Schedule Update - effective 1 April 2011 (text extract)

This is the text extract for Schedule Update - effective 1 April 2011, browse documents here.

Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 April 2011

Cumulative for January, February, March and April 2011 Section H for April 2011

Contents

Summary of PHARMAC decisions effective 1 April 2011 ............................... 3 Christchurch Earthquake ............................................................................... 6 Dietitian Prescribing ...................................................................................... 6 Special Foods ................................................................................................ 7 Sumatriptan injection .................................................................................... 8 Thalidomide - new brand and strength ......................................................... 8 Exemestane – fully subsidised ....................................................................... 8 Varenicline and Close Control........................................................................ 8 Ipratropium bromide – Change in Pack Size .................................................. 9 Pharmacy Brand Switch Payments ................................................................. 9 Saline injection subsidies ............................................................................... 9 Tender News ................................................................................................ 10 Looking Forward ......................................................................................... 10 Sole Subsidised Supply products cumulative to April 2011 ......................... 12 New Listings ................................................................................................ 22 Changes to Restrictions ............................................................................... 26 Changes to Subsidy and Manufacturer’s Price............................................. 60 Changes to General Rules............................................................................ 64 Changes to Brand Name ............................................................................. 64 Changes to Sole Subsidised Supply ............................................................. 64 Delisted Items ............................................................................................. 65 Items to be Delisted .................................................................................... 71 Section H changes to Part II ........................................................................ 74 Section H changes to Part III........................................................................ 75 Index ........................................................................................................... 76

Summary of PharmaC decisions

effeCtive 1 aPril 2011 New listings (page 22) • Metoprolol succinate (Myloc CR) tab long-acting 23.75 mg, 47.5 mg, 95 mg and 190 mg • Etanercept (Enbrel) inj 50 mg prefilled syringe – Special Authority – Retail pharmacy • Sumatriptan (Arrow-Sumatriptan) inj 12 mg per ml, 0.5 ml, 2 OP – Retail pharmacy-Specialist – maximum of 10 inj per prescription • Naltrexone hydrochloride (Naltraccord) tab 50 mg – Special Authority – Retail pharmacy • Nicotine (Habitrol) Lozenge 1 mg and 2 mg, 216 pack size, and patch 7 mg, 14 mg and 21 mg, 28 pack size – will not be funded Close Control in amounts less than 4 weeks • Thalidomide (Thalomid) cap 50 mg – PCT only – Specialist – Special Authority – Only on a controlled drug form • Ipratropium bromide (Univent) aqueous nasal spray, 0.03%, 15 ml OP • Pharmacy services (BSF m-Captorpil) brand switch fee – no patient co-payment payable – may only be claimed once per patient per fee Changes to restrictions (pages 26-48) • Lincomycin (Lincocin) inj 300 mg per ml, 2 ml – removal of Section 29 • Adalimumab inj 40 mg per 0.8 ml prefilled pen (HumiraPen) and inj 40 mg per 0.8 ml prefilled syringe (Humira) – amended Special Authority criteria • Etanercept (Enbrel) inj 25 mg, 50 mg autoinjector and inj 50 mg prefilled syringe – amended Special Authority criteria • Varenicline tartrate (Champix) tab 1 mg, and tab 0.5 mg x 11 and 1 mg x 14 – Varenicline will not be funded Close Control in amounts less than 2 weeks of treatment • Exemestane (Aromasin) tab 25 mg – Special Authority removed • Special Foods Special Authority applicant types extended to a relevant specialist or vocationally registered general practitioner. Reapplications from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner • Diabetic Products (Diason RTH, Glucerna Select RTH, Diasip, Glucerna Select and Resource Diabetic) liquid – amended Special Authority criteria • Removal of distinction between use of special foods as a supplement or as a complete diet. • “Oral Supplements” and “Adult Products Standard” groups replaced with “Standard Supplements” with new Special Authority criteria

Summary of PharmaC decisions – effective 1 april 2011 (continued) • Gluten Free Foods – the funding of gluten free foods is no longer being actively managed by PHARMAC from 1 April 2011 • Foods and Supplements for Inborn Errors of Metabolism – amended Special Authority criteria and removal of Prescribing Guideline • Low protein baking mix (Loprofin Mix) powder – change in chemical name from phenyl free baking mix • Low protein pasta (Loprofin) – change in chemical name from phenyl free pasta • Gastrointestinal and Other Malabsorptive Problems – removal of Prescribing Guideline • Elemental Formula separated into “Extensively Hydrolysed Formula” and “Amino Acid Formula”, with separate Special Authority criteria increased subsidy (pages 60-62) • Sotalol (Sotacor) inj 10 mg per ml, 4 ml • Fludrocortisone acetate (Florinef) tab 100 µg • Ethosuximide (Zarontin) oral liq 250 mg per 5 ml, 200 ml • Busulphan (Myleran) tab 2 mg • Chloramphenicol (Chloromycetin) ear drops 0.5%, 5 ml OP • Triamcinolone acetonide with gramicidin, Neomycin and nystatin (Kenacomb) ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g • Low protein baking mix (Loprofin Mix) powder, 500 g OP • Low protein pasta (Loprofin) lasagne and macaroni, 250 g OP; and animal shapes, low protein rice pasta, penne, spaghetti and spirals, 500 g OP • Extensively hydrolysed formula (Pepti Junior and Pepti Junior Gold) powder 450 g OP • Amino acid formula powder 48.5 g OP (Vivonex Pediatric), powder (tropical) 400 g OP (Neocate Advance), powder (unflavoured) 400 g OP (Elecare, Elecare LCP, Neocate Advance), and powder (vanilla) 400 g OP (Elecare) Decreased subsidy (pages 60-62) • Doxazosin mesylate (Apo-Doxazosin) tab 2 mg and 4 mg • Isosorbide mononitrate tab 20 mg (Ismo 20) and tab long-acting 40 mg (Corangin) • Amitriptyline (Amitrip) tab 25 mg and 50 mg • Metoclopramide hydrochloride (Metamide) tab 10 mg • Exemestane (Aromasin) tab 25 mg • Tamoxifen citrate (Genox) tab 20 mg

Summary of PharmaC decisions – effective 1 april 2011 (continued) • Oral feed 1.5kcal/ml (Fortisip and Ensure Plus) liquid (banana, chocolate, coffee latte, fruit of the forest, strawberry, toffee, tropical fruit, and vanilla) 200 ml OP and 237 ml OP • Oral feed with fibre 1.5kcal/ml (Fortisip Multi Fibre) liquid (chocolate, strawberry, vanilla) 200 ml OP • Oral feed 2kcal/ml (Two Cal HN) liquid (vanilla) 237 ml OP • Amino acid formula (Neocate and Neocate LCP) powder 400 g OP

6 Pharmaceutical Schedule - Update News

Christchurch Earthquake

Firstly, our thoughts go out to the people of Christchurch during this very tragic time. We want to acknowledge the incredible work that healthcare professionals have been doing in Canterbury and all around New Zealand to ensure the safety, healthcare and continuous supply of medicines to patients. Please refer to the PHARMAC website for regular updates for healthcare professionals for items related to the Canterbury Earthquake.

http://www.pharmac.govt.nz/patients/ EarthquakeUpdates

Dietitian Prescribing

Last August 2010, the definition of ‘Practitioner’ in the Pharmaceutical Schedule was amended to include registered dietitians. This enabled dietitians to prescribe subsidised products that are within their scope of practice (special foods, vitamin products, mineral products and oral electrolyte replacement products – the list is included in the Special Foods introduction section of the Pharmaceutical Schedule). From 1 April 2011 prescriptions written by dietitians will be eligible for subsidy as the technical changes have been completed by the pharmacy payment systems. Please note that not all dietitians have prescribing rights.

Pharmaceutical Schedule - Update News

Special Foods

From 1 April there will be a number of changes to the access and funding of special foods. • Delisting of Karicare Goats Milk Infant Formula, Delact lactose free infant formula, S26 Soy soya infant formula, and Karicare Soy All Ages infant soy formula. • The various brands of Pepti Junior, Elecare and Neocate will be fully subsidised. • New Special Authority criteria for ‘Standard Supplements’. • The subsidy for the standard ready-mixed oral feed 1.5kcal/ml with and without fibre (Fortisip, Ensure Plus and Fortisip Multi Fibre) and 2.0 kcal/ml liquids (Two Cal HN) will be reduced to the level of the subsidy for oral feed 1 kcal/ml powder (Ensure and Sustagen Hospital Formula) via the application of reference pricing. Those patients with existing Special Authority approvals do not need to reapply for new approvals until their current approval expires. Existing Special Authorities for ready-mixed oral feeds are interchangeable with powders. • Repeats for standard ready-mixed oral feed 1.5kcal/ml with and without fibre (Fortisip, Ensure Plus 237 ml OP and Fortisip Multi Fibre) and 2.0 kcal/ml liquids (Two Cal HN) will be fully subsidised where the initial dispensing was before 1 April 2011. • Nutricia has increased the price of Fortisip and Fortisip Multi Fibre which will increase the patient part charge on these products. • Gluten free foods will no longer be actively managed by PHARMAC (no new listings or subsidy changes). • New Special Authority criteria without renewal for ‘Foods and Supplements for Inborn Errors of Metabolism.’ • Increased subsidy for all brands of low protein baking mix and low protein pasta. • PHARMAC and bpacNZ are producing patient information leaflets. These will be distributed when available.

Pharmaceutical Schedule - Update News

Sumatriptan injection

From 1 April 2011 Arrow-Sumatriptan (sumatriptan inj 12 mg per ml, 0.5 ml) will be listed fully subsidised in the Pharmaceutical Schedule. The subsidy for the Imigran brand of sumatriptan injection will be reduced to the level of Arrow-Sumatriptan injection from 1 June 2011 via the application of reference pricing and Imigran injection will be delisted on 1 September 2011. The “Retail pharmacySpecialist” restriction will be removed from the listings of both brands of sumatriptan injection on 1 June 2011 but the “maximum of 10 inj per prescription” rule will remain. Like the Imigran brand of sumatriptan injection, the Arrow-Sumatriptan brand of sumatriptan injection is an autoinjector refill and Arrow Pharmaceuticals will provide the corresponding autoinjector device free of charge to prescribers and pharmacists (as appropriate) to provide to patients who are prescribed and dispensed the autoinjector refill.

Thalidomide - new brand and strength

From 1 April 2011 thalidomide 50 mg capsules (Thalomid) will be listed under Other Cytotoxic Agents (Oncology Agents and Immunosuppressants) therapeutic subgroup of Section B, and in Part II of Section H, of the Pharmaceutical Schedule. A new 100 mg capsule (Thalomid) strength will be listed from 1 May 2011. Thalidomide is a Class A controlled drug and can only be prescribed by registered prescribers in accordance with the supplier’s Risk Management Programme. The current Special Authority and other listing restriction which apply to thalidomide in Section B of the Pharmaceutical Schedule will also apply to the new Thalomid brand. The Pharmion brand of thalidomide is to be discontinued from 1 October 2011.

Exemestane – fully subsidised

The Aromasin brand of exemestane 25 mg tablets will be fully subsidised without the requirement for Special Authority from 1 April 2011.

Varenicline and Close Control

From 1 April 2011 varenicline tartrate tablets (Champix) will not be funded Close Control in amounts less than 2 weeks of treatment.

Pharmaceutical Schedule - Update News

Ipratropium bromide – Change in Pack Size

From 1 April 2011, a new brand of ipratropium bromide nasal spray, 0.03% Schedule and will be the Sole Subsidised brand in the community from 1 September 2011. Univent is supplied in a 15 ml glass bottle, as opposed to the current Apo-Ipravent brand Due to the reduction in bottle size, prescribers will need to prescribe "2 x OP" for regular users (those who use 30 ml per month).

(Univent) will be listed on the Pharmaceutical which is supplied in a 30 ml plastic bottle.

Pharmacy Brand Switch Payments

Brand switch payments for pharmacies will be payable for dispensings of the m-Captopril brand of captopril 12.5mg, 25 mg and 50 mg tablets from 1 April 2011. The brand switch fee is claimable via a Pharmacode on the first dispensing of captopril after 1 April 2011 for patients who have switched brands. Pharmacies should claim a fee even if the patient switched to the Sole Supply brand prior to 1 April 2011. The brand switch fee for captopril will be paid only once for each patient during the claim period. The brand switch fee will not be able to be claimed for this pharmaceutical for dispensing after 30 June 2011. Brand switch posters, leaflets and prescription bags are available free of charge. To order please go to www. pharmaconline.co.nz

Saline injection subsidies

We have received some calls around sodium chloride inj 0.9% and what it is/ isn’t funded for. Under Part II Community Pharmaceuticals Subsidy in Section A: General Rules, the following medicines, therapeutic medical devices, or related products are not eligible for subsidy: 2.2.17 substances in a form intended for intravenous delivery (other than by injection), unless it is specified in Section B to G that they may be in such a form. Hence, no funding is available for the use of sodium chloride inj 0.9% as nasal drops or for use in nebulisers. From 1 February 2011 sodium chloride 7 % solution was listed in the Pharmaceutical Schedule for use in nebulisers and is fully funded for this use.

tender News

Sole Subsidised Supply changes – effective 1 May 2011

Chemical Name Itraconazole Ondansetron Ondansetron Presentation; Pack size Cap 100 mg; 15 cap Tab 4 mg; 30 tab Tab 8 mg; 10 tab Sole Subsidised Supply brand (and supplier) Itrazole (Mylan) Dr Reddy's Ondansetron (Dr Reddy's) Dr Reddy's Ondansetron (Dr Reddy's)

looking forward

This section is designed to alert both pharmacists and prescribers to possible future changes to the Pharmaceutical Schedule. It may also assist pharmacists, distributors and wholesalers to manage stock levels. Possible decisions for implementation 1 may 2011 • Azithromycin (Arrow-Azithromycin) tab 500 mg – change to Special Authority criteria • Bortezomib (Vecade) inj 3.5 mg – new listing – PCT Only - Special Authority for Multiple Myeloma and Systemic AL Amyloidosis. • Clarithromycin (Klacid, Klamycin) tab 250 mg and grans for oral liq 125 mg per 5 ml – change to Special Authority criteria • Colestipol hydrochloride (Colestid) sachets 5 g – price increase • Digoxin (Lanoxin) tab 250 mg, 240 tab pack – new listing • Fluconazole (Pacific) cap 150 mg – removal of Retail pharmacy-Specialist and addition of Subsidy by endorsement • Imatinib mesylate (Glivec) tab 100 mg – change to access criteria • Lacosamide (Vimpat) tab 50 mg, 100 mg, 150 mg and 200 mg – new listing – Special Authority – listing in Section F • Modafinil (Modavigil) tab 100 mg – new listing – Special Authority • Nilotinib (Tasigna) cap 200 mg – new listing – Special Authority for chronic myeloid leukaemia • Ondansetron tab 4 mg and 8 mg and tab disp 4 mg and 8 mg – removal of prescribing and dispensing restrictions and Special Authority; removal from DCS list • Ornidazole (Arrow-Ornidazole) tab 500 mg – new listing • Pegylated interferon alpha-2A (Pegasys and Pegasys RBV Combination Pack) inj prefilled syringe with or without ribavarin – change to Special Authority criteria

Possible decisions for implementation 1 may 2011 (continued) • Thalidomide (Thalomid) cap 100 mg – new listing - PCT only - Specialist • Thalidomide (Thalomid cap 50 mg and 100 mg, and Thaliomide Pharmion cap 50 mg) – change to access criteria

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Acarbose Acetazolamide Aciclovir Allopurinol Amantadine hydrochloride Amlodipine Amoxycillin

Presentation

Tab 50 mg & 100 mg Tab 250 mg Tab dispersible 200 mg, 400 mg & 800 mg Tab 100 mg & 300 mg Cap 100 mg Tab 5 mg & 10 mg Cap 250 mg & 500 mg Grans for oral liq 250 mg per 5 ml Drops 125 mg per 1.25 ml Inj 250 mg, 500 mg & 1 g

Brand Name Expiry Date*

Glucobay Diamox Lovir Apo-Allopurinol Symmetrel Apo-Amlodipine Alphamox Ospamox Ospamox Paediatric Drops Ibiamox Curam Curam Synermox AFT Vitala-C Ethics Aspirin EC Ethics Aspirin Atenolol Tablet USP AstraZeneca Imuprine Imuran Arrow-Azithromycin Pacifen ArrowBendrofluazide Sandoz Beta Scalp Fibalip Bicalox Lax-Tab AFT healthE API 2011 2011 2013 2013 2012 2012 2013 2012 2012 2011 2011 2012 2011 2011 2013 2011 2012 2012 2011 2013 2011 2011 2011 2013 2012 2011

Amoxycillin clavulanate

Grans for oral liq amoxycillin 125 mg with potassium clavulanate 31.25 mg per 5 ml Grans for oral liq amoxycillin 250 mg with potassium clavulanate 62.5 mg per 5 ml Tab amoxycillin 500 mg with potassium clavulanate 125 mg Crm 500 g Tab 100 mg Tab 100 mg Tab dispersible 300 mg Tab 50 mg & 100 mg Inj 600 µg, 1 ml Tab 50 mg Inj 50 mg Tab 500 mg Tab 10 mg Tab 2.5 mg & 5 mg Inj 1 mega u Scalp app 0.1% Tab 200 mg Tab 50 mg Tab 5 mg Eye drops 0.2% Crm, aqueous, BP Lotn, BP

2012

Aqueous cream Ascorbic acid Aspirin Atenolol Atropine sulphate Azathioprine Azithromycin Baclofen Bendrofluazide Benzylpenicillin sodium (Penicillin G) Betamethasone valerate Bezafibrate Bicalutamide Bisacodyl Brimonidine tartrate Calamine

*Expiry date of the Sole Subsidised Supply period is 30 June of the year indicated unless otherwise stated. Please note that Sole Subsidised Supply may have been awarded for a wider scope than just those presentation(s) listed in the above table.

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Calcitonin Calcitriol Calcium carbonate

Presentation

Inj 100 iu per ml, 1 ml Cap 0.25 µg & 0.5 µg Tab 1.25 g (500 mg elemental) Tab 1.5 g (600 mg elemental) Tab eff 1.7 g (1 g elemental) Inj 50 mg Tab 12.5 mg, 25 mg & 50 mg Oral liq 5 mg per ml Grans for oral liq 125 mg per 5 ml Inj 500 mg & 1 g Inj 500 mg Inj 1 g Inj 750 mg & 1.5 g Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Tab 10 mg Oral liq 1 mg per ml Crm BP Eye drops 0.5% Eye oint 1% Handrub 1% with ethanol 70% Soln 4% Nail soln 8% Tab 0.5 mg, 2.5 mg & 5 mg Tab 5 mg with hydrochlorothiazide 12.5 mg Tab 250 mg, 500 mg & 750 mg Tab 20 mg Crm 0.05% Oint 0.05% Scalp app 0.05% Tab 500 µg & 2 mg TDDS 2.5 mg, 100 µg per day TDDS 5 mg, 200 µg per day TDDS 7.5 mg, 300 µg per day Inj 150 µg per ml, 1 ml Tab 25 µg Tab 150 µg Tab 75 mg

Brand Name Expiry Date*

Miacalcic Airflow Calci-Tab 500 Calci-Tab 600 Calsource Calcium Folinate Ebewe m-Captorpril Capoten Ranbaxy-Cefaclor Hospira Veracol Aspen Ceftriaxone Zinacef Cefalexin Sandoz Cefalexin Sandoz Zetop Cetirizine-AFT PSM Chlorafast Chlorsig healthE Orion Batrafen Zapril Inhibace Plus Rex Medical Arrow-Citalopram Dermol Dermol Dermol Paxam Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Catapres Dixarit Catapres Apo-Clopidogrel 2011 2012 2011

Calcium folinate Captopril Cefaclor monohydrate Cefazolin sodium Ceftriaxone sodium Cefuroxime sodium Cephalexin monohydrate Cetirizine hydrochloride Cetomacrogol Chloramphenicol Chlorhexidine gluconate Ciclopiroxolamine Cilazapril Cilazapril with hydrochlorothiazide Ciprofloxacin Citalopram Clobetasol propionate

2011 2013 2013 2011 2013 2011 2012 2011 2013 2012 2012 2011 2012 2013 2013 2011 2011 2012

Clonazepam Clonidine

2011 2012

Clonidine hydrochloride

2012

Clopidogrel

2013

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Clotrimazole

Presentation

Vaginal crm 1% with applicator Vaginal crm 2% with applicator Crm 1% Soln BP Tab 500 µg Crm 10% Tab 50 mg Tab 50 mg Tab 50 mg & 100 mg Tab 2 mg with ethinyloestradiol 35 µg and 7 inert tabs Nasal spray 10 µg per dose Eye drops 0.1% Inj 4 mg per ml, 1 ml & 2 ml Inj 50%, 10 ml Soln with electrolytes

Brand Name Expiry Date*

Clomazol Clomazol Clomazol Midwest Colgout Itch-Soothe Nausicalm Cycloblastin Siterone Ginet 84 Desmopressin-PH&T Maxidex Hospira Biomed Pedialyte – Fruit Pedialyte – Bubblegum Pedialyte – Plain Diclofenac Sandoz Voltaren Ophtha Voltaren Voltaren DHC Continus Dilzem Cardizem CD Pytazen SR Laxofast 50 Laxofast 120 Laxsol Donepezil-Rex AFT Arrow-Enalapril Clexane Comtan 2013 2011 2013 2013 2012 2012 2013 2012 2011 2011 2013 2013 2011 2013

Coal tar Colchicine Crotamiton Cyclizine hydrochloride Cyclophosphamide Cyproterone acetate Cyproterone acetate with ethinyloestradiol Desmopressin Dexamethasone Dexamethasone sodium phosphate Dextrose Dextrose with electrolytes

Diclofenac sodium

Tab EC 25 mg & 50 mg Eye drops 1 mg per ml Inj 25 mg per ml, 3 ml Suppos 12.5 mg, 25 mg, 50 mg & 100 mg Tab long-acting 60 mg Tab 30 mg & 60 mg Cap long-acting 120 mg, 180 mg & 240 mg Tab long-acting 150 mg Cap 50 mg Cap 120 mg Tab 50 mg with total sennosides 8 mg Tab 5 mg & 10 mg Oint BP Tab 5 mg, 10 mg & 20 mg Inj 20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg & 150 mg Tab 200 mg

2012 2011

Dihydrocodeine tartrate Diltiazem hydrochloride

2013 31/12/11

Dipyridamole Docusate sodium Docusate sodium with sennosides Donepezil hydrochloride Emulsifying ointment Enalapril Enoxaparin sodium (low molecular weight heparin) Entacapone

2011 2011 2013 2012 2011 2012 2012 2012

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Erythromycin ethyl succinate

Presentation

Tab 400 mg Grans for oral liq 200 mg per 5 ml Grans for oral liq 400 mg per 5 ml Tab 10 mg & 20 mg Tab 10 µg Tab 200 mg Tab long-acting 5 mg Tab long-acting 10 mg Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml) Tab 5 mg Cap 250 mg & 500 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Inj 250 mg, 500 mg & 1 g Cap 50 mg, 150 mg & 200 mg Inj 50 mg Tab 10 mg Eye drops 0.1% Cap 20 mg Tab dispersible 20 mg, scored Tab 250 mg Metered aqueous nasal spray, 50 µg per dose Inj 10 mg per ml, 2 ml Tab 40 mg Crm 2% Oint 2% Cap 100 mg, 300 mg & 400 mg Tab 600 mg Inj 40 mg per ml, 2 ml Tab 80 mg Tab 5 mg Liquid Tab 600 µg Oral pump spray 400 µg per dose TDDS 5 mg & 10 mg

Brand Name Expiry Date*

E-Mycin E-Mycin E-Mycin Loxalate NZ Medical and Scientific Arrow-Etidronate Felo 5 ER Felo 10 ER Ferodan Fintral AFT AFT AFT Flucloxin Pacific Fludara Fludara Oral FML Fluox Fluox Flutamin Flixonase Hayfever & Allergy Frusemide-Claris Diurin 40 Foban Foban Nupentin Lipazil Pfizer Apo-Gliclazide Minidiab healthE Lycinate Nitrolingual Pumpspray Nitroderm TTS 2012 2011 2013 2012 2012 2012 2013 2011 2012 2011 2011 2011 2012 2013 2013 31/1/13 2013 2012 2013 31/7/12 2013 2012 2011 2011 2013 2011

Escitalopram Ethinyloestradiol Etidronate disodium Felodipine Ferrous sulphate Finasteride Flucloxacillin sodium

Fluconazole Fludarabine phosphate Fluorometholone Fluoxetine hydrochloride Flutamide Fluticasone propionate Furosemide Fusidic acid Gabapentin Gemfibrozil Gentamicin sulphate Gliclazide Glipizide Glycerol Glyceryl trinitrate

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Haloperidol

Presentation

Inj 5 mg per ml, 1 ml Oral liq 2 mg per ml Tab 500 µg, 1.5 mg & 5 mg Inj 50 mg per ml, 1 ml Tab 5 mg & 20 mg Powder Crm 1%, 500 g Rectal foam 10%, CFC-free (14 applications) Crm 1% with miconazole nitrate 2% Lotn 1% with wool fat hydrous 3% and mineral oil Inj 1 mg per ml, 1 ml Tab 200 mg Eye drops 0.5% Inj 20 mg, 1 ml Tab 20 mg Oral liq 100 mg per 5 ml Tab 200 mg Tab 2.5 mg Nebuliser soln, 250 µg per ml, 1 ml & 2 ml Inj 50 mg per ml, 2 ml Cap 10 mg & 20 mg Shampoo 2% Oral liq 10 mg per ml Tab 150 mg Eye drops 50 µg per ml Tab 2.5 mg Subdermal implant (2 x 75 mg rods) Inj 1%, 5 ml & 20 ml Crm 2.5% with prilocaine 2.5% (5 g tubes) Crm 2.5% with prilocaine 2.5%; 30 g OP Tab 5 mg, 10 mg & 20 mg Cap 2 mg Oral liq 1 mg per ml Tab 10 mg

Brand Name Expiry Date*

Serenace Serenace Serenace Solu-Cortef Douglas ABM PSM Colifoam Micreme H DP Lotn HC ABM Hydroxocobalamin Plaquenil Methopt Buscopan Gastrosoothe Fenpaed Ethics Ibuprofen Dapa-Tabs Univent Ferrum H Oratane Sebizole 3TC 3TC Hysite Letara Jadelle Xylocaine EMLA EMLA Arrow-Lisinopril Diamide Relief Lorapaed Loraclear Hayfever Relief 2012 2013 2013 2013

Hydrocortisone

2013 2012 2011 2012 2013 2011 2012 2012 2011 2011 2013 2012 2013 2013 2011 2012 2011 2013 2012 2012 31/12/13 2013 2013

Hydrocortisone acetate Hydrocortisone with miconazole Hydrocortisone with wool fat and mineral oil Hydroxocobalamin Hydroxychloroquine sulphate Hypromellose Hysocine N-butylbromide Ibuprofen Indapamide Ipratropium bromide Iron polymaltose Isotretinoin Ketoconazole Lamivudine Latanoprost Letrozole Levonorgestrel Lignocaine hydrochloride Lignocaine with prilocaine

Lisinopril Loperamide hydrochloride Loratadine

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Lorazepam Malathion Mask for Spacer Device Mebendazole Mebeverine hydrochloride Megestrol acetate Mercaptopurine Mesalazine Metformin hydrochloride Methadone hydrochloride

Presentation

Tab 1 mg & 2.5 mg Liq 0.5% Shampoo 1% Device Tab 100 mg Tab 135 mg Tab 160 mg Tab 50 mg Enema 1 g per 100 ml Tab immediate-release 500 mg & 850 mg Tab 5 mg Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Inj 25 mg per ml, 2 ml & 20 ml Tab 2.5 mg & 10 mg Inj 100 mg per ml, 10 ml & 50 ml Tab 125 mg, 250 mg & 500 mg Tab 4 mg & 100 mg Inj 40 mg per ml, 1 ml Inj 40 mg per ml with lignocaine 1 ml Inj 40 mg per ml, 1 ml Inj 62.5 mg per ml, 2 ml Inj 500 mg Inj 1 g Inj 5 mg per ml, 2 ml Crm 2% Tab 150 mg & 300 mg Crm 0.1% Oint 0.1% Oral liq 1 mg per ml Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Cap long-acting 10 mg, 30 mg, 60 mg & 100 mg Tab immediate release 10 mg & 20 mg Inj 10 mg per ml, 1 ml Inj 30 mg per ml, 1 ml

Brand Name Expiry Date*

Ativan A-Lices A-Lices Foremount Child’s Silicone Mask De-Worm Colofac Apo-Megestrol Purinethol Pentasa Apotex Methatabs Biodone Biodone Forte Biodone Extra Forte Hospira Methoblastin Methotrexate Ebewe Prodopa Medrol Depo-Medrol Depo-Medrol with Lidocaine Solu-Medrol Solu-Medrol Solu-Medrol Solu-Medrol Pfizer Multichem Apo-Moclobemide m-Mometasone m-Mometasone RA-Morph RA-Morph RA-Morph RA-Morph m-Elson Sevredol Mayne Mayne 2013 2013 30/9/11 2011 2011 2012 2013 2012 2012 2013 2012

Methotrexate

2013 2012 2011 2011 2012 2011 2011 2012

Methyldopa Methylprednisolone Methylprednisolone acetate Methylprednisolone acetate with lignocaine Methylprednisolone sodium succinate

Metoclopramide hydrochloride Miconazole nitrate Moclobemide Mometasone furoate Morphine hydrochloride

2011 2011 2012 2012 2012

Morphine sulphate

2013 2012 2011

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Morphine tartrate Mucilaginous laxatives Naproxen Nevirapine

Presentation

Inj 80 mg per ml, 1.5 ml & 5 ml Dry Tab 250 mg Tab 500 mg Oral suspension 10 mg per ml Tab 200 mg

Brand Name Expiry Date*

Hospira Konsyl-D Noflam 250 Noflam 500 Viramune Suspension Viramune Noriday 28 Primolut N Norpress Nilstat Nilstat Nilstat Dr Reddy’s Omeprazole Dr Reddy’s Omeprazole Syntocinon Syntocinon Syntometrine Pamisol Pamisol Pamisol Dr Reddy’s Pantoprazole Pharmacare Paracare Junior Paracare Double Strength ParaCode Lacri-Lube Loxamine Breath-Alert 2013 2013 2012 2012

Norethisterone Nortriptyline hydrochloride Nystatin

Tab 350 µg Tab 5 mg Tab 10 mg & 25 mg Cap 500,000 u Tab 500,000 u Oral liq 100,000 u per ml, 24 ml OP Cap 10 mg, 20 mg & 40 mg Inj 40 mg

2012 2011 2011 2013 2011 2011

Omeprazole

Oxytocin

Inj 5 iu per ml, 1 ml Inj 10 iu per ml, 1 ml Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml Inj 3 mg per ml, 5 ml Inj 3 mg per ml, 10 ml Inj 6 mg per ml, 10 ml Tab 20 mg & 40 mg Tab 500 mg Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml Tab paracetamol 500 mg with codeine phosphate 8 mg Eye oint with soft white paraffin Tab 20 mg Low range and Normal range

2012

Pamidronate disodium

2011

Pantoprazole Paracetamol

2013 2011

Paracetamol with codeine Paraffin liquid with soft white paraffin Paroxetine hydrochloride Peak Flow Meter

2011 2013 2013 30/9/11

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Pegylated interferon alpha-2A

Presentation

Inj 135 µg prefilled syringe Inj 180 µg prefilled syringe Inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 Inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 Inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 Inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 Tab 0.25 mg & 1 mg Lotn 5% Cap potassium salt 250 mg & 500 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Tab 5 mg, 10 mg & 15 mg Tab 15 mg, 30 mg & 45 mg Tab 500 µg Oral drops 10% Eye drops 1.4% Eye drops 3% Tab long-acting 600 mg Tab 1 mg, 2.5 mg, 5 mg & 20 mg Oral liq 5 mg per ml Cassette Inj 1.5 mega u Oral liq 5 mg per 5 ml Tab 10 mg & 25 mg

Brand Name Expiry Date*

Pegasys Pegasys Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Permax A-Scabies Cilicaine VK AFT AFT Apo-Pindolol Pizaccord Sandomigran Coloxyl Vistil Vistil Forte Span-K Apo-Prednisone Redipred Innovacon hCG One Step Pregnancy Test Cilicaine Promethazine Winthrop Elixir Allersoothe Accupril Accuretic 10 Accuretic 20 Q 300 Mycobutin Ropin ArrowRoxithromycin 2012 2013 2013 2012 2012 2012 2012 2011 2011 2012 2011 2012 2012 2011 2012 2011 2011 2011 31/12/12

Pergolide Permethrin Phenoxymethylpenicillin (Pencillin V)

2011 2011 2013

Pindolol Pioglitazone Pizotifen Poloxamer Polyvinyl alcohol Potassium chloride Prednisone Prednisone sodium phosphate Pregnancy tests – hCG urine Procaine penicillin Promethazine hydrochloride

Quinapril Quinapril with hydrochlorothiazide

Tab 5 mg, 10 mg & 20 mg Tab 10 mg with hydrochlorothiazide 12.5 mg Tab 20 mg with hydrochlorothiazide 12.5 mg Tab 300 mg Cap 150 mg Tab 0.25 mg, 1 mg, 2 mg & 5 mg Tab 150 mg & 300 mg

Quinine sulphate Rifabutin Ropinirole hydrochloride Roxithromycin

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Salbutamol

Presentation

Oral liq 2 mg per 5 ml Nebuliser soln, 1 mg per ml, 2.5 ml Nebuliser soln, 2 mg per ml, 2.5 ml Nebuliser soln, 2.5 mg with ipratopium bromide 0.5 mg per vial, 2.5 ml Tab 5 mg Tab 50 mg & 100 mg Tab 10 mg Tab 20 mg Tab 40 mg Tab 80 mg Inj 23.4%, 20 ml Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml Grans effervescent 4 g sachets Eye drops 2% Nasal spray, 4% Inj cartridge 16 iu (5.3 mg) Inj cartridge 36 iu (12 mg) Tab 80 mg & 160 mg 230 ml, autoclavable & single patient Tab 25 mg & 100 mg Tab 50 mg & 100 mg Cap 400 µg Soln 2.3% Tab 10 mg Tab 1 mg, 2 mg & 5 mg Tab 250 mg Inj long-acting 100 mg per ml, 10 ml Cap 40 mg Inj 250 µg Inj 1 mg per ml, 1 ml Tab 10 mg Eye drops 0.25% & 0.5% Cap 50 mg Tab 500 mg

Brand Name Expiry Date*

Salapin Asthalin Asthalin Duolin 2013 2012 2012

Salbutamol with ipratropium bromide Selegiline hydrochloride Sertraline Simvastatin

Apo-Selegiline Arrow-Sertraline Arrow-Simva 10 mg Arrow-Simva 20 mg Arrow-Simva 40 mg Arrow-Simva 80 mg Biomed Micolette Ural Rexacrom Rex Genotropin Genotropin Mylan Space Chamber Spirotone Arrow-Sumatriptan Tamsulosin-Rex Pinetarsol Normison Arrow Apo-Terbinafine Depo-Testosterone Arrow-Testosterone Synacthen Synacthen Depot Apo-Timol Apo-Timop Arrow-Tramadol Cycklokapron

2012 2013 2011

Sodium chloride Sodium citrate with sodium lauryl sulphoacetate Sodium citro-tartrate Sodium cromoglycate Somatropin Sotalol Spacer Device Spironolactone Sumatriptan Tamsulosin hydrochloride Tar with triethanolamine lauryl sulphate and fluorescein Temazepam Terazosin hydrochloride Terbinafine Testosterone cypionate Testosterone undecanoate Tetracosactrin Timolol maleate Tramadol hydrochloride Tranexamic acid

2013 2013 2013 2013 2012 31/12/12 2012 30/9/11 2013 2013 2013 2011 2011 2013 2011 2011 2012 2011 2012 2011 2011 2013

Sole Subsidised Supply Products – cumulative to April 2011

Generic Name

Triamcinolone acetonide

Presentation

Crm 0.02% Oint 0.02% Inj 40 mg per ml, 1 ml 0.1% in Dental Paste USP Tab 300 mg Cap 5 mg Cap 300 mg Inj 50 mg per ml, 10 ml Tab, strong, BPC Tab (BPC cap strength) Cap 100 mg Oral liq 10 mg per ml Oint BP Cap 137.4 mg (50 mg elemental) Tab 7.5 mg

Brand Name Expiry Date*

Aristocort Aristocort Kenacort-A40 Oracort TMP Navoban Actigall Pacific B-PlexADE MultiADE Retrovir Retrovir PSM Zincaps Apo-Zopiclone 2011

Trimethoprim Tropisetron Ursodeoxycholic acid Vancomycin hydrochloride Vitamin B complex Vitamins Zidovudine [AZT] Zinc and castor oil Zinc sulphate Zopiclone April changes in bold

2011 2012 2011 2011 2013 2013 2013 2011 2011 2011

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings

Effective 1 April 2011

51 105 126 METOPROLOL SUCCINATE ❋ Tab long-acting 23.75 mg ........................................................ 2.18 ❋ Tab long-acting 47.5 mg .......................................................... 2.74 ❋ Tab long-acting 95 mg ............................................................. 4.71 ❋ Tab long-acting 190 mg ........................................................... 8.51 ETANERCEPT – Special Authority see SA1060 – Retail pharmacy Inj 50 mg prefilled syringe .................................................. 1,899.92 SUMATRIPTAN Inj 12 mg per ml, 0.5 ml – Retail pharmacy-Specialist ............. 36.00 Maximum of 10 inj per prescription 30 30 30 30 4 2 OP ✔ Myloc CR ✔ Myloc CR ✔ Myloc CR ✔ Myloc CR ✔ Enbrel ✔ Arrow-Sumatriptan

141 142

NALTREXONE HYDROCHLORIDE – Special Authority see SA0909 – Retail pharmacy Tab 50 mg ........................................................................... 123.00 30 NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks. Lozenge 1 mg ......................................................................... 19.94 Lozenge 2 mg ........................................................................ 24.27 Patch 7 mg ........................................................................... 18.13 Patch 14 mg .......................................................................... 18.81 Patch 21 mg .......................................................................... 19.14 THALIDOMIDE – PCT only – Specialist – Special Authority see SA0882 Only on a controlled drug form Cap 50 mg ........................................................................... 504.00 IPRATROPIUM BROMIDE Aqueous nasal spray, 0.03% .................................................... 4.03 PHARMACY SERVICES – May only be claimed once per patient ❋ Brand switch fee ....................................................................... 0.01 The Pharmacode for BSF m-Captorpil is 2378647 (BSF m-Captopril Brand switch fee to be delisted 1 July 2011)

✔ Naltraccord

216 216 28 28 28

✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol

150

28 15 ml OP 1 fee

✔ Thalomid ✔ Univent ✔ BSF m-Captopril

165 171

Effective 1 March 2011

28 50 82 LANSOPRAZOLE ❋ Cap 15 mg ................................................................................ 3.27 ❋ Cap 30 mg ................................................................................ 4.34 DIGOXIN ❋ Tab 62.5 µg – Up to 30 tab available on a PSO .......................... 6.67 CEFACLOR MONOHYDRATE Cap 250 mg ............................................................................ 24.57 28 28 240 100 ✔ Lanzol Relief ✔ Lanzol Relief ✔ Lanoxin PG ✔ Cefaclor Sandoz

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 March 2011 (continued)

83 94 94 127 CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA0988 Tab 250 mg .............................................................................. 7.75 14 ✔ Klacid DARUNAVIR – Special Authority see SA1025 – Retail pharmacy Tab 600 mg ....................................................................... 1,190.00 RITONAVIR – Special Authority see SA1025 – Retail pharmacy Tab 100 mg ............................................................................ 43.31 60 30 ✔ Prezista ✔ Norvir

ONDANSETRON a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 c) Not more than one prescription per month; can be waived by Special Authority see SA0887. d) The maximum of 6 tab per dispensing cannot be waived via Access Exemption Criteria. Tab disp 4 mg ........................................................................... 1.70 10 ✔ Dr Reddy’s Ondansetron Tab disp 8 mg ........................................................................... 2.00 10 ✔ Dr Reddy’s Ondansetron PHARMACY SERVICES – May only be claimed once per patient ❋ Brand switch fee ....................................................................... 0.01 The Pharmacode for BSF Zapril is 2378639 (BSF Zapril Brand switch fee to be delisted 1 June 2011) 1 fee ✔ BSF Zapril

171

Effective 1 February 2011

73 POTASSIUM CITRATE Oral liq 3 mmol per ml – Special Authority see SA1083 – Retail pharmacy................................................................ 30.00 200 ml OP ✔ Biomed

➽ SA1083 Special Authority for Subsidy Initial application only from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has recurrent calcium oxalate urolithiasis; and 2 The patient has had more than two renal calculi in the two years prior to the application. Renewal from any relevant practitioner. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefitting from the treatment. 77 OESTRADIOL – See prescribing guideline ❋ TDDS 25 µg per day ................................................................. 3.01 (10.86) a) Higher subsidy of $10.86 per 8 patch with Special Authority see SA1018 b) No more than 2 patch per week c) Only on a prescription ❋ TDDS 100 µg per day ............................................................... 7.05 (16.14) a) Higher subsidy of $16.14 per 8 patch with Special Authority see SA1018 b) No more than 2 patch per week c) Only on a prescription 8 Estradot

8 Estradot

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 February 2011 (continued)

86 117 LINCOMYCIN – Retail pharmacy-Specialist Inj 300 mg per ml, 2 ml ........................................................... 80.00 FENTANYL a) Only on a controlled drug form b) No patient co-payment payable Transdermal patch 12.5 µg per hour ......................................... 8.90 Transdermal patch 25 µg per hour ............................................ 9.15 Transdermal patch 50 µg per hour .......................................... 11.50 Transdermal patch 75 µg per hour .......................................... 13.60 Transdermal patch 100 µg per hour ........................................ 14.50 164 SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 µg with ipratropium bromide, 20 µg per dose CFC-free ..................................................................... 12.19 SODIUM CHLORIDE Soln 7% .................................................................................. 23.50 CAFFEINE CITRATE Oral liq 20 mg per ml (10 mg base per ml) ............................... 14.85 PHARMACY SERVICES – May only be claimed once per patient. ❋ Brand switch fee ....................................................................... 0.01 The Pharmacode for BSF Apo-Clopidogrel is 2378655 (BSF Apo-Clopidogrel Brand switch fee to be delisted 1 May 2011) 5 ✔ Lincocin S29

5 5 5 5 5

✔ Mylan Fentanyl Patch ✔ Mylan Fentanyl Patch ✔ Mylan Fentanyl Patch ✔ Mylan Fentanyl Patch ✔ Mylan Fentanyl Patch

200 dose OP ✔ Duolin HFA 90 ml OP 25 ml OP 1 fee ✔ Biomed ✔ Biomed ✔ BSF Apo-Clopidogrel

164 165 171

Effective 1 January 2011

34 43 LACTULOSE – Only on a prescription ❋ Oral liq 10 g per 15 ml .............................................................. 7.68 SODIUM CHLORIDE Inj 0.9%, 5 ml – Up to 5 inj available on a PSO ......................... 10.85 Inj 0.9%, 10 ml – Up to 5 inj available on a PSO ....................... 11.50 1,000 ml 50 50 ✔ Laevolac ✔ Multichem ✔ Multichem

INFLUENZA VACCINE – Hospital pharmacy [Xpharm] A) is available 1 March until vaccine supplies are exhausted each year for patients who meet the following criteria, as set by the Ministry of Health: 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; continued...

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 January 2011 (continued)

continued... 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. c) people under 65 years of age who are: i) pregnant; or ii) morbidly obsese d) children aged over 6 months and under 5 years who are from high deprivation backgrounds 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, 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 .......................................................................................... 90.00 10 ✔ Fluvax ✔ Fluarix

142

NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. Gum 2 mg (Classic) ............................................................... 14.97 96 Gum 4 mg (Classic) ............................................................... 20.02 96 PHARMACY SERVICES – May only be claimed once per patient. ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Imuprine is 2377829 ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Dapa-Tabs is 2377837 ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Univent is 2377845 ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Arrow Terazosin is 2377853 (BSF Imuprine to be delisted 1 April 2011) (BSF Dapa-Tabs to be delisted 1 April 2011) (BSF Univent to be delisted 1 April 2011) (BSF Arrow Terazosin to be delisted 1 April 2011) 1 fee 1 fee 1 fee 1 fee

✔ Habitrol ✔ Habitrol ✔ BSF Imuprine ✔ BSF Dapa-Tabs ✔ BSF Univent ✔ BSF Arrow Terazosin

171

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions

Effective 1 April 2011

48 86 101 CAPTOPRIL – Brand switch fee payable ❋ Tab 12.5 mg ............................................................................ 2.00 ❋ Tab 25 mg ............................................................................... 2.40 ❋ Tab 50 mg ............................................................................... 3.50 LINCOMYCIN – Retail pharmacy-Specialist Inj 300 mg per ml, 2 ml ........................................................... 80.00 100 100 100 5 ✔ m-Captopril ✔ m-Captopril ✔ m-Captopril ✔ Lincocin S29

ADALIMUMAB – Special Authority see SA1059 – Retail pharmacy Inj 40 mg per 0.8 ml prefilled pen ...................................... 1,799.92 2 ✔ HumiraPen Inj 40 mg per 0.8 ml prefilled syringe ................................. 1,799.92 2 ✔ Humira Note – this is a change to the renewal criteria for severe chronic plaque psoriasis only. The remainder of the Special Authority criteria remains unchanged. ➽ SA1059 Special Authority for Subsidy Renewal - (severe chronic plaque psoriasis) only from a dermatologist or Practitioner on the recommendation of a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a dermatologist; or 1.2 Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Both: 2.1.1 Patient had has "whole body" severe chronic plaque psoriasis at the start of treatment; and 2.1.2 Following each prior adalimumab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-adalimumab treatment baseline value; or 2.2 Both: 2.2.1 Patient had has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 2.2.2 Either: 2.2.2.1 Following each prior adalimumab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 2.2.2.2 Following each prior adalimumab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the preadalimumab treatment baseline value; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Note: A treatment course is defined as a minimum of 12 weeks adalimumab treatment.

105

ETANERCEPT – Special Authority see SA1060 – Retail pharmacy Inj 25 mg ............................................................................. 949.96 4 ✔ Enbrel Inj 50 mg autoinjector ........................................................ 1,899.92 4 ✔ Enbrel Inj 50 mg prefilled syringe .................................................. 1,899.92 4 ✔ Enbrel Note – this is a change to the renewal criteria for severe chronic plaque psoriasis only. The remainder of the Special Authority criteria remains unchanged. ➽ SA1060 Special Authority for Subsidy Renewal - (severe chronic plaque psoriasis) only from a dermatologist or Practitioner on the recommendation of a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: continued...

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... All of the following: 1 Either: 1.1 Applicant is a dermatologist; or 1.2 Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax \ recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Both: 2.1.1 Patient had has "whole body" severe chronic plaque psoriasis at the start of treatment; and 2.1.2 Following each prior adalimumab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-adalimumab treatment baseline value; or 2.2 Both: 2.2.1 Patient had has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 2.2.2 Either: 2.2.2.1 Following each prior adalimumab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 2.2.2.2 Following each prior adalimumab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the preadalimumab treatment baseline value; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. Note: A treatment course is defined as a minimum of 12 weeks etanercept treatment. 141 VARENICLINE TARTRATE – Special Authority see SA1054 – Retail pharmacy Varenicline will not be funded Close Control in amounts less than 2 weeks of treatment. Tab 1 mg ............................................................................... 67.74 28 ✔ Champix 135.48 56 ✔ Champix Tab 0.5 mg × 11 and 1 mg × 14 .......................................... 60.48 25 OP ✔ Champix EXEMESTANE – Additional subsidy by Special Authority see SA1000 – Retail pharmacy Tab 25 mg ............................................................................. 22.57 30 ✔ Aromasin ➽ SA1000 Special Authority for Alternate Subsidy Initial application from any relevant practitioner. Approvals valid for 5 years for applications meeting the following criteria: All of the following: 1 Patient is a postmenopausal woman; and 2 Patient has hormone receptor positive breast cancer; and 3 Any of the following: 3.1 The patient was receiving funded exemestane prior to 1 February 2010; or 3.2 The patient has advanced breast cancer and a very clear history of intolerance to anastrozole or letrozole; or 3.3 The patient has advanced breast cancer and disease has progressed following treatment with anastrozole or letrozole. Renewal from any relevant practitioner. Approvals valid without further renewal unless notified where the treatment remains appropriate and the patient is benefitting from treatment.

156

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

179 SECTION D: SPECIAL FOODS EXPLANATORY NOTES Who can apply for Special Authority? Initial Applications: Only Specialists from a relevant specialist or a vocationally registered general practitioner Reapplications: Specialist or general practitioner on recommendation of specialist. Only from a relevant specialist or a vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or a vocationally registered general practitioner. Other general practitioners must include the name of the relevant specialist or vocationally registered general practitioner and the date contacted. 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: Ministry of Health Sector Services Private Bag 3015 WHANGANUI 4540 Freefax 0800 100 131 181 CARBOHYDRATE CARBOHYDRATE SUPPLEMENT – Special Authority see SA1090 0912 – Hospital pharmacy [HP3] Powder .................................................................................. 36.50 5,000 g ✔ Morrex Maltodextrin 182.50 25,000 g ✔ Morrex Maltodextrin 1.30 400 g OP (5.29) Polycal (12.00) 368 g OP Moducal ➽ SA1090 0912 Special Authority for Subsidy Initial application — (Cystic fibrosis or renal failure) only from a relevant specialist or vocationally registered general practitioner. 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 or vocationally registered general practitioner. 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 , vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both: continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. Renewal — (Indications other than cystic fibrosis or renal failure) only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted. 181 CARBOHYDRATE AND FAT CARBOHYDRATE AND FAT SUPPLEMENT – Special Authority see SA1091 0581 – Hospital pharmacy [HP3] Powder (neutral) ..................................................................... 60.31 400 g OP ✔ Duocal Super Soluble Powder ➽ SA1091 0581 Special Authority for Subsidy Initial application — (Cystic fibrosis) only from a relevant specialist or vocationally registered general practitioner. 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 or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 infant aged four years or under; and 2 Any of the following: 2.1 cancer in children; or 2.2 failure to thrive; or 2.3 growth deficiency; or 2.4 bronchopulmonary dysplasia; or 2.5 premature and post premature infants. Renewal —(Cystic fibrosis) only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted. Renewal —(Indications other than cystic fibrosis) only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted.

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

182 FAT FAT SUPPLEMENT – Special Authority see SA1092 0899 – Hospital pharmacy [HP3] Emulsion (neutral) .................................................................. 12.30 200 ml OP 30.75 500 ml OP Emulsion (strawberry) ............................................................ 12.30 200 ml OP Oil .......................................................................................... 28.73 250 ml OP 30.00 500 ml OP

✔ Calogen ✔ Calogen ✔ Calogen ✔ Liquigen ✔ MCT oil (Nutricia)

➽ SA1092 0899 Special Authority for Subsidy Initial application — (Inborn errors of metabolism) only from a relevant specialist or vocationally registered general practitioner. 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 or vocationally registered general practitioner. 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted. Renewal — (Indications other than inborn errors of metabolism) only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted. 183 PROTEIN PROTEIN SUPPLEMENT – Special Authority see SA1093 0582 – Hospital pharmacy [HP3] Powder .................................................................................... 7.90 225 g OP ✔ Protifar 8.95 227 g OP ✔ Resource Beneprotein Powder (vanilla) ..................................................................... 12.90 275 g OP ✔ Promod ➽ SA1093 0582 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 protein losing enteropathy; or 2 high protein needs (eg burns). continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... Renewal only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted. 183 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. ➽ SA0583 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. 184 RESPIRATORY PRODUCTS CORD ORAL FEED 1.5KCAL/ML – Special Authority see SA1094 0588 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.66 237 ml OP ✔ Pulmocare ➽ SA1094 0588 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications where the patient has CORD and hypercapnia 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both All of the following: 1 The treatment remains appropriate and the patient is benefiting from treatment; and continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 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 relevant specialist or vocationally registered general practitioner and date contacted. 184 DIABETIC PRODUCTS DIABETIC ENTERAL FEED 1KCAL/ML – Special Authority see SA1095 0594 – Hospital pharmacy [HP3] Liquid ....................................................................................... 7.50 1,000 ml OP ✔ Diason RTH ✔ Glucerna Select RTH ORAL FEED 1KCAL/ML – Special Authority see SA1095 0594 – Hospital pharmacy [HP3] Liquid (strawberry) ................................................................... 1.50 200 ml OP ✔ Diasip Liquid (vanilla) .......................................................................... 1.50 200 ml OP ✔ Diasip 1.88 250 ml OP ✔ Glucerna Select 1.78 237 ml OP (2.10) Resource Diabetic ➽ SA1095 0594 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for where the patient has applications meeting the following criteria: Both: 1 Type I or and II diabetes who and is suffering weight loss and malnutrition that requires nutritional support. 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner and date contacted. 185 FAT MODIFIED PRODUCTS FAT MODIFIED FEED – Special Authority see SA1096 0615 – Hospital pharmacy [HP3] Powder .................................................................................. 60.48 400 g OP ✔ Monogen ➽ SA1096 0615 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. 185 HIGH PROTEIN PRODUCTS ORAL FEED 1KCAL/ML – Special Authority see SA1097 0589 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.90 200 ml OP ✔ Fortimel Regular ➽ SA1097 0589 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both All of the following: 1 Anorexia and weight loss; and 2 Either: 2.1 decompensating liver disease without encephalopathy; or 2.2 protein losing gastro-enteropathy; and 3 Either: 3.1 The product is to be used as a supplement (maximum 500 ml per day); or 3.2 The product is to be used as a complete diet. Renewal only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner and date contacted. 185 PAEDIATRIC PRODUCTS FOR CHILDREN AWAITING LIVER TRANSPLANT ENTERAL/ORAL FEED 1KCAL/ML – Special Authority see SA1098 0607 – Hospital pharmacy [HP3] Powder .................................................................................. 78.97 400 g OP ✔ Generaid Plus ➽ SA1098 0607 Special Authority for Subsidy Initial application only from a paediatrician relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications where the patient is a 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 relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years where 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. 3 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted.

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

186 PAEDIATRIC PRODUCTS FOR CHILDREN WITH CHRONIC RENAL FAILURE ENTERAL/ORAL FEED 1KCAL/ML – Special Authority see SA1099 0606 – Hospital pharmacy [HP3] Liquid ..................................................................................... 54.00 400 g OP ✔ Kindergen ➽ SA1099 0606 Special Authority for Subsidy Initial application only from a paediatrician relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications where the patient is a 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 relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years where 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. 3 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. 186 PAEDIATRIC PRODUCTS PAEDIATRIC ENTERAL FEED 1.5KCAL/ML – Special Authority see SA1100 0896 – Hospital pharmacy [HP3] Liquid ....................................................................................... 6.00 500 ml OP ✔ Nutrini Energy RTH PAEDIATRIC ENTERAL FEED 1KCAL/ML – Special Authority see SA1100 0896 – Hospital pharmacy [HP3] Liquid ....................................................................................... 2.68 500 ml OP ✔ Nutrini RTH ✔ Pediasure RTH PAEDIATRIC ORAL FEED 1.5KCAL/ML – Special Authority see SA1100 0896 – Hospital pharmacy [HP3] Liquid (strawberry) ................................................................... 1.60 200 ml OP ✔ NutriniDrink Liquid (vanilla) .......................................................................... 1.60 200 ml OP ✔ NutriniDrink PAEDIATRIC ORAL FEED 1KCAL/ML – Special Authority see SA1100 0896 – Hospital pharmacy [HP3] Liquid (chocolate) .................................................................... 1.07 200 ml OP ✔ Pediasure Liquid (strawberry) ................................................................... 1.07 200 ml OP ✔ Pediasure Liquid (vanilla) .......................................................................... 1.07 200 ml OP ✔ Pediasure 1.27 237 ml OP ✔ Pediasure PAEDIATRIC ORAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA1100 0896 – Hospital pharmacy [HP3] Liquid (chocolate) .................................................................... 1.60 200 ml OP ✔ NutriniDrink Multifibre Liquid (strawberry) ................................................................... 1.60 200 ml OP ✔ NutriniDrink Multifibre Liquid (vanilla) .......................................................................... 1.60 200 ml OP ✔ NutriniDrink Multifibre ➽ SA1100 0896 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both All of the following: 1 Infant aged one to eight years; and 2 Any of the following: continued...

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner and date contacted. 187 RENAL PRODUCTS ENTERAL FEED 2KCAL/ML – Special Authority see SA1101 0587 – Hospital pharmacy [HP3] Liquid ....................................................................................... 6.08 500 ml OP ✔ Nutrison Concentrated RENAL ORAL FEED 2KCAL/ML – Special Authority see SA1101 0587 – Hospital pharmacy [HP3] Liquid ....................................................................................... 2.43 200 ml OP ✔ Nepro (strawberry) ✔ Nepro (vanilla) 2.88 237 ml OP (3.31) NovaSource Renal Liquid (apricot) ......................................................................... 2.88 125 ml OP ✔ Renilon 7.5 Liquid (caramel) ....................................................................... 2.88 125 ml OP ✔ Renilon 7.5 ➽ SA1101 0587 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for where the patient has 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner and date contacted.

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

188 SPECIALISED AND ELEMENTAL PRODUCTS ENTERAL/ORAL ELEMENTAL FEED 1KCAL/ML – Special Authority see SA1102 0592 – 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 SA1102 0592 – 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 SA1102 0592 – Hospital pharmacy [HP3] Powder (unflavoured) ............................................................... 4.50 80.4 g OP ✔ Vivonex TEN SEMI-ELEMENTAL ENTERAL FEED 1KCAL/ML – Special Authority see SA1102 0592 – Hospital pharmacy [HP3] Liquid ..................................................................................... 12.04 1,000 ml OP ✔ Peptisorb ➽ SA1102 0592 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner and date contacted. 188 UNDYALISED END STAGE RENAL FAILURE RENAL ORAL FEED 1KCAL/ML – Special Authority see SA1103 0586 – Hospital pharmacy [HP3] Liquid ....................................................................................... 3.80 237 ml OP ✔ Suplena ➽ SA1103 0586 Special Authority for Subsidy Initial application only from a gastroenterologist or renal physician relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for where the patient has applications meeting the following criteria: Both: 1 undialysed end stage renal patients.; and continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner and date contacted. 189 ADULT PRODUCTS STANDARD ➽ SA0702 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: 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 continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 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. 189 STANDARD SUPPLEMENTS ORAL FEED 1KCAL/ML – Special Authority see SA1104 0583– Hospital pharmacy [HP3] Powder (chocolate) .................................................................. 4.22 400 g OP ✔ Ensure 9.50 900 g OP ✔ Ensure 10.22 ✔ Sustagen Hospital Formula Powder (strawberry) ................................................................. 4.22 400 g OP ✔ Ensure Powder (vanilla) ....................................................................... 4.22 400 g OP ✔ Ensure 9.50 900 g OP ✔ Ensure 10.22 ✔ Sustagen Hospital Formula ENTERAL FEED 1KCAL/ML – Special Authority see SA1104 0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.24 250 ml OP ✔ Isosource Standard ✔ Osmolite 2.65 500 ml OP ✔ Nutrison Standard RTH 5.29 1,000 ml OP ✔ Nutrison Standard RTH ✔ Isosource Standard RTH 2.65 500 ml OP ✔ Osmolite RTH 5.29 1,000 ml OP ✔ Osmolite RTH ENTERAL FEED WITH FIBRE 1 KCAL/ML – Special Authority see SA1104 0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.32 237 ml OP ✔ Jevity 2.65 500 ml OP ✔ Nutrison Multi Fibre 5.29 1,000 ml OP ✔ Nutrison Multi Fibre 2.65 500 ml OP ✔ Jevity RTH 5.29 1,000 ml OP ✔ Jevity RTH

continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA1104 0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.75 250 ml OP ✔ Ensure Plus HN 7.00 1,000 ml OP ✔ Ensure Plus RTH ✔ Nutrison Energy Multi Fibre ORAL FEED 1.5KCAL/ML – Special Authority see SA1104 0702 – Hospital pharmacy [HP3] Liquid (banana) ........................................................................ 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus Liquid (chocolate) .................................................................... 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus Liquid (coffee latte) ................................................................... 0.85 237 ml OP (1.33) Ensure Plus Liquid (fruit of the forest) .......................................................... 0.72 200 ml OP (1.45) Ensure Plus Liquid (strawberry) ................................................................... 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus Liquid (toffee) ........................................................................... 0.72 200 ml OP (1.26) Fortisip Liquid (tropical fruit) ................................................................. 0.72 200 ml OP (1.26) Fortisip Liquid (vanilla) .......................................................................... 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus Note: Repeats for Fortisip and Ensure Plus, 237 ml OP, will be fully subsidised where the initial dispensing was before 1 April 2011. Repeats for Ensure Plus, 200 ml OP, will be subsidised to the same subsidy level as prior to 1 April 2011 ORAL FEED WITH FIBRE 1.5 KCAL/ML – Special Authority see SA1104 0702 – Hospital pharmacy [HP3] Liquid (chocolate) .................................................................... 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (strawberry) ................................................................... 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (vanilla) .......................................................................... 0.72 200 ml OP (1.26) Fortisip Multi Fibre Note: Repeats for Fortisip Multi Fibre will be fully subsidised where the initial dispensing was before 1 April 2011. ➽ SA1104 Special Authority for Subsidy Initial application – (Children) only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 The patient is under 18 years of age; and 2 Any of the following: 2.1 The patient has a condition causing malabsorption; or continued... 2.2 The patient has failure to thrive; or Three months supply may be dispensed at one time ❋ Three months or six months, as if endorsed “certified exemption” by the prescriber. applicable, dispensed all-at-once

▲

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 2.3 The patient has increased nutritional requirements; and 3 A nutrition goal has been set (eg reach a specific weight or BMI).

Renewal application – (Children) only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 All of the following: 1.1 The patient is under 18 years of age; and 1.2 The treatment remains appropriate and the patient is benefiting from treatment; and 1.3 A nutrition goal has been set (eg reach a specific weight or BMI); and 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. Initial application – (Adults) only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Any of the following: Patient is Malnourished 1.1 Patient has a body mass index (BMI) of less than 18.5 kg/m2; or 1.2 Patient has unintentional weight loss greater than 10% within the last 3-6 months; or 1.3 Patient has a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3-6 months; and 2 Any of the following: First-line dietary measures Patient has not responded to first-line dietary measures over a 4 week period by: 2.1 increasing their food intake frequency (eg snacks between meals); or, 2.2 using high-energy foods (e.g. milkshakes, full fat milk, butter, cream, cheese, sugar etc); or, 2.3 using over the counter supplements (e.g. complan) and, 3 A nutrition goal has been set (e.g. to reach a specific weight or BMI) Renewal application – (Adults) only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: Both: 1 All of the following: 1.1 A nutrition goal has been set (eg reach a specific weight or BMI); and, 1.2 Any of the following: Patient is Malnourished 1.2.1 Patient has a body mass index (BMI) of less than 18.5 kg/m2; or 1.2.2 Patient has unintentional weight loss greater than 10%within the last 3-6 months; or 1.2.3 Patient has a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3-6 months; and 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. Initial application – (Adults transitioning from hospital Discretionary Community Supply) only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient has had up to a 30 day supply of a 1.0 or a 1.5 kcal/ml Standard Oral Supplement; and, 2 A nutrition goal has been set (eg reach a specific weight or BMI); and, 3 Any of the following: Patient is Malnourished 3.1 Patient has a body mass index (BMI) of less than 18.5 kg/m2; or continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 3.2 Patient has unintentional weight loss greater than 10%within the last 3-6 months; or 3.3 Patient has a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3-6 months; and

Initial application – (Specific medical condition) only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: The patient has any of the following: 1 Is being feed via a nasogastric tube or a nasogastric tube is to be inserted for feeding; or 2 Malignancy and is considered likely to develop malnutrition as a result; or 3 Is undergoing a bone marrow transplant; or, 4 Tempomandible joint surgery. Renewal application – (Specific medical condition) only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient has any of the following: 1.1 Is being fed via a nasogastric tube; or 1.2 Malignancy and is considered likely to develop malnutrition as a result; or 1.3 Has undergone a bone marrow transplant; or, 1.4 Tempomandible joint surgery. 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. Initial application – (Chronic disease OR tube feeding) only from a relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal for applications meeting the following criteria: The patient has any of the following: 1 Is being fed via a tube or a tube is to be inserted for the purpose of feeding (not nasogastric tube - refer to specific medical condition criteria); 2 Cystic Fibrosis; or 3 Liver disease; or 4 Chronic Renal failure; or 5 Inflammatory bowel disease; or 6 Chronic obstructive pulmonary disease with hypercapnia; or 7 Short bowel syndrome; or 8 Bowel fistula; or 9 Severe chronic neurological conditions Renewal application – (Chronic disease OR tube feeding for patients who have previously been funded under Special Authority forms SA0702 or SA0583) only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal for applications meeting the following criteria: Both: 1 The patient has any of the following: 1.1 Is being fed via a tube or a tube is to be inserted for the purpose of feeding (not nasogastric tube refer to specific medical condition criteria); 1.2 Cystic Fibrosis; or 1.3 Liver disease; or 1.4 Chronic Renal failure; or 1.5 Inflammatory bowel disease; or 1.6 Chronic obstructive pulmonary disease with hypercapnia; or 1.7 Short bowel syndrome; or 1.8 Bowel fistula; or continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 1.9 Severe chronic neurological conditions 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted

191

ADULT PRODUCTS HIGH CALORIE ORAL FEED 2KCAL/ML – Special Authority see SA1105 0585 – Hospital pharmacy [HP3] Liquid (vanilla) .......................................................................... 1.14 237 ml OP (2.25) Two Cal HN Note – Repeats for Two Cal HN will be fully subsidised where the initial dispensing was before 1 April 2011. ➽ SA1105 0585 Special Authority for Subsidy Initial application — (Cystic fibrosis) only from a relevant specialist or vocationally registered general practitioner. 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 or vocationally registered general practitioner. 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 3 years for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner 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, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both 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 relevant specialist or vocationally registered general practitioner 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. continued...

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 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. 192 FOOD THICKENERS FOOD THICKENER – Special Authority see SA1106 0595 – Hospital pharmacy [HP3] Powder ..................................................................................... 7.25 380 g OP

✔ Karicare Food Thickener

➽ SA1106 0595 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year where the patient has motor neurone disease with swallowing disorder. Renewal only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted. 192 GLUTEN FREE FOODS The funding of gluten free foods is no longer being actively managed by PHARMAC from 1 April 2011. This means that we are no longer considering the listing of new products, or making subsidy, or other changes to the existing listings. As a result we anticipate that the range of funded items will reduce over time. Management of Coeliac disease with a gluten free diet is necessary for good outcomes. A range of glutenfree options are available through retail outlets. ➽ SA1107 0722 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. 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 SA1107 0722 – Hospital pharmacy [HP3] Powder .................................................................................... 2.81 1,000 g OP (5.15) Healtheries Simple Baking Mix GLUTEN FREE BREAD MIX – Special Authority see SA1107 0722 – Hospital pharmacy [HP3] Powder .................................................................................... 3.93 1,000 g OP (7.32) NZB Low Gluten Bread Mix 4.77 (8.71) Bakels Gluten Free Health Bread Mix 3.51 (10.87) Horleys Bread Mix GLUTEN FREE FLOUR – Special Authority see SA1107 0722 – Hospital pharmacy [HP3] Powder .................................................................................... 5.62 2,000 g OP (18.10) Horleys Flour GLUTEN FREE PASTA – Special Authority see SA1107 0722 – Hospital pharmacy [HP3] Buckwheat Spirals .................................................................... 2.00 250 g OP (3.11) Orgran Corn and Vegetable Shells ........................................................ 2.00 250 g OP (2.92) Orgran continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... Corn and Vegetable Spirals ....................................................... 2.00 (2.92) Rice and Corn Lasagne Sheets ................................................. 1.60 (3.82) Rice and Corn Macaroni ........................................................... 2.00 (2.92) Rice and Corn Penne ................................................................ 2.00 (2.92) Rice and Maize Pasta Spirals .................................................... 2.00 (2.92) Rice and Millet Spirals .............................................................. 2.00 (3.11) Rice and corn spaghetti noodles ............................................... 2.00 (2.92) Vegetable and Rice Spirals ........................................................ 2.00 (2.92) Italian long style spaghetti ......................................................... 2.00 (3.11) 193 FOODS AND SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM ➽ SA1108 Special Authority for Subsidy Initial application 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 Dietary management of homocystinuria; or 2 Dietary management of maple syrup urine disease; or 3 Dietary management of phenylketonuria (PKU); or 4 For use as a supplement to the Ketogenic diet in patients diagnosed with epilepsy. Supplements For Homocystinuria AMINOACID FORMULA WITHOUT METHIONINE – Special Authority see SA1108 0732 – Hospital pharmacy [HP3] See prescribing guideline Powder ................................................................................ 461.94 500 g OP ✔ XMET Maxamum Supplements For MSUD AMINOACID FORMULA WITHOUT VALINE, LEUCINE AND ISOLEUCINE – Special Authority see SA1108 0732 – Hospital pharmacy [HP3] See prescribing guideline Powder ................................................................................ 300.54 500 g OP ✔ MSUD Maxamaid 437.22 ✔ MSUD Maxamum Foods and Supplements For PKU AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA1108 0733 – Hospital pharmacy [HP3] See prescribing guideline 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 ✔ PKU Anamix Infant ✔ XP Analog LCP Powder (orange) .................................................................. 221.00 500 g OP ✔ XP Maxamaid 320.00 ✔ XP Maxamum continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

250 g OP Orgran 200 g OP Orgran 250 g OP Orgran 250 g OP Orgran 250 g OP Orgran 250 g OP Orgran 375 g OP Orgran 250 g OP Orgran 220 g OP Orgran

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... Powder (unflavoured) ............................................................... 221.00 320.00 Liquid (berry) ............................................................................. 15.65 31.20 15.65 31.20 Liquid (citrus) ............................................................................. 15.65 31.20 15.65 31.20 Liquid (forest berries) ................................................................. 30.00 Liquid (orange) ........................................................................... 15.65 31.20 15.65 31.20 Liquid (tropical) .......................................................................... 30.00 500 g OP 62.5 ml OP 125 ml OP 62.5 ml OP 125 ml OP 62.5 ml OP 125 ml OP 62.5 ml OP 125 ml OP 250 ml OP 62.5 ml OP 125 ml OP 62.5 ml OP 125 ml OP 250 ml OP ✔ XP Maxamaid ✔ XP Maxamum ✔ Lophlex LQ ✔ Lophlex LQ ✔ PKU Lophlex LQ ✔ PKU Lophlex LQ ✔ Lophlex LQ ✔ Lophlex LQ ✔ PKU Lophlex LQ ✔ PKU Lophlex LQ ✔ Easiphen Liquid ✔ Lophlex LQ ✔ Lophlex LQ ✔ PKU Lophlex LQ ✔ PKU Lophlex LQ ✔ Easiphen

LOW PROTEIN PHENYL FREE BAKING MIX – Special Authority see SA1108 0733 – Hospital pharmacy [HP3] See prescribing guideline Powder .................................................................................... 8.22 500 g OP ✔ Loprofin Mix LOW PROTEIN PHENYL FREE PASTA – Special Authority see SA1108 0733 – Hospital pharmacy [HP3] See prescribing guideline Animal shapes ........................................................................ 11.91 500 g OP ✔ Loprofin Lasagne ................................................................................... 5.95 250 g OP ✔ Loprofin Low protein rice pasta ............................................................ 11.91 500 g OP ✔ Loprofin Macaroni .................................................................................. 5.95 250 g OP ✔ Loprofin Penne ..................................................................................... 11.91 500 g OP ✔ Loprofin Spaghetti ................................................................................ 11.91 500 g OP ✔ Loprofin Spirals .................................................................................... 11.91 500 g OP ✔ Loprofin Multivitamin And Mineral Supplements AMINOACID FORMULA WITH MINERALS WITHOUT PHENYLALANINE – Special Authority see SA1108 0962 – Retail pharmacy See prescribing guideline Powder .................................................................................. 23.38 100 g OP ✔ Metabolic Mineral Mixture 193 FOODS AND SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM - OTHER ➽ SA0732 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 continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... 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. 194 FOODS AND SUPPLEMENTS FOR INBORN ERRORS OF METABOLISM - PKU 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 AND SUPPLEMENTS FOR PKU ➽ SA0733 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. 196 Multivitamin And Mineral Supplements ➽ SA0962 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 Dietary management of phenylketonuria (PKU); or 2 For use as a supplement to the ketogenic diet in patients diagnosed with epilepsy; or 3 Patient has had a previous approval for metabolic mineral mixture. FOR PREMATURE INFANTS PREMATURE BIRTH FORMULA – Special Authority see SA1109 – Hospital pharmacy [HP3] Liquid ....................................................................................... 0.75 100 ml OP ✔ S26LBW Gold RTF ➽ SA1109 0602 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months where the patient is infant weighing less than 1.5 kg at birth.

194

196

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

196 FOR WILLIAMS SYNDROME LOW CALCIUM INFANT FORMULA – Special Authority see SA1110 0601 – Hospital pharmacy [HP3] Powder .................................................................................. 44.40 400 g OP ✔ Locasol ➽ SA1110 0601 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 1 year where the patient is an infant suffering from Williams Syndrome and associated hypercalcaemia. Renewal only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. 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 relevant specialist or vocationally registered general practitioner and date contacted. 196 FOR GASTROINTESTINAL AND OTHER MALABSORPTIVE PROBLEMS ➽ SA0603 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. AMINO ACID FORMULA – Special Authority see SA1111 – Hospital pharmacy [HP3 Powder .................................................................................. 56.00 400 g OP 6.00 Powder (tropical) .................................................................... 56.00 Powder (unflavoured) ............................................................. 56.00 Powder (vanilla) ..................................................................... 56.00 ✔ Neocate ✔ Neocate LCP 48.5 g OP ✔ Vivonex Pediatric 400 g OP ✔ Neocate Advance 400 g OP ✔ Elecare ✔ Elecare LCP ✔ Neocate Advance 400 g OP ✔ Elecare

197

➽ SA1111 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: Any of the following: 1 Extensively hydrolysed formula has been reasonably trialled and is inappropriate due to documented severe intolerance or allergy or malabsorption; or, 2 History of anaphylaxis to cows milk protein formula or dairy products; or 3 Eosinophilic oesophagitis.

continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

continued... Renewal only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: 1 Assessment as to whether the infant can be transitioned to a cows milk protein formula or an extensively hydrolysed formula. 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. 197 EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1112 – Hospital pharmacy [HP3 Powder .................................................................................. 15.21 450 g OP ✔ Pepti Junior Gold 19.01 ✔ Pepti Junior ➽ SA1112 Special Authority for Subsidy Initial application only from a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: Any of the following: 1 Cows milk formula is inappropriate due to severe intolerance or allergy to its protein content; and either 1.1 Soy milk formula has been trialled without resolution of symptoms; or 1.2 Soy milk formula is considered clinically inappropriate or contraindicated. 2 Severe malabsorption; or 3 Short bowel syndrome; or 4 Intractable diarrhoea; or 5 Biliary atresia; or 6 Cholestatic liver diseases causing malsorption; or 7 Chylous ascites; or 8 Chylothorax; or 9 Cystic fibrosis; or 10 Proven fat malabsorption; or 11 Severe intestinal motility disorders causing significant malabsorption; or 12 Intestinal failure. Renewal only from a relevant specialist, vocationally registered general practitioner or medical practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: 1 Assessment as to whether the infant can be transitioned to a cows milk protein formula has been undertaken, and 2 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted.

Effective 1 March 2011

31 BLOOD GLUCOSE DIAGNOSTIC TEST STRIP 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 × 50 and lancets × 5 ...................... 19.10 50 test OP 1 OP✔ On Call Advanced 19.60 ✔ CareSens Note – pack size change from 1 OP to 50 test OP. The pharmacodes for these packs have also changed. IMIGLUCERASE – Special Authority see SA0473 – Retail pharmacy Inj 40 iu per ml, 400 iu vial ................................................ 2,144.00 1 ✔ Cerezyme S29

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 March 2011 (continued)

48 56 CILAZAPRIL – Brand switch fee payable ❋ Tab 0.5 mg .............................................................................. 0.95 ❋ Tab 2.5 mg .............................................................................. 2.06 ❋ Tab 5 mg ................................................................................. 3.28 30 30 30 ✔ Zapril ✔ Zapril ✔ Zapril

SILDENAFIL – Special Authority see SA1086 0968 – Retail pharmacy Tab 25 mg ............................................................................. 52.00 4 ✔ Viagra Tab 50 mg ............................................................................. 59.50 4 ✔ Viagra Tab 100 mg ........................................................................... 68.00 4 ✔ Viagra Note – Change to criteria. Application details may be obtained from PHARMAC’s website http://www.pharmac. govt.nz or The Coordinator, PAH Panel. INFLUENZA VACCINE – Hospital pharmacy [Xpharm] A) is available 1 March until vaccine supplies are exhausted each year for patients who meet the following criteria, as set by the Ministry of Health: 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, or. h) pregnancy. c) people under 65 years of age who are: i) pregnant; or ii) morbidly obsese d) children aged over 6 months and under 5 years who are from high deprivation backgrounds 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, 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. continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 March 2011 (continued)

continued... 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 .......................................................................................... 90.00 10 ✔ Fluvax ✔ Fluarix 141 VARENICLINE TARTRATE – Special Authority see SA1054 – Retail pharmacy Tab 0.5 mg × 11 and 1 mg × 14 .......................................... 60.48 25 OP 1 OP ✔ Champix Note – pack size change from 1 OP to 25 tab OP. The pharmacode for this pack has also changed. GEMCITABINE HYDROCHLORIDE – PCT only – Specialist – Special Authority see SA1087 1012 Inj 1 g .................................................................................... 62.50 1 ✔ Gemcitabine Ebewe 349.20 ✔ Gemzar Inj 200 mg ............................................................................. 12.50 1 ✔ Gemcitabine Ebewe 78.00 ✔ Gemzar Inj 1 mg for ECP ....................................................................... 0.07 1 mg ✔ Baxter ➽ SA1087 1012 Special Authority for Subsidy Initial application — (Hodgkin’s Disease) 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: All of the following: 1 The patient has Hodgkin’s Disease*; and 2 Any of the following: 2.1 Disease has failed to respond to second-line salvage chemotherapy treatment; or 2.2 Disease has relapsed following transplant; or 2.3 The patient is unsuitable for, or intolerant to, second-line salvage chemotherapy or high dose chemotherapy and transplant; and 3 Gemcitabine to be given for a maximum of 6 treatment cycles. Initial application — (T-Cell Lymphoma) 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 T-cell Lymphoma*; and 2 Gemcitabine to be given for a maximum of 6 treatment cycles. Note: Indications marked with a * are Unapproved Indications. Initial application — (Cholangiocarcinoma) 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 locally advanced or metastatic, cholangiocarcinoma*; and 2 Gemcitabine to be given for a maximum of 8 treatment cycles. Notes: Cholangiocarcinoma encompasses epithelial tumours of the hepatobiliary tree, including tumours of bile ducts, ampulla of vater and gallbladder. Indications marked with a * are Unapproved Indications. Initial application — (Pancreatic 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: Either 1 Both: 1.1 The patient has macroscopically resected (R0) pancreatic carcinoma*; and 1.2 Adjuvant gemcitabine to be administered for a maximum of 6 cycles; or 2 Both: continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

145

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 March 2011 (continued)

continued... 2.1 The patient has advanced pancreatic carcinoma; and 2.2 The patient is gemcitabine treatment naïve. Note: Indications marked with a * are Unapproved Indications.

Renewal - (Pancreatic 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: All of the following: 1 The patient has received gemcitabine for advanced pancreatic carcinoma; and 2 The patient has not received gemcitabine for adjuvant treatment pancreatic carcinoma; and 3 The patient requires continued therapy. Initial application — (Other indications) 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 3 4 The patient has ovarian, fallopian tube* or primary peritoneal carcinoma*; or 4 5 The patient has advanced transitional cell carcinoma of the urothelial tract (locally advanced or metastatic). Note: Indications marked with a * are Unapproved Indications. Renewal — (Other indications) 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.

Effective 23 February 2011

27 CLARITHROMYCIN Tab 500 mg – Subsidy by endorsement .................................. 23.30 14 ✔ Klamycin a) Maximum of 14 tab per prescription a) If the prescription is for clarithromycin 250 mg tablets and the prescription is dispensed from 23 February 2011 and the prescription is endorsed accordingly. b) Subsidised only if prescribed for helicobacter pylori eradication and prescription is endorsed accordingly. Note: the prescription is considered endorsed if clarithromycin is prescribed in conjunction with a proton pump inhibitor and either amoxycillin or metronidazole. Note: Where clarithromycin 250 mg tablets have been prescribed, the subsidy will only apply for the 500 mg tablets if the prescription meets the restrictions for clarithromycin 250 mg tablets.

Effective 1 February 2011

41 CLOPIDOGREL – Brand switch fee payable Tab 75 mg ............................................................................... 5.05 16.25 FENTANYL – Special Authority see SA0935 – Retail pharmacy a) Only on a controlled drug form b) No patient co-payment payable Transdermal patch, matrix 25 µg per hour – Special Authority see SA1080 – Retail pharmacy .......................................... 55.23 28 90 ✔ Apo-Clopidogrel ✔ Apo-Clopidogrel

117

✔ Durogesic continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 February 2011 (continued)

continued... Transdermal patch, matrix 50 µg per hour – Special Authority see SA1080 – Retail pharmacy ........................................ 100.52 Transdermal patch, matrix 75 µg per hour – Special Authority see SA1080 – Retail pharmacy ........................................ 139.18 Transdermal patch, matrix 100 µg per hour – Special Authority see SA1080 – Retail pharmacy ........................................ 171.22 5 5 5 ✔ Durogesic ✔ Durogesic ✔ Durogesic

➽ SA1080 0935 Special Authority for Subsidy Notes: Subsidy for patients pre-approved by PHARMAC on 1 February 2011. Approvals valid for 6 months. No new approvals will be granted from 1 February 2011. Initial application from any relevant practitioner. 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 from any relevant practitioner. Approvals valid for 3 months where the treatment remains appropriate and the patient is benefiting from treatment. 132 RISPERIDONE – Special Authority see SA0926 – Retail pharmacy Inj Microspheres for injection 25 mg per 2 ml ....................... 175.00 Inj Microspheres for injection 37.5 mg per 2 ml .................... 230.00 Inj Microspheres for injection 50 mg per 2 ml ....................... 280.00 1 1 1 ✔ Risperdal Consta ✔ Risperdal Consta ✔ Risperdal Consta

➽ SA0926 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 depot injection microspheres; and 1.2 There is no clinical reason to discontinue treatment; or 2 The initiation of risperidone depot injection 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 depot injection microspheres. Note: Risperidone depot injection 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 depot injection microspheres.

Effective 1 January 2011

47 TERAZOSIN HYDROCHLORIDE – Brand switch fee payable ❋ Tab 1 mg ................................................................................. 1.50 ❋ Tab 2 mg ................................................................................. 0.80 ❋ Tab 5 mg ................................................................................. 1.00 28 28 28 ✔ Arrow ✔ Arrow ✔ Arrow

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 January 2011 (continued)

54 86 INDAPAMIDE – Brand switch fee payable ❋ Tab 2.5 mg .............................................................................. 2.95 90 ✔ Dapa-Tabs

MOXIFLOXACIN – Special Authority see SA1065 – Retail pharmacy – No patient co-payment payable Tab 400 mg ........................................................................... 52.00 5 ✔ Avelox ➽ SA1065 Special Authority for Subsidy Initial application only from a respiratory specialist or infectious disease specialist. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Both: 1.1 Active tuberculosis*; and 1.2 Any of the following: 1.2.1 Documented resistance to one or more first-line medications; or 1.2.2 Suspected resistance to one or more first-line medications (tuberculosis assumed to be contracted in an area with known resistance), as part of regimen containing other second-line agents; or 1.2.3 Impaired visual acuity (considered to preclude ethambutol use); or 1.2.4 Significant pre-existing liver disease or hepatotoxicity from tuberculosis medications; or 1.2.5 Significant documented intolerance and/or side effects following a reasonable trial of first-line medications; or 2 Mycobacterium avium-intracellulare complex not responding to other therapy or where such therapy is contraindicated.*. Note: Indications marked with * are Unapproved Indications (refer to Section A: General Rules, Part I (Interpretations and Definitions) and Part IV (Miscellaneous Provisions) rule 4.6). Renewal only from a respiratory specialist or infectious disease specialist. Approvals valid for 1 year where the treatment remains appropriate and the patient is benefiting from treatment.

DAPSONE – No patient co-payment payable Tab 25 mg ............................................................................. 95.00 Tab 100 mg ......................................................................... 110.00 BROMOCRIPTINE MESYLATE ❋ Cap 5 mg ............................................................................... 60.43 GABAPENTIN – Special Authority see SA1071 1009– Retail pharmacy ▲ Cap 100 mg ............................................................................. 7.16 ▲ Cap 300 mg ........................................................................... 11.50 ▲ Cap 400 mg ........................................................................... 14.75

100 100 100

✔ Dapsone S29 ✔ Dapsone S29 ✔ Apo-Bromocriptine

S29

115 123

100 100 100

✔ Nupentin ✔ Nupentin ✔ Nupentin

➽ SA1071 1009 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. continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 January 2011 (continued)

continued... 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 for applications meeting the following criteria: Either: 1 Patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life from gabapentin; or 2 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents, or seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents. 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. 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. 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 for applications meeting the following criteria: Either: 1 The patient has demonstrated a marked improvement in their control of pain (prescriber determined); or 2 The patient has previously demonstrated clinical responsiveness to gabapentin and has now developed neuropathic pain in a new site. 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 for applications meeting the following criteria: Either: 1 The patient has demonstrated a marked improvement in their control of pain (prescriber determined); or 2 The patient has previously demonstrated clinical responsiveness to gabapentin and has now developed neuropathic pain in a new site. 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. 125 VIGABATRIN – Special Authority see SA1072 1010 – Retail pharmacy ▲ Tab 500 mg ......................................................................... 119.30 100 ✔ Sabril

➽ SA1072 1010 Special Authority for Subsidy Initial application — (new patients) from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Both: 1 Either: 1.1 Patient has infantile spasms; or 1.2 Both: 1.2.1 Patient has epilepsy; and continued... 1.2.2 Either: Patients pay a manufacturer’s surcharge when S29 Unapproved medicine supplied under Section 29 the Manufacturer’s Price is greater than the Subsidy ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 January 2011 (continued)

continued... 1.2.2.1 Seizures are not adequately controlled with optimal treatment with other antiepilepsy agents; or 1.2.2.2 Seizures are controlled adequately but the patient has experienced unacceptable side effects from optimal treatment with other antiepilepsy agents; and

2 Either: 2.1 Patient is, or will be, receiving regular automated visual field testing (ideally before starting therapy and on a 6-monthly basis thereafter); or 2.2 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: Either: 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 It is impractical or impossible (due to comorbid conditions) to monitor the patient’s visual fields. Note: 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: 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. 137 DEXAMPHETAMINE SULPHATE – Special Authority see SA1073 0907 – Retail pharmacy Only on a controlled drug form Tab 5 mg ............................................................................... 16.50 100 ✔ PSM ➽ SA1073 0907 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: continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 January 2011 (continued)

continued... 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 the Contact Centre 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 the Contact Centre 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 the Contact Centre on 0800 243 666 for clarification if needed. Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 January 2011 (continued)

138 METHYLPHENIDATE HYDROCHLORIDE – Special Authority see SA1074 0908 – Retail pharmacy Only on a controlled drug form Tab immediate-release 5 mg ..................................................... 3.20 30 ✔ Rubifen Tab immediate-release 10 mg ................................................... 3.00 30 ✔ Ritalin ✔ Rubifen Tab immediate-release 20 mg ................................................... 7.85 30 ✔ Rubifen Tab sustained-release 20 mg .................................................. 10.95 30 ✔ Rubifen SR 50.00 100 ✔ Ritalin SR ➽ SA1074 0908 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: continued...

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 January 2011 (continued)

continued... 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 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 the Contact Centre 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 the Contact Centre 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 the Contact Centre on 0800 243 666 for clarification if needed. 142 NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. a) Maximum of 768 piece per prescription b) Maximum of 384 piece per dispensing c) For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks. d) The maximum of 384 piece per dispensing cannot be waived via Access Exemption Criteria. Gum 2 mg (Classic) ............................................................... 14.97 96 ✔ Habitrol Gum 2 mg (Fruit) .................................................................... 14.97 96 OP ✔ Habitrol Gum 2 mg (Mint) .................................................................... 14.97 96 OP ✔ Habitrol Gum 4 mg (Classic) ............................................................... 20.02 96 ✔ Habitrol Gum 4 mg (Fruit) .................................................................... 20.02 96 OP ✔ Habitrol Gum 4 mg (Mint) .................................................................... 20.02 96 OP ✔ Habitrol NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. a) Maximum of 432 loz per prescription b) Maximum of 216 loz per dispensing c) For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks. d) The maximum of 216 loz per dispensing cannot be waived via Access Exemption Criteria. Lozenge 1 mg ........................................................................ 11.08 36 OP ✔ Habitrol Lozenge 2 mg ........................................................................ 11.08 36 OP ✔ Habitrol NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. a) Maximum of 56 patch per prescription b) Maximum of 28 patch per dispensing c) For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks. d) The maximum of 28 patch per dispensing cannot be waived via Access Exemption Criteria. Patch 7 mg ............................................................................ 10.53 7 OP ✔ Habitrol Patch 14 mg .......................................................................... 11.63 7 OP ✔ Habitrol Patch 21 mg .......................................................................... 12.32 7 OP ✔ Habitrol

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

142

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 January 2011 (continued)

149 150 156 163 MITOMYCIN C – PCT only – Specialist Inj 5 mg ................................................................................. 72.75 TRETINOIN Cap 10 mg – PCT – Retail pharmacy-Specialist ................... 435.90 AZATHIOPRINE – Retail pharmacy-Specialist ❋ Tab 50 mg – Brand switch fee payable................................... 18.45 IPRATROPIUM BROMIDE Nebuliser soln, 250 µg per ml, 1 ml – Up to 40 neb available on a PSO – Brand switch fee payable ................................... 3.79 Nebuliser soln, 250 µg per ml, 2 ml – Up to 40 neb available ....... on a PSO – Brand switch fee payable ................................... 4.06 1 100 100 ✔ Arrow S29 ✔ Vesanoid ✔ Imuprine

20 20

✔ Univent ✔ Univent

172

EXTEMPORANEOUSLY COMPOUNDED PRODUCTS & GALENICALS Dermatological base: The products listed in the Barrier creams and Emollients section and the Topical Corticosteroids-Plain section of the Pharmaceutical Schedule are classified as dermatological bases for the purposes of extemporaneous compounding and are the bases to which the dermatological galenicals can be added. Also the dermatological bases in the Barrier Creams and Emollients section of the Pharmaceutical Schedule can be used for diluting proprietary Topical Corticosteroid-Plain preparations. The following products are dermatological bases: • Aqueous cream • Cetomacrogol cream BP • 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

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer’s Price

Effective 1 April 2011

47 52 55 75 119 DOXAZOSIN MESYLATE ( subsidy) ❋ Tab 2 mg .................................................................................. 8.23 ❋ Tab 4 mg ................................................................................ 12.40 SOTALOL ( subsidy) ❋ Inj 10 mg per ml, 4 ml ............................................................. 65.39 ISOSORBIDE MONONITRATE ( subsidy) ❋ Tab 20 mg .............................................................................. 17.10 ❋ Tab long-acting 40 mg .............................................................. 7.50 FLUDROCORTISONE ACETATE ( subsidy) ❋ Tab 100 µg ............................................................................. 14.32 AMITRIPTYLINE ( subsidy) Tab 25 mg ................................................................................ 1.85 Tab 50 mg ................................................................................ 3.60 ETHOSUXIMIDE ( subsidy) ❋‡ Oral liq 250 mg per 5 ml........................................................ 13.60 METOCLOPRAMIDE HYDROCHLORIDE ( subsidy) ❋ Tab 10 mg ................................................................................ 3.95 BUSULPHAN ( subsidy) Tab 2 mg ................................................................................ 59.50 EXEMESTANE ( subsidy) Tab 25 mg .............................................................................. 22.57 TAMOXIFEN CITRATE ( subsidy) ❋ Tab 20 mg ............................................................................... 8.75 CHLORAMPHENICOL ( subsidy) Ear drops 0.5%.......................................................................... 2.20 500 500 5 100 30 100 100 100 200 ml 100 100 30 100 5 ml OP ✔ Apo-Doxazosin ✔ Apo-Doxazosin ✔ Sotacor ✔ Ismo 20 ✔ Corangin ✔ Florinef ✔ Amitrip ✔ Amitrip ✔ Zarontin

123 127 143 156 156 166 166

✔ Metamide ✔ Myleran ✔ Aromasin ✔ Genox

✔ Chloromycetin

TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN ( subsidy) Ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g .................................................. 5.16 7.5 ml OP ✔ Kenacomb

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 April 2011 (continued)

191 ORAL FEED 1.5KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] ( subsidy) Liquid (banana) ........................................................................ 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus Liquid (chocolate) .................................................................... 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus Liquid (coffee latte) ................................................................... 0.85 237 ml OP (1.33) Ensure Plus Liquid (fruit of the forest) .......................................................... 0.72 200 ml OP (1.45) Ensure Plus Liquid (strawberry) ................................................................... 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus Liquid (toffee) ........................................................................... 0.72 200 ml OP (1.26) Fortisip Liquid (tropical fruit) ................................................................. 0.72 200 ml OP (1.26) Fortisip Liquid (vanilla) .......................................................................... 0.72 200 ml OP (1.26) Fortisip (1.45) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus Note: Repeats for Fortisip and Ensure Plus, 237 ml OP, will be fully subsidised where the initial dispensing was before 1 April 2011. Repeats for Ensure Plus, 200 ml OP, will be subsidised to the same subsidy level as prior to 1 April 2011 ORAL FEED WITH FIBRE 1.5 KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] ( subsidy) Liquid (chocolate) .................................................................... 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (strawberry) ................................................................... 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (vanilla) .......................................................................... 0.72 200 ml OP (1.26) Fortisip Multi Fibre Note: Repeats for Fortisip Multi Fibre will be fully subsidised where the initial dispensing was before 1 April 2011. ORAL FEED 2KCAL/ML – Special Authority see SA1105 – Hospital pharmacy [HP3] ( subsidy) Liquid (vanilla) .......................................................................... 1.14 237 ml OP (2.25) Two Cal HN Note: Repeats for Two Cal HN will be fully subsidised where the initial dispensing was before 1 April 2011.

191

192

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 April 2011 (continued)

195 LOW PROTEIN BAKING MIX – Special Authority see SA1108 – Hospital pharmacy [HP3] ( subsidy) Powder .................................................................................... 8.22 500 g OP ✔ Loprofin Mix LOW PROTEIN PASTA – Special Authority see SA1108 – Hospital pharmacy [HP3] ( subsidy) Animal shapes ........................................................................ 11.91 500 g OP ✔ Loprofin Lasagne ................................................................................... 5.95 250 g OP ✔ Loprofin Low protein rice pasta ............................................................ 11.91 500 g OP ✔ Loprofin Macaroni .................................................................................. 5.95 250 g OP ✔ Loprofin Penne ..................................................................................... 11.91 500 g OP ✔ Loprofin Spaghetti ................................................................................ 11.91 500 g OP ✔ Loprofin Spirals .................................................................................... 11.91 500 g OP ✔ Loprofin 197 EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1112 – Hospital pharmacy [HP3} ( subsidy) Powder .................................................................................. 15.21 450 g OP ✔ Pepti Junior Gold 19.01 ✔ Pepti Junior AMINO ACID FORMULA – Special Authority see SA1111 – Hospital pharmacy [HP3] ( subsidy) Powder ..................................................................................... 6.00 48.5 g OP ✔ Vivonex Pediatric Powder (tropical) .................................................................... 56.00 400 g OP ✔ Neocate Advance Powder (unflavoured) ............................................................. 56.00 400 g OP ✔ Elecare ✔ Elecare LCP ✔ Neocate Advance Powder (vanilla) ..................................................................... 56.00 400 g OP ✔ Elecare AMINO ACID FORMULA – Special Authority see SA1111 – Hospital pharmacy [HP3] ( subsidy) Powder ................................................................................... 56.00 400 g OP ✔ Neocate ✔ Neocate LCP

197

Effective 1 March 2011

34 43 99 113 LACTULOSE – Only on a prescription ( price) ❋ Oral liq 10 g per 15 ml ............................................................... 6.65 POTASSIUM CHLORIDE ( subsidy) ❋ Inj 75 mg per ml, 10 ml ........................................................... 55.00 NEOSTIGMINE ( subsidy) Inj 2.5 mg per ml, 1 ml .......................................................... 150.00 HYALURONIDASE ( price) Inj 1,500 iu per ml ................................................................... 18.32 (254.92) LITHIUM CARBONATE ( sudsidy) Tab long-acting 400 mg .......................................................... 18.50 1,000 ml 50 50 10 Hyalase 100 ✔ Priadel ✔ Duphalac ✔ AstraZeneca ✔ AstraZeneca

129

Effective 1 February 2011

34 LACTULOSE – Only on a prescription ( price) ❋ Oral liq 10 g per 15 ml .............................................................. 6.65 (7.68) 1,000 ml Duphalac

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Subsidy and Manufacturer's Price - effective 1 February 2011 (continued)

45 46 EZETIMIBE – Special Authority see SA1045 – Retail pharmacy ( subsidy) Tab 10 mg ............................................................................. 45.90 30 ✔ Ezetrol

EZETIMIBE WITH SIMVASTATIN – Special Authority see SA1046 – Retail pharmacy ( subsidy) Tab 10 mg with simvastatin 10 mg ......................................... 48.90 30 ✔ Vytorin Tab 10 mg with simvastatin 20 mg ......................................... 51.60 30 ✔ Vytorin Tab 10 mg with simvastatin 40 mg ......................................... 55.20 30 ✔ Vytorin Tab 10 mg with simvastatin 80 mg ......................................... 60.60 30 ✔ Vytorin GOSERELIN ACETATE ( subsidy) Inj 3.6 mg ............................................................................ 166.20 Inj 10.8 mg .......................................................................... 443.76 ITRACONAZOLE – Retail pharmacy-Specialist ( subsidy) Cap 100 mg ............................................................................. 4.25 (23.70) 1 1 15 Sporanox ✔ Zoladex ✔ Zoladex

127

ONDANSETRON ( subsidy) a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 c) Not more than one prescription per month; can be waived by Special Authority see SA0887. d) The maximum of 6 tab per dispensing cannot be waived via Access Exemption Criteria. Tab 4 mg ................................................................................. 1.70 10 (17.18) Zofran Tab 8 mg ................................................................................. 3.40 20 (33.89) Zofran

Effective 1 January 2011

37 VITAMINS ( subsidy) ❋ Tab (BPC cap strength) ............................................................ 8.00 (14.80) CAPTOPRIL ( subsidy) ❋ Tab 12.5 mg .......................................................................... 10.00 (10.40) ❋ Tab 25 mg ............................................................................. 12.00 (13.40) ❋ Tab 50 mg ............................................................................. 17.50 (19.00) 1,000 Healtheries Multivitamin tablets 500 Apo-Captopril 500 Apo-Captopril 500 Apo-Captopril

48 94 147

RALTEGRAVIR POTASSIUM – Special Authority see SA1025 – Retail pharmacy ( subsidy) Tab 400 mg ...................................................................... 1,090.00 60 ✔ Isentress METHOTREXATE ( subsidy) ❋ Inj 1 mg for ECP – PCT only – Specialist ................................... 0.10 1 mg ✔ Baxter

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to General Rules

Effective 1 March 2011

14 “Diabetes Nurse Prescriber” means a registered nurse practising in diabetes health who has authority to prescribe specified diabetes medicines in accordance with regulations made under the Medicines Act 1981, and who is practicing in an approved DHB demonstration site. “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 including, for the avoidance of doubt, a Diabetes Nurse Prescriber. 3.6 Diabetes Nurse Prescribers’ Prescriptions The following provisions apply to every Prescription written by a Diabetes Nurse Prescriber: 3.6.1 Prescriptions written by a Diabetes Nurse Prescriber for a Community Pharmaceutical will only be subsidised where they are for either: a) A Community Pharmaceutical classified as a Prescription Medicine or a Restricted Medicine and which Diabetes Nurse Prescribers is permitted under regulations to prescribe; or b) any other Community Pharmaceutical listed below, being an item that has been identified as being able to be prescribed by a Diabetes Nurse Prescriber, but which is not classified as a Prescription Medicine or a Restricted Medicine: aspirin, blood glucose diagnostic test meter, blood glucose diagnostic test strip, glucagon hydrochloride inj 1 mg syringe kit, insulin pen needles, insulin syringes disposable with attached needle, ketone blood beta-ketone electrodes test strip, nicotine, sodium nitroprusside test strip, 3.6.2 Any Diabetes Nurse Prescribers’ prescription for a medication requiring a Special Authority will only be subsidised if it is for a repeat prescription (ie after the initial prescription with Special Authority approval was dispensed). Note: A list of Diabetes Nurse Prescribers will be published periodically in the Update of the Pharmaceutical Schedule for the duration of an initial pilot scheme. After this period there will be no approved DHB demonstration sites and hence no Diabetes Nurse Prescribers.

Changes to Brand Name

Effective 1 March 2011

99 IBUPROFEN ❋ Tab long-acting 800 mg ........................................................... 9.12 30 ✔ Brufen SR Retard

Changes to Sole Subsidised Supply

Effective 1 April 2011

For the list of new Sole Subsidised Supply products effective 1 April 2011 refer to the bold entries in the cumulative Sole Subsidised Supply table pages 12-21.

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items

Effective 1 April 2011

37 VITAMINS ❋ Tab (BPC cap strength) ............................................................. 8.00 (14.80) SODIUM CHLORIDE Inj 0.9%, 5 ml – Up to 5 inj available on a PSO ......................... 11.50 Inj 0.9%, 10 ml – Up to 5 inj available on a PSO ....................... 11.50 1,000 Healtheries Multivitamin tablets 50 50 ✔ AstraZeneca ✔ AstraZeneca

WATER 1) On a prescription or Practitioner’s Supply Order only when on the same form as an injection listed in the Pharmaceutical Schedule requiring a solvent or diluent; or 2) On a bulk supply order; or 3) When used in the extemporaneous compounding of eye drops. Purified for inj, 5 ml – Up to 5 inj available on a PSO ................ 10.51 50 ✔ AstraZeneca Purified for inj, 10 ml – Up to 5 inj available on a PSO .............. 11.32 50 ✔ AstraZeneca CAPTOPRIL ❋ Tab 12.5 mg ........................................................................... 10.00 (10.40) ❋ Tab 25 mg .............................................................................. 12.00 (13.40) ❋ Tab 50 mg .............................................................................. 17.50 (19.00) AMILORIDE WITH HYDROCHLOROTHIAZIDE ❋ Tab 5 mg with hydrochlorothiazide 50 mg................................ 13.00 PIROXICAM ❋ Tab dispersible 10 mg ............................................................... 3.25 ❋ Tab dispersible 20 mg ............................................................... 5.50 PETHIDINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable Inj 50 mg per ml, 1.5 ml – Up to 5 inj available on a PSO ........... 4.35 PHARMACY SERVICES – May only be claimed once per patient. ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Imuprine is 2377829 ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Dapa-Tabs is 2377837 ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Univent is 2377845 ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Arrow Terazosin is 2377853 500 Apo-Captopril 500 Apo-Captopril 500 Apo-Captopril 500 50 100 ✔ Amizide ✔ Piram-D ✔ Piram-D

48 54 100 119

5 1 fee 1 fee 1 fee 1 fee

✔ Mayne ✔ BSF Imuprine ✔ BSF Dapa-Tabs ✔ BSF Univent ✔ BSF Arrow Terazosin

171 197

GOATS MILK INFANT FORMULA – Special Authority see SA0604 – Retail pharmacy Powder ..................................................................................... 9.42 900 g OP (22.75)

Karicare Goats Milk Infant Formula

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 April 2011 (continued)

198 LACTOSE FREE INFANT FORMULA – Special Authority see SA0604 – Retail pharmacy Powder ..................................................................................... 5.66 900 g OP (17.95) SOYA INFANT FORMULA – Special Authority see SA0604 – Retail pharmacy Powder ..................................................................................... 6.34 900 g OP (19.57) INFANT SOY FORMULA – Special Authority see SA0757 – Retail pharmacy Powder ..................................................................................... 7.27 (16.35) 900 g Karicare Soy All Ages

Delact

198

S26 Soy

198

Effective 1 March 2011

48 61 72 84 CILAZAPRIL ❋ Tab 0.5 mg .............................................................................. 0.95 (2.20) ❋ Tab 2.5 mg ............................................................................... 1.92 (4.10) ❋ Tab 5 mg ................................................................................. 3.06 (6.01) 30 Inhibace 28 Inhibace 28 Inhibace ✔ Locoid C ✔ Hospira S29

HYDROCORTISONE BUTYRATE WITH CHLORQUINALDOL – Only on a prescription Crm 0.1% with chlorquinaldol 3% .............................................. 3.49 15 g OP METHYLERGOMETRINE Inj 200 µg per ml, 1 ml – Up to 10 inj available on a PSO ........... 9.28 AMOXYCILLIN Cap 250 mg – Up to 30 cap available on a PSO ....................... 16.18 (17.30) Cap 500 mg ........................................................................... 26.50 (27.25) CYCLIZINE LACTATE Inj 50 mg per ml, 1 ml ............................................................ 14.95 CHLORAMPHENICOL Eye drops 0.5% ........................................................................ 1.28 (2.40) 10

500 500 5 10 ml OP

Apo-Amoxi Apo-Amoxi ✔ Valoid (AFT)

127 166

Chlorsig

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 February 2011

33 MUCILAGINOUS LAXATIVES – Only on a prescription ❋ Dry ........................................................................................... 3.91 (5.72) 4.58 (6.69) 5.42 (12.71) 6.02 (16.49) ❋ Dry-original flavour, regular texture only .................................... 4.05 (12.38) Note – Konsyl-D 500 g pack remains listed fully subsidised. VITAMIN B COMPLEX ❋ Tab, strong, BPC ...................................................................... 4.70 (12.10) CLOPIDOGREL Tab 75 mg ............................................................................... 5.06 5.06 (73.38) FUROSEMIDE ❋ Inj 10 mg per ml, 2 ml – Up to 5 inj available on a PSO ............ 13.00 (29.50) CLOMIPHENE CITRATE Tab 50 mg ............................................................................... 2.50 325 g OP Konsyl-D 380 g OP Mucilax 450 g OP Isogel 500 g OP Normacol 336 g OP Metamucil

36 41

500 Apo-B-Complex 28 28 50 Mayne 5 ✔ Phenate ✔ Arrow-Clopidogrel Plavix

54 80 82

CEFTRIAXONE SODIUM – 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 ............................................................................... 2.57 1 (3.99) AFT INDOMETHACIN ❋ Cap long-acting 75 mg ........................................................... 13.30 SODIUM CROMOGLYCATE Eye drops 2% ........................................................................... 2.36 (3.95) PHARMACY SERVICES – May only be claimed once per patient. ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Arrow-Enalapril is 2375613 100 10 ml OP Cromolux 1 fee ✔ BSF Arrow-Enalapril ✔ Rheumacin SR

100 167

171 184 191

ORAL FEED 1KCAL/ML – Special Authority see SA0594 – Hospital pharmacy [HP3] Liquid (strawberry) ................................................................... 1.78 237 ml OP ✔ Resource Diabetic ORAL FEED 1.5KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid (strawberry) ................................................................... 1.33 237 ml OP ✔ Resource Plus ❋ Three months or six months, as applicable, dispensed all-at-once

▲

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 January 2011

25 SODIUM ALGINATE ❋ Oral liq 500 mg with sodium bicarbonate 267 mg per 10 ml (aniseed) .................................................................................. 1.50 (8.64) ZINC OXIDE Oint zinc oxide with balsam peru ............................................... 4.50 (6.67) Suppos zinc oxide with balsam peru ......................................... 4.47 (6.49)

500 ml Gaviscon 50 g OP Anusol 12 Anusol

SODIUM CITRATE WITH SODIUM LAURYL SULPHOACETATE – Only on a prescription Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml .............................................................................. 6.00 12 (7.30) ASCORBIC ACID a) No more than 100 mg per dose b) Only on a prescription ❋ Tab 100 mg ........................................................................... 13.80 (17.25) MULTIVITAMINS – Special Authority see SA1036 – Retail pharmacy Powder .................................................................................. 36.00 Note – Paediatric Seravit powder 200 g OP remains subsidised. TERAZOSIN HYDROCHLORIDE ❋ Tab 1 mg ................................................................................. 1.50 (2.50) ❋ Tab 7 × 1 mg and 7 × 2 mg ................................................... 0.74 ❋ Tab 2 mg ............................................................................... 14.29 (23.30) ❋ Tab 5 mg ............................................................................... 17.86 (29.00) INDAPAMIDE ❋ Tab 2.5 mg .............................................................................. 3.25 CICLOPIROXOLAMINE a) Only on a prescription b) Not in combination Crm 1% .................................................................................... 1.00 (12.82)

Microlax

500 Apo-Ascorbic Acid 100 g OP ✔ Paediatric Seravit

47 54 58

28 14 OP 500 500 Apo-Terazosin 100 ✔ Napamide Apo-Terazosin ✔ Hytrin Starter Pack Apo-Terazosin

20 g OP Batrafen

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

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 January 2011 (continued)

62 62 62 GLYCEROL WITH PARAFFIN AND CETYL ALCOHOL – Only on a prescription ❋ Lotn 5% with paraffin liq 5% and cetyl alcohol 2% ..................... 1.40 250 ml (8.10) SODIUM HYPOCHLORITE – Subsidy by endorsement Only if prescribed for a dialysis patient and the prescription is endorsed accordingly. ❋ Soln ......................................................................................... 2.71 2,500 ml ZINC Crm BP .................................................................................... 6.55 (12.00) OILY CREAM ❋ Crm BP .................................................................................... 2.80 (13.60) (15.40) MALATHION Liq 0.5% ................................................................................... 3.79 (4.99) TAR WITH CADE OIL Bath emul 7.5% coal tar, 2.5% cade oil, 7.5% compound .......... 9.70 (29.60) HYDROGEN PEROXIDE ❋ Soln 20 vol – Maximum of 500 ml per prescription .................... 0.63 (2.35) 3.13 (7.00) APPLICATOR When ordered with a spermicide. ❋ 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 DIAPHRAGM – Up to 1 dev available on a PSO One of each size is permitted on a PSO. ❋ 55 mm ................................................................................... 42.90 ❋ 60 mm ................................................................................... 42.90 ❋ 65 mm ................................................................................... 42.90 ❋ 70 mm ................................................................................... 42.90 ❋ 75 mm ................................................................................... 42.90 ❋ 80 mm ................................................................................... 42.90 ❋ 85 mm ................................................................................... 42.90 ❋ 90 mm ................................................................................... 42.90 500 g PSM 500 g David Craig PSM 200 ml OP Derbac-M 350 ml Polytar Emollient 100 ml PSM 500 ml PSM

✔ Janola

68 68 69

1 108 g OP

✔ Ortho ✔ Gynol II

1 1 1 1 1 1 1 1

✔ Ortho Coil ✔ Ortho All-flex ✔ Ortho Coil ✔ Ortho Coil ✔ Ortho Coil ✔ Ortho Coil ✔ Ortho Coil ✔ Ortho All-flex ✔ Ortho Coil ✔ Ortho All-flex ✔ Ortho Coil

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items - effective 1 January 2011 (continued)

82 CEFTRIAXONE SODIUM – 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 1 g ...................................................................................... 2.10 1 (5.40) AFT INFLUENZA VACCINE – Hospital pharmacy [Xpharm] Inj ............................................................................................ 9.00 90.00 1 10 ✔ Fluvax ✔ Influvac ✔ Vaxigrip

142

NICOTINE a) Maximum of 768 piece per prescription b) Maximum of 384 piece per dispensing c) For the avoidance of doubt Nicotine will not be funded Close Control in amounts less than 4 weeks. d) The maximum of 384 piece per dispensing cannot be waived via Access Exemption Criteria. Gum 2 mg (Fruit) .................................................................... 23.41 96 OP ✔ Nicotinell Gum 2 mg (Mint) .................................................................... 23.41 96 OP ✔ Nicotinell Gum 4 mg (Fruit) .................................................................... 23.41 96 OP ✔ Nicotinell Gum 4 mg (Mint) .................................................................... 23.41 96 OP ✔ Nicotinell AZATHIOPRINE – Retail pharmacy-Specialist ❋ Tab 50 mg ............................................................................. 18.45 (34.90) IPRATROPIUM BROMIDE Nebuliser soln, 250 µg per ml, 1 ml – Up to 40 neb available on a PSO ................................................................................... 3.79 Nebuliser soln, 250 µg per ml, 2 ml – Up to 40 neb available on a PSO ................................................................................... 4.06 100 ✔ Azamun Imuran

156 163

20 20

✔ Ipratropium Steri-Neb ✔ Ipratropium Steri-Neb

186

PAEDIATRIC ENTERAL FEED 1.5KCAL/ML – Special Authority see SA0896 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.60 200 ml OP ✔ Nutrini Energy RTH Note – Nutrini Energy RTH liquid 500 ml OP remains subsidised. PAEDIATRIC ENTERAL FEED 1KCAL/ML – Special Authority see SA0896 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.07 200 ml OP ✔ Nutrini RTH Note – Nutrini RTH liquid 500 ml OP remains subsidised. ENTERAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid ....................................................................................... 1.75 250 ml OP ✔ Isosource 1.5 ORAL FEED 1.5KCAL/ML – Special Authority see SA0702 – Hospital pharmacy [HP3] Liquid (chocolate) .................................................................... 1.33 237 ml OP ✔ Resource Plus AMINOACID FORMULA WITH MINERALS WITHOUT PHENYLALANINE – Special Authority see SA0962 – Retail pharmacy – See prescribing guideline Powder .................................................................................. 58.44 250 g OP ✔ Metabolic Mineral Mixture Note – Metabolic Mineral Mixture powder 100 g OP remains subsidised.

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

186

190 191 196

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be Delisted

Effective 1 May 2011

87 ITRACONAZOLE – Retail pharmacy-Specialist Cap 100 mg ............................................................................. 4.25 (23.70) 15 Sporanox

127

ONDANSETRON a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 c) Not more than one prescription per month; can be waived by Special Authority see SA0887. d) The maximum of 6 tab per dispensing cannot be waived via Access Exemption Criteria. Tab 4 mg ................................................................................. 1.70 10 (17.18) Zofran Tab 8 mg ................................................................................. 3.40 20 (33.89) Zofran PHARMACY SERVICES – May only be claimed once per patient. ❋ Brand switch fee ....................................................................... 0.01 The Pharmacode for BSF Apo-Clopidogrel is 2378655 1 fee ✔ BSF Apo-Clopidogrel

171

Effective 1 June 2011

34 171 LACTULOSE – Only on a prescription ❋ Oral liq 10 g per 15 ml ............................................................... 6.65 PHARMACY SERVICES – May only be claimed once per patient ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Zapril is 2378639 1, 000 ml ✔ Duphalac 1 fee ✔ BSF Zapril

Effective 1 July 2011

64 116 118 POVIDONE IODINE Antiseptic soln 10% ................................................................ 51.06 LIGNOCAINE HYDROCHLORIDE Inj 0.5%, 5 ml – Up to 5 inj available on a PSO ......................... 44.10 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Cap long-acting 200 mg ......................................................... 17.00 4,500 ml 50 ✔ Betadine ✔ Xylocaine

✔ m-Eslon

142

NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. Lozenge 1 mg ........................................................................ 11.08 36 Lozenge 2 mg ........................................................................ 11.08 36 Patch 7 mg ............................................................................ 10.53 7 Patch 14 mg .......................................................................... 11.63 7 Patch 21 mg .......................................................................... 12.32 7

✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be delisted - effective 1 July 2011 (continued)

171 PHARMACY SERVICES – May only be claimed once per patient ❋ Brand switch fee ....................................................................... 0.01 The Pharmacode for BSF m-Captorpil is 2378647 1 fee ✔ BSF m-Captopril

Items to be delisted - effective 1 August 2011

36 PYRIDOXINE HYDROCHLORIDE a) No more than 100 mg per dose b) Only on a prescription ❋ Tab 25 mg – No patient co-payment payable ............................ 3.06 MEXILETINE HYDROCHLORIDE ▲ Cap 50 mg ............................................................................. 23.52 ▲ Cap 200 mg ........................................................................... 55.05

50 66

90 100 100

✔ Healtheries ✔ Mexitil ✔ Mexitil

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 .......................................................................................... 1.28 50 g OP (5.50) Aquasun Oil Free Faces SPF30+ STAVUDINE [D4T] – Special Authority see SA1025 – Retail pharmacy Cap 20 mg ........................................................................... 317.10 Powder for oral soln 1 mg per ml .......................................... 100.76 FENTANYL a) Only on a controlled drug form b) No patient co-payment payable Transdermal patch, matrix 25 µg per hour – Special Authority see SA1080 – Retail pharmacy ............................................ 55.23 Transdermal patch, matrix 50 µg per hour – Special Authority see SA1080 – Retail pharmacy .......................................... 100.52 Transdermal patch, matrix 75 µg per hour – Special Authority see SA1080 – Retail pharmacy .......................................... 139.18 Transdermal patch, matrix 100 µg per hour – Special Authority see SA1080 – Retail pharmacy .......................................... 171.22 MITOMYCIN C – PCT only – Specialist Inj 2 mg ............................................................................... 283.00 Inj 10 mg ............................................................................. 808.00 Note – Arrow mitomycin C inj 5 mg remains subsidised. 60 ✔ Zerit 200 ml OP ✔ Zerit

117

5 5 5 5 10 5

✔ Durogesic ✔ Durogesic ✔ Durogesic ✔ Durogesic ✔ Mitomycin-C S29 ✔ Mitomycin-C S29

149

Effective 1 September 2011

41 50 CLOPIDOGREL Tab 75 mg ................................................................................ 5.05 DIGOXIN ❋ Tab 62.5 µg – Up to 30 tab available on a PSO .......................... 6.94 28 250 ✔ Apo-Clopidogrel ✔ Lanoxin PG

Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

S29 Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be delisted - effective 1 September 2011 (continued)

65 SULPHUR Precipitated – Only in combination ............................................. 6.50 100 g ✔ ABM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, refer, page 172 2) With or without other dermatological galenicals. CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority SA0988 Tab 250 mg .............................................................................. 5.53 10 ✔ Klacid RITONAVIR – Special Authority see SA1025 – Retail pharmacy Cap 100 mg ......................................................................... 121.27 NAPROXEN SODIUM ❋ Tab 275 mg .............................................................................. 5.69 CLADRIBINE – PCT only – Specialist Inj 2 mg per ml, 5 ml ............................................................ 873.00 METHYL HYDROXYBENZOATE Powder ................................................................................... 10.00 SODIUM BICARBONATE Powder BP – Only in combination .............................................. 9.80 (11.99) Only in extemporaneously compounded omeprazole suspension. 84 120 1 25 g 500 g ✔ Norvir ✔ Sonaflam ✔ Litak S29 ✔ ABM ✔ ABM Biomed

83 94 100 145 178 178

Effective 1 October 2011

100 142 NAPROXEN SODIUM ❋ Tab 550 mg .............................................................................. 9.95 100 ✔ Synflex

NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. Gum 2 mg (Fruit) ..................................................................... 14.97 96 Gum 2 mg (Mint)..................................................................... 14.97 96 Gum 2 mg (Classic) ............................................................... 14.97 96 Gum 4 mg (Fruit) ..................................................................... 20.02 96 Gum 4 mg (Mint)..................................................................... 20.02 96 Gum 4 mg (Classic) ................................................................ 20.02 96 THALIDOMIDE – PCT only – Specialist – Special Authority see SA0882 Only on a controlled drug form Cap 50 mg ........................................................................... 490.00

✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol

150

✔ Thalidomide Pharmion

▲

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

❋ Three months or six months, as applicable, dispensed all-at-once

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes to Part II

Effective 1 April 2011

17 AMITRIPTYLINE ( price) Tab 25 mg – 1% DV Jun-11 to 2014 ......................................... 1.85 Tab 50 mg – 1% DV Jun-11 to 2014 ......................................... 3.60 AMPHOTERICIN B Lozenges 10 mg........................................................................ 5.86 BUSULPHAN Tab 2 mg ................................................................................ 59.50 DOPAMINE HYDROCHLORIDE (brand name change) Inj 40 mg per ml, 5 ml – 1% DV Feb-11 to 2012 ..................... 82.08 DOXAZOSIN MESYLATE ( price) Tab 2 mg – 1% DV Jun-11 to 2014 ........................................... 8.23 Tab 4 mg – 1% DV Jun-11 to 2014 ......................................... 12.40 EXEMESTANE ( price) Tab 25 mg – 1% DV Jun-11 to 2014 ....................................... 22.57 FLUDROCORTISONE ACETATE ( price) Tab 100 µg ............................................................................. 14.32 ISOSORBIDE MONONITRATE Tab 20 mg – 1% DV Jun-11 to 2014 ( price) ......................... 17.10 Tab long-acting 40 mg – 1% DV Jun-11 to 2014 (new listing) ... 7.50 METOCLOPRAMIDE HYDROCHLORIDE ( price) Tab 10 mg – 1% DV Jun-11 to 2014 ......................................... 3.95 METOPROLOL SUCCINATE Tab long-acting 23.75 mg ......................................................... 2.18 Tab long-acting 47.5 mg ........................................................... 2.74 Tab long-acting 95 mg ............................................................. 4.71 Tab long-acting 190 mg ............................................................ 8.51 NALTREXONE HYDROCHLORIDE Tab 50 mg – 1% DV Jun-11 to 2013 ..................................... 123.00 Note: ReVia Tab 50 mg to be delisted 1 June 2011 100 100 20 100 10 Amitrip Amitrip Fungilin Myleran Martindale Max Health Apo-Doxazosin Apo-Doxazosin Aromasin Florinef Ismo-20 Corangin Metamide Myloc CR Myloc CR Myloc CR Myloc CR Naltraccord

17 21 28

500 500 30 100 100 30 100 30 30 30 30 30

30 31 38

43 43

NICOTINE Lozenge 1 mg – 5% DV Jul-11 to 2014 ................................... 19.94 216 Habitrol Lozenge 2 mg – 5% DV Jul-11 to 2014 ................................... 24.27 216 Habitrol Patch 7 mg – 5% DV Jul-11 to 2014 ...................................... 18.13 28 Habitrol Patch 14 mg – 5% DV Jul-11 to 2014 ..................................... 18.81 28 Habitrol Patch 21 mg – 5% DV Jul-11 to 2014 ..................................... 19.14 28 Habitrol Note: Habitrol patch 7 mg, 14 mg, and 21 mg, 7 patch pack size, and lozenge 1 mg and 2 mg, 36 lozenge pack size, to be delisted 1 July 2011. Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes Part II - effective 1 April 2011 (continued)

46 NICOTINE Gum 2 mg (Fruit) ..................................................................... 14.97 96 Gum 2 mg (Mint)..................................................................... 14.97 96 Gum 2 mg (Classic) ............................................................... 14.97 96 Gum 4 mg (Fruit) ..................................................................... 20.02 96 Gum 4 mg (Mint)..................................................................... 20.02 96 Gum 4 mg (Classic) ................................................................ 20.02 96 Note: Habitrol 2 mg and 4 mg Classic, Mint and Fruit to be delisted 1 October 2011. SOTALOL Inj 10 mg per ml, 4 ml ............................................................. 65.39 SUMATRIPTAN Inj 12 mg per ml, 0.5 ml – 1% DV Jun-11 to 2013................... 36.00 TAMOXIFEN CITRATE ( price) Tab 20 mg – 1% DV Jun-11 to 2014 ......................................... 8.75 Note: Tamoxifen Sandoz tab 20 mg to be delisted 1 June 2011 THALIDOMIDE Cap 50 mg ............................................................................ 504.00 5 2 OP 100 Habitrol Habitrol Habitrol Habitrol Habitrol Habitrol

56 58 58

Sotacor Arrow-Sumatriptan Genox

59 62

Thalomid

TRIAMCINOLONE ACETONIDE WITH GRAMICIDIN, NEOMYCIN AND NYSTATIN ( price) Ear drops 1 mg with nystatin 100,000 u, neomycin sulphate 2.5 mg and gramicidin 250 µg per g .................................................. 5.16 7.5 ml ZOLEDRONIC ACID Soln for infusion 5 mg in 100 ml ............................................ 600.00 100 ml

Kenacomb Aclasta

Section H changes to Part III

Effective 1 April 2011

SPECIAL FOOD SUPPLEMENT Oral supplement 1kcal/ml, powder, 900 g ...........................Sustagen Hospital Formula Oral supplement 1kcal/ml, powder, 400 g ...........................Ensure Oral supplement 1kcal/ml, powder, 900 g ..........................Ensure Oral feed 1.5kcal/ml liquid, 200 ml ......................................Ensure Plus Oral feed 1.5kcal/ml liquid, 237 ml.......................................Ensure Plus Oral feed 1.5kcal/ml liquid, 200 ml ......................................Fortisip Oral feed with fibre 1.5kcal/ml liquid, 200 ml ............................Fortisip Multi Fibre For use in community/non-hospitalised patients for 10 days prior to hospitalisation and 30 days following discharge Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

Index

Pharmaceuticals and brands A Aclasta .............................................................. 75 Adult products high calorie ................................. 42 Adult products standard ..................................... 37 Adalimumab....................................................... 26 Alitraq ................................................................ 36 Amiloride with hydrochlorothiazide ..................... 65 Amino acid formula ...................................... 47, 62 Aminoacid formula with minerals without phenylalanine ............................................ 45, 70 Aminoacid formula without methionine ............... 44 Aminoacid formula without phenylalanine ........... 44 Aminoacid formula without valine, leucine and isoleucine ................................................. 44 Amitrip ......................................................... 60, 74 Amitriptyline ................................................. 60, 74 Amizide.............................................................. 65 Amoxycillin ........................................................ 66 Amphotericin B .................................................. 74 Anusol ............................................................... 68 Apo-Amoxi ......................................................... 66 Apo-Ascorbic Acid ............................................. 68 Apo-B-Complex ................................................. 67 Apo-Bromocriptine ............................................. 53 Apo-Captopril ............................................... 63, 65 Apo-Clopidogrel ........................................... 51, 72 Apo-Doxazosin............................................. 60, 74 Apo-Terazosin.................................................... 68 Applicator .......................................................... 69 Aquasun Oil Free Faces SPF30+ ........................ 72 Aromasin ............................................... 27, 60, 74 Arrow-Clopidogrel .............................................. 67 Arrow-Sumatriptan ....................................... 22, 75 Ascorbic acid ..................................................... 68 Avelox................................................................ 53 Azamun ............................................................. 70 Azathioprine ................................................. 59, 70 B Batrafen ............................................................. 68 Bakels Gluten Free Health Bread Mix ................... 43 Betadine............................................................. 71 Blood glucose diagnostic test strip ..................... 48 Bromocriptine mesylate...................................... 53 Brufen SR .......................................................... 64 BSF Apo-Clopidogrel .................................... 24, 71 BSF Arrow-Enalapril ........................................... 67 BSF Arrow Terazosin .................................... 25, 65 BSF Dapa-Tabs ............................................ 25, 65 BSF Imuprine ............................................... 25, 65 BSF m-Captopril ........................................... 22, 72 BSF Univent ................................................. 25, 65 BSF Zapril .................................................... 23, 71 Busulphan.................................................... 60, 74 C Caffeine citrate ................................................... 24 Calogen ............................................................. 30 Captopril ................................................ 26, 63, 65 Carbohydrate ..................................................... 28 Carbohydrate and fat .......................................... 29 CareSens ........................................................... 48 Cefaclor monohydrate ........................................ 22 Cefaclor Sandoz ................................................. 22 Ceftriaxone sodium ...................................... 67, 70 Cerezyme........................................................... 48 Champix ...................................................... 27, 50 Chloramphenicol .......................................... 60, 66 Chloromycetin.................................................... 60 Chlorsig ............................................................. 66 Ciclopiroxolamine............................................... 68 Cilazapril ...................................................... 49, 66 Cladribine........................................................... 73 Clarithromycin........................................ 23, 51, 73 Clomiphene citrate ............................................. 67 Clopidogrel ............................................ 51, 67, 72 Corangin ...................................................... 60, 74 Cord oral feed 1.5kcal/ml ................................... 31 Cromolux ........................................................... 67 Cyclizine lactate ................................................. 66 D Dapa-Tabs ......................................................... 53 Dapsone ............................................................ 53 Darunavir ........................................................... 23 Delact ................................................................ 66 Derbac-M .......................................................... 69 Dexamphetamine sulphate.................................. 55 Diabetic enteral feed 1kcal/ml ............................. 32 Diabetic products ............................................... 32 Diaphragm ......................................................... 69 Diasip ................................................................ 32 Diason RTH ....................................................... 32 Digoxin ........................................................ 22, 72 Diphemanil methylsulphate ................................. 68 Dopamine hydrochloride .................................... 74 Doxazosin mesylate ..................................... 60, 74 Dr Reddy’s Ondansetron .................................... 23 Duocal Super Soluble Powder ............................ 29 Duolin HFA ......................................................... 24 Duphalac ..................................................... 62, 71 Durogesic .............................................. 51, 52, 72 E Easiphen ............................................................ 45 Easiphen Liquid.................................................. 45 Elecare ........................................................ 47, 62 Elecare LCP ................................................. 47, 62

Index

Pharmaceuticals and brands Elemental 028 Extra ........................................... 36 Enbrel .......................................................... 22, 26 Ensure ......................................................... 38, 75 Ensure Plus............................................ 39, 61, 75 Ensure Plus HN .................................................. 39 Ensure Plus RTH ................................................ 39 Enteral feed 1kcal/ml .......................................... 38 Enteral feed 2kcal/ml .......................................... 35 Enteral feed with fibre 1.5kcal/ml .................. 39, 70 Enteral feed with fibre 1 kcal/ml .......................... 38 Enteral/oral elemental feed 1kcal/ml.................... 36 Enteral/oral feed 1kcal/ml ............................. 33, 34 Estradot ............................................................. 23 Etanercept.................................................... 22, 26 Ethosuximide ..................................................... 60 Exemestane ........................................... 27, 60, 74 Extemporaneously compounded products & galenicals .................................................... 59 Extensively hydrolysed formula..................... 48, 62 Ezetimibe ........................................................... 63 Ezetimibe with simvastatin ................................. 63 Ezetrol ............................................................... 63 F Fat ..................................................................... 30 Fat modified feed................................................ 32 Fat modified products......................................... 32 Fentanyl ................................................. 24, 51, 72 Florinef ........................................................ 60, 74 Fluarix .......................................................... 25, 50 Fludrocortisone acetate ................................ 60, 74 Fluvax .................................................... 25, 50, 70 Foods and supplements for inborn errors of metabolism ....................................... 44 Foods and supplements for inborn errors of metabolism - other ............................ 45 Foods and supplements for inborn errors of metabolism - pku .............................. 46 Foods and supplements for pku .......................... 46 Food thickener ................................................... 43 Food thickeners.................................................. 43 For premature infants ......................................... 46 Fortimel Regular ................................................. 33 Fortisip .................................................. 39, 61, 75 Fortisip Multi Fibre .................................. 39, 61, 75 For williams syndrome ....................................... 47 Fungilin .............................................................. 74 Furosemide ........................................................ 67 G Gabapentin ........................................................ 53 Gastrointestinal and other malabsorptive problems .................................. 47 Gaviscon ........................................................... 68 Gemcitabine Ebewe............................................ 50 Gemcitabine hydrochloride ................................. 50 Gemzar .............................................................. 50 Generaid Plus..................................................... 33 Genox .......................................................... 60, 75 Glucerna Select .................................................. 32 Glucerna Select RTH .......................................... 32 Gluten free baking mix ........................................ 43 Gluten free bread mix ......................................... 43 Gluten free flour ................................................. 43 Gluten free foods................................................ 43 Gluten free pasta ................................................ 43 Glycerol with paraffin and cetyl alcohol ............... 69 Goats milk infant formula.................................... 65 Goserelin acetate ............................................... 63 Gynol II .............................................................. 69 H Habitrol .......................... 22, 25, 58, 71, 73, 74, 75 Healtheries Multi-vitamin tablets ................... 63, 65 Healtheries Simple Baking Mix ............................ 43 High protein products ......................................... 33 Horleys Bread Mix .............................................. 43 Horleys Flour...................................................... 43 Humira............................................................... 26 HumiraPen ......................................................... 26 Hyalase.............................................................. 62 Hyaluronidase .................................................... 62 Hydrocortisone butyrate with chlorquinaldol........ 66 Hydrogen peroxide ............................................. 69 Hytrin Starter Pack ............................................. 68 I Ibuprofen ........................................................... 64 Imiglucerase ...................................................... 48 Imuprine ............................................................ 59 Imuran ............................................................... 70 Indapamide .................................................. 53, 68 Indomethacin ..................................................... 67 Infant soy formula .............................................. 66 Influenza vaccine.................................... 24, 49, 70 Influvac .............................................................. 70 Inhibace ............................................................. 66 Ipratropium bromide ............................... 22, 59, 70 Ipratropium Steri-Neb ......................................... 70 Isentress ............................................................ 63 Ismo 20 ............................................................. 60 Ismo-20 ............................................................. 74 Isogel................................................................. 67 Isosorbide mononitrate................................. 60, 74 Isosource 1.5..................................................... 70 Isosource Standard ............................................ 38 Isosource Standard RTH .................................... 38 Itraconazole ................................................. 63, 71

Index

Pharmaceuticals and brands J Janola ................................................................ 69 Jevity ................................................................. 38 Jevity RTH ......................................................... 38 K Karicare Food Thickener ..................................... 43 Karicare Goats Milk Infant Formula ..................... 65 Karicare Soy All Ages ......................................... 66 Kenacomb ................................................... 60, 75 Kindergen .......................................................... 34 Klacid .......................................................... 23, 73 Klamycin............................................................ 51 Konsyl-D............................................................ 67 L Lactose free infant formula ................................. 66 Lactulose ............................................... 24, 62, 71 Laevolac ............................................................ 24 Lanoxin PG .................................................. 22, 72 Lansoprazole ..................................................... 22 Lanzol Relief ...................................................... 22 Lignocaine hydrochloride ................................... 71 Lincocin ....................................................... 24, 26 Lincomycin .................................................. 24, 26 Liquigen ............................................................. 30 Litak .................................................................. 73 Lithium carbonate .............................................. 62 Locasol.............................................................. 47 Locoid C ............................................................ 66 Lophlex LQ......................................................... 45 Loprofin ....................................................... 45, 62 Loprofin Mix ................................................. 45, 62 Low calcium infant formula ................................ 47 Low protein baking mix ................................ 45, 62 Low protein pasta ........................................ 45, 62 Low protein phenyl free baking mix..................... 45 Low protein phenyl free pasta ............................. 45 M m-Captopril ........................................................ 26 m-Eslon ............................................................. 71 Malathion ........................................................... 69 MCT oil (Nutricia) ............................................... 30 Metabolic Mineral Mixture............................. 45, 70 Metamucil .......................................................... 67 Methylergometrine ............................................. 66 Methyl hydroxybenzoate ..................................... 73 Metamide..................................................... 60, 74 Methotrexate ...................................................... 63 Methylphenidate hydrochloride ........................... 57 Metoclopramide hydrochloride ..................... 60, 74 Metoprolol succinate .................................... 22, 74 Mexiletine hydrochloride ..................................... 72 Mexitil ................................................................ 72 Microlax ............................................................. 68 Minaphlex .......................................................... 44 Mitomycin C ................................................ 59, 72 Mitomycin-C ...................................................... 72 Moducal ............................................................ 28 Monogen ........................................................... 32 Morphine sulphate.............................................. 71 Morrex Maltodextrin ........................................... 28 Moxifloxacin....................................................... 53 MSUD Maxamaid ............................................... 44 MSUD Maxamum ............................................... 44 Mucilaginous laxatives ....................................... 67 Mucilax .............................................................. 67 Multivitamin And Mineral Supplements ......... 45, 46 Multivitamins ..................................................... 68 Mylan Fentanyl Patch ......................................... 24 Myleran ....................................................... 60, 74 Myloc CR ..................................................... 22, 74 N Naltraccord .................................................. 22, 74 Naltrexone hydrochloride .............................. 22, 74 Napamide .......................................................... 68 Naproxen sodium ............................................... 73 Neocate ....................................................... 47, 62 Neocate Advance ......................................... 47, 62 Neocate LCP ................................................ 47, 62 Neostigmine....................................................... 62 Nepro (strawberry) ............................................. 35 Nepro (vanilla) ................................................... 35 Nicotine ................... 22, 25, 58, 70, 71, 73, 74, 75 Nicotinell ............................................................ 70 Nonoxynol-9 ...................................................... 69 Normacol ........................................................... 67 Norvir .......................................................... 23, 73 NovaSource Renal.............................................. 35 Nupentin ............................................................ 53 NutriniDrink ........................................................ 34 NutriniDrink Multifibre ......................................... 34 Nutrini Energy RTH ....................................... 34, 70 Nutrini RTH .................................................. 34, 70 Nutrison Concentrated ........................................ 35 Nutrison Energy Multi Fibre................................. 39 Nutrison Multi Fibre ............................................ 38 Nutrison Standard RTH....................................... 38 NZB Low Gluten Bread Mix ................................. 43 O Oestradiol .......................................................... 23 Oily cream ......................................................... 69 On Call Advanced ............................................... 48 Ondansetron .......................................... 23, 63, 71 Oral elemental feed 0.8kcal/ml............................ 36 Oral elemental feed 1kcal/ml............................... 36

Index

Pharmaceuticals and brands Oral feed 1.5kcal/ml ......................... 39, 61, 67, 70 Oral feed 1kcal/ml ............................ 32, 33, 38, 67 Oral feed 2kcal/ml ........................................ 42, 61 Oral feed with fibre 1.5 Kcal/ml..................... 39, 61 Oral supplements ............................................... 31 Orgran ......................................................... 43, 44 Ortho ................................................................. 69 Ortho All-flex ...................................................... 69 Ortho Coil .......................................................... 69 Osmolite ............................................................ 38 Osmolite RTH..................................................... 38 P Paediatric enteral feed 1.5kcal/ml ................. 34, 70 Paediatric enteral feed 1kcal/ml .................... 34, 70 Paediatric oral feed 1.5kcal/ml............................ 34 Paediatric oral feed 1kcal/ml............................... 34 Paediatric oral feed with fibre 1.5kcal/ml............. 34 Paediatric products ............................................ 34 Paediatric products for children awaiting liver transplant ................................................ 33 Paediatric products for children with chronic renal failure......................................... 34 Paediatric Seravit ............................................... 68 Pediasure........................................................... 34 Pediasure RTH ................................................... 34 Pepti Junior.................................................. 48, 62 Pepti Junior Gold.......................................... 48, 62 Peptisorb ........................................................... 36 Pethidine hydrochloride ...................................... 65 Pharmacy services... 22, 23, 24, 25, 65, 67, 71, 72 Phenate ............................................................. 67 Phlexy 10........................................................... 44 Piram-D ............................................................. 65 Piroxicam........................................................... 65 PKU Anamix Infant ............................................. 44 PKU Lophlex LQ ................................................. 45 Plavix ................................................................. 67 Polycal............................................................... 28 Polytar Emollient ................................................ 69 Potassium chloride ............................................ 62 Potassium citrate ............................................... 23 Povidone iodine ................................................. 71 Prantal ............................................................... 68 Premature birth formula...................................... 46 Prezista.............................................................. 23 Priadel ............................................................... 62 Promod.............................................................. 30 Protein ............................................................... 30 Protifar............................................................... 30 Pulmocare ......................................................... 31 Pyridoxine hydrochloride .................................... 72 Q QV ..................................................................... 69 R Raltegravir potassium......................................... 63 Renal oral feed 1kcal/ml ..................................... 36 Renal oral feed 2kcal/ml ..................................... 35 Renal products................................................... 35 Renilon 7.5 ........................................................ 35 Resource Beneprotein ........................................ 30 Resource Diabetic ........................................ 32, 67 Resource Plus.............................................. 67, 70 Respiratory products .......................................... 31 Rheumacin SR ................................................... 67 Risperdal Consta ................................................ 52 Risperidone........................................................ 52 Ritalin ................................................................ 57 Ritalin SR ........................................................... 57 Ritonavir ...................................................... 23, 73 Rubifen .............................................................. 57 Rubifen SR ........................................................ 57 S S26LBW Gold RTF ............................................. 46 S26 Soy............................................................. 66 Sabril ................................................................. 54 Salbutamol with ipratropium bromide.................. 24 Semi-elemental enteral feed 1kcal/ml.................. 36 Sildenafil ............................................................ 49 Sodium alginate ................................................. 68 Sodium bicarbonate ........................................... 73 Sodium chloride ........................................... 24, 65 Sodium citrate with sodium lauryl sulphoacetate.................................................. 68 Sodium cromoglycate ........................................ 67 Sodium hypochlorite .......................................... 69 Sonaflam ........................................................... 73 Sotacor ........................................................ 60, 75 Sotalol ......................................................... 60, 75 Soya infant formula ............................................ 66 Special food supplement .................................... 75 Specialised and elemental products .................... 36 Sporanox ..................................................... 63, 71 Standard supplements........................................ 38 Stavudine [d4t] .................................................. 72 Sulphur .............................................................. 73 Sumatriptan ................................................. 22, 75 Sunscreens, proprietary ..................................... 72 Suplena ............................................................. 36 Sustagen Hospital Formula ........................... 38, 75 Synflex............................................................... 73 T Tamoxifen citrate.......................................... 60, 75 Tar with cade oil................................................. 69 79

Index

Pharmaceuticals and brands Terazosin hydrochloride ............................... 52, 68 Thalidomide ........................................... 22, 73, 75 Thalidomide Pharmion........................................ 73 Thalomid...................................................... 22, 75 Tretinoin ............................................................ 59 Triamcinolone acetonide with gramicidin, neomycin and nystatin .............................. 60, 75 Two Cal HN.................................................. 42, 61 U Undyalised end stage renal failure....................... 36 Univent ........................................................ 22, 59 V Valoid (AFT) ....................................................... 66 Varenicline tartrate ....................................... 27, 50 Vaxigrip ............................................................. 70 Vesanoid............................................................ 59 Viagra ................................................................ 49 Vigabatrin .......................................................... 54 Vital HN ............................................................. 36 Vitamin B complex ............................................. 67 Vitamins ...................................................... 63, 65 Vivonex Pediatric.......................................... 47, 62 Vivonex TEN....................................................... 36 Vytorin ............................................................... 63 W Water ................................................................. 65 X XMET Maxamum ................................................ 44 XP Analog LCP ................................................... 44 XP Maxamaid ............................................... 44, 45 XP Maxamum .............................................. 44, 45 Xylocaine ........................................................... 71 Z Zapril ................................................................. 49 Zarontin ............................................................. 60 Zerit ................................................................... 72 Zinc ................................................................... 69 Zinc oxide .......................................................... 68 Zofran .......................................................... 63, 71 Zoladex .............................................................. 63 Zoledronic acid .................................................. 75

Pharmaceutical Management Agency Level 9, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Phone: 64 4 460 4990 - Fax: 64 4 460 4995 - www.pharmac.govt.nz Freephone Information line (9am-5pm weekdays) 0800 66 00 50 ISSN 1172-9376 (Print) ISSN 1179-3686 (Online)

While care has been taken in compiling this Update, Pharmaceutical Management Agency takes no responsibility for any errors or omissions and shall not be liable to any person for any damages or loss arising out of reliance by that person for any purpose on any of the contents of this Update. Errors and omissions brought to the attention of Pharmaceutical Management Agency will be corrected if necessary by an erratum or otherwise in the next edition of the Update.

If Undelivered, Return To: PO Box 10-254, Wellington 6143, New Zealand

Metadata

Title

Schedule Update - effective 1 April 2011

Abstract

Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 April 2011 Cumulative for January, February, March and April 2011 Section H for April 2011 Contents Summary of PHARMAC decisions effective 1 April 2011 …. 3 Christchurch Earthquake …. 6…

Page 1

Note

This text has been extracted from the source PDF document.

Also available as plain text.

Please contact webmaster to discuss alternative format options.