Pharmaceutical Schedule - effective 1 October 2008 (text extract)

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Introducing PHARMAC

October 2008

Volume 15 Number 2

Editors Linda Wellington & Julie Lagan email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 14, Cigna House 40 Mercer Street PO Box 10 254 Wellington Freephone Information Line 0800 66 00 50 (9am – 5pm weekdays) Circulation Published each April, August and December. Changes to the contents are published in monthly updates. Annual subscription includes three Pharmaceutical Schedule books, 12 updates and occasional information on rule changes and news items. The Schedule is distributed free of charge to over 9,000 professionals, and is also available on an annual subscription. Prices $22.22 One Schedule book $4.44 One Update $120.00 Annual subscription All prices include postage and exclude GST. Production Typeset automatically from XML and TEX. Source XML suitable for database import available on request. Programmers Peter Ericson & John Geering email: texschedule@pharmac.govt.nz http://www.pharmac.govt.nz ISSN 1172 - 9376 Copyright c 1994 Pharmaceutical Management Agency. 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, PHARMAC takes no responsibility for any errors or omissions, and shall not be liable for any consequences arising therefrom.

Section A Section B

General Rules 12 Alimentary Tract & Metabolism 25

Blood & Blood Forming Organs 39 Cardiovascular System 52 Dermatologicals 61 Genito Urinary System 71 Hormone Preparations – Systemic 77 Infections – Agents For Systemic Use 88 Musculo-Skeletal System 100 Nervous System 105 Oncology Agents & Immunosuppressants 129 Respiratory System & Allergies 146 Sensory Organs 153 Various 158

Section C Extemporaneous Compounds (ECPs) 159 Section D Section E

Special Foods 165 Supply Orders (PSO & WSO) 185 Rural Areas 189

Section F Section G

Dispensing Period Exemptions 190 Safety Cap Medicines 192 Index 195

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 David Kerr 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. Murray Georgel, CE MidCentral 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. The policies and criteria set out in the Pharmaceutical Schedule and PHARMAC’s Operating Policies and Procedures arise out of, and are designed to help PHARMAC achieve and perform, PHARMAC’s objective and functions under the Act. However PHARMAC may, having regard to its public law obligations, depart from the strict application of those policies and criteria in certain exceptional cases where it considers this necessary or appropriate in the proper exercise of its statutory discretion and to give effect to its objective and functions, particularly with respect to: G Determining eligibility and criteria for the provision of subsidies; and G In exceptional circumstances providing for subsidies for the supply of pharmaceuticals not on the Pharmaceutical Schedule. 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: G the health needs of all eligible people within New Zealand (eligible deﬁned by the Government’s then current rules of eligibility); a G the particular health needs of M¯ ori and Paciﬁc peoples; G the availability and suitability of existing medicines, therapeutic medical devices and related products and related things; G the clinical beneﬁts and risks of pharmaceuticals; G the cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health and disability support services; G the budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Pharmaceutical Schedule; G the direct cost to health service users; G 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 G 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 and the Pharmaceutical Schedule:

PHARMAC manages the national Pharmaceutical Schedule, which lists: G Pharmaceuticals available in the community and subsidised by the Government with funding from the Pharmaceutical Budget; and G 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’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 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 PTAC Secretary Pharmaceutical Management Agency PO Box 10 254, WELLINGTON PTAC@pharmac.govt.nz

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 Chief Executive Adam McRae Team Leader, Access & Optimal Jason Arnold Senior Analyst Use Peter Alsop Manager, Corporate and Scott Metcalfe Chief Advisor Population External Relations Medicine / Public Health Karen Barris Senior Receptionist Physician Mike Bignall Therapeutic Group Manager Peter Moodie Medical Director Stephen Boxall Creative Director Deborah Nisbet Receptionist Diane Buysman-Bakkam Executive Assistant to Chief Jessica Nisbet Funding and Procurement Executive / Ofﬁce Manager Assistant Hayley Bythell PA to Medical Director Jan Quin Team Leader, Medical Team Christine Chapman Contract Manager Marama Parore Manager, Access & Optimal Yvonne Chen Tender Analyst Use & M¯ ori Health a Mary Chesterﬁeld High Cost Medicines Chris Peck Analyst Co-ordinator Melanie Pemberton Communications Advisor Steffan Crausaz Manager, Funding and Fisher Procurement Sharon Poniah Access and Optimal Use Andrew Davies Procurement Initiatives Manager Manager Matthew Poynton Analyst/Health Economist Sean Dougherty Therapeutic Group Manager Rachel Pratt Hospital Exceptional Kim Ellis Access & Optimal Use Circumstances Panel Co-ordinator Co-ordinator Simon England Communications Manager Ginny Priest Health Economist Peter Ericson Analyst/Programmer Dilky Rasiah Deputy Medical Director Andy Erceg IT Support Kyle Reid High Cost Medicines Panel Jackie Evans Therapeutic Group Manager Co-ordinator / Growth Hormone John Geering Systems Architect Brian Roulston Analyst Rachel Grocott Health Economist / Team Fiona Rutherford Senior Policy Analyst Leader Assessment Rico Schoeler Manager, Analysis and Cameron Hall Health Economist Assessment Susan Haniel PTAC Secretary / Panel Liz Skelley Finance Manager Co-ordinator Paula Smith Records Manager Karen Jacobs Access & Optimal Use Manager Maria Storey Therapeutic Group Manager Elspeth Kay Access & Optimal Use Manager Moana Tane M¯ ori Health Manager a Geoff Lawn Applications Developer Jayne Watkins Community Exceptional Julie Lagan Schedule Analyst Circumstances Panel Geraldine MacGibbon Therapeutic Group Manager Co-ordinator Janet Mackay Access & Optimal Use Manager Linda Wellington Schedule Analyst Rachel Mackay Manager, Schedule and Lisa Williams Legal Counsel Contracts Mary-Ann Wilson M¯ ori Health Analyst a Trish Mahoney Contract Manager Stephen Woodruffe Therapeutic Group Manager

Purpose of the Pharmaceutical Schedule

The purpose of the Schedule is to list: G 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 G 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. G Section A lists the General Rules in relation to Community Pharmaceuticals and related products. G 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. G Section C lists the rules in relation to Extemporaneously Compounded Products (ECPs) and Community Pharmaceuticals that will be subsidised when extemporaneously compounded. G Section D lists the rules in relation to Special Foods and the Special Foods that are subsidised. G Section E Part I lists the Community Pharmaceuticals that are subsidised on a Practitioner’s Supply Order (PSO) and Wholesale Supply Order (WSO). G Section E Part II lists rural areas for the purpose of PSOs. G Section F lists the Community Pharmaceuticals dispensing period exemptions. G 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: G Part I lists the rules in relation to Hospital Pharmaceuticals. G 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. G 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. G 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) $ Per Fully Brand or Subsidised Generic Manufacturer

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

THERAPEUTIC HEADING CHEMICAL L Presentation, form and strength .........................10.00

100

Brand A Brand B Brand C Brand D Brand or manufacturer’s name Sole subsidised supply product Fully subsidised product Original Pack Subsidy is rounded up to a multiple of whole packs

Presentation - Available on a PSO .....................15.00 ‡ Presentation - Retail pharmacy-specialist ..........18.00 a) Prescriptions must be written by a paediatrician or paediatric cardiologist; or b) on the recommnedation of a paediatrician or a paediatric cardiologist CHEMICAL F Presentation, form and strength .........................26 26.53 (35.27)

50 250 ml OP

100 Brand E

Quantity the Subsidy applies to Subsidy paid on a product before mark-ups and GST Manufacturer’s Price if different from Subsidy

Sole Supply Fully Subsidised

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

Glossary

Units of Measure gram ..................................................g kilogram...........................................kg international unit ...............................iu microgram........................................µg milligram .........................................mg millilitre.............................................ml millimole......................................mmol unit.....................................................u

Abbreviations Ampoule ...................................... Amp Granules ......................................Gran Suppository ................................ Supp Capsule ........................................ Cap Infusion............................................Inf Tablet .............................................Tab Cream...........................................Crm Injection ...........................................Inj Tincture.........................................Tinc Device........................................... Dev Linctus .......................................... Linc Trans Dermal Delivery Dispersible................................... Disp Liquid..............................................Liq System.................................. TDDS Effervescent.................................... Eff Long Acting..................................... LA Emulsion..................................... Emul Ointment....................................... Oint Enteric Coated................................EC Sachet ........................................ Sach Gelatinous ..................................... Gel Solution........................................ Soln BSO Bulk Supply Order. CBS Cost Brand Source. There is no set manufacturer’s price, and the Government subsidises the product at the price it is obtained by the 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. OP Original Pack – subsidy is rounded up to a multiple at whole packs. PSO Practitioner’s Supply Order. Sole Subsidised Supplier Only brand of this medicine subsidised. WSO Wholesale Supply Order. XPharm Pharmacies cannot claim subsidy because PHARMAC has made alternative distribution arrangements. L Three months supply may be dispensed at one time if the exempted medicine is endorsed ‘certiﬁed exemption’ by the practitioner. F 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 initialled by the prescriber. ‡ Safety cap required and subsidised 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. S29 This medicine is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Practitioners 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]

[HP3]

[HP4]

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. A Special Food with [HP3] annotation is subsidised when dispensed by a pharmacy that has a Special Foods Service appended to their Pharmacy Services Agreement by their DHB. 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.

Avaliable from selected pharmacies that have an exclusive contract to dispense ‘Hospital Pharmacy’ [HP4] pharmaceuticals.

Patient costs

Community Pharmaceuitical 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. SALBUTAMOL Aerosol inhaler 100 µg per dose....................................... 3.80 (6.00) 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 entitlements Not a PHO enrolee or No Card 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 Maximum prescription charge $15 $10 $0 $3 $3 $3 $3 $2 $2 $0 $0

PHO enrolee or Care plus patient Community Services Card (CSC) High Use Health Card (HUHC) Prescription Subsidy Card

for familes after ﬁrst 20 prescriptions since previous February* * Except prescriptions with $0 charge

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 surchage to patient = (price − subsidy) × 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 surchage 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 Pharmaceuticals including 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 prescibed 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 presciber 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 of 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: G Include the patients name, date of birth and NHI number (codes for AIDS patients’ applications) G Include the practitioner’s name, address and Medical Council registration number G Clearly indicate that the relevant criteria, have been met. G Be signed by the practitioner.

Exceptional Circumstances policies

The purpose of the Exceptional Circumstances policies are to provide: G 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 G an assessment process for the 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 G 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 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 demonstated 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 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: G the quantities, forms, and strengths, of subsidised Community Pharmaceuticals dispensed under valid prescription by each Contractor; G the amount of the Subsidy on the Manufacturer’s Price payable for each unit of the Community Pharmaceuticals dispensed by each Contractor and; G 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 October 2008 and is to be referred to as the Pharmaceutical Schedule Volume 15 Number 2, 2008. Distribution will be from 20 October 2008. This Schedule comes into force on 1 October 2008.

PART I INTERPRETATIONS 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. “Authority to Substitute” means an authority for the dispensing pharmacist to change a prescribed medicine in accordance with regulation 42(4) of the Medicines Regulations 1984. An authority to substitute letter, which may be used by Practitioners, is available on the ﬁnal page of the Schedule. “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

SECTION A: GENERAL RULES

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. “Close Control” means the dispensing of a Community Pharmaceutical, in accordance with a Prescription, in quantities less than one 90 Day Lot (or for 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, where any of a), b) or c) apply. a) All of the following conditions are met: i) the Community Pharmaceutical has been prescribed for a patient who: 1) is not a resident in a Penal Institution, Rest Home or Residential Disability Care Institution; and 2) either of the following: i) in the opinion of the prescribing Practitioner is: a) frail; or b) inﬁrm; or c) unable to manage their medication without additional support; or d) intellectually impaired; or e) requires close monitoring due to recent initiation onto, or dose change for, the Community Pharmaceutical (applicable to the patient’s ﬁrst changed Prescription only); and f) requires that Community Pharmaceutical to be dispensed in a smaller quantity than that for which it is currently funded, or ii) the Community Pharmaceutical is any of the following: a) a tri-cyclic antidepressant; or b) an antipsychotic; or c) a benzodiazepine; or d) a Class B Controlled Drug; and ii) the prescribing Practitioner has: A) endorsed each Community Pharmaceutical on the Prescription clearly with the words “Close Control” or “CC”; and B) initialled the endorsement in their own handwriting; and C) speciﬁed the maximum quantity or period of supply to be dispensed at any one time. b) All of the following conditions are met: i) The Community Pharmaceutical is prescribed for a patient who is a resident in a Rest Home or Residential Disability Care Institution; and A) the quantity or period of supply to be dispensed at any one time is not less than 28 days’ supply; and B) the prescriber or pharmacist has written the name of the Rest Home or Residential Disability Care Institution on the prescription; and C) the prescriber or pharmacist has: 1) written on the Prescription the words “Close Control” or “CC” (this applies to all medicines prescribed on the prescription), and 2) initialled the endorsement/annotation in their own handwriting; and 3) speciﬁed the maximum quantity or period of supply to be dispensed at any one time. c) All of the following conditions are met: i) where PHARMAC has approved and notiﬁed pharmacists to annotate prescriptions for a speciﬁed Community Pharmaceutical(s) “Close Control”without prescriber endorsement for a speciﬁed time; and ii) the dispensing pharmacist has: A) clearly annotated each of the approved Community Pharmaceuticals that appear on the prescription with the words “Close Control” or “CC”; and B) initialled the annotation in their own handwriting; and C) speciﬁed the maximum quantity or period of supply to be dispensed at any one time, as speciﬁed by PHARMAC at the time of notiﬁcation. “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

SECTION A: GENERAL RULES

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 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 person on the Prescription of a Practitioner. “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;

SECTION A: GENERAL RULES

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. For the purposes of this deﬁnition, a “specialist” means a doctor who holds a current annual practicing certiﬁcate and who satisﬁes the criteria set out in paragraphs (a) or (b) or (c) of the deﬁnitions of Specialist below. “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. “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 Subsi-

SECTION A: GENERAL RULES

dies. “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 Pharmaceuticals 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, a 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. “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. For the purposes of this deﬁnition, a “specialist” means a doctor who holds a current annual practicing certiﬁcate and who satisﬁes the criteria set out in paragraphs (a) or (b) or (c) of the deﬁnitions of Specialist below. “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 A: GENERAL RULES

“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 or Pharmaceutical Cancer Treatment 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, 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. “Unapproved Indication” means, for a Pharmaceutical, an indication for which it is not approved under the Medicines Act 1981. “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 regu-

SECTION A: GENERAL RULES

lation, 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 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

SECTION A: GENERAL RULES

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 suffcient 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 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.

SECTION A: GENERAL RULES

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: 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

SECTION A: GENERAL RULES

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 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 exist-

SECTION A: GENERAL RULES

ing 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’s 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”: 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 by funding their 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;

SECTION A: GENERAL RULES

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 Treatements 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; c) clauses 3.1 to 3.4; and d) 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 are Unapproved Indications. Some of these 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 Unapproved 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 sections 25 and 29 of the Medicines Act 1981, as applicable, 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 Comissioner’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 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 Unapproved Indication. 4.6 Practitioners prescribing unapproved Pharmaceuticals Practitioners should, where possible, prescribe Pharmaceuticals that are approved under the Medicines Act 1981. However, the access criteria under which a Pharmaceutical is listed on the Pharmaceutical Schedule may: a) in some case, explicitly permit Government funded access to a Pharmaceutical that is not approved under the Medicines Act 1981 or for an Unapproved Indication; or b) not explicitly preclude Government funded access to a Pharmaceutical when it is used for an Unapproved Indication; Accordingly, if Practitioners are planning on prescribing an unapproved Pharmaceutical or a Pharmaceutical for an Unapproved Indication, Practitioners should: a) be aware of and comply with their obligations under sections 25 and 29 of the Medicines Act 1981, as applicable, 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, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical or a Pharmaceutical for an Unapproved Indication. Practitioners should be aware that simply by listing a Pharmaceutical on the Pharmaceutical Schedule PHARMAC makes no representations about whether that Pharmaceutical has any form of approval or consent under, or whether the supply or use of the Pharmaceutical otherwise complies with, the Medicines Act 1981. Further, the Pharmaceutical Schedule does not constitute an advertisement, advertising material or a medical advertisement as deﬁned in the Medicines Act or otherwise. 4.7 Substitution Where a Practitioner has prescribed a brand of a Community Pharmaceutical that has no Subsidy or has a Manufacturer’s Price that is greater than the Subsidy and there is an alternative fully subsidised Community Pharmaceutical available, a Contractor may dispense the fully subsidised Community Pharmaceutical, subject to:

SECTION A: GENERAL RULES

a) the Contractor having received a general Authority to Substitute from the Practitioner in relation to the particular medicine or medicines in general; or b) the Practitioner having indicated their Authority to Substitute on the prescription; or c) the Practitioner having given their Authority to Substitute in relation to the particular prescription. Such an Authority to Substitute is valid whether or not there is a ﬁnancial implication for the Pharmaceutical Budget. When dispensing a subsidised alternative brand, the Contractor must annotate and initial the prescription. 4.8 Alteration to Presentation of Pharmaceutical Dispensed A Contractor, when dispensing a Community Pharmaceutical, may alter the presentation of a Pharmaceutical dispensed but may not alter the total daily dose. If the change will result in additional cost to the DHBs, then: a) the Practitioner must authorise and initial the alteration; or b) in cases where PHARMAC has approved and notiﬁed in writing such a change in dispensing of a named Pharmaceutical due to an out of stock event or short supply, the Contractor must annotate and initial the alteration. 4.9 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. 4.10 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

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antacids and Antiﬂatulants Antacids and Reﬂux Barrier Agents

ALGINIC ACID Sodium alginate 225 mg and magnesium alginate 87.5 mg per sachet ....................................................................................4.50

Gaviscon Infant

CALCIUM CARBONATE WITH AMINOACETIC ACID F Tab 420 mg with aminoacetic acid 180 mg – Higher subsidy of $38.73 per 1000 with Endorsement........................................ 30.00 1,000 (38.73) Titralac Additional subsidy by endorsement is available for pregnant women. The prescription must be endorsed accordingly. SIMETHICONE F Oral liq aluminium hydroxide 200 mg with magnesium hydroxide 200 mg and activated simethicone 20 mg per 5 ml ...............1.50 500 ml (4.05) Mylanta P SODIUM ALGINATE F Tab 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg - peppermint ﬂavour .......................................1.80 (7.97) F Oral liq 500 mg with sodium bicarbonate 267 mg and calcium carbonate 160 mg per 10 ml ........................................................1.50 (4.95) F Oral liq 500 mg with sodium bicarbonate 267 mg per 10 ml (aniseed) ......................................................................................1.50 (8.08)

60 Gaviscon Double Strength 500 ml Acidex 500 ml Gaviscon

Phosphate Binding Agents

ALUMINIUM HYDROXIDE Tab 600 mg .......................................................................................12.56 100

Alu-Tab

Antidiarrhoeals Agents Which Reduce Motility

DIPHENOXYLATE HYDROCHLORIDE WITH ATROPINE SULPHATE F Tab 2.5 mg with atropine sulphate 25 µg ............................................3.90 LOPERAMIDE HYDROCHLORIDE – Up to 30 tab available on a PSO F Tab 2 mg ...........................................................................................11.50 100 400

Diastop S29 Nodia

Rectal and Colonic Anti-inﬂammatories

BUDESONIDE Cap 3 mg – Special Authority see SA0913 on the next page – Retail pharmacy ................................................................... 166.50

Entocort CIR

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

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

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0913 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 3 months where the treatment remains appropriate and the patient is beneﬁting from treatment. The patient may not have had 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 (14 applications) ................................21.10 21.1 g OP Colifoam MESALAZINE Tab 400 mg – Retail pharmacy-Specialist ........................................49.50 Tab long-acting 500 mg – Retail pharmacy-Specialist .....................69.06 Enema 1 g per 100 ml – Retail pharmacy-Specialist .......................46.90 Suppos 500 mg ................................................................................25.20 Suppos 1 g .......................................................................................50.96 OLSALAZINE Tab 500 mg .......................................................................................59.86 Cap 250 mg ......................................................................................31.51 SODIUM CROMOGLYCATE Cap 100 mg ......................................................................................89.21 SULPHASALAZINE F Tab 500 mg .........................................................................................8.42 F Tab EC 500 mg ...................................................................................9.44 100 100 7 20 28 100 100 100 100 100

Asacol Pentasa Pentasa Asacol Pentasa Dipentum Dipentum Nalcrom Salazopyrin Salazopyrin EN

Antihaemorrhoidals Corticosteroids

FLUOCORTOLONE CAPROATE WITH FLUOCORTOLONE PIVALATE AND CINCHOCAINE Oint 950 µg, with ﬂuocortolone pivalate 920 µg, and cinchocaine hydrochloride 5 mg per g ............................................. 6.35 30 g OP Suppos 630 µg, with ﬂuocortolone pivalate 610 µg, and cinchocaine hydrochloride 1 mg ....................................................... 2.66 12

Ultraproct Ultraproct

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

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antispasmodics and Other Agents Altering Gut Motility

ATROPINE SULPHATE F Inj 600 µg, 1 ml – Up to 5 inj available on a PSO .............................26.00 F Inj 1200 µg, 1 ml – Up to 5 inj available on a PSO ...........................32.00 HYOSCINE N-BUTYLBROMIDE F Tab 10 mg ...........................................................................................1.62 F Inj 20 mg, 1 ml – Up to 5 inj available on a PSO ................................8.04 MEBEVERINE HYDROCHLORIDE F Tab 135 mg .......................................................................................18.00 50 50 20 5 90

AstraZeneca AstraZeneca Gastrosoothe Buscopan Colofac

Antiulcerants Antisecretory and Cytoprotective

MISOPROSTOL F Tab 200 µg ........................................................................................52.70 120

Cytotec

Helicobacter Pylori Eradication

OMEPRAZOLE, AMOXYCILLIN AND CLARITHROMYCIN Omeprazole cap 20 mg × 14, amoxycillin cap 500 mg × 28 and clarithromycin tab 500 mg × 14 .......................................... 55.00

1 OP

Losec Hp7 OAC

H2 Antagonists

CIMETIDINE – Only on a prescription F Tab 200 mg .........................................................................................5.00 (7.50) F Tab 400 mg .......................................................................................10.00 (12.00) FAMOTIDINE – Only on a prescription F Tab 20 mg ...........................................................................................8.10 F Tab 40 mg .........................................................................................11.35 RANITIDINE HYDROCHLORIDE – Only on a prescription F Tab 150 mg .........................................................................................7.99 F Tab 300 mg .......................................................................................10.94 F Oral liq 150 mg per 10 ml ...................................................................7.95 F Inj 25 mg per ml, 2 ml .........................................................................8.75 100 Apo-Cimetidine 100 Apo-Cimetidine 250 250 250 250 300 ml 5

Famox Famox Arrow-Ranitidine Arrow-Ranitidine Peptisoothe Zantac

Proton Pump Inhibitors

LANSOPRAZOLE F Cap 15 mg ..........................................................................................4.30 F Cap 30 mg ..........................................................................................8.59 28 28

Solox Solox

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

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

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

OMEPRAZOLE For omeprazole suspension refer, page 162 F Cap 10 mg ..........................................................................................2.14 17.37 2.14 (5.95) F Cap 20 mg ..........................................................................................3.05 24.81 3.05 (5.95) F Cap 40 mg ..........................................................................................3.59 29.05 3.59 (8.84) F Inj 40 mg ...........................................................................................12.50 PANTOPRAZOLE F Tab 20 mg ...........................................................................................2.24 F Tab 40 mg ...........................................................................................3.36

Dr Reddy’s

Omeprazole

Losec

Omezol 30

Dr Reddy’s

Omeprazole

Losec

Omezol 30

Dr Reddy’s

Omeprazole

Losec

Omezol 1 28 28

Losec Dr Reddy’s

Pantoprazole

Dr Reddy’s

Pantoprazole

Site Protective Agents

SUCRALFATE Tab 1 g ..............................................................................................35.50 (48.28) 120 Carafate

Diabetes Hyperglycaemic Agents

GLUCAGON HYDROCHLORIDE Inj 1 mg syringe kit – Up to 5 kit available on a PSO........................27.00 1

Glucagen Hypokit

Insulin - Short-acting Preparations

INSULIN NEUTRAL L Inj human 100 u per ml .....................................................................25.26 L Inj human 100 u per ml, 3 ml ............................................................42.66 10 ml OP 5

Actrapid Humulin R Actrapid Penﬁll Humulin R

Insulin - Intermediate-acting Preparations

INSULIN ISOPHANE L Inj human 100 u per ml .....................................................................17.68 L Inj human 100 u per ml, 3 ml ............................................................29.86 10 ml OP 5

Humulin NPH Protaphane Humulin NPH Protaphane Penﬁll

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

INSULIN ISOPHANE WITH INSULIN NEUTRAL L Inj human with neutral insulin 100 u per ml ......................................25.26 L Inj human with neutral insulin 100 u per ml, 3 ml .............................42.66

10 ml OP 5

Humulin 30/70 Mixtard 30 Humulin 30/70 PenMix 30 PenMix 40 PenMix 50

Insulin - Long-acting Preparations

INSULIN GLARGINE – Special Authority see SA0834 below – Retail pharmacy L Inj 100 u per ml, 10 ml ......................................................................63.00 L Inj 100 u per ml, 3 ml ........................................................................94.50 L Inj 100 u per ml, 3 ml disposable pen ...............................................94.50 1 5 5

Lantus Lantus Lantus SoloStar

¾SA0834 Special Authority for Subsidy 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: 1 Patient is continuing to derive beneﬁt due to reduced hypoglycaemic events whilst maintaining similar or better glycaemic control; or 2 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 L Inj 100 u per ml, 3 ml ........................................................................53.57 L Inj 100 u per ml, 10 ml ......................................................................31.43 INSULIN LISPRO L Inj 100 u per ml, 10 ml ......................................................................34.92 L Inj 100 u per ml, 3 ml ........................................................................59.52 5 1 10 ml OP 5

NovoRapid Penﬁll NovoRapid Humalog Humalog

Alpha Glucosidase Inhibitors

ACARBOSE – Special Authority see SA0925 on the next page – Retail pharmacy F Tab 50 mg .........................................................................................22.00 F Tab 100 mg .......................................................................................31.00 90 90

Glucobay Glucobay

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

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

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0925 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 The patient has type 2 diabetes; and 2 Either: 2.1 Metformin is not tolerated, or is contraindicated; or 2.2 The patient has not responded to the maximum appropriate dose of metformin.

Oral Hypoglycaemic Agents

GLIBENCLAMIDE F Tab 2.5 mg ..........................................................................................3.78 F Tab 5 mg .............................................................................................3.31 GLICLAZIDE F Tab 80 mg .........................................................................................22.24 GLIPIZIDE F Tab 5 mg .............................................................................................3.50 METFORMIN HYDROCHLORIDE F Tab 500 mg .........................................................................................9.75 F Tab 850 mg .........................................................................................8.00 PIOGLITAZONE – Special Authority see SA0859 below – 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 Arrow-Metformin Arrow-Metformin Actos Actos Actos

¾SA0859 Special Authority for Subsidy Initial application — (Patients with type 2 diabetes) from any relevant practitioner. Approvals valid for 1 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 is obese; 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 > 7.5% 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 > 7.5% measured within the last month of the six-month period); and 3.2 Sulphonylurea is contraindicated or not tolerated, or the patient is obese; or In combination with metformin after a trial of metformin and sulphonylurea continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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 > 7.5% 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. Renewal — (Patients with type 2 diabetes) from any relevant practitioner. Approvals valid for 1 year where patient is continuing to derive beneﬁt from treatment. Notes: 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. 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: serum creatinine ≥ 0.15 or creatinine clearance < 60 ml/min; signiﬁcant liver impairment; severe left ventricular dysfunction; and 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. For the purposes of these criteria “obese” is deﬁned as body mass index (BMI) greater than 33 kg/m2 . However, as ethnic differences between patients may vary BMI scores, practitioners may use discretion as to whether the patient meets this criterion. It is considered that when applying, that the patient may have initiated “six months diet and lifestyle changes” from the date of diagnosis of type 2 diabetes. TOLBUTAMIDE F Tab 500 mg ......................................................................................12.00 100 Diatol (Diatol Tab 500 mg to be delisted 1 December 2008)

Diabetes Management Glucose/Urine Testing

COPPER F Tab, diagnostic – Not on a BSO .........................................................5.02 (30.25) GLUCOSE OXIDASE Urine diagnostic test – Not on a BSO.................................................4.11 (7.00) Urine diagnostic test with peroxidase – Not on a BSO.......................4.13 (6.05) 4.11 (6.05) 36 OP Clinitest 50 strip OP Diabur 5000 50 strip OP Clinistix Diastix

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

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

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Glucose &/or Ketones/Urine Testing

GLUCOSE OXIDASE Urine diagnostic test with peroxidase, sodium nitroprusside and aminoacetic acid – Not on a BSO......................................... 4.53 (8.00) Urine diagnostic test with peroxidase, potassium iodide, sodium nitroprusside and aminoacetic acid – Not on a BSO.............................................................................................. 4.53 (7.50) SODIUM NITROPRUSSIDE F Urine diagnostic strips, buffered – Not on a BSO...............................3.39 (6.00) 3.40 (7.15)

50 stick OP Keto-Diabur 5000

50 strip OP Keto-Diastix 50 strip OP Ketur-Test Ketostix

Glucose/Blood Testing

GLUCOSE BLOOD DIAGNOSTIC TEST METER – Subsidy by endorsement a) Maximum of 1 meter per prescription b) 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. Meter ..................................................................................................9.00 1 Optium Xceed 19.00 Accu-Chek Performa GLUCOSE DEHYDROGENASE The number of test strips available on a prescription is restricted to 50 unless: 1) Prescribed with insulin or a sulphonylurea but are on a different prescription and the prescription is endorsed accordingly; or 2) Prescribed on the same prescription as insulin or a sulphonylurea in which case the prescription is deemed to be endorsed; or 3) Prescribed for a pregnant woman with diabetes and endorsed accordingly. Blood/glucose test strips ..................................................................22.00 50 test OP Accu-Chek Performa 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. INSULIN PEN NEEDLES – Maximum of 100 dev per prescription NovoFine pen needles 31 g × 6 mm are subsidised for children under 12 years of age. F 29 g × 12.7 mm ................................................................................11.75 100 ABM 13.09 B-D Micro-Fine F 31 g × 5 mm .....................................................................................13.09 100 B-D Micro-Fine F 31 g × 6 mm .....................................................................................11.75 100 ABM 26.00 NovoFine F 31 g × 8 mm .....................................................................................11.75 100 ABM 13.09 B-D Micro-Fine

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

INSULIN SYRINGES, DISPOSABLE WITH ATTACHED NEEDLE – Maximum of 100 dev per prescription F Syringe 0.3 ml with 29 g × 12.7 mm needle ....................................14.45 100 ABM 15.92 B-D Ultra Fine F Syringe 0.3 ml with 31 g × 8 mm needle .........................................14.45 100 ABM 15.92 B-D Ultra Fine II F Syringe 0.5 ml with 29 g × 12.7 mm needle ....................................14.45 100 ABM B-D Ultra Fine 15.92 F Syringe 0.5 ml with 31 g × 8 mm needle .........................................14.45 100 ABM 15.92 B-D Ultra Fine II F Syringe 1 ml with 29 g × 12.7 mm needle .......................................14.45 100 ABM 15.92 B-D Ultra Fine F Syringe 1 ml with 31 g × 8 mm needle ............................................14.45 100 ABM 15.92 B-D Ultra Fine II

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

300 300 300 250 100 100 100

Pancrex V Pancrex V Forte Pancrex V Cotazym ECS Creon 10000 Creon Forte Panzytrat Actigall

URSODEOXYCHOLIC ACID – Special Authority see SA0914 below – Retail pharmacy Cap 300 mg ....................................................................................179.00 100

¾SA0914 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. 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.

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

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

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Laxatives Bulk-forming Agents

MUCILAGINOUS LAXATIVES – Only on a prescription F Dry ......................................................................................................5.72 6.69 7.92 (12.71) 8.80 (15.27) F Dry-original ﬂavour, regular texture only .............................................5.91 (12.38) F Sugar Free ..........................................................................................4.84 (10.60) MUCILAGINOUS LAXATIVES WITH STIMULANTS F Dry ......................................................................................................3.52 (7.69) 8.80 (15.27) 325 g OP 380 g OP 450 g OP 500 g OP Normacol 336 g OP Metamucil 275 g OP Mucilax 200 g OP Normacol Plus 500 g OP Normacol Plus

Konsyl-D Mucilax

Isogel

Faecal Softeners

DOCUSATE SODIUM – Only on a prescription F Tab 50 mg ...........................................................................................4.89 F Tab 120 mg .........................................................................................6.73 F Enema conc 18% ...............................................................................5.40 DOCUSATE SODIUM WITH SENNOSIDES F Tab 50 mg with total sennosides 8 mg ...............................................7.98 POLOXAMER – Only on a prescription F Oral drops 10% ...................................................................................3.78 100 100 100 ml OP 200 30 ml OP

Coloxyl Coloxyl Coloxyl Laxsol Coloxyl

Osmotic Laxatives

GLYCEROL F Suppos 2.55 g – Only on a prescription .............................................3.12 F Suppos 3.6 g – Only on a prescription ...............................................5.00 LACTULOSE – Only on a prescription F Oral liq 10 g per 15 ml ........................................................................6.65 MACROGOL 3350 – Special Authority see SA0891 below – Retail pharmacy Powder 13.125 g, sachets – Maximum of 60 sach per prescription ......................................................................................18.14 12 20 1,000 ml

Fleet Glycerin

Suppositories

PSM Duphalac

Movicol

¾SA0891 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months where the patient has problematic constipation requiring intervention with a per rectal preparation despite an adequate trial of other oral pharmacotherapies including lactulose where lactulose is not contraindicated. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is compliant and is continuing to gain beneﬁt from treatment.

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

SODIUM ACID PHOSPHATE – Only on a prescription Enema 16% with sodium phosphate 8% ............................................2.50

Fleet Phosphate

Enema

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

Microlax

Stimulant Laxatives

BISACODYL – Only on a prescription F Tab 5 mg .............................................................................................5.09 F Suppos 5 mg ......................................................................................2.35 (3.00) F Suppos 10 mg ....................................................................................3.96 SENNA – Only on a prescription F Tab, standardised ...............................................................................2.17 (6.16) 200 6 12 100 Senokot

Lax-Tabs

Dulcolax

Fleet

Metabolic Disorder Agents Gaucher’s Disease

IMIGLUCERASE – Special Authority see SA0473 below – Hospital pharmacy [HP1] Inj 40 iu per ml, 200 iu vial ...........................................................1,072.00 1

Cerezyme

¾SA0473 Special Authority for Subsidy Special Authority approved by the Gaucher’s Treatment Panel Notes: Subject to a budgetary cap. Applications will be considered and approved subject to funding availability. Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Co-ordinator, Gaucher’s Treatment Panel Phone: (04) 460 4990 PHARMAC, PO Box 10 254 Facsimile: (04) 916 7571 Wellington Email: gaucherpanel@pharmac.govt.nz

Mouth and Throat Agents Used in Mouth Ulceration

BENZYDAMINE HYDROCHLORIDE Soln 0.15% .........................................................................................9.00 (15.36) CHLORHEXIDINE GLUCONATE Mouthwash 0.2% ................................................................................3.06 CHOLINE SALICYLATE WITH CETALKONIUM CHLORIDE F Adhesive gel 8.7% with cetalkonium chloride 0.01% .........................2.06 (5.05) 500 ml Difﬂam 200 ml OP 15 g OP Bonjela

Orion

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

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

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

SODIUM CARBOXYMETHYLCELLULOSE With pectin and gelatin paste ...........................................................17.20 1.52 (3.60) 4.55 (7.90) With pectin and gelatin powder ..........................................................8.48 (10.95) TRIAMCINOLONE ACETONIDE 0.1% in Dental Paste USP ..................................................................4.38

56 g OP 5 g OP 15 g OP

Stomahesive

Orabase Orabase

28 g OP Stomahesive 5 g OP

Oracort

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 ....................................................................3.19 20 40 g OP 24 ml OP

Fungilin Daktarin Nilstat

Other Oral Agents

For folinic mouthwash, pilocarpine oral liquid or saliva substitute formula refer, page 162 HYDROGEN PEROXIDE F Solution 10 vol – Maximum of 200 ml per prescription.......................1.28 100 ml THYMOL GLYCERIN F Compound, BPC .................................................................................9.15 500 ml

PSM PSM

Vitamins Vitamin A

VITAMIN A WITH VITAMINS D AND C Soln 1,000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops ................................................................................ 4.38 (5.51)

10 ml OP Vitadol C

Vitamin B Group

HYDROXOCOBALAMIN F Inj 1 mg per ml, 1 ml – Up to 6 inj available on a PSO .......................9.21 10.84 PYRIDOXINE HYDROCHLORIDE a) No more than 100 mg per dose b) Only on a prescription F Tab 25 mg – No patient co-payment payable .....................................3.06 F Tab 50 mg .........................................................................................17.63 THIAMINE HYDROCHLORIDE – Only on a prescription F Tab 50 mg ...........................................................................................5.62 3

ABM

Hydroxocobalamin

Neo-B12

90 500 100

Healtheries Apo-Pyridoxine Apo-Thiamine

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

VITAMIN B COMPLEX F Tab, strong, BPC ..............................................................................12.10

500

Apo-B-Complex

Vitamin C

ASCORBIC ACID a) No more than 100 mg per dose b) Only on a prescription F Tab 100 mg .......................................................................................17.25

500

Apo-Ascorbic Acid

Vitamin D

ALFACALCIDOL Cap 0.25 µg ......................................................................................26.32 Cap 1 µg ...........................................................................................87.98 Oral drops 2 µg per ml ......................................................................60.68 CALCITRIOL F Cap 0.25 µg ......................................................................................13.45 F Cap 0.5 µg ........................................................................................24.95 F Oral liq 1 µg per ml ...........................................................................39.40 CHOLECALCIFEROL F Tab 1.25 mg (50,000 iu) – Maximum of 12 tab per prescription .........10.35 100 100 20 ml OP 100 100 10 ml OP 12

One-Alpha One-Alpha One-Alpha Calcitriol-AFT Calcitriol-AFT Rocaltrol solution Cal-d-Forte

Vitamin E

ALPHA TOCOPHERYL ACETATE – Special Authority see SA0915 below – Hospital pharmacy [HP3] Water solubilised soln 156 iu/ml, with calibrated dropper .................18.30 50 ml OP Micelle E ¾SA0915 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Multivitamin Preparations

VITAMINS F Tab (BPC cap strength) ....................................................................14.80 1,000

Healtheries

Multi-vitamin tablets

Minerals Calcium

CALCIUM F Tab eff 1 g ..........................................................................................6.54 30

Calcium-Sandoz

1000

Calsource

(Calcium-Sandoz 1000 Tab eff 1 g to be delisted 1 December 2008)

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

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

ALIMENTARY TRACT AND METABOLISM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

CALCIUM CARBONATE F Tab 1.25 g ...........................................................................................9.18 F Tab 1.5 g ...........................................................................................10.33 F Tab dispersible 2.5 g ..........................................................................4.36 (Calci-Tab Effervescent Tab dispersible 2.5 g to be delisted 1 December 2008) CALCIUM GLUCONATE F Inj 10%, 10 ml ...................................................................................21.40

250 250 20 OP

Calci-Tab 500 Calci-Tab 600 Calci-Tab

Effervescent

Mayne

Fluoride

SODIUM FLUORIDE Tab 1.1 mg ..........................................................................................4.00 100

PSM

Iron

FERROUS FUMARATE Tab 200 mg .........................................................................................3.75 FERROUS FUMARATE WITH FOLIC ACID Tab 310 mg with folic acid 350 µg ......................................................3.95 FERROUS GLUCONATE WITH ASCORBIC ACID F Tab 170 mg with ascorbic acid 40 mg ..............................................12.04 FERROUS SULPHATE F Tab long-acting 325 mg ......................................................................5.06 (13.55) F‡ Oral liq 150 mg per 5 ml ...................................................................10.30 FERROUS SULPHATE WITH FOLIC ACID F Tab long-acting 325 mg with folic acid 350 µg ....................................1.80 (3.24) IRON POLYMALTOSE Inj 50 mg per ml, 2 ml .......................................................................20.95 (29.95) (Ferrosig Inj 50 mg per ml, 2 ml to be delisted 1 December 2008) 100 60 500

Ferro-tab Ferro-F-Tabs Healtheries Iron

with Vitamin C

150 Ferro-Gradumet 500 ml 30 Ferrograd-Folic 5

Ferodan

Ferrum H

Ferrosig

Magnesium

For magnesium hydroxide mixture refer, page 162 MAGNESIUM SULPHATE Inj 49.3% ...........................................................................................26.60

Mayne

Zinc

ZINC SULPHATE F Cap 220 mg ......................................................................................10.00 100

Zincaps

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS

The Assessment and Management of Cardiovascular Risk

intervention and follow-up.

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 disease, including lifestyle advice, diabetes care, the prescription of lipid-modifying and blood pressure lowering medication and/or medication after myocardial infraction (MI) or ischaemic stroke. The following steps explain the actions taken at each stage.

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: G people who have had a previous cardiovascular event G people with some gentic lipid disorders (familial hypercholesterolaemia, familial defective ApoB and familial combined dyslipidaemia G people with diabetes and overt nephropathy (albumin:creatinine radio ≥ 30 mg/mmol) or diabetes with other renal disease. 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. G TC greater than 8 mmol/L G TC:HDL ratio greater than 8 G Blood pressure consistently greater than 170/100 mm Hg G 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: G a family history of premature coronary heart disease or ischaemic stroke in father or brother before the age of 55 years or mother or sister before the age of 65 years G M¯ ori a G Paciﬁc or Indian people G diabetes and microalbuminuria G type 2 diabetes after 10 years G type 2 diabetes with an HbA1c > 8% G the metabolic syndrome These adjustments should be made once only for people who have more than one criteria (the maximum adjustment is 5%).

Step 1: Select people for risk assessment

Recommended ages for starting CV risk assessment G M¯ ori, Paciﬁc peoples and people from the Indian a subcontinent - age 35 years for men and age 45 years for women G People with known cardiovascular risk factors or at high risk of developing diabetes - age 35 years for men and age 45 years for women G Asymptomatic people, withouth known risk factors age 45 years for men and age 55 years for women.

Step 2: Measure and record risk factors

A comprehensive CV risk assessment includes measurement, and recording of: age, gender, ethnicity, smoking history, a fasting lipid proﬁle, a fasting plasma glucose, the average of two sitting BPs, family history, wasit 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 diagnostic levels of plasma glucose for diabetes are reached. People with IGT, IFG or the metabolic syndrome need active

–

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS Risk level women

Risk level women

NO DIABETES Non-smoker Smoker

4 180/105 160/95 140/85 120/75 5 6 7 8 4 5 6 7 8 4

DIABETES Non-smoker Smoker

5 6 7 8 4 5 6 7 8 180/105

AGE

160/95 140/85 120/75

180/105 160/95

180/105

AGE

160/95

Blood Pressure mm Hg

120/75 180/105 160/95 140/85 120/75 180/105 160/95 140/85 120/75 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8

120/75 180/105

AGE

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

AGE

160/95 140/85 120/75

Total Cholestrol: HDL ratio Total Cholesterol: 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 G Identify the table relating the to person’s sex, diabetic status, smoking history and age G 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. G 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.

Blood Pressure mm Hg

140/85

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS Risk level men

Risk level men

NO DIABETES Non-smoker Smoker

4 180/105 160/95 140/85 120/75 5 6 7 8 4 5 6 7 8 4

DIABETES Non-smoker Smoker

5 6 7 8 4 5 6 7 8 180/105

AGE

160/95 140/85 120/75

180/105 160/95

180/105

AGE

160/95

Blood Pressure mm Hg

120/75 180/105 160/95 140/85 120/75 180/105 160/95 140/85 120/75 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8

120/75 180/105

AGE

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

AGE

160/95 140/85 120/75

Total Cholestrol: HDL ratio Total Cholesterol: HDL ratio

Beneﬁts: NNT for 5 years to prevent one event (CVD events prevented per 100 people treated for 5 years) Risk level: 5 year CV risk (fatal and non-fatal) 30% 20% 15% 10% 5% 1 intervention (25% risk reduction) 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.

Blood Pressure mm Hg

140/85

CARDIOVASCULAR DISEASE: BASELINE RISK AND TREATMENT BENEFITS

Step 4: Intervention according to cardiovascular risk assessment

Cardiovascular risk CVD risk clinically determined more than 20% Lifestyle 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 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 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 lifestyle advice on a cardioprotective dietary pattern, physical activity and smoking cessation Drug Therapy 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) Treatment goals Efforts should be made to reach optimal risk factor levels Follow-up Cardiovascular risk assessments at least annually, risk factor monitoring every 3 to 6 months

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)

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

15% to 20%

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 Non-pharmacological approach to treating multiple risk factors

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

10% to 15%

Lifestyle advice aimed at reducing cardiovascular risk

Further cardiovascular risk assessment in 5 years

less than 10%

Non-pharmacological 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 Management of Cardiovascular Risk. It is available for download at www.nzgg.org.nz - click on ‘Guidelines/Publications’ then ‘Cardiology’.

–

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antianaemics Hypoplastic and Haemolytic

¾SA0922 Special Authority for Subsidy 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 ≤ 100g/L; and 2 Any of the following: 2.1 Both: 2.1.1 patient is not diabetic; and 2.1.2 glomerular ﬁltration rate ≤ 30ml/min; or 2.2 Both: 2.2.1 patient is diabetic; and 2.2.2 glomerular ﬁltration rate ≤ 45ml/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. Notes: 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) × Ideal Body Weight (kg) / 814 × serum creatinine (mmol/l) GFR (ml/min) (female) = Estimated GFR (male) × 0.85 ERYTHROPOIETIN ALPHA – Special Authority see SA0922 above – Hospital pharmacy [HP3] Inj human recombinant 1,000 iu pre-ﬁlled syringe ............................48.68 6 Eprex Inj human recombinant 2,000 iu, pre-ﬁlled syringe .........................120.18 6 Eprex Inj human recombinant 3,000 iu, pre-ﬁlled syringe .........................166.87 6 Eprex Inj human recombinant 4,000 iu, pre-ﬁlled syringe .........................193.13 6 Eprex Inj human recombinant 5,000 iu, pre-ﬁlled syringe .........................243.26 6 Eprex Inj human recombinant 6,000 iu, pre-ﬁlled syringe .........................291.92 6 Eprex Inj human recombinant 10,000 iu, pre-ﬁlled syringe .......................395.18 6 Eprex ERYTHROPOIETIN BETA – Special Authority see SA0922 above – Hospital pharmacy [HP3] Inj 1,000 iu, pre-ﬁlled syringe ..........................................................76.02 6 Inj 2,000 iu, pre-ﬁlled syringe .........................................................152.04 6 Inj 3,000 iu, pre-ﬁlled syringe .........................................................228.06 6 Inj 4,000 iu, pre-ﬁlled syringe .........................................................304.08 6 Inj 5,000 iu, pre-ﬁlled syringe .........................................................380.10 6 Inj 6,000 iu, pre-ﬁlled syringe .........................................................456.12 6 Inj 10,000 iu, pre-ﬁlled syringe .......................................................760.20 6 (Recormon Inj 1,000 iu, pre-ﬁlled syringe to be delisted 1 March 2009)

Recormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon NeoRecormon

Megaloblastic

FOLIC ACID F Tab 0.8 mg ........................................................................................16.50 F 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

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

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

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antiﬁbrinolytics, Haemostatics and Local Sclerosants

APROTININ – Hospital pharmacy [HP3]-Specialist F Inj 10,000 µg per ml 50 ml ...............................................................63.60 (73.40) (Trasylol Inj 10,000 µg per ml 50 ml to be delisted 1 November 2008) SODIUM TETRADECYL SULPHATE F Inj 0.5% 2 ml .....................................................................................23.20 (45.52) F Inj 1% 2 ml ........................................................................................25.00 (48.98) F 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 F Tab 10 mg ...........................................................................................4.75 PHYTOMENADIONE Tab 10 mg ...........................................................................................5.60 Inj 2 mg per 0.2 ml – Up to 5 inj available on a PSO..........................8.00 Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................9.21 100 10 5 5

K-Thrombin Konakion Konakion MM Konakion MM

Antithrombotic Agents Antiplatelet Agents

ASPIRIN F Tab 100 mg .......................................................................................16.83 CLOPIDOGREL – Special Authority see SA0867 below – Retail pharmacy Tab 75 mg .........................................................................................35.00 (73.38) 990 28

Ethics Aspirin EC Apo-Clopidogrel

Plavix

¾SA0867 Special Authority for Subsidy Initial application — (aspirin allergic patients) from any relevant 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. continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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 and aspirin naive patients) from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: Any of the following: The patient has: 1 experienced an acute myocardial infarction; or 2 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 3 had a troponin T or troponin I test result greater than the upper limit of the reference range; or 4 had a revascularisation procedure. Initial application — (patients awaiting revascularisation) from any relevant practitioner. Approvals valid for 6 months where the patient is on a waiting list or active review list for stenting, coronary artery bypass grafting, or percutaneous coronary angioplasty following acute coronary syndrome. Initial application — (post stenting) from any relevant practitioner. Approvals valid for 6 months where the patient has had a stent inserted in the previous 4 weeks. Initial application — (documented stent thrombosis) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis.. Renewal — (aspirin tolerant patients) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where while on treatment with aspirin the patient has experienced an additional vascular event following the recent cessation of clopidogrel. Renewal — (acute coronary syndrome - aspirin tolerant patients and aspirin naive patients) from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: Any of the following: The patient has: 1 experienced an acute myocardial infarction; or 2 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 3 had a troponin T or troponin I test result greater than the upper limit of the reference range; or 4 had a revascularisation procedure. Renewal — (patients awaiting revascularisation) from any relevant practitioner. Approvals valid for 6 months where the patient is on a waiting list or active review list for stenting, coronary artery bypass grafting or percutaneous coronary angioplasty following acute coronary syndrome. Renewal — (post stenting) from any relevant practitioner. Approvals valid for 6 months where the patient has had a stent inserted in the previous 4 weeks. Renewal — (documented stent thrombosis) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has, while on treatment with aspirin or clopidogrel, experienced documented stent thrombosis. DIPYRIDAMOLE F Tab 25 mg – Additional subsidy by Special Authority see SA0648 on the next page – Retail pharmacy ..............................0.16 84 (8.36) Persantin F Tab long-acting 150 mg – Special Authority see SA0649 on the next page – Retail pharmacy ............................................... 11.52 60 Pytazen SR

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

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

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0648 Special Authority for Manufacturers Price 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. ¾SA0649 Special Authority for Subsidy 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.

Heparin and Antagonist Preparations

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 (37.45) Inj 25,000 iu per ml, 0.2 ml – Hospital pharmacy [HP3]Specialist ...................................................................................... 7.50 (9.50) HEPARINISED SALINE F Inj 100 iu per ml, 2 ml .........................................................................8.30 F Inj 10 iu per ml, 5 ml .........................................................................18.00 F Inj 100 iu per ml, 5 ml ....................................................................103.76 (Mayne Inj 100 iu per ml, 5 ml to be delisted 1 March 2009) 50 1 5 10

Mayne Mayne Mayne

Multiparin

5 Mayne 10 50 50

Hospira S29 AstraZeneca Mayne

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

PROTAMINE SULPHATE F Inj 10 mg per ml, 5 ml .......................................................................22.40 (76.25)

10 Artex

Oral Anticoagulants

WARFARIN SODIUM Note: Marevan and Coumadin are not interchangeable. F Tab 1 mg .............................................................................................3.46 5.69 F Tab 2 mg .............................................................................................4.31 F Tab 3 mg .............................................................................................8.00 F Tab 5 mg .............................................................................................5.93 9.64

50 100 50 100 50 100

Coumadin Marevan Coumadin Marevan Coumadin Marevan

Fluids and Electrolytes Intravenous Administration

DEXTROSE F Inj 50%, 10 ml – Up to 5 inj available on a PSO...............................22.75 F Inj 50%, 90 ml – Up to 5 inj available on a PSO...............................11.25 POTASSIUM CHLORIDE F Inj 75 mg per ml, 10 ml .....................................................................26.00 F Inj 150 mg per ml, 10 ml ...................................................................26.00 5 1 50 50

Biomed Biomed AstraZeneca AstraZeneca

SODIUM BICARBONATE Inj 8.4%, 50ml ...................................................................................19.95 1 Biomed a) Up to 5 inj available on a PSO b) Not in combination Inj 8.4%, 100 ml ................................................................................20.50 1 Biomed a) Up to 5 inj available on a PSO b) Not in combination SODIUM CHLORIDE Inf 0.9% – Up to 2,000 ml 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 packs) Inj 23.4%, 20 ml ................................................................................26.50 5 Biomed Inj 0.9%, 5 ml – Up to 5 inj available on a PSO................................11.50 50 AstraZeneca Inj 0.9%, 10 ml – Up to 5 inj available on a PSO..............................11.50 50 AstraZeneca Inj 0.9%, 20 ml ....................................................................................7.86 20 Multichem 11.79 30 Pharmacia TOTAL PARENTERAL NUTRITION (TPN) – Hospital pharmacy [HP1]-Specialist Infusion .............................................................................................CBS 1 OP

TPN

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

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

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

WATER 1) On a prescription or Practitioner’s Supply Order only when on the same form Schedule requiring a solvent or diluent; or 2) On a bulk supply order; or 3) When used in the extemporaneous compounding of eye drops. Puriﬁed for inj 2 ml – Up to 5 inj available on a PSO ........................21.90 Puriﬁed for inj 5 ml – Up to 5 inj available on a PSO ..........................9.31 Puriﬁed for inj 10 ml – Up to 5 inj available on a PSO ......................10.38 Puriﬁed for inj 20 ml – Up to 5 inj available on a PSO ........................5.04

as an injection listed in the Pharmaceutical

50 50 50 20

Baxter Multichem Multichem Multichem

Oral Administration

CALCIUM POLYSTYRENE SULPHONATE – Retail pharmacy-Specialist Powder ............................................................................................169.85 COMPOUND ELECTROLYTES Powder for soln for oral use 5 g – Up to 10 sach available on a PSO........................................................................................... 2.86 DEXTROSE WITH ELECTROLYTES Soln with electrolytes ..........................................................................6.66 300 g OP

Calcium Resonium

10 1,000 ml OP

Enerlyte Pedialyte Bubblegum

6.78 POTASSIUM BICARBONATE – Retail pharmacy-Specialist Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg ......................................................82.50 POTASSIUM CHLORIDE F Tab eff 548 mg (14 m eq) with chloride 285 mg (8 m eq) ...................5.26 (11.85) F Tab long-acting 600 mg ......................................................................5.20 SODIUM POLYSTYRENE SULPHONATE – Retail pharmacy-Specialist Powder ..............................................................................................89.10

Pedialyte - Fruit Pedialyte - Plain

100 60

Phosphate-Sandoz

Chlorvescent 200 450 g OP

Span-K Resonium-A

Lipid Modifying Agents Fibrates

BEZAFIBRATE F Tab 200 mg .........................................................................................9.75 F Tab long-acting 400 mg ......................................................................7.60 90 30

Fibalip Bezalip Retard

Other Lipid Modifying Agents

ACIPIMOX – Retail pharmacy-Specialist F Cap 250 mg ......................................................................................18.75 NICOTINIC ACID F Tab 50 mg ...........................................................................................5.08 F Tab 500 mg .......................................................................................17.60 30 100 100

Olbetam Apo-Nicotinic Acid Apo-Nicotinic Acid

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Resins

CHOLESTYRAMINE WITH ASPARTAME Sachets 4 g with aspartame .............................................................19.25 (28.88) COLESTIPOL HYDROCHLORIDE Sachets 5 g .......................................................................................16.17 50 Questran-Lite 30

Colestid

HMG CoA Reductase Inhibitors (Statins)

Prescribing Guidelines Treatment with HMG CoA Reductase Inhibitors (statins) is recommended for patients with dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater. ATORVASTATIN – Additional subsidy by Special Authority see SA0788 below – Retail pharmacy See prescribing guideline above F Tab 10 mg ...........................................................................................4.03 30 (18.32) Lipitor F Tab 20 mg ...........................................................................................5.87 30 (26.70) Lipitor F Tab 40 mg ...........................................................................................8.14 30 (37.02) Lipitor ¾SA0788 Special Authority for Manufacturers Price 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). Notes: 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: G Constipation, ﬂatulence (may occur in >1% of patients) G Asthenia, abdominal pain, headache (may occur in >1% of patients) G Myopathy, rhabdomyolysis (may occur in <3% of patients) G 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.

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

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

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

PRAVASTATIN – Special Authority see SA0849 below – Retail pharmacy See prescribing guideline on the preceding page Tab 10 mg .........................................................................................27.46 Tab 20 mg .........................................................................................42.58 Tab 40 mg .........................................................................................65.31

30 30 30

Pravachol Pravachol Pravachol

¾SA0849 Special Authority for Subsidy 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 on the preceding page F Tab 10 mg ...........................................................................................1.27 30 SimvaRex 8.33 Lipex F Tab 20 mg ...........................................................................................1.54 30 SimvaRex 10.13 Lipex F Tab 40 mg ...........................................................................................2.74 30 SimvaRex 18.00 Lipex F Tab 80 mg ...........................................................................................3.18 30 SimvaRex 21.00 Lipex

Selective Cholesterol Absorption Inhibitors

EZETIMIBE – Special Authority see SA0796 below – Retail pharmacy Tab 10 mg .........................................................................................57.60 30

Ezetrol

¾SA0796 Special Authority for Subsidy 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 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 continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

BLOOD AND BLOOD FORMING ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 ezetimibe is to be used in combination with simvastatin; or 2.2 ezetimibe is to be used without a statin. EZETIMIBE WITH SIMVASTATIN – Special Authority see SA0826 below – Retail pharmacy Tab 10 mg with simvastatin 10 mg ...................................................69.00 30 Vytorin Tab 10 mg with simvastatin 20 mg ...................................................75.00 30 Vytorin Tab 10 mg with simvastatin 40 mg .................................................103.50 30 Vytorin Tab 10 mg with simvastatin 80 mg .................................................123.00 30 Vytorin ¾SA0826 Special Authority for Subsidy 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 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.

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

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

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Alpha Adrenoceptor Blockers

DOXAZOSIN MESYLATE F Tab 2 mg .............................................................................................4.81 F Tab 4 mg .............................................................................................6.37 PHENOXYBENZAMINE HYDROCHLORIDE F Cap 10 mg ..........................................................................................7.82 PHENTOLAMINE MESYLATE F Inj 10 mg per ml, 1 ml .......................................................................17.97 (31.65) PRAZOSIN HYDROCHLORIDE F Tab 0.5 mg .........................................................................................9.50 F Tab 1 mg .............................................................................................5.53 F Tab 2 mg .............................................................................................7.00 F Tab 5 mg ...........................................................................................11.70 (Hyprosin Tab 0.5 mg to be delisted 1 February 2009) TERAZOSIN HYDROCHLORIDE F Tab 7 × 1 mg and 7 × 2 mg ...............................................................0.74 F Tab 2 mg .............................................................................................1.48 (4.66) F Tab 5 mg .............................................................................................1.91 (5.60) 100 100 30 5 Regitine 100 100 100 100

Apo-Doxazosin Apo-Doxazosin Dibenyline S29

Hyprosin Apo-Prazo Apo-Prazo Apo-Prazo

14 OP 28 28

Hytrin Starter Pack

Hytrin Hytrin

Agents Affecting the Renin-Angiotensin System

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%.”

ACE Inhibitors

CAPTOPRIL F Tab 12.5 mg ......................................................................................10.40 F Tab 25 mg .........................................................................................13.40 F Tab 50 mg .........................................................................................19.00 F‡ Oral liq 5 mg per ml ..........................................................................51.04 Oral liquid restricted to children under 12 years of age. CILAZAPRIL F Tab 0.5 mg ..........................................................................................2.20 F Tab 2.5 mg ..........................................................................................4.39 F Tab 5 mg .............................................................................................6.44 500 500 500 95 ml OP

Apo-Captopril Apo-Captopril Apo-Captopril Capoten

30 30 30

Inhibace Inhibace Inhibace

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ENALAPRIL F Tab 5 mg .............................................................................................2.19 F Tab 10 mg ...........................................................................................2.76 F Tab 20 mg ...........................................................................................3.68 LISINOPRIL F Tab 5 mg .............................................................................................2.78 F Tab 10 mg ...........................................................................................3.16 F Tab 20 mg ...........................................................................................3.91 PERINDOPRIL F Tab 2 mg – Higher subsidy of $18.50 per 30 with Endorsement .........3.00 (18.50) F Tab 4 mg – Higher subsidy of $25.00 per 30 with Endorsement .........4.05 (25.00) QUINAPRIL F Tab 5 mg .............................................................................................2.36 F Tab 10 mg ...........................................................................................3.26 F Tab 20 mg ...........................................................................................4.30 TRANDOLAPRIL F Cap 1 mg – Higher subsidy of $18.67 per 28 with Endorsement .........3.06 (18.67) F Cap 2 mg – Higher subsidy of $27.00 per 28 with Endorsement .........4.43 (27.00)

90 90 90 30 30 30 30

m-Enalapril m-Enalapril m-Enalapril Arrow-Lisinopril Arrow-Lisinopril Arrow-Lisinopril

Coversyl 30 Coversyl 30 30 30 28 Gopten 28 Gopten

Accupril Accupril Accupril

ACE Inhibitors with Diuretics

CILAZAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 5 mg with hydrochlorothiazide 12.5 mg .......................................6.30 ENALAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 20 mg with hydrochlorothiazide 12.5 mg .....................................3.32 (8.70) QUINAPRIL WITH HYDROCHLOROTHIAZIDE F Tab 10 mg with hydrochlorothiazide 12.5 mg .....................................3.37 F Tab 20 mg with hydrochlorothiazide 12.5 mg .....................................4.57 28 30 Co-Renitec 30 30

Inhibace Plus

Accuretic 10 Accuretic 20

Angiotension II Antagonists

CANDESARTAN – Special Authority see SA0862 below – Retail pharmacy F Tab 4 mg – No more than 1.5 tab per day ........................................16.22 F Tab 8 mg – No more than 1.5 tab per day ........................................19.30 F Tab 16 mg – No more than 1 tab per day .........................................23.54 F Tab 32 mg – No more than 1 tab per day .........................................38.50 30 30 30 30

Atacand Atacand Atacand Atacand

¾SA0862 Special Authority for Subsidy 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: continued. . .

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

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

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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. LOSARTAN – Special Authority see SA0911 below – Retail pharmacy F Tab 12.5 mg ......................................................................................17.40 30 Cozaar F Tab 25 mg .........................................................................................21.76 30 Cozaar F Tab 50 mg .........................................................................................23.10 30 Cozaar Tab 50 mg with hydrochlorothiazide 12.5 mg ...................................30.00 30 Hyzaar F Tab 100 mg .......................................................................................35.40 30 Cozaar ¾SA0911 Special Authority for Subsidy Initial application — (ACE inhibitor intolerance) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Either: 1 Patient has persistent ACE inhibitor induced cough that is not resolved by ACE inhibitor retrial (same or new ACE inhibitor); or 2 Patient has a history of angioedema. Initial application — (Unsatisfactory response to ACE inhibitor) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where patient is not adequately controlled on maximum tolerated dose of an ACE inhibitor. Initial application — (Patient had an approval for Losartan with hydrochlorothiazide prior to 1 May 2008) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the treatment remains appropriate and the patient is beneﬁting from treatment.

Antiarrhythmics

For lignocaine hydrochloride refer to NERVOUS SYSTEM, Anaesthetics, Local, page 105 AMIODARONE HYDROCHLORIDE L Tab 100 mg – Retail pharmacy-Specialist ........................................18.65 30 L Tab 200 mg – Retail pharmacy-Specialist ........................................30.52 Inj 50 mg per ml, 3 ml – Up to 5 inj available on a PSO ...................60.84 DIGOXIN F Tab 62.5 µg – Up to 30 tab available on a PSO..................................6.94 F Tab 250 µg – Up to 30 tab available on a PSO.................................15.13 F‡ Oral liq 50 µg per ml .........................................................................16.60 DISOPYRAMIDE PHOSPHATE L Cap 100 mg ......................................................................................15.00 (23.87) L Cap 150 mg ......................................................................................26.21 30 10 250 250 60 ml 100 Rythmodan 100

Aratac Cordarone-X Aratac Cordarone-X Cordarone-X Lanoxin PG Lanoxin Lanoxin

Rythmodan

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

FLECAINIDE ACETATE – Retail pharmacy-Specialist L Tab 50 mg .........................................................................................42.82 L Tab 100 mg .......................................................................................75.63 L Cap long-acting 100 mg ...................................................................42.82 L Cap long-acting 200 mg ...................................................................75.63 Inj 10 mg per ml, 15 ml .....................................................................49.02 MEXILETINE HYDROCHLORIDE L Cap 50 mg ........................................................................................23.52 L Cap 200 mg ......................................................................................55.05 PROPAFENONE HYDROCHLORIDE – Retail pharmacy-Specialist L Tab 150 mg .......................................................................................40.90

60 60 30 30 5 100 100 50

Tambocor Tambocor Tambocor CR Tambocor CR Tambocor Mexitil Mexitil Rytmonorm

Antihypotensives

MIDODRINE – Special Authority see SA0361 below – Hospital pharmacy [HP3] Tab 2.5 mg ........................................................................................53.00 Tab 5 mg ...........................................................................................79.00 100 100

Gutron Gutron

¾SA0361 Special Authority for Subsidy 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. Notes: Treatment should be started with small doses and titrated upwards as necessary. Hypertension 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.

Beta Adrenoceptor Blockers

ACEBUTOLOL F Cap 100 mg ........................................................................................9.50 F Cap 200 mg ......................................................................................15.94 ATENOLOL F Tab 50 mg ..........................................................................................6.50 F Tab 100 mg ......................................................................................11.30 (Loten Tab 50 mg to be delisted 1 March 2009) (Loten Tab 100 mg to be delisted 1 March 2009) CARVEDILOL Tab 6.25 mg ......................................................................................21.00 Tab 12.5 mg ......................................................................................27.00 Tab 25 mg .........................................................................................33.75 CELIPROLOL F Tab 200 mg .......................................................................................19.00 30 30 30 180 100 100 500 500

ACB ACB Loten Paciﬁc Atenolol Loten Paciﬁc Atenolol

Dilatrend Dilatrend Dilatrend Celol

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

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

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

LABETALOL F Tab 50 mg ...........................................................................................8.66 F Tab 100 mg .......................................................................................10.59 F Tab 200 mg .......................................................................................18.47 F Tab 400 mg .......................................................................................34.44 F Inj 5 mg per ml, 5 ml .........................................................................14.77 (22.15) F Inj 5 mg per ml, 20 ml .......................................................................59.06 (88.60)

100 100 100 100 5 5

Hybloc Hybloc Hybloc Hybloc

Trandate S29 Trandate

METOPROLOL SUCCINATE Additional subsidy by endorsement is available for patients who: 1) were being prescribed metoprolol succinate prior to 1 October 2007; or 2) have experienced a myocardial infarction; or 3) have experienced heart failure and are either intolerant of carvedilol or it is contra-indicated. Pharmacists may annotate prescriptions for patients who were being prescribed metoprolol succinate prior to 1 October 2007 in which case the prescription is deemed to be endorsed. The pharmacist must be able to show a clear documented dispensing history for the patient. The prescription must be endorsed accordingly. F Tab long-acting 23.75 mg – Higher subsidy of $6.20 per 30 with Endorsement......................................................................... 5.20 30 (6.20) Betaloc CR F Tab long-acting 47.5 mg – Higher subsidy of $7.80 per 30 with Endorsement......................................................................... 6.50 30 (7.80) Betaloc CR F Tab long-acting 95 mg – Higher subsidy of $13.20 per 30 with Endorsement ..............................................................................11.20 30 (13.20) Betaloc CR F Tab long-acting 190 mg – Higher subsidy of $21.00 per 30 with Endorsement.......................................................................20.25 30 (21.00) Betaloc CR METOPROLOL TARTRATE F Tab 50 mg .........................................................................................16.50 F Tab 100 mg .......................................................................................21.80 F Tab long-acting 200 mg ....................................................................18.40 F Inj 1 mg per ml 5 ml ..........................................................................24.08 (34.00) NADOLOL F Tab 40 mg .........................................................................................14.97 F Tab 80 mg .........................................................................................22.19 PINDOLOL F Tab 5 mg .............................................................................................4.50 F Tab 10 mg ...........................................................................................8.35 F Tab 15 mg .........................................................................................12.00 PROPRANOLOL F Tab 10 mg ...........................................................................................3.55 F Tab 40 mg ...........................................................................................4.65 F Cap long-acting 160 mg ...................................................................16.90 100 60 28 5

Lopresor Lopressor Slow-Lopressor

Betaloc

100 100 100 100 100 100 100 100

Apo-Nadolol Apo-Nadolol Pindol Pindol Pindol Cardinol Cardinol Cardinol LA

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

SOTALOL F Tab 80 mg .........................................................................................27.50 F Tab 160 mg .......................................................................................10.50 F Inj 10 mg per ml, 4 ml .......................................................................41.34 TIMOLOL MALEATE F Tab 10 mg .........................................................................................10.55

500 100 5 100

Paciﬁc Paciﬁc Sotacor Apo-Timol

Calcium Channel Blockers Dihydropyridine Calcium Channel Blockers (DHP CCBs)

AMLODIPINE F Tab 5 mg .............................................................................................7.85 F Tab 10 mg .........................................................................................13.60 FELODIPINE F Tab long-acting 2.5 mg – No more than 1 tab per day .....................10.38 F Tab long-acting 5 mg ........................................................................16.50 F Tab long-acting 10 mg ......................................................................24.00 ISRADIPINE Cap long-acting 2.5 mg ......................................................................7.50 Cap long-acting 5 mg .........................................................................7.85 NIFEDIPINE F Tab long-acting 10 mg ......................................................................17.72 F Tab long-acting 20 mg ........................................................................7.30 F Tab long-acting 30 mg ......................................................................11.26 13.25 5.50 (19.90) F Tab long-acting 60 mg ......................................................................16.15 19.00 8.00 (29.50) 30 30 30 90 90 30 30 60 100 30

Calvasc Calvasc Plendil ER Felo 5 ER Felo 10 ER Dynacirc-SRO Dynacirc-SRO Adalat 10 Nyefax Retard Adeﬁn XL Arrow-Nifedipine XR

Adalat Oros

Adeﬁn XL Arrow-Nifedipine XR

Adalat Oros

Other Calcium Channel Blockers

DILTIAZEM HYDROCHLORIDE F Tab 30 mg ...........................................................................................4.50 F Tab 60 mg ...........................................................................................8.50 F Tab long-acting 180 mg ......................................................................7.65 F Tab long-acting 240 mg ....................................................................10.20 F Cap long-acting 90 mg .......................................................................7.65 F Cap long-acting 120 mg (once per day) .............................................5.10 F Cap long-acting 120 mg (twice per day) ...........................................18.00 F Cap long-acting 180 mg .....................................................................7.65 F Cap long-acting 240 mg ...................................................................10.20 100 100 30 30 60 30 100 30 30

Dilzem Dilzem Dilzem LA Dilzem LA Dilzem SR Cardizem CD Dilzem SR Cardizem CD Cardizem CD

PERHEXILINE MALEATE – Special Authority see SA0256 on the next page – Hospital pharmacy [HP3] F Tab 100 mg .......................................................................................62.90 100 Pexsig

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

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

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0256 Special Authority for Subsidy 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 F Tab 40 mg ..........................................................................................4.75 100 Verpamil 7.01 Isoptin F Tab 80 mg ..........................................................................................6.00 100 Verpamil 11.74 Isoptin 250 Verpamil SR F Tab long-acting 120 mg ....................................................................15.20 F Tab long-acting 240 mg ....................................................................25.00 250 Verpamil SR F Inj 2.5 mg per ml, 2 ml – Up to 5 inj available on a PSO ....................7.54 5 Isoptin (Verpamil Tab 40 mg to be delisted 1 March 2009) (Verpamil Tab 80 mg to be delisted 1 November 2008)

Centrally Acting Agents

CLONIDINE F TDDS 2.5 mg, 100 µg per day – Only on a prescription...................21.29 F TDDS 5 mg, 200 µg per day – Only on a prescription......................30.79 F TDDS 7.5 mg, 300 µg per day – Only on a prescription...................39.10 CLONIDINE HYDROCHLORIDE F Tab 150 µg ........................................................................................30.33 F Inj 150 µg per ml, 1 ml ......................................................................14.00 METHYLDOPA F Tab 125 mg .......................................................................................12.00 F Tab 250 mg .......................................................................................13.10 F Tab 500 mg .......................................................................................20.85 4 4 4 100 5 100 100 100

Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Catapres Catapres Prodopa Prodopa Prodopa

Diuretics Loop Diuretics

BUMETANIDE F Tab 1 mg ...........................................................................................16.36 F Inj 500 µg per ml, 4 ml ........................................................................7.95 FRUSEMIDE F Tab 40 mg – Up to 30 tab available on a PSO..................................11.50 F Tab 500 mg – Retail pharmacy-Specialist ........................................12.00 F‡ Oral liq 10 mg per ml ........................................................................10.66 F Infusion 10 mg per ml, 25 ml – Retail pharmacy-Specialist .............48.14 F Inj 10 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................29.50 100 5 1,000 100 30 ml OP 5 50

Burinex Burinex Diurin 40 Diurin 500 Lasix Lasix Mayne

Potassium Sparing Diuretics

AMILORIDE ‡ Oral liq 1 mg per ml – Retail pharmacy-Specialist ...........................26.20 Specialist must be a paediatrician or paediatric cardiologist. 25 ml OP

Biomed

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

SPIRONOLACTONE F Tab 25 mg ...........................................................................................8.50 F Tab 100 mg .......................................................................................21.70 ‡ Oral liq 5 mg per ml – Retail pharmacy-Specialist ...........................26.80 Specialist must be a paediatrician or paediatric cardiologist.

100 100 25 ml OP

Spirotone Spirotone Biomed

Potassium Sparing Combination Diuretics

AMILORIDE WITH FRUSEMIDE F Tab 5 mg with frusemide 40 mg .........................................................4.67 (8.63) AMILORIDE WITH HYDROCHLOROTHIAZIDE F Tab 5 mg with hydrochlorothiazide 50 mg ........................................13.00 TRIAMTERENE WITH HYDROCHLOROTHIAZIDE F Tab 50 mg with hydrochlorothiazide 25 mg ........................................5.00 28 Frumil 500 100

Amizide Triamizide

Thiazide and Related Diuretics

BENDROFLUAZIDE F Tab 2.5 mg – Up to 150 tab available on a PSO...............................13.50 May be supplied on a PSO for reasons other than emergency. F 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 F Tab 25 mg ...........................................................................................8.00 INDAPAMIDE F Tab 2.5 mg ..........................................................................................4.00 500 500 25 ml OP

Neo-Naclex Neo-Naclex Biomed

50 100

Hygroton Napamide

Nitrates

GLYCERYL TRINITRATE F Tab 600 µg – Up to 100 tab available on a PSO.................................8.00 F Oral pump spray 400 µg per dose – Up to 250 dose available on a PSO......................................................................................5.16 F TDDS 5 mg .......................................................................................16.56 F TDDS 10 mg .....................................................................................19.60 ISOSORBIDE MONONITRATE F Tab 20 mg .........................................................................................18.00 F Tab long-acting 40 mg ......................................................................14.84 F Tab long-acting 60 mg ........................................................................4.15 100 OP 250 dose OP 30 30 100 30 90

Lycinate S29 Nitrolingual

Pumpspray

Nitroderm TTS Nitroderm TTS Ismo 20 Corangin Duride

Sympathomimetics

ADRENALINE Inj 1 in 1,000, 1 ml – Up to 5 inj available on a PSO ..........................5.25 Inj 1 in 10,000, 10 ml – Up to 5 inj available on a PSO ....................27.00 ISOPRENALINE HYDROCHLORIDE F Inj 200 µg per ml, 1 ml ......................................................................36.80 (135.00)

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

5 5 25

Mayne Mayne

Isuprel

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

CARDIOVASCULAR SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Vasodilators

AMYL NITRITE F Ampoule, 0.3 ml crushable ...............................................................62.92 (73.40) HYDRALAZINE F Inj 20 mg per ml, 1 ml .......................................................................25.90 OXYPENTIFYLLINE – Hospital pharmacy [HP3] Tab 400 mg .......................................................................................36.94 (42.26) PAPAVERINE HYDROCHLORIDE F Inj 12 mg per ml, 10 ml .....................................................................73.12 12 Baxter 5 50 Trental 400 5

Apresoline

Mayne

Smoking Cessation

NICOTINE – Only on a Quitcard Patch 7 mg .......................................................................................10.53 Patch 14 mg .....................................................................................11.63 Patch 21 mg .....................................................................................12.32 Lozenge 1 mg ...................................................................................11.08 Lozenge 2 mg ...................................................................................11.08 Gum 2 mg (Fruit) ..............................................................................14.97 23.41 Gum 2 mg (Mint) ...............................................................................14.97 23.41 Gum 4 mg (Fruit) ..............................................................................20.02 23.41 Gum 4 mg (Mint) ...............................................................................20.02 23.41 (Nicotinell Gum 2 mg (Fruit) to be delisted 1 March 2009) (Nicotinell Gum 2 mg (Mint) to be delisted 1 March 2009) (Nicotinell Gum 4 mg (Fruit) to be delisted 1 March 2009) (Nicotinell Gum 4 mg (Mint) to be delisted 1 March 2009) 7 7 7 36 36 96 96 96 96

Habitrol Habitrol Habitrol Habitrol Habitrol Habitrol Nicotinell Habitrol Nicotinell Habitrol Nicotinell Habitrol Nicotinell

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antiacne Preparations

For systemic antibacterials, refer to INFECTIONS, Antibacterials, page 88 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 88 FUSIDIC ACID Crm 2 % ............................................................................................3.95 a) Maximum of 15 g per prescription b) Only on a prescription c) Not in combination Oint 2 % .............................................................................................3.95 a) Maximum of 15 g per prescription b) Only on a prescription c) Not in combination HYDROGEN PEROXIDE F Crm 1% ..............................................................................................8.56 MUPIROCIN Oint 2% ...............................................................................................6.60 (9.26) a) Only on a prescription b) Not in combination SILVER SULPHADIAZINE Crm 1% with chlorhexidine digluconate 0.2% ..................................15.04 a) Up to 500 g available on a PSO b) Not in combination

15 g OP

Foban

15 g OP

Foban

10 g OP 15 g OP

Crystacide

Bactroban

100 g OP

Silvazine

Antifungals Topical

For systemic antifungals, refer to INFECTIONS, Antifungals, page 92 AMOROLFINE a) Only on a prescription b) Not in combination Nail soln 5% ......................................................................................37.86 (61.87) CICLOPIROX OLAMINE a) Only on a prescription b) Not in combination Crm 1% ..............................................................................................1.00 (12.82) Nail soln 8% ......................................................................................37.81 (42.84) Soln 1% ..............................................................................................4.36 (11.54)

5 ml OP Loceryl

20 g OP Batrafen 3.5 ml OP Batrafen 20 ml OP Batrafen

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

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

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

CLOTRIMAZOLE F Crm 1% ..............................................................................................0.50 a) Only on a prescription b) Not in combination F Soln 1% ..............................................................................................4.36 (7.55) a) Only on a prescription b) Not in combination ECONAZOLE NITRATE Crm 1% ..............................................................................................1.00 (6.50) a) Only on a prescription b) Not in combination Foaming soln 1%, 10 ml sachets ........................................................9.89 (15.66) a) Only on a prescription b) Not in combination KETOCONAZOLE Crm 2% ..............................................................................................1.00 (10.00) a) Only on a prescription b) Not in combination MICONAZOLE NITRATE F Crm 2% ..............................................................................................0.42 a) Only on a prescription b) Not in combination F Lotn 2% ..............................................................................................4.36 (10.32) a) Only on a prescription b) Not in combination F Tincture 2% ........................................................................................4.36 (12.46) a) Only on a prescription b) Not in combination NYSTATIN Crm 100,000 u per g ..........................................................................1.00 (5.10) a) Only on a prescription b) Not in combination

20 g OP

Clomazol

20 ml OP Canesten

20 g OP Pevaryl

3 Pevaryl

15 g OP Nizoral

15 g OP

Multichem

30 ml OP Daktarin

15 g OP Mycostatin

Antipruritic Preparations

CALAMINE a) Only on a prescription b) Not in combination Crm, aqueous, BP ..............................................................................3.02 Lotn, BP ............................................................................................19.44

100 ml 2,000 ml

ABM ABM

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

CROTAMITON a) Only on a prescription b) Not in combination Crm 10% ............................................................................................4.26 (4.45) Lotn 10% ............................................................................................7.56 (7.70)

20 g OP Eurax 50 ml Eurax

MENTHOL – Only in combination 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 Crystals ..............................................................................................7.40 25 g PSM 29.60 100 g MidWest

Corticosteroids Topical

For systemic corticosteroids, refer to CORTICOSTEROIDS AND RELATED AGENTS, page 78

Corticosteroids - Plain

BETAMETHASONE DIPROPIONATE Crm 0.05% .........................................................................................2.96 (6.91) 8.97 (18.36) Crm 0.05% in propylene glycol base ..................................................4.33 (13.83) Oint 0.05% ..........................................................................................2.96 (6.51) 8.97 (17.11) Oint 0.05% in propylene glycol base ..................................................4.33 (13.83) BETAMETHASONE VALERATE F Crm 0.1% ...........................................................................................2.00 F Oint 0.1% ............................................................................................2.20 F Lotn 0.1% .........................................................................................10.05 CLOBETASOL PROPIONATE F Crm 0.05% .........................................................................................2.35 F Oint 0.05% ..........................................................................................1.60 CLOBETASONE BUTYRATE Crm 0.05% .........................................................................................5.38 (7.09) 16.13 (22.00) 15 g OP Diprosone 50 g OP Diprosone 30 g OP Diprosone OV 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 30 g OP Eumovate 100 g OP Eumovate

Beta Cream Beta Ointment Betnovate Dermol Dermol

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

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

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

DIFLUCORTOLONE VALERATE Crm 0.1% ...........................................................................................8.97 (15.23) Fatty oint 0.1% ....................................................................................8.97 (15.23) Oint 0.1% ...........................................................................................8.97 (15.23) (Nerisone Oint 0.1% to be delisted 1 January 2009) HYDROCORTISONE F Crm 1% – Only on a prescription .......................................................2.44

50 g OP Nerisone 50 g OP Nerisone 50 g OP Nerisone

100 g

Lemnis Fatty Cream

12.20 500 g F Powder – Only in combination .........................................................37.64 25 g Up to 5% in a dermatological base (not proprietary Topical Corticosteriod – Plain) with galenicals. Refer, page 159 HYDROCORTISONE BUTYRATE Crm 0.1% ...........................................................................................5.00 30 g OP 15.00 100 g OP Lipocream 0.1% ..................................................................................5.00 30 g OP 15.00 100 g OP Oint 0.1% ..........................................................................................15.00 100 g OP Milky Emulsion 0.1% ..........................................................................5.00 30 ml OP 15.00 100 ml OP HYDROCORTISONE WITH WOOL FAT AND MINERAL OIL Lotn 1% with wool fat hydrous 3% and mineral oil – Only on a prescription................................................................................ 9.95 METHYLPREDNISOLONE ACEPONATE Crm 0.1% ...........................................................................................4.95 Oint 0.1% ............................................................................................4.95 MOMETASONE FUROATE Crm 0.1% ...........................................................................................3.96 10.82 Oint 0.1% ............................................................................................3.96 10.82 Lotn 0.1% ...........................................................................................4.80 TRIAMCINOLONE ACETONIDE Crm 0.02% .........................................................................................6.63 Oint 0.02% ..........................................................................................6.69

PSM m-Hydrocortisone

or without other dermatological

Locoid Locoid Locoid Lipocream Locoid Lipocream Locoid Locoid Crelo Locoid Crelo

250 ml 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

DP Lotn HC 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) 15 g OP Betnovate-C 15 g OP Betnovate-C

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

BETAMETHASONE VALERATE WITH FUSIDIC ACID Crm 0.1% with fusidic acid 2% ...........................................................3.49 15 g OP (8.84) a) Maximum of 15 g per prescription b) Only on a prescription HYDROCORTISONE BUTYRATE WITH CHLORQUINALDOL – Only on a prescription Crm 0.1% with chlorquinaldol 3% .......................................................3.49 15 g OP HYDROCORTISONE WITH MICONAZOLE – Only on a prescription F Crm 1% with miconazole nitrate 2% ...................................................2.20 15 g OP

Fucicort

Locoid C Micreme H Pimafucort Pimafucort

HYDROCORTISONE WITH NATAMYCIN AND NEOMYCIN – Only on a prescription Crm 1% with natamycin 1% and neomycin sulphate 0.5% ................4.40 15 g OP Oint 1% with natamycin 1% and neomycin sulphate 0.5% .................4.40 15 g OP TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN Crm 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g – Only on a prescription .................3.49 15 g OP (4.49) Oint 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g – Only on a prescription .................3.00 15 g OP

Viaderm KC

Kenacomb

Disinfecting and Cleansing Agents

CHLORHEXIDINE GLUCONATE – Subsidy by endorsement a) No more than 500 ml per month b) Only if prescribed for a dialysis patient and the prescription is endorsed accordingly. F Handrub 1% with ethanol 70% ...........................................................5.40 500 ml F Soln 4% ..............................................................................................7.20 500 ml SODIUM HYPOCHLORITE – Subsidy by endorsement Only if prescribed for a dialysis patient and the prescription is endorsed accordingly. F Soln ....................................................................................................2.71 2,500 ml

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 Crm BP ...............................................................................................6.55 (9.79) ZINC AND CASTOR OIL Oint BP ..............................................................................................5.11 (Multichem Oint BP to be delisted 1 December 2008) 500 g PSM 500 g

Multichem PSM

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

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

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Emollients

AQUEOUS CREAM F Crm .....................................................................................................2.37 CETOMACROGOL F Crm BP ...............................................................................................3.50 EMULSIFYING OINTMENT F Oint BP ...............................................................................................3.69 GLYCEROL WITH PARAFFIN AND CETYL ALCOHOL – Only on a prescription F Lotn 5% with parafﬁn liq 5% and cetyl alcohol 2% .............................1.40 (8.10) OIL IN WATER EMULSION F Crm .....................................................................................................2.80 OILY CREAM F Crm BP ...............................................................................................2.80 (13.60) (15.40) UREA F Crm 10% ............................................................................................2.52 WOOL FAT WITH MINERAL OIL – Only on a prescription F Lotn hydrous 3% with mineral oil ........................................................1.40 (2.92) 5.60 (9.54) 1.40 (3.50) 5.60 (10.90) 1.12 (5.00) 2.10 (9.38) 5.60 (18.43) 1.40 (7.73) 5.60 (23.91) 500 g 500 g 500 g 250 ml QV 500 g 500 g David Craig PSM 100 g OP 250 ml OP Hydroderm Lotion 1,000 ml Hydroderm Lotion 250 ml OP DP Lotion 1,000 ml DP Lotion 200 ml OP Alpha-Keri Lotion 375 ml OP Alpha-Keri Lotion 1,000 ml Alpha-Keri Lotion 250 ml OP BK Lotion 1,000 ml BK Lotion

Multichem PSM AFT

Lemnis Fatty Cream

Nutraplus

Other Dermatological Bases

PARAFFIN White soft – Only in combination .....................................................20.20 2,500 g IPW 3.58 500 g (8.69) PSM Only in combination with a dermatological galenical or as a diluent for a proprietary Topical Corticosteroid – Plain.

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Minor Skin Infections

POVIDONE IODINE Oint 10% .............................................................................................2.88 (3.27) a) Maximum of 100 g per prescription b) Only on a prescription Antiseptic soln 10% ............................................................................6.20 Skin preparation, povidone iodine 10% with 30% alcohol ..................8.13 Skin preparation, povidone iodine 10% with 70% alcohol ..................8.13 (18.63) 25 g OP Betadine

500 ml 500 ml 500 ml

Betadine Riodine Betadine Skin Prep

Orion

Parasiticidal Preparations

GAMMA BENZENE HEXACHLORIDE Crm 1% ..............................................................................................3.50 MALATHION Liq 0.5% ..............................................................................................4.99 Shampoo 1% ......................................................................................2.83 50 g OP 200 ml 30 ml OP

Benhex Derbac-M A-Lices

PERMETHRIN 1) Should be strictly reserved for use as second line therapy in: 1) patients unable to tolerate the other medications, such as infants, young children and patients with allergies or eczema; 2) cases of scabies which are resistent to gamma benzene hexachloride and resistant to malathion. 2) 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: 1) a deﬁnite diagnosis of scabies should be made; 2) it should be ascertained that the medication was administered properly; 3) the possibility of reinfestation should have been excluded. Crm 5% ..............................................................................................4.20 30 g OP Lyderm

Psoriasis and Eczema Preparations

ACITRETIN – Hospital pharmacy [HP3]-Specialist prescription Specialist must be a dermatologist. Cap 10 mg ........................................................................................94.75 Cap 25 mg ......................................................................................203.70 CALCIPOTRIOL Crm 50 µg per g ...............................................................................20.76 57.89 Oint 50 µg per g ................................................................................20.76 57.89 Soln 50 µg per ml .............................................................................20.78 34.72

100 100 30 g OP 100 g OP 30 g OP 100 g OP 30 ml OP 60 ml OP

Neotigason Neotigason Daivonex Daivonex Daivonex Daivonex Daivonex Daivonex

COAL TAR Solution BP – Only in combination ..................................................36.48 500 ml PSM 12.98 200 ml (16.20) David Craig Up to 10 % Only in combination with a dermatological base or proprietary Topical Corticosteriod – Plain, refer, page 159 With or without other dermatological galenicals.

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

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

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

COAL TAR WITH ALLANTOIN, MENTHOL, PHENOL AND SULPHUR Soln 5% with sulphur 0.5%, menthol 0.75%, phenol 0.5% and allantoin crm 2.5% ....................................................................... 3.43 (4.35) 6.59 (8.00) COAL TAR WITH SALICYCLIC ACID AND SULPHUR Soln 12% with salicyclic acid 2% and sulphur 4% ointment ...............7.95 DITHRANOL Crm 1% ............................................................................................27.50

30 g OP Egopsoryl TA 75 g OP Egopsoryl TA 40 g OP 50 g OP

Coco-Scalp Micanol

SALICYLIC ACID Powder – Only in combination .........................................................15.00 500 g ABM 18.88 250 g PSM 15.00 500 g (55.63) David Craig 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain or collodion ﬂexible, refer, page 159 2) With or without other dermatological galenicals. 3) Maximum 20 g or 20 ml per prescription when prescribed with white soft parafﬁn or collodion ﬂexible. (David Craig Powder to be delisted 1 January 2009) SULPHUR Precipitated – Only in combination ....................................................6.50 100 g ABM (9.25) PSM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, refer, page 159 2) With or without other dermatological galenicals. TAR WITH CADE OIL Bath emulsion 7.5% coal tar, 2.5% cade oil, 7.5% compound ...........9.70 350 ml (29.60) Polytar Emollient TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN – Only on a prescription F Soln 2.3% with triethanolamine lauryl sulphate and ﬂuorescein sodium ................................................................................. 2.90 500 ml Pinetarsol

Scalp Preparations

BETAMETHASONE VALERATE F Scalp app 0.1% ..................................................................................5.25 CLOBETASOL PROPIONATE F Scalp app 0.05% ................................................................................3.20 HYDROCORTISONE BUTYRATE Scalp lotn 0.1% ...................................................................................7.52 KETOCONAZOLE Shampoo 2% .....................................................................................3.48 a) Maximum of 100 ml per prescription b) Only on a prescription (Ketopine Shampoo 2% to be delisted 1 January 2009) 100 ml OP 30 ml OP 100 ml OP 100 ml OP

Beta Scalp Dermol Locoid Ketopine Sebizole

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Sunscreens

SUNSCREENS, PROPRIETARY – Subsidy by endorsement Only if prescribed for a patient with severe photosensitivity secondary to a deﬁned clinical condition and the prescription is endorsed accordingly. Crm .....................................................................................................2.55 100 g OP (5.89) Hamilton Sunscreen 1.28 50 g OP (5.84) Aquasun Oil Free Faces SPF30+ Lotn ....................................................................................................2.55 100 ml OP Marine Blue Lotion SPF 30+ 5.10 200 ml OP Marine Blue Lotion SPF 30+ 3.19 125 ml OP (8.82) Aquasun Sensitive SPF 30+ (9.38) Aquasun 30+

Wart Preparations

For salicylic acid preparations refer to PSORIASIS AND ECZEMA PREPARATIONS, page 67 IMIQUIMOD – Special Authority see SA0923 below – Retail pharmacy Crm 5% sachet ...............................................................................110.40 12

Aldara

¾SA0923 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria: Any of the following: 1 The patient has external anogenital warts and podophyllotoxin has been tried and failed (or is contraindicated); or 2 The patient has external anogenital warts and podophyllotoxin is unable to be applied accurately to the site; or 3 The patient has conﬁrmed superﬁcial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate. Notes: Superﬁcial basal cell carcinoma G Surgical excision remains ﬁrst-line treatment for superﬁcial basal cell carcinoma as it has a higher cure rate than imiquimod and allows histological assessment of tumour clearance. G Imiquimod has not been evaluated for the treatment of superﬁcial basal cell carcinoma within 1 cm of the hairline, eyes, nose, mouth or ears. G Imiquimod is not indicated for recurrent, invasive, inﬁltrating, or nodular basal cell carcinoma. External anogenital warts G Imiquimod is only indicated for external genital and perianal warts (condyloma acuminata). Renewal from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria: Any of the following: 1 Inadequate response to initial treatment for anogenital warts; or 2 New conﬁrmed superﬁcial basal cell carcinoma where other standard treatments, including surgical excision, are contraindicated or inappropriate; or 3 Inadequate response to initial treatment for superﬁcial basal cell carcinoma. Note: Conﬁrmation that the lesion is a superﬁcial basal cell carcinoma should be obtained using a biopsy PODOPHYLLOTOXIN Soln 0.5% .........................................................................................33.60 3.5 ml OP Condyline a) Maximum of 3.5 ml per prescription b) Only on a prescription

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

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

DERMATOLOGICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Other Skin Preparations Antineoplastics

FLUOROURACIL SODIUM – Retail pharmacy-Specialist Crm 5% ............................................................................................23.89 (32.71) 20 g OP Efudix

Topical Analgesia

For aspirin & chloroform application refer, page 162 CAPSAICIN – Subsidy by endorsement Subsidised only if prescribed for post-herpetic neuralgia or diabetic peripheral neuropathy and the prescription is endorsed accordingly. Crm 0.075% .....................................................................................12.50 45 g OP Zostrix HP

Wound Management Products

HYDROGEN PEROXIDE F Solution 20 vol – Maximum of 500 ml per prescription.......................3.13 (7.00) MAGNESIUM SULPHATE Paste ..................................................................................................2.98 (4.90) 500 ml PSM 80 g PSM

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

GENITO-URINARY SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Contraceptives - Non-hormonal Condoms

CONDOMS F 49 mm – Up to 144 dev available on a PSO.....................................13.36 144

F 52 mm – Up to 144 dev available on a PSO.....................................13.36

144

F 52 mm extra strength – Up to 144 dev available on a PSO..............13.36 F 53 mm – Up to 144 dev available on a PSO.....................................13.36

144 144

F F F F

53 mm (chocolate) – Up to 144 dev available on a PSO..................13.36 53 mm (strawberry) – Up to 144 dev available on a PSO ................13.36 53 mm extra strength – Up to 144 dev available on a PSO..............13.36 54 mm, shaped – Up to 144 dev available on a PSO.......................13.36 (14.84) F 55 mm – Up to 144 dev available on a PSO.....................................13.36 F 56 mm, shaped – Up to 144 dev available on a PSO.......................13.36 F 60 mm – Up to 144 pack available on a PSO...................................13.36

144 144 144 144 144 144 144

Gold Knight MarquisTantiliza Shield 49 Marquis Selecta Marquis Sensolite Marquis Supalite Marquis Protecta Gold Knight Marquis Black Marquis Titillata Shield Blue Gold Knight Gold Knight Gold Knight

Lifestyles Flared

Gold Knight Marquis Conforma Durex Conﬁdence Shield XL

Spermicidal Agents

APPLICATOR When ordered with a spermicide. F Applicator – Up to 1 dev available on a PSO......................................4.34 NONOXYNOL-9 Jelly 2% – Up to 108 g available on a PSO......................................10.95

1 108 g OP

Ortho Gynol II

Contraceptive Devices

DIAPHRAGM F Diaphragm – Up to 1 dev available on a PSO ..................................42.90 One of each size is permitted on a PSO. INTRA-UTERINE DEVICE – Only on a WSO F IUD ...................................................................................................39.50 Distributed by Pharmaco NZ Ltd, PO Box 4079, Auckland Ph 09 377 3336 1

Ortho All-ﬂex Ortho Coil

Multiload Cu 375 Multiload Cu 375 SL

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

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

GENITO-URINARY SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Contraceptives - Hormonal Combined Oral Contraceptives

¾SA0500 Special Authority for Alternate Subsidy 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: 1 Patient is on a Social Welfare beneﬁt; or 2 Patient has an income no greater than the beneﬁt. Notes: 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: G on a Social Welfare beneﬁt; or G 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 and Microgynon 20 ED ETHINYLOESTRADIOL WITH DESOGESTREL F Tab 20 µg with desogestrel 150 µg .....................................................6.62 63 (16.50) Mercilon 21 a) Higher subsidy of $13.80 per 63 with Special Authority see SA0500 above b) Up to 63 tab available on a PSO F Tab 20 µg with desogestrel 150 µg and 7 inert tab .............................6.62 84 (16.50) Mercilon 28 a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO F Tab 30 µg with desogestrel 150 µg .....................................................6.62 63 (16.50) Marvelon 21 a) Higher subsidy of $13.80 per 63 with Special Authority see SA0500 above b) Up to 63 tab available on a PSO F Tab 30 µg with desogestrel 150 µg and 7 inert tab .............................6.62 84 (16.50) Marvelon 28 a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO ETHINYLOESTRADIOL WITH GESTODENE F Tab 30 µg with gestodene 75 µg and 7 inert tab ................................6.62 84 (14.49) Minulet 28 (16.50) Femodene 28 a) Higher subsidy of $14.49 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

GENITO-URINARY SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ETHINYLOESTRADIOL WITH LEVONORGESTREL F 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 Trifeme (9.45) Triquilar ED (14.49) Triphasil 28 a) Higher subsidy of up to $14.49 per 84 with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO F Tab 50 µg with levonorgestrel 125 µg and 7 inert tab – Up to 84 tab available on a PSO............................................................9.45 84 Microgynon 50 ED F Tab 30 µg with levonorgestrel 150 µg .................................................6.62 63 (16.50) Microgynon 30 a) Higher subsidy of $15.00 per 63 with Special Authority see SA0500 on the preceding page b) Up to 63 tab available on a PSO F Tab 30 µg with levonorgestrel 150 µg and 7 inert tab .........................6.62 84 Levlen ED Monofeme (14.49) Nordette 28 (16.50) Microgynon 30 ED a) Higher subsidy of up to $15.00 per 84 with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO ETHINYLOESTRADIOL WITH NORETHISTERONE F Tab 35 µg with norethisterone 1 mg – Up to 63 tab available on a PSO......................................................................................6.62 63 Brevinor 1/21 F Tab 35 µg with norethisterone 1 mg and 7 inert tab – Up to 84 tab available on a PSO............................................................6.62 84 Brevinor 1/28 F Tab 35 µg with norethisterone 500 µg – Up to 63 tab available on a PSO......................................................................................6.62 63 Brevinor 21 F Tab 35 µg with norethisterone 500 µg and 7 inert tab – Up to 84 tab available on a PSO............................................................6.62 84 Norimin NORETHISTERONE WITH MESTRANOL F Tab 1 mg with mestranol 50 µg and 7 inert tab ..................................6.62 84 (13.80) Norinyl-1/28 a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 on the preceding page b) Up to 84 tab available on a PSO

Combined Oral Contraceptives - Other

ETHINYLOESTRADIOL WITH LEVONORGESTREL F Tab 20 µg with levonorgestrel 100 µg and 7 inert tab – Up to 84 tab available on a PSO............................................................6.62 (16.50) (16.50)

84 Loette Microgynon 20 ED

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

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

GENITO-URINARY SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Progestogen-only Contraceptives

¾SA0500 Special Authority for Alternate Subsidy 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: 1 Patient is on a Social Welfare beneﬁt; or 2 Patient has an income no greater than the beneﬁt. Notes: 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: G on a Social Welfare beneﬁt; or G 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 and Microgynon 20 ED LEVONORGESTREL F Tab 30 µg ............................................................................................6.62 84 (16.50) Microlut a) Higher subsidy of $13.80 per 84 with Special Authority see SA0500 above b) Up to 84 tab available on a PSO MEDROXYPROGESTERONE ACETATE F Inj 150 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................8.05 1 Depo-Provera F Inj 150 mg per ml, 1 ml syringe – Up to 5 inj available on a PSO .........8.05 1 Depo-Provera NORETHISTERONE F Tab 350 µg – Up to 84 tab available on a PSO...................................7.15 84

Noriday 28

Emergency Contraceptives

LEVONORGESTREL F Tab 1.5 mg ........................................................................................12.50 a) Maximum of 2 tab per prescription b) Up to 5 tab available on a PSO F Tab 750 µg .........................................................................................8.50 a) Maximum of 4 tab per prescription b) Up to 10 tab available on a PSO (Postinor-2 Tab 750 µg to be delisted 1 December 2008) 1

Postinor-1 Postinor-2

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

GENITO-URINARY SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antiandrogen Oral Contraceptives

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: G $3.00 prescription charge (patient co-payment) will apply. G prescription may be written for up to six months supply. Prescriptions coded in any other way are subject to the non contraceptive prescription charges, and the non-contraceptive period of supply. ie. Prescriptions may be written for up to three months supply. CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL F Tab 2 mg with ethinyloestradiol 35 µg and 7 inert tabs ......................6.30 84 Estelle 35

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 (11.32) CLOTRIMAZOLE F Vaginal crm 1% with applicator(s) ......................................................1.45 F Vaginal crm 2% with applicators .........................................................3.99 MICONAZOLE NITRATE F Vaginal crm 2% with applicator ..........................................................2.75 (3.70) NYSTATIN Vaginal crm 100,000 u per 5 g with applicator(s) ...............................4.71

100 g OP Aci-Jel 35 g OP 25 g OP 40 g OP Micreme 75 g OP

Clomazol Clotrimaderm 2%

Nilstat

Myometrial and Vaginal Hormone Preparations

ERGOMETRINE MALEATE Inj 500 µg per ml, 1 ml – Up to 5 inj available on a PSO ..................11.60 METHYLERGOMETRINE Inj 200 µg per ml, 1 ml – Up to 10 inj available on a PSO ..................9.28 OESTRIOL F Crm 1 mg per g with applicator ..........................................................7.00 F Pessaries 500 µg ................................................................................7.25 OXYTOCIN – Up to 5 inj available on a PSO Inj 5 iu per ml, 1 ml .............................................................................5.40 Inj 10 iu per ml, 1 ml ...........................................................................6.80 Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml ........................9.20 5 10 15 g OP 15 5 5 5

Mayne Hospira S29 Ovestin Ovestin Syntocinon Syntocinon Syntometrine

Pregnancy Tests - HCG Urine

PREGNANCY TESTS - HCG URINE – Only on a WSO Cassette ...........................................................................................19.00 25 test Distributed by MDS Diagnostics, PO Box 24-162, Royal Oak, Auckland. Ph 09 570 5761

MDS Quick Card

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

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

GENITO-URINARY SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Urinary Agents

For urinary tract Infections refer to INFECTIONS, Antibacterials, page 98

5-Alpha Reductase Inhibitors

FINASTERIDE – Special Authority see SA0928 below – Retail pharmacy Tab 5 mg ...........................................................................................19.20 30

Fintral

¾SA0928 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 Patient has symptomatic benign prostatic hyperplasia; and 2 Either: 2.1 The patient is intolerant of non-selective alpha blockers or these are contraindicated; or 2.2 Symptoms are not adequately controlled with non-selective alpha blockers. Note: Patients with enlarged prostates are the appropriate candidates for therapy with ﬁnasteride.

Other Urinary Agents

OXYBUTYNIN F Tab 5 mg ...........................................................................................44.79 F Oral liq 5 mg per 5 ml .......................................................................50.40 SODIUM CITRO-TARTRATE F Grans eff 4 g sachets .........................................................................2.75 500 473 ml OP 28

Apo-Oxybutynin Apo-Oxybutynin Ural

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic 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

¾SA0797 Special Authority for Subsidy 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: 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 at least three months and has either; and 2 Either: 2.1 documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5); or 2.2 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: a) 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. b) 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. c) 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. ALENDRONATE SODIUM – Special Authority see SA0797 above – Retail pharmacy Tab 70 mg .........................................................................................35.91 4 Fosamax ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA0797 above – Retail pharmacy Tab 70 mg with cholecalciferol 2,800 iu ............................................35.91 4 Fosamax Plus

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

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Alendronate for Pagets Disease

¾SA0467 Special Authority for Subsidy 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. ALENDRONATE SODIUM – Special Authority see SA0467 above – Retail pharmacy Tab 40 mg .......................................................................................133.00 30 Fosamax

Other Treatments

CALCITONIN – Hospital pharmacy [HP3]-Specialist F Inj 100 iu per ml, 1 ml .....................................................................110.00 5

Miacalcic

ETIDRONATE DISODIUM F Tab 200 mg .......................................................................................22.80 60 Didronel 38.00 100 Etidrate Prescribing Guidelines 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 see SA0091 below – Hospital pharmacy [HP3] Inj 3 mg per ml, 5 ml .........................................................................18.75 1 Pamisol Inj 3 mg per ml, 10 ml .......................................................................37.50 1 Pamisol Inj 6 mg per ml, 10 ml .......................................................................75.00 1 Pamisol ¾SA0091 Special Authority for Subsidy 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.

Corticosteroids and Related Agents for Systemic Use

BETAMETHASONE SODIUM PHOSPHATE WITH BETAMETHASONE ACETATE F Inj 3.9 mg with betamethasone acetate 3 mg per ml, 1ml ................19.20 (33.60) 5 Celestone Chronodose

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

DEXAMETHASONE F Tab 1 mg – Retail pharmacy-Specialist ............................................16.08 100 Up to 30 tab available on a PSO F Tab 4 mg – Retail pharmacy-Specialist ............................................61.89 100 Up to 30 tab available on a PSO Oral liq 1 mg per ml – Retail pharmacy-Specialist ...........................39.90 25 ml OP Oral liq prescriptions: 1) Must be written by a Paediatrician or Paediatric Cardiologist; or 2) On the recommendation of a Paediatrician or Paediatric Cardiologist. DEXAMETHASONE SODIUM PHOSPHATE F Inj 4 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................21.50 5 F Inj 4 mg per ml, 2 ml – Up to 5 inj available on a PSO .....................31.00 5 FLUDROCORTISONE ACETATE F Tab 100 µg ..........................................................................................7.62 HYDROCORTISONE F Tab 5 mg .............................................................................................7.95 F Tab 20 mg .........................................................................................19.95 F Inj 50 mg per ml, 2 ml .........................................................................3.72 a) Up to 5 inj available on a PSO b) Only on a PSO METHYLPREDNISOLONE – Retail pharmacy-Specialist F Tab 4 mg ...........................................................................................48.57 F 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 F Oral liq 5 mg per ml – Up to 30 ml available on a PSO ......................9.95 Restricted to children under 12 years of age. PREDNISONE F Tab 1 mg ...........................................................................................10.68 F Tab 2.5 mg ........................................................................................12.09 F Tab 5 mg – Up to 30 tab available on a PSO....................................11.09 F Tab 20 mg .........................................................................................30.56 TETRACOSACTRIN F Inj 250 µg ........................................................................................177.18 F 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

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

Douglas Douglas Biomed

Mayne Mayne Florinef Douglas Douglas Solu-Cortef

100 100 100 1

100 20 1 1

Medrol Medrol Depo-Medrol Depo-Medrol with

lidocaine

25 25 1 1 30 ml OP

Solu-Medrol Solu-Medrol Solu-Medrol Solu-Medrol Redipred

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

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic 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 (Androcur Depot Inj 100 mg per ml, 3 ml to be delisted 1 December 2008) TESTOSTERONE Transdermal patch 2.5 mg per day ...................................................80.00 TESTOSTERONE CYPIONATE – Retail pharmacy-Specialist Inj long-acting 100 mg per ml, 10 ml ................................................61.41 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 Androcur Depot

60 1 1 60

Androderm Depo-Testosterone Sustanon Ampoules Panteston

Hormone Replacement Therapy - Systemic

¾SA0312 Special Authority for Alternate Subsidy 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 – where oral oestrogens are contraindicated as determined by a gastroenterologist or general physician. The applicant must keep written conﬁrmation from such a specialist with the patient’s record; or 2 oestrogen induced hypertension requiring antihypertensive therapy – documented evidence must be kept on ﬁle that raised blood pressure levels or inability to control blood pressure adequately occurred post oral oestrogens; or 3 hypertriglyceridaemia – documented evidence must be kept on ﬁle that triglyceride levels increased to at least 2 × normal triglyceride levels post oral oestrogens. 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”.

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Oestrogens

OESTRADIOL – See prescribing guideline on the preceding page F Tab 1 mg .............................................................................................4.12 28 OP (6.50) Estrofem F Tab 2 mg .............................................................................................4.12 28 OP (7.00) Estrofem F TDDS 25 µg per day ..........................................................................3.01 8 (10.86) Estraderm TTS 25 a) Higher subsidy of $10.86 per 8 with Special Authority see SA0312 on the preceding page b) No more than 2 patch per week c) Only on a prescription F TDDS 3.9 mg (releases 50 µg of oestradiol per day) ........................4.12 4 (14.50) Climara 50 (32.50) Femtran 50 a) Higher subsidy of $13.18 per 4 with Special Authority see SA0312 on the preceding page b) No more than 1 patch per week c) Only on a prescription F TDDS 50 µg per day ..........................................................................4.12 8 (13.18) Estraderm TTS 50 a) Higher subsidy of $13.18 per 8 with Special Authority see SA0312 on the preceding page b) No more than 2 patch per week c) Only on a prescription F TDDS 7.8 mg (releases 100 µg of oestradiol per day) ......................7.05 4 (17.75) Climara 100 (35.00) Femtran 100 a) Higher subsidy of $16.14 per 4 with Special Authority see SA0312 on the preceding page b) No more than 1 patch per week c) Only on a prescription F TDDS 100 µg per day ........................................................................7.05 8 (16.14) Estraderm TTS 100 a) Higher subsidy of $16.14 per 8 with Special Authority see SA0312 on the preceding page b) No more than 2 patch per week c) Only on a prescription OESTRADIOL VALERATE – See prescribing guideline on the preceding page F Tab 1 mg .............................................................................................8.24 56 Progynova F Tab 2 mg .............................................................................................4.12 28 Progynova OESTROGENS – See prescribing guideline on the preceding page F Conjugated, equine tab 300 µg ..........................................................3.01 (3.75) F Conjugated, equine tab 625 µg ..........................................................4.12 (5.14) 28 Premarin 28 Premarin

Progestogens

MEDROXYPROGESTERONE ACETATE – See prescribing guideline on the preceding page F Tab 2.5 mg ..........................................................................................2.07 30 F Tab 5 mg ...........................................................................................13.75 100 F Tab 10 mg ...........................................................................................7.57 30

Provera Provera Provera

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

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Progestogen and Oestrogen Combined Preparations

OESTRADIOL WITH LEVONORGESTREL – See prescribing guideline on page 80 F Tab 2 mg with 75 µg levonorgestrel (36) and tab 2 mg oestradiol (48) ......................................................................................16.20

Nuvelle

OESTRADIOL WITH NORETHISTERONE – See prescribing guideline on page 80 F Tab 1 mg with 0.5 mg norethisterone acetate .....................................5.40 28 OP (11.45) F Tab 2 mg with 1 mg norethisterone acetate ........................................5.40 28 OP (11.45) F Tab 2 mg with 1 mg norethisterone acetate (10), and 2 mg oestradiol tab (12) and 1 mg oestradiol tab (6) ............................ 5.40 28 OP (10.00) OESTROGENS WITH MEDROXYPROGESTERONE – See prescribing guideline on page 80 F Tab 625 µg conjugated equine with 2.5 mg medroxyprogesterone acetate tab (28) ................................................................ 5.40 28 OP (11.45) F Tab 625 µg conjugated equine with 5 mg medroxyprogesterone acetate tab (28) ................................................................ 5.40 (11.45)

Kliovance Kliogest

Trisequens

Premia 2.5 Continuous

28 OP Premia 5 Continuous

Other Oestrogen Preparations

ETHINYLOESTRADIOL F Tab 10 µg ..........................................................................................17.60 OESTRIOL F Tab 2 mg .............................................................................................7.00 100

NZ Medical and

Scientiﬁc

Ovestin

Other Progestogen Preparations

DYDROGESTERONE Tab 10 mg .........................................................................................27.50 (29.90) LEVONORGESTREL F Levonorgestrel - releasing intrauterine system 20µg/24 hr – Special Authority see SA0782 below – Retail pharmacy ......... 269.50 50 Duphaston

Mirena

¾SA0782 Special Authority for Subsidy 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 µg/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. continued. . .

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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: 1 The patient had a clinical diagnosis of heavy menstrual bleeding; and 2 Patient demonstrated clinical improvement of heavy menstrual bleeding; and 3 Applicant to state date of the previous insertion. 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: 1 Either: 1.1 Patient demonstrated clinical improvement of heavy menstrual bleeding; or 1.2 Previous insertion was removed or expelled within 3 months of insertion; and 2 Applicant to state date of the previous insertion. MEDROXYPROGESTERONE ACETATE F Tab 100 mg – Retail pharmacy-Specialist ......................................104.26 100 Provera F Tab 200 mg – Retail pharmacy-Specialist ........................................78.06 30 Provera NORETHISTERONE F Tab 5 mg – Up to 30 tab available on a PSO....................................25.00 100

Primolut N

Thyroid and Antithyroid Agents

CARBIMAZOLE F Tab 5 mg ...........................................................................................10.80 THYROXINE F Tab 50 µg ..........................................................................................64.28 ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 100 µg ........................................................................................66.78 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 100 1,000 1,000

Neo-Mercazole Eltroxin Eltroxin

Trophic Hormones Growth Hormones

¾SA0755 Special Authority for Subsidy Special Authority approved by the Growth Hormone Committee Notes: Subject to budgetary cap. Applications will be considered and approved subject to funding availability. Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: NZGHC Coordinator PHARMAC, PO Box 10-254, WELLINGTON Tel: 0800 808 476, Fax: (09) 939 3221, Email: growthhormone@pharmac.govt.nz GROWTH HORMONE BIOSYNTHETIC HUMAN – Special Authority see SA0755 above F Cartridge 16 iu per vial ................................................................1,600.00 5 F Cartridge 36 iu per vial ................................................................3,600.00 5

Genotropin Genotropin

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

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

RECOMBINANT HUMAN GROWTH HORMONE – Special Authority see SA0755 on the preceding page F Inj 5 mg ...........................................................................................300.00 1 Norditropin SimpleXx 5mg F Inj 10 mg .........................................................................................600.00 1 Norditropin SimpleXx 10mg 1 Norditropin F Inj 15 mg .........................................................................................900.00 SimpleXx 15mg

GnRH Analogues

BUSERELIN ACETATE – Special Authority see SA0835 below – Hospital pharmacy [HP3] Inj 1 mg per ml, 5.5 ml ....................................................................195.00 2 (272.53)

Suprefact

¾SA0835 Special Authority for Subsidy 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 intiated. 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: G 3 months to assess whether surgery is appropriate G 3 months for infertile patients after surgery G 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: 1 Both: 1.1 There has been a satisfactory response to the ﬁrst 3 months treatment; and 1.2 Surgery is inappropriate; or 2 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 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

GOSERELIN ACETATE – Special Authority see SA0839 below – Hospital pharmacy [HP3] Inj 3.6 mg ........................................................................................221.60 1 Inj 10.8 mg ......................................................................................554.70 1

Zoladex Zoladex

¾SA0839 Special Authority for Subsidy 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 intiated. 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: G 3 months to assess whether surgery is appropriate G 3 months for infertile patients after surgery G 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: 1 Both: 1.1 There has been a satisfactory response to the ﬁrst 3 months treatment; and 1.2 Surgery is inappropriate; or 2 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 FThree months or six months, as applicable, dispensed all-at-once

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

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

LEUPRORELIN – Special Authority see SA0837 below – Hospital pharmacy [HP3] Inj 3.75 mg ......................................................................................221.60 Inj 7.5 mg ........................................................................................184.90 Inj 11.25 mg ....................................................................................591.68 Inj 22.5 mg ......................................................................................554.70 Inj 30 mg .........................................................................................739.60 Inj 45 mg ......................................................................................1,109.40

1 1 1 1 1 1

Lucrin Depot Eligard Lucrin Depot Eligard Eligard Eligard

¾SA0837 Special Authority for Subsidy 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 intiated 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: G 3 months to assess whether surgery is appropriate G 3 months for infertile patients after surgery G 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 patients 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: 1 Both: 1.1 There has been a satisfactory response to the ﬁrst 3 months treatment; and 1.2 Surgery is inappropriate; or 2 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 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Vasopressin Agonists

DESMOPRESSIN L Nasal drops 100 µg per ml – Retail pharmacy-Specialist.................39.03 L Nasal spray 10 µg per dose – Retail pharmacy-Specialist ...............29.94 Inj 4 µg per ml, 1 ml – Special Authority see SA0090 below – Hospital pharmacy [HP3]............................................................ 67.18 2.5 ml OP 6 ml OP

Minirin DesmopressinPH&T

Minirin

¾SA0090 Special Authority for Subsidy 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 see SA0175 below....................... 105.03

Dostinex

¾SA0175 Special Authority for Waiver of Rule 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 Only a prescription for a female patient. Tab 50 mg ...........................................................................................2.50 5 Phenate 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 Cap 250 mg – Hospital pharmacy [HP3]-Specialist .......................238.00 30 30 8 OP 50

D-Zol D-Zol Dimetriose Metopirone

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

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic 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) PYRANTEL EMBONATE Tab 125 mg ........................................................................................5.31 (7.00) Tab 250 mg ........................................................................................3.76 (4.95) (Combantrin Tab 125 mg to be delisted 1 February 2009) (Combantrin Tab 250 mg to be delisted 1 February 2009) 6 Vermox 15 ml Vermox 18 Combantrin 6 Combantrin

Antibacterials

a) For topical antibacterials, refer to DERMATOLOGICALS, page 61 b) For anti-infective eye preparations, refer to SENSORY ORGANS, page 153

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

CEFAZOLIN SODIUM – Hospital pharmacy [HP3] – Subsidy by endorsement Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. Inj 500 mg ...........................................................................................5.00 5 Hospira 13.60 10 m-Cefazolin Inj 1 g ..................................................................................................8.00 5 Hospira 18.60 10 m-Cefazolin CEFOXITIN SODIUM – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. Inj 1 g ................................................................................................48.48 5 Mayne CEFTRIAXONE SODIUM – Hospital pharmacy [HP3] – Subsidy by endorsement a) Up to 5 inj available on a PSO b) 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 500 mg ...........................................................................................3.99 1 AFT Inj 1 g ..................................................................................................5.40 1 AFT CEFUROXIME AXETIL – Subsidy by endorsement Only if prescribed for prophylaxis of endocarditis and the prescription is endorsed accordingly. Tab 250 mg .......................................................................................29.40 50 Zinnat

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

CEFUROXIME SODIUM – Hospital pharmacy [HP3] Inj 250 mg – Maximum of 3 inj per prescription; can be waived by endorsement.......................................................................... 20.97 10 Mayne Inj 750 mg – Maximum of 1 inj per prescription; can be waived by endorsement.......................................................................... 10.71 5 Zinacef 21.42 10 (56.47) Mayne Inj 1.5 g – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement.................................................................................4.04 1 Zinacef 40.40 10 (123.55) Mayne Only if prescribed for a dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. (Mayne Inj 750 mg to be delisted 1 November 2008) (Mayne Inj 1.5 g to be delisted 1 November 2008)

Macrolides

AZITHROMYCIN – Subsidy by endorsement a) Maximum of 2 tab per prescription b) Up to 4 tab available on a PSO c) 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. Tab 500 mg .........................................................................................9.90 2 OP Arrow-Azithromycin CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA0657 below Tab 250 mg .........................................................................................7.75 14 Klamycin Grans for oral liquid 125 mg per 5 ml ...............................................23.12 70 ml Klacid ¾SA0657 Special Authority for Waiver of Rule 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: 1 Mycobacterium Avium Intracellulare Complex infections in patient with AIDS; or 2 Atypical and drug-resistant mycobacterial infection; or 3 All of the following: 3.1 Prophylaxis against disseminated Mycobacterium Avium Intracellulare Complex infection; and 3.2 HIV infection; and 3.3 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 – Up to 30 tab available on a PSO................................18.95 100 E-Mycin Grans for oral liq 200 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................4.35 100 ml E-Mycin Grans for oral liq 400 mg per 5 ml – Up to 200 ml available 100 ml E-Mycin on a PSO......................................................................................5.85

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

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ERYTHROMYCIN LACTOBIONATE Inj 300 mg ........................................................................................70.97 Inj 1 g ..................................................................................................6.50 (Mayne Inj 300 mg to be delisted 1 March 2009) ERYTHROMYCIN STEARATE Tab 250 mg – Up to 30 tab available on a PSO................................14.95 (22.29) Tab 500 mg .......................................................................................29.90 (44.58) ROXITHROMYCIN Tab 150 mg .........................................................................................9.50 Tab 300 mg .......................................................................................18.00

5 1

Mayne Erythrocin IV

100 ERA 100 ERA 50 50

ArrowRoxithromycin

Penicillins

AMOXYCILLIN Cap 250 mg – Up to 30 cap available on a PSO..............................17.30 Cap 500 mg ......................................................................................27.25 Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO...................................................................................... 1.00 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO...................................................................................... 1.27 Drops 125 mg per 1.25 ml ..................................................................7.25 Inj 250 mg ...........................................................................................6.32 Inj 500 mg ...........................................................................................7.23 Inj 1 g – Up to 5 inj available on a PSO............................................11.00 AMOXYCILLIN CLAVULANATE Tab amoxycillin 500 mg with potassium clavulanate 125 mg – Up to 30 tab available on a PSO ............................................... 6.40 Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml – Up to 200 ml available on a PSO.............................................................................................. 2.75 Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml – Up to 200 ml available on a PSO.............................................................................................. 4.75 BENZATHINE BENZYLPENICILLIN Inj 1.2 mega u per 2 ml – Up to 5 inj available on a PSO...............200.00 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 1 mega u – Up to 5 inj available on a PSO..................................10.49 DICLOXACILLIN Cap 250 mg ........................................................................................2.47 (4.35) Cap 500 mg ........................................................................................3.83 (8.65) 500 500 100 ml 100 ml 20 ml OP 5 5 5

Apo-Amoxi Apo-Amoxi Ranbaxy Amoxicillin Ranbaxy Amoxicillin Amoxil Paediatric

Drops

Ibiamox Ibiamox Ibiamox

Augmentin Augmentin Augmentin Bicillin LA Sandoz

100 ml

100 ml 10 10 24

Diclocil 24 Diclocil

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

FLUCLOXACILLIN SODIUM Cap 250 mg – Up to 30 cap available on a PSO..............................18.50 Cap 500 mg ......................................................................................57.90 Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................2.05 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................2.72 Inj 250 mg ...........................................................................................9.00 Inj 500 mg .........................................................................................10.40 Inj 1 g – Up to 5 inj available on a PSO............................................14.00 PHENOXYMETHYLPENICILLIN (PENICILLIN V) Cap potassium salt 250 mg – Up to 30 cap available on a PSO .........4.29 Cap potassium salt 500 mg ................................................................8.15 Grans for oral liq 125 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................1.68 Grans for oral liq 250 mg per 5 ml – Up to 200 ml available on a PSO......................................................................................1.82 PROCAINE PENICILLIN Inj 1.5 mega u – Up to 5 inj available on a PSO...............................50.86

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

Staphlex Staphlex AFT AFT Flucloxin Flucloxin Flucloxin Cilicaine VK Cilicaine VK AFT AFT Cilicaine

Tetracyclines

DOXYCYCLINE HYDROCHLORIDE F Tab 50 mg – Up to 30 tab available on a PSO....................................2.90 (6.00) F Tab 100 mg – Up to 30 tab available on a PSO..................................8.10 MINOCYCLINE HYDROCHLORIDE F Tab 50 mg ...........................................................................................5.79 (12.05) F Cap 100 mg ......................................................................................19.32 (52.04) 30 Doxy-50 250 60 Mino-tabs 100 Minomycin

Doxine

Other Antibiotics

For topical antibiotics, refer to DERMATOLOGICALS, page 61 CIPROFLOXACIN Tab 250 mg – Up to 5 tab available on a PSO....................................5.10 Tab 500 mg – Up to 5 tab 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 pharmacySpecialist .................................................................................... 19.45 CO-TRIMOXAZOLE F Tab trimethoprim 80 mg and sulphamethoxazole 400 mg – Up to 30 tab available on a PSO ................................................ 17.00 F Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml – Up to 200 ml available on a PSO ...........5.90

28 28 28

Cipﬂox Cipﬂox Cipﬂox

16 1

Dalacin C Dalacin C

500 500 ml

Trisul Trisul

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

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

COLISTIN SULPHOMETHATE – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. Inj 150 mg .........................................................................................65.00 1 Colistin-Link FUSIDIC ACID Tab 250 mg – Hospital pharmacy [HP3]-Specialist ..........................34.50 12 Fucidin Inj 500 mg sodium fusidate per 10 ml – Hospital pharmacy [HP3]-Specialist – Subsidy by endorsement ..............................12.87 1 (17.80) Fucidin 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 – Hospital pharmacy [HP3] – Subsidy by endorsement............................................................................ 8.56 5 Mayne Only if prescribed for a dialysis or cystic ﬁbrosis patient or for prophylaxis of endocarditis and the prescription is endorsed accordingly. Inj 40 mg per ml, 2 ml – Hospital pharmacy [HP3] – Subsidy by endorsement............................................................................ 4.56 10 Pﬁzer Only if prescribed for a dialysis or cystic ﬁbrosis patient or for prophylaxis of endocarditis and the prescription is endorsed accordingly. TOBRAMYCIN Inj 40 mg per ml, 2 ml – Hospital pharmacy [HP3] – Subsidy by endorsement..........................................................................27.50 5 Mayne Only if prescribed for dialysis or cystic ﬁbrosis patient and the prescription is endorsed accordingly. TRIMETHOPRIM F Tab 300 mg – Up to 30 tab available on a PSO..................................8.69 50 TMP VANCOMYCIN HYDROCHLORIDE – Hospital pharmacy [HP3] – 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 .......................................................................5.04 1 Paciﬁc

Antifungals

a) For topical antifungals refer to DERMATOLOGICALS, page 61 b) For topical antifungals refer to GENITO URINARY, page 75 FLUCONAZOLE – Hospital pharmacy [HP3]-Specialist Cap 50 mg ..........................................................................................6.82 Cap 150 mg ........................................................................................1.30 Cap 200 mg ......................................................................................19.05 ITRACONAZOLE – Hospital pharmacy [HP3]-Specialist Cap 100 mg ......................................................................................23.70 KETOCONAZOLE Tab 200 mg – Retail pharmacy-Specialist ........................................38.12 NYSTATIN Tab 500,000 u .....................................................................................9.60 Cap 500,000 u ..................................................................................11.64 TERBINAFINE Tab 250 mg .......................................................................................25.50

28 1 28 15 30 50 50 100

Paciﬁc Paciﬁc Paciﬁc Sporanox Nizoral Nilstat S29 Nilstat Apo-Terbinaﬁne

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antimalarials

HYDROXYCHLOROQUINE SULPHATE F Tab 200 mg .......................................................................................31.09 100

Plaquenil

Antitrichomonal Agents

METRONIDAZOLE Tab 200 mg – Up to 30 tab available on a PSO..................................9.50 Tab 400 mg .......................................................................................17.50 Oral liq benzoate 200 mg per 5 ml ...................................................25.00 Suppos 500 mg ................................................................................24.48 Suppos 1 g ......................................................................................33.31 (Flagyl Suppos 1 g to be delisted 1 February 2009) ORNIDAZOLE Tab 500 mg .......................................................................................12.38 100 100 100 ml 10 10

Trichozole Trichozole Flagyl-S Flagyl Flagyl

Tiberal

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 .........................................................................................95.00 100 Dapsone Tab 100 mg .....................................................................................110.00 100 Dapsone ETHAMBUTOL HYDROCHLORIDE – No patient co-payment payable Tab 400 mg .......................................................................................10.98 ISONIAZID – Retail pharmacy-Specialist No patient co-payment payable F Tab 100 mg .......................................................................................20.50 F Tab 100 mg with rifampicin 150 mg ..................................................90.04 F Tab 150 mg with rifampicin 300 mg ................................................179.57 PYRAZINAMIDE – Retail pharmacy-Specialist No patient co-payment payable F Tab 500 mg .......................................................................................59.00 RIFABUTIN – Hospital pharmacy [HP3]-Specialist No patient co-payment payable F Cap 150 mg ....................................................................................213.19 RIFAMPICIN – Retail pharmacy-Specialist No patient co-payment payable F Tab 600 mg .....................................................................................114.40 F Cap 150 mg ......................................................................................58.66 F Cap 300 mg ....................................................................................122.36 F Oral liq 100 mg per 5 ml ...................................................................12.66 56

Myambutol S29

100 100 100

PSM Riﬁnah Riﬁnah

100

AFT-Pyrazinamide

Mycobutin

30 100 100 60 ml

Rifadin Rifadin Rifadin Rifadin

Antivirals

For eye preparations refer to Eye Preparations, Anti-Infective Preparations, page 153

First Episode Genital Herpes

ACICLOVIR F Tab dispersible 200 mg .......................................................................1.98

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

Lovir 93

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Recurrent Episodes of Genital Herpes

ACICLOVIR F Tab dispersible 400 mg .......................................................................6.64 56

Lovir

Acute Herpes Zoster

ACICLOVIR F Tab dispersible 800 mg .......................................................................7.38 35

Lovir

Hepatitis B Treatment

ADEFOVIR DIPIVOXIL – Special Authority see SA0829 below – Retail pharmacy Tab 10 mg .......................................................................................670.00 30

Hepsera

¾SA0829 Special Authority for Subsidy Initial application only from a 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 × 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 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 × 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 10mg 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 see SA0832 on the next page – Retail pharmacy Tab 100mg ......................................................................................143.00 28 Zefﬁx Oral liq 5 mg per ml ..........................................................................90.00 240 ml Zefﬁx

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0832 Special Authority for Subsidy 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 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 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 1 All of the following: 1.1 Have maintained continuous treatment with lamivudine; and 1.2 Most recent test result shows continuing biochemical response (normal ALT); and 1.3 HBV DNA <100,00 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 2 All of the following: 2.1 Lamivudine to be used in combination with adefovir dipivoxil; and 2.2 Patient is cirrhotic; and Documented resistance to lamivudine, deﬁned as: 2.3 Patient has raised serum ALT (> 1 × ULN); and 2.4 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 2.5 Detection of M204I or M204V mutation; or Renewal when given in combination with adefovir dipivoxil for patients with resistance to adefovir dipivoxil 3 All of the following: 3.1 Lamivudine to be used in combination with adefovir dipivoxil; and Documented resistance to adefovir, deﬁned as: 3.2 Patient has raised serum ALT (> 1 × ULN); and 3.3 Patient has HBV DNA greater than 100,000 copies per mL, or viral load = 10 fold over nadir; and 3.4 Detection of N236T or A181T/V mutation.

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

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antiretrovirals

¾SA0779 Special Authority for Subsidy 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 Any of the following: 2.3.2.1 CD4 counts < 1000 cells/mm3 ; or 2.3.2.2 CD4 counts < 0.25 × total lymphocyte count; or 2.3.2.3 Viral load counts > 100000 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: Either: 1 Prevention of maternal foetal transmission; or 2 Treatment of the newborn for up to eight weeks. Notes: 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.

Non-nucleosides Reverse Transcriptase Inhibitors

EFAVIRENZ – Special Authority see SA0779 above – Hospital pharmacy [HP1] Tab 600 mg .....................................................................................474.99 Cap 50 mg ......................................................................................158.33 Cap 100 mg ....................................................................................158.33 Cap 200 mg ....................................................................................474.99 NEVIRAPINE – Special Authority see SA0779 above – Hospital pharmacy [HP1] Tab 200 mg .....................................................................................319.80 Oral suspension 10 mg per ml ........................................................134.55 30 30 30 90 60 240 ml

Stocrin Stocrin Stocrin Stocrin Viramune Viramune

Suspension

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Nucleosides Reverse Transcriptase Inhibitors

ABACAVIR SULPHATE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 300 mg .....................................................................................458.00 60 Ziagen Oral liq 20 mg per ml ......................................................................100.00 240 ml OP Ziagen ABACAVIR SULPHATE WITH LAMIVUDINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Note: Kivexa counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority. Tab 600 mg with lamivudine 300 mg ..............................................630.00 30 Kivexa DIDANOSINE [DDI] – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 125 mg ....................................................................................115.05 30 Videx EC Cap 200 mg ....................................................................................184.08 30 Videx EC Cap 250 mg ....................................................................................230.10 30 Videx EC Cap 400 mg ....................................................................................368.16 30 Videx EC EMTRICITABINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 200 mg ....................................................................................307.20 30 Emtriva LAMIVUDINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 150 mg .....................................................................................307.20 60 3TC Oral liq 10 mg per ml ......................................................................100.00 240 ml OP 3TC STAVUDINE [D4T] – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 20 mg ......................................................................................317.10 60 Zerit Cap 30 mg ......................................................................................377.80 60 Zerit Cap 40 mg ......................................................................................503.80 60 Zerit Powder for oral soln 1 mg per ml ....................................................100.76 200 ml OP Zerit TENOFOVIR DISOPROXIL FUMARATE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 300 mg .....................................................................................531.00 30 Viread ZIDOVUDINE [AZT] – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 100 mg ....................................................................................290.00 100 Retrovir Oral liq 10 mg per ml ........................................................................58.00 200 ml OP Retrovir ZIDOVUDINE [AZT] WITH LAMIVUDINE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Combivir counts as two anti-retroviral medications for the purposes of the anti-retroviral Special Authority. Tab 300 mg with lamivudine 150 mg ..............................................667.20 60 Combivir

Protease Inhibitors

ATAZANAVIR SULPHATE – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 150 mg ....................................................................................568.34 60 Reyataz Cap 200 mg ....................................................................................757.79 60 Reyataz INDINAVIR – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 200 mg ....................................................................................519.75 360 Cap 400 mg ....................................................................................519.75 180

Crixivan Crixivan

LOPINAVIR WITH RITONAVIR – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Tab 200 mg with ritonavir 50 mg .....................................................735.00 120 Kaletra Oral liq 80 mg with ritonavir 20 mg per ml ......................................735.00 300 ml OP Kaletra RITONAVIR – Special Authority see SA0779 on the preceding page – Hospital pharmacy [HP1] Cap 100 mg ....................................................................................121.27 84 Oral liq 80 mg per ml ......................................................................103.98 90 ml OP

Norvir Norvir

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

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

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

SAQUINAVIR – Special Authority see SA0779 on page 96 – Hospital pharmacy [HP1] Tab 500 mg .....................................................................................556.59 120 Cap 200 mg ...................................................................................519.75 270 (Invirase Cap 200 mg to be delisted 1 March 2009)

Invirase Invirase

Antiretrovirals - Additional Therapies HIV Fusion Inhibitors

ENFUVIRTIDE – Special Authority see SA0845 below – Hospital pharmacy [HP1] Powder for inj 90 mg per ml × 60 ................................................2,380.00 1

Fuzeon

¾SA0845 Special Authority for Subsidy 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 the 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: 1 Evidence of at least a 10 fold reduction in viral load at 12; and 2 The treatment remains appropriate and the patient is beneﬁting from treatment.

Urinary Tract Infections

HEXAMINE HIPPURATE F Tab 1 g ..............................................................................................18.40 (38.10) NITROFURANTOIN F Tab 50 mg .........................................................................................17.90 F Tab 100 mg .......................................................................................30.25 NORFLOXACIN Tab 400 mg – Maximum of 6 tab per prescription; can be waived by endorsement - Retail pharmacy - Specialist..............22.50 100 Hiprex 100 100

Nifuran Nifuran

100

Arrow-Norﬂoxacin

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

INFECTIONS - AGENTS FOR SYSTEMIC USE

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Vaccines Inﬂuenza vaccine

INFLUENZA VACCINE – Hospital pharmacy [Xpharm] A) is available between 1 March and 30 June 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: a) autoimmune disease, b) immune suppression, c) HIV, d) transplant recipients, e) neuromuscular and CNS diseases, f) haemoglobinopathies, or g) children on long term aspirin. The following conditions are excluded from funding: a) asthma not requiring regular preventative therapy, b) hypertension and/or dyslipidaemia without evidence of end-organ disease, c) 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 the above criteria 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 above criteria. 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 ........................................................................................................9.00 1 Fluvax 90.00 10 Vaxigrip

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

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

MUSCULO-SKELETAL SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Anticholinesterases

NEOSTIGMINE Inj 2.5 mg per ml, 1 ml ......................................................................20.30 PYRIDOSTIGMINE BROMIDE L Tab 60 mg .........................................................................................34.32 50 100

AstraZeneca Mestinon

Anti-inﬂammatory Non Steroidal Drugs (NSAIDs)

¾SA0291 Special Authority for Manufacturers Price 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 where the treatment remains appropriate and the patient is beneﬁting from treatment. DICLOFENAC SODIUM F Tab EC 25 mg .....................................................................................3.51 100 Apo-Diclo F Tab 50 mg dispersible – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy ............................. 1.50 20 (8.00) Voltaren D F Tab EC 50 mg ...................................................................................25.88 500 Apo-Diclo F Tab long-acting 75 mg ......................................................................22.78 500 Apo-Diclo SR F Tab long-acting 100 mg ....................................................................34.32 500 Apo-Diclo SR F Inj 25 mg per ml, 3 ml .......................................................................12.00 5 Voltaren Up to 5 inj available on a PSO F Suppos 12.5 mg .................................................................................1.85 10 Voltaren F Suppos 25 mg ....................................................................................2.22 10 Voltaren F Suppos 50 mg ....................................................................................3.84 10 Voltaren Up to 10 supp available on a PSO F Suppos 100 mg ..................................................................................6.36 10 Voltaren IBUPROFEN – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy F Tab 200 mg .........................................................................................1.78 100 F Tab 400 mg .........................................................................................1.07 30 (4.56) F Tab 600 mg .........................................................................................1.60 30 (6.84) F Tab long-acting 800 mg ......................................................................1.50 30 (9.12) F‡ Oral liq 100 mg per 5 ml .....................................................................3.49 200 ml KETOPROFEN – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy F Cap long-acting 100 mg .....................................................................6.72 100 (21.56) F Cap long-acting 200 mg ...................................................................13.44 100 (43.12)

I-Profen

Brufen Brufen Brufen Retard

Fenpaed

Oruvail 100 Oruvail 200

MEFENAMIC ACID – Additional subsidy by Special Authority see SA0291 above – Retail pharmacy F Cap 250 mg ........................................................................................2.50 100 (18.33) Ponstan

100

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

MUSCULO-SKELETAL SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

NAPROXEN F Tab 250 mg .......................................................................................21.00 F Tab 500 mg .......................................................................................17.95 F Tab long-acting 750 mg ....................................................................18.00 F Tab long-acting 1,000 mg .................................................................21.00 NAPROXEN SODIUM F Tab 275 mg .........................................................................................6.00 F Tab 550 mg .......................................................................................12.80

500 250 90 90 120 100

Noﬂam 250 Noﬂam 500 Naprosyn SR 750 Naprosyn SR 1000 Sonaﬂam Synﬂex

SULINDAC – Additional subsidy by Special Authority see SA0291 on the preceding page – Retail pharmacy F Tab 100 mg .........................................................................................5.32 100 (12.00) Daclin F Tab 200 mg .........................................................................................6.72 100 (20.00) Daclin 3.36 50 (15.87) Clinoril TENOXICAM F Tab 20 mg .........................................................................................23.75 F Suppos 20 mg ...................................................................................5.30 (Tilcotil Suppos 20 mg to be delisted 1 January 2009) 100 10

Tilcotil Tilcotil

TIAPROFENIC ACID – Additional subsidy by Special Authority see SA0291 on the preceding page – Retail pharmacy F Tab 300 mg .........................................................................................4.03 60 (19.26) Surgam

NSAIDs Other

INDOMETHACIN F Cap 25 mg ..........................................................................................5.90 F Cap 50 mg ..........................................................................................6.95 F Cap long-acting 75 mg .....................................................................13.30 F Suppos 100 mg ................................................................................14.50 PIROXICAM F Tab dispersible 10 mg .........................................................................3.25 F Tab dispersible 20 mg .........................................................................5.50 100 100 100 30 50 100

Rheumacin Rheumacin Rheumacin SR Arthrexin Piram-D Piram-D

Antirheumatoid Agents

AURANOFIN – Retail pharmacy-Specialist Tab 3 mg ...........................................................................................68.99 (70.97) 60 Ridaura

LEFLUNOMIDE – Special Authority see SA0635 on the next page – Retail pharmacy Tab 10 mg .........................................................................................55.00 30 79.27 Tab 20 mg .........................................................................................76.00 30 108.60 Tab 100 mg .......................................................................................54.44 3

AFT-Leﬂunomide Arava AFT-Leﬂunomide Arava Arava

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

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

101

MUSCULO-SKELETAL SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0635 Special Authority for Subsidy 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 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: 1 Compliance (prescriber determined) with medication; and 2 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 .......................................................................................61.93 100 D-Penamine Tab 250 mg .......................................................................................98.98 100 D-Penamine 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 10 10 10

Myocrisin Myocrisin Myocrisin

Tumour Necrosis Factor (TNF) Inhibitors

ADALIMUMAB – Special Authority see SA0812 below – Retail pharmacy Inj 40 mg per 0.8 ml pre-ﬁlled pen ...............................................1,799.92 Inj 40 mg per 0.8 ml preﬁlled syringe ..........................................1,799.92 2 2

HumiraPen Humira

¾SA0812 Special Authority for Subsidy 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 Either: 5.1 Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of Cyclosporin alone or in combination with another agent; or 5.2 Patient has tried and not responded to at least three months therapy at the maximum tolerated dose of Leﬂunomide alone or in combination with another agent; 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: continued. . .

102

fully subsidised [HP1], [HP3], [HP4] refer page 8

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MUSCULO-SKELETAL SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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; and 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. Notes: 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. Renewal only from a rheumatologist or general physician on the recommendation of a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 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 2.2 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 the physician. ETANERCEPT – Retail pharmacy-Specialist prescription – Special Authority see SA0868 below Inj 25 mg .........................................................................................949.96 4 Enbrel ¾SA0868 Special Authority for Subsidy Initial application only from a named specialist or rheumatologist. 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 diagnosed with Juvenile Idiopathic Arthritis (JIA); and 3 Patient has had severe active polyarticular course 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 or at the maximum tolerated dose) in combination with oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose); 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 or at the maximum tolerated dose) 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, swollen, 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. 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) Renewal only from a named specialist or rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Both: continued. . .

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

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

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 1 Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Either: 2.1 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 2.2 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.

Enzymes

HYALURONIDASE Inj 1,500 iu per ml .............................................................................18.32 (194.40) 10 Hyalase

Hyperuricaemia and Antigout

ALLOPURINOL F Tab 100 mg .......................................................................................11.45 F Tab 300 mg .......................................................................................21.20 COLCHICINE F Tab 500 µg ..........................................................................................9.60 PROBENECID F Tab 500 mg .......................................................................................55.00 500 500 100 100

Progout Progout Colgout AFT

Muscle Relaxants

BACLOFEN – Retail pharmacy-Specialist F Tab 10 mg ...........................................................................................3.75 DANTROLENE SODIUM – Retail pharmacy-Specialist F Cap 25 mg ........................................................................................32.96 F Cap 50 mg ........................................................................................51.70 ORPHENADRINE CITRATE Tab 100 mg .......................................................................................18.54 Inj 30 mg per ml, 2 ml ........................................................................9.60 (20.50) (Norﬂex Inj 30 mg per ml, 2 ml to be delisted 1 December 2008) QUININE SULPHATE F Tab 200 mg .......................................................................................15.95 ‡ Safety cap for extemporaneously compounded oral liquid preparations. F Tab 300 mg .......................................................................................34.75 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 100 100 100 100 3

Pacifen Dantrium Dantrium Norﬂex

Norﬂex

250 500

Q 200 Q 300

104

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Anaesthetics Local

BUPIVACAINE HYDROCHLORIDE – Hospital pharmacy [HP3] Inj 0.5%, 4 ml ....................................................................................29.35 Inj 0.5%, 8% glucose, 4 ml ...............................................................24.50 5 5

Marcain Isobaric Marcain Heavy

LIGNOCAINE HYDROCHLORIDE Inj 0.5%, 5 ml – Up to 5 inj available on a PSO................................44.10 50 Xylocaine 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 – Up to 5 inj available on a PSO...................................42.00 50 Xylocaine 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 – Up to 5 inj available on a PSO.................................23.50 5 Xylocaine Only if prescribed on prescription for a dialysis patient or child with rheumatic fever or on a PSO for emergency use. LIGNOCAINE WITH CHLORHEXIDINE Gel 2% with chlorhexidine 0.05%, 10 ml urethral syringes ...............43.26 10 Pﬁzer LIGNOCAINE WITH PRILOCAINE – Special Authority see SA0906 below – Hospital pharmacy [HP3] Crm 2.5% with prilocaine 2.5% ........................................................41.00 30 g OP EMLA Crm 2.5% with prilocaine 2.5% (5 g tubes) ......................................41.00 5 EMLA ¾SA0906 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years where the patient is a child with a chronic medical condition requiring frequent injections or venepuncture. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Analgesics

For Anti-inﬂammatory NSAIDS refer to MUSCULO-SKELETAL, page 100

Non-Opioid Analgesics

ASPIRIN F Tab EC 300 mg ...................................................................................7.25 (8.10) F Tab dispersible 300 mg – Up to 30 tab available on a PSO ...............2.15 NEFOPAM HYDROCHLORIDE Tab 30 mg .........................................................................................23.40 100 Aspec 300 100 90

Ethics Aspirin Acupan

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

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

105

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

PARACETAMOL F Tab 500 mg – Up to 30 tab available on a PSO................................13.23 F‡ Oral liq 120 mg per 5 ml ....................................................................6.80 a) Up to 200 ml available on a PSO b) Not in combination F‡ Oral liq 250 mg per 5 ml .....................................................................7.00

1,440 1,000 ml

Panadol Junior Parapaed Paracare Junior Paracare Double

Strength

1,000 ml

Six Plus Parapaed

a) Up to 100 ml available on a PSO b) Not in combination F Suppos 125 mg ..................................................................................6.51 F Suppos 250 mg ................................................................................12.52 F Suppos 500 mg ................................................................................20.50 (Junior Parapaed Oral liq 120 mg per 5 ml to be delisted 1 December 2008) (Six Plus Parapaed Oral liq 250 mg per 5 ml to be delisted 1 December 2008) 20 20 50

Panadol Panadol Paracare

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 ...........................................................................................5.50 Tab 30 mg ...........................................................................................8.50 Tab 60 mg .........................................................................................18.50 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 FENTANYL – Special Authority see SA0743 below – Retail pharmacy a) Only on a controlled drug form b) No patient co-payment payable Transdermal patch, matrix 25 µg per hour ........................................55.23 Transdermal patch, matrix 50 µg per hour ......................................100.52 Transdermal patch, matrix 75 µg per hour ......................................139.18 Transdermal patch, matrix 100 µg per hour ....................................171.22 5 Temgesic 100 100 100 500 Paradex 500 Capadex 60

PSM PSM PSM

DHC Continus

5 5 5 5

Durogesic Durogesic Durogesic Durogesic

¾SA0743 Special Authority for Subsidy 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.

106

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NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

METHADONE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable c) Extemporaneously compounded methadone will only be reimbursed at the rate of the cheapest form available (methadone powder, not methadone tablets). d) For methadone hydrochloride oral liquid refer, page 162 Tab 5 mg .............................................................................................2.10 10 Methatabs ‡ Oral liq 2 mg per ml ............................................................................6.55 200 ml Biodone ‡ Oral liq 5 mg per ml ............................................................................6.52 200 ml Biodone Forte ‡ Oral liq 10 mg per ml ..........................................................................9.50 200 ml Biodone Extra Forte Inj 10 mg per ml, 1 ml .......................................................................52.00 10 AFT MORPHINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable ‡ Oral liq 1 mg per ml ............................................................................8.06 ‡ Oral liq 2 mg per ml ............................................................................8.56 ‡ Oral liq 5 mg per ml ............................................................................9.61 ‡ Oral liq 10 mg per ml ........................................................................12.56 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Tab immediate-release 10 mg ............................................................2.64 Tab long-acting 10 mg ........................................................................1.80 Tab immediate-release 20 mg ............................................................5.10 Tab long-acting 30 mg ........................................................................3.60 Tab long-acting 60 mg ........................................................................7.20 Tab long-acting 100 mg ......................................................................8.50 Cap long-acting 10 mg .......................................................................1.80 Cap long-acting 30 mg .......................................................................2.64 Cap long-acting 60 mg .......................................................................7.20 Cap long-acting 100 mg .....................................................................7.85 Cap long-acting 200 mg ...................................................................17.00 Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO .......................5.17 Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................4.50 Inj 15 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................4.70 Inj 30 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................4.98 Suppos 30 mg ..................................................................................31.39 MORPHINE TARTRATE a) Only on a controlled drug form b) No patient co-payment payable Inj 80 mg per ml, 1.5 ml ....................................................................20.20 Inj 80 mg per ml, 5 ml .......................................................................67.37

200 ml 200 ml 200 ml 200 ml

RA-Morph RA-Morph RA-Morph RA-Morph

10 10 10 10 10 10 10 10 10 10 10 5 5 5 5 12

Sevredol LA-Morph Sevredol LA-Morph LA-Morph LA-Morph m-Eslon m-Eslon m-Eslon m-Eslon m-Eslon Mayne Mayne Mayne Mayne Martindale S29

5 5

Mayne Mayne

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

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

107

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

OXYCODONE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable Tab controlled-release 5 mg ...............................................................7.51 Tab controlled-release 10 mg ...........................................................11.14 Tab controlled-release 20 mg ...........................................................18.93 Tab controlled-release 40 mg ...........................................................33.29 Tab controlled-release 80 mg ...........................................................58.03 Cap 5 mg ............................................................................................2.83 Cap 10 mg ..........................................................................................5.58 Cap 20 mg ..........................................................................................9.77 ‡ Oral liq 5 mg per 5 ml .......................................................................11.20 Inj 10 mg per ml, 1 ml .......................................................................14.40 Inj 10 mg per ml, 2 ml .......................................................................28.80

20 20 20 20 20 20 20 20 250 ml 5 5

OxyContin OxyContin OxyContin OxyContin OxyContin OxyNorm OxyNorm OxyNorm OxyNorm OxyNorm OxyNorm

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. PARACETAMOL WITH CODEINE F Tab paracetamol 500 mg with codeine phosphate 8 mg ....................3.24 100 Codalgin PETHIDINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable Tab 50 mg ...........................................................................................3.00 Tab 100 mg .........................................................................................4.00 Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................3.75 Inj 50 mg per ml, 1.5 ml – Up to 5 inj available on a PSO ..................4.35 Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .....................4.18

10 10 5 5 5

PSM PSM Mayne Mayne Mayne

Antidepressants Cyclic and Related Agents

AMITRIPTYLINE Tab 10 mg ...........................................................................................2.77 3.00 Tab 25 mg ...........................................................................................3.40 Tab 50 mg ...........................................................................................5.20 (Amitrip Tab 10 mg to be delisted 1 March 2009) CLOMIPRAMINE HYDROCHLORIDE Tab 10 mg .........................................................................................10.00 Tab 25 mg .........................................................................................26.00 DOTHIEPIN HYDROCHLORIDE Tab 75 mg ...........................................................................................8.75 Cap 25 mg ..........................................................................................4.75 DOXEPIN HYDROCHLORIDE Cap 10 mg ..........................................................................................5.24 Cap 25 mg ..........................................................................................5.46 Cap 50 mg ..........................................................................................7.34 Cap 75 mg .......................................................................................10.99 (Anten Cap 75 mg to be delisted 1 April 2009)

fully subsidised [HP1], [HP3], [HP4] refer page 8

50 100 100 100

Amirol Amitrip Amitrip Amitrip

100 500 100 100 100 100 100 100

Clopress Clopress Dopress Dopress Anten Anten Anten Anten

108

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NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

IMIPRAMINE HYDROCHLORIDE Tab 10 mg ...........................................................................................5.48 Tab 25 mg ...........................................................................................8.80 MAPROTILINE HYDROCHLORIDE Tab 25 mg .........................................................................................25.06 Tab 75 mg .........................................................................................21.01

50 50 100 30

Tofranil Tofranil Ludiomil Ludiomil Tolvon

MIANSERIN HYDROCHLORIDE – Special Authority see SA0864 below – Retail pharmacy Tab 30 mg .........................................................................................29.25 30

¾SA0864 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Depression; and 2 Either: 2.1 Co-existent bladder neck obstruction; or 2.2 Cardiovascular disease. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. NORTRIPTYLINE HYDROCHLORIDE Tab 10 mg ...........................................................................................5.94 100 Norpress Tab 25 mg .........................................................................................20.06 250 Norpress 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 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. Tab 150 mg .......................................................................................49.45 500 Apo-Moclobemide Tab 300 mg .......................................................................................26.11 100 Apo-Moclobemide

Selective Serotonin Reuptake Inhibitors

CITALOPRAM HYDROBROMIDE F Tab 20 mg ...........................................................................................3.50 28

Arrow-Citalopram Celapram Citalopram - Rex

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

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

109

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

FLUOXETINE HYDROCHLORIDE F Tab dispersible 20 mg, scored – Subsidy by endorsement .................5.50 30 Fluox Subsidised by endorsement 1) When prescribed for a patient who cannot swallow whole tablets or capsules and the prescription is endorsed accordingly; or 2) 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. F Cap 20 mg ..........................................................................................4.39 90 Fluox PAROXETINE HYDROCHLORIDE Tab 20 mg ...........................................................................................5.90 30

Loxamine

Other Antidepressants

VENLAFAXINE – Special Authority see SA0789 below – Retail pharmacy Cap 37.5 mg .....................................................................................18.64 Cap 75 mg ........................................................................................37.27 Cap 150 mg ......................................................................................45.68 28 28 28

Efexor XR Efexor XR Efexor XR

¾SA0789 Special Authority for Subsidy 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 Inj 5 mg per ml, 2 ml – Subsidy by endorsement ...............................9.24 a) Up to 5 inj available on a PSO b) Only on a PSO c) PSO must be endorsed “not for anaesthetic procedures”. Rectal tubes 5 mg – Up to 5 tube available on a PSO .....................27.83 Rectal tubes 10 mg – Up to 5 tube available on a PSO ...................33.89 PARALDEHYDE F Inj 5 ml .........................................................................................1,500.00 PHENYTOIN SODIUM F Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................69.24 F Inj 50 mg per ml, 5 ml – Up to 5 inj available on a PSO ...................77.27 5 5

Rivotril Mayne

5 5 5 5 5

Stesolid Stesolid AFT Mayne Mayne

110

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Control of Epilepsy

CARBAMAZEPINE F Tab 200 mg .......................................................................................29.06 F Tab long-acting 200 mg ....................................................................16.98 F Tab 400 mg .......................................................................................34.58 F Tab long-acting 400 mg ....................................................................39.17 F‡ Oral liq 100 mg per 5 ml ...................................................................26.37 CLOBAZAM Tab 10 mg ...........................................................................................9.12 ‡ Safety cap for extemporaneously compounded oral liquid preparations. CLONAZEPAM Tab 500 µg ..........................................................................................6.26 Tab 2 mg ...........................................................................................11.15 ‡ Oral drops 2.5 mg per ml ....................................................................7.38 ETHOSUXIMIDE F Cap 250 mg ......................................................................................32.90 F‡ Oral liq 250 mg per 5 ml ...................................................................11.96 GABAPENTIN – Special Authority see SA0873 below – Retail pharmacy L Tab 600 mg .......................................................................................79.79 L Cap 100 mg ......................................................................................13.26 15.67 L Cap 300 mg ......................................................................................39.76 47.00 L Cap 400 mg ......................................................................................53.01 62.66 200 100 100 100 250 ml 50

Tegretol Tegretol CR Tegretol Tegretol CR Tegretol Frisium

100 100 10 ml OP 200 200 ml 100 100 100 100

Paxam Paxam Rivotril Zarontin Zarontin Neurontin Nupentin Neurontin Nupentin Neurontin Nupentin Neurontin

¾SA0873 Special Authority for Subsidy Initial application — (Epilepsy - new patients) from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Either: 1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents. Note: “Optimal treatment with other antiepilepsy agents” is deﬁned as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Initial application — (Epilepsy - patient has had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life from gabapentin, topiramate, vigabatrin and /or lamotrigine. Note: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Initial application — (Neuropathic pain - new patients) from any relevant practitioner. Approvals valid for 3 months where the patient has tried and failed, or has been unable to tolerate, treatment with a tricyclic antidepressant AND an anticonvulsant agent. Initial application — (Neuropathic pain - patient has had an approval for gabapentin for neuropathic pain prior to 1 August 2007) from any relevant practitioner. Approvals valid for 2 years where the patient has demonstrated a marked improvement in their control of pain (prescriber determined). continued. . .

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

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

111

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . Renewal — (Epilepsy) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed where the patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life. Notes: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. If the patient had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Renewal — (Neuropathic pain) from any relevant practitioner. Approvals valid for 2 years where the patient has demonstrated a marked improvement in their control of pain (prescriber determined). Note: If the patient had an approval for gabapentin for neuropathic pain prior to 1 August 2007 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. LAMOTRIGINE L Tab dispersible 2 mg ...........................................................................6.74 30 Lamictal L Tab dispersible 5 mg ...........................................................................9.64 30 Lamictal 15.00 56 Arrow-Lamotrigine L Tab dispersible 25 mg .......................................................................19.38 56 Logem 20.40 Arrow-Lamotrigine Mogine 29.09 Lamictal L Tab dispersible 50 mg .......................................................................32.97 56 Logem 34.70 Arrow-Lamotrigine Mogine 47.89 Lamictal L Tab dispersible 100 mg .....................................................................56.91 56 Logem 59.90 Arrow-Lamotrigine Mogine 79.16 Lamictal L Tab dispersible 200 mg ...................................................................101.80 56 Arrow-Lamotrigine Mogine LEVETIRACETAM – Special Authority see SA0921 below – Retail pharmacy Tab ....................................................................................................CBS 60

Keppra

¾SA0921 Special Authority for Subsidy Subsidy by application to the Levetiracetam Special Access Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Coordinator, Levetiracetam Special Access Panel Phone: (04) 916-7553 PHARMAC, PO Box 10 254 Facsimile: (09) 929-3226 Wellington Email: lsacoordinator@pharmac.govt.nz PHENOBARBITONE For phenobarbitone oral liquid refer, page 162 F Tab 15 mg .........................................................................................23.68 F Tab 30 mg .........................................................................................24.59 PHENYTOIN SODIUM F Tab 50 mg .........................................................................................15.63 F Cap 30 mg ........................................................................................15.50 F Cap 100 mg ......................................................................................14.69 F‡ Oral liq 30 mg per 5 ml .....................................................................11.19 PRIMIDONE F Tab 250 mg .......................................................................................17.25

500 500 200 200 200 500 ml 100

PSM PSM Dilantin Infatab Dilantin Dilantin Dilantin Apo-Primidone

112

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

SODIUM VALPROATE F Tab 100 mg .......................................................................................13.65 F Tab 200 mg EC .................................................................................27.44 F Tab 500 mg EC .................................................................................52.24 F‡ Oral liq 200 mg per 5 ml ...................................................................20.48 F Inj 100 mg per ml, 4 ml .....................................................................41.50 TOPIRAMATE L Tab 25 mg .........................................................................................26.04 L Tab 50 mg .........................................................................................44.26 L Tab 100 mg .......................................................................................75.25 L Tab 200 mg .....................................................................................129.85 L Sprinkle cap 15 mg ...........................................................................20.84 L Sprinkle cap 25 mg ...........................................................................26.04 VIGABATRIN – Special Authority see SA0875 below – Retail pharmacy L Tab 500 mg .....................................................................................119.30

100 100 100 300 ml 1 60 60 60 60 60 60 100

Epilim Crushable Epilim Epilim Epilim S/F Liquid Epilim Syrup Epilim IV Topamax Topamax Topamax Topamax Topamax Topamax Sabril

¾SA0875 Special Authority for Subsidy Initial application — (new patients) from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: All of the following: 1 Patient has epilepsy; and 2 Either: 2.1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 2.2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents; and 3 Either: 3.1 Patient is, or will be, receiving regular automated visual ﬁeld testing (ideally before starting therapy and on a 6-monthly basis thereafter); or 3.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. Notes: “Optimal treatment with other antiepilepsy agents” is deﬁned as treatment with other antiepilepsy agents which are indicated and clinically appropriate for the patient, given in adequate doses for the patient’s age, weight, and other features affecting the pharmacokinetics of the drug with good evidence of compliance. Vigabatrin is associated with a risk of irreversible visual ﬁeld defects, which may be asymptomatic in the early stages. Initial application — (patient has had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007) from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: 1 Patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life from gabapentin, topiramate, vigabatrin and or lamotrigine; and 2 Either: 2.1 Patient is receiving regular automated visual ﬁeld testing (ideally every 6 months) on an ongoing basis for the duration of treatment with vigabatrin; or 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. Notes: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Vigabatrin is associated with a risk of irreversible visual ﬁeld defects, which may be asymptomatic in the early stages. Renewal from any relevant practitioner. Approvals valid without further renewal unless notiﬁed for applications meeting the following criteria: Both: continued. . .

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

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

113

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 1 The patient has demonstrated a signiﬁcant and sustained improvement in seizure rate or severity and or quality of life; and 2 Either: 2.1 Patient is receiving regular automated visual ﬁeld testing (ideally every 6 months) on an ongoing basis for duration of treatment with vigabatrin; or 2.2 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual ﬁelds. Notes: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. Vigabatrin is associated with a risk of irreversible visual ﬁeld defects, which may be asymptomatic in the early stages. If the patient had an approval for gabapentin, lamotrigine, topiramate or vigabatrin for epilepsy prior to 1 August 2007 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application.

Antimigraine Preparations

For Anti-inﬂammatory NSAIDS refer to MUSCULO-SKELETAL, page 100

Acute Migraine Treatment

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 RIZATRIPTAN BENZOATE Wafer 10 mg .....................................................................................25.32 SUMATRIPTAN Tab 50 mg .........................................................................................12.00 22.00 Tab 100 mg .......................................................................................12.00 22.00 Inj 12 mg per ml, 0.5 ml – Hospital pharmacy [HP3]-Specialist .........80.00 Maximum of 10 inj per prescription 100 60 3 4

Cafergot Paramax Maxalt Melt Arrow-Sumatriptan Sumagran Imigran Arrow-Sumatriptan Sumagran Imigran Imigran

2 OP

Prophylaxis of Migraine

For Beta Adrenoceptor Blockers refer to CARDIOVASCULAR SYSTEM, page 55 CLONIDINE HYDROCHLORIDE F Tab 25 µg ..........................................................................................17.53 PIZOTIFEN F Tab 500 µg ........................................................................................21.10 (24.10)

100 100

Dixarit

Sandomigran

Antinausea and Vertigo Agents

For Antispasmodics refer to ALIMENTARY TRACT, page 27 BETAHISTINE DIHYDROCHLORIDE – Retail pharmacy-Specialist F Tab 16 mg ...........................................................................................7.56 CYCLIZINE HYDROCHLORIDE Tab 50 mg ...........................................................................................1.99 CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml .......................................................................14.95

fully subsidised [HP1], [HP3], [HP4] refer page 8

84 10 5

Vergo 16 Nausicalm Valoid (AFT)

114

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

DOMPERIDONE – Additional subsidy by Special Authority see SA0435 below – Retail pharmacy F Tab 10 mg ...........................................................................................3.90 100 (7.99)

Motilium

¾SA0435 Special Authority for Manufacturers Price 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 (SCOPOLAMINE) – Special Authority see SA0727 below – Hospital pharmacy [HP3] Patches, 1.5 mg ..................................................................................9.56 2 (12.40) Scopoderm TTS ¾SA0727 Special Authority for Subsidy 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. Renewal from any medical practitioner. Approvals valid for 1 year where the treatment remains appropriate and the patient is beneﬁting from treatment. HYOSCINE HYDROBROMIDE F Inj 400 µg per ml, 1 ml ........................................................................6.66 5 Mayne METOCLOPRAMIDE HYDROCHLORIDE F Tab 10 mg ...........................................................................................5.15 F Inj 5 mg per ml, 2 ml – Up to 5 inj available on a PSO .......................4.50 100 10

Metamide Pﬁzer

ONDANSETRON – Retail pharmacy-Specialist a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 below b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 below c) Not more than one prescription per month; can be waived by Special Authority see SA0887 below. Tab 4 mg ...........................................................................................17.18 10 Zofran Tab disp 4 mg ...................................................................................17.18 10 Zofran Zydis Tab 8 mg ...........................................................................................33.89 20 Zofran Tab disp 8 mg ...................................................................................20.43 10 Zofran Zydis ¾SA0887 Special Authority for Waiver of Rule Initial application from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment of malignancy. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment of malignancy. PROCHLORPERAZINE F Tab 3 mg buccal .................................................................................5.97 50 (15.00) Buccastem F Tab 5 mg – Up to 30 tab available on a PSO....................................16.85 500 Antinaus F Inj 12.5 mg per ml, 1 ml – Up to 5 inj available on a PSO ................14.91 10 (25.81) Stemetil F Suppos 5 mg .....................................................................................9.52 5 (18.13) Stemetil F Suppos 25 mg ..................................................................................12.54 5 (23.87) Stemetil (Stemetil Suppos 5 mg to be delisted 1 December 2008)

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

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

115

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

PROMETHAZINE THEOCLATE F Tab 25 mg ...........................................................................................1.20 (6.24) TROPISETRON – Hospital pharmacy [HP3]-Specialist a) Maximum of 6 cap per prescription b) Maximum of 3 cap per dispensing c) Not more than one prescription per month. Cap 5 mg ..........................................................................................77.41

10 Avomine

Navoban

Antiparkinson Agents Dopamine Agonists and Related Agents

AMANTADINE HYDROCHLORIDE L Cap 100 mg ......................................................................................47.81 APOMORPHINE HYDROCHLORIDE L Inj 10 mg per ml, 2 ml .......................................................................50.43 L Inj 10 mg per ml, 1 ml .......................................................................50.43 BROMOCRIPTINE MESYLATE F Tab 2.5 mg ........................................................................................32.08 F Tab 10 mg .......................................................................................120.86 ENTACAPONE L Tab 200 mg .....................................................................................129.00 LEVODOPA WITH BENSERAZIDE F Tab dispersible 50 mg with benserazide 12.5 mg .............................10.00 F F F F Cap 50 mg with benserazide 12.5 mg ................................................8.00 Cap 100 mg with benserazide 25 mg ...............................................12.50 Cap long-acting 100 mg with benserazide 25 mg ............................17.00 Cap 200 mg with benserazide 50 mg ...............................................25.00 60 5 5 100 100

Symmetrel APO-go S29 Mayne AlphaBromocriptine

AlphaBromocriptine

100 100 100 100 100 100 50 100 100 100 30 100 100

Comtan Madopar

Dispersible

Madopar 62.5 Madopar 125 Madopar HBS Madopar 250 Sindopa Sinemet Sinemet CR Sinemet Dopergin Permax Permax

LEVODOPA WITH CARBIDOPA F Tab 100 mg with carbidopa 25 mg ....................................................10.00 20.00 F Tab long-acting 200 mg with carbidopa 50 mg – Retail pharmacy-Specialist ...................................................................70.00 F Tab 250 mg with carbidopa 25 mg ....................................................57.50 LISURIDE HYDROGEN MALEATE L Tab 200 µg ........................................................................................27.50 PERGOLIDE – Retail pharmacy-Specialist L Tab 0.25 mg ......................................................................................48.00 L Tab 1 mg .........................................................................................170.00

116

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ROPINIROLE HYDROCHLORIDE – Retail pharmacy-Specialist L Tab 0.25 mg ......................................................................................31.50 L Tab 0.25 mg × 42, 0.5 mg × 42 and 1 mg × 21 ..............................35.70 L Tab 0.5 mg × 42, 1 mg × 42 and 2 mg × 63 .................................122.11 L Tab 1 mg ...........................................................................................67.20 L Tab 2 mg .........................................................................................101.21 L Tab 5 mg .........................................................................................150.00 SELEGILINE HYDROCHLORIDE F Tab 5 mg ...........................................................................................16.06 TOLCAPONE – Retail pharmacy-Specialist prescription Specialist must be a neurologist, geriatrician or general physician. L Tab 100 mg .....................................................................................128.75

210 105 OP 147 OP 84 84 84 100

Requip Requip Starter Pack Requip Follow-on

Pack

Requip Requip Requip Apo-Selegiline

100

Tasmar

Anticholinergics

BENZTROPINE MESYLATE Tab 2 mg .............................................................................................7.25 Inj 1 mg per ml, 2 ml .........................................................................36.35 a) Up to 5 inj available on a PSO b) Only on a PSO ORPHENADRINE HYDROCHLORIDE Tab 50 mg .........................................................................................31.93 PROCYCLIDINE HYDROCHLORIDE Tab 5 mg .............................................................................................7.40 60 5

Benztrop Cogentin

250 100

Disipal Kemadrin

Antipsychotics

Guidelines for the use of atypical antipsychotic 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 antipsychotic therapy, physicians should consider whether the patient is likely to respond to and/or tolerate conventional antipsychotic therapy and, where appropriate, trial one or more conventional agent prior to use of an atypical agent.

General

ARIPIPRAZOLE – Special Authority see SA0920 below – Retail pharmacy Tab 10 mg .......................................................................................123.54 Tab 15 mg .......................................................................................175.28 Tab 20 mg .......................................................................................213.42 Tab 30 mg .......................................................................................260.07 30 30 30 30

Abilify Abilify Abilify Abilify

¾SA0920 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient is suffering from schizophrenia or related psychoses; and 2 Either: 2.1 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of unacceptable side effects; or continued. . .

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

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

117

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 2.2 An effective dose of risperidone or quetiapine has been trialled and has been discontinued, or is in the process of being discontinued, because of inadequate clinical response. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. CHLORPROMAZINE HYDROCHLORIDE Tab 10 mg – Up to 30 tab available on a PSO..................................12.36 100 Largactil Tab 25 mg – Up to 30 tab available on a PSO..................................13.02 100 Largactil Tab 100 mg – Up to 30 tab available on a PSO................................30.61 100 Largactil Inj 25 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................25.66 10 Largactil CLOZAPINE – Hospital pharmacy [HP4]-Specialist prescription Tab 25 mg .........................................................................................17.60 Tab 50 mg .........................................................................................22.80 Tab 100 mg .......................................................................................45.60 Tab 200 mg .......................................................................................72.96 HALOPERIDOL Tab 500 µg – Up to 30 tab available on a PSO...................................4.93 Tab 1.5 mg – Up to 30 tab available on a PSO...................................7.45 Tab 5 mg – Up to 30 tab available on a PSO....................................23.49 Oral liq 2 mg per ml – Up to 200 ml available on a PSO ..................18.06 Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO .....................17.04 LITHIUM CARBONATE Tab 250 mg .......................................................................................25.45 Tab 400 mg .........................................................................................9.17 Tab long-acting 400 mg ....................................................................16.05 Cap 250 mg ........................................................................................7.22 METHOTRIMEPRAZINE Tab 25 mg .........................................................................................16.93 Tab 100 mg .......................................................................................43.96 Inj 25 mg per ml, 1 ml .......................................................................73.68 OLANZAPINE – Special Authority see SA0741 below – Retail pharmacy Tab 2.5 mg ........................................................................................51.07 Tab 5 mg .........................................................................................101.21 Tab 10 mg .......................................................................................204.49 50 50 50 50 100 100 100 100 ml 10 500 100 100 100 100 100 10 28 28 28

Clopine Clozaril Clopine Clopine Clozaril Clopine Serenace Serenace Serenace Serenace Serenace Lithicarb Lithicarb Priadel Douglas Nozinan Nozinan Nozinan Zyprexa Zyprexa Zyprexa

¾SA0741 Special Authority for Subsidy Initial application only from a psychiatrist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 Patient presents with ﬁrst episode schizophrenia or related psychoses; or 2 Both: 2.1 Patient suffering from schizophrenia and related psychoses or acute mania in bipolar disorder who is likely to beneﬁt from antipsychotic 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 continued. . .

118

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 2.2.2 An effective dose of risperidone had been trialled and has been discontinued because of inadequate clinical response after 4 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 2 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 ........................................................................................12.49 100 Neulactil Tab 10 mg .........................................................................................44.45 100 Neulactil QUETIAPINE Tab 25 mg .........................................................................................20.62 46.20 Tab 100 mg .......................................................................................41.25 92.40 Tab 200 mg .......................................................................................70.88 158.76 Tab 300 mg .....................................................................................119.25 267.12 RISPERIDONE Tab 0.5 mg ..........................................................................................5.20 Tab 1 mg ...........................................................................................30.77 Tab 2 mg ...........................................................................................61.53 Tab 3 mg ...........................................................................................92.32 Tab 4 mg .........................................................................................123.05 Oral liquid 1 mg per ml .....................................................................45.92 TRIFLUOPERAZINE HYDROCHLORIDE Tab 1 mg .............................................................................................9.83 (10.22) Tab 2 mg ...........................................................................................13.63 (15.61) Tab 5 mg ...........................................................................................15.79 (17.77) 90 60 90 60 90 60 90 60 20 60 60 60 60 30 ml 100 Stelazine S29 100 Stelazine S29 100 Stelazine S29

Quetapel Seroquel Quetapel Seroquel Quetapel Seroquel Quetapel Seroquel Ridal Risperdal Ridal Risperdal Ridal Risperdal Ridal Risperdal Ridal Risperdal Risperdal

ZIPRASIDONE – Subsidy by endorsement Ziprasidone is subsidised for patients suffering from schizophrenia or related psychoses after a trial of an effective dose of risperidone or quetiapine that has been discontinued, or is in the process of being discontinued, because of unacceptable side effects or inadequate response, and the prescription is endorsed accordingly. Cap 20 mg ........................................................................................87.88 60 Zeldox Cap 40 mg ......................................................................................164.78 60 Zeldox Cap 60 mg ......................................................................................247.17 60 Zeldox Cap 80 mg ......................................................................................329.56 60 Zeldox

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

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

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Depot Injections

FLUPENTHIXOL DECANOATE Inj 20 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................13.14 Inj 20 mg per ml, 2 ml – Up to 5 inj available on a PSO ...................20.90 Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO .................40.87 FLUPHENAZINE DECANOATE Inj 12.5 mg per 0.5 ml, 0.5 ml – Up to 5 inj available on a PSO .........17.60 Inj 25 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................27.90 Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO ...............154.50 HALOPERIDOL DECANOATE Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO ...................28.39 Inj 100 mg per ml, 1 ml – Up to 5 inj available on a PSO .................55.90 PIPOTHIAZINE PALMITATE Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .................178.48 Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .................353.32 RISPERIDONE – Special Authority see SA0926 below – 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 5 10 10 1 1 1

Fluanxol Fluanxol Fluanxol Modecate Modecate Modecate Haldol Haldol Concentrate Piportil Piportil Risperdal Consta Risperdal Consta Risperdal Consta

¾SA0926 Special Authority for Subsidy Initial application from any relevant practitioner. 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 antipsychotic 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 from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had less than 12 months treatment with risperidone microspheres; and 1.2 There is no clinical reason to discontinue treatment; or 2 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 antipsychotic medication). In some cases, it may be clinically appropriate to attempt to treat a patient with typical antipsychotic agents in depot injectable form before trialing risperidone microspheres. ZUCLOPENTHIXOL DECANOATE Inj 200 mg per ml, 1 ml – Up to 5 inj available on a PSO .................19.80 5 Clopixol

Orodispersible Antipsychotics

OLANZAPINE – Special Authority see SA0739 on the next page – Retail pharmacy Wafer 5 mg .....................................................................................102.19 Wafer 10 mg ...................................................................................204.37 28 28

Zyprexa Zydis Zyprexa Zydis

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NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0739 Special Authority for Subsidy 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: 1 The patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; and 2 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 see SA0927 below – Retail pharmacy Orally-disintegrating tablets 0.5 mg ..................................................21.42 28 Risperdal Quicklet Orally-disintegrating tablets 1 mg .....................................................42.84 28 Risperdal Quicklet Orally-disintegrating tablets 2 mg .....................................................85.71 28 Risperdal Quicklet ¾SA0927 Special Authority for Subsidy Initial application — (Acute situations) from any relevant practitioner. 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) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 2 The patient is under direct supervision for administration of medicine. Renewal from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is unable to take standard risperidone tablets or oral liquid, or once stabilized refuses to take risperidone tablets or oral liquid; and 2 The patient is under direct supervision for administration of medicine. Note: Risperdal Quicklets cost signiﬁcantly more than Risperdal Tablets and should only be used where necessary.

Anxiolytics

ALPRAZOLAM – Month Restriction Tab 250 µg ..........................................................................................3.25 50 Arrow-Alprazolam ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 500 µg ..........................................................................................4.30 50 Arrow-Alprazolam ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 1 mg .............................................................................................7.85 50 Arrow-Alprazolam ‡ Safety cap for extemporaneously compounded oral liquid preparations. BUSPIRONE HYDROCHLORIDE – Special Authority see SA0863 on the next page – Retail pharmacy Month Restriction Tab 5 mg ...........................................................................................28.00 100 Paciﬁc Buspirone Tab 10 mg .........................................................................................17.00 100 Paciﬁc Buspirone

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

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

121

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0863 Special Authority for Subsidy Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment. DIAZEPAM Tab 2 mg – Month Restriction.............................................................8.40 500 Pro-Pam ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 5 mg – Month Restriction.............................................................5.00 250 Pro-Pam ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 10 mg – Month Restriction...........................................................3.45 100 Pro-Pam ‡ Safety cap for extemporaneously compounded oral liquid preparations. LORAZEPAM – Month Restriction Tab 1 mg .............................................................................................6.28 250 Ativan ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 2.5 mg ..........................................................................................4.12 100 Ativan ‡ Safety cap for extemporaneously compounded oral liquid preparations. OXAZEPAM – Month Restriction Tab 10 mg ...........................................................................................1.98 100 (5.50) Ox-Pam ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 15 mg ...........................................................................................2.45 100 (7.60) Ox-Pam ‡ Safety cap for extemporaneously compounded oral liquid preparations.

Multiple Sclerosis Treatments

¾SA0855 Special Authority for Subsidy Special Authority approved by the Multiple Sclerosis Treatment Committee Notes: Budget managed by appointed clinicians on the Multiple Sclerosis Treatment Assessments Committee (MSTAC). Applications will be considered by MSTAC at its regular meetings and approved subject to eligibility according to the Entry and Stopping criteria (below). Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The coordinator Phone: 04 460 4990 Multiple Sclerosis Treatment Assessment Committee Facsimile: 04 916 7571 PHARMAC PO Box 10 254 Email: mstaccoordinator@pharmac.govt.nz Wellington Completed application forms must be sent to the coordinator for MSTAC and will be considered by MSTAC at the next practicable opportunity. Notiﬁcation of MSTAC’s decision will be sent to the patient, the applying clinician and the patient’s GP (if speciﬁed). 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. Prescribers must send quarterly prescriptions for approved patients to the MSTAC coordinator. 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, or 20 mg glatiramer acetate daily will be subsidised. Appeals against MSTAC’s decision and/or the processing of any application may be lodged with the MSTAC coordinator. Concerns that cannot be or have not been adequately addressed by MSTAC will be forwarded to a separate Appeal Committee if necessary. continued. . .

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . Switching between treatments is permitted within the 12 month approval period without reapproval by MSTAC. The MSTAC coordinator should be notiﬁed of the change and a new prescription provided. Entry Criteria 1) 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 2) patients must have active relapsing MS (conﬁrmed by MR scan where necessary) with or without underlying progression; and 3) patients must have either: a) EDSS score 2.5 - 5.5 with 2+ relapses: G experienced at least 2 signiﬁcant relapses of MS in the previous 12 months, and G an EDSS score of between 2.5 and 5.5 inclusive; or b) EDSS score 2.0 with 3+ relapses: G experienced at least 3 signiﬁcant relapses of MS in the previous 12 months, and G an EDSS score of 2.0; and 4) Each relapse must: a) 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); b) be associated with characteristic new symptom(s)/sign(s) or substantial worsening of previously experienced symptom(s)/sign(s); c) last at least one week; d) follow a period of stability of at least one month; e) be severe enough to change either the EDSS or at least one of the Kurtzke functional systems scores by at least 1 point; f) be distinguishable from the effects of general fatigue; and g) not be associated with a fever (T>37.5◦ C); and 5) applications must be made at least four weeks after the date of the onset of the last known relapse; and 6) patients must have no previous history of lack of response to beta-interferon or glatiramer acetate (see criteria for stopping). 7) applications must be submitted to the Multiple Sclerosis Treatment Assessment Committee (MSTAC) by the patient’s neurologist or a general physician; and 8) 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 9) 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 1) 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 2) stable or increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment); or 3) pregnancy and/or lactation; or 4) within the 12 month approval year, intolerance to interferon beta-1-alpha, and/or interferon beta-1-beta and/or glatiramer acetate; or 5) 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 6) 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. GLATIRAMER ACETATE – Special Authority see SA0855 on the preceding page Inj 20 mg pre-ﬁlled syringe ..........................................................1,089.25 28 Copaxone

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

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

123

NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

INTERFERON BETA-1-ALPHA – Special Authority see SA0855 on page 122 Inj 6 million iu preﬁlled syringe ....................................................1,245.13 Inj 6 million iu per vial ..................................................................1,245.13 INTERFERON BETA-1-BETA – Special Authority see SA0855 on page 122 Inj 8 million iu per 1 ml .................................................................1,378.71

4 4 15

Avonex Avonex Betaferon

Sedatives and Hypnotics

LORMETAZEPAM – Month Restriction Tab 1 mg .............................................................................................3.11 (23.50) ‡ Safety cap for extemporaneously compounded oral liquid preparations. MIDAZOLAM Tab 7.5 mg – Month Restriction........................................................10.38 (25.00) ‡ Safety cap for extemporaneously compounded oral liquid preparations. Inj 1 mg per ml, 5 ml .........................................................................12.65 (14.73) Inj 5 mg per ml, 3 ml .........................................................................14.00 (19.64) NITRAZEPAM – Month Restriction Tab 5 mg ............................................................................................2.00 (3.90) (4.65) ‡ Safety cap for extemporaneously compounded oral liquid preparations. (Insoma Tab 5 mg to be delisted 1 March 2009) TEMAZEPAM – Month Restriction Tab 10 mg ...........................................................................................0.83 ‡ Safety cap for extemporaneously compounded oral liquid preparations. TRIAZOLAM – Month Restriction Tab 125 µg ..........................................................................................5.10 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 250 µg ..........................................................................................4.10 ‡ Safety cap for extemporaneously compounded oral liquid preparations. ZOPICLONE – Month Restriction Tab 7.5 mg ........................................................................................22.13 30 Noctamid

100 Hypnovel 10 5

Hypnovel

Pﬁzer

Hypnovel

Pﬁzer

100 Insoma Nitrados

Normison

100 100

Hypam Hypam

500

Apo-Zopiclone

Other CNS Agents

DEXAMPHETAMINE SULPHATE – Special Authority see SA0907 below – Retail pharmacy Only on a controlled drug form Tab 5 mg ...........................................................................................17.00 100

PSM

¾SA0907 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over – new patients) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant 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: continued. . .

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NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients 5 or over - patient has had an approval for dexamphetamine for ADHD prior to 1 April 2008) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients under 5 – new patients) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deﬁcit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (ADHD in patients under 5 - patient has had an approval for dexamphetamine for ADHD in patients under 5 prior to 1 April 2008) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Initial application — (Narcolepsy – new patients) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Initial application — (Narcolepsy - patient has had an approval for dexamphetamine for narcolepsy prior to 1 April 2008) 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 medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Note: If the patient had an approval for dexamphetamine for ADHD prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone HealthPAC on 0800 243 666 for clariﬁcation if needed. 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. Note: If the patient had an approval for dexamphetamine for ADHD in patients under 5 prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone HealthPAC on 0800 243 666 for clariﬁcation if needed. 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. Note: If the patient had an approval for dexamphetamine for narcolepsy prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone HealthPAC on 0800 243 666 for clariﬁcation if needed.

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once LThree months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

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NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

DISULFIRAM Tab 200 mg .......................................................................................24.30

100

Antabuse

METHYLPHENIDATE HYDROCHLORIDE – Special Authority see SA0908 below – Retail pharmacy Only on a controlled drug form Tab immediate-release 5 mg ..............................................................3.20 30 Rubifen Tab immediate-release 10 mg ............................................................4.29 30 Rubifen Tab immediate-release 20 mg ............................................................7.85 30 Rubifen Tab sustained-release 20 mg ...........................................................10.95 30 Rubifen SR ¾SA0908 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over – new patients) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant 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 paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients 5 or over - patient has had an approval for methylphenidate for ADHD prior to 1 April 2008) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients under 5 – new patients) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deﬁcit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (ADHD in patients under 5 - patient has had an approval for methylphenidate for ADHD in patients under 5 prior to 1 April 2008) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is beneﬁting from treatment. Initial application — (Narcolepsy – new patients) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Initial application — (Narcolepsy - patient has had an approval for methylphenidate for narcolepsy prior to 1 April 2008) 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 medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: continued. . .

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NERVOUS SYSTEM

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Note: If the patient had an approval for methylphenidate for ADHD prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone HealthPAC on 0800 243 666 for clariﬁcation if needed. 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. Note: If the patient had an approval for methylphenidate for ADHD in patients under 5 prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone HealthPAC on 0800 243 666 for clariﬁcation if needed. 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. Note: If the patient had an approval for methylphenidate for narcolepsy prior to 1 April 2008 the applicant is required to submit a fresh initial application in the ﬁrst instance, not a renewal application. Please phone HealthPAC on 0800 243 666 for clariﬁcation if needed. METHYLPHENIDATE HYDROCHLORIDE EXTENDED RELEASE – Special Authority see SA0924 below – Retail pharmacy Only on a controlled drug form Tab extended-release 18 mg ............................................................58.96 30 Concerta Tab extended-release 27 mg ............................................................65.44 30 Concerta Tab extended-release 36 mg ............................................................71.93 30 Concerta Tab extended-release 54 mg ............................................................86.24 30 Concerta ¾SA0924 Special Authority for Subsidy Initial application only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deﬁcit and Hyperactivity Disorder); and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist; and 4 Either: 4.1 Patient is taking a currently subsidised formulation of methylphenidate hydrochloride (immediate-release or sustainedrelease) which has not been effective due to signiﬁcant administration and/or compliance difﬁculties; or 4.2 There is signiﬁcant concern regarding the risk of diversion or abuse of immediate-release methylphenidate hydrochloride. Renewal only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is beneﬁting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: continued. . .

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

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

127

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 2.2.1 Applicant is a medical practitioner and conﬁrms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. NALTREXONE HYDROCHLORIDE – Special Authority see SA0909 below – Retail pharmacy Tab 50 mg .......................................................................................180.00 30 ReVia ¾SA0909 Special Authority for Subsidy Initial application from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Patient is currently enrolled in a recognised comprehensive treatment programme for alcohol dependence; and 2 Applicant works in a community Alcohol and Drug Service contracted to one of the 21 District Health Boards or accredited against the New Zealand Alcohol and Other Drug Sector Standard or the National Mental Health Sector Standard. Renewal from any medical practitioner. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 Compliance with the medication (prescriber determined); and 2 Any of the following: 2.1 Patient is still unstable and requires further treatment; or 2.2 Patient achieved signiﬁcant improvement but requires further treatment; or 2.3 Patient is well controlled but requires maintenance therapy. The patient may not have had more than 1 prior approval in the last 12 months. TETRABENAZINE Tab 25 mg .......................................................................................243.00 112 Xenazine 25

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S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Chemotherapeutic Agents Alkylating Agents

BUSULPHAN – PCT – Retail pharmacy-Specialist Tab 2 mg ...........................................................................................47.89 CARBOPLATIN – PCT only – Specialist Inj 10 mg per ml, 5 ml .......................................................................12.00 Inj 10 mg per ml, 15 ml .....................................................................18.70 Inj 10 mg per ml, 45 ml .....................................................................55.50 Inj 10 mg per ml, 100 ml .................................................................135.65 Inj 1 mg for ECP .................................................................................0.13 CARMUSTINE – PCT only – Specialist Inj 100 mg .......................................................................................204.13 Inj 100 mg for ECP .........................................................................204.13 CHLORAMBUCIL – PCT – Retail pharmacy-Specialist Tab 2 mg ...........................................................................................22.35 CISPLATIN – PCT only – Specialist Inj 1 mg per ml, 50 ml .......................................................................19.00 Inj 1 mg per ml, 100 ml .....................................................................38.00 Inj 1 mg for ECP .................................................................................0.46 CYCLOPHOSPHAMIDE Tab 50 mg – PCT – Retail pharmacy-Specialist..............................25.71 Inj 1 g – PCT – Retail pharmacy-Specialist.....................................21.51 127.80 Inj 2 g – PCT only – Specialist.........................................................43.00 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.02 IFOSFAMIDE – PCT only – Specialist Inj 1 g ................................................................................................87.26 Inj 2 g ..............................................................................................162.80 Inj 1 mg for ECP .................................................................................0.09 LOMUSTINE – PCT only – Specialist Cap 10 mg ......................................................................................132.59 Cap 40 mg ......................................................................................399.15 MELPHALAN Tab 2 mg – PCT – Retail pharmacy-Specialist................................31.31 Inj 50 mg – PCT only – Specialist....................................................52.15 100 1 1 1 1 1 mg 1 100 mg OP 25 1 1 1 mg 50 1 6 1 1 mg 1 1 1 mg 20 20 25 1

Myleran Carboplatin Ebewe Carboplatin Ebewe Carboplatin Ebewe Carboplatin Ebewe Baxter BiCNU Baxter Leukeran FC Cisplatin Ebewe Mayne Cisplatin Ebewe Mayne Baxter Cycloblastin Endoxan Cytoxan Endoxan Baxter Holoxan Holoxan Baxter CeeNU CeeNU Alkeran Alkeran Eloxatin Eloxatin Baxter

OXALIPLATIN – PCT only – Specialist – Special Authority see SA0900 on the next page Inj 50 mg .........................................................................................410.00 1 Inj 100 mg .......................................................................................800.00 1 Inj 1 mg for ECP .................................................................................8.74 1 mg

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

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

129

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0900 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has metastatic colorectal cancer; and 1.2 To be used for ﬁrst or second line use as part of a combination chemotherapy regimen; or 2 Both: 2.1 The patient has stage III (Duke’s C) colorectal* cancer; and 2.2 Adjuvant oxaliplatin to be given in combination with a ﬂuoropyrimidine (ﬂuorouracil or capecitabine). Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. Note: Indications marked with * are Unapproved Indications, oxaliplatin is indicated for adjuvant treatment of stage III (Duke’s C) colon cancer after complete resection of the primary tumour.

Antimetabolites

CALCIUM FOLINATE Tab 15 mg – PCT – Hospital pharmacy [HP3]-Specialist ................63.89 Inj 3 mg per ml, 1 ml – PCT – Hospital pharmacy [HP1]Specialist ....................................................................................17.10 Inj 50 mg – PCT – Hospital pharmacy [HP1]-Specialist ..................24.50 Inj 100 mg – PCT only – Specialist..................................................15.00 Inj 300 mg – PCT only – Specialist..................................................45.00 Inj 1 g – PCT only – Specialist.......................................................152.00 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.10 10 5 5 1 1 1 1 mg

Mayne Mayne Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Calcium Folinate

Ebewe

Baxter Xeloda Xeloda

CAPECITABINE – Hospital pharmacy [HP1]-Specialist – Special Authority see SA0869 below Tab 150 mg .....................................................................................115.00 60 Tab 500 mg .....................................................................................705.00 120

¾SA0869 Special Authority for Subsidy 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 The patient has stage III (Duke’s stage C) colorectal*# cancer and undergone surgery; or 4 Both: 4.1 The patient has poor venous access or needle phobia*; and 4.2 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: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. Note: Indications marked with * are Unapproved Indications, # capecitabine is approved for stage III (Duke’s stage C) colon cancer.

130

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

CLADRIBINE – PCT only – Specialist Inj 2 mg per ml, 5 ml .......................................................................873.00 Inj 1 mg per ml, 10 ml ..................................................................5,249.72 Inj 10 mg for ECP ...........................................................................749.96 CYTARABINE Inj 100 mg – PCT – Retail pharmacy-Specialist..............................80.00 Inj 100 mg per ml, 5 ml – PCT – Retail pharmacy-Specialist ..........95.36 Inj 100 mg per ml, 10 ml – PCT – Retail pharmacy-Specialist .........42.65 Inj 100 mg per ml, 20 ml – PCT only – Specialist............................34.47 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.03 Inj 100 mg intrathecal syringe for ECP – PCT only – Specialist .........16.00 FLUDARABINE PHOSPHATE – PCT only – Specialist Tab 10 mg .......................................................................................650.25 Inj 50 mg ......................................................................................1,430.00 Inj 50 mg for ECP ...........................................................................299.25 FLUOROURACIL SODIUM Inj 50 mg per ml, 10 ml – PCT only – Specialist................................4.95 Inj 500 mg per 20 ml – PCT – Retail pharmacy-Specialist..............55.60 Inj 50 mg per ml, 20 ml – PCT only – Specialist................................8.60 Inj 25 mg per ml, 100 ml – PCT only – Specialist............................13.55 Inj 50 mg per ml, 50 ml – PCT only – Specialist..............................21.50 Inj 50 mg per ml, 100 ml – PCT only – Specialist............................43.00 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.01

1 7 10 mg OP 5 5 1 1 1 mg 100 mg OP 15 5 50 mg OP 1 10 1 1 1 1 1 mg

Litak S29 Leustatin Baxter Mayne Pharmacia Mayne Mayne Mayne Baxter Baxter Fludara Fludara Baxter Fluorouracil Ebewe Mayne Fluorouracil Ebewe Mayne Fluorouracil Ebewe Fluorouracil Ebewe Baxter

GEMCITABINE HYDROCHLORIDE – PCT only – Specialist – Special Authority see SA0877 below Inj 1 g ..............................................................................................349.20 1 Gemzar Inj 200 mg .........................................................................................78.00 1 Gemzar Inj 1 mg for ECP .................................................................................0.38 1 mg Baxter ¾SA0877 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of 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 IIIa, 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*; or 5 The patient has advanced transitional cell carcinoma of the urothelial tract (locally advanced or metastatic). Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. Note: Indications marked with a * are Unapproved Indications. IRINOTECAN – PCT only – Specialist – Special Authority see SA0878 on the next page Inj 20 mg per ml, 2 ml .....................................................................124.00 1 Camptosar Inj 20 mg per ml, 5 ml .....................................................................310.00 1 Camptosar Inj 1 mg for ECP .................................................................................3.19 1 mg Baxter

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

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

131

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0878 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of 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 or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment. MERCAPTOPURINE – PCT – Retail pharmacy-Specialist Tab 50 mg .........................................................................................47.06 25 Purinethol METHOTREXATE F Tab 2.5 mg – PCT – Hospital pharmacy [HP3]-Specialist .................5.80 F Tab 10 mg – PCT – Hospital pharmacy [HP3]-Specialist ................40.93 F Inj 2.5 mg per ml, 2 ml – PCT – Hospital pharmacy [HP1]Specialist ....................................................................................23.65 F Inj 25 mg per ml, 2 ml – PCT – Hospital pharmacy [HP1]Specialist ....................................................................................46.10 F Inj 100 mg per ml, 5 ml – PCT – Hospital pharmacy [HP1]Specialist ....................................................................................18.00 F Inj 25 mg per ml, 20 ml – PCT – Hospital pharmacy [HP1]Specialist ....................................................................................80.25 F Inj 100 mg per ml, 10 ml – PCT – Hospital pharmacy [HP1]Specialist ....................................................................................27.50 F Inj 100 mg per ml, 50 ml – PCT – Hospital pharmacy [HP1]Specialist .................................................................................. 135.00 F Inj 1 mg for ECP – PCT only – Specialist ..........................................0.10 F Inj 5 mg intrathecal syringe for ECP – PCT only – Specialist............4.73 (Methotrexate Ebewe Inj 100 mg per ml, 5 ml to be delisted 1 February 2009) THIOGUANINE – PCT – Hospital pharmacy [HP3]-Specialist Tab 40 mg .........................................................................................97.16 30 50 5 5 1 1 1 1 1 mg 5 mg OP

Methoblastin Methoblastin Mayne Mayne Methotrexate Ebewe Mayne Methotrexate Ebewe Methotrexate Ebewe Baxter Baxter

Lanvis

Other Cytotoxic Agents

ANAGRELIDE HYDROCHLORIDE – PCT only – Specialist – Special Authority see SA0879 on the next page Cap 0.5 mg .......................................................................................CBS 100 Agrylin S29

132

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0879 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of 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 or medical practitioner on the recommendation of 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 ......................................................................................2,475.55 10 AFT S29 BLEOMYCIN SULPHATE – PCT only – Specialist Inj 15,000 iu ....................................................................................680.00 Inj 1,000 iu for ECP ............................................................................5.26 COLASPASE (L-ASPARAGINASE) – PCT only – Specialist Inj 10,000 iu ....................................................................................102.32 Inj 10,000 iu for ECP ......................................................................102.32 DACARBAZINE – PCT only – Specialist Inj 200 mg .........................................................................................43.86 Inj 200 mg for ECP ...........................................................................43.86 DACTINOMYCIN (ACTINOMYCIN D) – PCT only – Specialist Inj 0.5 mg ..........................................................................................13.52 Inj 0.5 mg for ECP ............................................................................13.52 DAUNORUBICIN – PCT only – Specialist Inj 5 mg per ml, 4 ml .........................................................................99.00 Inj 20 mg for ECP .............................................................................99.00 DOCETAXEL – PCT only – Specialist – Special Authority see SA0880 below Inj 20 mg .........................................................................................460.00 Inj 80 mg ......................................................................................1,650.00 Inj 1 mg for ECP ...............................................................................23.81 10 1,000 iu 1 10,000 iu OP 1 200 mg OP 1 0.5 mg OP 1 20 mg OP 1 1 1 mg

Blenoxane Baxter Leunase Baxter Mayne Baxter Cosmegen Baxter Mayne Baxter Taxotere Taxotere Baxter

¾SA0880 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of 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 early breast cancer; and 3.2 Docetaxel is to be given concurrently with trastuzumab; or 4 Both: 4.1 The patient has non small-cell lung cancer; and continued. . .

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

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

133

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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 Docetaxel is to be used as second-line therapy. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic breast cancer, non small-cell lung cancer, or small-cell lung cancer*; and 2 Either: 2.1 The patient requires continued therapy; or 2.2 The tumour has relapsed and requires re-treatment. Note: indications marked with * are Unapproved Indications. DOXORUBICIN – PCT only – Specialist Inj 10 mg .............................................................................................8.80 1 Doxorubicin Ebewe Inj 50 mg ...........................................................................................39.40 1 Doxorubicin Ebewe Inj 100 mg .........................................................................................81.00 1 Doxorubicin Ebewe Inj 200 mg .......................................................................................162.00 1 Doxorubicin Ebewe Inj 1 mg for ECP .................................................................................0.87 1 mg Baxter EPIRUBICIN – PCT only – Specialist Inj 2 mg per ml, 5 ml .........................................................................24.70 Inj 2 mg per ml, 25 ml .....................................................................123.50 Inj 2 mg per ml, 50 ml .....................................................................247.00 Inj 2 mg per ml, 100 ml ...................................................................494.00 Inj 1 mg for ECP .................................................................................2.74 ETOPOSIDE Cap 50 mg – PCT – Hospital pharmacy [HP3]-Specialist .............340.73 Cap 100 mg – PCT – Hospital pharmacy [HP3]-Specialist ...........340.73 Inj 20 mg per ml, 5 ml – PCT – Hospital pharmacy [HP1]Specialist ....................................................................................25.00 612.20 Inj 1 mg for ECP – PCT only – Specialist ..........................................0.30 ETOPOSIDE PHOSPHATE – PCT only – Specialist Inj 100 mg (of etoposide base) .........................................................40.00 Inj 1 mg (of etoposide base) for ECP .................................................0.47 HYDROXYUREA – PCT – Retail pharmacy-Specialist 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 ...............................................................................37.74 1 1 1 1 1 mg 20 10 1 10 1 mg 1 1 mg 100 1 1 1 1 1 mg

Epirubicin Ebewe Epirubicin Ebewe Epirubicin Ebewe Epirubicin Ebewe Baxter Vepesid Vepesid Mayne Vepesid Baxter Etopophos Baxter Hydrea Zavedos Zavedos Zavedos Zavedos Baxter

134

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S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

MESNA – PCT only – Specialist Tab 400 mg .....................................................................................168.30 Tab 600 mg .....................................................................................251.35 Inj 100 mg per ml, 4 ml ...................................................................109.63 Inj 100 mg per ml, 10 ml .................................................................251.73 Inj 1 mg for ECP .................................................................................0.02 MITOMYCIN C – PCT only – Specialist Inj 2 mg ...........................................................................................283.00 Inj 10 mg .........................................................................................531.30 Inj 1 mg for ECP ...............................................................................11.85 MITOZANTRONE – PCT only – Specialist Inj 2 mg per ml, 5 ml .......................................................................110.00 Inj 2 mg per ml, 10ml ......................................................................220.00 Inj 2 mg per ml, 12.5 ml ..................................................................407.50 Inj 1 mg for ECP ...............................................................................12.43 PACLITAXEL – PCT only – Specialist Inj 30 mg ...........................................................................................37.95 Inj 100 mg .......................................................................................125.35 Inj 150 mg .......................................................................................188.03 Inj 300 mg .......................................................................................376.05 Inj 600 mg .......................................................................................724.50 Inj 1 mg for ECP .................................................................................1.32 PENTOSTATIN (DEOXYCOFORMYCIN) – PCT only – Specialist Inj 10 mg ...........................................................................................CBS PROCARBAZINE HYDROCHLORIDE – PCT only – Specialist Cap 50 mg ......................................................................................133.00 TEMOZOLOMIDE – Special Authority see SA0831 below – Hospital pharmacy [HP3] Cap 5 mg ..........................................................................................50.00 Cap 20 mg ......................................................................................170.00 Cap 100 mg ....................................................................................840.00 Cap 250 mg .................................................................................2,100.00

50 50 15 15 1 mg 10 5 1 mg 1 1 1 1 mg 1 1 1 1 1 1 mg 1 50 5 5 5 5

Uromitexan Uromitexan Uromitexan Uromitexan Baxter Mitomycin-C S29 Mitomycin-C S29 Baxter Mitozantrone Ebewe Mitozantrone Ebewe Onkotrone Baxter Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Paclitaxel Ebewe Baxter Nipent S29 Natulan S29 Temodal Temodal Temodal Temodal

¾SA0831 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 10 months for applications meeting the following criteria: All of the following: 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 . Notes: 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 10 Vumon Inj 50 mg for ECP .............................................................................84.51 50 mg OP Baxter THALIDOMIDE – PCT only – Specialist – Special Authority see SA0882 on the next page Only on a controlled drug form Cap 50 mg ......................................................................................490.00 28

Thalidomide

Pharmion

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

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

135

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0882 Special Authority for Subsidy Initial application — (for new patients) only from a relevant specialist or medical practitioner on the recommendation of 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 or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notiﬁed where the patient was receiving treatment with thalidomide for multiple myeloma on or before 31 December 2005. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notiﬁed where the patient has obtained a response from treatment during the initial approval period. Notes: Prescription must be written by a 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 VINBLASTINE SULPHATE Inj 10 mg – PCT – Retail pharmacy-Specialist..............................137.50 Inj 1 mg for ECP – PCT only – Specialist ..........................................3.05 VINCRISTINE SULPHATE Inj 1 mg per ml, 1 ml – PCT – Retail pharmacy-Specialist ..............99.00 Inj 1 mg per ml, 2 ml – PCT – Retail pharmacy-Specialist ............199.00 Inj 1 mg for ECP – PCT only – Specialist ........................................21.46 VINORELBINE – PCT only – Specialist – Special Authority see SA0901 below Inj 10 mg per ml, 1 ml .......................................................................42.00 Inj 10 mg per ml, 5 ml .....................................................................210.00 Inj 1 mg for ECP .................................................................................4.75 5 1 mg 5 5 1 mg 1 1 1 mg

Mayne Baxter Mayne Mayne Baxter Vinorelbine Ebewe Vinorelbine Ebewe Baxter

¾SA0901 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 The patient has metastatic breast cancer; or 2 The patient has non-small cell lung cancer (stage IIIa, or above); or 3 All of the following: 3.1 The patient has stage IB-IIIA non-small cell lung cancer; and 3.2 Vinorelbine is to be given as adjuvant treatment in combination with cisplatin; and 3.3 The patient has good performance status (WHO/ECOG grade 0-1). Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1 The patient requires continued therapy; or 2 The tumour has relapsed and requires re-treatment.

Protein-tyrosine Kinase Inhibitors

IMATINIB MESYLATE – Special Authority see SA0643 on the next page Tab 100 mg ..................................................................................2,400.00 60

Glivec

136

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0643 Special Authority for Subsidy Special Authority approved by the Glivec Co-ordinator Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz, and prescriptions should be sent to: The Glivec Co-ordinator Phone: (04) 460 4990 PHARMAC Facsimile: (04) 916 7571 PO Box 10 254 Email: mary.chesterﬁeld@pharmac.govt.nz 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 reapplication (after seven months) should provide details of the haematological response. The third reapplication should provide details of the cytogenetic response after 14-18 months from initiating therapy. All other reapplications 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: 1) complete haematologic response (as characterised by an absolute neutrophil count (ANC) > 1.5 × 109 /L, platelets > 100 × 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 2) no evidence of leukaemia (as characterised by an absolute neutrophil count (ANC) > 1.0 × 109 /L, platelets > 20 × 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 3) 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: 1) with a diagnosis (conﬁrmed by an oncologist) of unresectable and/or metastatic malignant gastrointestinal stromal tumour (GIST); and 2) 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

For GnRH ANALOGUES – refer to HORMONE PREPARATIONS, Trophic Hormones, page 83 ANASTROZOLE Tab 1 mg – Higher subsidy of $240.00 per 30 with Special Authority see SA0810 on the next page ................................... 146.46 30 (240.00)

Arimidex

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

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

137

ONCOLOGY AGENTS AND IMMUNOSUPPRESSANTS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

¾SA0810 Special Authority for Alternate Subsidy 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 women; 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. EXEMESTANE Tab 25 mg .......................................................................................175.00 30 Aromasin FLUTAMIDE – Hospital pharmacy [HP3]-Specialist Tab 250 mg .......................................................................................39.50 LETROZOLE Tab 2.5 mg – Higher subsidy of $200.00 per 30 with Special Authority see SA0811 below .................................................... 146.46 (200.00) 100

Flutamin

30 Femara

¾SA0811 Special Authority for Alternate Subsidy 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 women; 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. MEGESTROL ACETATE – Retail pharmacy-Specialist Tab 160 mg .......................................................................................74.25 30 Megace OCTREOTIDE (SOMATOSTATIN ANALOGUE) – Special Authority see SA0563 below – Hospital pharmacy [HP3] Inj 50 µg per ml, 1 ml ........................................................................43.50 5 Sandostatin Inj 100 µg per ml, 1 ml ......................................................................81.00 5 Sandostatin Inj 500 µg per ml, 1 ml ....................................................................399.00 5 Sandostatin LAR 10 mg pre-ﬁlled syringe .......................................................1,772.50 1 Sandostatin LAR LAR 20 mg pre-ﬁlled syringe .......................................................2,358.75 1 Sandostatin LAR LAR 30 mg pre-ﬁlled syringe .......................................................2,951.25 1 Sandostatin LAR ¾SA0563 Special Authority for Subsidy 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: continued. . .

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continued. . . 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 F Tab 10 mg ...........................................................................................9.00 100 Genox F Tab 20 mg ...........................................................................................9.25 100 Genox

Immunosuppressants Cytotoxic Immunosuppressants

AZATHIOPRINE – Retail pharmacy-Specialist F Tab 50 mg .........................................................................................25.00 (34.90) F Inj 50 mg ...........................................................................................46.33 (47.72) 100

Azamun Thioprine

Imuran Imuran

MYCOPHENOLATE MOFETIL – Special Authority see SA0893 below – Hospital pharmacy [HP3] Tab 500 mg .....................................................................................206.66 50 Cellcept Cap 250 mg ....................................................................................206.66 100 Cellcept Powder for oral liq 1 g per 5 ml – Subsidy by endorsement ............285.00 165 ml OP Cellcept Mycophenolate powder for oral liquid is subsidised only for patients unable to swallow tablets and capsules, and when the prescription is endorsed accordingly. ¾SA0893 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid without further renewal unless notiﬁed 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.

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

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

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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 1) Diagnosis G Anti-HCV positive on at least two occasions with a positive PCR for HCV-RNA and preferably conﬁrmed by a supplementary RIBA test; or G PCR-RNA positive for HCV on at least 2 occasions if antibody negative; or G 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. 2) Establishing Active Chronic Liver Disease G Conﬁrmed HCV infection and serum ALT/AST levels measured on at least three occasions over six months averaging > 1.5 × upper limit of normal. (ALT is the preferable enzyme); or G 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 1) Autoimmune liver disease. (Interferon may exacerbate autoimmune liver disease as well as other autoimmune diseases such as thyroid disease). 2) Pregnancy. 3) Neutropenia (<2.0 × 109 ) and/or thrombocytopenia. 4) Continuing alcohol abuse and/or continuing intravenous drug users. Dosage The current recommended dosage is 3 million units of interferon alpha-2a or interferon aplha-2b administered subcutaneously 3 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 See prescribing guideline above Inj 50 mg per ml, 5 ml ..................................................................2,137.50 5 ATGAM INTERFERON ALPHA-2A – PCT – Hospital pharmacy [HP3]-Specialist a) See prescribing guideline above b) Only one multidose cartridge starter pack to be prescribed and dispensed per patient. 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 × 2 starter pack .............................375.84 1

Roferon-A Roferon-A Roferon-A Roferon-A Roferon-A Roferon-A

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INTERFERON ALPHA-2A WITH RIBAVIRIN – Special Authority see SA0784 below – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Inj 18 m iu multidose cartridge × 2 with ribavirin tab 200 mg × 168 ....................................................................................1,375.84 1 OP Roferon RBV Combination Pack Inj 18 m iu multidose cartridge × 2 with with pen and needles with ribavirin tab 200 mg × 168 ............................................1,375.84 1 OP Roferon RBV Combination Pack Starter Kit ¾SA0784 Special Authority for Subsidy Initial application from any specialist. Approvals valid for 12 months where patient has chronic hepatitis C (all genotypes). INTERFERON ALPHA-2B – PCT – Hospital pharmacy [HP3]-Specialist See prescribing guideline on the preceding page Inj 18 m iu, 1.2 ml multidose pen ....................................................187.92 1 Intron-A Inj 30 m iu, 1.2 ml multidose pen ....................................................313.20 1 Intron-A Inj 60 m iu, 1.2 ml multidose pen ....................................................626.40 1 Intron-A PEGYLATED INTERFERON ALPHA-2A – Special Authority see SA0802 below – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Inj 135 µg preﬁlled syringe .............................................................362.00 1 Pegasys Inj 180 µg preﬁlled syringe .............................................................450.00 1 Pegasys Inj 135 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 112 .......................................................................................1,799.68 1 OP Pegasys RBV Combination Pack Inj 135 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 168 .......................................................................................1,975.00 1 OP Pegasys RBV Combination Pack Inj 180 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 112 .......................................................................................2,059.84 1 OP Pegasys RBV Combination Pack Inj 180 µg preﬁlled syringe × 4 with ribavirin tab 200 mg × 168 .......................................................................................2,190.00 1 OP Pegasys RBV Combination Pack ¾SA0802 Special Authority for Subsidy 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: 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: Both: 1 Patient has chronic hepatitis C, genotype 2 or 3 infection; and 2 Either: 2.1 Patient has bridging ﬁbrosis or cirrhosis (Metavir stage 3 or 4 or equivalent); or 2.2 is unsuitable for liver biopsy due to coagulopathy.

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

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

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PEGYLATED INTERFERON ALPHA-2B WITH RIBAVIRIN – Special Authority see SA0846 below – Hospital pharmacy [HP3] See prescribing guideline on page 140 Inj 50 µg × 4 with ribavirin cap 200 mg × 112 ............................1,080.40 1 OP Pegatron Combination Therapy Inj 50 µg × 4 with ribavirin cap 200 mg × 84 .................................976.80 1 OP Pegatron Combination Therapy Inj 80 µg × 4 with ribavirin cap 200 mg × 140 ............................1,583.60 1 OP Pegatron Combination Therapy Inj 80 µg × 4 with ribavirin cap 200 mg × 168 ............................1,687.20 1 OP Pegatron Combination Therapy Inj 80 µg × 4 with ribavirin cap 200 mg × 84 ..............................1,376.40 1 OP Pegatron Combination Therapy Inj 100 µg × 4 with ribavirin cap 200 mg × 112 ..........................1,746.40 1 OP Pegatron Combination Therapy Inj 100 µg × 4 with ribavirin cap 200 mg × 84 ............................1,642.80 1 OP Pegatron Combination Therapy Inj 120 µg × 4 with ribavirin cap 200 mg × 140 ..........................2,116.40 1 OP Pegatron Combination Therapy Inj 120 µg × 4 with ribavirin cap 200 mg × 84 ............................1,909.20 1 OP Pegatron Combination Therapy Inj 150 µg × 4 with ribavirin cap 200 mg × 140 ..........................2,516.00 1 OP Pegatron Combination Therapy Inj 150 µg × 4 with ribavirin cap 200 mg × 168 ..........................2,619.60 1 OP Pegatron Combination Therapy Inj 150 µg × 4 with ribavirin cap 200 mg × 84 ............................2,308.80 1 OP Pegatron Combination Therapy ¾SA0846 Special Authority for Subsidy 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 biopsy 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.

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RITUXIMAB – PCT only – Specialist – Special Authority see SA0884 below See prescribing guideline on page 140 Inj 100 mg per 10 ml vial .............................................................1,195.00 Inj 500 mg per 50 ml vial .............................................................2,987.00 Inj 1 mg for ECP .................................................................................6.27

2 1 1 mg

Mabthera Mabthera Baxter

¾SA0884 Special Authority for Subsidy Initial application — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 6 months where the patient has B-cell post-transplant lymphoproliferative disorder*. Note: For no more than 8 treatment cycles. Initial application — (Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of 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 or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has treatment naiive large B-cell NHL; and 2 To be used with CHOP (or alternative anthracycline containing multi-agent chemotherapy regimen given with curative intent). Note: For no more than 8 treatment cycles. Renewal — (Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 The patient has had a treatment-free interval of 6 months or more; and 2 Either: 2.1 Has B-cell post-transplant lymphoproliferative disorder*; or 2.2 Has low grade NHL – relapsed disease following prior chemotherapy. Notes: For no more than 4 treatment cycles for low grade NHL. Indications marked with * are Unapproved Indications. TRASTUZUMAB – PCT only – Specialist – Special Authority see SA0885 below See prescribing guideline on page 140 Inj 150 mg vial .............................................................................1,350.00 1 Herceptin Inj 440 mg vial .............................................................................3,875.00 1 Herceptin Inj 1 mg for ECP .................................................................................9.36 1 mg Baxter ¾SA0885 Special Authority for Subsidy Initial application — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months where the patient has metastatic breast cancer expressing HER-2 IHC 3+ or FISH+. Renewal — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic breast cancer; and 2 The cancer has not progressed. Initial application — (early breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 The patient has early breast cancer expressing HER 2 IHC 3+ or FISH +; and 2 Maximum cumulative dose of 20mg/kg (9 weeks treatment)*; and 3 Trastuzumab is to be given concurrently with adjuvant taxane chemotherapy*; and continued. . .

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

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

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continued. . . 4 Trastuzumab is not to be given concurrently with anthracycline chemotherapy. Notes: indications marked with * are Unapproved Indications. It is recommended that for early breast cancer trastuzumab be administered concurrently with docetaxel prior to anthracyclines as per the FinHer regimen (Joensuu H, Kellokumpu-Lehtinen P, Bono P, et al. Adjuvant docetaxel or vinorelbine with or without trastuzumab for breast cancer. N Engl J Med 2006;354(8):809-20).

Other Immunosuppressants

CYCLOSPORIN A – Special Authority see SA0470 below – Hospital pharmacy [HP3] Cap 25 mg ........................................................................................85.00 50 Cap 50 mg ......................................................................................169.34 50 Cap 100 mg ....................................................................................338.69 50 Oral liq 100 mg per ml ....................................................................377.38 50 ml OP

Neoral Neoral Neoral Neoral

¾SA0470 Special Authority for Subsidy 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: 1 Psoriasis; and 2 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: 1 Severe atopic dermatitis; and 2 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: 1 Nephrotic Syndrome; and 2 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: 1 Severe rheumatoid arthritis; and 2 The patient must be either unresponsive to or unable to tolerate, both sulphasalazine and methotrexate; and 3 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.

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Guidelines for use of cyclosporin A in rheumatoid arthritis Monitoring: All patients require frequent monitoring for creatinine levels and blood pressure: G fortnightly, in the ﬁrst three months of therapy and then monthly, if results are stable; G if dose is increased or there is a rise in serum creatinine or blood pressure, then more frequent monitoring is required. Contraindications: Cyclosporin A is contraindicated in patients with the following conditions: G current or past malignancy; G uncontrolled hypertension; G renal dysfunction (abnormal serum creatinine for age and sex); G immunodeﬁciency and neutropenia; G abnormally low white blood cell count or platelet count; or G liver function tests more than twice the upper limit of normal. Caution in use: G age above 65 years; G controlled hypertension; G use of anti-epileptic medications; G use of ketoconazole, ﬂuconazole, trimethoprim, erythromycin, verapamil, and diltiazem; G concurrent or previous use of alkylating agents such as cyclophosphamide; G use of any experimental drug within the past three months; G premalignant conditions such as leukoplakia, monoclonal paraproteinaemia, myelodysplastic syndrome and dysplastic naevi; G active infection may necessitate temporary discontinuation; G 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. SIROLIMUS – Special Authority see SA0866 below – Hospital pharmacy [HP3] Tab 1 mg .........................................................................................813.00 100 Rapamune Tab 2 mg ......................................................................................1,626.00 100 Rapamune Oral liq 1 mg per ml ........................................................................487.80 60 ml OP Rapamune ¾SA0866 Special Authority for Subsidy Initial application from any medical practitioner. Approvals valid without further renewal unless notiﬁed where the drug is to be used for rescue therapy for an organ transplant recipient. Notes: Rescue therapy deﬁned as unresponsive to calcineurin inhibitor treatment as deﬁned by refractory rejection; or intolerant to calcineurin inhibitor treatment due to any of the following: G GFR<30 ml/min; or G Rapidly progressive transplant vasculopathy; or G Rapidly progressive obstructive bronchiolitis; or G HUS or TTP; or G Leukoencepthalopathy; or G Signiﬁcant malignant disease TACROLIMUS – Special Authority see SA0669 below – Hospital pharmacy [HP3] Cap 0.5 mg .....................................................................................214.00 100 Prograf Cap 1 mg ........................................................................................428.00 100 Prograf Cap 5 mg .....................................................................................1,070.00 50 Prograf ¾SA0669 Special Authority for Subsidy 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 FThree months or six months, as applicable, dispensed all-at-once

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

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Antiallergy Preparations

BEE VENOM ALLERGY TREATMENT – Special Authority see SA0053 below – Hospital pharmacy [HP3] Maintenance kit - 6 vials 120 µg freeze dried venom, 6 diluent 1.8 ml ....................................................................................... 154.30 1 OP Albay Treatment kit - 1 vial 550 µg freeze dried venom, 1 diluent 9 ml, 3 diluent 1.8 ml ............................................................... 154.30 1 OP Albay ¾SA0053 Special Authority for Subsidy 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 see SA0053 below – Hospital pharmacy [HP3] 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 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 ¾SA0053 Special Authority for Subsidy 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 F Tab 1 mg .............................................................................................6.94 (16.90) CETIRIZINE HYDROCHLORIDE F Tab 10 mg ...........................................................................................3.32 F‡ Oral liq 1 mg per ml ............................................................................2.75 CHLORPHENIRAMINE MALEATE F‡ Oral liq 2 mg per 5 ml .........................................................................3.74 (7.26) CYPROHEPTADINE HYDROCHLORIDE F Tab 4 mg .............................................................................................6.27 DEXTROCHLORPHENIRAMINE MALEATE F Tab 2 mg .............................................................................................2.52 (9.99) F Tab long-acting 6 mg ..........................................................................5.40 (12.56) F‡ Oral liq 2 mg per 5 ml .........................................................................1.77 (10.29) 50 Zadine 90 100 ml OP 500 ml Histafen 100 50 Polaramine 40 Polaramine Repetab 100 ml Polaramine

Razene Allerid C

Periactin

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FEXOFENADINE HYDROCHLORIDE F Tab 60 mg ...........................................................................................4.34 (11.53) F Tab 120 mg .......................................................................................14.22 (29.81) KETOTIFEN F Oral liq 1 mg per 5 ml ........................................................................4.90 (5.90) (Asmafen Oral liq 1 mg per 5 ml to be delisted 1 February 2009) LORATADINE F Tab 10 mg ...........................................................................................3.58 F Oral liq 1 mg per ml ............................................................................3.65 PROMETHAZINE HYDROCHLORIDE F Tab 10 mg ...........................................................................................2.75 F Tab 25 mg ...........................................................................................4.50 F‡ Oral liq 5 mg per 5 ml .........................................................................3.53 (8.51) F Inj 25 mg per ml, 2 ml – Up to 5 inj available on a PSO .....................8.05 TRIMEPRAZINE TARTRATE ‡ Oral liq 30 mg per 5 ml .......................................................................2.79 (8.06)

20 Telfast 30 Telfast 200 ml Asmafen

100 100 ml 50 50 100 ml 5 100 ml OP

Loraclear Hayfever

Relief

Lorapaed Allersoothe Allersoothe

Phenergan

Mayne

Vallergan Forte

Inhaled Corticosteroids

BECLOMETHASONE DIPROPIONATE Aerosol inhaler, 50 µg per dose ..........................................................8.54 Aerosol inhaler, 100 µg per dose ......................................................12.50 Aerosol inhaler, 250 µg per dose ......................................................22.67 BUDESONIDE Powder for inhalation, 100 µg per dose ............................................17.00 Powder for inhalation, 200 µg per dose ............................................19.00 Powder for inhalation, 400 µg per dose ............................................32.00 FLUTICASONE Aerosol inhaler, 50 µg per dose CFC-free ..........................................7.50 Powder for inhalation, 50 µg per dose ................................................5.10 (8.67) Powder for inhalation, 100 µg per dose ..............................................7.50 (13.87) Aerosol inhaler, 125 µg per dose CFC-free ......................................13.60 Aerosol inhaler, 250 µg per dose CFC-free ......................................27.20 Powder for inhalation, 250 µg per dose ............................................13.60 (24.51) 200 dose OP 200 dose OP 200 dose OP 200 dose OP 200 dose OP 200 dose OP

Beclazone 50 Beclazone 100 Beclazone 250 Pulmicort

Turbuhaler

Pulmicort

Turbuhaler

Pulmicort

Turbuhaler

120 dose OP 60 dose OP 60 dose OP

Flixotide

Flixotide Accuhaler Flixotide Accuhaler

120 dose OP 120 dose OP 60 dose OP

Flixotide Flixotide

Flixotide Accuhaler

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

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

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Inhaled Long-acting Beta-adrenoceptor Agonists

Prescribing Guideline for Inhaled Long-Acting Beta-Adrenoceptor Agonists The addition of inhaled long-acting beta-adrenoceptor agonists (LABAs) to inhaled corticosteroids is recommended: G 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). G 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 Oxis Turbuhaler Powder for inhalation, 12 µg per dose, and monodose device .........35.80 60 dose Foradil SALMETEROL – See prescribing guideline above Aerosol inhaler CFC-free, 25 µg per dose ........................................26.46 Powder for inhalation, 50 µg per dose, breath activated ...................26.46 120 dose OP 60 dose OP

Serevent Serevent Accuhaler

Inhaled Corticosteroids with Long-Acting Beta-Adrenoceptor Agonists

¾SA0838 Special Authority for Subsidy 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 of 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 of 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.

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RESPIRATORY SYSTEM AND ALLERGIES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

BUDESONIDE WITH EFORMOTEROL – Special Authority see SA0838 on the preceding page – Retail pharmacy Aerosol inhaler 100 µg with eformoterol fumarate 6 µg ....................55.00 120 dose OP Vannair Powder for inhalation 100 µg with eformoterol fumarate 6 µg ..........55.00 120 dose OP Symbicort Turbuhaler 100/6 Aerosol inhaler 200 µg with eformoterol fumarate 6 µg ....................60.00 120 dose OP Vannair Powder for inhalation 200 µg with eformoterol fumarate 6 µg ..........60.00 120 dose OP Symbicort Turbuhaler 200/6 Powder for inhalation 400 µg with eformoterol fumarate 12 µg – No more than 2 dose per day .................................................. 60.00 60 dose OP Symbicort Turbuhaler 400/12 FLUTICASONE WITH SALMETEROL – Special Authority see SA0838 on the preceding page – Retail pharmacy Aerosol inhaler 50 µg with salmeterol 25 µg .....................................37.48 120 dose OP Seretide Aerosol inhaler 125 µg with salmeterol 25 µg ...................................49.69 120 dose OP Seretide Powder for inhalation 100 µg with salmeterol 50 µg – No more than 2 dose per day.................................................................... 37.48 60 dose OP Seretide Accuhaler Powder for inhalation 250 µg with salmeterol 50 µg – No more than 2 dose per day.................................................................... 49.69 60 dose OP Seretide Accuhaler

Beta-Adrenoceptor Agonists

SALBUTAMOL Tab long-acting 4 mg .......................................................................11.18 ‡ Oral liq 2 mg per 5 ml .........................................................................2.25 Infusion 1 mg per ml, 5 ml ..............................................................118.38 (130.21) Inj 500 µg per ml, 1 ml – Up to 5 inj available on a PSO ..................12.90 (Volmax Tab long-acting 4 mg to be delisted 1 March 2009) 56 150 ml 10 5

Volmax Salapin

Ventolin

Inhaled Beta-Adrenoceptor Agonists

SALBUTAMOL Aerosol inhaler, 100 µg per dose CFC free – Up to 1000 dose available on a PSO.......................................................................3.80 (6.00) Nebuliser soln, 1 mg per ml, 2.5 ml – Up to 30 neb available on a PSO......................................................................................3.70 Nebuliser soln, 2 mg per ml, 2.5 ml – Up to 30 neb available on a PSO......................................................................................3.85 TERBUTALINE SULPHATE Powder for inhalation, 250 µg per dose, breath activated .................18.20

200 dose OP

Respigen Salamol

Ventolin

20 20 200 dose OP

Asthalin Asthalin Bricanyl Turbuhaler

Inhaled Anticholinergic agents

IPRATROPIUM BROMIDE Aerosol inhaler, 20 µg per dose CFC-free ........................................16.20 Nebuliser soln, 250 µg per ml, 1 ml – Up to 40 neb available on a PSO......................................................................................4.30 Nebuliser soln, 250 µg per ml, 2 ml – Up to 40 neb available on a PSO......................................................................................5.25 200 dose OP 20

Atrovent Ipratropium

Steri-Neb

Ipratropium

Steri-Neb

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

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

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Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

TIOTROPIUM BROMIDE – Special Authority see SA0872 below – Retail pharmacy Powder for inhalation, 18 µg per dose ..............................................70.00 30 dose

Spiriva

¾SA0872 Special Authority for Subsidy 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 Any of the following: The patient’s breathlessness according to the Medical Research Council (UK) dyspnoea scale is: 3.1 Grade 4 (stops for breath after walking about 100 meters or after a few minutes on the level); or 3.2 Grade 5 (too breathless to leave the house, or breathless when dressing or undressing); and 4 Actual FEV1 (litres) < 0.6 × predicted (litres); and 5 Either: 5.1 Patient is not a smoker (for reporting purposes only); or 5.2 Patient is a smoker and has 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: 1 Patient is compliant with the medication; and 2 Patient has experienced improved COPD symptom control (prescriber determined); and 3 Applicant must state recent measurement of FEV1 (% of predicted).

Inhaled Beta-Adrenoceptor Agonists with Anticholinergic Agents

SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 µg with ipratropium bromide, 20 µg per dose ...........................................................................................13.50 Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml – Up to 20 neb available on a PSO ........................... 5.30

200 dose OP 20

Combivent Duolin

Mast cell stabilisers

NEDOCROMIL Aerosol inhaler, 2 mg per dose CFC-free .........................................23.20 (28.07) SODIUM CROMOGLYCATE Powder for inhalation, 20 mg per dose .............................................16.31 (17.94) Aerosol inhaler, 5 mg per dose CFC-free .........................................23.20 (28.07) 112 dose OP Tilade 50 dose Intal Spincaps 112 dose OP Vicrom

Methylxanthines

AMINOPHYLLINE F Inj 25 mg per ml, 10 ml – Up to 5 inj available on a PSO .................12.84 THEOPHYLLINE F Tab long-acting 250 mg ....................................................................21.51 F‡ Oral liq 80 mg per 15 ml .....................................................................4.06 (15.50) 5 100 500 ml

Mayne Nuelin-SR

Nuelin

150

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

RESPIRATORY SYSTEM AND ALLERGIES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Cystic Fibrosis

DORNASE ALFA – Special Authority see SA0611 below – Hospital pharmacy [HP1] Nebuliser soln, 2.5 mg per 2.5 ml ampoule ....................................294.30 6

Pulmozyme

¾SA0611 Special Authority for Subsidy Special Authority approved by the Cystic Fibrosis Advisory Panel Notes: Application details may be obtained from PHARMAC’s website http://www.pharmac.govt.nz or: The Co-ordinator, Cystic Fibrosis Advisory Panel Phone: (04) 460 4990 PHARMAC, PO Box 10 254 Facsimile: (04) 916 7571 Wellington Email: CFPanel@pharmac.govt.nz Prescriptions for patients approved for treatment must be written by respiratory physicians or paediatricians who have experience and expertise in treating cystic ﬁbrosis.

Nasal Preparations Allergy Prophylactics

BECLOMETHASONE DIPROPIONATE Metered aqueous nasal spray, 50 µg per dose ...................................2.35 Metered aqueous nasal spray, 100 µg per dose .................................2.46 BUDESONIDE Metered aqueous nasal spray, 50 µg per dose ...................................2.35 (2.95) Metered aqueous nasal spray, 100 µg per dose .................................2.61 (3.30) IPRATROPIUM BROMIDE Aqueous nasal spray, 0.03% ............................................................12.66 SODIUM CROMOGLYCATE Nasal spray, 4% ................................................................................13.50 200 dose OP 200 dose OP 200 dose OP Butacort Aqueous 200 dose OP Butacort Aqueous 30 ml OP 22 ml OP

Alanase Alanase

Apo-Ipravent Rex

Respiratory Devices

MASK FOR SPACER DEVICE a) Maximum of 20 dev per WSO b) Only on a WSO c) 1) 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. 2) Only available for children aged six years and under. 3) 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. 4) 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 Size 2 ..................................................................................................3.28 1 Foremount Child’s Silicone Mask

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

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

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RESPIRATORY SYSTEM AND ALLERGIES

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

PEAK FLOW METER a) Maximum of 10 dev per WSO b) Only on a WSO Low range .........................................................................................13.75 Normal range ....................................................................................13.75

1 1

Breath-Alert Breath-Alert

SPACER DEVICE a) Maximum of 20 dev per WSO b) Only on a WSO c) 1) 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. 2) Only available for children aged six years and under. 3) 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. 4) 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 323 270 230 ml (autoclavable) .......................................................................11.60 1 Space Chamber

152

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SENSORY ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Ear Preparations

ACETIC ACID WITH 1, 2- PROPANEDIOL DIACETATE AND BENZETHONIUM For Vosol ear drops with hydrocortisone powder refer, page 162 Ear drops 2% with 1, 2-Propanediol diacetate 3% and benzethonium chloride 0.02 % ....................................................6.97 CHLORAMPHENICOL Ear drops 0.5% ...................................................................................1.87 FLUMETASONE PIVALATE Ear drops 0.02% with clioquinol 1% ...................................................4.46

35 ml OP 5 ml OP 7.5 ml OP

Vosol Chloromycetin Locorten-Vioform

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 7.5 ml OP

Kenacomb

Ear/Eye Preparations

DEXAMETHASONE WITH FRAMYCETIN AND GRAMICIDIN 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

ACICLOVIR F Eye oint 3% ......................................................................................37.53 CHLORAMPHENICOL Eye oint 1% ........................................................................................2.48 Eye drops 0.5% ..................................................................................1.40 4.5 g OP 4 g OP 10 ml OP

Zovirax Chlorsig Chlorsig

CIPROFLOXACIN Eye Drops 0.3% ................................................................................12.43 5 ml OP Ciloxan For treatment of bacterial keratitis or severe bacterial conjunctivitis resistant to chloramphenicol. DIBROMOPROPAMIDINE ISETHIONATE F Eye oint 0.15% ..................................................................................2.97 5 g OP (7.99) Brolene (Brolene Eye oint 0.15% to be delisted 1 March 2009) FUSIDIC ACID Eye drops 1% .....................................................................................4.50 (9.83) GENTAMICIN SULPHATE Eye drops 0.3% ................................................................................11.40 PROPAMIDINE ISETHIONATE F Eye drops 0.1 % .................................................................................2.97 (7.99) 5 g OP Fucithalmic 5 ml OP 10 ml OP Brolene

Genoptic

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

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

153

SENSORY ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

SULPHACETAMIDE SODIUM F Eye drops 10% ...................................................................................4.41 TOBRAMYCIN Eye oint 0.3% ...................................................................................10.45 Eye drops 0.3% ................................................................................11.48

15 ml OP 3.5 g OP 5 ml OP

Bleph 10 Tobrex Tobrex

Corticosteroids and Other Anti-Inﬂammatory Preparations

DEXAMETHASONE F Eye oint 0.1% .....................................................................................5.86 F Eye drops 0.1 % .................................................................................4.50 DEXAMETHASONE WITH NEOMYCIN AND POLYMYXIN B SULPHATE F Eye oint 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per g ............................................................. 5.39 F Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml ...................................................... 4.50 DICLOFENAC SODIUM F Eye drops 1 mg per ml .....................................................................13.80 FLUOROMETHOLONE F 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 F Eye drops 0.12% ................................................................................4.50 (7.53) F Eye drops 1% .....................................................................................4.50 (9.44) SODIUM CROMOGLYCATE Eye drops 2% .....................................................................................3.95 3.5 g OP 5 ml OP

Maxidex Maxidex

3.5 g OP 5 ml OP 5 ml OP 5 ml OP 4 ml OP

Maxitrol Maxitrol Voltaren Ophtha Flucon

Livostin 10 ml OP 5 ml OP Pred Mild 5 ml OP Pred Forte 10 ml OP

Lomide

Cromolux

Glaucoma Preparations - Beta Blockers

BETAXOLOL HYDROCHLORIDE F Eye drops 0.25% ..............................................................................11.80 F Eye drops 0.5% ..................................................................................7.50 LEVOBUNOLOL F Eye drops 0.25% ................................................................................7.00 F Eye drops 0.5 % .................................................................................7.00 TIMOLOL MALEATE F Eye drops 0.25% ................................................................................2.37 F Eye drops 0.25%, gel forming ............................................................3.30 F Eye drops 0.5% ..................................................................................2.29 F Eye drops 0.5%, gel forming ..............................................................3.78 5 ml OP 5 ml OP 5 ml OP 5 ml OP 5 ml OP 2.5 ml OP 5 ml OP 2.5 ml OP

Betoptic S Betoptic Betagan Betagan Apo-Timop Timoptol XE Apo-Timop Timoptol XE

154

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SENSORY ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Glaucoma Preparations - Carbonic Anhydrase Inhibitors

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: 1) that person has previously trialled all other such subsidised agents (except brimonidine tartrate); and 2) those trials have indicated that that person does not respond adequately to treatment with those other agents. ACETAZOLAMIDE F Tab 250 mg .......................................................................................10.40 100 Diamox BRINZOLAMIDE L Eye Drops 1% .....................................................................................9.77 DORZOLAMIDE HYDROCHLORIDE F Eye drops 2% .....................................................................................9.77 (13.95) DORZOLAMIDE HYDROCHLORIDE WITH TIMOLOL MALEATE F Eye drops 2% with timolol maleate 0.5% .........................................18.50 5 ml OP 5 ml OP Trusopt 5 ml OP

Azopt

Cosopt

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 above 3 ml OP Lumigan L Eye Drops 0.03% ..............................................................................19.50 LATANOPROST – Retail pharmacy-Specialist See prescribing guideline above L Eye drops 50 µg per ml, 2.5ml ..........................................................19.50 TRAVOPROST – Retail pharmacy-Specialist See prescribing guideline above L Eye drops 0.004% ............................................................................19.50

2.5 ml OP

Xalatan

2.5 ml OP

Travatan

Glaucoma Preparations - Other

BRIMONIDINE TARTRATE F Eye Drops 0.2% ..................................................................................7.93 5 ml OP AFT Prescribing Guidelines Brimonidine tartrate is subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Brimonidine tartrate should not be prescribed for a person in whom less expensive ﬁrst line agents for the treatment of glaucoma are not contraindicated unless: G that person has previously trialled all other such subsidised agents (except dorzolamide hydrochloride); and G those trials have indicated that that person does not respond adequately to or does not tolerate treatment with those other agents. BRIMONIDINE TARTRATE WITH TIMOLOL MALEATE L Eye drops 0.2% with timolol maleate 0.5% ......................................18.50 5 ml OP Combigan

‡ safety cap FThree months or six months, as applicable, dispensed all-at-once LThree months supply may be dispensed at one time if endorsed “certiﬁed exemption” by the prescriber.

155

SENSORY ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Prescribing Guidelines Combigan is subsidised for use as either monotherapy or as an adjunctive agent for the treatment of glaucoma. Combigan should only be prescribed when: 1) less expensive ﬁrst line agents for the treatment of glaucoma are contraindicated; or 2) the response to such subsidised agents is inadequate; or 3) the patient cannot tolerate such subsidised agents. PILOCARPINE F Eye drops 0.5% ..................................................................................3.19 15 ml OP Pilopt F Eye drops 1% .....................................................................................3.24 15 ml OP Pilopt F Eye drops 2% .....................................................................................4.32 15 ml OP Pilopt F Eye drops 4% .....................................................................................6.57 15 ml OP Pilopt F Eye drops 6% .....................................................................................8.56 15 ml OP Pilopt F Eye drops 2% single dose – Special Authority see SA0895 below – Hospital pharmacy [HP3] ..............................................31.95 20 dose (32.72) Minims ¾SA0895 Special Authority for Subsidy Initial application from any relevant 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 relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is beneﬁting from treatment.

Mydriatics and Cycloplegics

ATROPINE SULPHATE F Eye drops 1% .....................................................................................4.40 CYCLOPENTOLATE HYDROCHLORIDE F Eye drops 1% .....................................................................................8.76 HOMATROPINE HYDROBROMIDE F Eye drops 2% .....................................................................................7.18 TROPICAMIDE F Eye drops 0.5% ..................................................................................7.15 F Eye drops 1% .....................................................................................8.66 15 ml OP 15 ml OP 15 ml OP 15 ml OP 15 ml OP

Atropt Cyclogyl Isopto Homatropine Mydriacyl Mydriacyl

Preparations for Tear Deﬁciency

For acetylcysteine eye drops refer, page 162 HYPROMELLOSE F Eye drops 0.3% ..................................................................................2.62 F Eye drops 0.5% ..................................................................................1.79 POLYVINYL ALCOHOL F Eye drops 1.4% ..................................................................................2.68 3.62 F Eye drops 3% .....................................................................................3.75 3.88 TYLOXAPOL F Eye drops 0.25% ................................................................................8.63

15 ml OP 15 ml OP 15 ml OP 15 ml OP

Poly-Tears Methopt Vistil Liquiﬁlm Tears Vistil Forte Liquiﬁlm Forte Enuclene

15 ml OP

156

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S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SENSORY ORGANS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Other Eye Preparations

NAPHAZOLINE HYDROCHLORIDE F Eye drops 0.1% ..................................................................................4.15 PARAFFIN LIQUID WITH SOFT WHITE PARAFFIN F Eye oint with soft white parafﬁn ..........................................................3.63 PARAFFIN LIQUID WITH WOOL FAT LIQUID F Eye oint 3% with wool fat liq 3% .........................................................3.63 PHENYLEPHRINE HYDROCHLORIDE F Eye drops 0.12% ................................................................................4.47 PHENYLEPHRINE HYDROCHLORIDE WITH ZINC SULPHATE F Eye drops 0.12% with zinc sulphate 0.25% ........................................4.51 15 ml OP 3.5 g OP 3.5 g OP 15 ml OP 15 ml OP

Naphcon Forte Lacri-Lube Poly-Visc Prefrin Zincfrin

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

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

157

VARIOUS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Agents Used in the Treatment of Poisonings

See also to MUSCULO-SKELETAL, Anticholinesterases, page 100 CHARCOAL F Tab 300 mg .........................................................................................7.13 F Oral liq 50 g per 250 ml ....................................................................37.75 a) Up to 250 ml available on a PSO b) Only on a PSO DESFERRIOXAMINE MESYLATE – Hospital pharmacy [HP3] F Inj 500 mg .........................................................................................99.00 IPECACUANHA F Tincture .............................................................................................41.20 (43.40) NALOXONE HYDROCHLORIDE a) Up to 5 inj available on a PSO b) Only on a PSO F Inj 400 µg per ml, 1 ml ......................................................................33.00 SODIUM CALCIUM EDETATE F Inj 200 mg per ml, 5 ml .....................................................................53.31 (156.71)

100 250 ml OP

Red Seal Carbosorb-X

10 500 ml

Mayne

PSM

5 6

Mayne

Calcium Disodium Versenate

Detection of Substances in Urine

ORTHO-TOLIDINE F Compound diagnostic sticks ...............................................................7.50 (8.25) TETRABROMOPHENOL F Blue diagnostic strips .........................................................................7.02 (13.92) 50 test OP Hemastix 100 test OP Albustix

158

fully subsidised [HP1], [HP3], [HP4] refer page 8

S29 Unapproved medicine supplied under Section 29 Sole Subsidised Supply

SECTION C: EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS

INTRODUCTION

The following extemporaneously compounded products are eligible for subsidy:

G G G G

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 a) One or more subsidised dermatological galenical(s) in a subsidised dermatological base. b) Dilution of proprietary Topical Corticosteroid-Plain preparations with a dermatological base (Retail pharmacy-specialist). c) 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:

G G G G G G G G G G G G G G

Aqueous cream Cetomacrogol cream BP Collodion ﬂexible 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

Dermatological galenical: Dermatological galenicals will only be subsidised when added to a dermatological base. More than one dermatological galenical can be added to a dermatological base. The following are dermatological galenicals:

G G G G

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.

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EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS

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: qs Solid dose form qs Preservative 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: G Mixing one or more proprietary oral liquids (eg an antihistamine with pholcodine linctus). G Extemporaneously compounding an oral liquid with more than one solid dose chemical. G Mixing more than one extemporaneously compounded oral liquid mixture. G Mixing one or more extemporaneously compounded oral liquid mixtures with one or more proprietary oral liquids. G The addition of a chemical/powder/agent/solution to a proprietary oral liquid or extemporaneously compounded oral mixture. Standard formulae 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. Dermatological Preparations Proprietary topical corticosteroid preparations may be diluted with a dermatological base (see page 159) 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 161 may assist you in deciding whether or not a dermatological ECP is subsidised.

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EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS

Dermatological ECPs

Is it subsidised?

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? Yes Is the second base a proprietary topical corticosteroid-plain? No Is prescription written by a specialist or on the recommendation of a specialist? Entire product is NSS

Yes

Entire product is NSS

This part of the product is subsidised

Yes

Has a non-subsidised ingredient been added: e.g. glycerol?

Has a dermatological galenical or other non-subsidised ingredient been added? Yes

Yes

The non-subsidised ingredient is not subsidised but the rest is

The dermatological galenicals & non-subsidised ingredients are NSS

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EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS

Standard Formulae

ACETYLCYSTEINE EYE DROPS Acetylcysteine inj 200 mg per ml, 10 ml qs Suitable eye drop base qs ASPIRIN AND 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 Methyl hydroxybenzoate Water (Not subsidised as a laxative) METHADONE MIXTURE Methadone powder Glycerol Water 275 g 1.5 g 770 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 Omeprazole capules Sodium bicarbonate powder BP Water PHENOBARBITONE ORAL LIQUID Phenobarbitone Sodium Glycerol BP Water

qs 8.4 g to 100 ml 1g 70 ml 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 quantity 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

qs qs to 100 ml

162

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Extemporaneously Compounded Preparations and Galenicals

ACETYLCYSTEINE – Hospital pharmacy [HP1]-Specialist Inj 200 mg per ml, 10 ml .................................................................137.06 (255.35) BENZOIN Tincture compound BP .....................................................................24.42 (38.00) CHLOROFORM – Only in combination Only in aspirin and chloroform application. Chloroform BP ..................................................................................25.50 10 Hospira 500 ml PSM

500 ml

PSM

CODEINE PHOSPHATE Powder – Only in combination .........................................................63.09 25 g (84.20) Douglas a) Only in extemporaneously compounded codeine linctus diabetic or codeine linctus paediatric. b) ‡ Safety cap for extemporaneously compounded oral liquid preparations. COLLODION FLEXIBLE Collodion ﬂexible ..............................................................................19.30 100 ml PSM COMPOUND HYDROXYBENZOATE – Only in combination Only in extemporaneously compounded oral mixtures. Soln ..................................................................................................34.18 GLYCEROL F Liquid – Only in combination ...........................................................19.80 24.75 19.80 (24.75) Only in extemporaneously compounded oral liquid preparations. MAGNESIUM HYDROXIDE Paste ................................................................................................22.61

100 ml 2,000 ml

David Craig ABM PSM

MidWest

500 g

PSM

ABM

MidWest

100 g

MidWest

fully subsidised

[HP1], [HP3], [HP4] refer page 8

163

EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS AND GALENICALS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

PROPYLENE GLYCOL Only in extemporaneously compounded methyl hydroxybenzoate 10% solution. Liq .....................................................................................................12.00 500 ml 17.70 SODIUM BICARBONATE Powder BP – Only in combination .....................................................9.80 (11.99) (29.50) Only in extemporaneously compounded omeprazole suspension. SYRUP (PHARMACEUTICAL GRADE) – Only in combination Only in extemporaneously compounded oral liquid preparations. Liq .....................................................................................................21.75 WATER Tap – Only in combination .................................................................0.00 500 g

ABM PSM ABM

Biomed David Craig

2,000 ml 1 ml

Midwest Tap water

164

fully subsidised

[HP1], [HP3], [HP4] refer page 8

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? Only Specialists 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 Growth deﬁciency An inability to gain or maintain weight resulting in physiological impairment. Where the weight of the child is less than the ﬁfth or possibly third percentile for their age, with evidence of malnutrition Initial Applications: Reapplications:

165

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Nutrient Modules Carbohydrate

¾SA0912 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis or renal failure) only from a 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) only from a 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; or 7 inborn errors of metabolism. Renewal — (Cystic ﬁbrosis or renal failure) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0912 above – Hospital pharmacy [HP3] Powder ..............................................................................................36.50 5,000 g Morrex Maltodextrin 1.30 400 g OP (5.29) Polycal 1.14 350 g OP (7.85) Polycose 1.30 368 g OP (12.00) Moducal

Carbohydrate And Fat

¾SA0581 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis) only from a 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) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: continued. . .

166

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0581 on the preceding page – Hospital pharmacy [HP3] Powder (neutral) ...............................................................................60.31 400 g OP Duocal Super Soluble Powder

Fat

¾SA0899 Special Authority for Subsidy Initial application — (Inborn errors of metabolism) only from a relevant specialist. Approvals valid for 3 years where the patient has inborn errors of metabolism. Initial application — (Indications other than inborn errors of metabolism) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Any of the following: 1 failure to thrive where other high calorie products are inappropriate or inadequate; 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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 8

167

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

FAT SUPPLEMENT – Special Authority see SA0899 on the preceding page – Hospital pharmacy [HP3] Emulsion (neutral) ............................................................................12.30 200 ml OP Calogen 30.75 500 ml OP Calogen Emulsion (strawberry) .......................................................................12.30 200 ml OP Calogen Oil .....................................................................................................28.73 250 ml OP Liquigen 30.00 500 ml OP MCT oil (Nutricia)

Protein

¾SA0582 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0582 above – Hospital pharmacy [HP3] Powder ................................................................................................7.90 225 g OP Protifar 90 Powder (vanilla) ................................................................................12.90 275 g OP 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. ¾SA0583 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis) only from a relevant specialist. Approvals valid for 3 years where the patient has cystic ﬁbrosis. Initial application — (Indications other than cystic ﬁbrosis) only from a 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

168

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ORAL SUPPLEMENT 1KCAL/ML – Special Authority see SA0583 on the preceding page – Hospital pharmacy [HP3] Powder (chocolate) .............................................................................9.22 900 g OP Sustagen Hospital Formula 4.75 400 g OP (7.22) Ensure Powder (strawberry) ...........................................................................4.75 400 g OP (7.22) Ensure Powder (vanilla) ..................................................................................9.22 900 g OP Sustagen Hospital Formula 11.50 Fortisip Powder 4.75 400 g OP (7.22) Ensure (Fortisip Powder Powder (vanilla) to be delisted 1 February 2009)

Oral Supplements/Complete Diet (Nasogastric/Gastrostomy Tube Feed) Respiratory Products

¾SA0588 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0588 above – Hospital pharmacy [HP3] Liquid ..................................................................................................1.66 237 ml OP Pulmocare

Diabetic Products

¾SA0594 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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: continued. . .

fully subsidised

[HP1], [HP3], [HP4] refer page 8

169

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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 – Special Authority see SA0594 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................7.50 1,000 ml OP Diason RTH Glucerna RTH Glucerna Select RTH Resource Diabetic TF RTH (Glucerna RTH Liquid to be delisted 1 December 2008) ORAL FEED 1KCAL/ML – Special Authority see SA0594 on the preceding page – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.78 237 ml OP Resource Diabetic Liquid (strawberry) ..............................................................................1.50 200 ml OP Diasip 1.78 237 ml OP Resource Diabetic Liquid (vanilla) ....................................................................................1.50 200 ml OP Diasip 1.78 237 ml OP Resource Diabetic 1.88 250 ml OP Glucerna Glucerna Select (Glucerna Liquid (vanilla) to be delisted 1 December 2008)

Fat Modiﬁed Products

¾SA0615 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0615 above – Hospital pharmacy [HP3] Powder ..............................................................................................60.48 400 g OP Monogen

High Protein Products

¾SA0589 Special Authority for Subsidy Initial application only from a 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 continued. . .

170

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 3.2 The product is to be used as a complete diet. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0589 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................1.50 200 ml OP Fortimel

Paediatric Products For Children Awaiting Liver Transplant

¾SA0607 Special Authority for Subsidy Initial application only from a 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 only from a 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 – Special Authority see SA0607 above – Hospital pharmacy [HP3] Powder ..............................................................................................78.97 400 g OP Generaid Plus

Paediatric Products For Children With Chronic Renal Failure

¾SA0606 Special Authority for Subsidy Initial application only from a 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 only from a 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 – Special Authority see SA0606 above – Hospital pharmacy [HP3] Liquid ................................................................................................54.00 400 g OP Kindergen

fully subsidised

[HP1], [HP3], [HP4] refer page 8

171

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Paediatric Products

¾SA0896 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 infant aged one to eight 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0896 above – Hospital pharmacy [HP3] Liquid ..................................................................................................1.60 200 ml OP Nutrini Energy RTH 6.00 500 ml OP Nutrini Energy RTH PAEDIATRIC ENTERAL FEED 1KCAL/ML – Special Authority see SA0896 above – Hospital pharmacy [HP3] Liquid ..................................................................................................1.07 200 ml OP Nutrini RTH 2.68 500 ml OP Nutrini RTH Pediasure RTH PAEDIATRIC ORAL FEED 1.5KCAL/ML – Special Authority see SA0896 above – Hospital pharmacy [HP3] Liquid (strawberry) ..............................................................................1.60 200 ml OP Fortini Liquid (vanilla) ....................................................................................1.60 200 ml OP Fortini PAEDIATRIC ORAL FEED 1KCAL/ML – Special Authority see SA0896 above – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.07 200 ml OP Pediasure 1.27 237 ml OP Pediasure Resource Just for Kids Liquid (strawberry) ..............................................................................1.07 200 ml OP Pediasure 1.27 237 ml OP Pediasure Liquid (vanilla) ....................................................................................1.27 237 ml OP Pediasure Resource Just for Kids PAEDIATRIC ORAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA0896 above – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.60 200 ml OP Fortini Multiﬁbre Liquid (strawberry) ..............................................................................1.60 200 ml OP Fortini Multiﬁbre 200 ml OP Fortini Multiﬁbre Liquid (vanilla) ....................................................................................1.60

172

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Renal Products

¾SA0587 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0587 above – Hospital pharmacy [HP3] Liquid ..................................................................................................6.08 500 ml OP Nutrison Concentrated RENAL ORAL FEED 2KCAL/ML – Special Authority see SA0587 above – Hospital pharmacy [HP3] Liquid ..................................................................................................2.43 200 ml OP Nepro (vanilla) 2.88 237 ml OP NovaSource Renal Liquid (apricot) ....................................................................................2.88 125 ml OP Renilon 7.5 Liquid (caramel) ..................................................................................2.88 125 ml OP Renilon 7.5

Specialised And Elemental Products

¾SA0592 Special Authority for Subsidy Initial application only from a 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. Notes: 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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.

fully subsidised

[HP1], [HP3], [HP4] refer page 8

173

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ENTERAL/ORAL ELEMENTAL FEED 1KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Powder ................................................................................................4.40 79 g OP Vital HN 7.50 76 g OP Alitraq ORAL ELEMENTAL FEED 0.8KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Liquid (grapefruit) ...............................................................................9.50 250 ml OP Elemental 028 Extra Liquid (pineapple & orange) ...............................................................9.50 250 ml OP Elemental 028 Extra Liquid (summer fruit) ..........................................................................9.50 250 ml OP Elemental 028 Extra ORAL ELEMENTAL FEED 1KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Powder (unﬂavoured) .........................................................................4.00 80.4 g OP Vivonex TEN SEMI-ELEMENTAL ENTERAL FEED 1KCAL/ML – Special Authority see SA0592 on the preceding page – Hospital pharmacy [HP3] Liquid ..................................................................................................6.02 500 ml OP Peptisorb 12.04 1,000 ml OP Peptisorb

Undyalised End Stage Renal Failure

¾SA0586 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0586 above – Hospital pharmacy [HP3] Liquid ..................................................................................................3.80 237 ml OP Suplena

Adult Products Standard

¾SA0702 Special Authority for Subsidy Initial application — (Oral feed for cystic ﬁbrosis patient) only from a 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) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: continued. . .

174

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . 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. Renewal — (Oral feed cystic ﬁbrosis patient) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Initial application — (Enteral feed) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Any of the following: 1.1 enteral feeding; or 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 — (Enteral feed or Oral feed for indications other than cystic ﬁbrosis) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Notes: 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.

fully subsidised

[HP1], [HP3], [HP4] refer page 8

175

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ENTERAL FEED 1KCAL/ML – Special Authority see SA0702 on page 174 – Hospital pharmacy [HP3] Liquid ..................................................................................................1.24 250 ml OP Isosource HN Isosource Standard 2.65 500 ml OP Nutrison Standard RTH 5.29 1,000 ml OP Nutrison Standard RTH Isosource HN RTH Isosource Standard RTH Osmolite RTH ENTERAL FEED WITH FIBRE 1 KCAL/ML – Special Authority see SA0702 on page 174 – Hospital pharmacy [HP3] Liquid ..................................................................................................1.24 250 ml OP Fibresource Fibresource HN 2.65 500 ml OP Nutrison Multi Fibre 5.29 1,000 ml OP Nutrison Multi Fibre Fibresource HN RTH Fibresource RTH Jevity RTH ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA0702 on page 174 – Hospital pharmacy [HP3] Liquid ..................................................................................................7.00 1,000 ml OP Ensure Plus RTH 1.75 250 ml OP Isosource 1.5 7.00 1,000 ml OP Isosource 1.5 Nutrison Energy Multi Fibre ORAL FEED 1.5KCAL/ML – Special Authority see SA0702 on page 174 – Hospital pharmacy [HP3] Liquid (banana) ...................................................................................1.12 200 ml OP Fortisip (1.45) Ensure Plus Liquid (chocolate) ...............................................................................1.12 200 ml OP Fortisip 1.33 237 ml OP Resource Plus 1.12 200 ml OP (1.45) Ensure Plus 1.33 237 ml OP Ensure Plus Liquid (coffee) .....................................................................................1.33 237 ml OP Ensure Plus Liquid (fruit of the forest) .....................................................................1.12 200 ml OP (1.45) Ensure Plus Liquid (strawberry) ..............................................................................1.12 200 ml OP Fortisip 1.33 237 ml OP Resource Plus 1.12 200 ml OP (1.45) Ensure Plus 1.33 237 ml OP Ensure Plus Liquid (toffee) ......................................................................................1.12 200 ml OP Fortisip Liquid (tropical fruit) ............................................................................1.12 200 ml OP Fortisip Liquid (vanilla) ....................................................................................1.12 200 ml OP Fortisip 1.33 237 ml OP Resource Plus 1.12 200 ml OP (1.45) Ensure Plus 1.33 237 ml OP Ensure Plus

176

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

ORAL FEED WITH FIBRE 1.5 KCAL/ML – Special Authority see SA0702 on page 174 – Hospital pharmacy [HP3] Liquid (chocolate) ...............................................................................1.12 200 ml OP Fortisip Multi Fibre Liquid (strawberry) ..............................................................................1.12 200 ml OP Fortisip Multi Fibre Liquid (vanilla) ....................................................................................1.12 200 ml OP Fortisip Multi Fibre

Adult Products High Calorie

¾SA0585 Special Authority for Subsidy Initial application — (Cystic ﬁbrosis) only from a 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) only from a 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Notes: 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 – Special Authority see SA0585 above – Hospital pharmacy [HP3] 237 ml OP Two Cal HN Liquid (vanilla) ....................................................................................2.25

fully subsidised

[HP1], [HP3], [HP4] refer page 8

177

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Food Thickeners

¾SA0595 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year where the patient has motor neurone disease with swallowing disorder. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0595 above – Hospital pharmacy [HP3] Powder ................................................................................................3.80 250 g OP Resource Thicken Up 4.56 380 g (7.25) Karicare Food Thickener

Gluten Free Foods

¾SA0722 Special Authority for Subsidy Initial application only from a 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 – Special Authority see SA0722 above – Hospital pharmacy [HP3] Powder ................................................................................................2.81 1,000 g OP (5.15) Healtheries Simple Baking Mix GLUTEN FREE BREAD MIX – Special Authority see SA0722 above – Hospital pharmacy [HP3] Powder ................................................................................................3.93 1,000 g OP (6.73) 4.77 (8.97) 3.51 (9.96) GLUTEN FREE FLOUR – Special Authority see SA0722 above – Hospital pharmacy [HP3] Powder ................................................................................................5.62 2,000 g OP (16.44)

NZB Low Gluten Bread Mix Bakels Gluten Free Health Bread Mix Horleys Bread Mix

Horleys Flour

178

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

GLUTEN FREE PASTA – Special Authority see SA0722 on the preceding page – Hospital pharmacy [HP3] Buckwheat Spirals ..............................................................................2.00 250 g OP (2.85) Orgran Corn and Parsley Fettucine ................................................................2.00 250 g OP (2.63) Orgran Corn and Spinach Rigatini ..................................................................2.00 250 g OP (2.63) Orgran Corn and Vegetable Shells .................................................................2.00 250 g OP (2.63) Orgran Corn and Vegetable Spirals ................................................................2.00 250 g OP (2.63) Orgran Garlic and Parsley Shells ...................................................................2.00 250 g OP (2.63) Orgran Garlic and Parsley Spirals .................................................................2.00 250 g OP (2.63) Orgran Rice and Corn Garden Herb Pasta .....................................................2.00 250 g OP (2.63) Orgran Rice and Corn Lasagne Sheets .........................................................1.60 200 g OP (2.80) Orgran Rice and Corn Macaroni .....................................................................2.00 250 g OP (2.63) Orgran Rice and Corn Penne .........................................................................2.00 250 g OP (2.63) Orgran Rice and Maize Pasta Spirals .............................................................2.00 250 g OP (2.63) Orgran Rice and Millet Spirals ........................................................................2.00 250 g OP (2.63) Orgran Rice and corn spaghetti noodles ........................................................2.00 375 g OP (2.63) Orgran Vegetable and Rice Spirals ................................................................2.00 250 g OP (2.85) Orgran (Orgran Garlic and Parsley Spirals to be delisted 1 January 2009)

Foods And Supplements For Inborn Errors Of Metabolism - Other

¾SA0732 Special Authority for Subsidy Initial application only from a 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 only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Prescribing Guideline 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.

fully subsidised [HP1], [HP3], [HP4] refer page 8

179

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Supplements For Homocystinuria

AMINOACID FORMULA WITHOUT METHIONINE – Special Authority see SA0732 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Powder ............................................................................................461.94 500 g OP XMET Maxamum

Supplements For MSUD

AMINOACID FORMULA WITHOUT VALINE, LEUCINE AND ISOLEUCINE – Special Authority see SA0732 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Powder ............................................................................................300.54 500 g OP MSUD Maxamaid 437.22 MSUD Maxamum

Foods And Supplements For Inborn Errors Of Metabolism - PKU

¾SA0733 Special Authority for Subsidy Initial application — (Patient aged over 16) only from a relevant specialist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 dietary management of PKU; and 2 The patient’s blood phenylalanine level is < 900 mmol/litre (average of tests over last 12 months). Initial application — (Patient aged 16 or under) only from a relevant specialist. Approvals valid for 3 years where the patient requires dietary management of PKU. Renewal — (Patient aged over 16) only from a relevant specialist. Approvals valid for 1 year where blood phenylalanine level < 900 mmol/litre (average of tests over last 12 months). Renewal — (Patient aged 16 or under) only from a relevant specialist or general practitioner on the recommendation of a relevant 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. Prescribing Guideline 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 – Special Authority see SA0733 above – Hospital pharmacy [HP3] See prescribing guideline above Powder ................................................................................................6.70 500 g OP (8.22)

Loproﬁn Mix

180

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

PHENYL FREE PASTA – Special Authority see SA0733 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Animal shapes ..................................................................................11.91 500 g OP Loproﬁn Lasagne ..............................................................................................5.95 250 g OP Loproﬁn Low protein rice pasta ......................................................................10.65 500 g OP (11.91) Loproﬁn 250 g OP Loproﬁn Macaroni .............................................................................................5.95 Penne ...............................................................................................11.91 500 g OP Loproﬁn Spaghetti ..........................................................................................10.65 500 g OP (11.91) Loproﬁn Spirals ...............................................................................................10.65 500 g OP (11.91) Loproﬁn

Supplements For PKU

AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA0733 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Tabs ..................................................................................................99.00 75 OP Phlexy 10 Sachets (pineapple/vanilla) 29 g ....................................................330.10 30 OP Minaphlex Sachets (tropical) ............................................................................324.00 30 Phlexy 10 Infant formula ..................................................................................174.72 400 g OP XP Analog LCP Powder (orange) .............................................................................221.00 500 g OP XP Maxamaid 320.00 XP Maxamum Powder (unﬂavoured) .....................................................................221.00 500 g OP XP Maxamaid 244.18 Aminogran Food Supplement 320.00 XP Maxamum Liquid (berry) ....................................................................................15.65 62.5 ml OP Lophlex LQ 31.20 125 ml OP Lophlex LQ Liquid (citrus) ....................................................................................15.65 62.5 ml OP Lophlex LQ 31.20 125 ml OP Lophlex LQ Liquid (forest berries) ........................................................................30.00 250 ml OP Easiphen Liquid Liquid (orange) .................................................................................15.65 62.5 ml OP Lophlex LQ 31.20 125 ml OP Lophlex LQ Liquid (tropical) .................................................................................30.00 250 ml OP Easiphen (Aminogran Food Supplement Powder (unﬂavoured) to be delisted 1 January 2009)

Multivitamin And Mineral Supplements

AMINOACID FORMULA WITH MINERALS WITHOUT PHENYLALANINE – Special Authority see SA0733 on the preceding page – Hospital pharmacy [HP3] See prescribing guideline on the preceding page Powder .............................................................................................45.06 250 g OP Aminogran Mineral Mix 58.44 Metabolic Mineral Mixture (Aminogran Mineral Mix Powder to be delisted 1 January 2009)

fully subsidised

[HP1], [HP3], [HP4] refer page 8

181

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

Multivitamin Supplements For Inborn Errors Of Metabolism

¾SA0600 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 3 years where the patient has inborn errors of metabolism. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0600 above – Hospital pharmacy [HP3] Tab ....................................................................................................19.65 100 Ketovite Powder ..............................................................................................36.00 100 g OP Paediatric Seravit Oral liq ................................................................................................8.98 150 ml OP (13.50) Ketovite Syrup

Infant Formulae For Premature Infants

¾SA0602 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 6 months where the patient is infant weighing less than 1.5 kg at birth. PREMATURE BIRTH FORMULA – Special Authority see SA0602 above – Hospital pharmacy [HP3] Liquid ..................................................................................................0.75 100 ml OP S26LBW Gold RTF

For Williams Syndrome

¾SA0601 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year where the patient is an infant suffering from Williams Syndrome and associated hypercalcaemia. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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 – Special Authority see SA0601 above – Hospital pharmacy [HP3] Powder ..............................................................................................44.40 400 g OP Locasol

182

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

For Gastrointestinal And Other Malabsorptive Problems

¾SA0603 Special Authority for Subsidy Initial application only from a relevant specialist. Approvals valid for 1 year where the patient is infant suffering from malabsorption and other gastrointestinal problems. Renewal only from a relevant specialist or general practitioner on the recommendation of a relevant 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. 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. ELEMENTAL FORMULA – Special Authority see SA0603 above – Hospital pharmacy [HP3] Powder ..............................................................................................15.52 450 g OP (19.01) Pepti Junior 63.97 400 g OP (67.08) Neocate (67.08) Neocate LCP 5.62 48.5 g OP (6.00) Vivonex Pediatric Powder (tropical) ...............................................................................52.90 400 g OP (56.00) Neocate Advance Powder (unﬂavoured) .......................................................................52.90 400 g OP (56.00) Neocate Advance

For Milk Intolerance

¾SA0604 Special Authority for Subsidy Initial application — (Lactase deﬁciency or disaccharide intolerance) only from a 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. Notes: 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) only from a 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. continued. . .

fully subsidised

[HP1], [HP3], [HP4] refer page 8

183

SPECIAL FOODS

Subsidy (Manufacturer’s Price) $ Fully Subsidised Per Brand or Generic Manufacturer

continued. . . Renewal — (Infant with intolerance to cows’ milk) only from a 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 – Special Authority see SA0604 on the preceding page – Retail pharmacy Powder ................................................................................................9.42 900 g OP (22.75) Karicare Goats Milk Infant Formula LACTOSE FREE INFANT FORMULA – Special Authority see SA0604 on the preceding page – Retail pharmacy Powder ................................................................................................5.66 900 g OP (17.95) Delact SOYA INFANT FORMULA – Special Authority see SA0604 on the preceding page – Retail pharmacy Powder ................................................................................................6.34 900 g OP (19.57) S26 Soy

Infant Formulae - Lactose Intolerance and Cows’ Milk Protein Intolerance

¾SA0757 Special Authority for Subsidy 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 – Special Authority see SA0757 above – Retail pharmacy Powder ................................................................................................7.27 900 g (16.35) Karicare Soy All Ages

184

fully subsidised

[HP1], [HP3], [HP4] refer page 8

SECTION E PART I PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS Pharmaceuticals and quantities that may be obtained on a Practitioner’s Supply Order

ADRENALINE Inj 1 in 1,000, 1 ml ...................................................... 5 Inj 1 in 10,000, 10 ml .................................................. 5 AMINOPHYLLINE Inj 25 mg per ml, 10 ml ............................................... 5 AMIODARONE HYDROCHLORIDE Inj 50 mg per ml, 3 ml ................................................. 5 AMOXYCILLIN Cap 250 mg .............................................................. 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 200 ml Inj 1 g.......................................................................... 5 AMOXYCILLIN CLAVULANATE Tab amoxycillin 500 mg with potassium clavulanate 125 mg ..............................................30 Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml................................................................ 200 ml Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml................................................................ 200 ml APPLICATOR Applicator.................................................................... 1 ASPIRIN Tab dispersible 300 mg............................................. 30 ATROPINE SULPHATE Inj 600 µg, 1 ml ........................................................... 5 Inj 1200 µg, 1 ml ......................................................... 5 AZITHROMYCIN Tab 500 mg ................................................................. 4 BENDROFLUAZIDE Tab 2.5 mg .............................................................. 150 BENZATHINE BENZYLPENICILLIN Inj 1.2 mega u per 2 ml ............................................... 5 BENZTROPINE MESYLATE Inj 1 mg per ml, 2 ml ................................................... 5 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 1 mega u ................................................................ 5 CEFTRIAXONE SODIUM Inj 500 mg ................................................................... 5 Inj 1 g.......................................................................... 5 CHARCOAL Oral liq 50 g per 250 ml ..................................... 250 ml CHLORPROMAZINE HYDROCHLORIDE Tab 10 mg ................................................................. 30 Tab 25 mg ................................................................. 30 Tab 100 mg ............................................................... 30 Inj 25 mg per ml, 2 ml ................................................. 5 CIPROFLOXACIN Tab 250 mg ................................................................. 5 Tab 500 mg ................................................................. 5 CO-TRIMOXAZOLE Tab trimethoprim 80 mg and sulphamethoxazole 400 mg..................................30 Oral liq sugar-free trimethoprim 40 mg and sulphamethoxazole 200 mg per 5 ml................................................................ 200 ml COMPOUND ELECTROLYTES Powder for soln for oral use 5 g ................................ 10 CONDOMS 49 mm..................................................................... 144 52 mm..................................................................... 144 52 mm extra strength.............................................. 144 53 mm..................................................................... 144 53 mm (chocolate) .................................................. 144 53 mm (strawberry)................................................. 144 53 mm extra strength.............................................. 144 54 mm, shaped ....................................................... 144 55 mm..................................................................... 144 56 mm, shaped ....................................................... 144 60 mm..................................................................... 144 DEXAMETHASONE Tab 1 mg ................................................................... 30 Tab 4 mg ................................................................... 30 DEXAMETHASONE SODIUM PHOSPHATE Inj 4 mg per ml, 1 ml ................................................... 5 Inj 4 mg per ml, 2 ml ................................................... 5 DEXTROSE Inj 50%, 10 ml ............................................................. 5 Inj 50%, 90 ml ............................................................. 5 DIAPHRAGM Diaphragm .................................................................. 1 DIAZEPAM Inj 5 mg per ml, 2 ml ................................................... 5 Rectal tubes 5 mg....................................................... 5 Rectal tubes 10 mg..................................................... 5 continued. . .

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

185

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

(continued) DICLOFENAC SODIUM Inj 25 mg per ml, 3 ml ................................................. 5 Suppos 50 mg........................................................... 10 DIGOXIN Tab 62.5 µg ............................................................... 30 Tab 250 µg ................................................................ 30 DOXYCYCLINE HYDROCHLORIDE Tab 50 mg ................................................................. 30 Tab 100 mg ............................................................... 30 ERGOMETRINE MALEATE Inj 500 µg per ml, 1 ml ................................................ 5 ERYTHROMYCIN ETHYL SUCCINATE Tab 400 mg ............................................................... 30 Grans for oral liq 200 mg per 5 ml ..................... 200 ml Grans for oral liq 400 mg per 5 ml ..................... 200 ml ERYTHROMYCIN STEARATE Tab 250 mg ............................................................... 30 ETHINYLOESTRADIOL WITH DESOGESTREL Tab 20 µg with desogestrel 150 µg ........................... 63 Tab 20 µg with desogestrel 150 µg and 7 inert tab ................................................................84 Tab 30 µg with desogestrel 150 µg ........................... 63 Tab 30 µg with desogestrel 150 µg and 7 inert tab ................................................................84 ETHINYLOESTRADIOL WITH GESTODENE Tab 30 µg with gestodene 75 µg and 7 inert tab ........................................................................84 ETHINYLOESTRADIOL WITH LEVONORGESTREL 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 ................................................................84 Tab 50 µg with levonorgestrel 125 µg and 7 inert tab ................................................................84 Tab 30 µg with levonorgestrel 150 µg ....................... 63 Tab 30 µg with levonorgestrel 150 µg and 7 inert tab ................................................................84 Tab 20 µg with levonorgestrel 100 µg and 7 inert tab ................................................................84 ETHINYLOESTRADIOL WITH NORETHISTERONE Tab 35 µg with norethisterone 1 mg.......................... 63 Tab 35 µg with norethisterone 1 mg and 7 inert tab ................................................................84 Tab 35 µg with norethisterone 500 µg....................... 63 Tab 35 µg with norethisterone 500 µg and 7 inert tab ................................................................84 FLUCLOXACILLIN SODIUM Cap 250 mg .............................................................. 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 200 ml Inj 1 g.......................................................................... 5 FLUPENTHIXOL DECANOATE Inj 20 mg per ml, 1 ml ................................................. 5 Inj 20 mg per ml, 2 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 FLUPHENAZINE DECANOATE Inj 12.5 mg per 0.5 ml, 0.5 ml ..................................... 5 Inj 25 mg per ml, 1 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 FRUSEMIDE Tab 40 mg ................................................................. 30 Inj 10 mg per ml, 2 ml ................................................. 5 GLUCAGON HYDROCHLORIDE Inj 1 mg syringe kit...................................................... 5 GLYCERYL TRINITRATE Tab 600 µg .............................................................. 100 Oral pump spray 400 µg per dose ................. 250 dose HALOPERIDOL Tab 500 µg ................................................................ 30 Tab 1.5 mg ................................................................ 30 Tab 5 mg ................................................................... 30 Oral liq 2 mg per ml ........................................... 200 ml Inj 5 mg per ml, 1 ml ................................................... 5 HALOPERIDOL DECANOATE Inj 50 mg per ml, 1 ml ................................................. 5 Inj 100 mg per ml, 1 ml ............................................... 5 HYDROCORTISONE Inj 50 mg per ml, 2 ml ................................................. 5 HYDROXOCOBALAMIN Inj 1 mg per ml, 1 ml ................................................... 6 HYOSCINE N-BUTYLBROMIDE Inj 20 mg, 1 ml ............................................................ 5 IPRATROPIUM BROMIDE Nebuliser soln, 250 µg per ml, 1 ml .......................... 40 Nebuliser soln, 250 µg per ml, 2 ml .......................... 40 LEVONORGESTREL Tab 30 µg .................................................................. 84 Tab 1.5 mg .................................................................. 5 Tab 750 µg ................................................................ 10 continued. . .

186

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

(continued) LIGNOCAINE HYDROCHLORIDE Inj 0.5%, 5 ml .............................................................. 5 Inj 1%, 5 ml ................................................................. 5 Inj 1%, 20 ml ............................................................... 5 LOPERAMIDE HYDROCHLORIDE Tab 2 mg ................................................................... 30 MEDROXYPROGESTERONE ACETATE Inj 150 mg per ml, 1 ml ............................................... 5 Inj 150 mg per ml, 1 ml syringe................................... 5 METHYLERGOMETRINE Inj 200 µg per ml, 1 ml .............................................. 10 METOCLOPRAMIDE HYDROCHLORIDE Inj 5 mg per ml, 2 ml ................................................... 5 METRONIDAZOLE Tab 200 mg ............................................................... 30 MORPHINE SULPHATE Inj 5 mg per ml, 1 ml ................................................... 5 Inj 10 mg per ml, 1 ml ................................................. 5 Inj 15 mg per ml, 1 ml ................................................. 5 Inj 30 mg per ml, 1 ml ................................................. 5 NALOXONE HYDROCHLORIDE Inj 400 µg per ml, 1 ml ................................................ 5 NONOXYNOL-9 Jelly 2% ............................................................... 108 g NORETHISTERONE Tab 350 µg ................................................................ 84 Tab 5 mg ................................................................... 30 NORETHISTERONE WITH MESTRANOL Tab 1 mg with mestranol 50 µg and 7 inert tab......... 84 OXYTOCIN Inj 5 iu per ml, 1 ml ..................................................... 5 Inj 10 iu per ml, 1 ml ................................................... 5 Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml...................................................................5 PARACETAMOL Tab 500 mg ............................................................... 30 Oral liq 120 mg per 5 ml .................................... 200 ml Oral liq 250 mg per 5 ml .................................... 100 ml PETHIDINE HYDROCHLORIDE Inj 50 mg per ml, 1 ml ................................................. 5 Inj 50 mg per ml, 1.5 ml .............................................. 5 Inj 50 mg per ml, 2 ml ................................................. 5 PHENOXYMETHYLPENICILLIN (PENICILLIN V) Cap potassium salt 250 mg ...................................... 30 Grans for oral liq 125 mg per 5 ml ..................... 200 ml Grans for oral liq 250 mg per 5 ml ..................... 200 ml PHENYTOIN SODIUM Inj 50 mg per ml, 2 ml ................................................. 5 Inj 50 mg per ml, 5 ml ................................................. 5 PHYTOMENADIONE Inj 2 mg per 0.2 ml ...................................................... 5 Inj 10 mg per ml, 1 ml ................................................. 5 PIPOTHIAZINE PALMITATE Inj 50 mg per ml, 1 ml ................................................. 5 Inj 50 mg per ml, 2 ml ................................................. 5 PREDNISOLONE SODIUM PHOSPHATE Oral liq 5 mg per ml ............................................. 30 ml PREDNISONE Tab 5 mg ................................................................... 30 PROCAINE PENICILLIN Inj 1.5 mega u ............................................................. 5 PROCHLORPERAZINE Tab 5 mg ................................................................... 30 Inj 12.5 mg per ml, 1 ml .............................................. 5 PROMETHAZINE HYDROCHLORIDE Inj 25 mg per ml, 2 ml ................................................. 5 SALBUTAMOL Inj 500 µg per ml, 1 ml ................................................ 5 Aerosol inhaler, 100 µg per dose CFC free .......................................................... 1000 dose Nebuliser soln, 1 mg per ml, 2.5 ml .......................... 30 Nebuliser soln, 2 mg per ml, 2.5 ml .......................... 30 SALBUTAMOL WITH IPRATROPIUM BROMIDE Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml ............................20 SILVER SULPHADIAZINE Crm 1% with chlorhexidine digluconate 0.2% ................................................................500 g SODIUM BICARBONATE Inj 8.4%, 50ml ............................................................. 5 Inj 8.4%, 100 ml .......................................................... 5 SODIUM CHLORIDE Inf 0.9%............................................................ 2000 ml Inj 0.9%, 5 ml .............................................................. 5 Inj 0.9%, 10 ml ............................................................ 5 continued. . .

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

187

PRACTITIONER’S AND WHOLESALE SUPPLY ORDERS

(continued) TRIMETHOPRIM Tab 300 mg ............................................................... 30 WATER Puriﬁed for inj 2 ml ...................................................... 5 Puriﬁed for inj 5 ml ...................................................... 5 Puriﬁed for inj 10 ml .................................................... 5 Puriﬁed for inj 20 ml .................................................... 5 ZUCLOPENTHIXOL DECANOATE Inj 200 mg per ml, 1 ml ............................................... 5

VERAPAMIL HYDROCHLORIDE Inj 2.5 mg per ml, 2 ml ................................................ 5

Pharmaceuticals that may be obtained on a Wholesale Supply Order

INTRA-UTERINE DEVICE IUD MASK FOR SPACER DEVICE Size 2 PEAK FLOW METER Low range Normal range PREGNANCY TESTS - HCG URINE Cassette SPACER DEVICE 230 ml (autoclavable)

188

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

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 Carteron Featherston Greytown Martinborough SOUTH ISLAND Nelson/Marlborough DHB Havelock Mapua Motueka Murchison Picton Takaka Wakeﬁeld West Coast DHB Dobson Greymouth Hokitika Karamea Reefton South Westland Westport Whataroa Canterbury DHB Akaroa Amberley Amuri Cheviot Darﬁeld Diamond Harbour Hanmer Springs Kaikoura Otago DHB Alexandra Balclutha Cromwell Kurow Lawrence Milton Oamaru Outram Owaka Palmerston Ranfurly Roxburgh Tapanui Wanaka Leeston Lincoln Methven Oxford Rakaia Rolleston Rotherham Templeton Waikari

South Canterbury DHB Fairlie Geraldine Pleasant Point Temuka Twizel Waimate

Southland DHB Gore Lumsden Mataura Otautau Queenstown Riverton Te Anau Tokonui Tuatapere Winton

fully subsidised brand available Please refer to Section A for a deﬁnition, and conditions of supply, of Practitioner’s Supply Orders.

189

SECTION F: COMMUNITY PHARMACEUTICALS DISPENSING PERIOD EXEMPTIONS SECTION F: PART I

A Community Pharmaceutical identiﬁed with a F 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 F 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 F 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 L 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 Prescrpition, 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 L 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.

190

SECTION F: PART II

ALIMENTARY TRACT AND METABOLISM INSULIN ASPART INSULIN GLARGINE INSULIN ISOPHANE INSULIN ISOPHANE WITH INSULIN NEUTRAL INSULIN LISPRO INSULIN NEUTRAL

MUSCULO-SKELETAL SYSTEM PYRIDOSTIGMINE BROMIDE

NERVOUS SYSTEM AMANTADINE HYDROCHLORIDE APOMORPHINE HYDROCHLORIDE ENTACAPONE GABAPENTIN

CARDIOVASCULAR SYSTEM AMIODARONE HYDROCHLORIDE Tab 100 mg Cordarone-X Tab 200 mg Cordarone-X DISOPYRAMIDE PHOSPHATE FLECAINIDE ACETATE Tab 50 mg Tab 100 mg Cap long-acting 100 mg Cap long-acting 200 mg Tambocor Tambocor Tambocor CR Tambocor CR

LAMOTRIGINE LISURIDE HYDROGEN MALEATE PERGOLIDE ROPINIROLE HYDROCHLORIDE TOLCAPONE TOPIRAMATE VIGABATRIN

MEXILETINE HYDROCHLORIDE PROPAFENONE HYDROCHLORIDE SENSORY ORGANS BIMATOPROST BRIMONIDINE TARTRATE WITH TIMOLOL MALEATE BRINZOLAMIDE LATANOPROST TRAVOPROST

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES DESMOPRESSIN Nasal drops 100 µg per Minirin ml Nasal spray 10 µg per Desmopressin-PH&T dose

191

SECTION G: SAFETY CAP MEDICINES

Pharmacists are required, under the Code of Ethics of the Pharmacy Council of New Zealand, to endeavour 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: G 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 G 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 G 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 Practitioner’s Supply Order that a safety cap has not been supplied.

Safety Caps (NZS 5825:1991)

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

192

SAFETY CAP MEDICINES

ALIMENTARY TRACT AND METABOLISM FERROUS SULPHATE Oral liq 150 mg per 5 ml Ferodan CARDIOVASCULAR SYSTEM AMILORIDE Oral liq 1 mg per ml Biomed 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 Capoten Biomed Lanoxin Lasix Biomed DIAZEPAM Tab 2 mg Pro-Pam Tab 5 mg Pro-Pam Tab 10 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 2 mg per ml Biodone Oral liq 5 mg per ml Biodone Forte Oral liq 10 mg per ml Biodone Extra Forte MIDAZOLAM Tab 7.5 mg Hypnovel (Extemporaneously compounded oral liquid preparations) MORPHINE HYDROCHLORIDE Oral liq 1 mg per ml RA-Morph Oral liq 2 mg per ml RA-Morph Oral liq 5 mg per ml RA-Morph Oral liq 10 mg per ml RA-Morph Insoma Nitrados (Extemporaneously compounded oral liquid preparations) OXAZEPAM Tab 10 mg Ox-Pam Tab 15 mg Ox-Pam (Extemporaneously compounded oral liquid preparations) OXYCODONE HYDROCHLORIDE Oral liq 5 mg per 5 ml OxyNorm PARACETAMOL Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml PHENYTOIN SODIUM Oral liq 30 mg per 5 ml Paracare Junior Junior Parapaed Paracare Double Strength Six Plus Parapaed Dilantin NITRAZEPAM Tab 5 mg

HORMONE PREPARATIONS - SYSTEMIC EXCLUDING CONTRACEPTIVE HORMONES THYROXINE Tab 50 µg Eltroxin Tab 100 µg Eltroxin (Extemporaneously compounded oral liquid preparations) MUSCULO-SKELETAL 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 250 µg Arrow-Alprazolam Tab 500 µg Arrow-Alprazolam Tab 1 mg Arrow-Alprazolam (Extemporaneously compounded oral liquid preparations) CARBAMAZEPINE Oral liq 100 mg per 5 ml

Tegretol

CLOBAZAM Tab 10 mg Frisium (Extemporaneously compounded oral liquid preparations) CLONAZEPAM Oral drops 2.5 mg per ml

Rivotril

193

SAFETY CAP MEDICINES

SODIUM VALPROATE Oral liq 200 mg per 5 ml SALBUTAMOL Oral liq 2 mg per 5 ml THEOPHYLLINE Oral liq 80 mg per 15 ml

Epilim S/F Liquid Epilim Syrup

Salapin Nuelin

TEMAZEPAM Tab 10 mg Normison (Extemporaneously compounded oral liquid preparations) TRIAZOLAM Tab 125 µg Hypam Tab 250 µg Hypam (Extemporaneously compounded oral liquid preparations) 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

TRIMEPRAZINE TARTRATE Oral liq 30 mg per 5 ml Vallergan Forte 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)

194

INDEX Generic Chemicals and Brands

- Symbols 3TC .................................................97 -AA-Lices ............................................67 Abacavir sulphate ...........................97 Abacavir sulphate with lamivudine ................................. 97 Abilify ............................................117 Acarbose ........................................29 ACB ................................................55 Accu-Chek Performa ......................32 Accupril ...........................................53 Accuretic 10 ....................................53 Accuretic 20 ....................................53 Acebutolol .......................................55 Acetazolamide ..............................155 Acetic acid with 1, 2- propanediol diacetate and benzethonium .......................... 153 Acetic acid with hydroxyquinoline and ricinoleic acid ...................... 75 Acetylcysteine ...............................163 Aci-Jel .............................................75 Aciclovir Infection ................................93–94 Sensory ....................................153 Acidex .............................................25 Acipimox .........................................48 Acitretin ...........................................67 Actigall ............................................33 Actos ...............................................30 Actrapid ..........................................28 Actrapid Penﬁll ................................28 Acupan .........................................105 Adalat 10 ........................................57 Adalat Oros .....................................57 Adalimumab ..................................102 Adeﬁn XL ........................................57 Adefovir dipivoxil .............................94 Adrenaline ......................................59 Advantan ........................................64 AFT-Pyrazinamide ..........................93 Agents Affecting the Renin-Angiotensin System .........52 Agents Used in the Treatment of Poisonings ............................... 158 Agrylin ..........................................132 Alanase .........................................151 Albay .............................................146 Albustix .........................................158 Aldara .............................................69 Alendronate sodium ..................77–78 Alendronate sodium with cholecalciferol ............................ 77 Alfacalcidol .....................................37 Alginic acid .....................................25 Alitraq ...........................................174 Alkeran .........................................129 Allerid C ........................................146 Allersoothe ....................................147 Allopurinol .....................................104 Alpha Adrenoceptor Blockers .........52 Alpha tocopheryl acetate ................37 Alpha-Bromocriptine .....................116 Alpha-Keri Lotion ............................66 Alprazolam ....................................121 Alu-Tab ...........................................25 Aluminium hydroxide ......................25 Amantadine hydrochloride ............116 Amiloride ........................................58 Amiloride with frusemide ................59 Amiloride with hydrochlorothiazide ................... 59 Aminogran Food Supplement ............................. 181 Aminogran Mineral Mix .................181 Aminophylline ...............................150 Amiodarone hydrochloride ..............54 Amirol ...........................................108 Amitrip ..........................................108 Amitriptyline ..................................108 Amizide ...........................................59 Amlodipine ......................................57 Amorolﬁne ......................................61 Amoxil Paediatric Drops .................90 Amoxycillin ......................................90 Amoxycillin clavulanate ..................90 Amphotericin B ...............................36 Amyl nitrite ......................................60 Anabolic Agents ..............................77 Anaesthetics .................................105 Anagrelide hydrochloride ..............132 Analgesics ....................................105 Anastrozole ...................................137 Androcur Depot ..............................80 Androderm ......................................80 Antabuse ......................................126 Antacids and Antiﬂatulants .............25 Anten ............................................108 Anthelmintics ..................................88 Anti-inﬂammatory Non Steroidal Drugs (NSAIDs) ....................... 100 Antiacne Preparations ....................61 Antiallergy Preparations ...............146 Antianaemics ..................................43 Antiandrogen Oral Contraceptives ........................... 75 Antiarrhythmics ...............................54 Antibacterials ..................................88 Antibacterials Topical ......................61 Anticholinesterases ......................100 Antidepressants ............................108 Antidiarrhoeals ................................25 Antiepilepsy Drugs .......................110 Antiﬁbrinolytics, Haemostatics and Local Sclerosants ............... 44 Antifungals ......................................92 Antifungals Topical ..........................61 Antihaemorrhoidals .........................26 Antihistamines ..............................146 Antihypotensives .............................55 Antimalarials ...................................93 Antimigraine Preparations ............114 Antinaus ........................................115 Antinausea and Vertigo Agents ..................................... 114 Antiparkinson Agents ...................116 Antipruritic Preparations .................62 Antipsychotics ...............................117 Antiretrovirals ..................................96 Antiretrovirals - Additional Therapies ................................... 98 Antirheumatoid Agents .................101 Antispasmodics and Other Agents Altering Gut Motility ....................................... 27 Antithrombotic Agents ....................44 Antithymocyte globulin (equine) ................................... 140 Antitrichomonal Agents ..................93 Antituberculotics and Antileprotics ............................... 93 Antiulcerants ...................................27 Antivirals .........................................93 Anusol .............................................26 Anxiolytics .....................................121 Apo-Amoxi ......................................90 Apo-Ascorbic Acid ..........................37 Apo-B-Complex ..............................37 Apo-Captopril .................................52 Apo-Cimetidine ...............................27 Apo-Clopidogrel ..............................44 Apo-Diclo ......................................100 Apo-Diclo SR ................................100 Apo-Doxazosin ...............................52 Apo-Folic Acid ................................43

195

INDEX Generic Chemicals and Brands

Apo-Gliclazide ................................30 APO-go .........................................116 Apo-Ipravent .................................151 Apo-Moclobemide .........................109 Apo-Nadolol ....................................56 Apo-Nicotinic Acid ..........................48 Apo-Oxybutynin ..............................76 Apo-Prazo .......................................52 Apo-Prednisone ..............................79 Apo-Primidone ..............................112 Apo-Pyridoxine ...............................36 Apo-Selegiline ..............................117 Apo-Terbinaﬁne ..............................92 Apo-Thiamine .................................36 Apo-Timol .......................................57 Apo-Timop ....................................154 Apo-Zopiclone ..............................124 Apomorphine hydrochloride .........116 Applicator ........................................71 Apresoline .......................................60 Aprotinin .........................................44 Aquasun 30+ ..................................69 Aquasun Oil Free Faces SPF30+ ..................................... 69 Aquasun Sensitive SPF 30+ ...........69 Aqueous cream ..............................66 Aratac .............................................54 Arava ............................................101 Arimidex ........................................137 Aripiprazole ...................................117 Aristocort ........................................64 Aromasin ......................................138 Arrow-Alprazolam .........................121 Arrow-Azithromycin ........................89 Arrow-Citalopram ..........................109 Arrow-Lamotrigine ........................112 Arrow-Lisinopril ...............................53 Arrow-Metformin .............................30 Arrow-Nifedipine XR .......................57 Arrow-Norﬂoxacin ...........................98 Arrow-Ranitidine .............................27 Arrow-Roxithromycin ......................90 Arrow-Sumatriptan ........................114 Arsenic trioxide .............................133 Arthrexin .......................................101 Asacol .............................................26 Ascorbic acid ..................................37 Asmafen .......................................147 Aspec 300 .....................................105 Aspirin Blood ..........................................44 Nervous ....................................105 Asthalin .........................................149 Atacand ..........................................53 Atazanavir sulphate ........................97 Atenolol ...........................................55 ATGAM .........................................140 Ativan ............................................122 Atorvastatin ....................................49 Atropine sulphate Alimentary ..................................27 Sensory ....................................156 Atropt ............................................156 Atrovent ........................................149 Augmentin ......................................90 Auranoﬁn ......................................101 Avomine ........................................116 Avonex ..........................................124 Azamun ........................................139 Azatadine maleate ........................146 Azathioprine .................................139 Azithromycin ...................................89 Azopt ............................................155 AZT .................................................97 -BB-D Micro-Fine ...............................32 B-D Ultra Fine .................................33 B-D Ultra Fine II ..............................33 Baclofen ........................................104 Bactroban .......................................61 Bakels Gluten Free Health Bread Mix ........................................... 178 Barrier Creams and Emollients .................................. 65 Batrafen ..........................................61 Beclazone 100 ..............................147 Beclazone 250 ..............................147 Beclazone 50 ................................147 Beclomethasone dipropionate ..................... 147, 151 Bee venom allergy treatment ................................. 146 Bendroﬂuazide ................................59 Benhex ...........................................67 Benzathine benzylpenicillin ............90 Benzoin .........................................163 Benztrop .......................................117 Benztropine mesylate ...................117 Benzydamine hydrochloride ...........35 Benzylpenicillin sodium (penicillin G) ............................................... 90 Beta Adrenoceptor Blockers ...........55 Beta Cream ....................................63 Beta Ointment .................................63 Beta Scalp ......................................68 Beta-Adrenoceptor Agonists .........149 Betadine .........................................67 Betadine Skin Prep .........................67 Betaferon ......................................124 Betagan ........................................154 Betahistine dihydrochloride ..........114 Betaloc ............................................56 Betaloc CR .....................................56 Betamethasone dipropionate ..........63 Betamethasone sodium phosphate with betamethasone acetate ............. 78 Betamethasone valerate ...........63, 68 Betamethasone valerate with clioquinol .................................... 64 Betamethasone valerate with fusidic acid ................................. 65 Betaxolol hydrochloride ................154 Betnovate .......................................63 Betnovate-C ....................................64 Betoptic .........................................154 Betoptic S .....................................154 Bezaﬁbrate .....................................48 Bezalip Retard ................................48 Bicillin LA ........................................90 BiCNU ...........................................129 Bimatoprost ..................................155 Biodone ........................................107 Biodone Extra Forte ......................107 Biodone Forte ...............................107 Bisacodyl ........................................35 BK Lotion ........................................66 Blenoxane .....................................133 Bleomycin sulphate ......................133 Bleph 10 .......................................154 Bonjela ............................................35 Breath-Alert ..................................152 Brevinor 1/21 ..................................73 Brevinor 1/28 ..................................73 Brevinor 21 .....................................73 Bricanyl Turbuhaler .......................149 Brimonidine tartrate ......................155 Brimonidine tartrate with timolol maleate .................................... 155 Brinzolamide .................................155 Brolene .........................................153 Bromocriptine mesylate ................116 Brufen ...........................................100 Brufen Retard ...............................100 Buccastem ....................................115 Budesonide Alimentary ..................................25 Respiratory .......................147, 151 Budesonide with

196

INDEX Generic Chemicals and Brands

eformoterol .............................. 149 Bumetanide ....................................58 Bupivacaine hydrochloride ...........105 Buprenorphine hydrochloride ........................... 106 Burinex ...........................................58 Buscopan ........................................27 Buserelin acetate ............................84 Buspirone hydrochloride ...............121 Busulphan .....................................129 Butacort Aqueous .........................151 -CCabergoline ....................................87 Cafergot ........................................114 Cal-d-Forte .....................................37 Calamine ........................................62 Calci-Tab 500 ..................................38 Calci-Tab 600 ..................................38 Calci-Tab Effervescent ....................38 Calcipotriol ......................................67 Calcitonin ........................................78 Calcitriol ..........................................37 Calcitriol-AFT ..................................37 Calcium ...........................................37 Calcium carbonate ..........................38 Calcium carbonate with aminoacetic acid ........................ 25 Calcium Channel Blockers .............57 Calcium Disodium Versenate ................................ 158 Calcium folinate ............................130 Calcium Folinate Ebewe ...............130 Calcium gluconate ..........................38 Calcium Homeostasis .....................77 Calcium polystyrene sulphonate ................................. 48 Calcium Resonium .........................48 Calcium-Sandoz 1000 ....................37 Calogen ........................................168 Calsource .......................................37 Calvasc ...........................................57 Camptosar ....................................131 Candesartan ...................................53 Canesten ........................................62 Capadex .......................................106 Capecitabine .................................130 Capoten ..........................................52 Capsaicin ........................................70 Captopril .........................................52 Carafate ..........................................28 Carbamazepine ............................111 Carbimazole ...................................83 Carboplatin ...................................129 Carboplatin Ebewe .......................129 Carbosorb-X .................................158 Cardinol ..........................................56 Cardinol LA .....................................56 Cardizem CD ..................................57 Carmustine ...................................129 Carvedilol .......................................55 Catapres .........................................58 Catapres-TTS-1 ..............................58 Catapres-TTS-2 ..............................58 Catapres-TTS-3 ..............................58 CeeNU ..........................................129 Cefaclor monohydrate ....................88 Cefazolin sodium ............................88 Cefoxitin sodium .............................88 Ceftriaxone sodium ........................88 Cefuroxime axetil ............................88 Cefuroxime sodium .........................89 Celapram ......................................109 Celestone Chronodose ...................78 Celiprolol .........................................55 Cellcept .........................................139 Celol ...............................................55 Cerezyme .......................................35 Cetirizine hydrochloride ................146 Cetomacrogol .................................66 Charcoal .......................................158 Chemotherapeutic Agents ............129 Chlorambucil .................................129 Chloramphenicol ...........................153 Chlorhexidine gluconate Alimentary ..................................35 Dermatological ...........................65 Chloroform ....................................163 Chloromycetin ...............................153 Chlorothiazide .................................59 Chlorpheniramine maleate ...........146 Chlorpromazine hydrochloride ........................... 118 Chlorsig ........................................153 Chlorthalidone ................................59 Chlorvescent ..................................48 Cholecalciferol ................................37 Cholestyramine with aspartame ................................. 49 Choline salicylate with cetalkonium chloride .................. 35 Ciclopirox olamine ..........................61 Cilazapril .........................................52 Cilazapril with hydrochlorothiazide ................... 53 Cilicaine ..........................................91 Cilicaine VK ....................................91 Ciloxan ..........................................153 Cimetidine .......................................27 Cipﬂox .............................................91 Ciproﬂoxacin Infection ......................................91 Sensory ....................................153 Cisplatin ........................................129 Cisplatin Ebewe ............................129 Citalopram - Rex ...........................109 Citalopram hydrobromide .............109 Cladribine .....................................131 Clarithromycin .................................89 Climara 100 ....................................81 Climara 50 ......................................81 Clindamycin ....................................91 Clinistix ...........................................31 Clinitest ...........................................31 Clinoril ..........................................101 Clobazam .....................................111 Clobetasol propionate ...............63, 68 Clobetasone butyrate .....................63 Clomazol Dermatological ...........................62 Genito-Urinary ............................75 Clomiphene citrate ..........................87 Clomipramine hydrochloride .........108 Clonazepam .........................110–111 Clonidine .........................................58 Clonidine hydrochloride Cardiovascular ...........................58 Nervous ....................................114 Clopidogrel .....................................44 Clopine .........................................118 Clopixol .........................................120 Clopress .......................................108 Clotrimaderm 2% ............................75 Clotrimazole Dermatological ...........................62 Genito-Urinary ............................75 Clozapine ......................................118 Clozaril .........................................118 Co-Renitec ......................................53 Co-trimoxazole ...............................91 Coal tar ...........................................67 Coal tar with allantoin, menthol, phenol and sulphur .................... 68 Coal tar with salicyclic acid and sulphur ....................................... 68 Coco-Scalp .....................................68 Codalgin .......................................108 Codeine phosphate Extemporaneous ......................163

197

INDEX Generic Chemicals and Brands

Nervous ....................................106 Cogentin .......................................117 Colaspase (L-asparaginase) .........133 Colchicine .....................................104 Colestid ...........................................49 Colestipol hydrochloride .................49 Colgout .........................................104 Colifoam .........................................26 Colistin sulphomethate ...................92 Colistin-Link ....................................92 Collodion ﬂexible ..........................163 Colofac ...........................................27 Coloxyl ............................................34 Combantrin .....................................88 Combigan .....................................155 Combivent ....................................150 Combivir .........................................97 Compound electrolytes ...................48 Compound hydroxybenzoate ..................... 163 Comtan .........................................116 Concerta .......................................127 Condoms ........................................71 Condyline ........................................69 Contraceptives - Hormonal .............72 Contraceptives Non-hormonal ............................ 71 Copaxone .....................................123 Copper ............................................31 Corangin .........................................59 Cordarone-X ...................................54 Corticosteroids and Related Agents for Systemic Use ........... 78 Corticosteroids Topical ...................63 Cosmegen ....................................133 Cosopt ..........................................155 Cotazym ECS .................................33 Coumadin .......................................47 Coversyl ..........................................53 Cozaar ............................................54 Creon 10000 ...................................33 Creon Forte ....................................33 Crixivan ...........................................97 Cromolux ......................................154 Crotamiton ......................................63 Crystacide ......................................61 Cyclizine hydrochloride .................114 Cyclizine lactate ............................114 Cycloblastin ..................................129 Cyclogyl ........................................156 Cyclopentolate hydrochloride ........................... 156 Cyclophosphamide .......................129 Cyclosporin A ...............................144 Cyklokapron ....................................44 Cyproheptadine hydrochloride ........................... 146 Cyproterone acetate .......................80 Cyproterone acetate with ethinyloestradiol ......................... 75 Cystic Fibrosis ..............................151 Cytarabine ....................................131 Cytotec ...........................................27 Cytoxan ........................................129 -DD-Penamine ..................................102 D-Zol ...............................................87 d4T .................................................97 Dacarbazine .................................133 Daclin ............................................101 Dactinomycin (actinomycin D) ............................................. 133 Daivonex .........................................67 Daktarin Alimentary ..................................36 Dermatological ...........................62 Dalacin C ........................................91 Danazol ..........................................87 Dantrium .......................................104 Dantrolene sodium .......................104 Dapsone .........................................93 Daunorubicin ................................133 DDI .................................................97 Deca-Durabolin Orgaject ................77 Delact ...........................................184 Depo-Medrol ...................................79 Depo-Medrol with lidocaine ............79 Depo-Provera .................................74 Depo-Testosterone .........................80 Derbac-M ........................................67 Dermol ......................................63, 68 Desferrioxamine mesylate ............158 Desmopressin .................................87 Desmopressin-PH&T ......................87 Detection of Substances in Urine ........................................ 158 Dexamethasone Hormone ....................................79 Sensory ....................................154 Dexamethasone sodium phosphate .................................. 79 Dexamethasone with framycetin and gramicidin ......................... 153 Dexamethasone with neomycin and polymyxin b sulphate .........154 Dexamphetamine sulphate ...........124 Dextrochlorpheniramine maleate .................................... 146 Dextropropoxyphene with paracetamol ............................. 106 Dextrose .........................................47 Dextrose with electrolytes ...............48 DHC Continus ...............................106 Diabetes .........................................28 Diabetes Management ...................31 Diabur 5000 ....................................31 Diamox .........................................155 Diaphragm ......................................71 Diasip ............................................170 Diason RTH ..................................170 Diastix .............................................31 Diastop ...........................................25 Diatol ..............................................31 Diazepam .............................110, 122 Dibenyline .......................................52 Dibromopropamidine isethionate ............................... 153 Diclocil ............................................90 Diclofenac sodium Musculo-skeletal ......................100 Sensory ....................................154 Dicloxacillin .....................................90 Didanosine [DDI] ............................97 Didronel ..........................................78 Difﬂam ............................................35 Diﬂucortolone valerate ....................64 Digestives Including Enzymes .................................... 33 Digoxin ............................................54 Dihydrocodeine tartrate ................106 Dilantin ..........................................112 Dilantin Infatab ..............................112 Dilatrend .........................................55 Diltiazem hydrochloride ..................57 Dilzem .............................................57 Dilzem LA .......................................57 Dilzem SR .......................................57 Dimetriose ......................................87 Dipentum ........................................26 Diphemanil methylsulphate ............65 Diphenoxylate hydrochloride with atropine sulphate ....................... 25 Diprosone .......................................63 Diprosone OV .................................63 Dipyridamole ...................................45 Disinfecting and Cleansing Agents ....................................... 65 Disipal ...........................................117

198

INDEX Generic Chemicals and Brands

Disopyramide phosphate ................54 Disulﬁram ......................................126 Dithranol .........................................68 Diuretics ..........................................58 Diurin 40 .........................................58 Diurin 500 .......................................58 Dixarit ...........................................114 Docetaxel ......................................133 Docusate sodium ............................34 Docusate sodium with sennosides ................................ 34 Domperidone ................................115 Dopergin .......................................116 Dopress ........................................108 Dornase alfa .................................151 Dorzolamide hydrochloride ...........155 Dorzolamide hydrochloride with timolol maleate ........................ 155 Dostinex ..........................................87 Dothiepin hydrochloride ................108 Doxazosin mesylate .......................52 Doxepin hydrochloride ..................108 Doxine ............................................91 Doxorubicin ...................................134 Doxorubicin Ebewe .......................134 Doxy-50 ..........................................91 Doxycycline hydrochloride ..............91 DP Lotion ........................................66 DP Lotn HC ....................................64 Dr Reddy’s Omeprazole .................28 Dr Reddy’s Pantoprazole ................28 Dulcolax ..........................................35 Duocal Super Soluble Powder ..................................... 167 Duolin ...........................................150 Duphalac ........................................34 Duphaston ......................................82 Durex Conﬁdence ...........................71 Duride .............................................59 Durogesic .....................................106 Dusting Powders .............................65 Dydrogesterone ..............................82 Dynacirc-SRO .................................57 -EE-Mycin ...........................................89 Ear Preparations ...........................153 Ear/Eye Preparations ...................153 Easiphen .......................................181 Easiphen Liquid ............................181 Econazole nitrate ............................62 Efavirenz .........................................96 Efexor XR .....................................110 Eformoterol fumarate ....................148 Efudix ..............................................70 Egopsoryl TA ..................................68 Elemental 028 Extra .....................174 Eligard ............................................86 Elocon .............................................64 Eloxatin .........................................129 Eltroxin ............................................83 EMLA ............................................105 Emtricitabine ...................................97 Emtriva ...........................................97 Emulsifying ointment ......................66 Enalapril .........................................53 Enalapril with hydrochlorothiazide ................... 53 Enbrel ...........................................103 Endocrine Therapy .......................137 Endoxan .......................................129 Enerlyte ..........................................48 Enfuvirtide ......................................98 Ensure ..........................................169 Ensure Plus ..................................176 Ensure Plus RTH ..........................176 Entacapone ..................................116 Entocort CIR ...................................25 Enuclene .......................................156 Enzymes .......................................104 Epilim ............................................113 Epilim Crushable ..........................113 Epilim IV .......................................113 Epilim S/F Liquid ...........................113 Epilim Syrup .................................113 Epirubicin ......................................134 Epirubicin Ebewe ..........................134 Eprex ..............................................43 ERA ................................................90 Ergometrine maleate ......................75 Ergotamine tartrate with caffeine .................................... 114 Erythrocin IV ...................................90 Erythromycin ethyl succinate ..........89 Erythromycin lactobionate ..............90 Erythromycin stearate ....................90 Erythropoietin alpha .......................43 Erythropoietin beta .........................43 Estelle 35 ........................................75 Estraderm TTS 100 ........................81 Estraderm TTS 25 ..........................81 Estraderm TTS 50 ..........................81 Estrofem .........................................81 Etanercept ....................................103 Ethambutol hydrochloride ...............93 Ethics Aspirin ................................105 Ethics Aspirin EC ............................44 Ethinyloestradiol .............................82 Ethinyloestradiol with desogestrel ................................ 72 Ethinyloestradiol with gestodene .................................. 72 Ethinyloestradiol with levonorgestrel ............................ 73 Ethinyloestradiol with norethisterone ............................ 73 Ethosuximide ................................111 Etidrate ...........................................78 Etidronate disodium ........................78 Etopophos ....................................134 Etoposide ......................................134 Etoposide phosphate ....................134 Eumovate .......................................63 Eurax ..............................................63 Exemestane ..................................138 Extemporaneously Compounded Preparations and Galenicals ................................ 163 Eye Preparations ..........................153 Ezetimibe ........................................50 Ezetimibe with simvastatin .............51 Ezetrol ............................................50 -FFamotidine ......................................27 Famox .............................................27 Felo 10 ER ......................................57 Felo 5 ER ........................................57 Felodipine .......................................57 Femara .........................................138 Femodene 28 .................................72 Femtran 100 ...................................81 Femtran 50 .....................................81 Fenpaed .......................................100 Fentanyl ........................................106 Ferodan ..........................................38 Ferro-F-Tabs ...................................38 Ferro-Gradumet ..............................38 Ferro-tab .........................................38 Ferrograd-Folic ...............................38 Ferrosig ..........................................38 Ferrous fumarate ............................38 Ferrous fumarate with folic acid ............................................ 38 Ferrous gluconate with ascorbic acid ............................................ 38 Ferrous sulphate .............................38 Ferrous sulphate with folic acid ............................................ 38 Ferrum H ........................................38 Fexofenadine hydrochloride .........147

199

INDEX Generic Chemicals and Brands

Fibalip .............................................48 Fibresource ...................................176 Fibresource HN ............................176 Fibresource HN RTH ....................176 Fibresource RTH ..........................176 Fibro-vein ........................................44 Finasteride ......................................76 Fintral ..............................................76 Flagyl ..............................................93 Flagyl-S ..........................................93 Flecainide acetate ..........................55 Fleet ................................................35 Fleet Glycerin Suppositories ..........34 Fleet Phosphate Enema .................35 Flixotide ........................................147 Flixotide Accuhaler .......................147 Florinef ...........................................79 Fluanxol ........................................120 Flucloxacillin sodium .......................91 Flucloxin .........................................91 Flucon ...........................................154 Fluconazole ....................................92 Fludara .........................................131 Fludarabine phosphate .................131 Fludrocortisone acetate ..................79 Fluids and Electrolytes ...................47 Flumetasone pivalate ...................153 Fluocortolone caproate with ﬂuocortolone pivalate and cinchocaine ................................ 26 Fluorometholone ...........................154 Fluorouracil Ebewe .......................131 Fluorouracil sodium Dermatological ...........................70 Oncology ..................................131 Fluox .............................................110 Fluoxetine hydrochloride ...............110 Flupenthixol decanoate ................120 Fluphenazine decanoate ..............120 Flutamide ......................................138 Flutamin ........................................138 Fluticasone ...................................147 Fluticasone with salmeterol ..........149 Fluvax .............................................99 Foban .............................................61 Folic acid ........................................43 Food Thickeners ...........................178 Foods And Supplements For Inborn Errors Of Metabolism Other ........................................ 179 Foods And Supplements For Inborn Errors Of Metabolism PKU ......................................... 180 Foradil ...........................................148 Foremount Child’s Silicone Mask ........................................ 151 Fortimel ........................................171 Fortini ...........................................172 Fortini Multiﬁbre ............................172 Fortisip ..........................................176 Fortisip Multi Fibre ........................177 Fortisip Powder .............................169 Fosamax ...................................77, 78 Fosamax Plus .................................77 Framycetin sulphate .....................153 Frisium ..........................................111 Frumil ..............................................59 Frusemide .......................................58 Fucicort ...........................................65 Fucidin ............................................92 Fucithalmic ...................................153 Fungilin ...........................................36 Fusidic acid Dermatological ...........................61 Infection ......................................92 Sensory ....................................153 Fuzeon ............................................98 -GGabapentin ...................................111 Gamma benzene hexachloride .............................. 67 Gastrosoothe ..................................27 Gaviscon .........................................25 Gaviscon Double Strength ..............25 Gaviscon Infant ...............................25 Gemcitabine hydrochloride ...........131 Gemzar .........................................131 Generaid Plus ...............................171 Genoptic .......................................153 Genotropin ......................................83 Genox ...........................................139 Gentamicin sulphate Infection ......................................92 Sensory ....................................153 Gestrinone ......................................87 Glatiramer acetate ........................123 Gliben .............................................30 Glibenclamide .................................30 Gliclazide ........................................30 Glipizide ..........................................30 Glivec ............................................136 Glucagen Hypokit ...........................28 Glucagon hydrochloride ..................28 Glucerna .......................................170 Glucerna RTH ...............................170 Glucerna Select ............................170 Glucerna Select RTH ....................170 Glucobay ........................................29 Glucose blood diagnostic test meter ......................................... 32 Glucose dehydrogenase .................32 Glucose oxidase .......................31–32 Gluten Free Foods ........................178 Glycerol Alimentary ..................................34 Extemporaneous ......................163 Glycerol with parafﬁn and cetyl alcohol ....................................... 66 Glyceryl trinitrate ............................59 Gold Knight .....................................71 Gopten ............................................53 Goserelin acetate ...........................85 Growth hormone biosynthetic human ........................................ 83 Gutron .............................................55 Gynaecological Anti-infectives ............................ 75 Gynol II ...........................................71 -HHabitrol ...........................................60 Haldol ...........................................120 Haldol Concentrate .......................120 Haloperidol ...................................118 Haloperidol decanoate .................120 Hamilton Sunscreen .......................69 Healtheries Iron with Vitamin C ................................................ 38 Healtheries Multi-vitamin tablets ........................................ 37 Healtheries Simple Baking Mix ........................................... 178 Hemastix .......................................158 Heparin sodium ..............................46 Heparinised saline ..........................46 Hepsera ..........................................94 Herceptin ......................................143 Hexamine hippurate .......................98 Hiprex .............................................98 Histafen ........................................146 Holoxan ........................................129 Homatropine hydrobromide ..........156 Horleys Bread Mix ........................178 Horleys Flour ................................178 Hormone Replacement Therapy Systemic .................................... 80 Humalog .........................................29 Humira ..........................................102 HumiraPen ....................................102 Humulin 30/70 ................................29

200

INDEX Generic Chemicals and Brands

Humulin NPH ..................................28 Humulin R .......................................28 Hyalase .........................................104 Hyaluronidase ...............................104 Hybloc .............................................56 Hydralazine .....................................60 Hydrea ..........................................134 Hydrocortisone Dermatological ...........................64 Hormone ....................................79 Hydrocortisone acetate ..................26 Hydrocortisone butyrate ...........64, 68 Hydrocortisone butyrate with chlorquinaldol ............................ 65 Hydrocortisone with miconazole ................................ 65 Hydrocortisone with natamycin and neomycin ............................ 65 Hydrocortisone with wool fat and mineral oil .................................. 64 Hydroderm Lotion ...........................66 Hydrogen peroxide Alimentary ..................................36 Dermatological .....................61, 70 Hydroxocobalamin ..........................36 Hydroxychloroquine sulphate .........93 Hydroxyurea .................................134 Hygroton .........................................59 Hyoscine (scopolamine) ...............115 Hyoscine hydrobromide ................115 Hyoscine N-butylbromide ...............27 Hypam ..........................................124 Hyperuricaemia and Antigout ................................... 104 Hypnovel .......................................124 Hypromellose ................................156 Hyprosin .........................................52 Hytrin ..............................................52 Hytrin Starter Pack .........................52 Hyzaar ............................................54 -II-Profen .........................................100 Ibiamox ...........................................90 Ibuprofen ......................................100 Idarubicin hydrochloride ...............134 Ifosfamide .....................................129 Imatinib mesylate ..........................136 Imiglucerase ...................................35 Imigran ..........................................114 Imipramine hydrochloride .............109 Imiquimod .......................................69 Immunosuppressants ...................139 Imuran ..........................................139 Indapamide .....................................59 Indinavir ..........................................97 Indomethacin ................................101 Infant Formulae ............................182 Inﬂuenza vaccine ............................99 Inhaled Anticholinergic agents ...................................... 149 Inhaled Corticosteroids .................147 Inhaled Long-acting Beta-adrenoceptor Agonists ................................... 148 Inhibace ..........................................52 Inhibace Plus ..................................53 Insoma ..........................................124 Insulin aspart ..................................29 Insulin glargine ...............................29 Insulin isophane ..............................28 Insulin isophane with insulin neutral ........................................ 29 Insulin lispro ....................................29 Insulin neutral .................................28 Insulin pen needles .........................32 Insulin syringes, disposable with attached needle ......................... 33 Intal Spincaps ...............................150 Interferon alpha-2a .......................140 Interferon alpha-2a with ribavirin .................................... 141 Interferon alpha-2b .......................141 Interferon beta-1-alpha .................124 Interferon beta-1-beta ...................124 Intra-uterine device .........................71 Intron-A .........................................141 Invirase ...........................................98 Ipecacuanha .................................158 Ipratropium bromide .............149, 151 Ipratropium Steri-Neb ...................149 Irinotecan ......................................131 Iron polymaltose .............................38 Ismo 20 ...........................................59 Isogel ..............................................34 Isoniazid .........................................93 Isoprenaline hydrochloride .............59 Isoptin .............................................58 Isopto Homatropine ......................156 Isosorbide mononitrate ...................59 Isosource 1.5 ................................176 Isosource HN ................................176 Isosource HN RTH .......................176 Isosource Standard ......................176 Isosource Standard RTH ..............176 Isotane 10 .......................................61 Isotane 20 .......................................61 Isotretinoin ......................................61 Isradipine ........................................57 Isuprel .............................................59 Itraconazole ....................................92 -JJanola .............................................65 Jevity RTH ....................................176 Junior Parapaed ...........................106 -KK-Thrombin .....................................44 Kaletra ............................................97 Karicare Food Thickener ..............178 Karicare Goats Milk Infant Formula ................................... 184 Karicare Soy All Ages ...................184 Kemadrin ......................................117 Kenacomb Dermatological ...........................65 Sensory ....................................153 Kenacort-A ......................................79 Kenacort-A40 ..................................79 Keppra ..........................................112 Keto-Diabur 5000 ............................32 Keto-Diastix ....................................32 Ketoconazole Dermatological .....................62, 68 Infection ......................................92 Ketopine .........................................68 Ketoprofen ....................................100 Ketostix ...........................................32 Ketotifen ........................................147 Ketovite .........................................182 Ketovite Syrup ..............................182 Ketur-Test .......................................32 Kindergen .....................................171 Kivexa .............................................97 Klacid ..............................................89 Klamycin .........................................89 Kliogest ...........................................82 Kliovance ........................................82 Konakion .........................................44 Konakion MM ..................................44 Konsyl-D .........................................34 -LLA-Morph ......................................107 Labetalol .........................................56 Lacri-Lube ....................................157 Lactulose ........................................34 Lamictal ........................................112 Lamivudine ...............................94, 97 Lamotrigine ...................................112 Lanoxin ...........................................54

201

INDEX Generic Chemicals and Brands

Lanoxin PG .....................................54 Lansoprazole ..................................27 Lantus .............................................29 Lantus SoloStar ..............................29 Lanvis ...........................................132 Largactil ........................................118 Lasix ...............................................58 Latanoprost ...................................155 Lax-Tabs .........................................35 Laxatives ........................................34 Laxsol .............................................34 Leﬂunomide ..................................101 Lemnis Fatty Cream .......................66 Lemnis Fatty Cream HC .................64 Letrozole .......................................138 Leukeran FC .................................129 Leunase ........................................133 Leuprorelin ......................................86 Leustatin .......................................131 Levetiracetam ...............................112 Levlen ED .......................................73 Levobunolol ..................................154 Levocabastine ..............................154 Levodopa with benserazide ..........116 Levodopa with carbidopa ..............116 Levonorgestrel Genito-Urinary ............................74 Hormone ....................................82 Lifestyles Flared .............................71 Lignocaine hydrochloride ..............105 Lignocaine with chlorhexidine ........................... 105 Lignocaine with prilocaine ............105 Lipex ...............................................50 Lipid Modifying Agents ...................48 Lipitor ..............................................49 Liquiﬁlm Forte ...............................156 Liquiﬁlm Tears ...............................156 Liquigen ........................................168 Lisinopril .........................................53 Lisuride hydrogen maleate ...........116 Litak ..............................................131 Lithicarb ........................................118 Lithium carbonate .........................118 Livostin .........................................154 Locasol .........................................182 Loceryl ............................................61 Locoid .......................................64, 68 Locoid C .........................................65 Locoid Crelo ...................................64 Locoid Lipocream ...........................64 Locorten-Vioform ..........................153 Lodoxamide trometamol ...............154 Loette .............................................73 Logem ...........................................112 Lomide ..........................................154 Lomustine .....................................129 Loperamide hydrochloride ..............25 Lophlex LQ ...................................181 Lopinavir with ritonavir ....................97 Lopresor .........................................56 Lopressor ........................................56 Loproﬁn .........................................181 Loproﬁn Mix ..................................180 Loraclear Hayfever Relief .............147 Lorapaed ......................................147 Loratadine .....................................147 Lorazepam ....................................122 Lormetazepam .............................124 Losartan .........................................54 Losec ..............................................28 Losec Hp7 OAC ..............................27 Loten ..............................................55 Lovir ..........................................93, 94 Loxamine ......................................110 Lucrin Depot ...................................86 Ludiomil ........................................109 Lumigan ........................................155 Lycinate ..........................................59 Lyderm ............................................67 -Mm-Cefazolin ....................................88 m-Enalapril .....................................53 m-Eslon ........................................107 m-Hydrocortisone ...........................64 Mabthera ......................................143 Macrogol 3350 ................................34 Madopar 125 ................................116 Madopar 250 ................................116 Madopar 62.5 ...............................116 Madopar Dispersible .....................116 Madopar HBS ...............................116 Magnesium hydroxide ...................163 Magnesium sulphate Alimentary ..................................38 Dermatological ...........................70 Malathion ........................................67 Maprotiline hydrochloride .............109 Marcain Heavy ..............................105 Marcain Isobaric ...........................105 Marevan ..........................................47 Marine Blue Lotion SPF 30+ ..........69 Marquis Black .................................71 Marquis Conforma ..........................71 Marquis Protecta ............................71 Marquis Selecta ..............................71 Marquis Sensolite ...........................71 Marquis Supalite .............................71 Marquis Titillata ..............................71 MarquisTantiliza ..............................71 Marvelon 21 ....................................72 Marvelon 28 ....................................72 Mask for spacer device .................151 Mast cell stabilisers ......................150 Maxalt Melt ...................................114 Maxidex ........................................154 Maxitrol .........................................154 MCT oil (Nutricia) .........................168 MDS Quick Card .............................75 Mebendazole ..................................88 Mebeverine hydrochloride ..............27 Medrol .............................................79 Medroxyprogesterone acetate Genito-Urinary ............................74 Hormone ..............................81, 83 Mefenamic acid ............................100 Megace .........................................138 Megestrol acetate .........................138 Melphalan .....................................129 Menadione sodium bisulphite .........44 Menthol ...........................................63 Mercaptopurine ............................132 Mercilon 21 .....................................72 Mercilon 28 .....................................72 Mesalazine .....................................26 Mesna ...........................................135 Mestinon .......................................100 Metabolic Disorder Agents .............35 Metabolic Mineral Mixture .............181 Metamide ......................................115 Metamucil .......................................34 Metformin hydrochloride .................30 Methadone hydrochloride Extemporaneous ......................163 Nervous ....................................107 Methatabs .....................................107 Methoblastin .................................132 Methopt .........................................156 Methotrexate .................................132 Methotrexate Ebewe .....................132 Methotrimeprazine ........................118 Methyl hydroxybenzoate ...............163 Methylcellulose .............................163 Methyldopa .....................................58 Methylergometrine ..........................75 Methylphenidate hydrochloride ........................... 126 Methylphenidate hydrochloride

202

INDEX Generic Chemicals and Brands

extended release ..................... 127 Methylprednisolone ........................79 Methylprednisolone aceponate .................................. 64 Methylprednisolone acetate ............79 Methylprednisolone acetate with lignocaine .................................. 79 Methylprednisolone sodium succinate ................................... 79 Methylxanthines ............................150 Metoclopramide hydrochloride ........................... 115 Metoclopramide hydrochloride with paracetamol ..................... 114 Metopirone ......................................87 Metoprolol succinate .......................56 Metoprolol tartrate ..........................56 Metronidazole .................................93 Metyrapone .....................................87 Mexiletine hydrochloride .................55 Mexitil .............................................55 Miacalcic .........................................78 Mianserin hydrochloride ...............109 Micanol ...........................................68 Micelle E .........................................37 Miconazole .....................................36 Miconazole nitrate Dermatological ...........................62 Genito-Urinary ............................75 Micreme ..........................................75 Micreme H ......................................65 Microgynon 20 ED ..........................73 Microgynon 30 ................................73 Microgynon 30 ED ..........................73 Microgynon 50 ED ..........................73 Microlax ..........................................35 Microlut ...........................................74 Midazolam ....................................124 Midodrine ........................................55 Minaphlex .....................................181 Minerals ..........................................37 Minidiab ..........................................30 Minirin .............................................87 Mino-tabs ........................................91 Minocycline hydrochloride ..............91 Minomycin ......................................91 Minor Skin Infections ......................67 Minulet 28 .......................................72 Mirena .............................................82 Misoprostol .....................................27 Mitomycin C ..................................135 Mitomycin-C ..................................135 Mitozantrone .................................135 Mitozantrone Ebewe .....................135 Mixtard 30 .......................................29 Moclobemide ................................109 Modecate ......................................120 Moducal ........................................166 Mogine ..........................................112 Mometasone furoate .......................64 Monofeme .......................................73 Monogen .......................................170 Morphine hydrochloride ................107 Morphine sulphate ........................107 Morphine tartrate ..........................107 Morrex Maltodextrin ......................166 Motilium ........................................115 Mouth and Throat ...........................35 Movicol ...........................................34 MSUD Maxamaid .........................180 MSUD Maxamum .........................180 Mucilaginous laxatives ....................34 Mucilaginous laxatives with stimulants .................................. 34 Mucilax ...........................................34 Multiload Cu 375 .............................71 Multiload Cu 375 SL .......................71 Multiparin ........................................46 Multiple Sclerosis Treatments ............................... 122 Multivitamin Supplements For Inborn Errors Of Metabolism .............................. 182 Mupirocin ........................................61 Muscle Relaxants .........................104 Myambutol ......................................93 Mycobutin .......................................93 Mycophenolate mofetil ..................139 Mycostatin ......................................62 Mydriacyl ......................................156 Mylanta P ........................................25 Myleran .........................................129 Myocrisin ......................................102 Myometrial and Vaginal Hormone Preparations .............................. 75 -NNadolol ...........................................56 Nalcrom ..........................................26 Naloxone hydrochloride ................158 Naltrexone hydrochloride ..............128 Nandrolone decanoate ...................77 Napamide .......................................59 Naphazoline hydrochloride ...........157 Naphcon Forte ..............................157 Naprosyn SR 1000 .......................101 Naprosyn SR 750 .........................101 Naproxen ......................................101 Naproxen sodium ..........................101 Nardil ............................................109 Nasal Preparations .......................151 Natulan .........................................135 Nausicalm .....................................114 Navoban .......................................116 Nedocromil ...................................150 Nefopam hydrochloride ................105 Neo-B12 .........................................36 Neo-Mercazole ...............................83 Neo-Naclex .....................................59 Neocate ........................................183 Neocate Advance .........................183 Neocate LCP ................................183 Neoral ...........................................144 NeoRecormon ................................43 Neostigmine ..................................100 Neotigason .....................................67 Nepro (vanilla) ..............................173 Nerisone .........................................64 Neulactil ........................................119 Neurontin ......................................111 Nevirapine ......................................96 Nicotine ...........................................60 Nicotinell .........................................60 Nicotinic acid ..................................48 Nifedipine ........................................57 Nifuran ............................................98 Nilstat Alimentary ..................................36 Genito-Urinary ............................75 Infection ......................................92 Nipent ...........................................135 Nitrados ........................................124 Nitrates ...........................................59 Nitrazepam ...................................124 Nitroderm TTS ................................59 Nitrofurantoin ..................................98 Nitrolingual Pumpspray ..................59 Nizoral Dermatological ...........................62 Infection ......................................92 Noctamid ......................................124 Nodia ..............................................25 Noﬂam 250 ...................................101 Noﬂam 500 ...................................101 Nonoxynol-9 ...................................71 Nordette 28 .....................................73 Norditropin SimpleXx 10mg ............84 Norditropin SimpleXx 15mg ............84 Norditropin SimpleXx 5mg ..............84

203

INDEX Generic Chemicals and Brands

Norethisterone Genito-Urinary ............................74 Hormone ....................................83 Norethisterone with mestranol ................................... 73 Norﬂex ..........................................104 Norﬂoxacin ......................................98 Noriday 28 ......................................74 Norimin ...........................................73 Norinyl-1/28 ....................................73 Normacol ........................................34 Normacol Plus ................................34 Normison ......................................124 Norpress .......................................109 Nortriptyline hydrochloride ............109 Norvir ..............................................97 NovaSource Renal .......................173 NovoFine ........................................32 NovoRapid ......................................29 NovoRapid Penﬁll ...........................29 Nozinan ........................................118 Nuelin ...........................................150 Nuelin-SR .....................................150 Nupentin .......................................111 Nutraplus ........................................66 Nutrient Modules ..........................166 Nutrini Energy RTH ......................172 Nutrini RTH ...................................172 Nutrison Concentrated .................173 Nutrison Energy Multi Fibre ..........176 Nutrison Multi Fibre ......................176 Nutrison Standard RTH ................176 Nuvelle ............................................82 Nyefax Retard .................................57 Nystatin Alimentary ..................................36 Dermatological ...........................62 Genito-Urinary ............................75 Infection ......................................92 NZB Low Gluten Bread Mix ..........178 -OOctreotide (somatostatin analogue) ................................. 138 Oestradiol .......................................81 Oestradiol valerate .........................81 Oestradiol with levonorgestrel .........82 Oestradiol with norethisterone ............................ 82 Oestriol Genito-Urinary ............................75 Hormone ....................................82 Oestrogens .....................................81 Oestrogens with medroxyprogesterone ................ 82 Oil in water emulsion ......................66 Oily cream ......................................66 Olanzapine ...........................118, 120 Olbetam ..........................................48 Olsalazine .......................................26 Omeprazole ....................................28 Omeprazole, amoxycillin and clarithromycin ............................ 27 Omezol ...........................................28 Ondansetron .................................115 One-Alpha ......................................37 Onkotrone .....................................135 Optium ............................................32 Optium Xceed .................................32 Orabase ..........................................36 Oracort ...........................................36 Oral Supplements .........................168 Oral Supplements/Complete Diet (Nasogastric/Gastrostomy Tube Feed) .............................. 169 Orgran ..........................................179 Ornidazole ......................................93 Orphenadrine citrate .....................104 Orphenadrine hydrochloride .........117 Ortho ..............................................71 Ortho All-ﬂex ...................................71 Ortho Coil .......................................71 Ortho-tolidine ................................158 Oruvail 100 ...................................100 Oruvail 200 ...................................100 Osmolite RTH ...............................176 Other CNS Agents ........................124 Other Endocrine Agents .................87 Other Oestrogen Preparations .............................. 82 Other Progestogen Preparations .............................. 82 Other Skin Preparations .................70 Ovestin Genito-Urinary ............................75 Hormone ....................................82 Ox-Pam ........................................122 Oxaliplatin .....................................129 Oxazepam ....................................122 Oxis Turbuhaler ............................148 Oxybutynin ......................................76 Oxycodone hydrochloride .............108 OxyContin .....................................108 OxyNorm ......................................108 Oxypentifylline ................................60 Oxytocin ..........................................75 -PPacifen ..........................................104 Paciﬁc Buspirone ..........................121 Paclitaxel ......................................135 Paclitaxel Ebewe ..........................135 Paediatric Seravit .........................182 Pamidronate disodium ....................78 Pamisol ...........................................78 Panadol ........................................106 Pancreatic enzyme .........................33 Pancrex V .......................................33 Pancrex V Forte ..............................33 Panteston .......................................80 Pantoprazole ...................................28 Panzytrat ........................................33 Papaverine hydrochloride ...............60 Paracare .......................................106 Paracare Double Strength ............106 Paracare Junior ............................106 Paracetamol .................................106 Paracetamol with codeine ............108 Paradex ........................................106 Parafﬁn ...........................................66 Parafﬁn liquid with soft white parafﬁn ..................................... 157 Parafﬁn liquid with wool fat liquid ........................................ 157 Paraldehyde ..................................110 Paramax .......................................114 Parasiticidal Preparations ...............67 Parnate .........................................109 Paroxetine hydrochloride ..............110 Paxam ..........................................111 Peak ﬂow meter ............................152 Pedialyte - Bubblegum ....................48 Pedialyte - Fruit ...............................48 Pedialyte - Plain ..............................48 Pediasure .....................................172 Pediasure RTH .............................172 Pegasys ........................................141 Pegasys RBV Combination Pack ......................................... 141 Pegatron Combination Therapy ................................... 142 Pegylated interferon alpha-2a ................................... 141 Pegylated interferon alpha-2b with ribavirin ............................ 142 Penicillamine ................................102 PenMix 30 .......................................29 PenMix 40 .......................................29 PenMix 50 .......................................29

204

INDEX Generic Chemicals and Brands

Pentasa ..........................................26 Pentostatin (deoxycoformycin) ................... 135 Pepti Junior ...................................183 Peptisoothe .....................................27 Peptisorb ......................................174 Pergolide ......................................116 Perhexiline maleate ........................57 Periactin ........................................146 Pericyazine ...................................119 Perindopril ......................................53 Permax .........................................116 Permethrin ......................................67 Persantin ........................................45 Pethidine hydrochloride ................108 Pevaryl ............................................62 Pexsig .............................................57 Phenate ..........................................87 Phenelzine sulphate .....................109 Phenergan ....................................147 Phenobarbitone ............................112 Phenobarbitone sodium ................163 Phenoxybenzamine hydrochloride ............................. 52 Phenoxymethylpenicillin (Penicillin V) ............................... 91 Phentolamine mesylate ..................52 Phenylephrine hydrochloride ........................... 157 Phenylephrine hydrochloride with zinc sulphate ............................ 157 Phenytoin sodium .................110, 112 Phlexy 10 ......................................181 Phosphate-Sandoz .........................48 Phytomenadione .............................44 Pilocarpine ....................................156 Pilopt .............................................156 Pimafucort ......................................65 Pindol ..............................................56 Pindolol ...........................................56 Pinetarsol ........................................68 Pioglitazone ....................................30 Piportil ..........................................120 Pipothiazine palmitate ..................120 Piram-D ........................................101 Piroxicam ......................................101 Pizotifen ........................................114 Plaquenil .........................................93 Plavix ..............................................44 Plendil ER .......................................57 Podophyllotoxin ..............................69 Polaramine ....................................146 Polaramine Repetab .....................146 Poloxamer .......................................34 Poly-Tears .....................................156 Poly-Visc .......................................157 Polycal ..........................................166 Polycose .......................................166 Polytar Emollient .............................68 Polyvinyl alcohol ...........................156 Ponstan ........................................100 Postinor-1 .......................................74 Postinor-2 .......................................74 Potassium bicarbonate ...................48 Potassium chloride ...................47–48 Povidone iodine ..............................67 Prantal ............................................65 Pravachol ........................................50 Pravastatin ......................................50 Prazosin hydrochloride ...................52 Pred Forte ....................................154 Pred Mild ......................................154 Prednisolone acetate ....................154 Prednisolone sodium phosphate .................................. 79 Prednisone .....................................79 Prefrin ...........................................157 Pregnancy tests - HCG urine .........75 Premarin .........................................81 Premia 2.5 Continuous ...................82 Premia 5 Continuous ......................82 Priadel ..........................................118 Primidone .....................................112 Primolut N .......................................83 Pro-Pam .......................................122 Probenecid ...................................104 Procaine penicillin ...........................91 Procarbazine hydrochloride ..........135 Prochlorperazine ..........................115 Procyclidine hydrochloride ............117 Prodopa ..........................................58 Progout .........................................104 Prograf ..........................................145 Progynova ......................................81 Promethazine hydrochloride .........147 Promethazine theoclate ................116 Promod .........................................168 Propafenone hydrochloride ............55 Propamidine isethionate ...............153 Propranolol .....................................56 Propylene glycol ...........................164 Protamine sulphate .........................47 Protaphane .....................................28 Protaphane Penﬁll ..........................28 Protifar 90 .....................................168 Provera .....................................81, 83 PSO ......................................185–188 Psoriasis and Eczema Preparations .............................. 67 Pulmicort Turbuhaler ....................147 Pulmocare ....................................169 Pulmozyme ...................................151 Purinethol .....................................132 Pyrantel embonate .........................88 Pyrazinamide ..................................93 Pyridostigmine bromide ................100 Pyridoxine hydrochloride ................36 Pytazen SR .....................................45 -QQ 200 ............................................104 Q 300 ............................................104 Questran-Lite ..................................49 Quetapel .......................................119 Quetiapine ....................................119 Quinapril .........................................53 Quinapril with hydrochlorothiazide ................... 53 Quinine sulphate ...........................104 QV ..................................................66 -RRA-Morph .....................................107 Ranbaxy Amoxicillin .......................90 Ranbaxy-Cefaclor ...........................88 Ranitidine hydrochloride .................27 Rapamune ....................................145 Razene .........................................146 Recombinant human growth hormone .................................... 84 Recormon .......................................43 Redipred .........................................79 Regitine ..........................................52 Renilon 7.5 ...................................173 Requip ..........................................117 Requip Follow-on Pack .................117 Requip Starter Pack .....................117 Resonium-A ....................................48 Resource Diabetic ........................170 Resource Diabetic TF RTH ..........170 Resource Just for Kids .................172 Resource Plus ..............................176 Resource Thicken Up ...................178 Respigen ......................................149 Respiratory Devices .....................151 Retrovir ...........................................97 ReVia ............................................128 Reyataz ..........................................97 Rheumacin ...................................101 Rheumacin SR .............................101

205

INDEX Generic Chemicals and Brands

Ridal .............................................119 Ridaura .........................................101 Rifabutin .........................................93 Rifadin ............................................93 Rifampicin .......................................93 Riﬁnah ............................................93 Riodine ...........................................67 Risperdal ......................................119 Risperdal Consta ..........................120 Risperdal Quicklet ........................121 Risperidone ..........................119–121 Ritonavir .........................................97 Rituximab ......................................143 Rivotril ...................................110, 111 Rizatriptan benzoate .....................114 Rocaltrol solution ............................37 Roferon RBV Combination Pack ......................................... 141 Roferon RBV Combination Pack Starter Kit ................................ 141 Roferon-A .....................................140 Ropinirole hydrochloride ...............117 Roxithromycin .................................90 Rubifen .........................................126 Rubifen SR ...................................126 Rythmodan .....................................54 Rytmonorm .....................................55 -SS26 Soy ........................................184 S26LBW Gold RTF .......................182 Sabril ............................................113 Salamol .........................................149 Salapin ..........................................149 Salazopyrin .....................................26 Salazopyrin EN ...............................26 Salbutamol ....................................149 Salbutamol with ipratropium bromide .................................... 150 Salicylic acid ...................................68 Salmeterol ....................................148 Sandomigran ................................114 Sandostatin ...................................138 Sandostatin LAR ...........................138 Sandoz ...........................................90 Saquinavir .......................................98 Scalp Preparations .........................68 Scopoderm TTS ...........................115 Sebizole ..........................................68 Sedatives and Hypnotics ..............124 Selegiline hydrochloride ...............117 Senna .............................................35 Senokot ..........................................35 Serenace ......................................118 Seretide ........................................149 Seretide Accuhaler .......................149 Serevent .......................................148 Serevent Accuhaler ......................148 Seroquel .......................................119 Sevredol .......................................107 Sex Hormones Non Contraceptive ............................ 80 Shield 49 .........................................71 Shield Blue .....................................71 Shield XL ........................................71 Silvazine .........................................61 Silver sulphadiazine ........................61 Simethicone ....................................25 SimvaRex .......................................50 Simvastatin .....................................50 Sindopa ........................................116 Sinemet ........................................116 Sinemet CR ..................................116 Sirolimus .......................................145 Siterone ..........................................80 Six Plus Parapaed ........................106 Slow-Lopressor ...............................56 Smoking Cessation .........................60 Sodium acid phosphate ..................35 Sodium alginate ..............................25 Sodium aurothiomalate .................102 Sodium bicarbonate Blood ..........................................47 Extemporaneous ......................164 Sodium calcium edetate ...............158 Sodium carboxymethylcellulose .............. 36 Sodium chloride ..............................47 Sodium citrate with sodium lauryl sulphoacetate ............................ 35 Sodium citro-tartrate .......................76 Sodium cromoglycate Alimentary ..................................26 Respiratory .......................150–151 Sensory ....................................154 Sodium ﬂuoride ..............................38 Sodium hypochlorite .......................65 Sodium nitroprusside ......................32 Sodium polystyrene sulphonate ................................. 48 Sodium tetradecyl sulphate ............44 Sodium valproate ..........................113 Sofradex .......................................153 Soframycin ....................................153 Solox ...............................................27 Solu-Cortef .....................................79 Solu-Medrol ....................................79 Sonaﬂam ......................................101 Sotacor ...........................................57 Sotalol .............................................57 Space Chamber ............................152 Spacer device ...............................152 Span-K ............................................48 Spiriva ...........................................150 Spironolactone ................................59 Spirotone ........................................59 Sporanox ........................................92 Staphlex ..........................................91 Stavudine [d4T] ..............................97 Stelazine .......................................119 Stemetil .........................................115 Stesolid .........................................110 Stocrin ............................................96 Stomahesive ...................................36 Sucralfate .......................................28 Sulindac ........................................101 Sulphacetamide sodium ...............154 Sulphasalazine ...............................26 Sulphur ...........................................68 Sumagran .....................................114 Sumatriptan ..................................114 Sunscreens .....................................69 Sunscreens, proprietary .................69 Suplena ........................................174 Suprefact ........................................84 Surgam .........................................101 Sustagen Hospital Formula ..........169 Sustanon Ampoules .......................80 Symbicort Turbuhaler 100/6 .........149 Symbicort Turbuhaler 200/6 .........149 Symbicort Turbuhaler 400/12 ..................................... 149 Symmetrel ....................................116 Sympathomimetics .........................59 Synacthen .......................................79 Synacthen Depot ............................79 Synﬂex ..........................................101 Syntocinon ......................................75 Syntometrine ..................................75 Syrup (pharmaceutical grade) ...................................... 164 -TTacrolimus ....................................145 Tambocor ........................................55 Tambocor CR ..................................55 Tamoxifen citrate ...........................139 Tap water ......................................164 Tar with cade oil ..............................68 Tar with triethanolamine lauryl

206

INDEX Generic Chemicals and Brands

sulphate and ﬂuorescein ............ 68 Tasmar ..........................................117 Taxotere ........................................133 Tegretol .........................................111 Tegretol CR ...................................111 Telfast ...........................................147 Temazepam ..................................124 Temgesic ......................................106 Temodal ........................................135 Temozolomide ..............................135 Teniposide ....................................135 Tenofovir disoproxil fumarate ..........97 Tenoxicam ....................................101 Terazosin hydrochloride ..................52 Terbinaﬁne ......................................92 Terbutaline sulphate .....................149 Testosterone ...................................80 Testosterone cypionate ...................80 Testosterone esters ........................80 Testosterone undecanoate .............80 Tetrabenazine ...............................128 Tetrabromophenol .........................158 Tetracosactrin .................................79 Thalidomide ..................................135 Thalidomide Pharmion .................135 Theophylline .................................150 Thiamine hydrochloride ..................36 Thioguanine ..................................132 Thioprine ......................................139 Thymol glycerin ..............................36 Thyroid and Antithyroid Agents ....................................... 83 Thyroxine ........................................83 Tiaprofenic acid ............................101 Tiberal .............................................93 Tilade ............................................150 Tilcotil ...........................................101 Timolol maleate Cardiovascular ...........................57 Sensory ....................................154 Timoptol XE ..................................154 Tiotropium bromide .......................150 Titralac ............................................25 TMP ................................................92 Tobramycin Infection ......................................92 Sensory ....................................154 Tobrex ...........................................154 Tofranil ..........................................109 Tolbutamide ....................................31 Tolcapone .....................................117 Tolvon ...........................................109 Topamax .......................................113 Topiramate ....................................113 Total parenteral nutrition (TPN) ......................................... 47 TPN ................................................47 Trandate ..........................................56 Trandolapril .....................................53 Tranexamic acid ..............................44 Tranylcypromine sulphate .............109 Trastuzumab .................................143 Trasylol ...........................................44 Travatan ........................................155 Travoprost .....................................155 Trental 400 ......................................60 Tretinoin ........................................136 Triamcinolone acetonide Alimentary ..................................36 Dermatological ...........................64 Hormone ....................................79 Triamcinolone acetonide with gramicidin, neomycin and nystatin Dermatological ...........................65 Sensory ....................................153 Triamizide .......................................59 Triamterene with hydrochlorothiazide ................... 59 Triazolam ......................................124 Trichozole .......................................93 Trifeme ............................................73 Triﬂuoperazine hydrochloride ........................... 119 Trimeprazine tartrate ....................147 Trimethoprim ...................................92 Trimipramine maleate ...................109 Triphasil 28 .....................................73 Tripress .........................................109 Triquilar ED .....................................73 Trisequens ......................................82 Trisul ...............................................91 Trophic Hormones ..........................83 Tropicamide ..................................156 Tropisetron ....................................116 Trusopt ..........................................155 Two Cal HN ...................................177 Tyloxapol .......................................156 -UUltraproct ........................................26 Ural .................................................76 Urea ................................................66 Urinary Agents ................................76 Urinary Tract Infections ...................98 Uromitexan ...................................135 Ursodeoxycholic acid ......................33 -VVaccines .........................................99 Vallergan Forte .............................147 Valoid (AFT) ..................................114 Vancomycin hydrochloride ..............92 Vannair .........................................149 Vasodilators ....................................60 Vasopressin Agonists .....................87 Vaxigrip ...........................................99 Venlafaxine ...................................110 Ventolin .........................................149 Vepesid .........................................134 Verapamil hydrochloride .................58 Vergo 16 .......................................114 Vermox ...........................................88 Verpamil .........................................58 Verpamil SR ...................................58 Vesanoid .......................................136 Viaderm KC ....................................65 Vicrom ..........................................150 Videx EC .........................................97 Vigabatrin .....................................113 Vinblastine sulphate .....................136 Vincristine sulphate ......................136 Vinorelbine ....................................136 Vinorelbine Ebewe ........................136 Viramune ........................................96 Viramune Suspension ....................96 Viread .............................................97 Vistil ..............................................156 Vistil Forte ....................................156 Vitadol C .........................................36 Vital HN ........................................174 Vitamin A with vitamins D and C ................................................ 36 Vitamin B complex ..........................37 Vitamins ....................................36–37 Vivonex Pediatric ..........................183 Vivonex TEN .................................174 Volmax ..........................................149 Voltaren ........................................100 Voltaren D .....................................100 Voltaren Ophtha ............................154 Vosol .............................................153 Vumon ..........................................135 Vytorin ............................................51 -WWarfarin sodium ..............................47 Wart Preparations ...........................69 Wasp venom allergy treatment ................................. 146 Water

207

INDEX Generic Chemicals and Brands

Blood ..........................................48 Extemporaneous ......................164 Wholesale Supply Order ...............188 Wool fat with mineral oil ..................66 -XXalatan .........................................155 Xeloda ..........................................130 Xenazine 25 ..................................128 XMET Maxamum ..........................180 XP Analog LCP .............................181 XP Maxamaid ...............................181 XP Maxamum ...............................181 Xylocaine ......................................105 -ZZadine ...........................................146 Zantac .............................................27 Zarontin ........................................111 Zavedos ........................................134 Zefﬁx ...............................................94 Zeldox ...........................................119 Zerit ................................................97 Ziagen .............................................97 Zidovudine [AZT] ............................97 Zidovudine [AZT] with lamivudine ................................. 97 Zinacef ............................................89 Zinc .................................................65 Zinc and castor oil ..........................65 Zinc oxide .......................................26 Zinc sulphate ..................................38 Zincaps ...........................................38 Zincfrin ..........................................157 Zinnat ..............................................88 Ziprasidone ...................................119 Zofran ...........................................115 Zofran Zydis ..................................115 Zoladex ...........................................85 Zopiclone ......................................124 Zostrix HP .......................................70 Zovirax ..........................................153 Zuclopenthixol decanoate .............120 Zyprexa .........................................118 Zyprexa Zydis ...............................120

208

AUTHORITY TO SUBSTITUTE

Dear Pharmacist Where I refer in a prescription to a medicine by its trade mark or trade name (brand), or by the name of its manufacturer, I give authority to substitute an alternative brand of the same medicine in the following situations: Sole Supply Products Where PHARMAC has entered into sole supply arrangement for the medicine 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. Other subsidised products Where PHARMAC has listed one or more brands of the medicine on the Pharmaceutical Schedule (and the brand that I have prescribed is not listed or has a Manufacturer’s Price that is greater than the Subsidy) you may substitute with a listed 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 pharmaceuticals which I may have provided previously. This authority to substitute is valid unless I have indicated on the prescription an instruction not to substitute. This authority is valid whether or not there is a ﬁnancial implication for the Funder. Please inform my patient that I have authorised substitution.

Name:

NZMC:

Signature:

Date:

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

Name:

NZMC:

Signature:

Date:

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

Name:

NZMC:

Signature:

Date:

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

Name:

NZMC:

Signature:

Date:

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

Name:

NZMC:

Signature:

Date:

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

Name:

NZMC:

Signature:

Date:

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

Name:

NZMC:

Signature:

Date:

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

Name:

NZMC:

Signature:

Date:

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

Metadata

Title

Pharmaceutical Schedule - effective 1 October 2008

Abstract

Introducing PHARMAC 2 October 2008 Volume 15 Number 2 Editors Linda Wellington & Julie Lagan email: schedule@pharmac.govt.nz Telephone +64 4 460 4990 Facsimile +64 4 460 4995 Level 14, Cigna House 40 Mercer Street PO Box 10 254 Wellington Freephone…

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