority for Subsidy - form: SA0053 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 1 RASt or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. WASP VenoM AlleRgy tReAtMent - Special Authority - Hospital Pharmacy [HP3] treatment kit (yellow jacket venom) - 1 vial 550 µg freeze dried vespula venom, 1 diluent 9 ml, 1 diluent 1.8 ml........................... 154.30 1 oP ✓ Albay treatment kit (Paper wasp venom) - 1 vial 550 µg freeze dried polister venom, 1 diluent 9 ml, 1 diluent 1.8 ml ........................... 154.30 1 oP ✓ Albay Special Authority for Subsidy - form: SA0053 initial application only from a relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 1 RASt or skin test positive; and 2 Patient has had severe generalised reaction to the sensitising agent. Renewal only from a relevant specialist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

AntihiStAmineS

AZAtAdine MAleAte ❋ tab 1 mg .................................................................................................... 6.94 (16.90) CetiRiZine HydRoCHloRide ❋ tab 10 mg .................................................................................................. 3.32 ❋‡oral liq 1 mg per ml .................................................................................... 2.75 CHloRPHeniRAMine MAleAte ❋‡oral liq 2 mg per 5 ml ................................................................................. 3.74 (7.26) CyPRoHePtAdine HydRoCHloRide ❋ tab 4 mg .................................................................................................... 6.27 dextRoCHloRPHeniRAMine MAleAte ❋ tab 2 mg .................................................................................................... 2.52 (9.99) ❋ tab long-acting 6 mg.................................................................................. 5.40 (12.56) ❋‡oral liq 2 mg per 5 ml ................................................................................. 1.77 (10.29) (Polaramine tab 2 mg 30 tab pack to be delisted 1 May 2007) 50 Zadine ✓ razene ✓ Allerid c

90 100 ml oP 500 ml

Histafen ✓ Periactin

100 50 40 100 ml

Polaramine Polaramine Repetab Polaramine

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Antihistamines inhaled corticosteroids - metered dose inhalers

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer fexofenAdine HydRoCHloRide ❋ tab 60 mg .................................................................................................. 4.34 (11.53) ❋ tab 120 mg .............................................................................................. 14.22 (29.81) Ketotifen ❋ oral liq 1 mg per 5 ml ................................................................................. 4.90 (5.90) loRAtAdine ❋ tab 10 mg .................................................................................................. 6.70 ❋ oral liq 1 mg per ml .................................................................................... 3.95 PRoMetHAZine HydRoCHloRide ❋ tab 10 mg ................................................................................................. 2.37 (8.58) ❋ tab 25 mg .................................................................................................. 4.74 (14.47) ❋‡oral liq 5 mg per 5 ml ................................................................................ 3.53 (8.51) ❋ inj 25 mg per ml, 1 ml - Available on a PSo .............................................. 12.68 (20.24) ❋ inj 25 mg per ml, 2 ml - Available on a PSo ................................................ 8.05 (Phenergan inj 25 mg per ml, 1 ml to be delisted 1 January 2007) 20 telfast 30 telfast 200 ml Asmafen 100 100 ml 50 Phenergan 50 Phenergan 100 ml Phenergan 10 5 Phenergan ✓ Mayne ✓ Apo-Loratadine ✓ Lorapaed

ReSPiRAtoRy SyStem And AlleRgieS

tRiMePRAZine tARtRAte ‡ oral liq 30 mg per 5 ml ............................................................................... 2.79 100 ml oP (8.06)

Vallergan forte

inhAled coRticoSteRoidS - meteRed doSe inhAleRS low dose

beCloMetHASone diPRoPionAte Aerosol inhaler, 50 µg per dose .................................................................. 8.54 200 dose oP ✓ Beclazone 50

medium dose

beCloMetHASone diPRoPionAte Aerosol inhaler, 100 µg per dose .............................................................. 12.50 200 dose oP flutiCASone Aerosol inhaler, 50 µg per dose CfC-free.................................................... 7.50 120 dose oP ✓ Beclazone 100 ✓ Flixotide

high dose

beCloMetHASone diPRoPionAte Aerosol inhaler, 250 µg per dose .............................................................. 22.67 200 dose oP flutiCASone Aerosol inhaler, 125 µg per dose CfC-free................................................ 13.60 120 dose oP ✓ Beclazone 250 ✓ Flixotide

Very high dose

flutiCASone Aerosol inhaler, 250 µg per dose CfC-free................................................ 27.20 120 dose oP ✓ Flixotide

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

ReSPiRAtoRy SyStem And AlleRgieS

inhaled corticosteroids - breath Activated devices inhaled beta-Adrenoceptor Agents - breath Activated devices

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

inhAled coRticoSteRoidS - bReAth ActiVAted deViceS medium dose

budeSonide Powder for inhalation, 100 µg per dose .................................................... 17.00 200 dose oP flutiCASone Powder for inhalation, 50 µg per dose, breath activated .............................. 5.10 60 dose oP (8.67) ✓ Pulmicort turbuhaler

flixotide Accuhaler

high dose

budeSonide Powder for inhalation, 200 µg per dose .................................................... 19.00 200 dose oP flutiCASone Powder for inhalation, breath activated, 100 µg per dose ............................ 7.50 60 dose oP (13.87) ✓ Pulmicort turbuhaler

flixotide Accuhaler

Very high dose

budeSonide Powder for inhalation, 400 µg per dose .................................................... 32.00 200 dose oP flutiCASone Powder for inhalation, breath activated, 250 µg per dose .......................... 13.60 60 dose oP (24.51) ✓ Pulmicort turbuhaler

flixotide Accuhaler

nedocRomil

nedoCRoMil Aerosol inhaler, 2 mg per dose CfC-free ................................................... 23.20 112 dose oP (28.07) tilade

SodiUm cRomoglycAte

SodiuM CRoMoglyCAte Aerosol inhaler, 5 mg per dose CfC-free ................................................... 23.20 112 dose oP (28.07) Powder for inhalation, 20 mg per dose...................................................... 16.31 50 (17.94) Vicrom intal Spincaps

inhAled betA-AdRenocePtoR AgoniStS - meteRed doSe inhAleRS low dose

SAlbutAMol - Available on a PSo Aerosol inhaler, 100 µg per dose CfC-free.................................................. 4.00 200 dose oP (6.00) ✓ Salamol Ventolin

inhAled betA-AdRenocePtoR AgoniStS - bReAth ActiVAted deViceS high dose

teRbutAline SulPHAte Powder for inhalation, 250 µg per dose, breath activated .......................... 18.20 200 dose oP ✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

✓ Bricanyl turbuhaler

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

inhaled beta-Adrenoceptor Agonists - long Acting

ReSPiRAtoRy SyStem And AlleRgieS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

inhAled betA-AdRenocePtoR AgoniStS - long Acting

Prescribing guideline for Inhaled Long-Acting Beta-Adrenoceptor Agonists the addition of inhaled long-acting beta-adrenoceptor agonists (lAbAs) to inhaled corticosteroids is recommended: • for younger children (aged under 12 years) where asthma is poorly controlled despite using inhaled corticosteroids for at least three months at total daily doses of 200 µg beclomethasone or budesonide (or 100 µg fluticasone). • for adults and older children (aged 12 years and over) where asthma is poorly controlled despite using inhaled corticosteroids for at least three months at total daily doses of 400 µg beclomethasone or budesonide (or 200 µg fluticasone). note: further information on the place of inhaled corticosteroids and inhaled lAbAs in the management of asthma can be found in the new Zealand guidelines for asthma in adults (www.nzgg.org.nz) and in the new Zealand guidelines for asthma in children aged 1-15 (www.paediatrics.org.nz). efoRMoteRol fuMARAte – See Prescribing guideline above Powder for inhalation, 6 µg per dose, breath activated .............................. 16.90 60 dose oP Powder for inhalation, 12 µg per dose, and monodose device .....................35.80 60 doses SAlMeteRol - See Prescribing guideline above Aerosol inhaler, 25 µg per dose ................................................................ 26.46 120 dose oP Powder for inhalation, 50 µg per dose, breath activated ............................ 26.46 60 dose oP ✓ oxis turbuhaler ✓ Foradil ✓ Serevent ✓ Serevent Accuhaler

inhaled corticosteroids with long-acting beta-adrenoceptor agonists

Special Authority for Subsidy – form: SA0838 initial Application only from a relevant specialist or general Practitioner. Approvals valid for 2 years for applications meeting the following criteria: either: 1 All of the following: 1.1 Patient is a child under the age of 12; and 1.2 All of the following: Has, for 3 months or more, been treated with: 1.2.1 An inhaled long-acting beta adrenoceptor agonist; and 1.2.2 inhaled corticosteroids at a dose of at least 400 µg per day beclomethasone or budesonide, or 200 µg per day fluticasone; and 1.3 the prescriber considers that the patient would receive additional clinical benefit from switching to a combination product; or 2 All of the following: 2.1 Patient is over the age of 12; and 2.2 All of the following: Has, for 3 months or more, been treated with: 2.2.1 An inhaled long-acting beta adrenoceptor agonist; and 2.2.2 inhaled corticosteroids at a dose of at least 800 µg per day beclomethasone or budesonide, or 500 µg per day fluticasone; and 2.3 the prescriber considers that the patient would receive additional clinical benefit from switching to a combination product. Renewal only from a relevant specialist or general Practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

ReSPiRAtoRy SyStem And AlleRgieS

inhaled beta-Adrenoceptor Agonists - long Acting inhaled beta-Adrenoceptor Agonists - nebuliser Solutions inhaled Anticholinergic Agents - breath Activated devices

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer budeSonide WitH efoRMoteRol - Special Authority - Retail pharmacy Powder for inhalation 100 µg with eformoterol fumarate 6 µg ................... 55.00 120 dose oP Powder for inhalation 200 µg with eformoterol fumarate 6 µg ................... 60.00 120 dose oP Powder for inhalation 400 µg with eformoterol fumarate 12 µg................. 60.00 60 dose oP no more than 2 doses per day flutiCASone WitH SAlMeteRol - Special Authority - Retail pharmacy Aerosol inhaler 50 µg with salmeterol 25 µg ............................................. 37.48 Aerosol inhaler 125 µg with salmeterol 25 µg ........................................... 49.69 Powder for inhalation 100 µg with salmeterol 50 µg ................................. 37.48 no more than 2 doses per day Powder for inhalation 250 µg with salmeterol 50 µg ................................. 49.69 no more than 2 doses per day 120 dose oP 120 dose oP 60 dose oP 60 dose oP ✓ Symbicort turbuhaler 100/6 ✓ Symbicort turbuhaler 200/6 ✓ Symbicort turbuhaler 400/12 ✓ Seretide ✓ Seretide ✓ Seretide Accuhaler ✓ Seretide Accuhaler

inhAled betA-AdRenocePtoR AgoniStS - nebUliSeR SolUtionS low dose

SAlbutAMol - Available on a PSo nebuliser soln, 1 mg per ml, 2.5 ml ............................................................ 4.83 20 ✓ ventolin nebules

high dose

SAlbutAMol - Available on a PSo nebuliser soln, 2 mg per ml, 2.5 ml ............................................................ 5.10 20 ✓ ventolin nebules

inhAled AnticholineRgic AgentS - bReAth ActiVAted deViceS

tiotRoPiuM bRoMide – Special Authority – Retail pharmacy Powder for inhalation, dose device, 18 µg per dose ...................................................................................... 70.00 30 dose ✓ Spiriva

Special Authority for Subsidy – form: SA0758 initial application only from a general practitioner or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 1 to be used for the long-term maintenance treatment of bronchospasm and dyspnoea associated with CoPd; and 2 in addition to standard treatment, the patient has trialled a dose of at least 40 µg ipratropium q.i.d for one month; and 3 The patient’s breathlessness ≥ grade 4 according to the Medical Research Council (UK) dyspnoea scale (see note). grade must be stated on the application; and 4 feV1 < 40% of predicted (actual result and predicted value to be stated on form); and 5 either: 5.1 Patient is not a smoker; or 5.2 Patient is a smoker and been offered smoking cessation counselling; and 6 the patient has been offered annual influenza immunisation. Renewal only from a general practitioner or relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: All of the following: 7 Patient is compliant with the medication; and 8 Patient has experienced improved CoPd symptom control (prescriber determined); and 9 Applicant must supply recent measurement of feV1 (% of predicted). Value to be stated on form. continued…

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

inhaled Anticholinergic Agents - breath Activated devices beta-Adrenoceptor Agonists - long-acting tablets

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… note grade 4 = stops for breath after walking about 100 metres or after a few minutes on the level; grade 5 = too breathless to leave the house, or breathless when dressing or undressing

ReSPiRAtoRy SyStem And AlleRgieS

inhAled AnticholineRgic AgentS - meteRed doSe inhAleRS low dose

iPRAtRoPiuM bRoMide Aerosol inhaler, 20 µg per dose CfC-free.................................................. 16.20 200 dose oP ✓ Atrovent

inhAled AnticholineRgic AgentS - nebUliSeR SolUtionS low dose

iPRAtRoPiuM bRoMide - Available on a PSo nebuliser soln, 250 µg per 1 ml, 1 ml ......................................................... 5.50 20 ✓ Steri-neb

high dose

iPRAtRoPiuM bRoMide - Available on a PSo nebuliser soln, 500 µg per 2 ml, 2 ml ......................................................... 6.50 20 ✓ Steri-neb

inhAled betA-AdRenocePtoR AgoniSt And AnticholineRgic AgentS - mdi

SAlbutAMol WitH iPRAtRoPiuM bRoMide Aerosol inhaler, 100 µg with ipratropium bromide, 20 µg per dose .................................................... 12.19 200 dose oP ✓ combivent

inhAled betA-AdRenocePtoR AgoniSt And AnticholineRgic AgentS - nebUliSeR SolUtion Salbutamol

SAlbutAMol WitH iPRAtRoPiuM bRoMide - Available on a PSo nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per 2.5 ml vial, 2.5 ml ................................. 5.30 20 ✓ duolin

betA-AdRenocePtoR AgoniStS - long-Acting tAbletS low dose

SAlbutAMol tab long-acting 4 mg................................................................................ 11.18 56 ✓ volmax

high dose

SAlbutAMol tab long-acting 8 mg................................................................................ 15.30 56 ✓ volmax

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

beta-Adrenoceptor Agonists - oral liquids cystic fibrosis

ReSPiRAtoRy SyStem And AlleRgieS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

betA-AdRenocePtoR AgoniStS - oRAl liQUidS

SAlbutAMol ‡ oral liq 2 mg per 5 ml ................................................................................. 2.45 150 ml ✓ Salapin

betA-AdRenocePtoR AgoniStS - injection

SAlbutAMol inj 500 µg per ml, 1 ml - Available on a PSo............................................. 12.90 infusion 1 mg per ml, 5 ml ...................................................................... 118.38 (130.21) teRbutAline SulPHAte inj 500 µg per ml, 1 ml ............................................................................. 10.21 5 10 ✓ ventolin Ventolin 5 ✓ Bricanyl

theoPhylline deRiVAtiVeS

AMinoPHylline ❋ inj 25 mg per ml, 10 ml - Available on a PSo ............................................ 12.84 tHeoPHylline ❋ tab long-acting 250 mg............................................................................ 21.51 ❋ tab long-acting 350 mg............................................................................ 29.28 ❋‡oral liq 80 mg per 15 ml ............................................................................. 4.06 (15.50) 5 100 100 500 ml ✓ Mayne ✓ nuelin-Sr ✓ nuelin-Sr nuelin

coUgh PRePARAtionS

for codeine phosphate linctus diabetic and linctus paediatric refer page 164

cyStic fibRoSiS

doRnASe AlfA - Special Authority nebuliser soln, 2.5 mg per 2.5 ml ampoule............................................. 294.30 6 ✓ Pulmozyme

Special Authority - Hospital pharmacy [HP1] a) dornase alfa will be subsidised for patients meeting the treatment guidelines and who are approved by the Cystic fibrosis Advisory Panel. Application details may be obtained from: the Co-ordinator Phone: (04) 460 4990 Cystic fibrosis Advisory Panel facsimile: (04) 916 7571 PHARMAC, Po box 10 254 email: erin.murphy@pharmac.govt.nz Wellington b) Prescriptions for patients approved for treatment must be written by respiratory physicians or paediatricians who have experience and expertise in treating cystic fibrosis.

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

ReSPiRAtoRy SyStem And AlleRgieS

nasal Preparations Respiratory devices

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

nASAl PRePARAtionS Allergy Prophylactics

beCloMetHASone diPRoPionAte Metered aqueous nasal spray, 50 µg per dose........................................... 2.35 200 dose oP Metered aqueous nasal spray, 100 µg per dose......................................... 2.46 200 dose oP budeSonide Metered aqueous nasal spray, 50 µg per dose............................................ 2.35 200 dose oP Metered aqueous nasal spray, 100 µg per dose......................................... 2.61 200 dose oP iPRAtRoPiuM bRoMide Aqueous nasal spray, 0.03% .................................................................... 11.79 15 ml oP ✓ Alanase ✓ Alanase ✓ Butacort Aqueous ✓ Butacort Aqueous ✓ Atrovent nasal Aqueous

SodiuM CRoMoglyCAte nasal spray, 4%........................................................................................ 16.08 22 ml oP (28.19)

Rynacrom forte

ReSPiRAtoRy deViceS

PeAK floW MeteRS a) only on a WSo b) Maximum of 10 per WSo low range ................................................................................................ 14.90 normal range ............................................................................................ 14.90 SPACeR deViCeS And MASKS - only on a WSo a) only on a WSo b) Maximum of 5 per WSo Spacer device ........................................................................................... 12.50 Mask, size 2 ............................................................................................... 4.10 a) b) c) d)

1 oP 1 oP

✓ Breath-Alert ✓ Breath-Alert

✓ Space chamber ✓ Foremount child’s Silicone Mask Spacer devices and masks also available to paediatricians employed by a dHb on a wholesale supply order signed by the paediatrician. limited to one pack of 20 per order. orders via a hospital pharmacy. only available for children aged six years and under. for Space Chamber and foremount Child’s Silicone Mask wholesale supply order must indicate clearly if either the spacer device, the mask, or both are required. distributed by Airflow Products. forward orders to: Airflow Products telephone: 04 499 1240 or 0800 AiR floW Po box 1485, Wellington facsimile: 04 499 1245 or 0800 323 270

oP oP

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

s three months supply may be dispensed at one time

if endorsed “certified exemption” by the prescriber.

SenSoRy oRgAnS

ear Preparations ear/eye Preparations eye Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

eAR PRePARAtionS

ACetiC ACid WitH 1, 2-PRoPAnediol diACetAte And benZetHoniuM ear drops 2% with 1, 2-propanediol diacetate 3% and benzethonium chloride 0.02%.................................................................. 6.39 for Vosol ear drops with hydrocortisone powder refer page 164 CHloRAMPHeniCol ear drops 0.5% ........................................................................................... 1.87 5 ml oP ✓ chloromycetin 35 ml oP ✓ vosol

fluMetASone PiVAlAte ear drops 0.02% with clioquinol 1% ............................................................ 4.46 7.5 ml oP (4.65) tRiAMCinolone ACetonide WitH gRAMiCidin, neoMyCin And nyStAtin ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g ......................................... 3.35

locorten-Vioform

7.5 ml oP

✓ kenacomb

eAR/eye PRePARAtionS

dexAMetHASone WitH fRAMyCetin And gRAMiCidin Retail pharmacy – specialist when used in the treatment of eye conditions ear/eye drops 500 µg with framycetin sulphate 5 mg and gramicidin 50 µg per ml ......................................................................... 4.50 (9.27) fRAMyCetin SulPHAte ear/eye drops 0.5% .................................................................................... 4.13 (8.65)

8 ml oP Sofradex 8 ml oP Soframycin

eye PRePARAtionS Anti-infective Preparations

See also Corticosteroids & other Anti-inflammatory Preparations, page 155 ACiCloViR - Retail pharmacy-specialist ❋ eye oint 3% .............................................................................................. 37.53 CHloRAMPHeniCol eye drops 0.5% .......................................................................................... 1.40 eye oint 1%................................................................................................. 2.48 4.5 g oP 10 ml oP 4 g oP ✓ Zovirax ✓ chlorsig ✓ chlorsig

CiPRofloxACin - Retail pharmacy-specialist prescription eye drops 0.3% ........................................................................................ 12.43 5 ml oP ✓ ciloxan a) Specialist must be an ophthalmologist. b) for treatment of bacterial keratitis or severe bacterial conjunctivitis resistant to chloramphenicol. dibRoMoPRoPAMidine iSetHionAte ❋ eye oint 0.15% .......................................................................................... 2.97 (7.99) fuSidiC ACid eye drops 1% ............................................................................................. 4.50 (9.10) gentAMiCin SulPHAte - Retail pharmacy-specialist eye drops 0.3% ....................................................................................... 11.40 5 g oP brolene 5 g oP fucithalmic 5 ml oP ✓ genoptic

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

SenSoRy oRgAnS

eye Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer PRoPAMidine iSetHionAte ❋ eye drops 0.1% .......................................................................................... 2.97 10 ml oP (7.99) SulPHACetAMide SodiuM ❋ eye drops 10% ........................................................................................... 3.60 4.41 tobRAMyCin - Retail pharmacy-specialist eye drops 0.3% ....................................................................................... 11.48 eye oint 0.3%............................................................................................ 10.45 15 ml oP 15 ml oP 5 ml oP 3.5 g oP

brolene ✓ Acetopt ✓ Bleph 10 ✓ tobrex ✓ tobrex

corticosteroids and other Anti-inflammatory Preparations

dexAMetHASone - Retail pharmacy-specialist ❋ eye drops 0.1% ......................................................................................... 4.50 ❋ eye oint 0.1%.............................................................................................. 5.86 5 ml oP 3.5 g oP ✓ Maxidex ✓ Maxidex

dexAMetHASone WitH neoMyCin And PolyMyxin b SulPHAte - Retail pharmacy-specialist ❋ eye drops 0.1% with neomycin sulphate 0.35% and polymyxin b sulphate 6,000 u per ml ................................................ 4.50 5 ml oP ✓ Maxitrol ❋ eye oint 0.1% with neomycin sulphate 0.35% and polymyxin b sulphate 6,000 u per g .................................................. 5.39 3.5 g oP ✓ Maxitrol diClofenAC SodiuM - Retail pharmacy-specialist ❋ eye drops 1 mg per ml ............................................................................. 13.80 fluoRoMetHolone - Retail pharmacy-specialist ❋ eye drops 0.1% .......................................................................................... 4.30 leVoCAbAStine eye drops 0.5 mg per ml ............................................................................ 8.71 (11.26) lodoxAMide tRoMetAMol eye drops 0.1% .......................................................................................... 8.71 PRedniSolone ACetAte - Retail pharmacy-specialist ❋ eye drops 0.12% ........................................................................................ 4.50 (7.53) ❋ eye drops 1% ............................................................................................. 4.50 (9.44) SodiuM CRoMoglyCAte eye drops 2% ............................................................................................. 3.29 5 ml oP 5 ml oP 4 ml oP livostin 10 ml oP 5 ml oP Pred Mild 5 ml oP Pred forte 10 ml oP ✓ cromolux ✓ Lomide ✓ voltaren ophtha ✓ Flucon

glaucoma Preparations – beta blockers

betAxolol HydRoCHloRide - Retail pharmacy-specialist ❋ eye drops 0.25% ...................................................................................... 11.80 ❋ eye drops 0.5% .......................................................................................... 7.50 leVobunolol - Retail pharmacy-specialist ❋ eye drops 0.25% ........................................................................................ 7.00 ❋ eye drops 0.5% .......................................................................................... 7.00 tiMolol MAleAte - Retail pharmacy-specialist ❋ eye drops 0.25%, gel forming ..................................................................... 5.30 ❋ eye drops 0.25% ........................................................................................ 2.37 ❋ eye drops 0.5%, gel forming ....................................................................... 5.78 ❋ eye drops 0.5% ......................................................................................... 2.29 ‡ safety cap ❋ three months or six months, as applicable, dispensed all-at-once

5 ml oP 5 ml oP 5 ml oP 5 ml oP 2.5 ml oP 5 ml oP 2.5 ml oP 5 ml oP

✓ Betoptic S ✓ Betoptic ✓ Betagan ✓ Betagan ✓ timoptol xE ✓ Apo-timop ✓ timoptol xE ✓ Apo-timop

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

SenSoRy oRgAnS

eye Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

glaucoma Preparations – carbonic Anhydrase inhibitors

ACetAZolAMide ❋ tab 250 mg ................................................................................................ 8.75 bRinZolAMide s eye drops 1% ............................................................................................. 9.77 See Prescribing guidelines below. doRZolAMide HydRoCHloRide - Retail pharmacy-specialist ❋ eye drops 2% ............................................................................................. 9.77 (13.95) See prescribing guidelines below. 100 5 ml oP ✓ diamox ✓ Azopt

5 ml oP trusopt

doRZolAMide HydRoCHloRide WitH tiMolol MAleAte - Retail pharmacy-specialist ❋ eye drops 2% with timolol maleate 0.5%................................................... 18.50 5 ml oP

✓ cosopt

Prescribing guidelines trusopt, Cosopt and Azopt are subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. trusopt, Cosopt and Azopt should not be prescribed for a person in whom less expensive first line agents for the treatment of glaucoma are not contraindicated unless: a) that person has previously trialled all other such subsidised agents (except brimonidine tartrate); and b) those trials have indicated that that person does not respond adequately to treatment with those other agents.

glaucoma Preparations – Prostaglandin Analogues

Prescribing guideline bimatoprost, lantanoprost and travoprost are subsidised for use in the treatment of glaucoma as either monotherapy or as an adjunctive agent for patients in whom prostaglandin analogue monotherapy has been ineffective in controlling intraocular pressure. bimatoprost, lantanoprost and travoprost should not be prescribed for a person in whom less expensive first line agents for the treatment of glaucoma are not contraindicated unless: 1 that person has previously trialled all other such subsidised agents (beta-blockers, pilocarpine, carbonic anhydrase inhibitors); and 2 those trials have indicated that that person does not respond adequately to treatment with those other agents. biMAtoPRoSt - Retail pharmacy - specialist - See Prescribing guideline s eye drops 0.03% ...................................................................................... 19.50 3 ml oP ✓ Lumigan

lAtAnoPRoSt - Retail pharmacy - specialist - See Prescribing guideline s eye drops 50 µg per ml, 2.5 ml ................................................................ 19.50 2.5 ml oP (24.18) tRAVoPRoSt - Retail pharmacy - specialist - See Prescribing guidelines s eye drops 0.004% .................................................................................... 19.50 2.5 ml oP

xalatan ✓ travatan

glaucoma Preparations – other

bRiMonidine tARtRAte - Retail pharmacy-specialist ❋ eye drops 0.2% ........................................................................................ 14.00 5 ml oP ✓ Alphagan

Prescribing guidelines Alphagan is subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Alphagan should not be prescribed for a person in whom less expensive first line agents for the treatment of glaucoma are not contraindicated unless: a) that person has previously trialled all other such subsidised agents (except dorzolamide hydrochloride); and b) those trials have indicated that that person does not respond adequately to or does not tolerate treatment with those other agents. ✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

SenSoRy oRgAnS

eye Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer bRiMonidine tARtRAte WitH tiMolol MAleAte – Retail pharmacy-specialist s eye drops 0.2% with timolol maleate 0.5%................................................ 18.50 5 ml oP ✓ combigan Prescribing guideline Combigan is subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Combigan should only be prescribed when: a) less expensive first line agents for the treatment of glaucoma are contraindicated; or b) the response to such subsidised agents is inadequate; or c) the patient cannot tolerate such subsidised agents. CARbACHol - Retail pharmacy-specialist ❋ eye drops 1.5% .......................................................................................... 6.82 ❋ eye drops 3% ............................................................................................. 6.99 (Isopto Carbachol eye drops 1.5% to be delisted 1 January 2007) diPiVefRin HydRoCHloRide - Retail pharmacy-specialist s eye drops 0.1% .......................................................................................... 5.50 (Propine eye drops 0.1% to be delisted 1 February 2007) PiloCARPine ❋ eye drops 0.5% .......................................................................................... 3.19 ❋ eye drops 1% ............................................................................................. 3.24 ❋ eye drops 2% ............................................................................................. 4.32 ❋ eye drops 3% ............................................................................................. 6.41 ❋ eye drops 4% ............................................................................................. 6.57 ❋ eye drops 6% ............................................................................................. 8.56 ❋ eye drops 2%, single dose - Special Authority - Hospital pharmacy [HP3] ........ 31.95 (32.72) 15 ml oP 15 ml oP Isopto carbachol Isopto carbachol

10 ml oP

✓ Propine

15 ml oP 15 ml oP 15 ml oP 15 ml oP 15 ml oP 15 ml oP 20 dose

✓ Pilopt ✓ Pilopt ✓ Pilopt ✓ Pilopt ✓ Pilopt ✓ Pilopt Minims

Special Authority for Subsidy - form: SA0121 initial application from any medical practitioner. Approvals valid for 2 years for applications meeting the following criteria: either: 1 Patient has to use an unpreserved solution due to an allergy to the preservative; or 2 Patient wears soft contact lenses. note Minims for a general practice are considered to be “tools of trade” and are not approved as special authority items. Renewal from any medical practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment.

mydriatics and cycloplegics

AtRoPine SulPHAte ❋ eye drops 0.5% ......................................................................................... 4.02 ❋ eye drops 1% ............................................................................................ 4.01 (Atropt eye drops 0.5% to be delisted 1 April 2007) CyCloPentolAte HydRoCHloRide ❋ eye drops 1% ............................................................................................. 8.76 HoMAtRoPine HydRobRoMide ❋ eye drops 2% ............................................................................................. 7.18 ❋ eye drops 5% ............................................................................................ 8.73 (Isopto Homatropine eye drops 5% to be delisted 1 January 2007) tRoPiCAMide ❋ eye drops 0.5% ......................................................................................... 7.15 ❋ eye drops 1% ............................................................................................. 8.66 15 ml oP 15 ml oP ✓ Atropt ✓ Atropt

15 ml oP 15 ml oP 15 ml oP

✓ cyclogyl ✓ Isopto Homatropine ✓ Isopto Homatropine

15 ml oP 15 ml oP

✓ Mydriacyl ✓ Mydriacyl

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

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

SenSoRy oRgAnS

eye Preparations

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Preparations for tear deficiency

for acetylcysteine eye drops refer page 164 HyPRoMelloSe ❋ eye drops 0.3% .......................................................................................... 2.62 ❋ eye drops 0.5% .......................................................................................... 1.79 ❋ eye drops 1% ............................................................................................. 1.91 (Methopt Forte eye drops 1% to be delisted 1 January 2007) PolyVinyl AlCoHol ❋ eye drops 1.4% .......................................................................................... 3.62 ❋ eye drops 3% ............................................................................................. 3.88 PolyVinyl AlCoHol WitH PoVidone ❋ eye drops 1.4% with povidone 0.6% ........................................................... 3.62 tyloxAPol ❋ eye drops 0.25% ........................................................................................ 8.63 15 ml oP 15 ml oP 15 ml oP ✓ Poly-tears ✓ Methopt ✓ Methopt Forte

15 ml oP 15 ml oP 15 ml oP 15 ml oP

✓ Liquifilm tears ✓ Liquifilm Forte ✓ tears Plus ✓ Enuclene

other eye Preparations

nAPHAZoline HydRoCHloRide ❋ eye drops 0.1% .......................................................................................... 4.15 PARAffin liQuid WitH Soft WHite PARAffin ❋ eye oint with soft white paraffin .................................................................. 3.63 PARAffin liQuid WitH Wool fAt liQuid ❋ eye oint 3% with wool fat liq 3% ................................................................. 3.63 15 ml oP 3.5 g oP 3.5 g oP ✓ naphcon Forte ✓ Lacri-Lube ✓ Poly-visc ✓ Isopto Frin Prefrin ✓ Zincfrin

PHenylePHRine HydRoCHloRide ❋ eye drops 0.12% ........................................................................................ 3.25 15 ml oP (4.18) PHenylePHRine HydRoCHloRide WitH ZinC SulPHAte ❋ eye drops 0.12% with zinc sulphate 0.25% ................................................ 4.51 15 ml oP

✓ fully subsidised [HP1], [HP3], [HP4] refer page 10

S29

unapproved Medicines Supplied under Section 29 Sole Subsidised Supply

Agents Used in the treatment of Poisonings detection of Substances in Urine

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

VARioUS

AgentS USed in the tReAtment of PoiSoningS

Refer also to MuSCulo-SKeletAl, Anticholinesterases, page 104 CHARCoAl ❋ tab 300 mg ................................................................................................ 7.13 ❋ oral liq 50 g per 300 ml – only on a PSo .................................................. 19.95 ❋ oral liq 50 g per 250 ml – only on a PSo .................................................. 19.95 100 300 ml oP 250 ml oP ✓ red Seal ✓ carbosorb ✓ carbosorb-x S29

note: because activated charcoal is used in acute poisonings, patient details required under Section 29 of the Medicines Act may be retrospectively provided to the supplier. deSfeRRioxAMine MeSylAte - Hospital pharmacy [HP3] ❋ inj 500 mg ................................................................................................ 99.00 iPeCACuAnHA ❋ tincture .................................................................................................... 41.20 (43.40) nAloxone HydRoCHloRide - only on a PSo ❋ inj 400 µg per ml, 1 ml ............................................................................. 27.00 SodiuM CAlCiuM edetAte ❋ inj 200 mg per ml, 5 ml ............................................................................ 53.31 (55.99) 10 500 ml PSM 5 6 Calcium disodium Versenate ✓ Mayne ✓ Mayne

detection of SUbStAnceS in URine

oRtHo-tolidine ❋ Compound diagnostic sticks ....................................................................... 7.50 50 stick oP (8.25) tetRAbRoMoPHenol ❋ blue diagnostic strips.................................................................................. 7.02 100 strip oP (13.92) Hemastix

Albustix

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

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

Section c eXtemPoRAneoUSly comPoUnded PRePARAtionS & gAlenicAlS

intRodUction

• • • • Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

the following extemporaneously compounded products are eligible for subsidy:

the “Standard formulae”. oral liquid mixtures for patients unable to swallow subsidised solid dose oral formulations. the preparation of syringe drivers when prescribed by a general practitioner. dermatological preparations; - one or more subsidised dermatological galenical(s) in a subsidised dermatological base. - dilution of proprietary topical Corticosteroid-Plain preparations with a dermatological base (Retail pharmacyspecialist). - Menthol crystals only in the following bases: Aqueous cream urea cream 10% Wool fat with mineral oil lotion Hydrocortisone 1% with wool fat and mineral oil lotion glycerol, paraffin and cetyl alcohol lotion.

glossary

dermatological base: the products listed in the barrier creams and emollients section and the topical Corticosteroids-Plain section of the Pharmaceutical Schedule are classified as dermatological bases for the purposes of extemporaneous compounding and are the bases to which the dermatological galenicals can be added. Also the dermatological bases in the barrier Creams and emollients section of the Pharmaceutical Schedule can be used for diluting proprietary topical Corticosteroid-Plain preparations. the following products are dermatological bases: • Aqueous cream • Cetomacrogol cream bP • emulsifying ointment bP • glycerol with paraffin and cetyl alcohol lotion • Hydrocortisone with wool fat and mineral oil lotion • oil in water emulsion • oily cream • urea cream 10% • White soft paraffin • Wool fat with mineral oil lotion • Zinc cream bP • Zinc and castor oil ointment bP • Proprietary topical Corticosteroid-Plain preparations

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

eXtemPoRAneoUSly comPoUnded PRePARAtionS & gAlenicAlS

Subsidy fully brand or dermatological galenical: dermatological galenicals will only be subsidised when addedSubsidised genericbase. More than to a dermatological (Manufacturer’s Price) one dermatological galenical can be added to a dermatological base. $ Per ✓ Manufacturer the following are dermatological galenicals: • Coal tar solution bP – up to 10% • Hydrocortisone powder – up to 5% • Salicylic acid powder • Sulphur precipitated powder Standard formulae: Standard formulae are a list of fomulae for eCPs that are subsidised. their ingredients are listed under the appropriate therapeutic heading in Section b of the Pharmaceutical Schedule and also in Section C.

Explanatory notes

oral liquid mixtures

oral liquid mixtures are subsidised for patients unable to swallow subsidised solid oral dose forms where no suitable alternative proprietary formulation is subsidised. Suitable alternatives include dispersible and sublingual formulations, oral liquid formulations or rectal formulations. before extemporaneously compounding an oral liquid mixture, other alternatives such as dispersing the solid dose form (if appropriate) or crushing the solid dose form in jam, honey or soft foods such as yoghurt should be explored. Subsidy for extemporaneously compounded oral liquid mixtures is based on: Solid dose form qs Preservative qs Suspending agent qs Water to 100% Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients such as flavouring and colouring agents, but these extra ingredients will not be reimbursed. the subsidised ingredients in the formula will be reimbursed and a compounding fee paid. the majority of extemporaneously compounded oral liquid mixtures should contain a preservative and suspending agent. Methylcellulose 3% is considered a suitable suspending agent and compound hydroxybenzoate solution or methyl hydroxybenzoate 10% solution are considered to be suitable preservatives. usually 1 ml of these preservative solutions is added to 100 ml of oral liquid mixture. Some solid oral dose forms are not appropriate for compounding into oral liquid mixtures and should therefore not be used/ considered for extemporaneously compounded oral liquid mixtures. this includes long-acting solid dose formulations, enteric coated tablets or capsules, sugar coated tablets, hard gelatin capsules and chemotherapeutic agents. the following practices will not be subsidised: • Mixing one or more proprietary oral liquids (eg an antihistamine with pholcodine linctus). • extemporaneously compounding an oral liquid with more than one solid dose chemical. • Mixing more than one extemporaneously compounded oral liquid mixture. • Mixing one or more extemporaneously compounded oral liquid mixtures with one or more proprietary oral liquids. • the addition of a chemical/powder/agent/solution to a proprietary oral liquid or extemporaneously compounded oral mixture.

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

eXtemPoRAneoUSly comPoUnded PRePARAtionS & gAlenicAlS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer A list of standard formulae is contained in this section. All ingredients associated with a standard formula will be subsidised and an appropriate compounding fee paid. Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients, but these extra ingredients will not be reimbursed. the subsidised ingredients in the formula will be reimbursed and a compounding fee paid.

Standard formulae

dermatological Preparations

Proprietary topical corticosteroid preparations may be diluted with a dermatological base (see page 160) from the barrier Creams and emollients section of the Pharmaceutical Schedule (Retail pharmacy-Specialist). dilution of proprietary topical corticosteroid preparations should only be prescribed for withdrawing patients off higher strength proprietary topical corticosteroid products where there is no suitable proprietary product of a lower strength available or an extemporaneously compounded product with up to 5% hydrocortisone is not appropriate. (in general proprietary topical corticosteroid preparations should not be diluted because dilution effects can be unpredictable and may not be linear, and usually there is no stability data available for diluted products). one or more dermatological galenicals may be added to a dermatological base (including proprietary topical corticosteroid preparations). Prescribers may prescribe or pharmacists may add extra non-subsidised ingredients, but these extra ingredients will not be reimbursed. the subsidised ingredients in the formula will be reimbursed and a compounding fee paid. the addition of dermatological galenicals to diluted proprietary topical Corticosteroids-Plain will not be subsidised. the flow diagram on page 163 may assist you in deciding whether or not a dermatological eCP is subsidised.

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

eXtemPoRAneoUSly comPoUnded PRePARAtionS & gAlenicAlS

Dermatological ECPs

is it subsidised?

no does the formula contain a subsidised dermatological base? yes is there only one dermatological base (e.g. aqueous cream)? yes is the galenical(s) a subsidised dermatological galenical? no yes entire product is nSS no

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

entire product is nSS

is the second base a proprietary topical corticosteriod-plain? no yes entire product is nSS

is prescription written by a specialist or on the recommendation of a specialist? no yes entire product is nSS

this part of the product is subsidised

Has a non-subsidised ingredient been added: e.g. glycerol? yes the non-subsidised ingredient is not subsidised but the rest is

Has a dermatological galenical or other nonsubsidised ingredient been added? yes the dermatological galenicals & nonsubsidised ingredients are nSS

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

eXtemPoRAneoUSly comPoUnded PRePARAtionS & gAlenicAlS

Standard Formulae

ACetylCySteine eye dRoPS Acetylcysteine inj 200 mg per ml, 10 ml Suitable eye drop base qs qs

Subsidy fully (Manufacturer’s Price) Subsidised $ Per ✓ PHenobARbitone oRAl liQuid Phenobarbitone Sodium glycerol bP Water

brand or generic Manufacturer 1g 70 ml to 100 ml

ASPiRin & CHloRofoRM APPliCAtion Aspirin Soluble tabs 300 mg 12 tabs Chloroform to 100 ml Codeine linCtuS PAediAtRiC (3 mg per 5 ml) Codeine phosphate 60 mg glycerol 40 ml Preservative qs Water to 100 ml Codeine linCtuS diAbetiC (15 mg per 5 ml) Codeine phosphate 300 mg glycerol 40 ml Preservative qs Water to 100 ml foliniC MoutHWASH Calcium folinate 15 mg tab 1 tab Preservative qs Water to 500 ml (Preservative should be used if quantity supplied is for more than 5 days. Maximum 500 ml per prescription.) MAgneSiuM HydRoxide MixtuRe Magnesium hydroxide paste 275 g Methyl hydroxybenzoate 1.5 g Water 770 ml (not subsidised as a laxative) MetHAdone MixtuRe Methadone powder glycerol Water qs qs to 100 ml

PiloCARPine oRAl liQuid Pilocarpine 6% eye drops qs Preservative qs Water to 500 ml (Preservative should be used if quantity supplied is for more than 5 days.) SAliVA SubStitute foRMulA Methylcellulose 5g Preservative qs Water to 500 ml (Preservative should be used if quanitity supplied is for more than 5 days. Maximum 500 ml per prescription.) VoSol eAR dRoPS WitH HydRoCoRtiSone PoWdeR 1% Hydrocortisone powder 1% Vosol ear drops to 35 ml

MetHyl HydRoxybenZoAte 10% Solution Methyl hydroxybenzoate 10 g Propylene glycol to 100 ml (use 1 ml of the 10% solution per 100 ml of oral liquid mixture.) oMePRAZole SuSPenSion omerprazole capsules qs Sodium bicarbonate powder bP 8.4 g Water to 100 ml

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

eXtemPoRAneoUSly comPoUnded PRePARAtionS & gAlenicAlS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer ACetylCySteine - Hospital pharmacy [HP1] - specialist inj 200 mg per ml, 10 ml ........................................................................ 137.06 (242.50) benZoin tincture compound bP ............................................................................. 24.42 (38.00) CHloRofoRM - only in combination Chloroform bP .......................................................................................... 21.30 (only in aspirin and chloroform application) (32.00) 10 Parvolex 500 ml PSM 500 ml PSM

Codeine PHoSPHAte Powder ..................................................................................................... 63.09 25 g (72.55) ‡ Safety caps for extemporaneously compounded oral liquid preparations. (only in extemporaneously compounded codeine linctus diabetic or codeine linctus paediatric) Collodion flexible ................................................................................... 14.60 (24.00) CoMPound HydRoxybenZoAte Solution .................................................................................................... 34.18 (only in extemporaneously compounded oral mixtures) 100 ml

douglas

PSM 100 ml ✓ david craig

glyCeRol - only in combination ❋ liquid ....................................................................................................... 24.75 2,000 ml ✓ MidWest (33.00) PSM (only in extemporaneously compounded methadone mixture, codeine linctus diabetic, codeine linctus paediatric or phenobarbitone oral liquid) MAgneSiuM HydRoxide Paste ........................................................................................................ 22.61 500 g ✓ PSM

MetHAdone HydRoCHloRide a) only on a controlled drug form. b) extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). Powder ....................................................................................................... 7.84 1g ✓ AFt ‡ Safety caps for extemporaneously compounded oral liquid preparations. MetHylCelluloSe Powder ..................................................................................................... 17.72 MetHylHydRoxybenZoAte ....................................................................... 15.62 (18.45) PHenobARbitone SodiuM Powder ................................................................................................... 325.00 a) only in combination b) only in children up to 12 years. PRoPylene glyCol .................................................................................... 16.20 (19.20) (only in extemporaneously compounded methylhydroxybenzoate 10% solution) SodiuM biCARbonAte - only in combination Powder bP................................................................................................ 11.99 (17.50) (only in extemporaneously compounded omeprazole suspension) WAteR tap ............................................................................................................ 0.00 ✓ fully subsidised 100 g 25 g PSM 100 g ✓ Midwest ✓ MidWest

500 ml PSM

500 g

✓ Biomed david Craig ✓ tap water

1 ml

[HP1], [HP3], [HP4] refer page 10

Section d: SPeciAl foodS

eXPlAnAtoRy noteS

the list of special foods to which Subsidies apply is contained in this section. the list of available products, guidelines for use, subsidies and charges is reviewed as required. Applications for new listings and changes to subsidies and access criteria will be considered by the special foods sub-committee of PtAC which meets as and when required. in all cases, subsidies are available by Special Authority only. this means that, unless a patient has a valid Special Authority number for their special food requirements, they must pay the full cost of the products themselves.

Eligibility for Special Authority

Special Authorities will be approved for patients meeting conditions specified under the Conditions and Guidelines for each product. in some cases there are also limits to how products can be prescribed (for example quantity, use or duration). only those brands, presentations and flavours of special foods listed in this section are subsidised.

Who can apply for Special Authority?

Initial applications: only specialists Reapplications: Specialist or general practitioner on recommendation of specialist. Reapplications by general practitioners on specialist recommendation must include the name of the specialist and the date the specialist was contacted. All applications must be made on an official form available from the PHARMAC website www.pharmac.govt.nz. All applications must include specific details as requested on the form relating to the application. A supporting letter may be included if desired. Applications must be forwarded to: HealthPAC Special Authorities Section Private bag 3015 Wanganui freefax 0800 100 131

Subsidies and manufacturer’s surcharges

the Subsidies for some special foods are based on the lowest priced product within each group. Where this is so, or where special foods are otherwise not fully subsidised, a manufacturer’s surcharge may be payable by the patient. the manufacturer’s surcharge is the difference between the price of the product and the subsidy attached to it and may be subject to mark-ups applied at a pharmacy level. As a result the manufacturer’s surcharge may vary. fully subsidised alternatives are available in most cases (as indicated by a tick in the left hand column). Patients should only have to pay a co-payment on these products.

Where are special foods available from?

distribution arrangements for special foods vary from region to region. Special foods are available from hospital pharmacies providing an outpatient dispensing service as well as retail pharmacies in the northern, Midland and Central (including nelson and blenheim) regions.

definitions

Failure to thrive An inability to gain or maintain weight resulting in physiological impairment. Growth deficiency Where the weight of the child is less than the fifth or possibly third percentile for their age, with evidence of malnutrition.

SPeciAl foodS

nutrient modules

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

nUtRient modUleS carbohydrate

Special Authority for Subsidy – form: SA0579 initial application - Cystic fibrosis or renal failure Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: either: 1) Cystic fibrosis; or 2) Chronic renal failure or continuous ambulatory peritoneal dialysis (CAPd) patient. initial application - indications other than cystic fibrosis or renal failure Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1) Cancer in children; or 2) Cancers affecting alimentary tract where there are malabsorption problems in patients over the age of 20 years; or 3) failure to thrive; or 4) growth deficiency; or 5) bronchopulmonary dysplasia; or 6) Premature and post premature infant Renewal - Cystic fibrosis or renal failure Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. Renewal - indications other than cystic fibrosis or renal failure Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. CARboHydRAte SuPPleMent - Hospital Pharmacy [HP3] - Special Authority Powder ..................................................................................................... 36.50 5,000 g 1.30 400 g oP (5.29) 1.14 350 g oP (7.85) 1.30 368 g oP (12.00) ✓ Morrex Maltodextrin Polycal Polycose Moducal

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

nutrient modules

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

carbohydrate and fat

Special Authority for Subsidy – form: SA0581 initial application - Cystic fibrosis Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) infant aged four years or under; and 2) Cystic fibrosis initial application - indications other than cystic fibrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) infant aged four years or under; and 2) Any of the following: 2.1) Cancer in children; or 2.2) failure to thrive; or 2.3) growth deficiency; or 2.4) bronchopulmonary dysplasia; or 2.5) Premature and post premature infants. Renewal - Cystic fibrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. Renewal - indications other than cystic fibrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. CARboHydRAte And fAt SuPPleMent - Hospital Pharmacy [HP3] - Special Authority Powder (neutral) ....................................................................................... 50.26 400 g oP ✓ duocal Super Soluble Powder

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

nutrient modules

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

fat

Special Authority for Subsidy – form: SA0580 initial application - inborn errors of metabolism Applications only from relevant specialist. Approvals valid for 3 years where the patient has inborn errors of metabolism initial application - indications other than inborn errors of metabolism Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1) failure to thrive ; or 2) growth deficiency; or 3) bronchopulmonary dysplasia ; or 4) fat malabsorption ; or 5) lymphangiectasia; or 6) Short bowel syndrome ; or 7) infants with necrotising enterocolitis; or 8) biliary atresia. Renewal - inborn errors of metabolism Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. Renewal - indications other than inborn errors of metabolism Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. fAt SuPPleMent - Hospital Pharmacy [HP3] - Special Authority emulsion (neutral)..................................................................................... 15.38 250 ml oP 30.75 500 ml oP 61.50 1,000 ml oP emulsion (strawberry) .............................................................................. 15.38 250 ml oP oil .......................................................................................................... 95.75 1,000 ml oP 25.00 500 ml oP 23.94 250 ml oP (Calogen emulsion (neutral) 1,000 ml OP to be delisted 1 January 2007) (Liquigen oil 1,000 ml OP to be delisted 1 April 2007) ✓ calogen ✓ calogen ✓ calogen ✓ calogen ✓ Liquigen ✓ Mct oil (nutricia) ✓ Liquigen

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

nutrient modules oral Supplements

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Protein

Special Authority for Subsidy – form: SA0582 initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: either: 1) Protein losing enteropathy; or 2) High protein needs (eg burns). Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. PRotein SuPPleMent - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 7.90 Powder (vanilla)........................................................................................ 12.90 225 g oP 275 g oP ✓ Protifar 90 ✓ Promod

oRAl SUPPlementS

these products are to be used only as supplements to a person’s dietary needs. Subsidy for up to 500 ml a day. Amounts prescribed in excess of this amount must be paid for by the patient. Special Authority for Subsidy – form: SA0583 initial application - Cystic fibrosis Applications only from relevant specialist. Approvals valid for 3 years where the patient has cystic fibrosis initial application - indications other than cystic fibrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1) Cancer in children; or 2) inflammatory bowel disease; or 3) Cancers affecting alimentary tract where there are malabsorption problems in patients over the age of 20 years; or 4) Malnutrition requiring nutritional support. Renewal - Cystic fibrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. Renewal - indications other than cystic fibrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted.

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

oral Supplements oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer oRAl SuPPleMent 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority Powder (chocolate) .................................................................................... 9.22 900 g oP ✓ Sustagen Hospital Formula ensure ensure ✓ nutridrink ✓ Sustagen Hospital Formula ensure

SPeciAl foodS

4.75 400 g oP (7.22) Powder (strawberry) ................................................................................... 4.75 400 g oP (7.22) Powder (vanilla)........................................................................................ 11.50 900 g oP 9.22 4.75 400 g oP (7.22)

oRAl SUPPlementS/comPlete diet (nASogAStRic/gAStRoStomy tUbe feed) Respiratory Products

Special Authority for Subsidy – form: SA0588 initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) CoRd patients who have hypercapnia; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. CoRd oRAl feed 1.5KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 1.66 237 ml oP ✓ Pulmocare

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

diabetic Products

Special Authority for Subsidy – form: SA0594 initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) type i and ii diabetics who require nutritional supplementation; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. diAbetiC enteRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 7.50 1,000 ml oP ✓ diason rtH ✓ glucerna rtH ✓ resource diabetic rtH ✓ resource diabetic ✓ diasip ✓ resource diabetic ✓ diasip ✓ glucerna ✓ resource diabetic

oRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid (chocolate) ....................................................................................... 1.78 liquid (strawberry) ..................................................................................... 1.50 1.78 liquid (vanilla) ............................................................................................ 1.50 1.88 1.78

237 ml oP 200 ml oP 237 ml oP 200 ml oP 250 ml oP 237 ml oP

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

SPeciAl foodS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

fat modified Products

Special Authority for Subsidy – form: SA0615 initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the product is to be used as a complete diet; and 2) either: 2.1) Patient has metabolic disorders of fat metabolism; or 2.2) Patient has chylothorax. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. fAt Modified feed - Hospital Pharmacy [HP3] - Special Authority Powder ..................................................................................................... 50.40 400 g oP ✓ Monogen

high Protein Products

Special Authority for Subsidy – form: SA0589 initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) Anorexia and weight loss; and 2) either: 2.1) decompensating liver disease without encephalopathy; or 2.2) Protein losing gastro-enteropathy; and 3) either: 3.1) the product is to be used as a supplement (maximum 500 ml per day); or 3.2) the product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. oRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 1.50 200 ml oP ✓ Fortimel

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Paediatric Products for children awaiting liver transplant

Special Authority for Subsidy – form: SA0607 initial application Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: both: 1) Child (up to 18 years) who is awaiting liver transplant; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet. Renewal Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet. enteRAl/oRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority Powder ..................................................................................................... 65.81 400 g oP ✓ generaid Plus

Paediatric Products for children with chronic Renal failure

Special Authority for Subsidy – form: SA0606 initial application Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: both: 1) Child (up to 18 years) with chronic renal failure; and 2) either: 2.1) the product is to be used as a supplement; or 2.2) the product is to be used as a complete diet. Renewal Applications only from paediatrician. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement; or 2.2) the product is to be used as a complete diet. enteRAl/oRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ....................................................................................................... 45.00 400 g oP ✓ kindergen

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

SPeciAl foodS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Paediatric Products

Special Authority for Subsidy – form: SA0590 initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) infant aged one to six years; and 2) Any of the following: 2.1) Any condition causing malabsorption ; or 2.2) failure to thrive; or 2.3) increased nutritional requirements; and 3) either: 3.1) the product is to be used as a supplement (maximum 500 ml per day); or 3.2) the product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. PAediAtRiC enteRAl feed 1.5KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 1.60 200 ml oP 6.00 500 ml oP PAediAtRiC enteRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 1.07 200 ml oP 2.68 500 ml oP 2.68 500 ml oP PAediAtRiC oRAl feed 1.5KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid (strawberry) ..................................................................................... 1.60 200 ml oP liquid (vanilla) ............................................................................................ 1.60 200 ml oP PAediAtRiC oRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid (chocolate) ....................................................................................... 1.27 237 ml oP liquid (strawberry) ..................................................................................... 1.27 liquid (vanilla) ............................................................................................ 1.27 237 ml oP 237 ml oP ✓ nutrini Energy rtH ✓ nutrini Energy rtH ✓ nutrini rtH ✓ nutrini rtH ✓ Pediasure rtH ✓ Fortini ✓ Fortini ✓ Pediasure ✓ resource Just for kids ✓ Pediasure ✓ Pediasure ✓ resource Just for kids

PAediAtRiC oRAl feed WitH fibRe 1.5KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid (chocolate) ....................................................................................... 1.60 200 ml oP ✓ Fortini Multifibre liquid (strawberry) ..................................................................................... 1.60 200 ml oP ✓ Fortini Multifibre liquid (vanilla) ............................................................................................ 1.60 200 ml oP ✓ Fortini Multifibre

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Renal Products

Special Authority for Subsidy – form: SA0587 initial application Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) Acute or chronic renal failure; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. enteRAl feed 2KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 6.08 RenAl oRAl feed 2KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 2.88 liquid (apricot) ........................................................................................... 2.88 liquid (caramel) ......................................................................................... 2.88 500 ml oP 237 ml oP 125 ml oP 125 ml oP ✓ nutrison concentrated ✓ nepro (vanilla) ✓ novaSource renal ✓ renilon 7.5 ✓ renilon 7.5

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

SPeciAl foodS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Specialised and elemental Products

Special Authority for Subsidy – form: SA0592 initial application Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) Any of the following: 1.1) Malabsorption; or 1.2) Short bowel syndrome; or 1.3) enterocutaneous fistulas; or 1.4) Pancreatitis; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet. note: each of these products is highly specialised and would be prescribed only by an expert for a specific disorder. the alternative is hospitalisation. elemental 028 extra is more expensive than other products listed in this section and should only be used where the alternatives have been tried first and/or are unsuitable. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. enteRAl/oRAl eleMentAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 7.50 76 g oP 4.40 79 g oP oRAl eleMentAl feed 0.8KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid (grapefruit) ....................................................................................... 8.70 250 ml oP liquid (pineapple & orange) ........................................................................ 8.70 250 ml oP liquid (summer fruit) .................................................................................. 8.70 250 ml oP oRAl eleMentAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority Powder (unflavoured) ................................................................................. 4.00 80.4 g oP SeMi-eleMentAl enteRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 6.02 500 ml oP 12.04 1,000 ml oP ✓ Alitraq ✓ vital Hn ✓ Elemental 028 Extra ✓ Elemental 028 Extra ✓ Elemental 028 Extra ✓ vivonex tEn ✓ Peptisorb ✓ Peptisorb

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Undyalised end Stage Renal failure

Special Authority for Subsidy – form: SA0586 initial application Applications only from gastroenterologist or renal physician. Approvals valid for 3 years for applications meeting the following criteria: both: 1) undialysed end stage renal patients; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet. note: Where possible, the requirements for oral supplementation should be established in conjunction with assessment by a dietician. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement (maximum 500 ml per day); or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. RenAl oRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 3.80 237 ml oP ✓ Suplena

Adult Products Standard

Special Authority for Subsidy – form: SA0702 initial application - oral feed for cystic fibrosis patient Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) Cystic fibrosis; and 2) either: 2.1) the product is to be used as a supplement; or 2.2) the product is to be used as a complete diet. initial application - oral feed for indications other than cystic fibrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) Any of the following: 1.1) Any condition causing malabsorption; or 1.2) failure to thrive; or 1.3) increased nutritional requirements; and 2) either: 2.1) the product is to be used as a supplement; or 2.2) the product is to be used as a complete diet. initial application - enteral feed Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) Any of the following: continued… 1.1 enteral feeding; or

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

SPeciAl foodS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer continued… 1.2) nasogastric; or 1.3) nasoduodenal ; or 1.4) nasojejunal; or 1.5) gastrostomy/jejunostomy; and 2) either: 2.1) the product is to be used as a supplement; or 2.2) the product is to be used as a complete diet. Renewal - oral feed cystic fibrosis patient Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement; or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. Renewal - enteral feed or oral feed for indications other than cystic fibrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) either: 2.1) the product is to be used as a supplement; or 2.2) the product is to be used as a complete diet; and 3) general Practitioners must include the name of the specialist and date contacted. note: this group of products can be used either as a supplement or as a complete diet. if a product is being used as a supplement, the limit is 500 ml per day. Cystic fibrosis patients are exempt the 500 ml per day volume restriction when using ensure Plus, fortisip or Resource Plus as a supplement. enteRAl feed 1KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 1.24 250 ml oP 2.65 500 ml oP 5.29 1,000 ml oP ✓ Isosource Standard ✓ nutrison Standard rtH ✓ Isosource Standard rtH ✓ nutrison Standard rtH ✓ osmolite rtH ✓ Fibresource ✓ nutrison Multi Fibre ✓ Fibresource rtH ✓ Jevity rtH ✓ nutrison Multi Fibre ✓ Ensure Plus rtH ✓ Isosource 1.5 ✓ nutrison Energy Multi Fibre ✓ Isosource 1.5 ✓ nutrison Energy Multi Fibre

enteRAl feed WitH fibRe 1 KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 1.24 250 ml oP 2.65 500 ml oP 5.29 1,000 ml oP

enteRAl feed WitH fibRe 1.5KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid ......................................................................................................... 7.00 1,000 ml oP 1.75 3.50 250 ml oP 500 ml oP

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer oRAl feed 1.5KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid (banana)........................................................................................... 1.12 200 ml oP (1.45) liquid (chocolate) ....................................................................................... 1.12 200 ml oP (1.45) 1.33 237 ml oP liquid (coffee) ............................................................................................ 1.33 liquid (fruit of the forest) ............................................................................ 1.12 (1.45) liquid (strawberry) ..................................................................................... 1.12 (1.45) 1.33 liquid (toffee) ............................................................................................. 1.12 liquid (tropical fruit).................................................................................... 1.12 liquid (vanilla) ............................................................................................ 1.12 (1.45) 1.33 237 ml oP 200 ml oP 200 ml oP 237 ml oP 200 ml oP 200 ml oP 200 ml oP 237 ml oP ✓ Fortisip ensure Plus ✓ Fortisip ensure Plus ✓ Ensure Plus ✓ resource Plus ✓ Ensure Plus ensure Plus ✓ Fortisip ensure Plus ✓ Ensure Plus ✓ resource Plus ✓ Fortisip ✓ Fortisip ✓ Fortisip ensure Plus ✓ Ensure Plus ✓ resource Plus ✓ Fortisip Multi Fibre ✓ Fortisip Multi Fibre ✓ Fortisip Multi Fibre

oRAl feed WitH fibRe 1.5KCAl/Ml- Hospital Pharmacy [HP3] - Special Authority liquid (vanilla) ............................................................................................ 1.12 200 ml oP liquid (chocolate) ....................................................................................... 1.12 200 ml oP liquid (strawberry) ..................................................................................... 1.12 200 ml oP

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

oral Supplements/complete diet (nasogastric/gastrostomy tube feed)

SPeciAl foodS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Adult Products high calorie

Special Authority for Subsidy – form: SA0585 initial application - Cystic fibrosis Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) Cystic fibrosis; and 2) other lower calorie products have been tried; and 3) Patient has substantially increased metabolic requirements; and 4) either: 4.1) the product is to be used as a supplement; or 4.2) the product is to be used as a complete diet. initial application - indications other than cystic fibrosis Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) Any of the following: 1.1) Any condition causing malabsorption; or 1.2) failure to thrive; or 1.3) increased nutritional requirements; and 2) other lower calorie products have been tried; and 3) Patient has substantially increased metabolic requirements; and 4) either: 4.1) the product is to be used as a supplement; or 4.2) the product is to be used as a complete diet. Renewal - Cystic fibrosis Applications only from relevant specialist or general practitioner (on the recommendation of a specialist). Approvals valid for 3 years for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted; and 3) either: 3.1) the product is to be used as a supplement; or 3.2) the product is to be used as a complete diet. Renewal - indications other than cystic fibrosis Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted; and 3) either: 3.1) the product is to be used as a supplement; or 3.2) the product is to be used as a complete diet. note: this product can be used either as a supplement or as a complete diet. if it is being used as a supplement, the limit is 500 ml per day. oRAl feed 2KCAl/Ml - Hospital Pharmacy [HP3] - Special Authority liquid (vanilla) ............................................................................................ 2.25 237 ml oP ✓ two cal Hn

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

food thickeners gluten free foods

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

food thicKeneRS

Special Authority for Subsidy – form: SA0595 initial application Applications only from relevant specialist. Approvals valid for 1 year where the patient has motor neurone disease with swallowing disorder. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. food tHiCKeneR - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 3.80 250 g oP 4.56 380 g oP (7.25) (Karicare Food Thickener 300 g OP to be delisted 1 June 2007) ✓ resource thicken up Karicare food thickener

glUten fRee foodS

Special Authority for Subsidy – form: SA0722 initial application Applications only from relevant specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria: either: 1) gluten enteropathy has been diagnosed by biopsy; or 2) Patient suffers from dermatitis herpetiformis. gluten fRee bAKing Mix - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 2.81 1,000 g oP (5.15) gluten fRee bReAd Mix - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 3.93 1,000 g oP (5.21) 3.51 (5.80) 4.77 4.77 (7.63) gluten fRee flouR - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 5.62 2,000 g oP (9.98)

Healtheries Simple baking Mix

nZb low gluten bread Mix Horleys bread Mix bakels gluten free bread Mix

Horleys flour

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

gluten free foods

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer gluten fRee PAStA - Hospital Pharmacy [HP3] - Special Authority buckwheat Spirals ...................................................................................... 2.00 (2.85) Corn and Parsley fettucine.......................................................................... 2.00 (2.63) Corn and Spinach Rigatini ........................................................................... 2.00 (2.63) Corn and Vegetable Shells .......................................................................... 2.00 (2.63) garlic and Parsley Spirals ........................................................................... 2.00 (2.63) Rice and Corn garden Herb Pasta ............................................................... 2.00 (2.63) Rice and Corn lasagne Sheets ................................................................... 1.60 (2.80) Rice and Corn Macaroni ............................................................................. 2.00 (2.63) Rice and Corn Penne .................................................................................. 2.00 (2.63) Rice and Maize Pasta Spirals ...................................................................... 2.00 (2.63) Rice and Maize Spaghetti ............................................................................ 2.00 (2.63) Rice and Millet Spirals................................................................................. 2.00 (2.63) tomato and basil Spirals ............................................................................ 2.00 (2.63) Vegetable and Rice Spirals.......................................................................... 2.00 (2.85)

250 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran 200 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran 250 g oP orgran

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

food and Supplements for inborn errors of metabolism - other

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

food And SUPPlementS foR inboRn eRRoRS of metAboliSm - otheR

Special Authority for Subsidy – form: SA0732 initial application Applications only from relevant specialist. Approvals valid for 3 years for applications meeting the following criteria: either: 1) dietary management of homocystinuria; or 2) dietary management of maple syrup urine disease. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. it can cost up to $70,000 a year to keep an adult on protein supplements. because protein substitutes are so expensive and because they are only effective in controlling PKu if a restricted diet is followed, adults with PKu will be required to demonstrate they are following the prescribed diet by regular blood testing. the requirement for testing applies to those aged over 16 years. failure to follow an appropriate diet results in high blood phenylalanine levels. the subsidy for these products reflects the philosophy that the patient incurs no additional financial burden for purchasing specialised more expensive products.

Supplements for homocystinuria

AMinoACid foRMulA WitHout MetHionine - Hospital Pharmacy [HP3] - Special Authority Powder ................................................................................................... 384.95 500 g oP ✓ xMEt Maxamum

Supplements for mSUd

AMinoACid foRMulA WitHout VAline, leuCine And iSoleuCine - Hospital Pharmacy [HP3] - Special Authority Powder ................................................................................................... 250.45 500 g oP ✓ Maxamaid MSud ✓ Maxamum MSud 364.35 ✓ MSud Aid 487.38

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

food and Supplements for inborn errors of metabolism - PKU

SPeciAl foodS

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

food And SUPPlementS foR inboRn eRRoRS of metAboliSm - PKU

Special Authority for Subsidy – form: SA0733 initial application - Patient aged over 16 Applications only from relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) dietary management of PKu; and 2) blood phenylalanine level < 900 mmol/litre (average of tests over last 12 months). initial application - Patient aged 16 or under Applications only from relevant specialist. Approvals valid for 3 years where the patient requires dietary management of PKu. Renewal - Patient aged over 16 Applications only from relevant specialist. Approvals valid for 1 year where the patients blood phenylalanine level is < 900 mmol/litre (average of tests over last 12 months) Renewal - Patient aged 16 or under Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. it can cost up to $70,000 a year to keep an adult on protein supplements. because protein substitutes are so expensive and because they are only effective in controlling PKu if a restricted diet is followed, adults with PKu will be required to demonstrate they are following the prescribed diet by regular blood testing. the requirement for testing applies to those aged over 16 years. failure to follow an appropriate diet results in high blood phenylalanine levels. the subsidy for these products reflects the philosophy that the patient incurs no additional financial burden for purchasing specialised more expensive products.

foods for PKU

PHenyl fRee bAKing Mix - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 6.70 500 g oP (8.22) PHenyl fRee PAStA - Hospital Pharmacy [HP3] - Special Authority low protein rice pasta .............................................................................. 10.65 500 g oP (11.91) Macaroni .................................................................................................. 10.65 500 g oP (11.91) Spaghetti .................................................................................................. 10.65 500 g oP (11.91) Spirals ...................................................................................................... 10.65 500 g oP (11.91) loprofin Mix

loprofin loprofin loprofin loprofin

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

food and Supplements for inborn errors of metabolism - PKU multivitamin Supplements for inborn errors of metabolism

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

Supplements for PKU

AMinoACid foRMulA WitHout PHenylAlAnine - Hospital Pharmacy [HP3] - Special Authority tabs ......................................................................................................... 82.50 75 oP ✓ Phlexy 10 Sachets (pineapple/vanilla) 29 g ............................................................. 320.10 30 oP ✓ Minaphlex Sachets (tropical) ................................................................................... 270.00 30 ✓ Phlexy 10 infant formula ......................................................................................... 145.60 400 g oP ✓ Analog LcP liquid (grapefruit) ..................................................................................... 22.50 250 ml oP ✓ Easiphen Liquid liquid (forest berries)................................................................................ 22.50 250 ml oP ✓ Easiphen Liquid Powder (orange) ..................................................................................... 195.00 500 g oP ✓ Maxamaid xP ✓ Maxamum xP 305.00 Powder (unflavoured) ............................................................................. 244.18 500 g oP ✓ Aminogran Food Supplement ✓ Maxamaid xP 195.00 ✓ Maxamum xP 305.00

multivitamin and mineral Supplements

AMinoACid foRMulA WitH MineRAlS WitHout PHenylAlAnine - Hospital Pharmacy [HP3] - Special Authority Powder ..................................................................................................... 45.06 250 g oP ✓ Aminogran Mineral Mix ✓ Metabolic Mineral 48.70 Mixture

mUltiVitAmin SUPPlementS foR inboRn eRRoRS of metAboliSm

Special Authority for Subsidy – form: SA0600 initial application Applications only from relevant specialist. Approvals valid for 3 years where the patient has inborn errors of metabolism. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 3 years for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. MultiVitAMinS - Hospital Pharmacy [HP3] - Special Authority tab ........................................................................................................... 19.65 100 Powder ..................................................................................................... 30.00 100 g oP oral liq ........................................................................................................ 8.98 150 ml oP (13.50) ✓ ketovite ✓ Paediatric Seravite Ketovite Syrup

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

infant formulae

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

infAnt foRmUlAe for Premature infants

Special Authority for Subsidy – form: SA0602 initial application Applications only from relevant specialist. Approvals valid for 6 months where the patient is an infant weighing less than 1.5 kg at birth. PReMAtuRe biRtH foRMulA - Hospital Pharmacy [HP3] - Special Authority Powder ....................................................................................................... 7.41 0.98 400 g oP 120 ml oP ✓ S26LBW gold ✓ Similac Special care

for Williams Syndrome

Special Authority for Subsidy – form: SA0601 initial application Applications only from relevant specialist. Approvals valid for 1 year where the patient is an infant suffering from Williams Syndrome and associated hypercalcaemia. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. loW CAlCiuM infAnt foRMulA - Hospital Pharmacy [HP3] - Special Authority Powder ..................................................................................................... 36.99 400 g oP ✓ Locasol

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

infant formulae

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

for gastrointestinal and other malabsorptive Problems

neocate should be used only as a last resort when the infant is unable to absorb any of the below formulae. the objective with each of the formulae prescribed is to get the infant off them as soon as possible. this may take six months, it may take three years. because of this, variation on age limit is not regarded as appropriate.these formulae will be available only from a hospital pharmacy. Vivonex Pediatric may be a suitable and less expensive alternative for many children that would otherwise be eligible for a subsidy for neocate and should, therefore, be tried first in these cases. the subsidy for these products reflects the philosophy that the patient incurs no additional financial burden for purchasing specialised more expensive products. Special Authority for Subsidy – form: SA0603 initial application Applications only from relevant specialist. Approvals valid for 1 year where the patient is an infant suffering from malabsorption and other gastrointestinal problems. Renewal Applications only from relevant specialist or general practitioner on the recommendation of a specialist. Approvals valid for 1 year for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) general Practitioners must include the name of the specialist and date contacted. eleMentAl foRMulA - Hospital Pharmacy [HP3] - Special Authority Powder ..................................................................................................... 15.52 450 g oP (19.01) 63.97 400 g oP (67.08) 5.62 48.5 g oP (6.00)

Pepti junior neocate Vivonex Pediatric

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

infant formulae

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

for milk intolerance

Special Authority for Subsidy – form: SA0604 initial application - lactase deficiency or disaccharide intolerance Applications only from relevant specialist. Approvals valid for 2 years for applications meeting the following criteria: both: 1) Patient is less than 3 years of age; and 2) either: 2.1) diagnosed as suffering from congenital lactase deficiency; or 2.2) Suffering from disaccharide intolerance. note Secondary lactose intolerance in children is usually short lasting, and can be controlled by dietary measures and by giving sufficient calories to regenerate digestive enzymes. the subsidy for these products reflects the philosophy that the patient incurs no additional financial burden for purchasing specialised more expensive products. initial application - infant with intolerance to cows’ milk Applications only from relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: both: 1) intolerant to cows’ milk; and 2) Patient is less than 3 years of age. note the subsidy for these products reflects the philosophy that the patient incurs no additional financial burden for purchasing specialised more expensive products. Renewal - infant with intolerance to cows’ milk Applications only from relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: both: 1) the treatment remains appropriate and the patient is benefiting from treatment; and 2) Patient is less than 3 years of age. goAtS MilK infAnt foRMulA - Retail Pharmacy - Special Authority Powder ....................................................................................................... 9.42 900 g oP (22.75) lACtoSe fRee infAnt foRMulA - Retail Pharmacy - Special Authority Powder ....................................................................................................... 5.66 900 g oP (17.95) SoyA infAnt foRMulA - Retail Pharmacy - Special Authority Powder ....................................................................................................... 6.34 900 g oP (18.32)

Karicare goats Milk infant formula

delact

infasoy

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

SPeciAl foodS

infant formulae

Subsidy fully brand or (Manufacturer’s Price) Subsidised generic $ Per ✓ Manufacturer

infant formulae - lactose intolerance and cows’ milk Protein intolerance

Special Authority for Subsidy – form: SA0757 initial application only from a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 the patient is less than 2 years of age; and 2 intolerant to cows’ milk; and 3 diagnosed as suffering from congenital lactase deficiency. Renewal only from a relevant specialist. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefiting from treatment. infAnt Soy foRMulA - Retail Pharmacy - Special Authority Powder ....................................................................................................... 7.27 (16.35) 900 g Karicare Soy All Ages

✓ fully subsidised

[HP1], [HP3], [HP4] refer page 10

Section e PARt i PRActitioneR’S And WholeSAle SUPPly oRdeRS

Please refer to Section A for a definition, and conditions of supply, of Practitioner’s Supply orders.

Pharmaceuticals that may be obtained on a Practitioner’s Supply order

therapeutic group chemical Alimentary tract Atropine Sulphate and Metabolism dicyclomine Hydrochloride glucagon Hydrochloride Hyoscine n-butylbromide loperamide Hydrochloride Compound electrolytes dextrose Phytomenadione Sodium Chloride Water for injection Presentation inj 400 µg, 1 ml inj 600 µg, 1 ml inj 1200 µg, 1 ml tab 10 mg inj 1 mg syringe kit inj 20 mg, 1 ml tab 2 mg Powder for soln for oral use 5 g inj 50%, 10 ml inj 2 mg per 0.2 ml inj 10 mg per ml, 1 ml inf 0.9% inj 0.9%, 5 ml inj 0.9%, 10 ml Purified for inj 2 ml Purified for inj 5 ml Purified for inj 10 ml Purified for inj 20 ml inj 1 in 1,000, 1 ml inj 1 in 10,000, 10 ml inj 50 mg per ml, 3 ml tab 2.5 mg (May be supplied for reasons other than emergency) tab 62.5 µg tab 250 µg tab 40 mg inj 10 mg per ml, 2 ml oral pump spray 400 µg per dose inj 2.5 mg per ml, 2 ml Crm 1% with chlorhexidine digluconate 0.2% device Condoms, proprietary Condoms, proprietary diaphragm Quantity 5 5 5 30 5 5 30 10 5 5 5 2000 ml 5 5 5 5 5 5 5 5 5 150 30 30 30 5 250 dose 5 500 g 1 144 144 1 each size 5 63 84 63 84 84 63 84 84

blood and blood forming organs

Cardiovascular System

Adrenaline Amiodarone hydrochloride Bendrofluazide digoxin frusemide glyceryl trinitrate Verapamil Hydrochloride Silver Sulphadiazine Applicator Condoms extra Strength Condoms without Spermicide diaphragm ergometrine Maleate ethinyloestradiol with desogestrel

dermatologicals genito-urinary System

inj 500 µg per ml, 1 ml tab 20 µg with desogestrel 150 µg tab 20 µg with desogestrel 150 µg and 7 inert tab tab 30 µg with desogestrel 150 µg tab 30 µg with desogestrel 150 µg and 7 inert tab ethinyloestradiol with gestodene tab 20 µg with gestodene 75 µg and 7 inert tab tab 30 µg with gestodene 75 µg tab 30 µg with gestodene 75 µg and 7 inert tab ethinyloestradiol with levonorgestrel tab 20 µg with levonorgestrel 100 µg and 7 inert tab tab ethinyloestradiol 30 µg with levonorgestrel 50 µg (6) and ethinyloestradiol 40 µg with levonorgestrel 75 µg (5), and ethinyloestradiol 30 µg with levonorgestrel 125 µg (10) and 7 inert tab tab 30 µg with levonorgestrel 150 µg tab 30 µg with levonorgestrel 150 µg and 7 inert tab tab 50 µg with levonorgestrel 125 µg and 7 inert tab

84 63 84 84

PRActitioneR’S And WholeSAle SUPPly oRdeRS

therapeutic group chemical genito-urinary ethinyloestradiol with norethisterone System (continued)

Presentation tab 35 µg with norethisterone 500 µg tab 35 µg with norethisterone 500 µg and 7 inert tab tab ethinyloestradiol 35 µg with norethisterone 500 µg (7) and tab ethinyloestradiol 35 µg with norethisterone 1 mg (9) and tab ethinyloestradiol 35 µg with norethisterone 500 µg (5) and 7 inert tab 35 µg with norethisterone 1 mg tab 35 µg with norethisterone 1 mg and 7 inert tab ethynodiol diacetate tab 500 µg levonorgestrel tab 30 µg tab 750 µg Medroxyprogesterone Acetate inj 150 mg per ml, 1 ml syringe nonoxynol-9 jelly 2% norethisterone tab 350 µg norethisterone with Mestranol tab 1 mg with mestranol 50 µg tab 1 mg with mestranol 50 µg and 7 inert tab oxytocin inj 5 iu per ml, 1 ml inj 10 iu per ml, 1 ml inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml Hormone dexamethasone tab 1 mg Preparations tab 4 mg Systemic dexamethasone Sodium Phosphate inj 4 mg per ml, 1 ml excluding inj 4 mg per ml, 2 ml Contraceptive Hydrocortisone inj 50 mg per ml, 2 ml Hormones norethisterone tab 5 mg Prednisolone Sodium Phosphate oral liq 5 mg per ml Prednisone tab 5 mg Cap 250 mg infections - Agents Amoxycillin for Systemic use grans for oral liq 125 mg per 5 ml grans for oral liq 250 mg per 5 ml inj 1 g Amoxycillin Clavulanate tab 500 mg with potassium clavulanate 125 mg grans for oral liq 125 mg with potassium clavulanate 31.25 mg per 5 ml grans for oral liq 250 mg with potassium clavulante 62.5 mg per 5 ml Azithromycin tab 500 mg benzathine benzylpenicillin inj 1.2 mega u per 2 ml inj 1.2 mega u inj 1 mega u benzylpenicillin Sodium (Penicillin g) Ceftriaxone sodium inj 250 mg inj 500 mg inj 1 g Ciprofloxacin tab 250 mg tab 500 mg Co-trimoxazole tab trimethoprim 80 mg and sulphamethoxazole 400 mg oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml doxycycline Hydrochloride tab 50 mg tab 100 mg erythromycin ethyl Succinate tab 400 mg grans for oral liq 200 mg per 5 ml grans for oral liq 400 mg per 5 ml

Quantity 63 84

84 63 84 84 84 10 5 108 g 84 63 84 5 5 5 30 30 5 5 5 30 30 ml 30 30 200 ml 200 ml 5 30 200 ml 200 ml 4 5 5 5 5 5 5 5 5 30 200 ml 30 30 30 200 ml 200 ml

PRActitioneR’S And WholeSAle SUPPly oRdeRS

therapeutic group chemical infections - Agents erythromycin Stearate for Systemic use flucloxacillin Sodium (continued) Metronidazole Phenoxymethylpenicillin (Penicillin V) Procaine Penicillin trimethoprim diclofenac Sodium tenoxicam Aspirin benztropine Mesylate Chlorpromazine Hydrochloride

Presentation tab 250 mg Cap 250 mg grans for oral liq 125 mg per 5 ml grans for oral liq 250 mg per 5 ml inj 1 g tab 200 mg Cap 250 mg grans for oral liq 125 mg per 5 ml grans for oral liq 250 mg per 5 ml inj 1.5 mega u tab 300 mg inj 25 mg per ml, 3 ml Suppos 50 mg inj 10 mg per ml, 2 ml tab, dispersible 300 mg inj 1 mg per ml, 2 ml tab 10 mg tab 25 mg tab 100 mg oral liq 100 mg per 5 ml inj 25 mg per ml, 2 ml inj 5 mg per ml, 2 ml Rectal tubes 5 mg Rectal tubes 10 mg inj 20 mg per ml, 1 ml inj 20 mg per ml, 2 ml inj 100 mg per ml, 1 ml inj 12.5 mg per 0.5 ml, 0.5 ml inj 25 mg per ml, 1 ml inj 25 mg per ml, 2 ml inj 100 mg per ml, 1 ml tab 500 µg tab 1.5 mg tab 5 mg oral liq 2 mg per ml inj 5 mg per ml, 1 ml inj 50 mg per ml, 1 ml inj 100 mg per ml, 1 ml inj 0.5%, 5 ml inj 1%, 5 ml inj 1%, 20 ml inj 5 mg per ml, 2 ml inj 5 mg per ml, 1 ml inj 10 mg per ml, 1 ml inj 15 mg per ml, 1 ml inj 30 mg per ml, 1 ml tab 500 mg oral liq 120 mg per 5 ml oral liq 250 mg per 5 ml inj 50 mg per ml, 1 ml inj 50 mg per ml, 1.5 ml inj 50 mg per ml, 2 ml inj 50 mg per ml, 2 ml inj 50 mg per ml, 5 ml inj 50 mg per ml, 1 ml inj 50 mg per ml, 2 ml

Quantity 30 30 200 ml 200 ml 5 30 30 200 ml 200 ml 5 30 5 10 5 30 5 30 30 30 200 ml 5 5 5 5 5 5 5 5 5 5 5 30 30 30 200 ml 5 5 5 5 5 5 5 5 5 5 5 30 200 ml 100 ml 5 5 5 5 5 5 5

Musculoskeletal System nervous System

diazepam flupenthixol decanoate fluphenazine decanoate

Haloperidol

Haloperidol decanoate lignocaine Hydrochloride Metoclopramide Hydrochloride Morphine Sulphate

Paracetamol Pethidine Hydrochloride Phenytoin Sodium Pipothiazine Palmitate

PRActitioneR’S And WholeSAle SUPPly oRdeRS

therapeutic group chemical nervous System Prochlorperazine (continued) Zuclopenthixol decanoate Respiratory Aminophylline System and ipratropium bromide Allergies Promethazine Hydrochloride Salbutamol

Presentation tab 5 mg inj 12.5 mg per ml, 1 ml inj 200mg per ml, 1 ml inj 25 mg per ml, 10 ml nebuliser soln, 250 µg per 1 ml nebuliser soln, 500 µg per 2 ml inj 25 mg per ml, 1 ml inj 25 mg per ml, 2 ml Aerosol inhaler, 100 µg per dose CfC free nebuliser soln, 1 mg per ml, 2.5 ml nebuliser soln, 2 mg per ml, 2.5 ml inj 500 µg per ml, 1 ml nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per 2.5 ml vial oral liq 50 g per 300 ml oral liq 50 g per 250 ml inj 400 µg per ml, 1 ml

Various

Salbutamol with ipratropium bromide Charcoal naloxone Hydrochloride

Quantity 30 5 5 5 40 40 5 5 1000 dose 30 30 5 20 300 ml 250 ml 5

Pharmaceuticals that may be obtained on a Wholesale Supply order

therapeutic group genito-urinary System Respiratory System and Allergies chemical intra-uterine device Pregnancy tests - HCg urine Peak flow Meters Spacer devices and Masks Presentation iud urine diagnostic test Peak flow meters-low range Peak flow meters-normal range Mask, size 2 Spacer device

Section e PARt ii: RURAl AReAS

Rural Areas for Practitioner’s Supply orders

nortH ISLAnd

northland dHB dargaville Hikurangi Kaeo Kaikohe Kaitaia Kawakawa Kerikeri Mangonui Maungaturoto Moerewa ngunguru Paihia Rawene Ruakaka Russell tutukaka Waipu Whangaroa Waitemata dHB Helensville Huapai Kumeu Snells beach Waimauku Warkworth Wellsford Auckland dHB great barrier island oneroa ostend counties Manukau dHB tuakau Waiuku Waikato dHB Coromandel Huntly Kawhia Matamata Morrinsville ngatea otorohanga Paeroa Pauanui beach Putaruru Raglan tairua taumarunui te Aroha te Kauwhata te Kuiti tokoroa Waihi Whangamata Whitianga Bay of Plenty dHB edgecumbe Katikati Kawerau Murupara opotiki taneatua te Kaha Waihi beach Whakatane Lakes dHB Mangakino turangi tairawhiti dHB Ruatoria te Araroa te Karaka te Puia Springs tikitiki tokomaru bay tolaga bay taranaki dHB eltham inglewood Manaia oakura okato opunake Patea Stratford Waverley Hawkes Bay dHB Chatham islands Waipawa Waipukurau Wairoa Whanganui dHB bulls Marton ohakune Raetihi taihape Waiouru Midcentral dHB dannevirke foxton levin otaki Pahiatua Shannon Woodville Wairarapa dHB Carterton featherston greytown Martinborough Hanmer Springs Kaikoura leeston lincoln Methven oxford Rakaia Rolleston Rotherham templeton Waikari South canterbury dHB fairlie geraldine Pleasant Point temuka twizel Waimate

otago dHB Alexandra balclutha Cromwell SoutH ISLAnd Kurow nelson/Marlborough dHB lawrence Havelock Milton Mapua oamaru Motueka outram Murchison owaka Picton Palmerston takaka Ranfurly Wakefield Roxburgh West coast dHB tapanui dobson Wanaka greymouth Southland dHB Hokitika gore Karamea lumsden Reefton Mataura South Westland otautau Westport Queenstown Whataroa Riverton canterbury dHB te Anau Akaroa tokonui Amberley tuatapere Amuri Winton Cheviot Darfield diamond Harbour

Section f: commUnity PhARmAceUticAl diSPenSing PeRiod eXemPtionS

Section f: PARt i

A Community Pharmaceutical identified with a ❋ within the other sections of the Pharmaceutical Schedule: (a) is exempt from any requirement to dispense in Monthly lots; (b) will only be subsidised if it is dispensed in a 90 day lot unless it is Close Control. A Community Pharmaceutical that is an oral contraceptive and that is identified with a ❋ within the other sections of the Pharmaceutical Schedule: (a) is exempt from any requirement to dispense in Monthly lots; (b) will only be subsidised if it is dispensed in a 180 day lot unless it is Close Control.

Section f: PARt ii: ceRtified eXemPtionS And AcceSS eXemPtionS to monthly diSPenSing

A Community Pharmaceutical, other than a Community Pharmaceutical identified with a ❋ within the other sections of the Pharmaceutical Schedule, may be dispensed in a 90 day lot if: (a) the Community Pharmaceutical is identified with a s within the other sections of the Pharmaceutical Schedule

and the prescriber has endorsed the Prescription item(s) on the Prescription to which the exemption applies “certified exemption”.

in endorsing the Prescription items for a certified exemption, the prescriber is certifying that: (i) the patient wished to have the medicine dispensed in a quantity greater than a Monthly lot; and (ii) the patient has been stabilised on the same medicine for a reasonable period of time; and (iii) the prescriber has reason to believe the patient will continue on the medicine and is compliant; (b) a patient, who has difficulty getting to and from a pharmacy, signs the back of the Prescription to qualify for an Access exemption. in signing the Prescription, the patient or his or her nominated representative must also certify which of the following criteria they meet: (i) have limited physical mobility; (ii) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; (iii) are relocating to another area; (iv) are travelling extensively and will be out of town when the repeat prescriptions are due. the following Community Pharmaceuticals are identified with a s within the other sections of the Pharmaceutical Schedule and may be dispensed in a 90 day lot if endorsed as a certified exemption in accordance with paragraph (a) in Section f Part ii above.

Section f: PARt ii

ALIMEntArY trAct And MEtABoLISM inSulin neutRAl inSulin iSoPHAne inSulin iSoPHAne WitH inSulin neutRAl inSulin ASPARt inSulin glARgine inSulin liSPRo cArdIovAScuLAr SYStEM AMiodARone HydRoCHloRide tab 100 mg Cordarone-x tab 200 mg Cordarone-x diSoPyRAMide PHoSPHAte fleCAinide ACetAte tab 50 mg tambocor tab 100 mg tambocor Cap long-acting 100 mg tambocor CR Cap long-acting 200 mg tambocor CR Mexiletine HydRoCHloRide PRoPAfenone HydRoCHloRide HorMonE PrEPArAtIonS - SYStEMIc ExcLudIng contrAcEPtIvE HorMonES deSMoPReSSin nasal Spray 10 µg per dose desmopressin-PH&t Minirin nasal drops 100 µg per ml

MuScuLo-SkELEtAL SYStEM PyRidoStigMine bRoMide nErvouS SYStEM AMAntAdine HydRoCHloRide APoMoRPHine HydRoCHloRide entACAPone gAbAPentin lAMotRigine liSuRide HydRogen MAleAte PeRgolide RoPiniRole HydRoCHloRide tolCAPone toPiRAMAte VigAbAtin SEnSorY orgAnS biMAtoPRoSt bRiMonidine tARtRAte WitH tiMolol MAleAte bRinZolAMide diPiVefRin HydRoCHloRide lAtAnoPRoSt tRAVoPRoSt

Section g: SAfety cAP medicineS

Pharmacists are required, under the Code of ethics of the Pharmacy Council of new Zealand, to use safety caps when dispensing any of the medicines listed in Section g in an oral liquid formulation pursuant to a prescription or Practitioner’s Supply order. this includes all proprietary and extemporaneously compounded oral liquid preparations of those pharmaceuticals listed in Section g of the Pharmaceutical Schedule. these medicines will be identified throughout Section b of the Pharmaceutical Schedule with the symbol ’‡’.

exemptions

oral liquid preparations of the pharmaceuticals listed in Section g of the Pharmaceutical Schedule will be dispensed in a container with a safety cap unless: • the practitioner has endorsed the Prescription or Practitioner’s Supply order, stating that, the Pharmaceutical is not to be dispensed in a container with a safety cap; or • the Contractor has annotated the Prescription or Practitioner’s Supply order stating that, because of infirmity of the particular person, the Pharmaceutical to be used by that person should not be dispensed in a container with a safety cap; or • the Pharmaceutical is packaged in an original Pack so designed that on the professional judgement of the

Contractor, transfer to a container with a safety cap would be inadvisable or a retrograde procedure.

Reimbursment

Pharmacists will be reimbursed according to their agreement. Where an additional fee is paid on safety caps it will be paid

on all dispensings of oral liquid preparations for those pharmaceuticals listed in Section g of the Pharmaceutical Schedule unless the practitioner has endorsed or the contractor has annotated the Prescription or Practitioners Supply order that a safety cap has not been supplied.

Safety caps (nZS :)

20 mm ............................Clic-Loc, united Closures & Plastics PlC, england Kerr, Cormack Packaging, Sydney, under licence to Kerr uSA 24 mm ............................Clic-Loc, united Closures & Plastics PlC, england Clic-Loc, ACi Closures under license to owens-illinois Kerr, Cormack Packaging, Sydney, under licence to Kerr uSA 28 mm ............................Clic-Loc, united Closures & Plastics PlC, england

Clic-Loc, ACi Closures under license to owens-illinois Kerr, Cormack Packaging, Sydney, under licence to Kerr uSA PDL Squeezlok PDL FG

SAfety cAP medicineS

ALIMEntArY trAct And MEtABoLISM feRRouS SulPHAte oral liq 150 mg per 5 ml ferro-liquid cArdIovAScuLAr SYStEM AMiloRide oral liq 1 mg per ml CAPtoPRil oral liq 5 mg per ml CHloRotHiAZide oral liq 50 mg per ml digoxin oral liq 50 µg per ml fRuSeMide oral liq 10 mg per ml SPiRonolACtone oral liq 5 mg per ml

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ExtEMPorAnEouSLY coMPoundEd PrEPArAtIonS And gALEnIcALS Codeine PHoSPHAte Powder douglas (Extemporaneously compounded oral liquid preparations) MetHAdone HydRoCHloRide Powder Aft (Extemporaneously compounded oral liquid preparations) PHenobARbitone SodiuM Powder MidWest (Extemporaneously compounded oral liquid preparations) HorMonE PrEPArAtIonS - SYStEMIc ExcLudIng contrAcEPtIvE HorMonES tHyRoxine tab 100 µg eltroxin tab 50 µg eltroxin (Extemporaneously compounded oral liquid preparations) MuScuLoSkELEtAL SYStEM ibuPRofen oral liq 100 mg per 5 ml fenpaed Quinine SulPHAte tab 200 mg Q 200 tab 300 mg Q 300 (Extemporaneously compounded oral liquid preparations)

nErvouS SYStEM AlPRAZolAM tab 1 mg xanax tab 250 µg xanax tab 500 µg xanax (Extemporaneously compounded oral liquid preparations) CARbAMAZePine oral liq 100 mg per 5 ml tegretol CHloRPRoMAZine HydRoCHloRide oral liq 100 mg per 5 ml largactil forte ClobAZAM tab 10 mg frisium (Extemporaneously compounded oral liquid preparations) ClonAZePAM oral drops 2.5 mg per ml Rivotril diAZePAM tab 10 mg Pro-Pam tab 2 mg Pro-Pam tab 5 mg Pro-Pam (Extemporaneously compounded oral liquid preparations) etHoSuxiMide oral liq 250 mg per 5 ml Zarontin loRAZePAM tab 1 mg Ativan tab 2.5 mg Ativan (Extemporaneously compounded oral liquid preparations) loRMetAZePAM tab 1 mg noctamid (Extemporaneously compounded oral liquid preparations) MetHAdone HydRoCHloRide oral liq 10 mg per ml biodone extra forte oral liq 2 mg per ml biodone oral liq 5 mg per ml biodone forte MetoCloPRAMide HydRoCHloRide oral liq 5 mg per 5 ml Maxolon MidAZolAM tab 7.5 mg Hypnovel (Extemporaneously compounded oral liquid preparations) MoRPHine HydRoCHloRide oral liq 1 mg per ml RA-Morph oral liq 10 mg per ml RA-Morph oral liq 2 mg per ml RA-Morph oral liq 5 mg per ml RA-Morph

SAfety cAP medicineS

nErvouS SYStEM (continued) nitRAZePAM tab 5 mg insoma nitrados (Extemporaneously compounded oral liquid preparations) oxAZePAM tab 10 mg ox-Pam tab 15 mg ox-Pam (Extemporaneously compounded oral liquid preparations) PARACetAMol oral liq 120 mg per 5 ml junior Parapaed oral liq 250 mg per 5 ml Six Plus Parapaed PHenytoin SodiuM oral liq 30 mg per 5 ml dilantin SodiuM VAlPRoAte oral liq 200 mg per 5 ml epilim S/f liquid epilim Syrup teMAZePAM tab 10 mg normison (Extemporaneously compounded oral liquid preparations) tRiAZolAM tab 125 µg Halcion Hypam tab 250 µg Hypam (Extemporaneously compounded oral liquid preparations) tRifluoPeRAZine HydRoCHloRide oral liq 1 mg per ml Stelazine

rESPIrAtorY SYStEM And ALLErgIES CetiRiZine HydRoCHloRide oral liq 1 mg per ml Allerid C CHloRPHeniRAMine MAleAte oral liq 2 mg per 5 ml Histafen dextRoCHloRPHeniRAMine MAleAte oral liq 2 mg per 5 ml Polaramine PRoMetHAZine HydRoCHloRide oral liq 5 mg per 5 ml Phenergan SAlbutAMol oral liq 2 mg per 5 ml Salapin tHeoPHylline oral liq 80 mg per 15 ml nuelin tRiMePRAZine tARtRAte oral liq 30 mg per 5 ml Vallergan forte

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Symbols A

3tC ............................................................................. 101 A-lices .......................................................................... 69 Abacavir sulphate......................................................... 101 Acarbose ....................................................................... 31 ACb ............................................................................... 59 Accu-Chek Advantage .................................................... 34 Accupril ......................................................................... 56 Accuretic 10 .................................................................. 56 Accuretic 20 .................................................................. 56 Acebutolol...................................................................... 59 Acetazolamide ............................................................. 156 Acetic acid with 1, 2-propanediol diacetate and benzethonium .......................................................... 154 Acetic acid with hydroxyquinoline and ricinoleic acid ...... 76 Acetopt ........................................................................ 155 Acetylcysteine.............................................................. 165 Acetylcysteine eye drops.............................................. 164 Acidex ........................................................................... 26 Aciclovir eye ointment ............................................................ 154 tab disp.................................................................98, 99 Acicvir ..................................................................... 98, 99 Aci-jel ........................................................................... 76 Acipimox ....................................................................... 47 Actigall .......................................................................... 35 Acitretin ......................................................................... 70 Actos ............................................................................. 32 Actrapid ......................................................................... 30 Actrapid Penfill ............................................................... 30 Acupan ........................................................................ 109 Adalat 10 ....................................................................... 60 Adalat oros .................................................................... 60 Adalimumab................................................................. 106 Adefin XL ....................................................................... 60 Adefovir dipivoxil ............................................................ 97 Adrenaline...................................................................... 63 Advantan ....................................................................... 67 Aft-Pyrazinamide .......................................................... 96 Agrylin ......................................................................... 131 Alanase........................................................................ 153 Albay ........................................................................... 146 Albustix........................................................................ 159 Aldazine ....................................................................... 122 Alendronate sodium ................................................. 78, 79 Alfacalcidol .................................................................... 39 Alginic acid .................................................................... 26 Alitraq .......................................................................... 177 Alkeran ........................................................................ 128 Allerid C ....................................................................... 146 Allopurinol.................................................................... 108 Alpha Ascorbic Acid ....................................................... 38 Alpha-bromocriptine .................................................... 119 Alpha-Keri lotion ........................................................... 69 Alphagan ..................................................................... 156

Alpha tocopheryl acetate ................................................ 39 Alprazolam ................................................................... 124 Aluminium hydroxide...................................................... 26 Alu-tab .......................................................................... 26 Amantadine hydrochloride ............................................ 119 Amiloride ....................................................................... 62 Amiloride with frusemide ................................................ 62 Amiloride with hydrochlorothiazide ................................. 62 Aminogran food Supplement........................................ 186 Aminogran Mineral Mix................................................. 186 Aminophylline .............................................................. 152 Amiodarone hydrochloride.............................................. 58 Amitrip ......................................................................... 112 Amitriptyline ................................................................. 112 Amizide.......................................................................... 62 Amlodipine..................................................................... 60 Amorolfine ..................................................................... 64 Amoxil Paediatric drops ................................................. 92 Amoxycillin .................................................................... 92 Amoxycillin clavulanate .................................................. 93 Amphotericin b .............................................................. 37 Amyl nitrite .................................................................... 63 Anagrelide Hydrochloride ............................................. 131 Analog lCP .................................................................. 186 Anastrozole .................................................................. 136 Androcur depo............................................................... 81 Antabuse ..................................................................... 127 Anten ........................................................................... 112 Antinaus ...................................................................... 118 Antithymocyte globulin (equine) ................................... 139 Anusol ........................................................................... 28 Apo-Amoxi..................................................................... 92 Apo-Ascorbic Acid ......................................................... 38 Apo-b-Complex ............................................................. 38 Apo-Captopril ................................................................. 55 Apo-Cimetidine .............................................................. 29 Apo-diclo..................................................................... 104 Apo-diclo SR ............................................................... 104 Apo-folic Acid ............................................................... 42 Apo-gliclazide ................................................................ 32 Apo-loratadine ............................................................ 147 Apo-Moclobemide........................................................ 113 Apo-nadolol ................................................................... 60 Apo-nicotinic Acid ......................................................... 47 Apo-oxybutynin ............................................................. 77 Apo-Prednisone ............................................................. 80 Apo-Primidone ............................................................. 115 Apo-Pyridoxine .............................................................. 38 Apo-Selegiline .............................................................. 119 Apo-Terbinafine.............................................................. 95 Apo-timol ...................................................................... 60 Apo-timop................................................................... 155 Apo-thiamine ................................................................ 38 Apo-Zopiclone.............................................................. 125 Apomorphine hydrochloride.......................................... 119 Applicator ...................................................................... 73

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Apresoline...................................................................... 63 Aprotinin ........................................................................ 42 Aquabloc 30+ ............................................................... 71 Aquasun 30+ ................................................................ 71 Aquasun oil free faces SPf30+ .................................... 71 Aqueous cream .............................................................. 68 Aratac ............................................................................ 58 Arava ........................................................................... 105 Aropax ......................................................................... 113 Arimidex ...................................................................... 136 Aristocort ....................................................................... 67 Arrow-Citalopram ......................................................... 113 Arrow-nifedipine xR ....................................................... 60 Arrow-Norfloxacin ........................................................ 102 Arrow-Ranitidine ............................................................ 29 Arsenic trioxide ............................................................ 131 Arthrexin ...................................................................... 105 Asacol ........................................................................... 27 Ascorbic acid ................................................................. 38 Ascorbic acid and sodium ascorbate .............................. 38 Asmafen ...................................................................... 147 Aspec 300 ................................................................... 109 Aspirin Analgesics ............................................................... 109 Antiplatelet Agents...................................................... 43 Aspirin & chloroform application................................... 146 Atacand ......................................................................... 56 Atazanavir sulphate ...................................................... 101 Atenolol ......................................................................... 59 AtgAM ........................................................................ 139 Ativan .......................................................................... 124 Atorvastatin.................................................................... 47 Atropine sulphate injection ..................................................................... 28 eye drops ................................................................ 157 Atropt .......................................................................... 157 Atrovent ....................................................................... 151 Atrovent nasal Aqueous ............................................... 153 Avomine ...................................................................... 119 Avonex ........................................................................ 142 Augmentin ..................................................................... 93 Auranofin ..................................................................... 105 Azamun ....................................................................... 138 Azatadine maleate ........................................................ 146 Azathioprine ................................................................. 138 Azithromycin .................................................................. 91 Azopt ........................................................................... 156 AZt.............................................................................. 101

b-d Micro-fine............................................................... 34 b-d ultra fine................................................................. 34 b-d ultra fine ii .............................................................. 34 baclofen ...................................................................... 108 bactroban ...................................................................... 64 bakels gluten free bread Mix ....................................... 182 batrafen ......................................................................... 64

beclazone 100 ............................................................. 147 beclazone 250 ............................................................. 147 beclazone 50 ............................................................... 147 beclomethasone dipropionate inhaled cortosteroids ................................................ 147 nasal preparations ................................................... 153 bee venom allergy treatment ........................................ 146 Bendrofluazide ............................................................... 62 benhex .......................................................................... 69 benzathine benzylpenicillin ............................................. 93 benzoin tincture ........................................................... 165 benztrop ...................................................................... 120 benztropine mesylate ................................................... 120 benzydamine hydrochloride............................................ 37 benzylpenicillin sodium (Penicillin g) .............................. 93 beta Cream .................................................................... 66 beta ointment ................................................................ 66 beta Scalp ..................................................................... 71 betadine......................................................................... 69 betadine Skin Prep ......................................................... 69 betaferon ..................................................................... 142 betagan ....................................................................... 155 betahistine dihydrochloride........................................... 117 betaloc .......................................................................... 59 betaloc CR ..................................................................... 59 betamethasone dipropionate Cream, ointment ........................................................ 66 nasal spray .............................................................. 153 betamethasone sodium phosphate with betamethasone acetate ....................................................................... 80 betamethasone valerate Cream, oint, lotion ...................................................... 66 Scalp application ........................................................ 71 betamethasone valerate with clioquinol........................... 67 betamethasone valerate with fusidic acid ........................ 67 betaxolol hydrochloride ................................................ 155 betnovate....................................................................... 66 betnovate-C ................................................................... 67 betoptic ....................................................................... 155 betoptic S .................................................................... 155 Bezafibrate ..................................................................... 47 bezalip Retard ................................................................ 47 bicillin ............................................................................ 93 biCnu .......................................................................... 128 bimatoprost ................................................................. 156 biocil ............................................................................. 69 biodone ....................................................................... 110 biodone extra forte ...................................................... 110 biodone forte............................................................... 110 bisacodyl ....................................................................... 36 bK lotion ....................................................................... 69 blenoxane .................................................................... 131 bleomycin sulphate ...................................................... 131 bleph 10 ...................................................................... 155 bonjela .......................................................................... 37 breath-Alert.................................................................. 153

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brevinor 1/21 ................................................................. 75 brevinor 1/28 ................................................................. 75 brevinor 21 .................................................................... 75 bricanyl injection ................................................................... 152 bricanyl turbuhaler ...................................................... 148 brimonidine tartrate ...................................................... 156 brimonidine tartrate with timolol maleate....................... 157 brinzolamide ................................................................ 156 brolene ................................................................. 154,155 bromocriptine mesylate................................................ 119 brufen.......................................................................... 104 brufen Retard ............................................................... 104 buccastem................................................................... 118 budesonide Cap ............................................................................ 27 inhalers, nebuliser solution....................................... 148 nasal spray .............................................................. 153 budesonide with eformoterol ........................................ 150 bumetanide.................................................................... 62 bupivacaine hydrochloride............................................ 109 buprenorphine hydrochloride ........................................ 110 burinex .......................................................................... 62 buscopan ...................................................................... 28 buserelin acetate ............................................................ 86 buspirone hydrochloride............................................... 124 busulphan.................................................................... 128 butacort Aqueous ........................................................ 153

Cabergoline.................................................................... 89 Cafergot ....................................................................... 117 Cal-d-forte..................................................................... 39 Calci-tab 500 ................................................................ 40 Calci-tab 600 ................................................................ 40 Calci-tab effervescent ................................................... 40 Calamine........................................................................ 65 Calcipotriol..................................................................... 70 Calcitonin....................................................................... 79 Calcitriol ........................................................................ 39 Calcitriol-Aft ................................................................. 39 Calcium carbonate ......................................................... 40 Calcium carbonate with aminoacetic acid ....................... 26 Calcium disodium Versenate ........................................ 159 Calcium folinate ........................................................... 129 Calcium folinate ebewe................................................ 129 Calcium gluconate ......................................................... 40 Calcium lactate-gluconate .............................................. 40 Calcium polystyrene sulphonate ..................................... 46 Calcium Resonium ......................................................... 46 Calcium-Sandoz 1000 .................................................... 40 Calogen ....................................................................... 169 Calvasc.......................................................................... 60 Camptosar ................................................................... 130 Candesartan................................................................... 56 Canesten ....................................................................... 64 Capadex....................................................................... 110

Capecitabine ................................................................ 129 Capoten ......................................................................... 55 Capsaicin ....................................................................... 72 Captopril ........................................................................ 55 Carafate ......................................................................... 29 Carbachol .................................................................... 157 Carbamazepine ............................................................ 114 Carbimazole ................................................................... 85 Carboplatin .................................................................. 128 Carboplatin ebewe ....................................................... 128 Carbosorb .................................................................... 159 Carbosorb-x ................................................................ 159 Cardinol ......................................................................... 60 Cardinol lA .................................................................... 60 Cardizem Cd .................................................................. 61 Carmustine .................................................................. 128 Cartia ............................................................................. 43 Catapres ........................................................................ 61 Catapres-ttS-1 ............................................................. 61 Catapres-ttS-2 ............................................................. 61 Catapres-ttS-3 ............................................................. 61 Carvedilol ....................................................................... 59 Ceenu ......................................................................... 128 Cefaclor monohydrate .................................................... 90 Cefamandole nafate ....................................................... 90 Cefazolin sodium............................................................ 90 Cefoxitin sodium ............................................................ 90 Ceftriaxone sodium ........................................................ 91 Cefuroxime axetil............................................................ 91 Cefuroxime sodium ........................................................ 91 Celestone Chronodose ................................................... 80 Celiprolol ....................................................................... 59 Cellcept ....................................................................... 138 Celol .............................................................................. 59 Cephalexin monohydrate ................................................ 91 Cephradine .................................................................... 91 Cerezyme....................................................................... 37 Cetirizine hydrochloride ................................................ 146 Cetomacrogol cream ...................................................... 68 Charcoal ...................................................................... 159 Chlorambucil................................................................ 128 Chloramphenicol ear drops ................................................................. 154 eye drops/oint .......................................................... 154 Chlorhexidine gluconate ........................................... 37, 68 Chloroform .................................................................. 165 Chloromycetin.............................................................. 154 Chlorothiazide ................................................................ 62 Chlorthalidone ................................................................ 62 Chlorpheniramine maleate ............................................ 146 Chlorpromazine hydrochloride ...................................... 120 Chlorsig ....................................................................... 154 Chlorvescent .................................................................. 46 Cholecalciferol ............................................................... 39 Cholestyramine with aspartame ...................................... 47 Choline salicylate with cetalkonium chloride.................... 37

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generic chemicals and brands

Ciclopiroxolamine........................................................... 64 Cilazapril ........................................................................ 55 Cilazapril with hydrochlorothiazide .................................. 56 Cilicaine ......................................................................... 93 Cilicaine VK.................................................................... 93 Ciloxan......................................................................... 154 Cimetidine...................................................................... 29 Cipflox ........................................................................... 94 Ciprofloxacin eye drops ................................................................ 154 tab ............................................................................ 94 Cisplatin....................................................................... 128 Citalopram hydrobromide ............................................. 113 Cladribine..................................................................... 129 Clarac ............................................................................ 91 Clarithromycin................................................................ 91 Climara 50 ..................................................................... 82 Climara 100 ................................................................... 82 Clindamycin ................................................................... 94 Clinistix .......................................................................... 33 Clinitest.......................................................................... 33 Clinoril ......................................................................... 105 Clobazam..................................................................... 115 Clobetasol propionate Cream, oint ................................................................ 66 Scalp appl .................................................................. 71 Clobetasone butyrate...................................................... 66 Clomazol.................................................................. 64, 76 Clomiphene citrate ......................................................... 89 Clomipramine hydrochloride ......................................... 112 Clonazepam injection ................................................................... 114 tab, oral drops......................................................... 115 Clonidine........................................................................ 61 Clonidine hydrochloride .......................................... 61, 117 Clopidogrel .................................................................... 43 Clopine ........................................................................ 120 Clopixol........................................................................ 123 Clopress ...................................................................... 112 Clotrimaderm 2% ........................................................... 76 Clotrimazole Cream, solution .......................................................... 64 Vag crm ..................................................................... 76 Clozapine ..................................................................... 120 Clozaril......................................................................... 120 Co-Renitec ..................................................................... 56 Co-trimoxazole ............................................................... 94 Coal tar .......................................................................... 70 Coal tar with allantoin, menthol, phenol and sulphur ........ 70 Coal tar with salicylic acid and sulphur ........................... 70 Coco-Scalp .................................................................... 70 Codalax ......................................................................... 36 Codalax forte ................................................................. 36 Codalgin ...................................................................... 110 Codeine lintus paediatric .............................................. 164 Codeine lintus diabetic ................................................. 164

Codeine phosphate Powder .................................................................... 165 tab .......................................................................... 110 Cogentin ...................................................................... 120 Colaspase (l-asparaginase) ......................................... 131 Colchicine .................................................................... 108 Colestid ......................................................................... 47 Colestipol hydrochloride ................................................. 47 Colifoam ........................................................................ 27 Colistin sulphomethate ................................................... 94 Colgout ........................................................................ 108 Collodion flexible .......................................................... 165 Colofac .......................................................................... 28 Coloxyl .......................................................................... 36 Colymycin-m ................................................................. 94 Combantrin .................................................................... 90 Combigan .................................................................... 157 Combivent ................................................................... 151 Combivir ...................................................................... 101 Compound electrolytes................................................... 46 Compound hydroxybenzoate ........................................ 165 Comtan ........................................................................ 119 Condoms extra strength ................................................. 73 Condoms without spermicide ......................................... 73 Condyline....................................................................... 71 Copaxone .................................................................... 142 Copper........................................................................... 33 Corangin ........................................................................ 63 Cordarone-x .................................................................. 58 Cosmegen ................................................................... 131 Cosopt ......................................................................... 156 Cotazym eCS ................................................................. 35 Coumadin ...................................................................... 45 Coversyl ........................................................................ 56 Cozaar ........................................................................... 57 Creon 10000.................................................................. 35 Creon forte .................................................................... 35 Crixivan........................................................................ 101 Cromolux ..................................................................... 155 Crotamiton ..................................................................... 65 Cyclizine hydrochloride ................................................ 117 Cyclizine lactate ........................................................... 118 Cycloblastin ................................................................. 128 Cyclogyl....................................................................... 157 Cyclophosphamide ...................................................... 128 Cyclosporin A .............................................................. 144 Cyclopentolate hydrochloride ....................................... 157 Cyproheptadine hydrochloride ...................................... 146 Cyproterone acetate ....................................................... 81 Cyproterone acetate with ethinyloestradiol ...................... 76 Crystacide...................................................................... 64 Cyklokapron ................................................................... 42 Cytarabine ................................................................... 129 Cytotec .......................................................................... 28 Cytoxan ....................................................................... 128

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d-Penamine ................................................................. 106 d-Zol ............................................................................. 89 d4t ............................................................................. 101 dacarbazine ................................................................. 131 daclin .......................................................................... 105 dactinomycin (actinomycin d) ..................................... 131 daivonex ........................................................................ 70 daktarin lotn, tincture.............................................................. 65 oral gel ...................................................................... 37 dalacin C ....................................................................... 94 danazol.......................................................................... 89 danthron with poloxamer................................................ 36 dantrium ...................................................................... 108 dantrolene sodium ....................................................... 108 dapsone ........................................................................ 96 daunorubicin ............................................................... 131 ddi .............................................................................. 101 de-nol............................................................................ 29 deca-durabolin orgaject ................................................ 78 delact .......................................................................... 189 depo-Medrol .................................................................. 80 depo-Medrol with lidocaine ............................................ 80 depo-Provera ................................................................. 75 depo-testosterone......................................................... 81 dermol Cream, oint ................................................................ 66 Scalp appl .................................................................. 71 desferrioxamine mesylate ............................................ 159 desipramine hydrochloride ........................................... 112 desmopressin ................................................................ 89 desmopressin-PH&t...................................................... 89 dexamethasone eye drops, ointment ................................................. 155 tab, oral liq ................................................................ 80 dexamethasone sodium phosphate ................................ 80 dexamethasone with framycetin and gramicidin............ 154 dexamethasone with neomycin and polymyxin b sulphate ................................................................ 155 dexamphetamine sulphate............................................ 126 dextrochlorpheniramine maleate ................................... 146 dextropropoxyphene with paracetamol ......................... 110 dextrose ........................................................................ 45 dextrose with electrolytes............................................... 46 dHC Continus .............................................................. 110 diabur 5000 ................................................................... 33 diamox ........................................................................ 156 diaphragm ..................................................................... 73 diasip .......................................................................... 172 diason RtH ................................................................. 172 diastix ........................................................................... 33 diastop .......................................................................... 27 diatol ............................................................................. 33 diazemuls .................................................................... 114

diazepam Rectal tubes, inj ....................................................... 114 tab .......................................................................... 124 dibenyline ...................................................................... 55 dibromopropamidine isethionate .................................. 154 diclocil .......................................................................... 93 diclofenac sodium eye drops ................................................................ 155 tab, suppos, inj ....................................................... 104 dicloxacillin.................................................................... 93 dicyclomine hydrochloride ............................................. 28 didanosine ................................................................... 101 didronel ......................................................................... 79 Difflam ........................................................................... 37 Diflucan ......................................................................... 95 Diflucortolone valerate .................................................... 66 digoxin .......................................................................... 58 dihydrocodeine tartrate ................................................ 110 dilantin ........................................................................ 115 dilantin infatab ............................................................. 115 dilatrend ........................................................................ 59 diltiazem hydrochloride .................................................. 61 dilzem ........................................................................... 61 dilzem lA ...................................................................... 61 dilzem SR ...................................................................... 61 dimenhydrinate ............................................................ 118 dimetriose ..................................................................... 89 dipentum ....................................................................... 27 diphemanil methylsulphate ............................................. 68 diphenoxylate hydrochloride with atropine sulphate ........ 27 dipivefrin hydrochloride................................................ 157 diprosone ...................................................................... 66 diprosone oV................................................................. 66 dipyridamole.................................................................. 44 disipal ......................................................................... 120 disopyramide phosphate ................................................ 58 Disulfiram .................................................................... 127 dithranol ........................................................................ 70 diurin 40 ........................................................................ 62 diurin 500 ...................................................................... 62 dixarit .......................................................................... 117 docetaxel ..................................................................... 132 docusate sodium ........................................................... 36 docusate sodium with sennosides ................................. 36 domperidone ............................................................... 118 dopergin ...................................................................... 119 dopress ....................................................................... 112 dornase alfa................................................................. 152 dorzolamide hydrochloride ........................................... 156 dorzolamide hydrochloride with timolol maleate............ 156 dosan ............................................................................ 55 dostinex ........................................................................ 89 dothiepin hydrochloride................................................ 112 doxazosin mesylate ....................................................... 55 doxepin hydrochloride.................................................. 112 doxine ........................................................................... 93

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generic chemicals and brands

doxorubicin ................................................................. 132 doxorubicin ebewe ...................................................... 132 doxy-50......................................................................... 93 doxycycline hydrochloride.............................................. 93 dP lotion ....................................................................... 69 dP lotn HC .................................................................... 66 dramamine .................................................................. 118 dulcolax......................................................................... 36 duocal Super Soluble Powder ...................................... 168 duolin .......................................................................... 151 duphaston ..................................................................... 84 Durex Confidence ........................................................... 73 duride ............................................................................ 63 durogesic .................................................................... 110 dydrogesterone.............................................................. 84 dyzole ........................................................................... 95

e-Mycin ......................................................................... 92 easiphen liquid............................................................ 186 econazole nitrate Cream, foaming soln .................................................. 65 Pessaries ................................................................... 76 ecotrin ......................................................................... 109 ecreme .......................................................................... 65 efavirenz ...................................................................... 101 efexor xR ..................................................................... 114 eformoterol fumarate.................................................... 149 efudix ............................................................................ 72 egopsoryl tA ................................................................. 70 elocon ........................................................................... 67 eloxatin ........................................................................ 128 elemental 028 extra ..................................................... 177 eltroxin .......................................................................... 85 emla ............................................................................ 109 emulsifying ointment bP................................................. 68 enalapril ......................................................................... 55 enalapril with hydrochlorothiazide ................................... 56 enbrel .......................................................................... 107 endoxan....................................................................... 128 enerlyte ......................................................................... 46 enfuvirtide .................................................................... 102 ensure ......................................................................... 171 ensure Plus.................................................................. 180 ensure Plus RtH .......................................................... 179 entacapone .................................................................. 119 entocort CiR .................................................................. 27 enuclene ...................................................................... 158 epilim .......................................................................... 115 epilim Crushable .......................................................... 115 epilim iV ...................................................................... 115 epilim S/f liquid .......................................................... 115 epilim Syrup ................................................................ 115 epirubicin..................................................................... 132 epirubicin ebewe.......................................................... 132 eprex ............................................................................. 41 eRA ............................................................................... 92

ergometrine maleate ...................................................... 76 ergotamine tartrate with caffeine................................... 117 erythromycin ethyl succinate .......................................... 92 erythromycin lactobionate .............................................. 92 erythromycin stearate .................................................... 92 erythropoietin alpha........................................................ 41 erythropoietin beta ......................................................... 41 estelle 35 ....................................................................... 76 estraderm ttS 25 .......................................................... 82 estraderm ttS 50 .......................................................... 82 estraderm ttS 100 ........................................................ 82 estrofem ........................................................................ 82 etanercept.................................................................... 107 ethambutol .................................................................... 96 ethics Aspirin ............................................................... 109 ethics Aspirin eC............................................................ 43 ethinyloestradiol ............................................................. 83 ethinyloestradiol with desogestrel ................................... 74 ethinyloestradiol with gestodene ..................................... 74 ethinyloestradiol with levonorgestrel .......................... 74,75 ethinyloestradiol with norethisterone ............................... 75 ethosuximide ............................................................... 115 etidrate .......................................................................... 79 etidronate disodium ....................................................... 79 etopophos ................................................................... 133 etoposide..................................................................... 132 etoposide phosphate .................................................... 133 eumovate....................................................................... 66 eurax ............................................................................. 65 ezetimibe ....................................................................... 48 ezetimibe with simvastatin ............................................. 49 ezetrol ........................................................................... 48

famotidine ..................................................................... 29 famox............................................................................ 29 felodipine ...................................................................... 60 felo 5 eR ....................................................................... 60 felo 10 eR ..................................................................... 60 femara ........................................................................ 136 femodene 28 ................................................................. 74 femtran 50 .................................................................... 82 femtran 100 .................................................................. 82 fenpaed ....................................................................... 104 fentanyl ....................................................................... 110 ferro-gradumet.............................................................. 40 ferro-liquid .................................................................... 40 ferro-tab ........................................................................ 40 ferrograd-folic............................................................... 40 ferrosig ......................................................................... 40 ferrous fumarate ............................................................ 40 ferrous gluconate with ascorbic acid .............................. 40 ferrous sulphate ............................................................ 40 ferrous sulphate with folic acid ...................................... 40 fexofenadine hydrochloride .......................................... 147 fibalip ............................................................................ 47 fibresource .................................................................. 179

generic chemicals and brands

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fibresource RtH .......................................................... 179 fibro-vein....................................................................... 42 flagyl ............................................................................. 95 flagyl-S ......................................................................... 95 flecainide acetate........................................................... 58 fleet bisacodyl Suppositories ......................................... 36 fleet glycerin Suppositories ........................................... 36 fleet Phosphate enema .................................................. 36 flixotide ....................................................................... 147 flixotide Accuhaler ....................................................... 148 florinef .......................................................................... 80 fluanxol ....................................................................... 122 flucloxacillin sodium ...................................................... 93 flucloxin ........................................................................ 93 flucon.......................................................................... 155 fluconazole .................................................................... 95 fludara......................................................................... 129 fludarabine phosphate ................................................. 129 fludrocortisone acetate .................................................. 80 flumetasone pivalate .................................................... 154 Fluocortolone caproate with fluocortolone pivalate and cinchocaine ............................................................... 28 fluorometholone .......................................................... 155 fluorouracil sodium dermatologicals ......................................................... 72 oncology agents and immunosuppressants .............. 130 fluox............................................................................ 113 fluoxetine hydrochloride ............................................... 113 flupenthixol decanoate ................................................. 122 fluphenazine decanoate ............................................... 122 flutamide ..................................................................... 136 flutamin ....................................................................... 136 fluticasone .......................................................... 147, 148 fluticasone with salmeterol .......................................... 150 fluvax .......................................................................... 103 foban ............................................................................ 64 folic acid ....................................................................... 42 folinic mouthwash ....................................................... 164 food thickener ............................................................. 182 foradil ......................................................................... 149 foremount Child’s Silicone Mask .................................. 153 fortimel ....................................................................... 173 fortini .......................................................................... 175 Fortini Multifibre ........................................................... 175 fortisip ........................................................................ 180 fortisip Multi fibre ........................................................ 180 fortovase ..................................................................... 102 fosamax .................................................................. 78, 79 framycetin sulphate ..................................................... 154 frisium ........................................................................ 115 frumil ............................................................................ 62 frusemide ...................................................................... 62 fucicort ......................................................................... 67 fucidin ........................................................................... 94 fucithalmic .................................................................. 154 fungilin .......................................................................... 37

fusidic acid eye drops ................................................................ 154 Cream, oint ................................................................ 64 tab, inj ...................................................................... 94 fuzeon ......................................................................... 102

gabapentin .................................................................. 116 gamma benzene hexachloride ........................................ 69 gastrogel ....................................................................... 26 gaviscon ....................................................................... 26 gaviscon double Strength .............................................. 26 gaviscon infant .............................................................. 26 gemcitabine hydrochloride .................................... 130,133 gemzar ........................................................................ 130 generaid Plus............................................................... 174 genoptic ...................................................................... 154 genotropin ..................................................................... 85 genox .......................................................................... 137 gentamicin sulphate eye drops ................................................................ 154 inj .............................................................................. 94 gestrione ....................................................................... 89 glatiramer acetate ........................................................ 142 gliben ............................................................................ 32 glibenclamide ................................................................ 32 gliclazide ....................................................................... 32 glipizide ......................................................................... 32 glivec .......................................................................... 135 glucagen Hypokit ........................................................... 30 glucagon hydrochloride ................................................. 30 glucerna ...................................................................... 172 glucerna RtH .............................................................. 172 glucobay ....................................................................... 31 glucose blood diagnostic test meter ............................... 34 glucose dehydrogenase ................................................. 34 glucose oxidase............................................................. 33 glycerol liquid ...................................................................... 165 Suppositories ............................................................. 36 glyceryl trinitrate ............................................................ 63 Glycerol with paraffin and cetyl alcohol ........................... 68 gold Knight .................................................................... 73 gopten ........................................................................... 56 goserelin acetate ........................................................... 87 granocol ........................................................................ 36 growth Hormone biosynthetic human ............................. 85 gutron ........................................................................... 58 gynol ii .......................................................................... 73

Habitrol .......................................................................... 63 Haldol .......................................................................... 122 Haldol Concentrate ....................................................... 122 Haloperidol .................................................................. 120 Haloperidol decanoate .................................................. 122 Hamilton Sunscreen ....................................................... 71 Healtheries iron with Vitamin C ....................................... 40

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generic chemicals and brands

Healtheries Multi-vitamin tablets ..................................... 39 Healtheries Simple baking Mix ...................................... 182 Healtheries Vitamin C ..................................................... 38 Hemastix...................................................................... 159 Heparin sodium.............................................................. 45 Heparinised saline .......................................................... 45 Herceptin ..................................................................... 141 Hespera ......................................................................... 97 Hexamine hippurate...................................................... 102 Hiprex .......................................................................... 102 Histafen ....................................................................... 146 Holoxan ....................................................................... 128 Homatropine hydrobromide .......................................... 157 Horleys bread Mix ........................................................ 182 Horleys flour................................................................ 182 Humalog ........................................................................ 31 Humira......................................................................... 106 Humulin 30/70 ............................................................... 30 Humulin 70/30 ............................................................... 30 Humulin n ...................................................................... 30 Humulin nPH ................................................................. 30 Humulin R ...................................................................... 30 Hyalase........................................................................ 108 Hyaluronidase .............................................................. 108 Hybloc ........................................................................... 59 Hydralazine .................................................................... 63 Hydrea ......................................................................... 133 Hydrocortisone Crm, powder .............................................................. 66 tab, inj ...................................................................... 80 Hydrocortisone acetate .................................................. 27 Hydrocortisone butyrate Cream, oint, lipocream, milky emulsion ...................... 67 Scalp lotion ................................................................ 71 Hydrocortisone butyrate with chlorquinaldol.................... 67 Hydrocortisone with miconazole ..................................... 67 Hydrocortisone with natamycin and neomycin ................ 67 Hydrocortisone with wool fat and mineral oil ................... 66 Hydroderm lotion .......................................................... 69 Hydrogen peroxide 10 vol ........................................................................ 38 20 vol ........................................................................ 72 Crm ........................................................................... 64 Hydroxocobalamin ......................................................... 38 Hydroxychloroquine sulphate.......................................... 95 Hydroxyurea ................................................................ 133 Hygroton........................................................................ 62 Hyoscine (scopolamine)............................................... 118 Hyoscine hydrobromide ............................................... 118 Hyoscine n-butylbromide ............................................... 28 Hypam ......................................................................... 125 Hypnovel ..................................................................... 125 Hypromellose............................................................... 158 Hyprosin ........................................................................ 55 Hytrin............................................................................. 55 Hytrin Starter Pack ......................................................... 55

Hyzaar ........................................................................... 57

i-Profen ....................................................................... 104 ibiamox.......................................................................... 92 ibuprofen ..................................................................... 104 idarubicin hydrochloride ............................................... 133 ifosfamide.................................................................... 128 imatinib mesylate ......................................................... 135 imiglucerase .................................................................. 37 imigran ........................................................................ 117 imipramine hydrochloride ............................................. 112 imuran ......................................................................... 138 indapamide .................................................................... 62 indinavir ....................................................................... 101 indomethacin ............................................................... 105 infasoy ........................................................................ 189 Influenza vaccine.......................................................... 103 inhibace ......................................................................... 55 inhibace Plus ................................................................. 56 interferon alpha-2A ...................................................... 139 interferon alpha-2A with ribavirin .................................. 139 interferon alpha-2b....................................................... 139 interferon beta-1-alpha ................................................. 142 interferon beta-1-beta................................................... 142 intra-uterine device......................................................... 73 intron-A ....................................................................... 139 insoma ........................................................................ 125 insulatard ....................................................................... 30 insulin aspart ................................................................. 31 insulin glargine ............................................................... 31 insulin isophane ............................................................. 30 insulin isophane with insulin neutral................................ 30 insulin lispro .................................................................. 31 insulin neutral ................................................................ 30 insulin pen needles......................................................... 34 insulin syringes .............................................................. 34 intal Spincaps .............................................................. 148 invirase ........................................................................ 102 ipecacuanha ................................................................ 159 ipratropium bromide inhaler, nebules ....................................................... 151 nasal preparations ................................................... 153 irinotecan..................................................................... 130 iron polymaltose ............................................................ 40 ismo 20 ......................................................................... 63 isogel............................................................................. 35 isoniazid ........................................................................ 96 isoprenaline hydrochloride.............................................. 63 isoptin ........................................................................... 61 isopto Carbachol .......................................................... 157 isopto frin.................................................................... 158 isopto Homatropine ...................................................... 157 isosorbide mononitrate................................................... 63 isosource 1.5............................................................... 179 isosource Standard ...................................................... 179 isosource Standard RtH .............................................. 179

generic chemicals and brands

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isotane 10...................................................................... isotane 20...................................................................... isotretinoin ..................................................................... isuprel ........................................................................... itraconazole ...................................................................

64 64 64 63 95

janola ............................................................................ 68 jevity RtH ................................................................... 179 junior Parapaed ........................................................... 109

K-thrombin.................................................................... 42 Kaletra ......................................................................... 102 Karicare food thickener ............................................... 182 Karicare goats Milk infant formula ............................... 189 Karicare Soy All Ages ................................................... 190 Keflex ............................................................................ 91 Kemadrin ..................................................................... 120 Kenacomb inj .............................................................................. 67 ear drops ................................................................. 154 Kenacort A ..................................................................... 80 Kenacort A40 ................................................................. 80 Keto-diabur 5000........................................................... 33 Keto-diastix ................................................................... 33 Ketoconazole Crm ........................................................................... 65 Scalp preparations ..................................................... 71 tab ............................................................................ 95 Ketopine ........................................................................ 71 Ketoprofen ................................................................... 104 Ketostix.......................................................................... 34 Ketotifen ...................................................................... 147 Ketovite ....................................................................... 186 Ketovite Syrup.............................................................. 186 Ketur-test ...................................................................... 34 Kindergen .................................................................... 174 Klacid ............................................................................ 91 Kliogest ......................................................................... 83 Kliovance ....................................................................... 83 Konakion ....................................................................... 42 Konakion MM................................................................. 42 Konsyl-d........................................................................ 35

lA-Morph .................................................................... 111 labetalol ........................................................................ 59 lacri-lube ................................................................... 158 lactulose ....................................................................... 36 laevolac ........................................................................ 36 lamictal ....................................................................... 116 lamivudine Anti-retrovirals ......................................................... 101 tab, oral liq ................................................................ 97 lamotrigine.................................................................. 116 lanoxin .......................................................................... 58 lanoxin Pg .................................................................... 58 lansoprazole ................................................................. 29

lantus ........................................................................... 31 lanvis .......................................................................... 131 largactil....................................................................... 120 lasix .............................................................................. 62 latanoprost.................................................................. 156 lax-tabs........................................................................ 36 laxsol ............................................................................ 36 Leflunomide ................................................................. 105 lemnis fatty Cream ....................................................... 68 lemnis fatty Cream HC.................................................. 66 letrozole ...................................................................... 136 leucovorin ................................................................... 129 leucovorin Calcium ..................................................... 129 leukeran fC ................................................................. 128 leunase ....................................................................... 131 leustatin ...................................................................... 129 levlen ed ...................................................................... 74 levobunolol ................................................................. 155 levocabastine .............................................................. 155 levodopa with benserazide .......................................... 119 levodopa with carbidopa ............................................. 119 levonorgestrel .................................................... 75,76, 84 lifestyles flared ............................................................. 73 lignocaine hydrochloride Anaesthetics ............................................................ 109 lignocaine with prilocaine hydrochloride ...................... 109 lipex.............................................................................. 48 lipitor ............................................................................ 47 lisinopril ........................................................................ 56 lisuride hydrogen maleate............................................ 119 lithicarb ...................................................................... 120 lithium carbonate ........................................................ 120 Liquifilm Forte .............................................................. 158 Liquifilm Tears ............................................................. 158 liquigen ....................................................................... 169 livostin ........................................................................ 155 locasol........................................................................ 187 loceryl .......................................................................... 64 locoid Cream, oint ................................................................ 67 Scalp lotion ................................................................ 71 locoid C ........................................................................ 67 locoid Crelo .................................................................. 67 locoid lipocream .......................................................... 67 locorten-Vioform ......................................................... 154 lodoxamide trometamol ............................................... 155 loette ............................................................................ 75 lomide ........................................................................ 155 lomustine.................................................................... 128 loperamide hydrochloride .............................................. 27 lopinavir with ritonavir ................................................. 102 lopresor ........................................................................ 59 Loprofin ....................................................................... 185 Loprofin Mix ................................................................. 185 lorapaed ..................................................................... 147 loratadine.................................................................... 147

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generic chemicals and brands

lorazepam ................................................................... 124 lormetazepam ............................................................. 125 losartan ........................................................................ 57 losartan with hydrochlorothiazide .................................. 57 losec ............................................................................ 29 losec Hp7 oAC ............................................................. 28 loten ............................................................................. 59 lovir ........................................................................ 98, 99 lucrin depot .................................................................. 88 ludiomil....................................................................... 112 lueprorelin..................................................................... 88 lumigan ...................................................................... 156 lyderm .......................................................................... 69

m-Cefazolin ................................................................... 90 m-enalapril .................................................................... 55 m-eslon ....................................................................... 111 m-Hydrocortisone .......................................................... 66 Mabthera ..................................................................... 141 Madopar 125 ............................................................... 119 Madopar 250 ............................................................... 119 Madopar 62.5 .............................................................. 119 Madopar dispersible .................................................... 119 Madopar HbS .............................................................. 119 Magnesium hydroxide Paste ....................................................................... 165 Magnesium hydroxide mixture ...................................... 164 Magnesium sulphate inj .............................................................................. 40 Paste ......................................................................... 72 Malathion ....................................................................... 69 Maldison ........................................................................ 69 Mandol .......................................................................... 90 Maprotiline hydrochloride ............................................. 112 Marcain Heavy ............................................................. 109 Marcain isobaric .......................................................... 109 Marevan......................................................................... 45 Marquis Protecta ............................................................ 73 Marquis Supalite ............................................................ 73 Marvelon 21................................................................... 74 Marvelon 28................................................................... 74 Marzine........................................................................ 117 Maxamaid MSud ......................................................... 184 Maxamaid xP ............................................................... 186 Maxamum MSud ......................................................... 184 Maxamum xP .............................................................. 186 Maxidex ....................................................................... 155 Maxitrol........................................................................ 155 Maxolon ....................................................................... 118 MCt oil ........................................................................ 169 MdS Quick Card ............................................................ 77 Mebendazole.................................................................. 90 Mebeverine hydrochloride .............................................. 28 Medrol ........................................................................... 80

Medroxyprogesterone acetate inj .............................................................................. 75 tab ...................................................................... 83, 84 Mefenamic acid ........................................................... 104 Megace........................................................................ 137 Megestrol acetate......................................................... 137 Melphalan .................................................................... 128 Menadione sodium bisulphite ......................................... 42 Menthol ......................................................................... 65 Merbentyl....................................................................... 28 Mercaptopurine ............................................................ 130 Mercilon 21 ................................................................... 74 Mercilon 28 ................................................................... 74 Mesalazine ..................................................................... 27 Mesna ......................................................................... 133 Mestinon...................................................................... 104 Metabolic Mineral Mixture............................................. 186 Metamide..................................................................... 118 Metamucil ...................................................................... 35 Metformin hydrochloride ................................................ 32 Methadone hydrochloride Analgesics ............................................................... 110 Powder .................................................................... 165 Methadone mixture....................................................... 164 Methoblastin ................................................................ 131 Methopt ....................................................................... 158 Methopt forte............................................................... 158 Methotrexate ................................................................ 131 Methotrexate ebewe ..................................................... 131 Methotrimeprazine........................................................ 120 Methoxsalen .................................................................. 70 Methylcellulose ............................................................ 165 Methyldopa .................................................................... 61 Methylhydroxybenzoate ................................................ 165 Methylhydroxybenzoate 10% solution ........................... 164 Methylphenidate hydrochloride ..................................... 126 Methylprednisolone ........................................................ 80 Methylprednisolone aceponate ....................................... 67 Methylprednisolone acetate ............................................ 80 Methylprednisolone acetate with lignocaine .................... 80 Methylprednisolone sodium phosphate ........................... 80 Methylprednisolone sodium succinate ............................ 80 Metoclopramide hydrochloride ..................................... 118 Metoclopramide hydrochloride with paracetamol .......... 117 Metomin ........................................................................ 32 Metopirone .................................................................... 89 Metoprolol succinate ...................................................... 59 Metoprolol tartrate .......................................................... 59 Metronidazole ................................................................ 95 Metyrapone.................................................................... 89 Mexiletine hydrochloride ................................................. 58 Mexitil ............................................................................ 58 Miacalcic ....................................................................... 79 Mianserin hydrochloride ............................................... 112 Micanol.......................................................................... 70 Miconazole .................................................................... 37

generic chemicals and brands

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Miconazole nitrate Crm, lotn, tincture ...................................................... 65 Vag crm ..................................................................... 76 Micelle e ........................................................................ 39 Micreme ........................................................................ 76 Micreme H ..................................................................... 67 Microgynon 20 ed ......................................................... 75 Microgynon 30............................................................... 74 Microgynon 30 ed ......................................................... 74 Microgynon 50 ed ......................................................... 74 Microlax ......................................................................... 36 Microlut ......................................................................... 75 Midazolam ................................................................... 125 Midodrine ...................................................................... 58 Minaphlex .................................................................... 186 Minidiab ......................................................................... 32 Minirin ........................................................................... 89 Mino-tabs ...................................................................... 93 Minocycline hydrochloride.............................................. 93 Minomycin ..................................................................... 93 Minulet 28...................................................................... 74 Mirena ........................................................................... 84 Misoprostol.................................................................... 28 Mitomycin C ................................................................ 133 Mitomycin-C Kyowa ..................................................... 133 Mitozantrone ................................................................ 133 Mixtard 30 ..................................................................... 30 Mixtard 50 ..................................................................... 30 Moclobemide ............................................................... 113 Modecate..................................................................... 122 Moducal ...................................................................... 167 Mometasone furoate ...................................................... 67 Monofeme ..................................................................... 74 Monogen ..................................................................... 173 Morphine hydrochloride................................................ 110 Morphine sulphate........................................................ 111 Morphine tartrate .......................................................... 111 Morrex Maltodextrin ..................................................... 167 Motilium ...................................................................... 118 MSud Aid .................................................................... 184 Mucilaginous laxatives ................................................... 35 Mucilaginous laxatives with stimulants ........................... 36 Mucilax .......................................................................... 35 Multiload Cu 375............................................................ 73 Multiload Cu 375Sl........................................................ 73 Multiparin....................................................................... 45 Mupirocin ...................................................................... 64 Myambutol..................................................................... 96 Mycobutin........................................................................96 Mycophenolate mofetil ................................................. 138 Mydriacyl ..................................................................... 157 Mylanta P ...................................................................... 26 Myleran ....................................................................... 128 Myocrisin..................................................................... 106 Mycostatin ..................................................................... 65

nadolol .......................................................................... 60 nalcrom ......................................................................... 27 naloxone hydrochloride ................................................ 159 naltrexone hydrochloride .............................................. 127 nandrolene decanoate .................................................... 78 napamide ...................................................................... 62 naphazoline hydrochloride ........................................... 158 naphcon forte ............................................................. 158 naprosyn SR 1000....................................................... 105 naprosyn SR 750......................................................... 105 naproxen ..................................................................... 105 naproxen sodium ......................................................... 105 nardil ........................................................................... 113 natulan ........................................................................ 134 nausicalm.................................................................... 117 navelbine ..................................................................... 135 navoban ...................................................................... 119 naxen .......................................................................... 105 nedocromil .................................................................. 148 nefopam hydrochloride ................................................ 109 Nelfinavir...................................................................... 102 neo-Cytamen ................................................................. 38 neo-Mercazole ............................................................... 85 neo-naclex .................................................................... 62 neocate ....................................................................... 188 neostigmine................................................................. 104 neotigason .................................................................... 70 neoral .......................................................................... 144 nepro .......................................................................... 176 nerisone ........................................................................ 66 neulactil....................................................................... 121 neurontin ..................................................................... 116 nevirapine .................................................................... 101 niacin-odan ................................................................... 47 nicotine ......................................................................... 63 nicotinic acid ................................................................. 47 nifedipine....................................................................... 60 nifuran ......................................................................... 102 nilstat oral liq, tab, cap ................................................... 37, 95 Vag crm ..................................................................... 76 nipent .......................................................................... 134 nitrados ....................................................................... 125 nitrazepam................................................................... 125 nitroderm ttS................................................................ 63 nitrofurantoin ............................................................... 102 nitrolingual Pumpspray .................................................. 63 nizoral Crm ........................................................................... 65 tab ............................................................................ 95 noctamid ..................................................................... 125 nodia ............................................................................. 27 Noflam 250 .................................................................. 105 Noflam 500 .................................................................. 105 nonoxynol-9 .................................................................. 73

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generic chemicals and brands

nordette 28 .................................................................... 74 norditropin Simplexx 5 mg ............................................. 85 norditropin Simplexx 10 mg ........................................... 85 norditropin Simplexx 15 mg ........................................... 85 norethisterone ......................................................... 75, 84 norethisterone with mestranol ........................................ 75 Norflex ......................................................................... 108 Norfloxacin .................................................................. 102 noriday 28 ..................................................................... 75 norimin .......................................................................... 75 norinyl-1/28 .................................................................. 75 normacol ....................................................................... 35 normacol Plus ............................................................... 36 normison ..................................................................... 125 norpress ...................................................................... 112 nortriptyline hydrochloride............................................ 112 norvir .......................................................................... 102 novaSource Renal........................................................ 176 novofine........................................................................ 34 novoRapid ..................................................................... 31 NovoRapid Penfill ........................................................... 31 nozinan ....................................................................... 120 nuelin .......................................................................... 152 nuelin-SR .................................................................... 152 nupentin ...................................................................... 116 nutraplus ....................................................................... 68 nutridrink ..................................................................... 171 nutrini energy RtH ....................................................... 175 nutrini RtH .................................................................. 175 nutrison Concentrated .................................................. 176 nutrison energy Multi fibre........................................... 179 nutrison Multi fibre ...................................................... 179 nutrison Standard RtH................................................. 179 nuvell ............................................................................ 83 nyefax Retard ................................................................ 60 nystatin Crm ........................................................................... 65 oral liq ....................................................................... 37 tab, cap .................................................................... 95 Vag crm ..................................................................... 76 nZb low gluten bread Mix ........................................... 182

octreotide .................................................................... 137 oestradiol ...................................................................... 82 oestradiol valerate.......................................................... 82 oestradiol with levonorgestrel ......................................... 83 oestradiol with northisterone .......................................... 83 oestriol Crm, pessaries ........................................................... 76 tab ............................................................................ 83 oestrogens .................................................................... 83 oestrogens with medroxyprogesterone ........................... 83 oil in water emulsion ...................................................... 68 oily cream bP ................................................................ 68 oily phenol ..................................................................... 28 olanzapine ............................................................ 121,123

olbetam ......................................................................... 47 olsalazine ...................................................................... 27 omeprazole.................................................................... 29 omeprazole, amoxycillin and clarithromycin ................... 28 omeprazole suspension ............................................... 164 ondansetron ................................................................ 118 one-Alpha ...................................................................... 39 onkotrone .................................................................... 133 optium........................................................................... 34 orabase ......................................................................... 37 oracort .......................................................................... 37 orap ............................................................................ 121 orgran buckwheat Spirals.................................................... 183 Corn and Parsley fettucine ....................................... 183 Corn and Spinach Rigatini ........................................ 183 Corn and Vegetable Shells ........................................ 183 garlic and Parsley Spirals ......................................... 183 Rice and Corn garden Herb Pasta............................. 183 Rice and Corn lasagne Sheets ................................. 183 Rice and Corn Macaroni ........................................... 183 Rice and Corn Penne ................................................ 183 Rice and Maize Pasta Spirals .................................... 183 Rice and Maize Spaghetti ......................................... 183 Rice and Millet Spirals .............................................. 183 tomato and basil Spirals .......................................... 183 Vegetable and Rice Spirals ....................................... 183 ornidazole...................................................................... 95 orphenadrine citrate ..................................................... 108 orphenadrine hydrochloride.......................................... 120 ortho ............................................................................. 73 ortho All-flex .................................................................. 73 ortho Coil ...................................................................... 73 ortho-tolidine ............................................................... 159 oruvail 100 .................................................................. 104 oruvail 200 .................................................................. 104 osmolite RtH............................................................... 179 ospamox ....................................................................... 92 ospamox Paediatric drops ............................................. 92 ovestin .................................................................... 76, 83 ox-Pam ....................................................................... 124 oxaliplatin .................................................................... 128 oxazepam .................................................................... 124 oxis turbuhaler ............................................................ 149 oxsoralen....................................................................... 70 oxybutynin ..................................................................... 77 oxycodone hydrochloride ............................................. 111 oxyContin .................................................................... 111 oxynorm ..................................................................... 111 oxypentifylline ................................................................ 63 oxytocin ........................................................................ 76

Pacifen ........................................................................ 108 Pacific Buspirone ......................................................... 124 Pacific Cyproterone ........................................................ 81 Paclitaxel ..................................................................... 133

generic chemicals and brands

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Paclitaxel ebewe .......................................................... 133 Pedialyte fruit ................................................................ 46 Paediatric Seravite........................................................ 186 Pallidone ...................................................................... 110 Pamidronate disodium ................................................... 79 Pamisol ......................................................................... 79 Panadol ....................................................................... 109 Pan benzathine benzylpenicillin ...................................... 93 Pancreatic enzyme ......................................................... 35 Pancrex V ...................................................................... 35 Pancrex V forte .............................................................. 35 Panteseton ..................................................................... 81 Pantoprazole .................................................................. 29 Panzytrat........................................................................ 35 Papaverine hydrochloride ............................................... 76 Paracare ...................................................................... 109 Paracetamol................................................................. 109 Paracetamol with codeine ............................................ 110 Paradex ....................................................................... 110 Paraffin liquid with soft white paraffin ........................... 158 Paraffin liquid with wool fat liquid ................................. 158 Paraffin, white soft ......................................................... 69 Paraldehyde ................................................................. 114 Paramax ...................................................................... 117 Parnate ........................................................................ 113 Paroxetine hydrochloride .............................................. 113 Parvolex ....................................................................... 165 Paxam ......................................................................... 115 Peak flow meters ......................................................... 153 Pediasure..................................................................... 175 Pediasure RtH ............................................................. 175 Pegasys....................................................................... 139 Pegasys RbV Combination Pack .................................. 139 Pegatron Combination therapy ..................................... 140 Pegylated interferon alpha-2A ....................................... 139 Pegylated interferon alpha-2b with ribavirin .................. 140 Penicillamine................................................................ 106 PenMix 10 ..................................................................... 30 PenMix 20 ..................................................................... 30 PenMix 30 ..................................................................... 30 PenMix 40 ..................................................................... 30 PenMix 50 ..................................................................... 30 Pentasa ......................................................................... 27 Pentostatin (deoxycoformycin) ..................................... 134 Peptisorb ..................................................................... 177 Pepti junior.................................................................. 188 Pergolide ..................................................................... 119 Perhexiline maleate ........................................................ 61 Periactin ...................................................................... 146 Pericyazine .................................................................. 121 Perindopril ..................................................................... 56 Permax ........................................................................ 119 Permethrin ..................................................................... 69 Persantin ....................................................................... 44 Pertofran ...................................................................... 112 Pethidine hydrochloride ................................................ 111

Pevaryl .......................................................................... 65 Pevaryl ovules ............................................................... 76 Pexsig............................................................................ 61 Pharmorubicin ............................................................. 132 Phenate ......................................................................... 89 Phenelzine sulphate.............................................................. Phenergan ................................................................... 147 Phenobarbitone ............................................................ 115 Phenobarbitone sodium................................................ 165 Phenobarbitone oral liquid ............................................ 164 Phenoxybenzamine hydrochloride................................... 55 Phenoxymethylpenicill (Penicillin V) ................................ 93 Phentolamine mesylate .................................................. 55 Phenylephrine hydrochloride ........................................ 158 Phenylephrine hydrochloride with zinc sulphate ............ 158 Phenytoin sodium Cap, tab, oral liq ....................................................... 115 inj ............................................................................ 114 Phlexy 10..................................................................... 186 Phosphate-Sandoz ......................................................... 46 Phytomenadione ............................................................ 42 Pilocarpine eye drops ................................................................ 157 Pilocarpine oral liquid ................................................... 164 Pilopt ........................................................................... 157 Pimafucort ..................................................................... 67 Pimozide ...................................................................... 121 Pindol ............................................................................ 60 Pindolol ......................................................................... 60 Pinetarsol....................................................................... 71 Pioglitazone ................................................................... 32 Piportil ......................................................................... 122 Pipothiazine palmitate................................................... 122 Piram-d ....................................................................... 105 Piroxicam..................................................................... 105 Pizotifen ....................................................................... 117 Plaquenil ........................................................................ 95 Plasma-lyte oral............................................................ 46 Plavix ............................................................................. 43 Plendil eR ...................................................................... 60 Podophyllotoxin ............................................................. 71 Polaramine................................................................... 146 Polaramine Repetab ..................................................... 146 Poloxamer ..................................................................... 36 Poly-tears ................................................................... 158 Poly-Visc ..................................................................... 158 Polycal......................................................................... 167 Polycose...................................................................... 167 Polysiloxane................................................................... 26 Polytar emollient ............................................................ 71 Polyvinyl alcohol .......................................................... 158 Polyvinyl alcohol with povidone .................................... 158 Ponstan ....................................................................... 104 Postinor-2...................................................................... 76 Potassium bicarbonate ................................................... 46 Potassium chloride

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generic chemicals and brands

inj .............................................................................. 45 tab ............................................................................ 46 Povidone iodine ............................................................. 69 Prantal ........................................................................... 68 Pravachol....................................................................... 48 Pravastatin ..................................................................... 48 Prazosin hydrochloride ................................................... 55 Prednisolone acetate .................................................... 155 Prednisone..................................................................... 80 Pred forte .................................................................... 155 Pred Mild ..................................................................... 155 Prefrin.......................................................................... 158 Pregnancy test - HCg urine ............................................ 77 Premia 2.5 Continuous ................................................... 83 Premia 5 Continuous ...................................................... 83 Premarin ........................................................................ 82 Priadel ......................................................................... 120 Primidone .................................................................... 115 Primolut n...................................................................... 84 Primoteston ................................................................... 81 Prinivil............................................................................ 56 Prodopa ......................................................................... 61 Pro-Pam ...................................................................... 124 Probenecid .................................................................. 108 Procaine penicillin .......................................................... 93 Procarbazine hydrochloride .......................................... 134 Prochlorperazine .......................................................... 118 Procyclidine hydrochloride ........................................... 120 Progout........................................................................ 108 Prograf ........................................................................ 145 Progynova ..................................................................... 82 Promethazine hydrochloride ......................................... 147 Promethazine theoclate ................................................ 119 Promod........................................................................ 170 Propafenone hydrochloride ............................................. 58 Propamidine isethionate ............................................... 155 Propine ........................................................................ 157 Propranolol .................................................................... 60 Propylene glycol .......................................................... 165 Protamine sulphate ........................................................ 45 Protaphane .................................................................... 30 Protaphane Penfill .......................................................... 30 Protifar 90.................................................................... 170 Provera .................................................................... 83, 84 PSo ............................................................................. 191 Pulmicort turbuhaler .................................................... 148 Pulmocare ................................................................... 171 Pulmozyme .................................................................. 152 Purinethol .................................................................... 130 Pyrazinamide ................................................................. 96 Pytazen SR .................................................................... 44 Pyrantel embonate ......................................................... 90 Pyridostigmine bromide................................................ 104 Pyridoxine hydrochloride ................................................ 38

Q 300 .......................................................................... 108 Quellada-P ..................................................................... 69 Questran-lite ................................................................. 47 Quetiapine.................................................................... 121 Quinapril ........................................................................ 56 Quinapril with hydrochlorothiazide .................................. 56 Quinine sulphate .......................................................... 108 QV ................................................................................. 68

Q 200 .......................................................................... 108

R3 Superfeucht .............................................................. 73 RA-Morph .................................................................... 110 Ranbaxy Amoxicillin ....................................................... 92 Ranbaxy-Cefaclor........................................................... 90 Ranitidine hydrochloride ................................................. 29 Razene ........................................................................ 146 Recombinant human growth hormone ............................ 85 Recormon ...................................................................... 41 Redipred ........................................................................ 80 Regitine ......................................................................... 55 Renilon 7.5 .................................................................. 176 Resonium-A ................................................................... 46 Resource diabetic ........................................................ 172 Resource diabetic RtH ................................................ 172 Resource just for Kids ................................................. 175 Resource Plus.............................................................. 180 Resource thicken up ................................................... 182 Retrovir ........................................................................ 101 Requip ......................................................................... 119 Reyataz........................................................................ 101 ReVia ........................................................................... 127 Ridaura ........................................................................ 105 Rifabutin ........................................................................ 96 Rifadin ........................................................................... 96 Rifampicin ..................................................................... 96 Rifinah ........................................................................... 96 Riodine .......................................................................... 69 Risperdal ..................................................................... 121 Risperdal Consta .......................................................... 122 Risperdal Quicklet ........................................................ 123 Risperidone tab, oral liq .............................................................. 121 inj ............................................................................ 122 oral disintergrating tab ............................................. 123 Ritalin SR ..................................................................... 126 Ritonavir ...................................................................... 102 Rituximab .................................................................... 141 Rivotril injection ................................................................... 114 oral drops ................................................................ 115 Rheumacin .................................................................. 105 Rheumacin SR ............................................................. 105 RMS ............................................................................ 111 Rocaltrol ........................................................................ 39 Rocaltrol solution ........................................................... 39 Rocephin ....................................................................... 91 Rocephin iV ................................................................... 91

generic chemicals and brands

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Roferon-A .................................................................... 139 Roferon RbV Combination Pack ................................... 139 Roferon RbV Combination Pack Starter Kit ................... 139 Romicin ......................................................................... 92 Ropinirole hydrochloride............................................... 119 Roxithromycin................................................................ 92 Rubifen ........................................................................ 126 Rubifen SR .................................................................. 126 Rural Areas for Practitioner’s Supply orders ................. 195 R V Paque ...................................................................... 71 Rythmodan .................................................................... 58 Rytmonorm.................................................................... 58 Rynacrom forte ........................................................... 153

S26lbW gold .............................................................. 187 Sabril ........................................................................... 117 Safety Cap Medicines................................................... 198 Salamol ....................................................................... 148 Salapin ........................................................................ 152 Salazopyrin .................................................................... 27 Salazopyrin en ............................................................... 27 Salbutamol inhaler...................................................................... 148 inj, inf, oral liq .......................................................... 152 nebuliser soln .......................................................... 150 tab .......................................................................... 151 Salbutamol with ipratropium bromide............................ 151 Salicylic acid .................................................................. 70 Saliva substitute formula .............................................. 164 Salmeterol ................................................................... 149 Sandomigran ............................................................... 117 Sandostatin .................................................................. 137 Sandostatin lAR .......................................................... 137 Saquinavir .................................................................... 102 Scopoderm ttS ........................................................... 118 Selegiline hydrochloride ............................................... 119 Senna ............................................................................ 36 Senokot ......................................................................... 36 Serenace ..................................................................... 120 Seretide ....................................................................... 150 Seretide Accuhaler ....................................................... 150 Serevent ...................................................................... 149 Serevent Accuhaler ...................................................... 149 Seroquel ...................................................................... 121 Sevredol ...................................................................... 111 Shield blue ..................................................................... 73 Silvazine ........................................................................ 64 Silver sulphadiazine ........................................................ 64 Simethicone ................................................................... 26 Similac Special Care .................................................... 187 Simvastatin .................................................................... 48 Sindopa ....................................................................... 119 Sinemet ....................................................................... 119 Sinemet CR.................................................................. 119 Siterone ......................................................................... 81 Six Plus Parapaed ........................................................ 109

Slow-lopresor ............................................................... 59 Sodium acid phosphate .................................................. 36 Sodium aurothiomalate ................................................ 106 Sodium alginate ............................................................. 26 Sodium bicarbonate ..................................................... 165 Sodium calcium edetate ............................................... 159 Sodium carboxymethylcellulose ..................................... 37 Sodium chloride ............................................................. 45 Sodium citrate with sodium lauryl sulphoacetate ............. 36 Sodium citro-tartrate ...................................................... 77 Sodium cromoglycate Cap ............................................................................ 27 eye drops ................................................................ 155 nasal spray .............................................................. 153 Respiratory system .................................................. 148 Sodium fluoride .............................................................. 40 Sodium hypochlorite ...................................................... 68 Sodium nitroprusside ..................................................... 34 Sodium polystyrene sulphonate ...................................... 46 Sodium tetradecyl sulphate ............................................ 42 Sodium valproate ......................................................... 115 Sofradex ...................................................................... 154 Soframycin eye preparations ...................................................... 154 Solox ............................................................................. 29 Solu-Cortef .................................................................... 80 Solu-Medrol ................................................................... 80 Somac ........................................................................... 29 Sotacor .......................................................................... 60 Sotalol ........................................................................... 60 Spacer devices and masks ........................................... 153 Space Chamber ........................................................... 153 Span-K .......................................................................... 46 Spiriva ......................................................................... 150 Spironolactone ............................................................... 62 Spirotone ....................................................................... 62 Sporanox ....................................................................... 95 Stavudine ..................................................................... 101 Stelazine ...................................................................... 122 Stelazine Section 29 ..................................................... 122 Stemetil ....................................................................... 118 Stesolid ....................................................................... 114 Steri-neb ..................................................................... 151 Stocrin ......................................................................... 101 Stomahesive .................................................................. 37 Sucralfate ...................................................................... 29 Sulindac....................................................................... 105 Sumatriptan ................................................................. 117 Sulphacetamide sodium ............................................... 155 Sulphasalazine ............................................................... 27 Sulphur .......................................................................... 71 Sunscreens, proprietary ................................................. 71 Suplena ....................................................................... 178 Suprefact ....................................................................... 86 Sustanon Ampoules ....................................................... 81 Surgam ........................................................................ 105

indeX

generic chemicals and brands

Surgam SA .................................................................. 105 Sustagen Hospital formula ........................................... 171 Symbicort turbuhaler 100/6 ......................................... 150 Symbicort turbuhaler 200/6 ......................................... 150 Symbicort turbuhaler 400/12 ....................................... 150 Symmetrel ................................................................... 119 Synacthen...................................................................... 80 Synacthen depo ............................................................. 80 Synflex......................................................................... 105 Synphasic 28 ................................................................. 75 Syntocinon..................................................................... 76 Syntometrine.................................................................. 76

tacrolimus................................................................... 145 tears Plus.................................................................... 158 tambocor ...................................................................... 58 tambocor CR ................................................................ 58 tamoxifen citrate.......................................................... 137 tar with cade oil............................................................. 71 Tar with triethanolamine lauryl sulphate and fluorescein .. 71 tasmar ........................................................................ 120 taxol............................................................................ 133 taxotere....................................................................... 132 tegretol ....................................................................... 114 tegretol CR .................................................................. 114 telfast ......................................................................... 147 tenoxicam ................................................................... 105 temazepam ................................................................. 125 temgesic ..................................................................... 110 temodal ...................................................................... 134 temozolomide ............................................................. 134 teniposide ................................................................... 134 terazosin hydrochloride ................................................. 55 teril ............................................................................. 114 testosterone cypionate .................................................. 81 testosterone enanthate .................................................. 81 testosterone esters ........................................................ 81 testosterone undecanoate.............................................. 81 tetrabenazine............................................................... 127 tetrabromophenol ........................................................ 159 tetracosactrin ................................................................ 80 Terbinafine ..................................................................... 95 terbutaline sulphate inhaler and turbuhaler .............................................. 148 inj ............................................................................ 152 thalidomide ................................................................. 134 thalidomide Pharmion.................................................. 134 theophylline ................................................................ 152 thiamine hydrochloride .................................................. 38 thioguanine ................................................................. 131 thioprine ..................................................................... 138 thioridazine hydrochloride............................................ 122 thymol glycerin mouthwash........................................... 38 thyroxine ....................................................................... 85 tiaprofenic acid ........................................................... 105 tiberal ........................................................................... 95

tilade........................................................................... 148 tilcotil .......................................................................... 105 timolol maleate eye drops ................................................................ 155 tabs .......................................................................... 60 timoptol xe ................................................................. 155 tinidazole ...................................................................... 95 tiotropium bromide ...................................................... 150 titralac .......................................................................... 26 tMP............................................................................... 94 tobramycin eye drops & oint ...................................................... 155 inj .............................................................................. 94 tobrex ......................................................................... 155 tofranil ........................................................................ 112 tolbutamide ................................................................... 33 tolcapone .................................................................... 120 tolvon ......................................................................... 112 topamax...................................................................... 117 topiramate................................................................... 117 total Parenteral nutrition (tPn) ...................................... 46 trandate ........................................................................ 59 trandolapril .................................................................... 56 tranexamic acid ............................................................. 42 tranylcypromine sulphate ............................................ 113 trastuzumab ................................................................ 141 trasylol.......................................................................... 42 travatan....................................................................... 156 travoprost ................................................................... 156 trental 400 .................................................................... 63 tretinoin ...................................................................... 134 triamcinolone acetonide Crm, oint.................................................................... 67 inj .............................................................................. 80 Paste ......................................................................... 37 triamcinolone acetonide with gramicidin, neomycin & nystatin Crm, oint.................................................................... 67 ear drops ................................................................. 154 triamizide ...................................................................... 62 triamterene with hydrochlorothiazide.............................. 62 triazolam ..................................................................... 125 trichozole ...................................................................... 95 trifeme .......................................................................... 74 trifluoperazine hydrochloride ........................................ 122 trimeprazine tartrate .................................................... 147 trimethoprim ................................................................. 94 trimipramine maleate ................................................... 113 triphasil 28 .................................................................... 74 tripotassium dicitratobismuthate .................................... 29 tripress ....................................................................... 113 trisequens ..................................................................... 83 trisul ............................................................................. 94 triquilar ed .................................................................... 74 tropicamide ................................................................. 157 tropisetron .................................................................. 119

generic chemicals and brands

indeX

trusopt ........................................................................ 156 two Cal Hn.................................................................. 181 tyloxapol ..................................................................... 158

Vosol ........................................................................... 154 Vosol ear drops with hydrocortisone powder 1%........... 164 Vumon ......................................................................... 134 Vytorin ........................................................................... 49

ultraproct ....................................................................... 28 ural................................................................................ 77 urea............................................................................... 68 uromitexan .................................................................. 133 ursodeoxycholic acid ..................................................... 35

Warfarin sodium............................................................. 45 Wasp venom allergy treatment ..................................... 146 Water ..................................................................... 46, 165 Wool fat with mineral oil ................................................. 69 Wholesale Supply order ............................................... 194

Valaciclovir hydrochloride............................................... 98 Vallergan forte ............................................................. 147 Valoid (Aft) ................................................................. 118 Valtrex ........................................................................... 98 Vancomycin hydrochloride ............................................. 95 Vaxigrip ....................................................................... 103 Velosef .......................................................................... 91 Venlafaxine .................................................................. 114 Ventolin inhaler...................................................................... 148 inj, inf, oral liq .......................................................... 152 Ventolin nebules .......................................................... 150 Vepesid........................................................................ 132 Verapamil hydrochloride ................................................. 61 Vergo 16 ...................................................................... 117 Vermox .......................................................................... 90 Verpamil ........................................................................ 61 Verpamil SR ................................................................... 61 Vesanoid...................................................................... 134 Viaderm KC.................................................................... 67 Vicrom ......................................................................... 148 Videx eC ...................................................................... 101 Vigabatrin .................................................................... 117 Vinblastine sulphate ..................................................... 135 Vincristine sulphate ...................................................... 135 Vinorelbine ................................................................... 135 Vinorelbine ebewe ........................................................ 135 Viracept ....................................................................... 102 Viramune ..................................................................... 101 Viramune Suspension .................................................. 101 Vitadol C ........................................................................ 38 Vital Hn ....................................................................... 177 Vitamins ........................................................................ 39 Vitamin A with vitamins d and C ..................................... 38 Vitamin b complex ......................................................... 38 Vivonex Pediatric.......................................................... 188 Vivonex ten................................................................. 177 Volmax ........................................................................ 151 Voltaren ....................................................................... 104 Voltaren d .................................................................... 104 Voltaren ophtha ........................................................... 155

xalatan......................................................................... xanax........................................................................... xeloda ......................................................................... xenazine 25 ................................................................. xMet Maxamum .......................................................... xylocaine 0.5% ............................................................ xylocaine 1.0% ............................................................

156 124 129 127 184 109 109

Zadine.......................................................................... 146 Zantac............................................................................ 29 Zarontin ....................................................................... 115 Zavedos ....................................................................... 133 Zeffix.............................................................................. 97 Zerit ............................................................................. 101 Ziagen.......................................................................... 101 Zidovudine ................................................................... 101 Zidovudine with lamivudine........................................... 101 Zinacef ........................................................................... 91 Zincaps .......................................................................... 40 Zincfrin ........................................................................ 158 Zinc and castor oil ointment............................................ 68 Zinc cream ..................................................................... 68 Zinc oxide ...................................................................... 28 Zinc sulphate.................................................................. 40 Zinnat ............................................................................ 91 Zithromax....................................................................... 91 Zocor ............................................................................. 48 Zofran .......................................................................... 118 Zofran Zydis ................................................................. 118 Zoladex .......................................................................... 87 Zopiclone ..................................................................... 125 Zostrix HP ...................................................................... 72 Zovirax ................................................................................. eye preparations ...................................................... 154 tab ............................................................................ 98 Zuclopenthixol decanoate ............................................. 123 Zyprexa ........................................................................ 121 Zyprexa Zydis ............................................................... 123

noteS

AutHorItY to SuBStItutE

Dear Pharmacist Please inform my patient that I have authorised substitution. Name: Signature: NZMC: Date:

Where PHARMAC has entered into sole supply or preferred brand (preferred supplier) arrangements, I give authority to substitute an alternative brand of the same medicinal substance in the same strength and pharmaceutical form in the following situations:

Sole Supply Products You may substitute the sole supply brand, except if the patient chooses to pay for the non-sole supply brand. This includes repeat dispensings where the brand I have prescribed is no longer subsidised or is partly subsidised. Preferred Brand (Preferred Supplier) Products You may substitute the preferred brand, except if the patient specifically requests the brand prescribed.

This includes repeat dispensings where the brand I have prescribed is no longer subsidised or is partly subsidised.

Exceptions I do not want substitution to occur for the following chemical entities, unless I am contacted verbally in each specific case.

This authority to substitute replaces all previous authorities relating to these particular chemical entities which I may have provided previously.

This authority to substitute is valid unless I have indicated on the prescription an instruction not to substitute.

Authority for the dispensing pharmacist to change a prescribed medicine in this way is contained in regulation 42 (4) of the Medicines Regulations 1984.

noteS

AutHorItY to SuBStItutE

Dear Pharmacist Please inform my patient that I have authorised substitution. Name: Signature: NZMC: Date:

This includes repeat dispensings where the brand I have prescribed is no longer subsidised or is partly subsidised.

Exceptions I do not want substitution to occur for the following chemical entities, unless I am contacted verbally in each specific case.

This authority to substitute replaces all previous authorities relating to these particular chemical entities which I may have provided previously.

This authority to substitute is valid unless I have indicated on the prescription an instruction not to substitute.

Authority for the dispensing pharmacist to change a prescribed medicine in this way is contained in regulation 42 (4) of the Medicines Regulations 1984.

noteS

AutHorItY to SuBStItutE

Dear Pharmacist Please inform my patient that I have authorised substitution. Name: Signature: NZMC: Date:

This includes repeat dispensings where the brand I have prescribed is no longer subsidised or is partly subsidised.

Exceptions I do not want substitution to occur for the following chemical entities, unless I am contacted verbally in each specific case.

This authority to substitute replaces all previous authorities relating to these particular chemical entities which I may have provided previously.

This authority to substitute is valid unless I have indicated on the prescription an instruction not to substitute.

Authority for the dispensing pharmacist to change a prescribed medicine in this way is contained in regulation 42 (4) of the Medicines Regulations 1984.

noteS

Publishing and subscription details

it Manager Schedule Analysts email

circulation

john geering linda Wellington, Kaye Wilson schedule@pharmac.govt.nz

the Pharmaceutical Schedule is published in April, August and december each year. Changes to the contents of the Schedule are published in monthly updates. An annual subscription includes three Pharmaceutical Schedule books, 12 updates, and occasional additional information on rule changes and news items. the Schedule is distributed free to over 9000 health professionals, and is also available on an annual subscription. back issues are available on request, subject to supply.

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Copyright 1994 Pharmaceutical Management Agency This Schedule is copyright. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the Copyright Act, no part may be reproduced in any form or by any process without written permission, nor be used in any form of advertising, sales, promotion or publicity. While care has been taken in compiling this Schedule, Pharmaceutical Management Agency takes no responsibility for any errors or omissions and shall not be liable to any person for any damages or loss arising out of reliance by that person for any purpose on any of the contents of this Schedule. Errors and omissions brought to the attention of Pharmaceutical Management Agency will be corrected if necessary by an erratum or otherwise in the next edition of the Schedule.

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0800 66 00 50

New Zealand Pharmaceutical Schedule

December 2006

Level 14, Cigna House 40 Mercer St Wellington

www.pharmac.govt.nz

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Title

Pharmaceutical Schedule - effective 1 December 2006

Abstract

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