Schedule Update - effective 1 May 2011 (text extract)

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Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 May 2011

Section H cumulative for April and May 2011

Contents

Summary of PHARMAC decisions effective 1 May 2011 ................................ 3 Special foods ................................................................................................. 5 Ondansetron – widened access ..................................................................... 6 Clarithromycin 500 mg tablet – restriction reinstated ................................... 6 Named Specialists for etanercept juvenile idiopathic arthritis Special Authority applications ....................................................................... 6 New funded treatment for epilepsy .............................................................. 7 New funded treatment for narcolepsy .......................................................... 7 New treatment options for patients with multiple myeloma and amyloidosis ............................................................................. 7 News in Brief ................................................................................................. 8 Tender News .................................................................................................. 9 Looking Forward ........................................................................................... 9 Sole Subsidised Supply products cumulative to May 2011 .......................... 10 New Listings ................................................................................................ 20 Changes to Restrictions ............................................................................... 23 Changes to Subsidy and Manufacturer’s Price............................................. 31 Changes to Brand Name ............................................................................. 33 Changes to Section F Part II ......................................................................... 33 Changes to Sole Subsidised Supply ............................................................. 33 Delisted Items ............................................................................................. 34 Items to be Delisted .................................................................................... 35 Section H changes to Part II ........................................................................ 37 Section H changes to Part III........................................................................ 40 Index ........................................................................................................... 41

Summary of PharmaC decisions

effeCtive 1 may 2011 New listings (pages 20-22) • Compound electrolytes (Electral) powder for soln for oral use 4.4 g – Up to 10 sachets available on a PSO • Digoxin (Lanoxin) tab 250 μg , 240 tab pack - Up to 30 tab available on a PSO • Fentanyl citrate (Boucher and Muir) inj 50 μg per ml, 2 ml and 10 ml – Only on a controlled drug form and no patient co-payment payable • Lacosamide (Vimpat) tab 50 mg, 100 mg, 150 mg and 200 mg – Special Authority – Retail pharmacy - listing in Section F Part II • Modafinil (Modavigil) tab 100 mg – Special Authority – Retail pharmacy • Bortezomib inj 3.5 mg (Velcade) and inj 1 mg for ECP, 3.5 mg OP (Baxter) – PCT only – Specialist – Special Authority • Thalidomide (Thalomid) cap 100 mg – PCT only – Specialist – Special Authority – Only on a controlled drug form • Paediatric oral feed 1.5kcal/ml (Fortini) liquid (strawberry and vanilla) 200 ml OP – Special Authority – Hospital pharmacy [HP3] • Paediatric oral feed with fibre 1.5kcal/ml (Fortini Multi Fibre) liquid (chocolate, strawberry and vanilla) 200 ml OP – Special Authority – Hospital pharmacy [HP3] Changes to restrictions (pages 23-30) • Clarithromycin (Klamycin) tab 500 mg – removal of endorsement for dispensing 250 mg tablets • Influenza vaccine – amend access criteria • Ondansetron tab 4 mg and 8 mg, and tab disp 4 mg and 8 mg – removal of prescribing and dispensing restrictions and Special Authority • Thalidomide (Thalomid and Thalidomide Pharmion) cap 50 mg and 100 mg – amended Special Authority criteria • Standard supplements (Ensure, Sustagen Hospital Formula, Isosource Standard, Osmolite, Nutrison Standard RTH, Isosource Standard RTH, Osmolite RTH, Jevity, Nutrison Multi Fibre, Jevity RTH, Ensure Plus HN, Ensure Plus RTH, Nutrison Energy Multifibre, Fortisip, Ensure Plus, Fortisip Multi Fibre) liquid and powder - amended Special Authority criteria • Standard supplements (Ensure Plus) liquid (flavours) 200 ml OP – Higher subsidy by endorsement for bolus tube fed patients • Amino acid formula (Vivonex Pediatric, Neocate, Neocate LCP, Neocate Advance, Elecare, Elecare LCP) powder (flavours) – amended Special Authority criteria • Extensively hydrolysed formula (Pepti Junior Gold, Pepti Junior) powder – amended Special Authority criteria

Summary of PharmaC decisions – effective 1 may 2011 (continued) increased subsidy (page 31) • Colestipol hydrochloride (Colestid) sachets 5 g Decreased subsidy (page 31) • Abacavir sulphate (Ziagen) tab 300 mg and oral liq 20 mg per ml • Alendronate sodium (Fosamax) tab 70 mg • Alendronate sodium with cholecalciferol (Fosamax Plus) tab 70 mg with cholecalciferol 5,600 iu • Ondansetron (Zofran Zydis) tab disp 4 mg and 8 mg

Pharmaceutical Schedule - Update News

Special foods

Last month we implemented a number of changes to the access and funding of special foods. Following this implementation we have made some further changes with effect from 1 May 2011 as follows: • A full subsidy is available for patients being bolus fed through a feeding tube on readymix standard supplements (Fortisip, Ensure Plus 237 ml, Fortisip Multi Fibre and Two Cal HN) when the prescription is endorsed by the prescriber from 1 April 2011. A valid Special Authority is still required for partial subsidy for these ready-mixed products, but the endorsement is required to gain a full subsidy. Please note that this endorsement applies to Ensure Plus 200 ml tetrapak from 1 May 2011 and does not apply during the month of April 2011. • The Standard Supplements Special Authority criteria will be amended to enable on-line Special Authority applications to be processed electronically. • Abbott Laboratories has reduced the price of its Ensure Plus 200 ml tetrapak to the same price as Fortisip. This means that bolus tube fed patients will get a full subsidy for this product with prescriber endorsement. • Patients with outstanding repeats for Ensure Plus 200 ml tetrapaks will be fully subsidised where the initial dispensing was before 1 April 2011. This applies to existing

prescriptions only and not prescriptions written after 1 April 2011. • The Amino Acid formula and Extensively Hydrolysed formula Special Authority approval criteria will be amended to enable renewals for these products to be processed more smoothly. The patient information leaflet explaining the changes to the funding of nutritional products is available to order in hard copy from bpacnz. There is no restriction on how many information leaflets you can order. Links to the order forms are as follows • http://www.bpac.org.nz/resources/orders/ admin/resource_order.asp • http://www.pharmac.govt.nz/patients/ SpecialFoodsChanges

Pharmaceutical Schedule - Update News

Ondansetron – widened access

From 1 May 2011 the prescribing and dispensing restrictions that currently apply to ondansetron tablets and dispersible tablets will be removed. This means that there will be no restriction on the number of tablets subsidised per prescription or dispensing, regardless of indication. The Special Authority that waived the tablet restriction for patients undergoing highly emetogenic chemotherapy or radiation therapy will also be removed as it will no longer be needed.

Clarithromycin 500 mg tablet – restriction reinstated

Due to an out-of-stock on clarithromycin 250 mg tablets, PHARMAC permitted pharmacists to substitute the clarithromycin 500 mg tablets from 23 February 2011. Supplies of Klacid, clarithromycin 250 mg tablets (14 tab pack), are now available. From 1 May 2011 we will reinstate the prescribing and dispensing rules that previously applied to clarithromycin 500 mg tablets. These are: • Maximum of 14 tablets per prescription, and • Subsidy by endorsement – subsidised only if prescribed for helicobacter pylori eradication and the prescription is endorsed accordingly.

Named Specialists for etanercept juvenile idiopathic arthritis Special Authority applications

Initial Special Authority applications for etanercept for the Juvenile Idiopathic Arthritis indications can only be made by a “named specialist or rheumatologist”. Renewal applications can be made by a “named specialist, rheumatologist or Practitioner on Whangarei Dr Caroline Meadows Auckland Dr Jackie Yan Hamilton Dr Peter Heron Tauranga Dr Justin Wilde the recommendation of a named specialist or rheumatologist.” Below is the list of approved “named specialists” who can apply for Special Authority initial and renewal applications for etanercept for Juvenile Idiopathic Arthritis, effective from 1 May 2011: Rotorua Dr Erik Grangaard Lower Hutt Dr Priscilla Campbell-Stokes Nelson Dr Peter McIlroy Christchurch Dr James Hector-Taylor

Pharmaceutical Schedule - Update News

New funded treatment for epilepsy

Lacosamide (Vimpat) tablets will be fully funded as a last-line treatment for epilepsy from 1 May 2011. Funding will be subject to Special Authority criteria for patients with partial-onset epilepsy and seizures which are not adequately controlled by, or the patient has experienced unacceptable side effects from, optimal treatment with other epilepsy treatments. Please refer to page 20 of this Update for the Special Authority criteria.

New funded treatment for narcolepsy

Modafinil (Modavigil) 100 mg tablets will be fully funded for the treatment of narcolepsy from 1 May 2011. Funding will be available via Special Authority approval for the treatment of hypersomnia associated with narcolepsy in patients who cannot tolerate methylphenidate or dexamphetamine, or in whom both methylphenidate and dexamphetamine are contraindicated. Please refer to page 20 of this Update for the Special Authority criteria.

New treatment options for patients with multiple myeloma and amyloidosis

Bortezomib (Velcade) 3.5 mg injection and 1 mg for ECP will be funded for patients with treatment naïve and relapsed/ refractory multiple myeloma and systemic AL amyloidosis (i.e. first and second line treatment) through an agreement with Janssen-Cilag Pty Limited. From 1 May 2011 bortezomib will be listed in the Pharmaceutical Schedule as a Pharmacy Cancer Treatment (PCT only – Specialist), meaning that only DHB hospitals can claim for its use. It will be subsidised via a Special Authority approval. A new strength of thalidomide, 100 mg capsule, will be subsidised from 1 May 2011. Celgene Pty Ltd’s brand Thalomid will be subsidised in both the 50 mg and 100 mg capsule presentations, giving prescribers greater choice in dose selection. It should be noted that thalidomide is a Class A controlled drug and can only be prescribed by registered prescribers in accordance with the Misuse of Drugs Act 1971 and the supplier’s Risk Management Programme. The “Pharmaceutical Cancer Treatment – Only” (PCT-only – Specialist) restriction remains on all strengths and brands of thalidomide. Funded access to thalidomide will also be widened from 1 May 2011 to include

Pharmaceutical Schedule - Update News

funding for all patients with multiple myeloma and systemic AL amyloidosis through an agreement with Celgene Pty Limited.

Please refer to page 21 of this Update for the Special Authority criteria.

News in Brief

• Lanoxin (digoxin) 250 µg tablets will be supplied in a 240 tablet pack size from 1 May 2011. The 250 tablet pack size is being discontinued internationally. The new pack size will be available in blisters (strips of 30) rather than in bottles. • Hospital Supply Status (HSS) has been reinstated from 1 May 2011 on the Aspen Ceftriaxone brand of ceftriaxone sodium 1 g injection. HSS was suspended from 18 February 2011 due to an out-of-stock. Aspen Ceftriaxone 1 g injection will be the HSS brand until 30 June 2013. • The access criteria for funded influenza vaccine has also widened. Subsidy is now available for people under 18 years of age living within the boundaries of the Canterbury District Health Board. • Baclofen intrathecal injection has been added to the Discretionary Community Supply (DCS) list for patients with severe chronic spasticity of cerebral origin or due to multiple sclerosis, spinal cord injury or spinal cord disease, where oral antispastic agents have failed or have caused unacceptable side effects.

tender News

Sole Subsidised Supply changes – effective 1 June 2011

Chemical Name Lactulose Presentation; Pack size Oral liq 10 g per 15 ml; 1,000 ml Sole Subsidised Supply brand (and supplier) Laevolac (Douglas)

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 June 2011 • Azithromycin (Arrow-Azithromycin) tab 500 mg – amended Special Authority criteria • Bortezomib inj 1 mg (Velcade) and 1 mg for ECP, 1 mg (Baxter) – new listing – PCT only with Special Authority • Clarithromycin (Klacid, Klamycin) tab 250 mg and grans for oral liq 125 mg per 5 ml – amended Special Authority criteria • Fluconazole (Pacific) cap 150 mg – removal of Retail pharmacy-Specialist, addition of subsidy by endorsement, and only 1 cap subsidised per prescription • Olanzapine (Olanzine and Dr Reddy’s) tab 2.5 mg, 5 mg and 10 mg – new listing without Special Authority • Olanzapine (Olanzine-D and Dr Reddy’s) orodispersible tab 5 mg and 10 mg – new listing without Special Authority • 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 – amended Special Authority criteria • Sumatriptan injection – remove Retail pharmacy-Specialist

Sole Subsidised Supply Products – cumulative to May 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 May 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 May 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 May 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 May 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 Cap 100 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

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 Itrazole Sebizole 3TC 3TC Hysite Letara Jadelle Xylocaine EMLA EMLA Arrow-Lisinopril Diamide Relief 2012 2013 2013

Hydrocortisone

2013 2012 2011 2012 2013 2011 2012 2012 2011 2011 2013 2012 2013 2013 2011 2012 2013 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 Itraconazole Ketoconazole Lamivudine Latanoprost Letrozole Levonorgestrel Lignocaine hydrochloride Lignocaine with prilocaine

Lisinopril Loperamide hydrochloride

Sole Subsidised Supply Products – cumulative to May 2011

Generic Name

Loratadine

Presentation

Oral liq 1 mg per ml Tab 10 mg 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

Brand Name Expiry Date*

Lorapaed Loraclear Hayfever Relief 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 2013

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

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

Sole Subsidised Supply Products – cumulative to May 2011

Generic Name

Morphine sulphate

Presentation

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 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*

m-Elson Sevredol Mayne Mayne 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 Dr Reddy’s Ondansetron Syntocinon Syntocinon Syntometrine Pamisol Pamisol Pamisol Dr Reddy’s Pantoprazole Pharmacare Paracare Junior Paracare Double Strength ParaCode Lacri-Lube Loxamine Breath-Alert 2013 2012 2011 2013 2013 2012 2012

Morphine tartrate Mucilaginous laxatives Naproxen Nevirapine

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

Ondansetron Oxytocin

Tab 4 mg & 8 mg 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

2013 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 May 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 May 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 May 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 May changes in bold

2011 2012 2011 2011 2013 2013 2013 2011 2011 2011

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings

Effective 1 May 2011

44 COMPOUND ELECTROLYTES Powder for soln for oral use 4.4 g – Up to 10 sach available on a PSO ............................................................................... 1.12 DIGOXIN ❋ Tab 250 µg – Up to 30 tab available on a PSO ......................... 14.52 FENTANYL CITRATE a) Only on a controlled drug form b) No patient co-payment payable Inj 50 µg per ml, 2 ml ............................................................... 6.43 Inj 50 µg per ml, 10 ml ........................................................... 16.81 LACOSAMIDE – Special Authority see SA1125 – Retail pharmacy s Tab 50 mg .............................................................................. 25.04 s Tab 100 mg ............................................................................ 50.06 200.24 s Tab 150 mg ............................................................................ 75.10 300.40 s Tab 200 mg .......................................................................... 400.55 5 240 ✔ Electral ✔ Lanoxin

49 115

10 10 14 14 56 14 56 56

✔ Boucher and Muir ✔ Boucher and Muir ✔ Vimpat ✔ Vimpat ✔ Vimpat ✔ Vimpat ✔ Vimpat ✔ Vimpat

121

➽ SA1125 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 15 months for applications meeting the following criteria: Both: 1 Patient has partial-onset epilepsy; and 2 Seizures are not adequately controlled by, or patient has experienced unacceptable side effects from, optimal treatment with all of the following: sodium valproate, topiramate, levetiracetam and any two of carbamazepine, lamotrigine and phenytoin sodium (see Note). Note: “Optimal treatment” is defined as treatment which is 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. Women of childbearing age are not required to have a trial of sodium valproate. Renewal from any relevant practitioner. Approvals valid for 24 months where the patient has demonstrated a significant and sustained improvement in seizure rate or severity and/or quality of life compared with that prior to starting lacosamide treatment (see Note). Note: As a guideline, clinical trials have referred to a notional 50% reduction in seizure frequency as an indicator of success with anticonvulsant therapy and have assessed quality of life from the patient’s perspective. 136 MODAFINIL – Special Authority see SA1126 – Retail pharmacy Tab 100 mg ............................................................................ 72.50 30 ✔ Modavigil

➽ SA1126 Special Authority for Subsidy Initial application only from a neurologist or respiratory specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 The patient has a diagnosis of narcolepsy and has excessive daytime sleepiness associated with narcolepsy occurring almost daily for three months or more; and 2 Either: 2.1 The patient has a multiple sleep latency test with a mean sleep latency of less than or equal to 10 minutes and 2 or more sleep onset rapid eye movement periods; or 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

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Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 May 2011 (continued)

continued... 2.2 The patient has at least one of: cataplexy, sleep paralysis or hypnagogic hallucinations; and 3 Either: 3.1 An effective dose of a subsidised formulation of methylphenidate or dexamphetamine has been trialled and discontinued because of intolerable side effects; or 3.2 Methylphenidate and dexamphetamine are contraindicated. Note: Modafinil will not be subsidised for hypersomnia associated with any condition other than narcolepsy.

Renewal only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment. 144 BORTEZOMIB – PCT only – Specialist – Special Authority see SA1127 Inj 3.5 mg ......................................................................... 1,892.50 Inj 1 mg for ECP ................................................................. 1,892.50 1 ✔ Velcade 3.5 mg OP ✔ Baxter

➽ SA1127 Special Authority for Subsidy Initial application – treatment-naïve multiple myeloma/amyloidosis - only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 15 months for applications meeting the following criteria: Both: 1 Either: 1.1 The patient has treatment-naïve symptomatic multiple myeloma; or 1.2 The patient has treatment-naïve symptomatic systemic AL amyloidosis; and 2 Maximum of 9 treatment cycles. Initial application – relapsed/refractory multiple myeloma/amyloidosis - only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 8 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 The patient has relapsed or refractory multiple myeloma; or 1.2 The patient has relapsed or refractory systemic AL amyloidosis; and 2 The patient has received only one prior front line chemotherapy for multiple myeloma or amyloidosis; and 3 The patient has not had prior publicly funded treatment with bortezomib; and 4 Maximum of 4 treatment cycles. Renewal – relapsed/refractory multiple myeloma/amyloidosis - only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 8 months for applications meeting the following criteria: Both: 1 The patient’s disease obtained at least a partial response from treatment with bortezomib at the completion of cycle 4; and 2 Maximum of 4 further treatment cycles (making a total maximum of 8 consecutive treatment cycles). Note: Responding relapsed/refractory multiple myeloma patients should receive no more than 2 additional cycles of treatment beyond the cycle at which a confirmed complete response was first achieved. A line of therapy is considered to comprise either: a) a known therapeutic chemotherapy regimen and supportive treatments or b) a transplant induction chemotherapy regimen, stem cell transplantation and supportive treatments. Refer to datasheet for recommended dosage and number of doses of bortezomib per treatment cycle. 147 THALIDOMIDE – PCT only – Specialist – Special Authority see SA1124 Only on a controlled drug form Cap 100 mg ...................................................................... 1,008.00

✔ Thalomid

183

PAEDIATRIC ORAL FEED 1.5KCAL/ML – Special Authority see SA1100 – Hospital pharmacy [HP3] Liquid (strawberry) ................................................................... 1.60 200 ml OP ✔ Fortini Liquid (vanilla) .......................................................................... 1.60 200 ml OP ✔ Fortini ❋ 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.

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Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 May 2011 (continued)

183 PAEDIATRIC ORAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA1100 – Hospital pharmacy [HP3] Liquid (chocolate) .................................................................... 1.60 200 ml OP ✔ Fortini Multi Fibre Liquid (strawberry) ................................................................... 1.60 200 ml OP ✔ Fortini Multi Fibre Liquid (vanilla) .......................................................................... 1.60 200 ml OP ✔ Fortini Multi Fibre

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

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions

Effective 1 May 2011

28 CLARITHROMYCIN Tab 500 mg – Subsidy by endorsement .................................. 23.30 14 ✔ Klamycin a) Maximum of 14 tab per prescription 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. b) If the prescription is for clarithromycin 250 mg tablets and the prescription is dispensed from 23 February 2011 and the prescription is endorsed accordingly. 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, g) children on long term aspirin, or h) pregnancy, c) people under 18 years of age living within the boundaries of the Canterbury District Health Board. 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 ✔ Fluarix ✔ Fluvax

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

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 May 2011 (continued)

124 ONDANSETRON a) Maximum of 12 tab per prescription; can be waived by Special Authority see SA0887 below b) Maximum of 6 tab per dispensing; can be waived by Special Authority see SA0887 below c) Not more than one prescription per month; can be waived by Special Authority see SA0887 below. d) The maximum of 6 tab per dispensing cannot be waived via Access Exemption Criteria. Tab 4 mg ................................................................................. 5.10 30 ✔ Dr Reddy’s Ondansetron Tab disp 4 mg .......................................................................... 1.70 10 ✔ Dr Reddy’s Ondansetron (17.18) Zofran Zydis Tab 8 mg ................................................................................. 1.70 10 ✔ Dr Reddy’s Ondansetron Tab disp 8 mg .......................................................................... 2.00 10 ✔ Dr Reddy’s Ondansetron (20.43) Zofran Zydis ➽ SA0887 Special Authority for Waiver of Rule Initial application from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment of malignancy. Renewal from any relevant practitioner. Approvals valid for 12 months where the patient is undergoing prolonged treatment with highly emetogenic chemotherapy and/or highly emetogenic radiation therapy for the treatment of malignancy. 147 THALIDOMIDE – PCT only – Specialist – Special Authority see SA1124 0882 Only on a controlled drug form Cap 50 mg ........................................................................... 490.00 28 504.00 Cap 100 mg ....................................................................... 1,008.00 28

✔ Thalidomide Pharmion ✔ Thalomid ✔ Thalomid

➽ SA1124 0882 Special Authority for Subsidy Initial application — (for new patients) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Either: 1. The patient has multiple myeloma; or 2. The patient has systemic AL amyloidosis*. Both: 1 The patient has refractory, progressive or relapsed multiple myeloma; and 2 The patient has received prior chemotherapy. Note: Indication marked with * is an Unapproved Indication. Initial application — (for patients receiving thalidomide prior to 1 January 2006) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notified where the patient was receiving treatment with thalidomide for multiple myeloma on or before 31 December 2005. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid without further renewal unless notified where the patient has obtained a response from treatment during the initial approval period. Notes: Prescription must be written by a registered prescriber in the thalidomide risk management programme operated by the supplier. Maximum dose of 400 mg daily as monotherapy or in a combination therapy regimen. 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

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 May 2011 (continued)

185 STANDARD SUPPLEMENTS ➽ 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 2.2 The patient has failure to thrive; or 2.3 The patient has increased nutritional requirements; and 3 Nutrition goal has been set (eg reach a specific weight or BMI). Renewal — (Children) 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 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: 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 — (Adults) 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 6 months for applications meeting the following criteria: Both All of the following: 1 A nutrition goal has been set (eg reach a specific weight or BMI); and 2 Any of the following: Patient is Malnourished 2.1 Patient has a body mass index (BMI) of less than 18.5 kg/m2; or 2.2 Patient has unintentional weight loss greater than 10% within the last 3-6 months; or 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 3 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. 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 May 2011 (continued)

continued... 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 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. 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: 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 Temporomandibular joint surgery. Renewal — (Specific medical condition) 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 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 Temporomandibular joint surgery; and 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 unless notified for applications meeting the following criteria: 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); or 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 — (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 general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Any of the following: 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

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 May 2011 (continued)

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

189

ORAL FEED 1.5KCAL/ML (TETRAPAK) – Special Authority see SA1104 – Hospital pharmacy [HP3] a) Repeats for Fortisip and Ensure Plus will be fully subsidised where the initial dispensing was before 1 April 2011. b) Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube. The prescription must be endorsed accordingly. Repeats for Ensure Plus, 200 ml OP, will be subsidised to the same subsidy level as prior to 1 April 2011 where the initial dispensing was before 1 April 2011. Liquid (banana) – Higher subsidy of $1.26 per 200 ml with Endorsement. ....... 0.72 200 ml OP ( 1.26) Ensure Plus Liquid (chocolate) – Higher subsidy of $1.26 per 200 ml with Endorsement. ....... 0.72 200 ml OP (1.26) Ensure Plus Liquid (fruit of the forest) – Higher subsidy of $1.26 per 200 ml with Endorsement. ....... 0.72 200 ml OP (1.26) Ensure Plus Liquid (strawberry) – Higher subsidy of $1.26 per 200 ml with Endorsement. ....... 0.72 200 ml OP (1.26) Ensure Plus Liquid (vanilla) – Higher subsidy of $1.26 per 200 ml with Endorsement. ....... 0.72 200 ml OP (1.26) Ensure Plus AMINO ACID FORMULA – Special Authority see SA1111 – Hospital pharmacy [HP3] Powder .................................................................................... 6.00 48.5 g OP 56.00 400 g OP Powder (tropical) .................................................................... 56.00 400 g OP Powder (unflavoured) ............................................................. 56.00 400 g OP Powder (vanilla) ..................................................................... 56.00 400 g OP ✔ Vivonex Pediatric ✔ Neocate ✔ Neocate LCP ✔ Neocate Advance ✔ Elecare ✔ Elecare LCP ✔ Neocate Advance ✔ Elecare

193

➽ SA1111 Special Authority for Subsidy Initial Application – Transition from Old Form (SA0603). Applications 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 6 months for applications meeting the following criteria: All of the following: 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 May 2011 (continued)

continued... 1 The patient is currently receiving funded amino acid formula under Special Authority form SA0603, and 2 An assessment as to whether the infant can be transitioned to a cows milk protein, soy, or extensively hydrolysed infant formula has been undertaken; and, 3 The outcome of the assessment is that the infant continues to require an amino acid infant formula. 4 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and the date contacted. 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. 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 6 months for applications meeting the following criteria: All of the following: Both: 1 An assessment as to whether the infant can be transitioned to a cows milk protein, soy, or extensively hydrolysed infant formula has been undertaken; and, An assessment as to whether the infant can be transitioned to a cows milk protein formula or an extensively hydrolysed formula has been undertaken; and 2 The outcome of the assessment is that the infant continues to require an amino acid infant formula. 32 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. 194 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 – Transition from Old Form (SA0603). Applications 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 6 months for applications meeting the following criteria: Either: 1 All of the following: 1.1 The infant is currently receiving funded amino acid fomula under Special Authority form SA0603, and 1.2 The infant is to be assessed as to whether they can transition to an extensively hydrolysed infant formula, and 1.3 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and the date contacted. 2 All of the following: 2.1 The patient is currently receiving funded extensively hydrolysed formula under Special Authority form SA0603, and 2.2 An assessment as to whether the infant can be transitioned to a cows milk protein or soy infant formula has been undertaken; and, 2.3 The outcome of the assessment is that the infant continues to require an extensively hydrolysed infant formula, and 2.4 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and the date contacted. 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: 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 May 2011 (continued)

continued... 1 Both: 1.1 Cows milk formula is inappropriate due to severe intolerance or allergy to its protein content; and 1.2 Either: 1.2.1 Soy milk formula has been trialled without resolution of symptoms; or 1.2.2 Soy milk formula is considered clinically inappropriate or contraindicated; or 2 Severe malabsorption; or 3 Short bowel syndrome; or 4 Intractable diarrhea; or 5 Biliary atresia; or 6 Cholestatic liver diseases causing malsorption; or 7 Chylous ascite; 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 general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: Both: 1 An assessment as to whether the infant can be transitioned to a cows milk protein or soy infant formula has been undertaken; and, Assessment as to whether the infant can be transitioned to a cows milk protein formula has been undertaken; and 2 The outcome of the assessment is that the infant continues to require an extensively hydrolysed infant formula; and 32 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and date contacted. Renewal – Step Down from Amino Acid Formula. Applications 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 6 months for applications meeting the following criteria: All of the following: 1 The infant is currently receiving funded amino acid formula under Special Authority form SA0603, and 2 The infant is to be trialled on, or transitioned to, an extensively hydrolysed formula; and, 3 General Practitioners must include the name of the relevant specialist or vocationally registered general practitioner and the date contacted.

Effective 1 April 2011

188 ORAL FEED 1.5KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] a) Repeats for Fortisip and Ensure Plus 237 ml OP will be fully subsidised where the initial dispensing was before 1 April 2011. b) Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube. The prescription must be endorsed accordingly. Liquid (banana) – Higher subsidy of $1.26 per 200 ml with Endorsement ........................................................................ 0.72 200 ml OP (1.26) Fortisip Liquid (chocolate) – Higher subsidy of up to $1.33 per 237 ml with Endorsement .................................................................. 0.85 237 ml OP (1.33) Ensure Plus 0.72 200 ml OP (1.26) Fortisip continued... ❋ 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

Changes to Restrictions - effective 1 April 2011 (continued)

continued... Liquid (coffee latte) – Higher subsidy of up to $1.33 per 237 ml with Endorsement ..................................................... 0.85 (1.33) Liquid (strawberry) – Higher subsidy of up to $1.33 per 237 ml with Endorsement ..................................................... 0.85 (1.33) 0.72 (1.26) Liquid (toffee) – Higher subsidy of $1.26 per 200 ml with Endorsement ......................................................................... 0.72 (1.26) Liquid (tropical fruit) – Higher subsidy of $1.26 per 200 ml with Endorsement .................................................................. 0.72 (1.26) Liquid (vanilla) – Higher subsidy of up to $1.33 per 237 ml with Endorsement .................................................................. 0.85 (1.33) 0.72 (1.26) 189 237 ml OP Ensure Plus 237 ml OP Ensure Plus 200 ml OP Fortisip 200 ml OP Fortisip 200 ml OP Fortisip 237 ml OP Ensure Plus 200 ml OP Fortisip

ORAL FEED WITH FIBRE 1.5 KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] a) Repeats for Fortisip Multi Fibre will be fully subsidised where the initial dispensing was before 1 April 2011. b) Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube. The prescription must be endorsed accordingly. Liquid (chocolate) – Higher subsidy of $1.26 per 200 ml with Endorsement ........................................................................ 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (strawberry) – Higher subsidy of $1.26 per 200 ml with Endorsement ........................................................................ 0.72 200 ml OP (1.26) Fortisip Multi Fibre Liquid (vanilla) – Higher subsidy of $1.26 per 200 ml with Endorsement ........................................................................ 0.72 200 ml OP (1.26) Fortisip Multi Fibre ORAL FEED 2KCAL/ML – Special Authority see SA1105 – Hospital pharmacy [HP3] a) Repeats for Two Cal HN will be fully subsidised where the initial dispensing was before 1 April 2011. b) Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube. The prescription must be endorsed accordingly. Liquid (vanilla) – Higher subsidy of $2.25 per 237 ml with Endorsement ........................................................................ 1.14 237 ml OP (2.25) Two Cal HN

190

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 May 2011

34 MUCILAGINOUS LAXATIVES WITH STIMULANTS ( price) ❋ Dry............................................................................................ 2.41 (8.72) 6.02 (17.32) COLESTIPOL HYDROCHLORIDE ( subsidy) Sachets 5 g ............................................................................ 20.00 200 g OP Normacol Plus 500 g OP Normacol Plus 30 ✔ Colestid

44 90

ABACAVIR SULPHATE – Special Authority see SA1025 – Retail pharmacy ( subsidy) Tab 300 mg ......................................................................... 229.00 60 ✔ Ziagen Oral liq 20 mg per ml ............................................................... 50.00 240 ml OP ✔ Ziagen ALENDRONATE SODIUM – Special Authority see SA1039 – Retail pharmacy ( subsidy) Tab 70 mg .............................................................................. 22.90 4 ✔ Fosamax ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA1039 – Retail pharmacy ( subsidy) Tab 70 mg with cholecalciferol 5,600 iu................................... 22.90 4 ✔ Fosamax Plus DANTROLENE SODIUM ( price) ❋ Cap 25 mg .............................................................................. 32.96 (65.00) ❋ Cap 50 mg ............................................................................. 51.70 (77.00) ONDANSETRON ( subsidy) Tab disp 4 mg .......................................................................... 1.70 (17.18) Tab disp 8 mg. .......................................................................... 2.00 (20.43) 100 Dantrium 100 Dantrium 10 Zofran Zydis 10 Zofran Zydis

108 108

111 124

189

ORAL FEED 1.5KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] ( price and  alternate subsidy) a) Repeats for Fortisip and Ensure Plus will be fully subsidised where the initial dispensing was before 1 April 2011. b) Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube. The prescription must be endorsed accordingly. Liquid (banana) – Higher subsidy of $1.26 per 200 ml with Endorsement. ................................................................. 0.72 200 ml OP (1.26) Ensure Plus Liquid (chocolate) – Higher subsidy of $1.26 per 200 ml with Endorsement. ................................................................. 0.72 200 ml OP (1.26) Ensure Plus Liquid (fruit of the forest) – Higher subsidy of $1.26 per 200 ml with Endorsement. ................................................................. 0.72 200 ml OP (1.26) Ensure Plus

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 Subsidy and Manufacturer's Price - effective 1 May 2011 (continued)

continued... Liquid (strawberry) – Higher subsidy of $1.26 per 200 ml with Endorsement. ................................................................. 0.72 200 ml OP (1.26) Ensure Plus Liquid (vanilla) – Higher subsidy of $1.26 per 200 ml with Endorsement. ................................................................. 0.72 200 ml OP (1.26) Ensure Plus Note: Additional subsidy by endorsement and repeats will now be fully subsidised for the tetrapaks

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 Brand Name

Effective 1 May 2011

96 KETOPROFEN – Additional subsidy by Special Authority see SA1038 – Retail pharmacy ❋ Cap long-acting 100 mg ........................................................... 6.72 100 (21.56) ❋ Cap long-acting 200 mg ......................................................... 13.44 100 (43.12) Oruvail SR 100 Oruvail SR 200

Changes to Section F Part II

Effective 1 May 2011

201 NERVOUS SYSTEM Lacosamide

Changes to Sole Subsidised Supply

Effective 1 May 2011

For the list of new Sole Subsidised Supply products effective 1 May 2011 refer to the bold entries in the cumulative Sole Subsidised Supply table pages 10-19.

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 May 2011

33 PANCREATIC ENZYME Cap 8,000 USP u lipase, 30,000 USP u amylase, 30,000 USP u protease ........................................................ 85.00 ITRACONAZOLE – Retail pharmacy-Specialist Cap 100 mg ............................................................................. 4.25 (23.70) ONDANSETRON Tab 4 mg .................................................................................. 1.70 (17.18) Tab 8 mg ................................................................................. 3.40 (33.89) RISPERIDONE Tab 0.5 mg .............................................................................. 1.17 Note – Ridal tab 0.5 mg, 60 tab pack, remains subsidised. PHARMACY SERVICES - May only be claimed once per patient. ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Apo-Clopidogrel is 2378655

250 15

✔ Cotazym ECS

Sporanox 10 Zofran 20 Zofran 20 ✔ Ridal

124

127

168

1 fee

✔ BSF Apo-Clopidogrel

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 June 2011

144 BORTEZOMIB – PCT only – Specialist – Special Authority see SA1127 Inj 1 mg for ECP ................................................................. 1,892.50 3.5 mg OP ✔ Baxter

Effective 1 August 2011

124 ONDANSETRON Tab disp 4 mg .......................................................................... 1.70 (17.18) Tab disp 8 mg .......................................................................... 2.00 (20.43) 10 Zofran Zydis 10 Zofran Zydis

Effective 1 November 2011

32 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 ..................................................... 10.82 25 test OP ✔ Optium 5 second test PANCREATIC ENZYME Tab EC 1,900 BP u lipase, 1,700 BP u amylase, 110 BP u protease ............................................................... 32.46 IPECACUANHA ❋ Tincture................................................................................... 41.20 (43.40) DIGOXIN ❋ Tab 250 µg – Up to 30 tab available on a PSO ........................ 15.13

300 500 ml

✔ Pancrex V

39 44 63

PSM 250 ✔ Lanoxin

SALICYLIC ACID Powder – Only in combination ................................................ 15.00 500 g ✔ ABM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain or collodion flexible, 2) With or without other dermatological galenicals. 3) Maximum 20 g or 20 ml per prescription when prescribed with white soft paraffin or collodion flexible. SULPHUR Precipitated – Only in combination ............................................ 6.35 100 g (9.25) PSM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain 2) With or without other dermatological galenicals.

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 November 2011 (continued)

114 BUPRENORPHINE HYDROCHLORIDE – Only on a controlled drug form Inj 0.3 mg per ml, 1 ml ............................................................ 7.42 (9.38) SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 µg with ipratropium bromide, 20 µg per dose ................................................................... 13.50 SULPHACETAMIDE SODIUM ❋ Eye drops 10% ......................................................................... 4.41 5 Temgesic

161

200 dose OP ✔ Combivent 15 ml OP ✔ Bleph 10 Hospital pharmacy ✔ Lophlex LQ ✔ Lophlex LQ ✔ Lophlex LQ ✔ Lophlex LQ ✔ Lophlex LQ ✔ Lophlex LQ ✔ XP Analog LCP

163 192

AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA1108 – [HP3] Liquid (berry) .......................................................................... 15.65 62.5 ml OP 31.20 125 ml OP Liquid (citrus) ......................................................................... 15.65 62.5 ml OP 31.20 125 ml OP Liquid (orange) ........................................................................ 15.65 62.5 ml OP 31.20 125 ml OP Infant formula ....................................................................... 174.72 400 g OP

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

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes to Part II

Effective 1 May 2011

16 ABACAVIR SULPHATE Tab 300 mg – 1% DV Jul-11 to 2014 .................................... 229.00 Oral liq 20 mg per ml – 1% DV Jul-11 to 2014 ........................ 50.00 ALENDRONATE SODIUM ( price) Tab 70 mg ............................................................................. 22.90 ALENDRONATE SODIUM WITH CHOLECALCIFEROL ( price) Tab 70 mg with cholecalciferol 5,600 iu................................... 22.90 BLOOD GLUCOSE DIAGNOSTIC TEST STRIP Blood glucose test strips ......................................................... 10.82 Note: Optium 5 second test 25 test to be delisted 1 July 2011 BORTEZOMIB Inj 3.5 mg ......................................................................... 1,892.50 CEFTRIAXONE SODIUM Inj 1 g – 1% DV May-11 to 2013 ............................................. 10.49 Note: HSS reinstated from 1 May 2011 DANTROLENE SODIUM ( price) Cap 25 mg ............................................................................. 65.00 Cap 50 mg .............................................................................. 77.00 FENTANYL CITRATE Inj 50 µg per ml, 2 ml – 1% DV Jul-11 to 2012 ......................... 6.43 Inj 50 µg per ml, 10 ml – 1% DV Jul-11 to 2012 ..................... 16.81 Note: Hospira 50 µg per ml, 2 ml and 10 ml to be delisted 1 July 2011 LACOSAMIDE Tab 50 mg .............................................................................. 25.04 Tab 100 mg ............................................................................ 50.06 200.24 Tab 150 mg ............................................................................ 75.10 300.40 Tab 200 mg .......................................................................... 400.55 60 240 ml 4 4 25 test Ziagen Ziagen Fosamax Fosamax Plus Optium 5 second test

16 16 20

20 23

1 5

Velcade Aspen Ceftriaxone

100 100 10 10

Dantrium Dantrium Boucher and Muir Boucher and Muir

14 14 56 14 56 56

Vimpat Vimpat Vimpat Vimpat Vimpat Vimpat

OCTREOTIDE Inj 50 µg per ml, 1 ml. ............................................................. 43.50 5 Sandostatin Inj 100 µg per ml, 1 ml ............................................................ 81.00 5 Sandostatin Inj 500 µg per ml, 1 ml .......................................................... 399.00 5 Sandostatin Note: Sandostatin 50 µg per 1 ml, 100 µg per 1 ml and 500 µg per 1 ml to be delisted 1 May 2011 SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 µg with ipratropium bromide, 20 µg per dose .................................................................... 13.50 Note: Combivent aerosol inhaler to be delisted 1 July 2011

200 dose

Combivent

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 May 2011 (continued)

54 SALICYLIC ACID Powder .................................................................................. 15.00 Note: ABM salicylic acid to be delisted 1 July 2011 SPECIAL FOOD SUPPLEMENT ( price) Oral feed 1.5 kcal/ml, liquid (banana) ........................................ 1.26 Oral feed 1.5 kcal/ml, liquid (chocolate) .................................... 1.26 Oral feed 1.5 kcal/ml, liquid (fruit of the forest) ........................... 1.26 Oral feed 1.5 kcal/ml, liquid (vanilla) ......................................... 1.26 500 g ABM

200 ml 200 ml 200 ml 200 ml

Ensure Plus Ensure Plus Ensure Plus Ensure Plus

TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN (price correction) Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium – 1% DV Dec-08 to 2011 ...................................................... 5.54 1,000 ml Pinetarsol THALIDOMIDE Cap 100 mg ....................................................................... 1,008.00 28 Thalomid

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 Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated 100 100 20 100 10 Amitrip Amitrip Fungilin Myleran Martindale Max Health Apo-Doxazosin Apo-Doxazosin Aromasin Florinef Ismo-20 Corangin Metamide

17 21 28

500 500 30 100 100 30 100

30 31 38

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

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

43 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 30 30 30 30 30 Myloc CR Myloc CR Myloc CR Myloc CR Naltraccord

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. 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

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 to Part III

Effective 1 May 2011

63 BACLOFEN Inj 10 mg ...................................Lioresal Intrathecal Indefinite supply for patients with severe chronic spasticity of cerebral origin or due to multiple sclerosis, spinal cord injury or spinal cord disease, where oral antispastic agents have failed or have caused unacceptable side effects. ONDANSETRON Tab 4 mg ...................................Dr Reddy’s Ondansetron Zofran Tab 8 mg ...................................Dr Reddy’s Ondansetron Zofran Tab dispersible 4 mg .................Dr Reddy’s Ondansetron Zofran Tab dispersible 8 mg..................Dr Reddy’s Ondansetron Zofran For treatment of patients with hyperemesis gravidarum for the term of the pregnancy following failure of other antiemetic regimens.

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. 66

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 Abacavir sulphate......................................... 31, 37 Aclasta .............................................................. 39 Alendronate sodium ..................................... 31, 37 Alendronate sodium with cholecalciferol ....... 31, 37 Amino acid formula ............................................ 27 Aminoacid formula without phenylalanine ........... 36 Amitrip ............................................................... 38 Amitriptyline ....................................................... 38 Amphotericin B .................................................. 38 Apo-Doxazosin................................................... 38 Aromasin ........................................................... 38 Arrow-Sumatriptan ............................................. 39 Aspen Ceftriaxone .............................................. 37 B Baclofen ............................................................ 40 Bleph 10 ............................................................ 36 Blood glucose diagnostic test strip ............... 35, 37 Bortezomib ............................................ 21, 35, 37 Boucher and Muir......................................... 20, 37 BSF Apo-Clopidogrel .......................................... 34 Buprenorphine hydrochloride .............................. 36 Busulphan.......................................................... 38 C Ceftriaxone sodium ............................................ 37 Clarithromycin.................................................... 23 Combivent ................................................... 36, 37 Corangin ............................................................ 38 Cotazym ECS ..................................................... 34 Colestid ............................................................. 31 Colestipol hydrochloride ..................................... 31 Compound electrolytes....................................... 20 D Dantrium ...................................................... 31, 37 Dantrolene sodium ....................................... 31, 37 Digoxin ........................................................ 20, 35 Dopamine hydrochloride .................................... 38 Doxazosin mesylate ........................................... 38 Dr Reddy’s Ondansetron .............................. 24, 40 E Elecare .............................................................. 27 Elecare LCP ....................................................... 27 Electral .............................................................. 20 Ensure ............................................................... 40 Ensure Plus.................... 27, 29, 30, 31, 32, 38, 40 Exemestane ....................................................... 38 Extensively hydrolysed formula........................... 28 F Fentanyl citrate............................................. 20, 37 Florinef .............................................................. 38 Fluarix ................................................................ 23 Fludrocortisone acetate ...................................... 38 Fluvax ................................................................ 23 Fortini ................................................................ 21 Fortini Multi Fibre................................................ 22 Fortisip .................................................. 29, 30, 40 Fortisip Multi Fibre ........................................ 30, 40 Fosamax ...................................................... 31, 37 Fosamax Plus .............................................. 31, 37 Fungilin .............................................................. 38 G Genox ................................................................ 39 H Habitrol .............................................................. 39 I Influenza vaccine................................................ 23 Ipecacuanha ...................................................... 35 Ismo-20 ............................................................. 38 Isosorbide mononitrate....................................... 38 Itraconazole ....................................................... 34 K Kenacomb ......................................................... 39 Ketoprofen ......................................................... 33 Klamycin............................................................ 23 L Lacosamide ........................................... 20, 33, 37 Lanoxin ........................................................ 20, 35 Lioresal Intrathecal ............................................. 40 Lophlex LQ......................................................... 36 M Max Health ......................................................... 38 Metamide........................................................... 38 Metoclopramide hydrochloride ........................... 38 Metoprolol succinate .......................................... 39 Modafinil ............................................................ 20 Modavigil ........................................................... 20 Mucilaginous laxatives with stimulants ............... 31 Myleran ............................................................. 38 Myloc CR ........................................................... 39 N Naltraccord ........................................................ 39 Naltrexone hydrochloride .................................... 39 Neocate ............................................................. 27 Neocate Advance ............................................... 27 Neocate LCP ...................................................... 27 Nervous system ................................................. 33 Nicotine ............................................................. 39 Normacol Plus ................................................... 31 O Octreotide .......................................................... 37 Ondansetron .............................. 24, 31, 34, 35, 40 Optium 5 second test ................................... 35, 37 Oral feed 1.5kcal/ml ..................................... 29, 31 Oral feed 1.5kcal/ml (tetrapak) ........................... 27

Index

Pharmaceuticals and brands Oral feed 2kcal/ml .............................................. 30 Oral feed with fibre 1.5 Kcal/ml........................... 30 Oruvail 100 ........................................................ 33 Oruvail 200 ........................................................ 33 Oruvail SR.......................................................... 33 P Paediatric oral feed 1.5kcal/ml............................ 21 Paediatric oral feed with fibre 1.5kcal/ml............. 22 Pancreatic enzyme ....................................... 34, 35 Pancrex V .......................................................... 35 Pepti Junior........................................................ 28 Pepti Junior Gold................................................ 28 Pharmacy services............................................. 34 Pinetarsol........................................................... 38 R Ridal .................................................................. 34 Risperidone........................................................ 34 S Salbutamol with ipratropium bromide............ 36, 37 Salicylic acid ................................................ 35, 38 Sandostatin ........................................................ 37 Sotacor .............................................................. 39 Sotalol ............................................................... 39 Special food supplement .............................. 38, 40 Sporanox ........................................................... 34 Standard supplements........................................ 25 Sulphacetamide sodium ..................................... 36 Sulphur .............................................................. 35 Sumatriptan ....................................................... 39 Sustagen Hospital Formula ................................. 40 T Tamoxifen citrate................................................ 39 Tar with triethanolamine lauryl sulphate and fluorescein.................................. 38 Temgesic ........................................................... 36 Thalidomide ..................................... 21, 24, 38, 39 Thalidomide Pharmion........................................ 24 Thalomid.......................................... 21, 24, 38, 39 Triamcinolone acetonide with gramicidin, neomycin and nystatin .................. 39 Two Cal HN........................................................ 30 V Velcade........................................................ 21, 37 Vimpat ......................................................... 20, 37 Vivonex Pediatric................................................ 27 X XP Analog LCP ................................................... 36 Z Ziagen.......................................................... 31, 37 Zofran .......................................................... 34, 40 Zofran Zydis ........................................... 24, 31, 35 Zoledronic acid .................................................. 39

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 May 2011

Abstract

Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 May 2011 Section H cumulative for April and May 2011 Contents Summary of PHARMAC decisions effective 1 May 2011 ….. 3 Special foods …. 5 Ondansetron – widened access ……

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