Schedule Update - effective 1 July 2011 (text extract)

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Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 July 2011

Cumulative for May, June and July 2011 Section H cumulative for April, May, June and July 2011

Contents

Summary of PHARMAC decisions effective 1 July 2011 ................................. 3 Changes to Schedule subscriptions ............................................................... 6 Varenicline (Champix) – clarification of funded treatment length ................. 6 Special Foods - substitution clarification and stock report ............................ 7 Fluconazole 150 mg – further clarification .................................................... 7 Dabigatran – new listing ............................................................................... 7 Nicotine Replacement Therapy (NRT) – addition to Practitioners Supply Order (PSO) list .................................................................................. 8 Paracetamol with codeine tablets ................................................................. 8 Symbicort Turbuhaler, Vannair and Oxis Turbuhaler – changes to subsidy for new patients ............................................................. 8 Olanzapine depot injection – new listing ...................................................... 8 Osteoporosis treatments – two new listings and amendment to restrictions ............................................................................ 9 Docetaxel – Removal of Special Authority ..................................................... 9 Hospital Sole Supply (HSS) expiry date .......................................................... 9 Tender News ................................................................................................ 10 Looking Forward ......................................................................................... 10 Sole Subsidised Supply products cumulative to July 2011 ........................... 11 New Listings ................................................................................................ 18 Changes to Restrictions ............................................................................... 25 Changes to Subsidy and Manufacturer’s Price............................................. 44 Changes to Brand Name ............................................................................. 50 Changes to Section E Part I ......................................................................... 50 Changes to Section F Part II ......................................................................... 50 Changes to Sole Subsidised Supply ............................................................. 51 Items to be Delisted .................................................................................... 54 Section H changes to Part II ........................................................................ 57 Section H changes to Part III........................................................................ 68 Index ........................................................................................................... 70

Summary of PharmaC decisions

effeCtive 1 July 2011 New listings (pages 18-20) • Omeprazole (Midwest) powder 5 g – only in combination – only in extemporaneously compounded omeprazole suspension • Pyridoxine hydrochloride (PyridoxADE) tab 25 mg – no more than 100 mg per dose – only on a prescription - no patient co-payment payable • Dabigatran (Pradaxa) cap 75 mg, 110 mg and 150 mg, 60 cap OP – will not be funded Close Control in amounts less than 4 weeks of treatment – cap 75 mg no more than 2 cap per day • Permethrin (Lyderm) crm 5%, 30 g OP • Clindamycin (Dalacin C) inj phosphate 150 mg per ml, 4 ml, 10 inj pack – Retail pharmacy – Specialist • Raloxifene hydrochloride (Evista) tab 60 mg – Special Authority – Retail pharmacy • Teriparatide (Forteo) inj 250 μg per ml, 2.4 ml – Special Authority – Retail pharmacy • Paracetamol with codeine (Relieve) tab paracetamol 500 mg with codeine phosphate 8 mg • Olanzapine pamoate monohydrate (Zyprexa Relprevv) inj 210 mg, 300 mg and 405 mg – Special Authority – Retail pharmacy • Nicotine (Habitrol) gum 2 mg and 4 mg (classic, fruit and mint), 384 piece pack – up to 384 pieces of gum available on a PSO – nicotine will not be funded Close Control in amounts less than 4 weeks of treatment • Fludarabine phosphate (Fludarabine Ebewe) inj 50 mg – PCT only – Specialist • Mycophenolate mofetil (Ceptolate) cap 250 mg and tab 500 mg - Special Authority – Retail pharmacy Changes to restrictions (pages 25-31) • Fluconazole (Pacific) cap 150 mg – amended endorsement • Vancomycin hydrochloride (Mylan) inj 500 mg – amended presentation description and brand name change • Alendronate sodium (Fosamax) tab 70 mg – amended Special Authority criteria • Alendronate sodium with cholecalciferol (Fosamax Plus) tab 70 mg with cholecalciferol 5, 600 iu – amended Special Authority criteria • Zoledronic acid (Aclasta) soln for infusion 5 mg in 100 ml – amended Special Authority criteria • Lignocaine hydrochloride (Xylocaine Viscous) viscous soln 2% – amended presentation description • Nictoine (Habitrol) all strengths of patches, lozenge and gum – available on PSO

Summary of PharmaC decisions – effective 1 July 2011 (continued) • Varenicline tartrate (Champix) tab 1 mg and 0.5 mg – amended Special Authority criteria • Docetaxel (Docetaxel Ebewe, Taxotere and Baxter) inj 20 mg, inj 80 mg and inj 1 mg for ECP – removal of Special Authority • Eformoterol fumarate (Oxis Turbuhaler) powder for inhalation, 6 μg per dose, breath activated – higher subsidy with endorsement • Budesonide with eformoterol (Vannair and Symbicort Turbuhaler) all presentations – higher subsidy with endorsement • Omeprazole suspension – change to Standard Formulae increased subsidy (page 44-47) • Tetracosactrin (Synacthen Depot) inj 1 mg per ml, 1 ml • Amoxycillin Clavulanate (Synermox) tab amoxicillin 500 mg with potassium clavulanate 125 mg • Ketoprofen (Oruvail SR) cap long-acting 100 mg and 200 mg • Tiaprofenic acid (Surgam) tab 300 mg Decreased subsidy (page 44-47) • Mesalazine (Asacol) suppos 500 mg • Hyoscine n-butylbromide (Gastrosoothe) tab 10 mg • Ranitidine hydrochloride (Arrow-Ranitidine) tab 150 mg and 300 mg • Ranitidine hydrochloride (Peptisoothe) oral liq 150 mg per 10 m • Omeprazole (Dr Reddy’s Omeprazole) inj 40 mg • Pantoprazole (Pantocid IV) inj 40 mg • Gliclazide (Apo-Gliclazide) tab 80 mg • Docusate sodium (Laxofast 50 and 120) cap 50 mg and 120 mg • Triamcinolone acetonide (Oracort) 0.1% in Dental Paste USP • Pyridoxine hydrochloride (Apo-Pyridoxine) tab 50 mg • Dextrose (Biomed) inj 50%, 10 ml • Compound electrolytes (Enerlyte) powder for soln for oral use 5 g • Nicotinic acid (Apo-Nicotinic Acid) tab 50 mg and 500 mg • Simvastatin (Arrow-Simva) tab 10 mg, 20 mg, 40 mg and 80 mg • Nifedipine (Arrow-Nifedipine XR) tab long-acting 30 mg and 60 mg • Bendrofluazide (Arrow-Bendrofluazide) tab 2.5 mg and 5 mg • Glyceryl trinitrate (Nitroderm TTS) TDDS 10 mg • Chlorhexidine gluconate (Orion) soln 4% • Aqueous cream (AFT) crm 500 g • Emulsifying ointment (AFT) oint BP 500 g • Permethrin (A-Scabies) lotn 5 %

Summary of PharmaC decisions – effective 1 July 2011 (continued) • Ketoconazole (Sebizole) shampoo 2% • Cyproterone acetate with ethinyloestradiol (Ginet 84) tab 2 mg with ethinyloestradiol 35 μg and 7 inert tabs • Desmopressin (Desmopressin-PH&T) nasal spray 10 μg per dose • Doxycycline hydrochloride (Doxine) tab 100 mg • Tobramycin (DBL Tobramycin) inj 40 mg per ml, 2 ml • Vancomycin hydrochloride (Mylan) inj 500 mg • Norfloxacin (Arrow-Norfloxacin) tab 400 mg • Neostigmine (AstraZeneca) inj 2.5 mg per ml, 1 ml • Pyridostigmine bromide (Mestinon) tab 60 mg • Amantadine hydrochloride (Symmetrel) cap 100 mg • Tolcapone (Tasmar) tab 100 mg • Paracetamol (Paracare Double Strength) oral liq 250 mg per 5 ml • Tramadol hydrochloride (Arrow-Tramadol) cap 50 mg • Fentanyl citrate (Hospira) inj 50 μg per ml, 2 ml and 10 ml • Citalopram hydrobromide (Arrow-Citalopram) tab 20 mg • Zopiclone (Apo-Zopiclone) tab 7.5 mg • Docetaxel (Docetaxel Ebewe and Baxter) ini 20 mg, 80 mg and inj 1 mg for ECP • Anastrozole (DP-Anastrozole) tab 1 mg • Cetirizine hydrochloride (Zetop) tab 10 mg • Eformoterol fumarate (Oxis) powder for inhalation, 6 μg per dose, breath activated • Budesonide with eformoterol (Vannair) aerosol inhaler 100 μg with eformoterol fumarate 6 μg and aerosol inhaler 200 μg with eformoterol fumarate 6 μg • Budesonde with eformoterol (Symbicort Turbuhaler) powder for inhalation 100 μg with eformoterol fumarate 6 μg, powder for inhalation 200 μg with eformoterol fumarate 6 μg and powder for inhalation 400 μg with eformoterol fumarate 12 μg

6 Pharmaceutical Schedule - Update News

Changes to Schedule subscriptions

Later this year PHARMAC will be introducing changes to the subscriptions for the Pharmaceutical Schedule publications. Subscribers will be able to receive electronic copies of the publications by e-mail free of charge whereas hard copies will attract a fee. Annual subscription fees for hard copies of the Pharmaceutical Schedule and Updates will cost $55.00, Section H will cost $15.00, or a combined subscription will cost $65.00. These fees do not represent full cost recovery, but a contribution towards the cost of printing and postage. PHARMAC will shortly announce when the new fees will apply, and how to activate your free e-mail subscription and/or the paid hard copy subscription. Subscriptions will be managed via a secure website, links

to which will be via the PHARMAC website. We note that in addition to e-mail and hard copy subscription the Pharmaceutical Schedule can also be freely accessed online, anytime, via the PHARMAC website. Functionality of the online Schedule continues to be improved and we welcome your suggestions for further improvement.

Varenicline (Champix) – clarification of funded treatment length

Amendments have been made to the Special Authority criteria for varenicline tartrate (Champix) tablets to make it clear that a maximum of 3 months’ varenicline will be subsidised on each Special Authority approval from 1 July 2011. This was the original intent of the 3-month Special Authority approval period but it was not previously explicitly stated on the application form. Patients should be prescribed one starter pack and the remainder of the 12-week funded treatment course on the same prescription to avoid potential confusion.

Pharmaceutical Schedule - Update News

Special Foods - substitution clarification and stock report

Ensure powder vanilla, both 400 g and 900 g tins, have arrived and we have confirmation there is sufficient stock at wholesalers. Ensure powder chocolate 900 g is due to arrive on July 17 2011 and back orders will be filled shortly after this date. Sustagen Hospital Formula vanilla and chocolate both remain in stock and we do not anticipate any stock issues. Pharmacists will continue to be able to interchange and annotate prescriptions between the two powdered supplements upon verbal confirmation with the prescriber. This is intended to help reduce the burden for pharmacists as prescriptions do not need to be sent back to the prescribers, rather the change is annotated by the pharmacist and initialled once the prescriber has been contacted.

Fluconazole 150 mg – further clarification

From 1 June 2011 fluconazole 150 mg capsules were taken off specialist restriction and replaced with subsidy by endorsement. Any practitioner from 1 June 2011 has been able to prescribe one fluconazole 150 mg capsules for patients with vaginal candida albicans with endorsement. Fluconazole 150 mg capsules will not be funded in amounts greater than one capsule per prescription, even if prescribed by or on the recommendation of a specialist. For prescriptions greater than one 150 mg capsule written by or on the recommendation of a specialist, pharmacists are able to change to the 50 mg capsules. The prescriber does not need to be contacted as it is not a change in dose and there is no extra cost to the DHB.

Dabigatran – new listing

Dabigatran 75 mg, 110 mg and 150 mg capsules (Pradaxa) will be fully subsidised from 1 July 2011 without Special Authority restrictions. Note that dabigatran will not be funded Close Control in amounts less than 4 weeks of treatment and that there is a restriction on the 75 mg capsules of no more than 2 capsules per day. Due to the short shelf life of the capsules once opened, Original Pack dispensing arrangements will be in place. Pradaxa will initially be provided in a bottle presentation, which has a shelf-life of 30 days once opened, but we are working with the supplier to introduce a blister packaging.

Pharmaceutical Schedule - Update News

Nicotine Replacement Therapy (NRT) – addition to Practitioners Supply Order (PSO) list

All strengths and flavours (where relevant) of nicotine patches, lozenges and gum will be available on a PSO from 1 July 2011. Note that the PSO may only be used to ensure medical supplies for emergency use, teaching and demonstration purposes, and for the provision to certain patient groups where individual prescription is not practicable. We expect the main use of NRT obtained on a PSO would be for teaching and demonstration purposes. Patients will still need to obtain prescriptions or Quit Cards for funded NRT.

Paracetamol with codeine tablets

The listing date for the Mylan brand of paracetamol 500 mg with codeine 8 mg tablets (Relieve) has been brought forward to 1 July 2011. We have been informed that Mylan’s stock will be available from mid July. The delisting date of Arrow’s Paracode (1 February 2012) is unchanged.

Symbicort Turbuhaler, Vannair and Oxis Turbuhaler– changes to subsidy for new patients

From 1 July 2011, a part charge will apply to all new patients prescribed budesonide with eformoterol powder for inhalation (Symbicort Turbuhaler), and eformoterol fumarate powder for inhalation 6 µg (Oxis Turbuhaler). All current patients will remain fully funded under a Pharmacist endorsement. Budesonide with eformoterol aerosol inhalers (Vannair) remains fully subsidised for all patients with a price and subsidy decrease from 1 July 2011.

Olanzapine depot injection – new listing

From 1 July 2011 olanzapine depot injection 210 mg, 300 mg and 405 mg (Zyprexa Relprevv) will be funded subject to Special Authority restrictions for patients with schizophrenia who are non-compliant with oral medications and who have been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment, for 30 days or more in the last 12 months.

Pharmaceutical Schedule - Update News

Osteoporosis treatments – two new listings and amendment to restrictions

Raloxifene (Evista) 60 mg tablets will be funded for patients with osteoporosis subject to Special Authority restrictions similar to those that currently apply to alendronate and zoledronic acid from 1 July 2011. Changes have also been made to the Special Authority criteria for alendronate and zoledronic acid to ensure that patients who receive an approval for raloxifene will be able to access alendronate and zoledronic acid. Also from 1 July 2011, teriparatide (Forteo) injection 250 μg per ml, 2.4 ml, will be funded subject to Special Authority restrictions as a last-line treatment for osteoporosis.

Docetaxel – Removal of Special Authority

From 1 July 2011 the Special Authority criteria applying to the funding of docetaxel (20 mg and 80 mg injections and 1 mg injection for extemporaneous compounding (ECP)) will be removed. Docetaxel will remain listed as “PCT only – Specialist” pharmaceutical meaning it is only subsidised when claimed for by DHB Hospitals as a treatment for cancer

Hospital Sole Supply (HSS) expiry date

The end of June each year sees the expiry date of many sole supply contracts. This year is no different. For items listed in Part II of Section H that expire on 30 June 2011, and where there are no further changes to the listing of a product, the HSS expiry have not been reflected in this Update as they have in previous years.

tender News

Sole Subsidised Supply changes – effective 1 August 2011

Chemical Name Abacavir sulphate Abacavir sulphate Fentanyl Fentanyl Fentanyl Fentanyl Fentanyl Ondansetron Ondansetron Presentation; Pack size Oral liq 20 mg per ml; 240 ml OP Tab 300 mg; 60 tab Transdermal patch 12.5 µg per hour; 5 patch Transdermal patch 25 µg per hour; 5 patch Transdermal patch 50 µg per hour; 5 patch Transdermal patch 75 µg per hour; 5 patch Transdermal patch 100 µg per hour; 5 patch Tab disp 4 mg; 10 tab Tab disp 8 mg; 10 tab Sole Subsidised Supply brand (and supplier) Ziagen (GSK) Ziagen (GSK) Mylan Fentanyl Patch (Mylan) Mylan Fentanyl Patch (Mylan) Mylan Fentanyl Patch (Mylan) Mylan Fentanyl Patch (Mylan) Mylan Fentanyl Patch (Mylan) Dr Reddy's Ondansetron (Dr Reddy's) Dr Reddy's Ondansetron (Dr Reddy's)

looking forward

This section is designed to alert both pharmacists and prescribers to possible future changes to the Pharmaceutical Schedule. It may also assist pharmacists, distributors and wholesalers to manage stock levels. Possible decisions for implementation 1 august 2011 • Omeprazole (Omezol Relief) cap 10 mg, 20 mg and 40 mg – new listing • Rituximab (Mabthera) inj – price and subsidy decrease and amend Special Authority criteria • Venlafaxine (Arrow-Venlafaxine XR) tab 37.5 mg, 75 mg and 150 mg – new listing with existing Special Authority criteria

Sole Subsidised Supply Products – cumulative to July 2011

Generic Name

Acarbose Aciclovir Amitriptyline Amoxycillin Amoxycillin clavulanate

Presentation

Tab 50 mg & 100 mg Tab dispersible 200 mg, 400 mg & 800 mg Tab 25 mg & 50 mg Cap 250 mg & 500 mg Grans for oral liq 250 mg per 5 ml 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 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 Scalp app 0.1% Tab 5 mg Crm, aqueous, BP Lotn, BP Cap 0.25 µg & 0.5 µg 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 Inj 1 g Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Crm BP Eye drops 0.5% Eye oint 1% Handrub 1% with ethanol 70% Nail soln 8% Tab 0.5 mg, 2.5 mg & 5 mg Tab 5 mg with hydrochlorothiazide 12.5 mg

Brand Name Expiry Date*

Glucobay Lovir Amitrip Alphamox Ospamox Curam Curam 2012 2013 2014 2013 2012 2012

Ascorbic acid Aspirin Atenolol Atropine sulphate Azathioprine Azithromycin Baclofen Betamethasone valerate Bisacodyl Calamine Calcitriol Captopril Cefaclor monohydrate Ceftriaxone sodium Cephalexin monohydrate Cetomacrogol Chloramphenicol Chlorhexidine gluconate Ciclopiroxolamine Cilazapril Cilazapril with hydrochlorothiazide

Vitala-C Ethics Aspirin EC Ethics Aspirin Atenolol Tablet USP AstraZeneca Imuprine Imuran Arrow-Azithromycin Pacifen Beta Scalp Lax-Tab healthE API Airflow m-Captorpril Capoten Ranbaxy-Cefaclor Veracol Aspen Ceftriaxone Cefalexin Sandoz Cefalexin Sandoz PSM Chlorafast Chlorsig healthE Batrafen Zapril Inhibace Plus

2013 2013 2012 2012 2013 2012 2012 2012 2013 2012 2012 2013 2013 2013 2012 2013 2012 2012 2012 2013 2013

*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 July 2011

Generic Name

Clobetasol propionate

Presentation

Crm 0.05% Oint 0.05% Scalp app 0.05% 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 Vaginal crm 1% with applicator Vaginal crm 2% with applicator Soln BP Tab 500 µg Crm 10% Tab 50 mg Tab 50 mg Tab 50 mg & 100 mg Eye drops 0.1% Inj 4 mg per ml, 1 ml & 2 ml Soln with electrolytes

Brand Name Expiry Date*

Dermol Dermol Dermol Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Catapres Dixarit Catapres Apo-Clopidogrel Clomazol Clomazol Midwest Colgout Itch-Soothe Nausicalm Cycloblastin Siterone Maxidex Hospira Pedialyte – Fruit Pedialyte – Bubblegum Pedialyte – Plain Diclofenac Sandoz DHC Continus Dilzem Cardizem CD Laxsol Donepezil-Rex Apo-Doxazosin Arrow-Enalapril Clexane Comtan E-Mycin Loxalate 2012

Clonidine

2012

Clonidine hydrochloride

2012

Clopidogrel Clotrimazole Coal tar Colchicine Crotamiton Cyclizine hydrochloride Cyclophosphamide Cyproterone acetate Dexamethasone Dexamethasone sodium phosphate Dextrose with electrolytes

2013 2013 2013 2013 2012 2012 2013 2012 2013 2013 2013

Diclofenac sodium Dihydrocodeine tartrate Diltiazem hydrochloride

Tab EC 25 mg & 50 mg Tab long-acting 60 mg Tab 30 mg & 60 mg Cap long-acting 120 mg, 180 mg & 240 mg Tab 50 mg with total sennosides 8 mg Tab 5 mg & 10 mg Tab 2 mg & 4 mg 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 Tab 400 mg Tab 10 mg & 20 mg

2012 2013 31/12/11

Docusate sodium with sennosides Donepezil hydrochloride Doxazosin mesylate Enalapril Enoxaparin sodium (low molecular weight heparin) Entacapone Erythromycin ethyl succinate Escitalopram

2013 2012 2014 2012 2012 2012 2012 2013

Sole Subsidised Supply Products – cumulative to July 2011

Generic Name

Ethinyloestradiol Etidronate disodium Exemestane Felodipine Ferrous sulphate Flucloxacillin sodium

Presentation

Tab 10 µg Tab 200 mg Tab 25 mg Tab long-acting 5 mg Tab long-acting 10 mg Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml) Cap 250 mg & 500 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml 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 Liquid 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 Rectal foam 10%, CFC-free (14 applications) Crm 1% with miconazole nitrate 2% Inj 1 mg per ml, 1 ml Tab 200 mg Oral liq 100 mg per 5 ml Tab 200 mg Tab 2.5 mg

Brand Name Expiry Date*

NZ Medical and Scientific Arrow-Etidronate Aromasin Felo 5 ER Felo 10 ER Ferodan AFT AFT AFT FML Fluox Fluox Flutamin Flixonase Hayfever & Allergy Frusemide-Claris Diurin 40 Foban Foban Nupentin Lipazil Pfizer healthE Serenace Serenace Serenace Solu-Cortef Douglas Colifoam Micreme H ABM Hydroxocobalamin Plaquenil Fenpaed Ethics Ibuprofen Dapa-Tabs 2012 2012 2014 2012 2013 2012

Fluorometholone Fluoxetine hydrochloride Flutamide Fluticasone propionate Furosemide Fusidic acid Gabapentin Gemfibrozil Gentamicin sulphate Glycerol Haloperidol

2012 2013 2013 31/1/13 2013 2012 2013 31/7/12 2013 2012 2013 2013

Hydrocortisone Hydrocortisone acetate Hydrocortisone with miconazole Hydroxocobalamin Hydroxychloroquine sulphate Ibuprofen Indapamide

2013 2012 2012 2013 2012 2012 2013 2012 2013

Sole Subsidised Supply Products – cumulative to July 2011

Generic Name

Ipratropium bromide Isosorbide mononitrate Isotretinoin Itraconazole Lactulose Lamivudine Latanoprost Letrozole Levonorgestrel Lignocaine hydrochloride Lignocaine with prilocaine

Presentation

Nebuliser soln, 250 µg per ml, 1 ml & 2 ml Tab 20 mg Tab long-acting 40 mg Cap 10 mg & 20 mg Cap 100 mg Oral liq 10 g per 15 ml Oral liq 10 mg per ml Tab 150 mg Eye drops 50 µg per ml Tab 2.5 mg Subdermal implant (2 x 75 mg rods) Inj 1%, 5 ml & 20 ml Crm 2.5% with prilocaine 2.5% (5 g tubes) Crm 2.5% with prilocaine 2.5%; 30 g OP Tab 5 mg, 10 mg & 20 mg Cap 2 mg Oral liq 1 mg per ml Tab 10 mg Tab 1 mg & 2.5 mg Liq 0.5% Shampoo 1% Device 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 Tab 4 mg & 100 mg

Brand Name Expiry Date*

Univent Ismo 20 Corangin Oratane Itrazole Laevolac 3TC 3TC Hysite Letara Jadelle Xylocaine EMLA EMLA Arrow-Lisinopril Diamide Relief Lorapaed Loraclear Hayfever Relief Ativan A-Lices A-Lices Foremount Child’s Silicone Mask Apo-Megestrol Purinethol Pentasa Apotex Methatabs Biodone Biodone Forte Biodone Extra Forte Hospira Methoblastin Medrol 2012 2013 2013 2013 2014 2012 2013 2013 2013 2012 2012 31/12/13 2013 2013

Lisinopril Loperamide hydrochloride Loratadine

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

2013 2013 30/9/11 2012 2013 2012 2012 2013 2012

Methotrexate Methylprednisolone

2013 2012 2012

Sole Subsidised Supply Products – cumulative to July 2011

Generic Name

Methylprednisolone sodium succinate

Presentation

Inj 40 mg per ml, 1 ml Inj 62.5 mg per ml, 2 ml Inj 500 mg Inj 1 g Tab 10 mg Tab 150 mg & 300 mg Crm 0.1% Oint 0.1% Oral liq 1 mg per ml Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Cap long-acting 10 mg, 30 mg, 60 mg & 100 mg Tab immediate release 10 mg & 20 mg Inj 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*

Solu-Medrol Solu-Medrol Solu-Medrol Solu-Medrol Metamide Apo-Moclobemide m-Mometasone m-Mometasone RA-Morph RA-Morph RA-Morph RA-Morph m-Elson Sevredol Hospira Konsyl-D Noflam 250 Noflam 500 Viramune Suspension Viramune Habitrol Habitrol Noriday 28 Nilstat Nilstat Dr Reddy’s Ondansetron Syntocinon Syntocinon Syntometrine Dr Reddy’s Pantoprazole Lacri-Lube Loxamine Breath-Alert 2012

Metoclopramide hydrochloride Moclobemide Mometasone furoate Morphine hydrochloride

2014 2012 2012 2012

Morphine sulphate

2013 2012 2013 2013 2012 2012

Morphine tartrate Mucilaginous laxatives Naproxen Nevirapine

Nicotine Norethisterone Nystatin Ondansetron Oxytocin

Lozenge 1 mg & 2 mg Patch 7 mg, 14 mg & 21 mg Tab 350 µg Cap 500,000 u Tab 500,000 u 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 Tab 20 mg & 40 mg Eye oint with soft white paraffin Tab 20 mg Low range and Normal range

2014 2012 2013 2013 2012

Pantoprazole Paraffin liquid with soft white paraffin Paroxetine hydrochloride Peak Flow Meter

2013 2013 2013 30/9/11

Sole Subsidised Supply Products – cumulative to July 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 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 Tab long-acting 600 mg Oral liq 5 mg per ml Cassette Oral liq 5 mg per 5 ml Tab 300 mg Cap 150 mg Tab 0.25 mg, 1 mg, 2 mg & 5 mg Tab 150 mg & 300 mg 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 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%

Brand Name Expiry Date*

Pegasys Pegasys Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Cilicaine VK AFT AFT Apo-Pindolol Pizaccord Sandomigran Span-K Redipred Innovacon hCG One Step Pregnancy Test Promethazine Winthrop Elixir Q 300 Mycobutin Ropin ArrowRoxithromycin Salapin Asthalin Asthalin Duolin 2012 2012 2012 2012 2012 2012 2012 2012 2013 2013 2012 2013 2012 2012 31/12/12

Phenoxymethylpenicillin (Pencillin V)

2013

Pindolol Pioglitazone Pizotifen Potassium chloride Prednisone sodium phosphate Pregnancy tests – hCG urine Promethazine hydrochloride Quinine sulphate Rifabutin Ropinirole hydrochloride Roxithromycin Salbutamol

Salbutamol with ipratropium bromide Selegiline hydrochloride Sertraline Sodium chloride Sodium citrate with sodium lauryl sulphoacetate Sodium citro-tartrate Sodium cromoglycate

Apo-Selegiline Arrow-Sertraline Biomed Micolette Ural Rexacrom Rex

2012 2013 2013 2013 2013 2013 2012

Sole Subsidised Supply Products – cumulative to July 2011

Generic Name

Somatropin Sotalol Spacer Device Spironolactone Sumatriptan Tamsulosin hydrochloride Terazosin hydrochloride Testosterone undecanoate Timolol maleate Tranexamic acid Tropisetron Vitamin B complex Vitamins Zidovudine [AZT] July changes in bold

Presentation

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 Tab 1 mg, 2 mg & 5 mg Cap 40 mg Tab 10 mg Tab 500 mg Cap 5 mg Tab, strong, BPC Tab (BPC cap strength) Cap 100 mg Oral liq 10 mg per ml

Brand Name Expiry Date*

Genotropin Genotropin Mylan Space Chamber Spirotone Arrow-Sumatriptan Tamsulosin-Rex Arrow Arrow-Testosterone Apo-Timol Cycklokapron Navoban B-PlexADE MultiADE Retrovir Retrovir 31/12/12 2012 30/9/11 2013 2013 2013 2013 2012 2012 2013 2012 2013 2013 2013

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings

Effective 1 July 2011

29 OMEPRAZOLE ❋ Powder – Only in combination ................................................ 42.50 Only in extemporaneously compounded omeprazole suspension. PYRIDOXINE HYDROCHLORIDE a) No more than 100 mg per dose b) Only on a prescription ❋ Tab 25 mg – No patient co-payment payable ............................ 2.20 5g ✔ Midwest

✔ PyridoxADE

DABIGATRAN Dabigatran will not be funded Close Control in amounts less than 4 weeks of treatment. Cap 75 mg – No more than 2 cap per day ............................. 148.00 60 OP ✔ Pradaxa Cap 110 mg .......................................................................... 148.00 60 OP ✔ Pradaxa Cap 150 mg .......................................................................... 148.00 60 OP ✔ Pradaxa PERMETHRIN Crm 5% .................................................................................... 4.20 CLINDAMYCIN Inj phosphate 150 mg per ml, 4 ml – Retail pharmacySpecialist .......................................................................... 160.00 30 g OP ✔ Lyderm

62 82

✔ Dalacin C ✔ Evista

109

RALOXIFENE HYDROCHLORIDE – Special Authority see SA1138 – Retail pharmacy Tab 60 mg .............................................................................. 53.76 28

➽ SA1138 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Notes); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Notes); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Notes); or 6 Patient has had a prior Special Authority approval for zoledronic acid (Underlying cause – Osteoporosis) or alendronate (Underlying cause - Osteoporosis). Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence used by the UK National Institute for Health and Clinical Excellence (NICE) in developing its guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for raloxifene funding. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures 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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Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 July 2011 (continued)

continued... are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. 1 ✔ Forteo

109

TERIPARATIDE – Special Authority see SA11339 – Retail pharmacy Inj 250 µg per ml, 2.4 ml ...................................................... 490.00

➽ SA1139 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 18 months for applications meeting the following criteria: All of the following: 1 The patient has severe, established osteoporosis; and 2 The patient has a documented T-score less than or equal to -3.0 (see Notes); and 3 The patient has had two or more fractures due to minimal trauma; and 4 The patient has experienced at least one symptomatic new fracture after at least 12 months’ continuous therapy with a funded antiresorptive agent at adequate doses (see Notes). Notes: a) The bone mineral density (BMD) measurement used to derive the T-score must be made using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Antiresorptive agents and their adequate doses for the purposes of this Special Authority are defined as: alendronate sodium tab 70 mg or tab 70 mg with cholecalciferol 5,600 iu once weekly; raloxifene hydrochloride tab 60 mg once daily; zoledronic acid 5 mg per year. If an intolerance of a severity necessitating permanent treatment withdrawal develops during the use of one antiresorptive agent, an alternate antiresorptive agent must be trialled so that the patient achieves the minimum requirement of 12 months’ continuous therapy. c) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. d) A maximum of 18 months of treatment (18 cartridges) will be subsidised. 116 128 PARACETAMOL WITH CODEINE ❋ Tab paracetamol 500 mg with codeine phosphate 8 mg ............ 2.70 100 ✔ Relieve

OLANZAPINE PAMOATE MONOHYDRATE – Special Authority see SA1146 – Retail pharmacy Inj 210 mg ............................................................................ 280.00 1 ✔ Zyprexa Relprevv Inj 300 mg ............................................................................ 460.00 1 ✔ Zyprexa Relprevv Inj 405 mg ............................................................................ 560.00 1 ✔ Zyprexa Relprevv ➽ SA1146 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 The patient has schizophrenia; and 2 The patient has tried but failed to comply with treatment using oral atypical antipsychotic agents; and 3 The patient has been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment for 30 days or more in the last 12 months. Renewal from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: 1 Both: 1.1 The patient has had less than 12 months’ treatment with olanzapine depot injection; and continued...

▲

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

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

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Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 July 2011 (continued)

continued... 1.2 There is no clinical reason to discontinue treatment; or 2 The initiation of olanzapine depot injection has been associated with fewer days of intensive intervention than was the case during a corresponding period of time prior to the initiation of olanzapine depot injection. Note: The patient should be monitored for post-injection syndrome for at least three hours after each injection. NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. Gum 2 mg (Classic) – up to 384 pieces of gum available on a PSO ....................................................... 36.47 384 Gum 2 mg (Fruit) – up to 384 pieces of gum available on a PSO ....................................................... 36.47 384 Gum 2 mg (Mint) – up to 384 pieces of gum available on a PSO ....................................................... 36.47 384 Gum 4 mg (Classic) – up to 384 pieces of gum available on a PSO ....................................................... 42.04 384 Gum 4 mg (Fruit) – up to 384 pieces of gum available on a PSO ....................................................... 42.04 384 Gum 4 mg (Mint) – up to 384 pieces of gum available on a PSO ....................................................... 42.04 384 FLUDARABINE PHOSPHATE – PCT only – Specialist Inj 50 mg ............................................................................. 525.00 5

137

✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Fludarabine Ebewe

141 153

MYCOPHENOLATE MOFETIL – Special Authority see SA1041 – Retail pharmacy Dispensing pharmacy should check which brand to dispense with the prescriber if prescribed generically. Tab 500 mg ........................................................................... 60.00 50 ✔ Ceptolate Cap 250 mg ........................................................................... 30.00 50 ✔ Ceptolate

Effective 1 June 2011

47 61 CILAZAPRIL ❋ Tab 2.5 mg .............................................................................. 6.18 ❋ Tab 5 mg ................................................................................. 9.84 Note – change in pack size, and change from blister packs to bottles. 90 90 ✔ Zapril ✔ Zapril

TRICLOSAN – Subsidy by endorsement a) Maximum of 500 ml per prescription b) a) Only if prescribed for a patient identified with Methicillin-resistant Staphylococcus aureus (MRSA) prior to elective surgery in hospital and the prescription is endorsed accordingly; or b) Only if prescribed for a patient with recurrent Staphylococcus aureus infection and the prescription is endorsed accordingly Soln 1% ................................................................................... 4.50 500 ml OP ✔ Pharmacy Health ORNIDAZOLE Tab 500 mg ............................................................................ 16.50 10 ✔ Arrow-Ornidazole

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

New listings – effective 1 June 2011 (continued)

116 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Tab long-acting 10 mg ............................................................. 1.98 Tab long-acting 30 mg ............................................................. 3.15 Tab long-acting 60 mg ............................................................. 7.20 Tab long-acting 100 mg ........................................................... 7.85 OLANZAPINE Tab 2.5 mg .............................................................................. 2.00 Tab 5 mg ................................................................................. 3.85 Tab 10 mg ............................................................................... 6.35

10 10 10 10 28 28 28

✔ Arrow-Morphine LA ✔ Arrow-Morphine LA ✔ Arrow-Morphine LA ✔ Arrow-Morphine LA ✔ Dr Reddy’s Olanzapine ✔ Olanzine ✔ Dr Reddy’s Olanzapine ✔ Olanzine ✔ Dr Reddy’s Olanzapine ✔ Olanzine ✔ Dr Reddy’s Olanzapine ✔ Olanzine-D ✔ Dr Reddy’s Olanzapine ✔ Olanzine-D

126

129

OLANZAPINE Orodispersible tab 5 mg ............................................................ 6.36 Orodispersible tab 10 mg .......................................................... 8.76

28 28

143

METHOTREXATE ❋ Inj 25 mg per ml, 40 ml – PCT – Retail pharmacy-Specialist .................................................. 25.00 BORTEZOMIB – PCT only – Specialist – Special Authority SA1127 Inj 1 mg ............................................................................... 540.70 Inj 1 mg for ECP .................................................................... 594.77 DOXORUBICIN – PCT only – Specialist Inj 50 mg ............................................................................... 40.00 PACLITAXEL – PCT only – Specialist Inj 150 mg ........................................................................... 137.50 Inj 300 mg ........................................................................... 275.00

✔ DBL Methotrexate

S29

144

1 1 mg 1

✔ Velcade ✔ Baxter ✔ DBL Doxorubicin

S29

145

146

1 1

✔ Anzatax ✔ Anzatax

Effective 9 May 2011

111 ALLOPURINOL ❋ Tab 300 mg ............................................................................. 4.03 100 ✔ Apo-Allopurinol S29

S29

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 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 ▲ Tab 50 mg .............................................................................. 25.04 ▲ Tab 100 mg ............................................................................ 50.06 200.24 ▲ Tab 150 mg ............................................................................ 75.10 300.40 ▲ 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 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 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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Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 May 2011 (continued)

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 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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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions

Effective 1 July 2011

83 FLUCONAZOLE Cap 150 mg –Subsidy by Endorsement ..................................... 1.30 1 ✔ Pacific a) Maximum of one cap per prescription b) Patient has vaginal candida albicans and the Practitioner authorised prescriber considers that a topical imidazole (used intra-vaginally) is not recommended and the prescription is endorsed accordingly. VANCOMYCIN HYDROCHLORIDE – Subsidy by endorsement Only if prescribed for a dialysis or cystic fibrosis patient or in the treatment of pseudomembranous colitis or for prophylaxis of endocarditis and the prescription is endorsed accordingly. Inj 500 mg 50 mg per ml, 10 ml ............................................... 3.58 1 ✔ Mylan ALENDRONATE SODIUM – Special Authority see SA1039 – Retail pharmacy Tab 70 mg .............................................................................. 22.90 4 ✔ Fosamax ALENDRONATE SODIUM WITH CHOLECALCIFEROL – Special Authority see SA1039 – Retail pharmacy Tab 70 mg with cholecalciferol 5,600 iu................................... 22.90 4 ✔ Fosamax Plus ➽ SA1039 Special Authority for Subsidy Initial application — (Underlying cause – Osteoporosis) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 6 Patient has had a Special Authority approval for zoledronic acid (Underlying cause - Osteoporosis) or raloxifene. Initial application — (Underlying cause – glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is receiving systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Any of the following: 2.1 The patient has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5) (see Note); or 2.2 The patient has a history of one significant osteoporotic fracture demonstrated radiologically; or 2.3 The patient has had a Special Authority approval for zoledronic acid (Underlying cause glucocorticosteroid therapy). Renewal — (Underlying cause was, and remains, glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year where the patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents). Renewal — (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause osteoporosis’ criteria) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: continued...

▲

108

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 July 2011 (continued)

continued... Any of the following: 1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 3 History of two significant osteoporotic fractures demonstrated radiologically; or 4 Documented T-Score ≤ -3.0 (see Note); or 5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 6 Patient has had a Special Authority approval for zoledronic acid (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - Osteoporosis’ criteria) or raloxifene. Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence used by National Institute for Health and Clinical Excellence (NICE) guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for treatment with bisphosphonates. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis, and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) In line with the Australian guidelines for funding alendronate, a vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. 109 ZOLEDRONIC ACID – Special Authority see SA1035 – Retail pharmacy Soln for infusion 5 mg in 100 ml ........................................... 600.00 100 ml ✔ Aclasta

➽ SA1035 Special Authority for Subsidy Initial application — (Paget’s disease) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 Paget’s disease; and 2 Any of the following: 2.1 Bone or articular pain; or 2.2 Bone deformity; or 2.3 Bone, articular or neurological complications; or 2.4 Asymptomatic disease, but risk of complications; or 2.5 Preparation for orthopaedic surgery; and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Initial application — (Underlying cause - Osteoporosis) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Any of the following: 1.1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2011 (continued)

continued... 1.2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 1.3 History of two significant osteoporotic fractures demonstrated radiologically; or 1.4 Documented T-Score ≤ -3.0 (see Note); or 1.5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 1.6 Patient has had a Special Authority approval for alendronate (Underlying cause - Osteoporosis) or raloxifene; and 2 The patient will not be prescribed more than one infusion in a 12-month period.

Initial application — (Underlying cause - glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 The patient is receiving systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents) and has already received or is expected to receive therapy for at least three months; and 2 Any of the following: 2.1 The patient has documented BMD ≥ 1.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -1.5) (see Note); or 2.2 The patient has a history of one significant osteoporotic fracture demonstrated radiologically; or 2.3 The patient has had a Special Authority approval for alendronate (Underlying cause - glucocorticosteroid therapy); and 3 The patient will not be prescribed more than one infusion in the 12-month approval period. Renewal — (Paget’s disease) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 Any of the following: 1.1 The patient has relapsed (based on increases in serum alkaline phosphatase); or 1.2 The patient’s serum alkaline phosphatase has not normalised following previous treatment with zoledronic acid; or 1.3 Symptomatic disease (prescriber determined); and 2 The patient will not be prescribed more than one infusion in the 12-month approval period. The patient may not have had an approval in the past 12 months. Renewal —(Underlying cause was, and remains, glucocorticosteroid therapy) from any relevant practitioner. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is continuing systemic glucocorticosteriod therapy (≥ 5 mg per day prednisone equivalents); and 2 The patient will not be prescribed more than one infusion in the 12-month approval period. The patient may not have had an approval in the past 12 months. Renewal — (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause osteoporosis’ criteria) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Any of the following: 1.1 History of one significant osteoporotic fracture demonstrated radiologically and documented bone mineral density (BMD) ≥ 2.5 standard deviations below the mean normal value in young adults (i.e. T-Score ≤ -2.5) (see Note); or 1.2 History of one significant osteoporotic fracture demonstrated radiologically, and either the patient is elderly, or densitometry scanning cannot be performed because of major logistical, technical or pathophysiological reasons. It is unlikely that this provision would apply to many patients under 75 years of age; or 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 July 2011 (continued)

continued... 1.3 History of two significant osteoporotic fractures demonstrated radiologically; or 1.4 Documented T-Score ≤ -3.0 (see Note); or 1.5 A 10-year risk of hip fracture ≥ 3%, calculated using a published risk assessment algorithm (e.g. FRAX or Garvan) which incorporates BMD measurements (see Note); or 1.6 Patient has had a Special Authority approval for alendronate (Underlying cause was glucocorticosteroid therapy but patient now meets the ‘Underlying cause - Osteoporosis’ criteria) or raloxifene; and 2 The patient will not be prescribed more than one infusion in a 12-month period.

Notes: a) BMD (including BMD used to derive T-Score) must be measured using dual-energy x-ray absorptiometry (DXA). Quantitative ultrasound and quantitative computed tomography (QCT) are not acceptable. b) Evidence used by National Institute for Health and Clinical Excellence (NICE) guidance indicates that patients aged 75 years and over who have a history of significant osteoporotic fracture demonstrated radiologically are very likely to have a T-Score ≤ -2.5 and, therefore, do not require BMD measurement for treatment with bisphosphonates. c) Osteoporotic fractures are the incident events for severe (established) osteoporosis and can be defined using the WHO definitions of osteoporosis and fragility fracture. The WHO defines severe (established) osteoporosis as a T-score below -2.5 with one or more associated fragility fractures. Fragility fractures are fractures that occur as a result of mechanical forces that would not ordinarily cause fracture (minimal trauma). The WHO has quantified this as forces equivalent to a fall from a standing height or less. d) A vertebral fracture is defined as a 20% or greater reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or a 20% or greater reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. 113 137 LIGNOCAINE HYDROCHLORIDE Viscous soln solution 2% ....................................................... 55.00 200 ml ✔ Xylocaine Viscous

NICOTINE a) Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. b) Note - New pack sizes (384 pieces) of nicotine gum (Habitrol) will be listed from 1 July 2011. Patch 7 mg – up to 28 patches available on a PSO ............... 18.13 28 ✔ Habitrol Patch 14 mg – up to 28 patches available on a PSO ............. 18.81 28 ✔ Habitrol Patch 21 mg – up to 28 patches available on a PSO ............. 19.14 28 ✔ Habitrol Lozenge 1 mg – up to 216 lozenges available on a PSO ........ 19.94 216 ✔ Habitrol Lozenge 2 mg – up to 216 lozenges available on a PSO ....... 24.27 216 ✔ Habitrol Gum 2 mg (Classic) – up to 384 pieces of gum available on a PSO .................................................... 14.97 96 ✔ Habitrol 36.47 384 ✔ Habitrol Gum 2 mg (Fruit) – up to 384 pieces of gum available on a PSO .................................................... 14.97 96 ✔ Habitrol 36.47 384 ✔ Habitrol Gum 2 mg (Mint) – up to 384 pieces of gum available on a PSO .................................................... 14.97 96 ✔ Habitrol 36.47 384 ✔ Habitrol Gum 4 mg (Classic) – up to 384 pieces of gum available on a PSO .................................................... 20.02 96 ✔ Habitrol 42.04 384 ✔ Habitrol Gum 4 mg (Fruit) – up to 384 pieces of gum available on a PSO .................................................... 20.02 96 ✔ Habitrol 42.04 384 ✔ Habitrol Gum 4 mg (Mint) – up to 384 pieces of gum available on a PSO .................................................... 20.02 96 ✔ Habitrol 42.04 384 ✔ Habitrol

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

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

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 July 2011 (continued)

137 VARENICLINE TARTRATE – Special Authority see SA1135 1054 – Retail pharmacy a) Varenicline will not be funded Close Control in amounts less than 2 weeks of treatment. b) A maximum of 3 months' varenicline will be subsidised on each Special Authority approval. Tab 1 mg ............................................................................... 67.74 28 ✔ Champix 135.48 56 ✔ Champix Tab 0.5 mg × 11 and 1 mg × 14 .......................................... 60.48 25 OP ✔ Champix ➽ SA1135 1054 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 Either: 3.1 The patient has tried but failed to quit smoking after at least two separate trials of nicotine replacement therapy, at least one of which included the patient receiving comprehensive advice on the optimal use of nicotine replacement therapy; or 3.2 The patient has tried but failed to quit smoking using bupropion or nortriptyline; and 4 The patient has not used funded varenicline in the last 12 months; and 5 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and 6 The patient is not pregnant; and 7 The patient will not be prescribed more than 3 months funded varenicline (see Note). Renewal from any relevant practitioner. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 The patient has not used funded varenicline in the last 12 months; and 4 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and 5 The patient is not pregnant; and 6 The patient will not be prescribed more than 3 months funded varenicline (see Note). The patient may not have had an approval in the past 12 months. Note: A maximum of 3 months' varenicline will be subsidised on each Special Authority approval. 144 DOCETAXEL – PCT only – Specialist – Special Authority see SA0880 Inj 20 mg ............................................................................... 48.75 460.00 Inj 80 mg ............................................................................. 195.00 1,650.00 Inj 1 mg for ECP ....................................................................... 2.63 1 1 1 mg ✔ Docetaxel Ebewe ✔ Taxotere ✔ Docetaxel Ebewe ✔ Taxotere ✔ Baxter

➽ SA0880 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Any of the following: 1 Both: 1.1 The patient has ovarian*, fallopian* or primary peritoneal cancer*; and 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

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Changes to Restrictions - effective 1 July 2011 (continued)

continued... 1.2 Either: 1.2.1 Has not received prior chemotherapy; or 1.2.2 Has received prior chemotherapy but has not previously been treated with taxanes; or The patient has metastatic breast cancer; or Both: 3.1 The patient has early breast cancer; and 3.2 Docetaxel is to be given concurrently with trastuzumab; or Both: 4.1 The patient has non small-cell lung cancer; and 4.2 Either: 4.2.1 Has advanced disease (stage IIIa or above); or 4.2.2 Is receiving combined chemotherapy and radiotherapy; or Both: 5.1 The patient has small-cell lung cancer*; and 5.2 Docetaxel is to be used as second-line therapy.

2 3 4

Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic breast cancer, non small-cell lung cancer, or small-cell lung cancer*; and 2 Either: 2.1 The patient requires continued therapy; or 2.2 The tumour has relapsed and requires re-treatment. Note: indications marked with * are Unapproved Indications. 159 EFORMOTEROL FUMARATE – See prescribing guideline ( subsidy) Additional subsidy by endorsement for Oxis Turbuhaler is available for patients where the initial dispensing was before 1 July 2011. Pharmacists may annotate prescriptions for patients who were being prescribed Oxis Turbuhaler prior to 1 July 2011 in which case the prescription is deemed to be endorsed. The pharmacist must be able to show clear documented dispensing history for the patient. The prescription must be endorsed accordingly. Powder for inhalation, 6 µg per dose, breath activated – Higher subsidy of $16.90 per 60 dose with Endorsement ...................................................................... 14.60 60 dose OP (16.90) Oxis Turbuhaler BUDESONIDE WITH EFORMOTEROL – Special Authority see SA0958– Retail pharmacy ( subsidy) Additional subsidy by endorsement for budesonide with eformoterol powder for inhalation (Symbicort Turbuhaler) is available for patients where the initial dispensing was before 1 July 2011. Pharmacists may annotate prescriptions for patients who were being prescribed budesonide with eformoterol powder for inhalation (Symbicort Turbuhaler) prior to 1 July 2011 in which case the prescription is deemed to be endorsed. The pharmacist must be able to show clear documented dispensing history for the patient. The prescription must be endorsed accordingly. Powder for inhalation 100 µg with eformoterol fumarate 6 µg – Higher subsidy of $55.00 per 120 dose with Endorsement ......................................... 41.25 120 dose OP (55.00) Symbicort Turbuhaler 100/6

159

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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Changes to Restrictions - effective 1 July 2011 (continued)

continued... Powder for inhalation 200 µg with eformoterol fumarate 6 µg – Higher subsidy of $60.00 per 120 dose with Endorsement ......................................... 45.00 120 dose OP (60.00) Powder for inhalation 400 µg with eformoterol fumarate 12 µg – No more than 2 dose per day – Higher subsidy of $60.00 per 120 dose with Endorsement ............................................................... 45.00 60 dose OP (60.00) 173 OMEPRAZOLE SUSPENSION Omeprazole capsules or powder Sodium bicarbonate powder BP Water

Symbicort Turbuhaler 200/6

Symbicort Turbuhaler 400/12

qs 8.4 g to 100 ml

Effective 1 June 2011

80 AZITHROMYCIN – Subsidy by endorsement; can be waived by Special Authority see SA1130 0964 a) Maximum of 2 tab per prescription; can be waived by Special Authority see SA1130 0964 b) Up to 8 tab available on a PSO c) Subsidised only if prescribed for patients with uncomplicated urethritis or cervicitis proven or presumed to be due to chlamydia trachomatis and their sexual contacts and prescription or PSO is endorsed accordingly; can be waived by Special Authority see SA1130 0964. Tab 500 mg ............................................................................. 5.95 2 OP ✔ Arrow-Azithromycin ➽ SA1130 0964 Special Authority for Waiver of Rule Initial application – (cystic fibrosis) only from a respiratory specialist or paediatrician. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 The applicant is part of multidisciplinary team experienced in the management of cystic fibrosis; and 2 The patient has been definitively diagnosed with cystic fibrosis*; and 3 The patient has chronic infection with Pseudomonas aeruginosa or Pseudomonas related gram negative organisms as defined by two positive respiratory tract cultures at least three months apart*; and 4 The patient has negative cultures for non-tuberculous mycobacteria. Note: Caution is advised if using azithromycin as an antibiotic in the treatment of cystic fibrosis patients with pneumonia. Testing for non-tuberculosis mycobacteria should occur annually. Indications marked with * are Unapproved Indications (refer to Section A: General Rules, Part I (Interpretations and Definitions) and Part IV (Miscellaneous Provisions) rule 4.6). Initial application – (bronchiolitis obliterans syndrome) only from a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Patient has received a lung transplant; and 2 Azithromycin is to be used for prophylaxis of bronchiolitis obliterans syndrome*; and 3 The applicant is experienced in managing patients who have received a lung transplant. Renewal – (bronchiolitis obliterans syndrome) only from a relevant specialist. Application valid without further renewal, unless notified, for applications meeting the following criteria:

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

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 June 2011 (continued)

continued... Both 1 The patient remains well and free from bronchiolits obliterans syndrome*; and 2 The applicant is experienced in managing patients who have received a lung transplant. Indications marked with * are Unapproved Indications. 80 CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority SA1131 0988 Tab 250 mg ............................................................................. 7.75 14 ✔ Klacid ✔ Klamycin Grans for oral liq 125 mg per 5 ml .......................................... 23.12 70 ml ✔ Klacid ➽ SA1131 0988 Special Authority for Waiver of Rule Initial application - (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years for applications meeting the following criteria: Either: Any of the following 1 Mycobacterium Avium Intracellulare Complex infections in patient with AIDS; or 12 Atypical and drug-resistant mycobacterial infection; or 2 Mycobacterium tuberculosis infection where there is drug-resistance or intolerance to standard pharmaceutical agents. 3 All of the following: 3.1 Prophylaxis against disseminated Mycobacterium Avium Intracellulare Complex infection; and 3.2 HIV infection; and 3.3 CD4 count <= 50 cells/mm3. Renewal - (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. 83 FLUCONAZOLE Cap 150 mg – Retail Pharmacy Specialist Subsidy by endorsement......................................................................... 1.30 1 ✔ Pacific a) Maximum of one cap per prescription b) Patient has vaginal candida albicans and the authorised prescriber considers that a topical imidazole is not recommended and the prescription is endorsed accordingly. PEGYLATED INTERFERON ALPHA-2A – Special Authority see SA1134 0952 – Retail pharmacy See prescribing guideline Inj 135 μg prefilled syringe ................................................... 362.00 1 ✔ Pegasys 1,448.00 4 ✔ Pegasys Inj 180 μg prefilled syringe ................................................... 450.00 1 ✔ Pegasys 1,800.00 4 ✔ Pegasys Inj 135 μg prefilled syringe × 4 with ribavirin tab 200 mg × 112 ............................................................................... 1,799.68 1 OP ✔ Pegasys RBV Combination Pack Inj 135 μg prefilled syringe × 4 with ribavirin tab 200 mg × 168 ............................................................................... 1,975.00 1 OP ✔ Pegasys RBV Combination Pack Inj 180 μg prefilled syringe × 4 with ribavirin tab 200 mg × 112 ............................................................................... 2,059.84 1 OP ✔ Pegasys RBV Combination Pack Inj 180 μg prefilled syringe × 4 with ribavirin tab 200 mg × 168 ............................................................................... 2,190.00 1 OP ✔ Pegasys RBV Combination Pack 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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Changes to Restrictions - effective 1 June 2011 (continued)

continued... ➽ SA1134 0952 Special Authority for Subsidy Initial application - (chronic hepatitis C - genotype 1, 4, 5 or 6 infection or co-infection with HIV) from any specialist. Approvals valid for 48 weeks 18 months for applications meeting the following criteria: Both: 1 Either: 1.1 Patient has chronic hepatitis C, genotype 1, 4, 5 or 6 infection; or 1.2 Patient has chronic hepatitis C and is co-infected with HIV; and 2 maximum of 48 weeks therapy Note • Consider stopping treatment if there is absence of a virological response (defined as at least a 2-log reduction in viral load) following 12 weeks of treatment since this is predictive of treatment failure. • Consider reducing treatment to 24 weeks if serum HCV RNA level at Week 4 is undetectable by sensitive PCR assay (less than 50IU/ml) AND Baseline serum HCV RNA is less than 400,000IU/ml Initial application - (chronic hepatitis C - genotype 2 or 3 infection without co-infection with HIV) from any specialist. Approvals valid for 6 12 months for applications meeting the following criteria: Both: 1 where pPatient has chronic hepatitis C, genotype 2 or 3 infection; and 2 maximum of 6 months therapy Initial application - (Hepatitis B) only from a gastroenterologist, infectious disease specialist or general physician. Approvals valid for 48 weeks 18 months for applications meeting the following criteria: All of the following: 1 Patient has confirmed Hepatitis B infection (HBsAg positive for more than 6 months); and 2 Patient is Hepatitis B treatment-naïve; and 3 ALT > 2 times Upper Limit of Normal; and 4 HBV DNA < 10 log10 IU/ml; and 5 Either: 5.1 HBeAg positive; or 5.2 serum HBV DNA = 2,000 units/ml and significant fibrosis (= Metavir Stage F2); and 6 Compensated liver disease; and 7 No continuing alcohol abuse or intravenous drug use; and 8 Not co-infected with HCV, HIV or HDV; and 9 Neither ALT nor AST > 10 times upper limit of normal; and 10 No history of hypersensitivity or contraindications to pegylated interferon; and 11 maximum of 48 weeks therapy Notes: • Approved dose is 180 μg once weekly. • The recommended dose of Pegylated Interferon-alpha 2a is 180 μg once weekly. • In patients with renal insufficiency (calculated creatinine clearance less than 50ml/min), Pegylated Interferonalpha 2a dose should be reduced to 135 mcg once weekly. • In patients with neutropaenia and thrombocytopaenia, dose should be reduced in accordance with the datasheet guidelines. • Pegylated Interferon-alpha 2a is not approved for use in children. 123 SUMATRIPTAN Inj 12 mg per ml, 0.5 ml – Retail pharmacy-Specialist .............. 36.00 (80.00) Maximum of 10 inj per prescription 2 OP ✔ Arrow-Sumatriptan Imigran

▲

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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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 June 2011 (continued)

144 BORTEZOMIB – PCT only – Specialist – Special Authority see SA1127 Inj 1 mg ................................................................................ 540.70 Inj 3.5 mg ......................................................................... 1,892.50 Inj 1 mg for ECP ................................................................... 594.77 1 1 1 mg ✔ Velcade ✔ Velcade ✔ Baxter

➽ SA1127 Special Authority for Subsidy Initial application — (Treatment naive 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-naive symptomatic multiple myeloma; or 1.2 The patient has treatment-naive symptomatic systemic AL amyloidosis✱; and 2 Maximum of 9 treatment cycles. Indications marked with ✱ are Unapproved Indications. 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 further treatment cycles. Indications marked with ✱ are Unapproved Indications. 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). Notes: 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.

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.

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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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 May 2011 (continued)

95 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

continued...

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

S29

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 May 2011 (continued)

continued... 1 Any of the following: 1.1 Is being fed via a tube or a tube is to be inserted for the purpose of feeding (not nasogastric tube - refer to specific medical condition criteria); 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.

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011

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

189

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

190 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

▲

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 July 2011

27 28 28 29 29 30 34 36 37 MESALAZINE ( subsidy) Suppos 500 mg ...................................................................... 22.80 HYOSCINE N-BUTYLBROMIDE ( subsidy) ❋ Tab 10 mg ............................................................................... 1.48 RANITIDINE HYDROCHLORIDE – Only on a prescription ( subsidy) ❋ Tab 150 mg ............................................................................. 6.79 ❋ Tab 300 mg ............................................................................. 9.34 ❋ Oral liq 150 mg per 10 ml ......................................................... 5.92 OMEPRAZOLE ( subsidy) ❋ Inj 40 mg ............................................................................... 28.65 PANTOPRAZOLE ( subsidy) ❋ Inj 40 mg ................................................................................. 6.50 GLICLAZIDE ( subsidy) ❋ Tab 80 mg ............................................................................. 17.60 DOCUSATE SODIUM – Only on a prescription ( subsidy) ❋ Cap 50 mg ............................................................................... 2.57 ❋ Cap 120 mg ............................................................................. 3.48 TRIAMCINOLONE ACETONIDE ( subsidy) 0.1% in Dental Paste USP ......................................................... 4.34 PYRIDOXINE HYDROCHLORIDE ( subsidy) a) No more than 100 mg per dose b) Only on a prescription ❋ Tab 50 mg ............................................................................. 12.16 DEXTROSE ( subsidy) ❋ Inj 50%, 10 ml – Up to 5 inj available on a PSO ........................ 19.50 COMPOUND ELECTROLYTES ( subsidy) Powder for soln for oral use 5 g – Up to 10 sach available on a PSO .................................................................................... 2.24 NICOTINIC ACID ( subsidy) ❋ Tab 50 mg ............................................................................... 4.17 ❋ Tab 500 mg ........................................................................... 16.54 SIMVASTATIN – See prescribing guideline ( subsidy) ❋ Tab 10 mg ............................................................................... 1.40 ❋ Tab 20 mg ............................................................................... 1.95 ❋ Tab 40 mg ............................................................................... 3.18 ❋ Tab 80 mg ............................................................................... 9.31 20 20 250 250 300 ml 5 ✔ Asacol ✔ Gastrosoothe ✔ Arrow-Ranitidine ✔ Arrow-Ranitidine ✔ Peptisoothe ✔ Dr Reddy’s Omeprazole ✔ Pantocid IV ✔ Apo-Gliclazide ✔ Laxofast 50 ✔ Laxofast 120 ✔ Oracort

1 500 100 100 5 g OP

43 44

500 5

✔ Apo-Pyridoxine ✔ Biomed

10 100 100 90 90 90 90

✔ Enerlyte ✔ Apo-Nicotinic Acid ✔ Apo-Nicotinic Acid ✔ Arrow-Simva 10mg ✔ Arrow-Simva 20mg ✔ Arrow-Simva 40mg ✔ Arrow-Simva 80mg

44 45

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 July 2011 (continued)

52 53 54 60 NIFEDIPINE ( subsidy) ❋ Tab long-acting 30 mg ............................................................. 8.56 ❋ Tab long-acting 60 mg ........................................................... 12.28 BENDROFLUAZIDE ( subsidy) ❋ Tab 2.5 mg – Up to 150 tab available on a PSO ......................... 6.48 May be supplied on a PSO for reasons other than emergency. ❋ Tab 5 mg ................................................................................. 9.95 GLYCERYL TRINITRATE ( subsidy) ❋ TDDS 10 mg .......................................................................... 19.50 30 30 500 500 30 ✔ Arrow-Nifedipine XR ✔ Arrow-Nifedipine XR ✔ Arrow-Bendrofluazide ✔ Arrow-Bendrofluazide ✔ Nitroderm TTS

61 61 62 64

CHLORHEXIDINE GLUCONATE – Subsidy by endorsement ( subsidy) a) No more than 500 ml per month b) Only if prescribed for a dialysis patient and the prescription is endorsed accordingly. ❋ Soln 4% ................................................................................... 5.90 500 ml ✔ Orion AQUEOUS CREAM ( subsidy) ❋ Crm .......................................................................................... 1.96 EMULSIFYING OINTMENT ( subsidy) ❋ Oint BP ..................................................................................... 3.04 PERMETHRIN ( subsidy) Lotn 5% ................................................................................... 3.24 KETOCONAZOLE ( subsidy) Shampoo 2% ............................................................................ 3.08 a) Maximum of 100 ml per prescription b) Only on a prescription CYPROTERONE ACETATE WITH ETHINYLOESTRADIOL ( subsidy) ❋ Tab 2 mg with ethinyloestradiol 35 µg and 7 inert tabs ............... 3.89 TETRACOSACTRIN ( subsidy) ❋ Inj 1 mg per ml, 1 ml .............................................................. 29.56 DESMOPRESSIN ( subsidy) ▲ Nasal spray 10 µg per dose – Retail pharmacy-Specialist ........ 27.48 AMOXYCILLIN CLAVULANATE ( subsidy) Tab amoxycillin 500 mg with potassium clavulanate 125 mg – Up to 30 tab available on a PSO ....................................... 26.00 DOXYCYCLINE HYDROCHLORIDE ( subsidy) ❋ Tab 100 mg – Up to 30 tab available on a PSO .......................... 7.95 500 g 500 g 30 ml OP ✔ AFT ✔ AFT ✔ A-Scabies

100 ml OP ✔ Sebizole

69 73 77 81

84 1 6 ml OP

✔ Ginet 84 ✔ Synacthen Depot ✔ Desmopressin-PH&T

100 250

✔ Synermox ✔ Doxine

82 83

TOBRAMYCIN ( subsidy) Inj 40 mg per ml, 2 ml – Subsidy by endorsement .................. 29.32 5 ✔ DBL Tobramycin Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly.

▲

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 July 2011 (continued)

83 VANCOMYCIN HYDROCHLORIDE – Subsidy by endorsement ( subsidy) Only if prescribed for a dialysis or cystic fibrosis patient or in the treatment of pseudomembranous colitis or for prophylaxis of endocarditis and the prescription is endorsed accordingly. Inj 500 mg ............................................................................... 3.58 1 ✔ Mylan NORFLOXACIN ( subsidy) Tab 400 mg – Maximum of 6 tab per prescription; can be waived by endorsement - Retail pharmacy – Specialist......... 15.45 KETOPROFEN ( subsidy) ❋ Cap long-acting 100 mg ......................................................... 21.56 ❋ Cap long-acting 200 mg ......................................................... 43.12 NEOSTIGMINE ( subsidy) Inj 2.5 mg per ml, 1 ml ......................................................... 140.00 PYRIDOSTIGMINE BROMIDE ( subsidy) ▲ Tab 60 mg ............................................................................. 38.90 TIAPROFENIC ACID ( subsidy) ❋ Tab 300 mg ........................................................................... 19.26 AMANTADINE HYDROCHLORIDE ( subsidy) ▲ Cap 100 mg ........................................................................... 38.24 TOLCAPONE ( subsidy) ▲ Tab 100 mg ......................................................................... 126.20 PARACETAMOL ( subsidy) ❋‡ Oral liq 250 mg per 5 ml ......................................................... 6.70 a) Up to 100 ml available on a PSO b) Not in combination 114 115 TRAMADOL HYDROCHLORIDE ( subsidy) Cap 50 mg ............................................................................... 4.95 FENTANYL CITRATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable Inj 50 µg per ml, 2 ml ............................................................... 3.22 (6.10) Inj 50 µg per ml, 10 ml ............................................................. 8.41 (15.65) CITALOPRAM HYDROBROMIDE ( subsidy) ❋ Tab 20 mg ............................................................................... 2.34 ZOPICLONE ( subsidy) Tab 7.5 mg ............................................................................ 11.90 100 ✔ Arrow-Tramadol

100 100 100 50 100 60 60 100 1,000 ml

✔ Arrow-Norfloxacin ✔ Oruvail SR ✔ Oruvail SR ✔ AstraZeneca ✔ Mestinon ✔ Surgam ✔ Symmetrel ✔ Tasmar ✔ Paracare Double Strength

96 96 96 97 112 112 114

5 Hospira 5 Hospira 84 500 ✔ Arrow-Citalopram ✔ Apo-Zopiclone

118 133

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 July 2011 (continued)

144 DOCETAXEL – PCT only – Specialist ( subsidy) Inj 20 mg ............................................................................... 48.75 Inj 80 mg ............................................................................. 195.00 Inj 1 mg for ECP ....................................................................... 2.63 ANASTROZOLE ( subsidy) Tab 1 mg ............................................................................... 26.55 CETIRIZINE HYDROCHLORIDE ( subsidy) ❋ Tab 10 mg ............................................................................... 1.59 1 1 1 mg 30 100 ✔ Docetaxel Ebewe ✔ Docetaxel Ebewe ✔ Baxter ✔ DP-Anastrozole ✔ Zetop

152 157 159

EFORMOTEROL FUMARATE – See prescribing guideline ( subsidy) Additional subsidy by endorsement for Oxis Turbuhaler is available for patients where the initial dispensing was before 1 July 2011. Pharmacists may annotate prescriptions for patients who were being prescribed Oxis Turbuhaler prior to 1 July 2011 in which case the prescription is deemed to be endorsed. The pharmacist must be able to show clear documented dispensing history for the patient. The prescription must be endorsed accordingly. Powder for inhalation, 6 µg per dose, breath activated – Higher subsidy of $16.90 per 60 dose with Endorsement ....................................................................... 14.60 60 dose OP (16.90) Oxis Turbuhaler BUDESONIDE WITH EFORMOTEROL – Special Authority see SA0958– Retail pharmacy ( subsidy) Additional subsidy by endorsement for budesonide with eformoterol powder for inhalation (Symbicort Turbuhalar) is available for patients where the initial dispensing was before 1 July 2011. Pharmacists may annotate prescriptions for patients who were being prescribed budesonide with eformoterol powder for inhalation (Symbicort Turbuhalar) prior to 1 July 2011 in which case the prescription is deemed to be endorsed. The pharmacist must be able to show clear documented dispensing history for the patient. The prescription must be endorsed accordingly. Aerosol inhaler 100 µg with eformoterol fumarate 6 µg ........... 33.96 120 dose OP ✔ Vannair Powder for inhalation 100 µg with eformoterol fumarate 6 µg – Higher subsidy of $55.00 per 120 dose with Endorsement ........................................... 41.25 120 dose OP (55.00) Aerosol inhaler 200 µg with eformoterol fumarate 6 µg ........... 40.06

159

Symbicort Turbuhaler 100/6

120 dose OP ✔ Vannair

Powder for inhalation 200 µg with eformoterol fumarate 6 µg – Higher subsidy of $60.00 per 120 dose with Endorsement ........................................... 45.00 120 dose OP (60.00) Powder for inhalation 400 µg with eformoterol fumarate 12 µg – No more than 2 dose per day – Higher subsidy of $60.00 per 120 dose with Endorsement ................................................................ 45.00 60 dose OP (60.00)

Symbicort Turbuhaler 200/6

Symbicort Turbuhaler 400/12

▲

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 June 2011

38 123 SODIUM FLUORIDE ( subsidy) Tab 1.1 mg (0.5 mg elemental).................................................. 5.00 SUMATRIPTAN ( subsidy) Inj 12 mg per ml, 0.5 ml .......................................................... 36.00 (80.00) Maximum of 10 inj per prescription 100 2 OP Imigran ✔ PSM

136 152 162

NALTREXONE HYDROCHLORIDE – Special Authority SA0909 – Retail pharmacy ( subsidy) Tab 50 mg ........................................................................... 123.00 30 ✔ ReVia TAMOXIFEN CITRATE ( subsidy) ❋ Tab 20 mg ............................................................................... 5.25 (6.66) IPRATROPIUM BROMIDE ( subsidy) Aqueous nasal spray, 0.03% .................................................... 8.06 (12.66) 60 Tamoxifen Sandoz 30 ml OP Apo-Ipravent

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

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 (continued)

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 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

▲

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 Brand Name

Effective 1 July 2011

83 ✔ DBL Tobramycin Mayne Only if prescribed for dialysis or cystic fibrosis patient and the prescription is endorsed accordingly. 83 VANCOMYCIN HYDROCHLORIDE – Subsidy by endorsement Only if prescribed for a dialysis or cystic fibrosis patient or in the treatment of pseudomembranous colitis or for prophylaxis of endocarditis and the prescription is endorsed accordingly. Inj 500 mg ............................................................................... 5.04 1 ✔ Mylan Pacific TOBRAMYCIN Inj 40 mg per ml, 2 ml – Subsidy by endorsement .................. 29.32 5

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 E Part I

Effective 1 July 2011

197 LIGNOCAINE HYDROCHLORIDE ✔ Inj 0.5%, 5 ml 5 197 NICOTINE ✔ Patch 7 mg ✔ Patch 14 mg ✔ Patch 21 mg ✔ Lozenge 1 mg ✔ Lozenge 2 mg ✔ Gum 2 mg (Classic) ✔ Gum 2 mg (Fruit) ✔ Gum 2 mg (Mint) ✔ Gum 4 mg (Classic) ✔ Gum 4 mg (Fruit) ✔ Gum 4 mg (Mint) 28 28 28 216 216 384 384 384 384 384 384

Changes to Section F Part II

Effective 1 May 2011

201 NERVOUS SYSTEM Lacosamide

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 Sole Subsidised Supply

Effective 1 July 2011

For the list of new Sole Subsidised Supply products effective 1 July 2011 refer to the bold entries in the cumulative Sole Subsidised Supply table pages 11-17.

▲

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 July 2011

62 110 POVIDONE IODINE Antiseptic soln 10% ................................................................ 51.06 HYALURONIDASE Inj 1,500 iu per ml .................................................................. 18.32 (254.92) LIGNOCAINE HYDROCHLORIDE Inj 0.5%, 5 ml – Up to 5 inj available on a PSO ......................... 44.10 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Cap long-acting 200 mg ......................................................... 17.00 4,500 ml 10 Hyalase 50 ✔ Xylocaine ✔ Betadine

113 116

✔ m-Eslon

137

NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. Patch 7 mg – Up to 28 patches available on a PSO .................. 10.53 7 Patch 14 mg – Up to 28 patches available on a PSO ................ 11.63 7 Patch 21 mg – Up to 28 patches available on a PSO ................ 12.32 7 Lozenge 1 mg – Up to 216 lozenges available on a PSO........... 11.08 36 Lozenge 2 mg – Up to 216 lozenges available on a PSO........... 11.08 36 PHARMACY SERVICES – May only be claimed once per patient. ❋ Brand switch fee ....................................................................... 0.01 The Pharmacode for BSF m-Captopril is 2378647 1 fee

✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ BSF m-Captopril

168

Effective 1 June 2011

34 37 51 75 LACTULOSE – Only on a prescription ❋ Oral liq 10 g per 15 ml ............................................................... 6.65 1,000 ml ✔ Duphalac ✔ Micelle E ✔ Hybloc

ALPHA TOCOPHERYL ACETATE – Special Authority see SA0915 – Retail pharmacy Water solubilised soln 156 iu/ml, with calibrated Dropper ......... 18.30 50 ml OP LABETALOL ❋ Tab 400 mg ........................................................................... 34.44 DYDROGESTERONE Tab 10 mg ............................................................................. 15.40 (16.75) BORTEZOMIB – PCT only – Specialist – Special Authority see SA1127 Inj 1 mg for ECP ................................................................. 1,892.50 PHARMACY SERVICES – May only be claimed once per patient ❋ Brand switch fee........................................................................ 0.01 The Pharmacode for BSF Zapril is 2378639 100 28

Duphaston 3.5 mg OP ✔ Baxter 1 fee ✔ BSF Zapril

144 168

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted items – effective 1 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

▲

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 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 September 2011

123 SUMATRIPTAN Inj 12 mg per ml, 0.5 ml ......................................................... 36.00 (80.00) Maximum of 10 inj per prescription 2 OP Imigran

136 152 162

NALTREXONE HYDROCHLORIDE – Special Authority SA0909 – Retail pharmacy Tab 50 mg ........................................................................... 123.00 30 TAMOXIFEN CITRATE ❋ Tab 20 mg ............................................................................... 5.25 (6.66) IPRATROPIUM BROMIDE Aqueous nasal spray, 0.03% .................................................... 8.06 (12.66) 60

✔ ReVia

Tamoxifen Sandoz 30 ml OP Apo-Ipravent

Effective 1 November 2011

44 COMPOUND ELECTROLYTES Powder for soln for oral use 5 g – Up to 10 sach available on a PSO .................................................................................... 2.24 FENTANYL CITRATE a) Only on a controlled drug form b) No patient co-payment payable Inj 50 µg per ml, 2 ml ............................................................... 3.22 (6.10) Inj 50 µg per ml, 10 ml ............................................................. 8.41 (15.65)

✔ Enerlyte

115

5 Hospira 5 Hospira

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

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 November 2011 (continued)

33 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. 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

114

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

Effective 1 December 2011

33 PANCREATIC ENZYME Tab EC 5,600 BP u lipase, 5,000 BP u amylase, 330 BP u protease .............................................................. 58.44 Cap 8,000 BP u lipase, 9,000 BP u amylase, 430 BP u protease .............................................................. 67.26 Three months supply may be dispensed at one time if endorsed “certified exemption” by the prescriber.

300 300

✔ Pancrex V Forte ✔ Pancrex V

▲

❋ 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 December 2011 (continued)

47 51 97 194 CILAZAPRIL ❋ Tab 2.5 mg .............................................................................. 2.06 ❋ Tab 5 mg ................................................................................. 3.28 Note – Zapril tab 2.5 mg and 5 mg, 90 tab packs remain listed. METOPROLOL TARTRATE ❋ Tab 100 mg ........................................................................... 10.90 Note – Lopresor tab 100 mg 60 tab pack remains listed. 30 30 ✔ Zapril ✔ Zapril

✔ Lopresor

SULINDAC – Additional subsidy by Special Authority see SA1038 – Retail pharmacy ❋ Tab 200 mg ............................................................................. 3.36 50 (15.87)

Clinoril

EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1112 – Hospital pharmacy [HP3] Powder .................................................................................. 19.01 450 g OP ✔ Pepti Junior Note – Pepti Junior Gold powder 450 g OP remains listed.

Effective 1 January 2012

74 OESTRADIOL – See prescribing guideline ❋ TDDS 25 µg per day ................................................................. 3.01 8 (10.86) Estraderm TTS 25 a) Higher subsidy of $10.86 per 8 patch with Special Authority see SA1018 b) No more than 2 patch per week c) Only on a prescription ❋ TDDS 50 µg per day ................................................................. 4.12 8 (13.18) Estraderm TTS 50 a) Higher subsidy of $13.18 per 8 patch with Special Authority see SA1018 on the preceding page b) No more than 2 patch per week c) Only on a prescription ❋ TDDS 100 µg per day ............................................................... 7.05 8 (16.14) Estraderm TTS 100 a) Higher subsidy of $16.14 per 8 patch with Special Authority see SA1018 on the preceding page b) No more than 2 patch per week c) Only on a prescription CLINDAMYCIN Inj phosphate 150 mg per ml, 4 ml – Retail pharmacySpecialist ............................................................................ 16.00 1 ✔ Dalacin C Note – Dalacin C inj phosphate 150 mg per ml, 4 ml, 10 injection pack listed 1 July 2011. DARUNAVIR – Special Authority see SA1025 – Retail pharmacy Tab 300 mg ...................................................................... 1,190.00 120 ✔ Prezista

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 July 2011

17 17 AMANTADINE HYDROCHLORIDE ( price and continuation of HSS) Cap 100 mg – 1% DV Sep-11 to 2014 ................................... 38.24 AMOXYCILLIN CLAVULANATE (expiry of HSS and  price) Tab amoxycillin 500 mg with potassium clavulanate 125 mg – 1% DV May-09 to 2011 .................................................... 26.00 ANASTROZOLE ( price) Tab 1 mg ................................................................................ 26.55 AQUEOUS CREAM ( price and continuation of HSS) Crm 100 g – 1% DV Sep-11 to 2014 ........................................ 1.23 Note: DV Limit applies to pack sizes of 100 g or less. Crm 500 g – 1% DV Sep-11 to 2014......................................... 1.96 Note: DV Limit applies to pack sizes of greater than 100 g. AZTREONAM (new listing) Inj 1 g – 1% DV Sep-11 to 2014 ........................................... 131.00 BENDROFLUAZIDE ( price and continuation of HSS) Tab 2.5 mg – 1% DV Sep-11 to 2014 ....................................... 6.48 Tab 5 mg – 1% DV Sep-11 to 2014 .......................................... 9.95 CALCITONIN (continuation of HSS) Inj 100 u per ml, 1 ml – 1% DV Sep-11 to 2014 .................... 110.00 CETIRIZINE HYDROCHLORIDE ( price and continuation of HSS) Tab 10 mg – 1% DV Sep-11 to 2014 ........................................ 1.59 CITALOPRAM HYDROBROMIDE ( price and continuation of HSS) Tab 20 mg – 1% DV Sep-11 to 2014 ........................................ 2.34 CLINDAMYCIN (new pack size) Inj phosphate 150 mg per ml, 4 ml – 1% DV Jul-10 to 2013 ................................................... 160.00 Note – Dalacin C inj, 1 injection pack, to be delisted 1 September 2011. DABIGATRAN (new listing) Cap 75 mg ............................................................................ 148.00 Cap 110 mg .......................................................................... 148.00 Cap 150 mg .......................................................................... 148.00 DARUNAVIR Tab 300 mg ...................................................................... 1,190.00 Note – Prezista tab 300 mg to be delisted 1 September 2011. DESMOPRESSIN ( price and continuation of HSS) Nasal spray 10 µg per dose – 1% DV Sep-11 to 2014 ............ 27.48 60 Symmetrel

100 30 100 g 500 g

Synermox DP-Anastrozole AFT AFT

17 18

19 19

5 500 500 5 100 84

Azactam Arrow-Bendrofluazide Arrow-Bendrofluazide Miacalcic Zetop Arrow-Citalopram

21 23 24 24

Dalacin C

60 60 60 120

Pradaxa Pradaxa Pradaxa Prezista

6 ml

Desmopressin-PH&T

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 July 2011 (continued)

27 27 27 27 28 DEXAMETHASONE (new listing) Eye oint 0.1% – 1% DV Sep-11 to 2014 .................................... 5.86 DEXTROSE ( price and continuation of HSS) Inj 50%, 10 ml – 1% DV Sep-11 to 2014 ................................. 19.50 DEXTROSE (new listing) Inj 50%, 50 ml – 1% DV Sep-11 to 2014 ................................. 10.85 DEXTROSE (addition of HSS) Inj 50%, 90 ml – 1% DV Sep-11 to 2014 ................................. 11.25 DICLOFENAC SODIUM (continuation of HSS) Eye drops 1 mg per ml – 1% DV Sep-11 to 2014 ................... 13.80 Inj 25 mg per ml, 3 ml – 1% DV Sep-11 to 2014 ..................... 12.00 Suppos 12.5 mg – 1% DV Sep-11 to 2014 ............................... 1.85 Suppos 25 mg – 1% DV Sep-11 to 2014 .................................. 2.22 Suppos 50 mg – 1% DV Sep-11 to 2014 .................................. 3.84 Suppos 100 mg – 1% DV Sep-11 to 2014 ................................ 6.36 DOCETAXEL ( price and continuation of HSS) Inj 20 mg – 1% DV Sep-11 to 2014 ........................................ 48.75 Inj 80 mg – 1% DV Sep-11 to 2014 ...................................... 195.00 DOCUSATE SODIUM ( price and continuation of HSS) Cap 50 mg – 1% DV Sep-11 to 2014 ........................................ 2.57 Cap 120 mg – 1% DV Sep-11 to 2014 ...................................... 3.48 DOXYCYCLINE HYDROCHLORIDE ( price and addition of HSS) Tab 100 mg – 1% DV Sep-11 to 2014 ...................................... 7.95 EMULSIFYING OINTMENT ( price and continuation of HSS) Oint BP 500 g – 1% DV Sep-11 to 2014 .................................... 3.04 Note: DV Limit applies to pack sizes of greater than 100 g ETOPOSIDE PHOSPHATE (new listing) Inj 100 mg (of etoposide base) – 1% DV Sep-11 to 2014 ........ 40.00 FLUDARABINE PHOSPHATE (new listing) Inj 50 mg – 1% DV Sep-11 to 2014 ..................................... 525.00 Note – Fludara inj 50 mg to be delisted 1 September 2011. GLICLAZIDE ( price and continuation of HSS) Tab 80 mg – 1% DV Sep-11 to 2014 ..................................... 17.60 GLYCERYL TRINITRATE (continuation of HSS) Tab 600 µg – 1% DV Sep-11 to 2014 ....................................... 8.00 TDDS 5 mg – 1% DV Sep-11 to 2014 ..................................... 16.56 TDDS 10 mg – 1% DV Sep-11 to 2014 ( price) ..................... 19.50 3.5 g 5 1 1 5 ml 5 10 10 10 10 1 1 100 100 250 500 g Maxidex Biomed Biomed Biomed Voltaren Ophtha Voltaren Voltaren Voltaren Voltaren Voltaren Docetaxel Ebewe Docetaxel Ebewe Laxofast 50 Laxofast 120 Doxine AFT

29 29

30 31

1 5

Etopophos Fludarabine Ebewe

33 34

500 100 30 30

Apo-Gliclazide Lycinate Nitroderm TTS 5 Nitroderm TTS 10

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 July 2011 (continued)

36 38 38 HYOSCINE N-BUTYLBROMIDE ( price and continuation of HSS) Tab 10 mg – 1% DV Sep-11 to 2014 ....................................... 1.48 KETOCONAZOLE ( price and continuation of HSS) Shampoo 2% – 1% DV Sep-11 to 2014 .................................... 3.08 KETOPROFEN (new listing) Cap long-acting 100 mg .......................................................... 21.56 Cap long-acting 200 mg .......................................................... 43.12 LIGNOCAINE HYDROCHLORIDE (new listing) Viscous soln 2%– 1% DV Sep-11 to 2014 ............................... 55.00 LOMUSTINE (new listing) Cap 10 mg – 1% DV Sep-11 to 2014 .................................... 132.59 Cap 40 mg – 1% DV Sep-11 to 2014 .................................... 399.15 MEBEVERINE HYDROCHLORIDE (continuation of HSS) Tab 135 mg – 1% DV Sep-11 to 2014 ................................... 18.00 MESALAZINE ( price and addition of HSS) Suppos 500 mg – 1% DV Sep-11 to 2014............................... 22.80 METOCLOPRAMIDE HYDROCHLORIDE (continuation of HSS) Inj 5 mg per ml, 2 ml – 1% DV Sep-11 to 2014 ......................... 4.50 MYCOPHENOLATE MOFETIL (new listing) Tab 500 mg ........................................................................... 60.00 Cap 250 mg ........................................................................... 30.00 NAPHAZOLINE HYDROCHLORIDE (new listing) Eye drops 0.1% – 1% DV Sep-11 to 2014 ................................. 4.15 NEOSTIGMINE METHYLSULPHATE ( price and addition of HSS) Inj 2.5 mg per ml, 1 ml – 1% DV Sep-11 to 2014 .................. 140.00 20 100 ml 100 100 200 ml 20 20 90 20 10 50 50 15 ml 50 Gastrosoothe Sebizole Oruvail SR Oruvail SR Xylocaine Viscous Ceenu Ceenu Colofac Asacol Pfizer Ceptolate Ceptolate Naphcon Forte AstraZeneca

40 40

41 42 43 45

45 45 46

NICOTINE (new listing) Gum 2 mg (classic) – 5% DV Oct-11 to 2014 ......................... 36.47 384 Habitrol Gum 2 mg (fruit) – 5% DV Oct-11 to 2014 .............................. 36.47 384 Habitrol Gum 2 mg (mint) – 5% DV Oct-11 to 2014 ............................. 36.47 384 Habitrol Gum 4 mg (classic) – 5% DV Oct-11 to 2014 ......................... 42.04 384 Habitrol Gum 4 mg (fruit) – 5% DV Oct-11 to 2014 .............................. 42.04 384 Habitrol Gum 4 mg (mint) – 5% DV Oct-11 to 2014 ............................. 42.04 384 Habitrol Note – Habitrol gum (classic, fruit and mint) 2 mg and 4 mg, 96 piece packs, to be delisted 1 October 2011. NIFEDIPINE ( price) Tab long-acting 30 mg ............................................................. 8.56 Tab long-acting 60 mg ........................................................... 12.28 NORFLOXACIN ( price and addition of HSS) Tab 400 mg – 1% DV Sep-11 to 2014 .................................... 15.45 30 30 100 Arrow-Nifedipine XR Arrow-Nifedipine XR Arrow-Norfloxacin

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 July 2011 (continued)

46 47 NYSTATIN (continuation of HSS) Oral liq 100,000 u per ml – 1% DV Sep-11 to 2014 ................... 3.19 OLANZAPINE PAMOATE MONOHYDRATE (new listing) Inj 210 mg ........................................................................... 280.00 Inj 300 mg ........................................................................... 460.00 Inj 405 mg ........................................................................... 560.00 OMEPRAZOLE (new listing) Powder – 1% DV Sep-11 to 2014 .......................................... 42.50 OMEPRAZOLE ( price and continuation of HSS) Inf 40 mg – 1% DV Sep-11 to 2014 ........................................ 19.00 Inj 40 mg – 1% DV Sep-11 to 2014 ....................................... 28.65 48 48 PANTOPRAZOLE ( price, amended brand name and addition of HSS) Inj 40 mg – 1% DV Sep-11 to 2014 .......................................... 6.50 PARACETAMOL ( price and continuation of HSS) Oral liq 250 mg per 5 ml – 20% DV Sep-11 to 2014 ................. 6.70 PARACETAMOL WITH CODEINE (new listing) Tab paracetamol 500 mg with codeine phosphate 8 mg – 1% DV Nov-11 to 2014 ............................ 2.70 PERGOLIDE (continuation of HSS) Tab 0.25 mg – 1% DV Sep-11 to 2014 .................................. 48.00 Tab 1 mg – 1% DV Sep-11 to 2014 ..................................... 170.00 PERMETHRIN (new listing) Crm 5% – 1% DV Sep-11 to 2014 ............................................ 4.20 PERMETHRIN ( price and continuation of HSS) Lotn 5% – 1% DV Sep-11 to 2014 ........................................... 3.24 POLOXAMER (continuation of HSS) Oral drops 10% – 1% DV Sep-11 to 2014 ................................ 3.78 PROPOFOL (new listing) Inj 1%, 20 ml ............................................................................ 7.60 Inj 1%, 50 ml ............................................................................ 4.00 Inj 1%, 100 ml .......................................................................... 7.60 PYRIDOSTIGMINE BROMIDE (new listing) Tab 60 mg – 1% DV Sep-11 to 2014 ...................................... 38.90 24 ml 1 1 1 5g 5 5 Nilstat Zyprexa Relprevv Zyprexa Relprevv Zyprexa Relprevv Midwest Dr Reddy’s Omeprazole Dr Reddy’s Omeprazole Pantocid IV Paracare Double Strength

47 47

1 1,000 ml

100 100 100 30 g 30 ml 30 ml 5 1 1 100

Relieve Permax Permax Lyderm A-Scabies Coloxyl Fresofol 1% Fresofol 1% Fresofol 1% Mestinon PyridoxADE Apo-Pyridoxine

49 49 49 51

51 51

PYRIDOXINE HYDROCHLORIDE (new listing) Tab 25 mg – 1% DV Sep-11 to 2014 ........................................ 2.20 90 Tab 50 mg – 1% DV Sep-11 to 2014 ...................................... 12.16 500 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 July 2011 (continued)

52 52 RALOXIFENE HYDROCHLORIDE (new listing) Tab 60 mg .............................................................................. 53.76 RANITIDINE HYDROCHLORIDE ( price and addition of HSS) Tab 150 mg – 1% DV Sep-11 to 2014 ...................................... 6.79 Tab 300 mg – 1% DV Sep-11 to 2014 ...................................... 9.34 Oral liq 150 mg per 10 ml – 1% DV Sep-11 to 2014 .................. 5.92 SIMVASTATIN ( price and continuation of HSS) Tab 10 mg – 1% DV Sep-11 to 2014 ....................................... 1.40 Tab 20 mg – 1% DV Sep-11 to 2014 ....................................... 1.95 Tab 40 mg – 1% DV Sep-11 to 2014 ....................................... 3.18 Tab 80 mg – 1% DV Sep-11 to 2014 ....................................... 9.31 SODIUM HYALURONATE (addition of HSS) Inj 10 ml per ml, 0.5 ml; and inj 30 mg per ml with chondroitin sulphte 40 mg per ml, 0.55 ml – 1% DV Sep-11 to 2014 .................................................... 74.00 AMINO ACID FORMULA (amended chemical name) Amino acid based elemental formula, powder (unflavoured) ...... 6.00 Elemental formula 1 kcal/ml, powder (unflavoured) ................. 56.00 Elemental formula 1 kcal/ml, powder (vanilla) ......................... 56.00 57 57 57 CORD ORAL FEED 1.5 KCAL/ML (amended chemical name) Cord oral feed 1.5 kcal/ml, liquid (vanilla) ................................. 1.66 DIABETIC ENTERAL FEED 1KCAL/ML (amended chemical name) Diabetic enteral feed 1 kcal/ml, liquid (vanilla) ........................... 7.50 DIABETIC ORAL FEED 1KCAL/ML (amended chemical name) Oral feed 1 kcal/ml, liquid (vanilla) ............................................ 2.10 1.88 ENTERAL FEED 1KCAL/ML (amended chemical name) Enteral feed 1 kcal/ml, liquid ..................................................... 1.24 2.65 5.29 ENTERAL FEED WITH FIBRE 1KCAL/ML (amended chemical name) Enteral feed with fibre 1 kcal/ml, liquid ...................................... 1.32 2.65 5.29 ENTERAL FEED WITH FIBRE 1.5KCAL/ML (amended chemical name) Enteral feed with fibre 1.5 kcal/ml, liquid ................................... 1.75 7.00 28 250 250 300 ml 90 90 90 90 Evista Arrow-Ranitidine Arrow-Ranitidine Peptisoothe Arrow-Simva Arrow-Simva Arrow-Simva Arrow-Simva

1 48.5 g 400 g 400 g 237 ml 1,000 ml 237 ml 250 ml 250 ml 500 ml 1,000 ml 237 ml 500 ml 1,000 ml 250 ml 1,000 ml 76 g 79 g

Duovisc Vivonex Pediatric Elecare Elecare LCP Elecare Pulmocare Glucerna Select RTH Resource Diabetic Glucerna Select Osmolite Osmolite Osmolite RTH Jevity Jevity RTH Jevity RTH Ensure Plus HN Ensure Plus RTH Alitraq Vital HN

ENTERAL/ORAL ELEMENTAL FEED 1KCAL/ML (amended chemical name) Enteral/oral elemental feed 1 kcal/ml, powder ............................ 7.50 4.40 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 July 2011 (continued)

57 57 57 57 FAT FREE ARGININE SUPPLEMENT (amended chemical name) Fat free arginine supplement, powder (orange) .......................... 2.15 ORAL ELEMENTAL FEED 1KCAL/ML (amended chemical name) Oral elemental feed 1 kcal/ml, powder (unflavoured) ................. 4.50 ORAL ELEMENTAL FEED 1KCAL/ML (amended chemical name) Oral elemental feed 1 kcal/ml liquid (vanilla) .............................. 4.95 ORAL FEED 1.5KCAL/ML (amended chemical name) Oral feed 1.5 kcal/ml, liquid (banana) ........................................ 1.26 Oral feed 1.5 kcal/ml, liquid (chocolate) .................................... 1.26 1.33 Oral feed 1.5 kcal/ml, liquid (coffee latte) .................................. 1.33 Oral feed 1.5 kcal/ml, liquid (fruit of the forest) .......................... 1.26 Oral feed 1.5 kcal/ml, liquid (strawberry) ................................... 1.33 Oral feed 1.5 kcal/ml, liquid (vanilla) ......................................... 1.26 1.33 ORAL FEED 2KCAL/ML (amended chemical name) Oral feed 2 kcal/ml, liquid (vanilla) ............................................ 2.25 PAEDIATRIC ENTERAL FEED 1KCAL/ML (amended chemical name) Paediatric enteral feed 1 kcal/ml, liquid ..................................... 2.68 PAEDIATRIC ORAL FEED 1KCAL/ML (amended chemical name) Paediatric oral feed 1 kcal/ml, liquid (chocolate) ........................ 1.07 Paediatric oral feed 1 kcal/ml, liquid (strawberry) ...................... 1.07 Paediatric oral feed 1 kcal/ml, liquid (vanilla) ............................. 1.07 1.27 PROTEIN SUPPLEMENT (amended chemical name) Protein supplement powder ...................................................... 8.95 RENAL ORAL FEED 2KCAL/ML (amended chemical name) Renal oral feed 2 kcal/ml, liquid (strawberry) ............................. 2.43 Renal oral feed 2 kcal/ml, liquid (vanilla) ................................... 2.43 3.31 9.2 g 80.4 g 237 ml 200 ml 200 ml 237 ml 237 ml 200 ml 237 ml 200 ml 237 ml 237 ml 500 ml 200 ml 200 ml 200 ml 237 ml 227 g 200 ml 200 ml 237 ml Resource Arginaid Vivonex TEN Peptamen OS 1.0 Ensure Plus Ensure Plus Ensure Plus Ensure Plus Ensure Plus Ensure Plus Ensure Plus Ensure Plus Two Cal HN Pediasure RTH Pediasure Pediasure Pediasure Pediasure Resource Beneprotein Nepro Nepro Novasource Renal Ensure Ensure Sustagen Hospital Formula Ensure Ensure Ensure Sustagen Hospital Formula

57 57 57

57 57

STANDARD SUPPLEMENT ORAL FEED 1KCAL/ML (amended chemical name) Oral supplement 1 kcal/ml, powder (chocolate) ......................... 4.22 400 g 9.50 900 g 10.22 Oral supplement 1 kcal/ml, powder (strawberry) ....................... 4.22 Oral supplement 1 kcal/ml, powder (vanilla) .............................. 4.22 9.50 10.22 400 g 400 g 900 g

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

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Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

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

57 STANDARD SUPPLEMENT ORAL FEED 1.4KCAL/ML (amended chemical name) Liquid (chocolate) .................................................................... 4.00 237 ml Liquid (vanilla) .......................................................................... 4.00 59 59 TERIPARATIDE (new listing) Inj 250 µg per ml, 2.4 ml ....................................................... 490.00 TETRACOSACTRIN (continuation of HSS) Inj 1 mg per ml, 1 ml – 1% DV Sep-11 to 2014 ( price) ......... 29.56 Inj 250 µg – 1% DV Sep-11 to 2014 .................................... 177.18 TIAPROFENIC ACID (new listing) Tab 300 mg ............................................................................ 19.26 TOBRAMYCIN (new listing) Eye drops 0.3% – 1% DV Sep-11 to 2014 .............................. 11.48 Eye oint 0.3% – 1% DV Sep-11 to 2014 ................................. 10.45 TOBRAMYCIN ( price, amended brand name and addition of HSS) Inj 40 mg per ml, 2 ml – 1% DV Sep-11 to 2014 ..................... 29.32 TOLCAPONE (new listing) Tab 100 mg – 1% DV Sep-11 to 2014 .................................. 126.20 TRAMADOL HYDROCHLORIDE ( price and continuation of HSS) Cap 50 mg – 1% DV Sep-11 to 2014 ....................................... 4.95 TRIAMCINOLONE ACETONIDE (continuation of HSS) 0.1% in dental paste USP – 1% DV Sep-11 to 2014 ( price) ..... 4.34 Crm 0.02% – 1% DV Sep-11 to 2014 ....................................... 6.63 Oint 0.02% – 1% DV Sep-11 to 2014 ....................................... 6.69 TROPICAMIDE (new listing) Eye drops 0.5% – 1% DV Sep-11 to 2014 ................................. 7.15 Eye drops 1% – 1% DV Sep-11 to 2014 .................................... 8.66 237 ml Impact Advanced Recovery Impact Advanced Recovery Forteo Synacthen Depot Synacthen Surgam Tobrex Tobrex DBL Tobramycin Mayne Tasmar Arrow-Tramadol Oracort Aristocort Aristocort Mydriacyl Mydriacyl

1 1 10 60 5 ml 3.5 g 5

59 59

59 60 60

100 100 5g 100 g 100 g 15 ml 15 ml

60 61

VANCOMYCIN HYDROCHLORIDE ( price, amended brand name and presentation, and addition of HSS) Inj 500 mg 50 mg per ml, 10 ml – 1% DV Sep-11 to 2014 ........ 3.58 1 Mylan Pacific VERAPAMIL HYDROCHLORIDE (addition of HSS) Tab 40 mg – 1% DV Sep-11 to 2014 ........................................ 7.01 Tab 80 mg – 1% DV Sep-11 to 2014 ...................................... 11.74 100 100 Isoptin Isoptin

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 June 2011

20 24 BORTEZOMIB Inj 1 mg ............................................................................... 540.70 CILAZAPRIL Tab 0.5 mg .............................................................................. 2.20 Tab 2.5 mg .............................................................................. 4.10 Tab 5 mg ................................................................................. 6.01 Note – Inhibace delisted 1 June 2011 DOXORUBICIN Inj 50 mg ................................................................................ 40.00 METHOTREXATE Inj 25 mg per ml, 40 ml ........................................................... 25.00 MORPHINE SULPHATE Tab long-acting 10 mg – 1% DV Aug-11 to 2013 ...................... 1.98 Tab long-acting 30 mg – 1% DV Aug-11 to 2013 ...................... 3.15 Tab long-acting 60 mg – 1% DV Aug-11 to 2013 ...................... 7.20 Tab long-acting 100 mg – 1% DV Aug-11 to 2013 .................... 7.85 1 30 28 28 Velcade Inhibace Inhibace Inhibace

29 42 45

1 1 10 10 10 10

DBL Doxorubicin DBL Methotrexate Arrow-Morphine LA Arrow-Morphine LA Arrow-Morphine LA Arrow-Morphine LA

OLANZAPINE Tab 2.5 mg – 5% DV Aug-11 to 2013 ....................................... 2.00 28 Olanzine Tab 5 mg – 5% DV Aug-11 to 2013 .......................................... 3.85 28 Olanzine Tab 10 mg – 5% DV Aug-11 to 2013 ........................................ 6.35 28 Olanzine Orodispersible tab 5 mg – 5% DV Aug-11 to 2013..................... 6.36 28 Olanzine-D Orodispersible tab 10 mg – 5% DV Aug-11 to 2013................... 8.76 28 Olanzine-D Note – Zyprexa tab 2.5 mg, 5 mg and 10 mg and Zyprexa Zydis wafer 5 mg and 10 mg to be delisted 1 August 2011 ORNIDAZOLE Tab 500 mg ............................................................................ 16.50 PACLITAXEL Inj 150 mg ............................................................................ 137.50 Inj 300 mg ........................................................................... 275.00 TRICLOSAN Soln 1% ................................................................................... 4.50 10 1 1 500 ml Arrow-Ornidazole Anzatax Anzatax Pharmacy Health

47 48

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 60 240 ml 4 Ziagen Ziagen Fosamax

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)

16 20 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 4 25 test Fosamax Plus Optium 5 second test

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 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

200 dose

Combivent

500 g

ABM

200 ml 200 ml 200 ml 200 ml

Ensure Plus Ensure Plus Ensure Plus Ensure Plus

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

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Brand or Generic Manufacturer

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

58 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 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 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 Myloc CR Myloc CR Myloc CR Myloc CR Naltraccord

17 21 28

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

30 31 38

43 43

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

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

45 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

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Brand or Generic Manufacturer

Section H changes to Part III

Effective 1 July 2011

67 VANCOMYCIN HYDROCHLORIDE Inj 500 mg 50 mg per ml, 10 ml For any indication approved by the hospital service, with review at 6 weeks.

Effective 1 June 2011

64 CYCLOSPORIN Cap 25 mg ................................Gengraf Neoral Cap 50 mg ................................Gengraf Neoral Cap 100 mg ...............................Gengraf Neoral Oral liq 100 mg per ml ..............Gengraf Neoral For aplastic anaemia

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.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

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Brand or Generic Manufacturer

Section H changes to Part III – effective 1 April 2011

66 SPECIAL FOOD SUPPLEMENT Oral supplement 1kcal/ml, powder, 900 g .......................Sustagen Hospital Formula Oral supplement 1kcal/ml, powder, 400 g ........................Ensure Oral supplement 1kcal/ml, powder, 900 g .......................Ensure Oral feed 1.5kcal/ml liquid, 200 ml ...................................Ensure Plus Oral feed 1.5kcal/ml liquid, 237 ml....................................Ensure Plus Oral feed 1.5kcal/ml liquid, 200 ml ...................................Fortisip Oral feed with fibre 1.5kcal/ml liquid, 200 ml .........................Fortisip Multi Fibre For use in community/non-hospitalised patients for 10 days prior to hospitalisation and 30 days following discharge.

Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

Index

Pharmaceuticals and brands A A-Scabies .................................................... 45, 60 Abacavir sulphate......................................... 48, 64 Aclasta ........................................................ 26, 67 Alendronate sodium ............................... 25, 48, 64 Alendronate sodium with cholecalciferol . 25, 48, 65 Alitraq ................................................................ 61 Allopurinol.......................................................... 21 Alpha tocopheryl acetate .................................... 52 Amantadine hydrochloride ............................ 46, 57 Amino acid formula ...................................... 39, 61 Aminoacid formula without phenylalanine ........... 55 Amitrip ............................................................... 66 Amitriptyline ....................................................... 66 Amoxycillin clavulanate ................................ 45, 57 Amphotericin B .................................................. 66 Anastrozole .................................................. 47, 57 Anzatax ........................................................ 21, 64 Apo-Allopurinol S29 ........................................... 21 Apo-Doxazosin................................................... 66 Apo-Gliclazide .............................................. 44, 58 Apo-Ipravent ................................................ 48, 54 Apo-Nicotinic Acid ............................................. 44 Apo-Pyridoxine ............................................ 44, 60 Apo-Zopiclone.................................................... 46 Aqueous cream ............................................ 45, 57 Aristocort ........................................................... 63 Aromasin ........................................................... 66 Arrow-Azithromycin ........................................... 31 Arrow-Bendrofluazide ................................... 45, 57 Arrow-Citalopram ......................................... 46, 57 Arrow-Morphine LA ...................................... 21, 64 Arrow-Nifedipine XR ..................................... 45, 59 Arrow-Norfloxacin ........................................ 46, 59 Arrow-Ornidazole ......................................... 20, 64 Arrow-Ranitidine .......................................... 44, 61 Arrow-Simva ...................................................... 61 Arrow-Simva 10mg ............................................ 44 Arrow-Simva 20mg ............................................ 44 Arrow-Simva 40mg ............................................ 44 Arrow-Simva 80mg ............................................ 44 Arrow-Sumatriptan ....................................... 33, 67 Arrow-Tramadol ........................................... 46, 63 Asacol ......................................................... 44, 59 Aspen Ceftriaxone .............................................. 65 Azactam ............................................................ 57 Azithromycin ...................................................... 31 Aztreonam ......................................................... 57 B Baclofen ............................................................ 68 Bendrofluazide ............................................. 45, 57 Betadine............................................................. 52 Bleph 10 ............................................................ 55 Blood glucose diagnostic test strip ............... 54, 65 Bortezomib .......................... 21, 23, 34, 52, 64, 65 BSF Apo-Clopidogrel .......................................... 53 BSF m-Captopril ................................................. 52 BSF Zapril .......................................................... 52 Budesonide with eformoterol ........................ 30, 47 Buprenorphine hydrochloride .............................. 55 Busulphan.......................................................... 66 C Calcitonin........................................................... 57 Ceenu ................................................................ 59 Ceftriaxone sodium ............................................ 65 Ceptolate ..................................................... 20, 59 Cetirizine hydrochloride ................................ 47, 57 Champix ............................................................ 29 Chlorhexidine gluconate ..................................... 45 Cilazapril ................................................ 20, 56, 64 Citalopram hydrobromide ............................. 46, 57 Clarithromycin.............................................. 32, 34 Clindamycin ........................................... 18, 56, 57 Clinoril ............................................................... 56 Colestid ............................................................. 48 Colestipol hydrochloride ..................................... 48 Colofac .............................................................. 59 Coloxyl .............................................................. 60 Compound electrolytes........................... 22, 44, 54 Combivent ................................................... 55, 65 Corangin ............................................................ 66 Cord oral feed 1.5 Kcal/ml .................................. 61 Cotazym ECS ..................................................... 53 Cyclosporin........................................................ 68 Cyproterone acetate with ethinyloestradiol .......... 45 D Dabigatran ................................................... 18, 57 Dalacin C ............................................... 18, 56, 57 Dantrium ...................................................... 48, 65 Dantrolene sodium ....................................... 48, 65 Darunavir ..................................................... 56, 57 DBL Doxorubicin .......................................... 21, 64 DBL Methotrexate......................................... 21, 64 DBL Tobramycin .................................... 45, 50, 63 Desmopressin .............................................. 45, 57 Desmopressin-PH&T.................................... 45, 57 Dexamethasone ................................................. 58 Dextrose ...................................................... 44, 58 Diabetic oral feed 1kcal/ml ................................. 61 Diabetic enteral feed 1kcal/ml ............................. 61 Diclofenac sodium ............................................. 58 Digoxin ........................................................ 22, 55 Docetaxel ............................................... 29, 47, 58 Docetaxel Ebewe .................................... 29, 47, 58

Index

Pharmaceuticals and brands Docusate sodium ......................................... 44, 58 Dopamine hydrochloride .................................... 66 Doxazosin mesylate ........................................... 66 Doxine ......................................................... 45, 58 Doxorubicin ................................................. 21, 64 Doxycycline hydrochloride............................ 45, 58 DP-Anastrozole ............................................ 47, 57 Dr Reddy’s Olanzapine ....................................... 21 Dr Reddy’s Omeprazole................................ 44, 60 Dr Reddy’s Ondansetron .............................. 36, 68 Duphalac ........................................................... 52 Duphaston ......................................................... 52 Duovisc ............................................................. 61 Dydrogesterone.................................................. 52 E Elecare ........................................................ 39, 61 Elecare LCP ................................................. 39, 61 Electral .............................................................. 22 Emulsifying ointment .................................... 45, 58 Eformoterol fumarate.................................... 30, 47 Enerlyte ....................................................... 44, 54 Ensure ......................................................... 62, 69 Ensure Plus.......................... 39, 42, 49, 62, 65, 69 Ensure Plus HN .................................................. 61 Ensure Plus RTH ................................................ 61 Enteral feed 1kcal/ml .......................................... 61 Enteral feed with fibre 1.5kcal/ml ........................ 61 Enteral feed with fibre 1kcal/ml ........................... 61 Enteral/oral elemental feed 1kcal/ml.................... 61 Estraderm TTS 100 ............................................ 56 Estraderm TTS 25 .............................................. 56 Estraderm TTS 50 .............................................. 56 Etopophos ......................................................... 58 Etoposide phosphate .......................................... 58 Evista........................................................... 18, 61 Exemestane ....................................................... 66 Extensively hydrolysed formula..................... 40, 56 F Fat free arginine supplement ............................... 62 Fentanyl citrate................................. 22, 46, 54, 65 Florinef .............................................................. 66 Fluarix ................................................................ 35 Fluconazole .................................................. 25, 32 Fludarabine Ebewe ....................................... 20, 58 Fludarabine phosphate ................................. 20, 58 Fludrocortisone acetate ...................................... 66 Fluvax ................................................................ 35 Forteo .......................................................... 19, 63 Fortini ................................................................ 23 Fortini Multi Fibre................................................ 24 Fortisip ........................................................ 42, 69 Fortisip Multi Fibre ........................................ 42, 69 Fosamax ................................................ 25, 48, 64 Fosamax Plus ........................................ 25, 48, 65 Fresofol 1%........................................................ 60 Fungilin .............................................................. 66 G Gastrosoothe ............................................... 44, 59 Gengraf.............................................................. 68 Genox ................................................................ 67 Ginet 84 ............................................................. 45 Gliclazide ..................................................... 44, 58 Glucerna Select .................................................. 61 Glucerna Select RTH .......................................... 61 Glyceryl trinitrate .......................................... 45, 58 H Habitrol ...................................... 20, 28, 52, 59, 67 Hyalase.............................................................. 52 Hyaluronidase .................................................... 52 Hybloc ............................................................... 52 Hyoscine n-butylbromide ............................. 44, 59 I Impact Advanced Recovery ................................ 63 Influenza vaccine................................................ 35 Imigran .................................................. 33, 48, 54 Inhibace ............................................................. 64 Ipecacuanha ...................................................... 55 Ipratropium bromide ..................................... 48, 54 Ismo-20 ............................................................. 66 Isoptin ............................................................... 63 Isosorbide mononitrate....................................... 66 Itraconazole ....................................................... 53 J Jevity ................................................................. 61 Jevity RTH ......................................................... 61 K Kenacomb ......................................................... 67 Ketoconazole ............................................... 45, 59 Ketoprofen ............................................. 46, 50, 59 Klacid ................................................................ 32 Klamycin...................................................... 32, 34 L Labetalol ............................................................ 52 Lacosamide ........................................... 22, 50, 65 Lactulose ........................................................... 52 Lanoxin ........................................................ 22, 55 Laxofast 50 .................................................. 44, 58 Laxofast 120 ................................................ 44, 58 Lignocaine hydrochloride ................. 28, 50, 52, 59 Lioresal Intrathecal ............................................. 68 Lomustine.......................................................... 59 Lophlex LQ......................................................... 55 Lopresor ............................................................ 56 Lycinate ............................................................. 58

Index

Pharmaceuticals and brands Lyderm ........................................................ 18, 60 M m-Eslon ............................................................. 52 Maxidex ............................................................. 58 Mebeverine hydrochloride .................................. 59 Mesalazine ................................................... 44, 59 Mestinon...................................................... 46, 60 Metamide........................................................... 66 Methotrexate ................................................ 21, 64 Metoclopramide hydrochloride ..................... 59, 66 Metoprolol succinate .......................................... 66 Metoprolol tartrate .............................................. 56 Miacalcic ........................................................... 57 Micelle E ............................................................ 52 Modafinil ............................................................ 22 Modavigil ........................................................... 22 Morphine sulphate.................................. 21, 52, 64 Mucilaginous laxatives with stimulants ............... 48 Mycophenolate mofetil ................................. 20, 59 Mydriacyl ........................................................... 63 Myleran ............................................................. 66 Myloc CR ........................................................... 66 N Naltraccord ........................................................ 66 Naltrexone hydrochloride ........................ 48, 54, 66 Naphazoline hydrochloride ................................. 59 Naphcon Forte ................................................... 59 Neocate ............................................................. 39 Neocate Advance ............................................... 39 Neocate LCP ...................................................... 39 Neoral ................................................................ 68 Neostigmine....................................................... 46 Neostigmine methylsulphate ............................... 59 Nepro ................................................................ 62 Nervous system ................................................. 50 Nicotine ............................... 20, 28, 50, 52, 59, 67 Nicotinic acid ..................................................... 44 Nifedipine..................................................... 45, 59 Nilstat ................................................................ 60 Nitroderm TTS.................................................... 45 Nitroderm TTS 10............................................... 58 Nitroderm TTS 5................................................. 58 Norfloxacin .................................................. 46, 59 Normacol Plus ................................................... 48 Novasource Renal .............................................. 62 Nystatin ............................................................. 60 O Octreotide .......................................................... 65 Oestradiol .......................................................... 56 Olanzapine ................................................... 21, 64 Olanzapine pamoate monohydrate ................ 19, 60 Olanzine ....................................................... 21, 64 Olanzine-D ................................................... 21, 64 Omeprazole............................................ 18, 44, 60 Omeprazole suspension ..................................... 31 Ondansetron .............................. 36, 48, 53, 54, 68 Optium 5 second test ................................... 54, 65 Oracort ........................................................ 44, 63 Oral elemental feed 1kcal/ml............................... 62 Oral feed 1.5kcal/ml ......................... 39 ,42, 49, 62 Oral feed 1.5kcal/ml (tetrapak) ........................... 39 Oral feed 2kcal/ml ...................................... , 43, 62 Oral feed with fibre 1.5 Kcal/ml........................... 42 Ornidazole.................................................... 20, 64 Oruvail 100 ........................................................ 50 Oruvail 200 ........................................................ 50 Oruvail SR.............................................. 46, 50, 59 Osmolite ............................................................ 61 Osmolite RTH..................................................... 61 Oxis Turbuhaler ............................................ 30, 47 P Paclitaxel ..................................................... 21, 64 Paediatric enteral feed 1kcal/ml .......................... 62 Paediatric oral feed 1.5kcal/ml............................ 23 Paediatric oral feed 1kcal/ml............................... 62 Paediatric oral feed with fibre 1.5kcal/ml............. 24 Pancreatic enzyme ....................................... 53, 55 Pancrex V .......................................................... 55 Pancrex V Forte .................................................. 55 Pantocid IV .................................................. 44, 60 Pantoprazole ................................................ 44, 60 Paracare Double Strength ............................. 46, 60 Paracetamol................................................. 46, 60 Paracetamol with codeine ............................ 19, 60 Pediasure........................................................... 62 Pediasure RTH ................................................... 62 Pegasys............................................................. 32 Pegasys RBV Combination Pack ........................ 32 Pegylated interferon alpha-2a ............................. 32 Peptamen OS 1.0 ............................................... 62 Pepti Junior.................................................. 40, 56 Pepti Junior Gold................................................ 40 Peptisoothe .................................................. 44, 61 Pergolide ........................................................... 60 Permax .............................................................. 60 Permethrin ............................................. 18, 45, 60 Pharmacy services....................................... 52, 53 Pinetarsol........................................................... 66 Poloxamer ......................................................... 60 Povidone iodine ................................................. 52 Pradaxa ....................................................... 18, 57 Prezista........................................................ 56, 57 Propofol ............................................................. 60 Protein supplement ............................................ 62

Index

Pharmaceuticals and brands Pulmocare ......................................................... 61 Pyridostigmine bromide................................ 46, 60 PyridoxADE .................................................. 18, 60 Pyridoxine hydrochloride ........................ 18, 44, 60 R Raloxifene hydrochloride .............................. 18, 61 Ranitidine hydrochloride ............................... 44, 61 Relieve......................................................... 19, 60 Renal oral feed 2kcal/ml ..................................... 62 Resource Arginaid .............................................. 62 Resource Beneprotein ........................................ 62 Resource Diabetic .............................................. 61 ReVia ........................................................... 48, 54 Ridal .................................................................. 53 Risperidone........................................................ 53 S Salbutamol with ipratropium bromide............ 55, 65 Salicylic acid ................................................ 55, 65 Sandostatin ........................................................ 65 Sebizole ....................................................... 45, 59 Simvastatin .................................................. 44, 61 Sodium fluoride .................................................. 48 Sodium hyaluronate ........................................... 61 Sotacor .............................................................. 67 Sotalol ............................................................... 67 Special food supplement .............................. 65, 69 Sporanox ........................................................... 53 Standard supplement oral feed 1.4kcal/ml .......... 63 Standard supplement oral feed 1kcal/ml ............. 62 Standard supplements........................................ 37 Sulindac............................................................. 56 Sulphacetamide sodium ..................................... 55 Sulphur .............................................................. 55 Sumatriptan ..................................... 33, 48, 54, 67 Surgam ........................................................ 46, 63 Sustagen Hospital Formula ........................... 62, 69 Symbicort Turbuhaler 100/6 ......................... 30, 47 Symbicort Turbuhaler 200/6 ......................... 31, 47 Symbicort Turbuhaler 400/12 ....................... 31, 47 Symmetrel ................................................... 46, 57 Synacthen.......................................................... 63 Synacthen Depot .......................................... 45, 63 Synermox .................................................... 45, 57 T Tamoxifen citrate.................................... 48, 54, 67 Tamoxifen Sandoz........................................ 48, 54 Tar with triethanolamine lauryl sulphate and fluorescein ............................................... 66 Tasmar ........................................................ 46, 63 Taxotere............................................................. 29 Temgesic ........................................................... 55 Teriparatide .................................................. 19, 63 Tetracosactrin .............................................. 45, 63 Thalidomide ..................................... 23, 36, 66, 67 Thalidomide Pharmion........................................ 36 Thalomid.......................................... 23, 36, 66, 67 Tiaprofenic acid ........................................... 46, 63 Tobramycin............................................ 45, 50, 63 Tobrex ............................................................... 63 Tolcapone .................................................... 46, 63 Tramadol hydrochloride................................ 46, 63 Triamcinolone acetonide .............................. 44, 63 Triamcinolone acetonide with gramicidin, neomycin and nystatin .................................... 67 Triclosan...................................................... 20, 64 Tropicamide ....................................................... 63 Two Cal HN.................................................. 43, 62 V Vancomycin hydrochloride ......... 25, 46, 50, 63, 68 Vannair .............................................................. 47 Varenicline tartrate ............................................. 29 Velcade...................................... 21, 23, 34, 64, 65 Verapamil hydrochloride ..................................... 63 Vimpat ......................................................... 22, 65 Vital HN ............................................................. 61 Vivonex Pediatric.......................................... 39, 61 Vivonex TEN....................................................... 62 Voltaren ............................................................. 58 Voltaren Ophtha ................................................. 58 X XP Analog LCP ................................................... 55 Xylocaine ........................................................... 52 Xylocaine Viscous ........................................ 28, 59 Z Zapril ........................................................... 20, 56 Zetop ........................................................... 47, 57 Ziagen.......................................................... 48, 64 Zofran .......................................................... 53, 68 Zofran Zydis ............................... 36, 48, 53, 54, 68 Zoledronic acid ............................................ 26, 67 Zopiclone ........................................................... 46 Zyprexa Relprevv.......................................... 19, 60

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

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Title

Schedule Update - effective 1 July 2011

Abstract

Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 July 2011 Cumulative for May, June and July 2011 Section H cumulative for April, May, June and July 2011 Contents Summary of PHARMAC decisions effective 1 July 2011 … 3…

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