Schedule Update - effective 1 August 2011 (text extract)

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Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 August 2011

Cumulative for May, June, July and August 2011 Section H for August 2011

Contents

Summary of PHARMAC decisions effective 1 August 2011 ............................ 3 Mental health medication brand change workshops for pharmacists ........... 4 Fluconazole powder for oral suspension – new listing .................................. 4 Venlafaxine – new brand listed ..................................................................... 5 Omeprazole – new listing .............................................................................. 5 Rituximab – wider access and subsidy and price decrease ............................. 5 Sodium chloride 7% nebulising solution – change to packaging................... 6 Glyceryl trinitrate spray – delay in listing AFT’s Glytrin .................................. 6 Minor amendments to General Rules ............................................................ 6 Tender News .................................................................................................. 7 Looking Forward ........................................................................................... 7 Sole Subsidised Supply products cumulative to August 2011 ....................... 8 New Listings ................................................................................................ 15 Changes to Restrictions ............................................................................... 22 Changes to Subsidy and Manufacturer’s Price............................................. 45 Changes to General Rules............................................................................ 52 Changes to Brand Name ............................................................................. 54 Changes to Section E Part I ......................................................................... 54 Changes to Section F Part II ......................................................................... 55 Changes to Sole Subsidised Supply ............................................................. 55 Delisted Items ............................................................................................. 56 Items to be Delisted .................................................................................... 59 Section H changes to Part II ........................................................................ 62 Section H changes to General Rules ............................................................ 64 Index ........................................................................................................... 66

Summary of PharmaC decisions

effeCtIve 1 auguSt 2011 New listings (page 15) • Omeprazole (Omezol Relief) cap 10 mg, 20 mg and 40 mg • Fluconazole (Diflucan) powder for oral suspension 10 mg per ml, 35 ml – Special Authority – Retail pharmacy • Venlafaxine (Arrow-Venlafaxine XR) tab 37.5 mg, 75 mg and 150 mg – Special Authority – Retail pharmacy Changes to restrictions (pages 22-26) • Dexamphetamine sulphate (PSM) tab 5 mg – amended Special Authority criteria • Methylphenidate hydrochloride tab immediate-release 5 mg (Rubifen), 10 mg (Ritalin and Rubifen) and 20 mg (Rubifen), and tab sustained-release 20 mg (Rubifen SR and Ritalin SR) – amended Special Authority criteria • Methylphenidate hydrochloride extended-release tab extended-release 18 mg, 27 mg, 36 mg and 54 mg (Concerta), and cap modified-release 10 mg, 20 mg, 30 mg and 40 mg (Ritalin LA) – amended Special Authority criteria • Daunorubicin (Pfizer) inj 2 mg per ml, 10 ml – removal of Section 29 • Rituximab inj 100 mg per 10 ml vial and 500 mg per 50 ml vial (Mabthera) and inj 1 mg for ECP (Baxter) – amended Special Authority criteria Increased subsidy (page 45) • Mometasone furoate (Elocon) lotn 0.1%, 30 ml OP • Oxazepam (Ox-Pam) tab 10 mg and 15 mg • Interferon beta-1-alpha (Avonex) inj 6 million iu prefilled syringe and vial Decreased subsidy (page 45) • Iron polymaltose (Ferrum H) inj 50 mg per ml, 2 ml • Amlodipine (Apo-Amlodipine) tab 5 mg and 10 mg • Sildenafil (Viagra) tab 25 mg, 50 mg and 100 mg • Ibuprofen (Brufen SR) tab long-acting 800 mg • Morphine sulphate (LA-Morph) tab long-acting 30 mg and 100 mg • Rituximab inj 100 mg per 10 ml vial and 500 mg per 50 ml vial (Mabthera) and inj 1 mg for ECP (Baxter)

4 Pharmaceutical Schedule - Update News

Mental health medication brand change workshops for pharmacists

A training programme is being held to support pharmacists in providing appropriate support and counselling to people changing brands of mental health medication. The programme includes a 4-hour practical workshop that will provide an overview of some common mental health illnesses and medications, using olanzapine as an example. Pharmacists will be eligible to receive 10 College CE credits and the course will contribute to Continuing Professional Development (CPD) credits.

To register phone 04 381 6382 or email Helen. teo@blueprint.co.nz. More information can be found on the PHARMAC website at www. pharmac.govt.nz/CounsellingBrandChange

Fluconazole powder for oral suspension – new listing

Fluconazole powder for oral suspension 10 mg per ml (Diflucan) will be fully subsidised from 1 August 2011 subject to Special Authority restrictions for prophylaxis for, or treatment of, systemic candidiasis where the patient is unable to swallow capsules. As this is a reconstituted solution, the wastage rule that currently applies to antibiotics will apply to fluconazole, requiring pharmacists to enter the amount required on the prescription and claim the remainder of the pack (if any) as wastage.

Pharmaceutical Schedule - Update News

Venlafaxine – new brand listed

A new brand of venlafaxine will be subsidised from 1 August 2011. ArrowVenlafaxine XR 37.5 mg, 75 mg and 150 mg tablets will be funded subject to the same Special Authority criteria as the Efexor XR brand of venlafaxine. The Efexor XR brand will continue to be listed in Section B of the Pharmaceutical Schedule subject to its current Special Authority restrictions There is no planned sole supply arrangement for venlafaxine at this time. We have been informed by the supplier that stock of Arrow-Venlafaxine XR will not be available until early to mid August.

Omeprazole – new listing

A new brand of omeprazole, Omezol Relief, will be subsidised from 1 August 2011. Omezol Relief 10 mg, 20 mg and 40 mg is supplied by Mylan and will be the sole subsidised brand of omeprazole from 1 January 2012. Dr Reddy’s Omeprazole will be reference priced to Omezol Relief from 1 October 2011.

Rituximab – wider access and subsidy and price decrease

From 1 August the Special Authority applying to the Pharmaceutical Cancer Treatment rituximab (MabThera) will be widened to include funding for patients with Chronic Lymphocytic Leukemia (CLL). Rituximab will be funded for treatment naïve CLL patients as well as in rituximab naïve patients whose CLL disease has relapsed following up to three prior lines of therapy. In addition, from 1 August the price and subsidies for rituximab inj 100 mg per 10 ml vial (MabThera), inj 500 mg per 50 ml vial (MabThera) and inj 1 mg for ECP (Baxter) will be reduced.

Pharmaceutical Schedule - Update News

Sodium chloride 7% nebulising solution – change to packaging

In future the 90 ml bottle of Sodium Chloride 7% will not be sealed with a metal band. This means that patients will be able to measure the required volume without having to use a syringe to withdraw the solution.

Glyceryl trinitrate spray – delay in listing AFT’s Glytrin

The listing date of AFT’s glyceryl trinitrate spray, 400 µg per dose, has been delayed from 1 September 2011 until 1 January 2012. We expect that AFT will have stock available by mid-January 2012. Douglas’ Nitrolingual Pumpspray will continue to be listed and fully subsidised until 1 March 2012 when it will be reference priced to AFT’s Glytrin. Douglas’ Nitrolingual Pumpspray will be delisted on 1 June 2012.

Minor amendments to General Rules

Following the decision to combine the Community and Pharmaceutical Cancer Treatment Budgets from 1 July 2011, some minor consequential amendments to the General Rules have been made.

tender News

Sole Subsidised Supply changes – effective 1 September 2011

Chemical Name Ipratropium bromide Naltrexone hydrochloride Sumatriptan Tamoxifen citrate Presentation; Pack size Aqueous nasal spray, 0.03%; 15 ml OP Tab 50 mg; 30 tab Inj 12 mg per ml, 0.5 ml; 2 inj OP Tab 20 mg; 100 tab Sole Subsidised Supply brand (and supplier) Univent (Rex Medical) Naltraccord (Arrow) Arrow-Sumatriptan (Arrow) Genox (Mylan)

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 September 2011 • Adalimumab inj 40 mg per 0.8 ml prefilled pen and syringe (HumiraPen and Humira) – amended Special Authority criteria • Etanercept (Enbrel) inj 25 mg, and inj 50 mg autoinjector and prefilled syringe – amended Special Authority criteria • Fludarabine (Baxter) inj 50 mg for ECP – subsidy decrease • Imiquimod (Aldara) crm 5%, sachet – subsidy decrease • Olanzapine (Zyprexa) tab 2.5 mg, 5 mg and 10 mg – subsidy decrease and remove Special Authority • Olanzapine (Zyprexa Zydis) wafer 5 mg and 10 mg – subsidy decrease and remove Special Authority

Sole Subsidised Supply Products – cumulative to August 2011

Generic Name

Abacabir sulphate Acarbose Aciclovir Amitriptyline Amoxycillin Amoxycillin clavulanate

Presentation

Oral liq 20 mg per ml Tab 300 mg 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

Brand Name Expiry Date*

Ziagen Ziagen Glucobay Lovir Amitrip Alphamox Ospamox Curam Curam 2014 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

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

2013 2013 2012 2012 2013 2012 2012 2012 2013 2012 2012 2013 2013 2013 2012 2013 2012 2012 2012 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 August 2011

Generic Name

Cilazapril with hydrochlorothiazide Clobetasol propionate

Presentation

Tab 5 mg with hydrochlorothiazide 12.5 mg 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*

Inhibace Plus 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 2013 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

2012 2013 31/12/11

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

2013 2012 2014 2012 2012 2012 2012

Sole Subsidised Supply Products – cumulative to August 2011

Generic Name

Escitalopram Ethinyloestradiol Etidronate disodium Exemestane Felodipine Fentanyl

Presentation

Tab 10 mg & 20 mg Tab 10 µg Tab 200 mg Tab 25 mg Tab long-acting 5 mg Tab long-acting 10 mg Transdermal patch 12.5 µg per hour, 25 µg per hour, 50 µg per hour, 75 µg per hour, 100 µg per hour 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

Brand Name Expiry Date*

Loxalate NZ Medical and Scientific Arrow-Etidronate Aromasin Felo 5 ER Felo 10 ER Mylan Fentanyl Patch 2013 2012 2012 2014 2012 2013

Ferrous sulphate Flucloxacillin sodium

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

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

2013 2012 2012 2013 2012 2012

Sole Subsidised Supply Products – cumulative to August 2011

Generic Name

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

Presentation

Oral liq 100 mg per 5 ml Tab 2.5 mg 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

Brand Name Expiry Date*

Fenpaed Dapa-Tabs 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 2012 2013 2013 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

2013 2012

Sole Subsidised Supply Products – cumulative to August 2011

Generic Name

Methylprednisolone Methylprednisolone sodium succinate

Presentation

Tab 4 mg & 100 mg 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*

Medrol 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 Dr Reddy’s Ondansetron Syntocinon Syntocinon Syntometrine Dr Reddy’s Pantoprazole Lacri-Lube Loxamine Breath-Alert 2012 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

Lozenge 1 mg & 2 mg Patch 7 mg, 14 mg & 21 mg Tab 350 µg Cap 500,000 u Tab 500,000 u Tab disp 4 mg & 8 mg Tab 4 mg & 8 mg

2014 2012 2013 2013

Oxytocin

Inj 5 iu per ml, 1 ml Inj 10 iu per ml, 1 ml Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml Tab 20 mg & 40 mg Eye oint with soft white paraffin Tab 20 mg Low range and Normal range

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 August 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 August 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] August 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 August 2011

29 OMEPRAZOLE ❋ Cap 10 mg ............................................................................... 2.91 ❋ Cap 20 mg ............................................................................... 3.78 ❋ Cap 40 mg ............................................................................... 5.57 90 90 90 ✔ Omezol Relief ✔ Omezol Relief ✔ Omezol Relief

FLUCONAZOLE Powder for oral suspension 10 mg per ml – Special Authority see SA1148– Retail pharmacy .............................. 34.56 35 ml ✔ Diflucan ➽ SA1148 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 6 weeks for applications meeting the following criteria: Both: 1. Patient requires prophlaxis for, or treatment of systemic candidiasis; and 2. Patient is unable to swallow capsules. Renewal from any relevant practitioner. Approvals valid for 6 weeks for applications meeting the following criteria: Both: 1. Patient requires prophlaxis for, or treatment of systemic candidiasis; and 2. Patient is unable to swallow capsules.

119

VENLAFAXINE – Special Authority see SA1061 – Retail pharmacy Tab 37.5 mg .......................................................................... 18.64 Tab 75 mg ............................................................................. 37.27 Tab 150 mg ........................................................................... 45.68

28 28 28

✔ Arrow-Venlafaxine XR ✔ Arrow-Venlafaxine XR ✔ Arrow-Venlafaxine XR

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 30 g OP ✔ Lyderm

▲

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 July 2011 (continued)

82 CLINDAMYCIN Inj phosphate 150 mg per ml, 4 ml – Retail pharmacySpecialist .......................................................................... 160.00

✔ 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 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. 109 TERIPARATIDE – Special Authority see SA11339 – Retail pharmacy Inj 250 µg per ml, 2.4 ml ...................................................... 490.00 1 ✔ Forteo

➽ 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: 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

New listings – effective 1 July 2011 (continued)

continued... 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. 111 ALLOPURINOL ❋ Tab 300 mg ...............................................................................20.15 PARACETAMOL WITH CODEINE ❋ Tab paracetamol 500 mg with codeine phosphate 8 mg ............ 2.70 500 ✔ Apo-Allopurinol S29

S29

116 128

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 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.

▲

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 July 2011 (continued)

137 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

✔ 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 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 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 10 ✔ Arrow-Ornidazole

84 116

10 10 10 10

✔ Arrow-Morphine LA ✔ Arrow-Morphine LA ✔ Arrow-Morphine LA ✔ Arrow-Morphine LA

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 June 2011 (continued)

126 OLANZAPINE Tab 2.5 mg .............................................................................. 2.00 Tab 5 mg ................................................................................. 3.85 Tab 10 mg ............................................................................... 6.35 28 28 28 ✔ 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

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

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 5 240 ✔ Electral ✔ Lanoxin

▲

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)

115 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

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 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.

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings – effective 1 May 2011 (continued)

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 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

183

▲

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 August 2011

36 VITAMINS Alpha tocopheryl acetate is available fully subsidised for specific patients at the Medical Director of PHARMAC’s discretion. Refer to PHARMAC website www.pharmac.govt.nz for the “Alpha tocopheryl acetate information sheet and application form”. DEXAMPHETAMINE SULPHATE – Special Authority see SA1149 1073 – Retail pharmacy Only on a controlled drug form Tab 5 mg ............................................................................... 16.50 100 ✔ PSM ➽ SA1149 1073 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients aged 5 years or over; and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Renewal — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Renewal — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment.

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 Restrictions - effective 1 August 2011 (continued)

134 METHYLPHENIDATE HYDROCHLORIDE – Special Authority see SA1150 1074– Retail pharmacy Only on a controlled drug form Tab immediate-release 5 mg ..................................................... 3.20 30 ✔ Rubifen Tab immediate-release 10 mg ................................................... 3.00 30 ✔ Ritalin ✔ Rubifen Tab immediate-release 20 mg ................................................... 7.85 30 ✔ Rubifen Tab sustained-release 20 mg .................................................. 10.95 30 ✔ Rubifen SR 50.00 100 ✔ Ritalin SR ➽ SA1150 1074 Special Authority for Subsidy Initial application — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients aged 5 years or over; and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist. Initial application — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 ADHD (Attention Deficit and Hyperactivity Disorder) patients under 5 years of age; and 2 Diagnosed according to DSM-IV or ICD 10 criteria. Initial application — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the patient suffers from narcolepsy. Renewal — (ADHD in patients 5 or over) only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. Renewal — (ADHD in patients under 5) only from a paediatrician or psychiatrist. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from treatment. Renewal — (Narcolepsy) only from a neurologist or respiratory specialist. Approvals valid for 24 months where the treatment remains appropriate and the patient is benefiting from treatment.

▲

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 August 2011 (continued)

135 METHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE – Special Authority see SA1151 0924 – Retail pharmacy Only on a controlled drug form Tab extended-release 18 mg ................................................... 58.96 30 ✔ Concerta Tab extended-release 27 mg ................................................... 65.44 30 ✔ Concerta Tab extended-release 36 mg ................................................... 71.93 30 ✔ Concerta Tab extended-release 54 mg ................................................... 86.24 30 ✔ Concerta Cap modified-release 10 mg ................................................... 19.50 30 ✔ Ritalin LA Cap modified-release 20 mg ................................................... 25.50 30 ✔ Ritalin LA Cap modified-release 30 mg ................................................... 31.90 30 ✔ Ritalin LA Cap modified-release 40 mg ................................................... 38.25 30 ✔ Ritalin LA ➽ SA1151 0924 Special Authority for Subsidy Initial application only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: All of the following: 1 ADHD (Attention Deficit and Hyperactivity Disorder); and 2 Diagnosed according to DSM-IV or ICD 10 criteria; and 3 Either: 3.1 Applicant is a paediatrician or psychiatrist; or 3.2 Both: 3.2.1 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 3.2.2 Provide name of the recommending specialist; and 4 Either: 4.1 Patient is taking a currently subsidised formulation of methylphenidate hydrochloride (immediate-release or sustained-release) which has not been effective due to significant administration and/or compliance difficulties; or 4.2 There is significant concern regarding the risk of diversion or abuse of immediate-release methylphenidate hydrochloride. Renewal only from a paediatrician, psychiatrist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 24 months for applications meeting the following criteria: Both: 1 The treatment remains appropriate and the patient is benefiting from treatment; and 2 Either: 2.1 Applicant is a paediatrician or psychiatrist; or 2.2 Both: 2.2.1 Applicant is a medical practitioner and confirms that a relevant specialist has been consulted within the last 2 years and has recommended treatment for the patient; and 2.2.2 Provide name of the recommending specialist. 144 DAUNORUBICIN – PCT only – Specialist Inj 2 mg per ml, 10 ml .......................................................... 118.72 153 RITUXIMAB – PCT only – Specialist – Special Authority see SA1152 1050 Inj 100 mg per 10 ml vial ................................................... 1,075.50 Inj 500 mg per 50 ml vial ................................................... 2,688.30 Inj 1 mg for ECP ....................................................................... 5.64 1 2 1 1 mg ✔ Pfizer S29 ✔ Mabthera ✔ Mabthera ✔ Baxter

➽ SA1152 1050 Special Authority for Subsidy Initial application — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 August 2011 (continued)

continued... Both: 1 The patient has B-cell post-transplant lymphoproliferative disorder*; and 2 To be used for a maximum of 8 treatment cycles. Note: Indications marked with * are Unapproved Indications. Initial application — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has indolent low grade NHL with relapsed disease following prior chemotherapy; and 1.2 To be used for a maximum of 6 treatment cycles; or 2 Both: 2.1 The patient has indolent, low grade lymphoma requiring first-line systemic chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/ Waldenstrom macroglobulinaemia. Rituximab is not funded for Chronic lymphocytic leukaemia/small lymphocytic lymphoma. Initial application — (Aggressive CD20 positive NHL) 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 All of the following: 1.1 The patient has treatment naive aggressive CD20 positive NHL; and 1.2 To be used with a multi-agent chemotherapy regimen given with curative intent; and 1.3 To be used for a maximum of 8 treatment cycles; or 2 Both: 2.1 The patient has aggressive CD20 positive NHL with relapsed disease following prior chemotherapy; and 2.2 To be used for a maximum of 6 treatment cycles. Note: ’Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia Initial application — (Chronic lymphocytic leukaemia) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has progressive Binet stage A, B or C chronic lymphocytic leukaemia (CLL) requiring treatment; and 2 The patient is rituximab treatment naïve; and 3 Either: 3.1 The patient is chemotherapy treatment naïve; or 3.2 Both: 3.2.1 The patient’s disease has relapsed following no more than three prior lines of chemotherapy treatment; and 3.2.2 The patient has had a treatment-free interval of 12 months or more if previously treated with fludarabine and cyclophosphamide chemotherapy; and 4 The patient has good performance status; and 5 The patient has good renal function (creatinine clearance ≥ 30 ml/min); and 6 The patient does not have chromosome 17p deletion CLL; and 7 Rituximab to be administered in combination with fludarabine and cyclophosphamide for a maximum of 6 treatment cycles; 8 It is planned that the patient receives full dose fludarabine and cyclophosphamide (orally or dose equivalent intravenous administration). 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 August 2011 (continued)

continued... Notes: ‘Chronic lymphocytic leukaemia’ includes small lymphocytic lymphoma. A line of chemotherapy treatment is considered to comprise a standard therapeutic chemotherapy regimen and supportive treatments. ‘Good performance status’ means ECOG score of 0-1; however, in patients temporarily debilitated by their CLL disease symptoms a higher ECOG (2 or 3) is acceptable where treatment with rituximab is expected to improve symptoms and improve ECOG score to <2. Renewal — (Post-transplant) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has B-cell post-transplant lymphoproliferative disorder*; and 3 To be used for no more than 6 treatment cycles. Note: Indications marked with * are Unapproved Indications. Renewal — (Indolent, Low-grade lymphomas) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has indolent, low-grade NHL with relapsed disease following prior chemotherapy; and 3 To be used for no more than 6 treatment cycles. Note: ’Indolent, low-grade lymphomas’ includes follicular, mantle, marginal zone and lymphoplasmacytic/ Waldenstrom macroglobulinaemia. Rituximab is not funded for Chronic lymphocytic leukaemia/small lymphocytic lymphoma Renewal — (Aggressive CD20 positive NHL) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has had a rituximab treatment-free interval of 12 months or more; and 2 The patient has relapsed refractory/aggressive CD20 positive NHL; and 3 To be used with a multi-agent chemotherapy regimen given with curative intent; and 4 To be used for a maximum of 4 treatment cycles. Note: ’Aggressive CD20 positive NHL’ includes large B-cell lymphoma and Burkitt’s lymphoma/leukaemia

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 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

108

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... 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: 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.

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... 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 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 continued... 2 Any of the following: 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 July 2011 (continued)

continued... 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 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.

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 July 2011 (continued)

continued... 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 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 continued...

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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... 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 1.2 Either: 1.2.1 Has not received prior chemotherapy; or 1.2.2 Has received prior chemotherapy but has not previously been treated with taxanes; or 2 The patient has metastatic breast cancer; or 3 Both: 3.1 The patient has early breast cancer; and 3.2 Docetaxel is to be given concurrently with trastuzumab; or 4 Both: 4.1 The patient has non small-cell lung cancer; and 4.2 Either: 4.2.1 Has advanced disease (stage IIIa or above); or 4.2.2 Is receiving combined chemotherapy and radiotherapy; 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... 5 Both: 5.1 The patient has small-cell lung cancer*; and 5.2 Docetaxel is to be used as second-line therapy. Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic breast cancer, non small-cell lung cancer, or small-cell lung cancer*; and 2 Either: 2.1 The patient requires continued therapy; or 2.2 The tumour has relapsed and requires re-treatment. Note: indications marked with * are Unapproved Indications. 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 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) Symbicort Turbuhaler 200/6 Powder for inhalation 400 µg with eformoterol fumarate 12 µg – No more than 2 dose per day – Higher subsidy of $60.00 per 60 dose with Endorsement ............................................................... 45.00 60 dose OP (60.00) Symbicort Turbuhaler 400/12 OMEPRAZOLE SUSPENSION Omeprazole capsules or powder Sodium bicarbonate powder BP Water qs 8.4 g to 100 ml

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

159

173

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

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - 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: 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.

▲

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 June 2011 (continued)

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 ➽ 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: 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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Changes to Restrictions - effective 1 June 2011 (continued)

continued... 6 7 8 9 10 11 5.1 HBeAg positive; or 5.2 serum HBV DNA = 2,000 units/ml and significant fibrosis (= Metavir Stage F2); and Compensated liver disease; and No continuing alcohol abuse or intravenous drug use; and Not co-infected with HCV, HIV or HDV; and Neither ALT nor AST > 10 times upper limit of normal; and No history of hypersensitivity or contraindications to pegylated interferon; and 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 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 2 OP ✔ Arrow-Sumatriptan Imigran

144

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: 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

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Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 June 2011 (continued)

continued... 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. 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, 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 May 2011 (continued)

continued... 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 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. 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 — (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. 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: 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 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. 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 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... 8 Bowel fistula; or 9 Severe chronic neurological conditions. Renewal — (Chronic disease OR tube feeding for patients who have previously been funded under Special Authority forms SA0702 or SA0583) only from a relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a relevant specialist or vocationally registered general practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: Both: 1 Any of the following: 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

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)

193 AMINO ACID FORMULA – Special Authority see SA1111 – Hospital pharmacy [HP3] Powder .................................................................................... 6.00 48.5 g OP ✔ Vivonex Pediatric 56.00 400 g OP ✔ Neocate ✔ Neocate LCP Powder (tropical) .................................................................... 56.00 400 g OP ✔ Neocate Advance Powder (unflavoured) ............................................................. 56.00 400 g OP ✔ Elecare ✔ Elecare LCP ✔ Neocate Advance Powder (vanilla) ..................................................................... 56.00 400 g OP ✔ Elecare ➽ 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: 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 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... 1.2 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: 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. Patients pay a manufacturer’s surcharge when S29 Unapproved medicine supplied under Section 29 the Manufacturer’s Price is greater than the Subsidy ‡ safety cap reimbursed Sole Subsidised Supply

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 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

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 April 2011 (continued)

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

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 August 2011

39 52 IRON POLYMALTOSE ( subsidy) Inj 50 mg per ml, 2 ml ............................................................. 19.90 AMLODIPINE ( subsidy) ❋ Tab 5 mg ................................................................................. 2.65 ❋ Tab 10 mg ............................................................................... 4.15 SILDENAFIL – Special Authority SA1086 – Retail pharmacy ( subsidy) Tab 25 mg ............................................................................. 39.00 Tab 50 mg ............................................................................. 43.50 Tab 100 mg ............................................................................ 47.00 MOMETASONE FUROATE ( subsidy) Lotn 0.1% ................................................................................ 7.35 IBUPROFEN ( subsidy) ❋ Tab long-acting 800 mg ............................................................ 8.12 MORPHINE SULPHATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable Tab long-acting 30 mg .............................................................. 3.15 (3.60) Tab long-acting 100 mg ........................................................... 7.85 (8.50) OXAZEPAM ( subsidy) Tab 10 mg ................................................................................ 5.89 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 15 mg ................................................................................ 8.13 ‡ Safety cap for extemporaneously compounded oral liquid preparations. INTERFERON BETA-1-ALPHA – Special Authority SA1062 ( subsidy) Inj 6 million iu prefilled syringe ............................................ 1,425.10 Inj 6 million iu per vial ........................................................ 1,425.10 5 100 100 4 4 4 30 ml OP 30 ✔ Ferrum H ✔ Apo-Amlodipine ✔ Apo-Amlodipine ✔ Viagra ✔ Viagra ✔ Viagra ✔ Elocon ✔ Brufen SR

60 96 116

10 LA-Morph 10 LA-Morph 100 100 ✔ Ox-Pam ✔ Ox-Pam

130

132

4 4

✔ Avonex ✔ Avonex ✔ Mabthera ✔ Mabthera ✔ Baxter

153

RITUXIMAB – PCT only – Specialist – Special Authority SA1052 ( subsidy) Inj 100 mg per 10 ml vial ................................................... 1,075.50 2 Inj 500 mg per 50 ml vial .................................................... 2,688.30 1 Inj 1 mg for ECP ........................................................................ 5.64 1 mg

Effective 1 July 2011

27 28 MESALAZINE ( subsidy) Suppos 500 mg ...................................................................... 22.80 HYOSCINE N-BUTYLBROMIDE ( subsidy) ❋ Tab 10 mg ............................................................................... 1.48 20 20 ✔ Asacol ✔ Gastrosoothe

▲

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)

28 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 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 ................................................................................. 9.95 250 250 300 ml 5 ✔ Arrow-Ranitidine ✔ Arrow-Ranitidine ✔ Peptisoothe ✔ Dr Reddy’s Omeprazole ✔ Pantocid IV ✔ Apo-Gliclazide ✔ Laxofast 50 ✔ Laxofast 120 ✔ Oracort

29 30 34

1 500 100 100 5 g OP

36 37

500 5

✔ Apo-Pyridoxine ✔ Biomed

43 44

10 100 100 90 90 90 90 30 30 500 500

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

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)

54 60 GLYCERYL TRINITRATE ( subsidy) ❋ TDDS 10 mg .......................................................................... 19.50 30 ✔ Nitroderm TTS

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

61 61 62 64

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. 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

100

✔ Arrow-Norfloxacin

▲

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)

96 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 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 ............................................................................... 1.59 100 ✔ Arrow-Tramadol 100 100 50 100 60 60 100 1,000 ml ✔ Oruvail SR ✔ Oruvail SR ✔ AstraZeneca ✔ Mestinon ✔ Surgam ✔ Symmetrel ✔ Tasmar ✔ Paracare Double Strength

96 96 97 112 112 114

5 Hospira 5 Hospira 84 500 1 1 1 mg 30 100 ✔ Arrow-Citalopram ✔ Apo-Zopiclone ✔ Docetaxel Ebewe ✔ Docetaxel Ebewe ✔ Baxter ✔ DP-Anastrozole ✔ Zetop

118 133 144

152 157

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)

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 60 dose with Endorsement ................................................................ 45.00 60 dose OP (60.00)

Symbicort Turbuhaler 200/6

Symbicort Turbuhaler 400/12

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

NALTREXONE HYDROCHLORIDE – Special Authority SA0909 – Retail pharmacy ( subsidy) Tab 50 mg ........................................................................... 123.00 30 ✔ ReVia

▲

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 (continued)

152 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

162

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 General Rules

Effective 1 August 2011

10 Hospital Pharmaceutical and Pharmaceutical Cancer Treatment Costs The cost of purchasing Hospital Pharmaceuticals and Pharmaceutical Cancer Treatments (for use in DHB hospitals and/or in association with Outpatient services provided in DHB hospitals) is met by the relevant DHB hospital Funder (in particular, the relevant DHB) from its own budget. Pharmaceutical Cancer Treatments (for use in DHB hospitals and/or in association with Outpatient services provided in DHB hospitals) are funded through the Combined Pharmaceutical Budget. As required by section 23(7) of the Act, in performing any of their functions in relation to the supply of Pharmaceuticals including Pharmaceutical Cancer Treatments, DHBs must not act inconsistently with the Pharmaceutical Schedule. Exceptional Circumstances policies The purpose of the Exceptional Circumstances policies are to provide: • funding from within the Pharmaceutical Budget Community Exceptional Circumstances budget for medication, to be used in the community, in circumstances where the provision of a funded community medication is appropriate, but funding from the Pharmaceutical Budget is not able to be provided through the Pharmaceutical Schedule (“Community Exceptional Circumstances”); or • an assessment process for the DHB Hospitals to determine whether they can fund medication, to be used in the community, in circumstances where the medication is neither a Community Pharmaceutical nor a Discretionary Community Supply Pharmaceutical and where the patient does not meet the criteria for Community Exceptional Circumstances (“Hospital Exceptional Circumstances”); or • funding from the Pharmaceutical Budget for an assessment process for DHB Hospitals to determine whether they can fund pharmaceuticals for the treatment of cancer in their DHB Hospitals, or in association with Outpatient services provided in their DHB hospitals, in circumstances where the pharmaceutical is not identified as a Pharmaceutical Cancer Treatment (“Cancer Exceptional Circumstances”) in Sections A-H of the Pharmaceutical Schedule. Upon receipt of an application for approval for Community Exceptional Circumstances or Hospital Exceptional Circumstances, the Exceptional Circumstances Panel first decides whether an application will be assessed initially under the Community Exceptional Circumstances criteria or the Hospital Exceptional Circumstances criteria. Cancer Exceptional Circumstances is a separate process. Cancer Exceptional Circumstances Permission to fund a pharmaceutical for the treatment of cancer from the Hospital’s own budget under Cancer Exceptional Circumstances will only be granted by PHARMAC where it has been demonstrated that the proposed use meets the criteria. If the patient being treated with a pharmaceutical under Cancer Exceptional Circumstances usually resides in a district other than that within the jurisdiction of the DHB initiating the treatment, then the DHB initiating the treatment must either agree to fund any on-going treatment required once the patient has returned to his/her usual DHB, or obtain written consent from the DHB or DHBs in which the patient will reside following the commencement of treatment. “Cancer Exceptional Circumstances” means the policies and criteria administered by PHARMAC relating to the ability to fund, from a DHB hospital’s own budget, pharmaceuticals for the treatment of cancer that are not identified as Pharmaceutical Cancer Treatments in Sections A-H of the Pharmaceutical Schedule. “Pharmaceutical Budget” means the pharmaceutical budget set for PHARMAC by the Crown for the subsidised supply of Community Pharmaceuticals and Pharmaceutical Cancer Treatments including for named patients in exceptional circumstances. “Pharmaceutical Cancer Treatment” means Pharmaceuticals for the treatment of cancer, listed in Sections A to G of the Schedule and identified therein as a “PCT” or “PCT only” Pharmaceutical that DHBs must provide access to fund, from their own budgets, for use in their hospitals, and/or in association with Outpatient services provided in their DHB Hospitals, in relation to the treatment of cancers.

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to General Rules - effective 1 August 2011 (continued)

24 4.4 Pharmaceutical Cancer Treatments 4.4.1 DHBs must provide access to Pharmaceutical Cancer Treatments for by funding their use in the treatment of cancers in their DHB hospitals, and/or in association with Outpatient services provided in their DHB hospitals.

▲

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 August 2011

116 PARACETAMOL WITH CODEINE ❋ Tab paracetamol 500 mg with codeine phosphate 8 mg ............. 2.70 100 ✔ Paracetemol + Codeine (Relieve) Relieve

Effective 1 July 2011

83 TOBRAMYCIN Inj 40 mg per ml, 2 ml – Subsidy by endorsement .................. 29.32 ✔ 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 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

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 Section F Part II

Effective 1 May 2011

201 NERVOUS SYSTEM Lacosamide

Changes to Sole Subsidised Supply

Effective 1 August 2011

For the list of new Sole Subsidised Supply products effective 1 August 2011 refer to the bold entries in the cumulative Sole Subsidised Supply table pages 8-14.

▲

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 August 2011

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

90 100 100

✔ Healtheries ✔ Mexitil ✔ Mexitil

SUNSCREENS, PROPRIETARY – Subsidy by endorsement Only if prescribed for a patient with severe photosensitivity secondary to a defined clinical condition and the prescription is endorsed accordingly. Crm .......................................................................................... 1.28 50 g OP (5.50) Aquasun Oil Free Faces SPF30+ STAVUDINE [D4T] – Special Authority see SA1025 – Retail pharmacy Cap 20 mg ............................................................................ 317.10 Powder for oral soln 1 mg per ml ........................................... 100.76 FENTANYL a) Only on a controlled drug form b) No patient co-payment payable Transdermal patch, matrix 25 µg per hour – Special Authority see SA1080 – Retail pharmacy ........................................... 55.23 Transdermal patch, matrix 50 µg per hour – Special Authority see SA1080 – Retail pharmacy. ......................................... 100.52 Transdermal patch, matrix 75 µg per hour – Special Authority see SA1080 – Retail pharmacy .......................................... 139.18 Transdermal patch, matrix 100 µg per hour – Special Authority see SA1080 – Retail pharmacy .......................................... 171.22 ONDANSETRON Tab disp 4 mg ........................................................................... 1.70 (17.18) Tab disp 8 mg .......................................................................... 2.00 (20.43) MITOMYCIN C – PCT only – Specialist Inj 2 mg ................................................................................ 283.00 Inj 10 mg .............................................................................. 808.00 Note – Arrow mitomycin C inj 5 mg remains subsidised. 60 ✔ Zerit 200 ml OP ✔ Zerit

115

5 5 5 5 10

✔ Durogesic ✔ Durogesic ✔ Durogesic ✔ Durogesic

124

Zofran Zydis 10 Zofran Zydis

146

10 5

✔ Mitomycin-C S29 ✔ Mitomycin-C S29

Effective 1 July 2011

62 POVIDONE IODINE Antiseptic soln 10% ................................................................ 51.06 4,500 ml ✔ Betadine

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 July 2011 (continued)

110 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 10 Hyalase 50 ✔ Xylocaine

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

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted items – effective 1 May 2011

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

250 15

✔ Cotazym ECS

Sporanox 10 Zofran 20 Zofran 20 ✔ Ridal

124

127

168

1 fee

✔ BSF Apo-Clopidogrel

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be Delisted

Effective 1 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

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

162

Effective 1 October 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

Effective 1 November 2011

32 BLOOD GLUCOSE DIAGNOSTIC TEST STRIP The number of test strips available on a prescription is restricted to 50 unless: 1) Prescribed with insulin or a sulphonylurea but are on a different prescription and the prescription is endorsed accordingly; or 2) Prescribed on the same prescription as insulin or a sulphonylurea in which case the prescription is deemed to be endorsed; or 3) Prescribed for a pregnant woman with diabetes and endorsed accordingly. Blood glucose test strips ..................................................... 10.82 25 test OP ✔ Optium 5 second test PANCREATIC ENZYME Tab EC 1,900 BP u lipase, 1,700 BP u amylase, 110 BP u protease ............................................................... 32.46 IPECACUANHA ❋ Tincture................................................................................... 41.20 (43.40) DIGOXIN ❋ Tab 250 µg – Up to 30 tab available on a PSO ........................ 15.13 Three months supply may be dispensed at one time if endorsed “certified exemption” by the prescriber.

300 500 ml

✔ Pancrex V

PSM 250 ✔ Lanoxin

▲

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

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

63 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) MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Tab long-acting 10 mg ............................................................. 1.80 Tab long-acting 30 mg .............................................................. 3.15 (3.60) Tab long-acting 60 mg ............................................................. 7.20 Tab long-acting 100 mg ............................................................ 7.85 (8.50) 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

116

10 10 10 10

✔ LA-Morph LA-Morph ✔ LA-Morph LA-Morph

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

300 300

✔ Pancrex V Forte ✔ Pancrex V

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 December 2011 (continued)

47 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

194

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

Effective 1 February 2012

144 DAUNORUBICIN – PCT only – Specialist Inj 5 mg per ml, 4 ml .............................................................. 99.00 1 ✔ Mayne

▲

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

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

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes to Part II

Effective 1 August 2011

17 AMLODIPINE ( price and addition of HSS) Tab 5 mg – 1% DV Oct-11 to 2014 ........................................... 2.65 Tab 10 mg – 1% DV Oct-11 to 2014 ......................................... 4.15 CEFOTAXIME ( price and addition of HSS) Inj 500 mg – 1% DV Oct-11 to 2014 ......................................... 1.90 CEFTAZIDIME ( price and addition of HSS) Inj 500 mg – 1% DV Oct-11 to 2014 ......................................... 2.37 CEFTAZIDIME Inj 1 g – 1% DV Oct-11 to 2014 ................................................ 3.25 Inj 2 g – 1% DV Oct-11 to 2014 ................................................ 6.49 Note: Fortum inj 1 g and 2 g to be delisted 1 October 2011. CLARITHROMYCIN Inj 500 mg – 1% DV Oct-11 to 2014 ....................................... 30.00 DAUNORUBICIN Inj 5 mg per ml, 4 ml .............................................................. 99.00 Note: Daunorubiin inj 5 mg per ml, 4 ml to be delisted 1 October 2011 DIPYRIDAMOLE (addition of HSS) Tab long-acting 150 mg – 1% DV Oct-11 to 2014 .................. 11.52 FACTOR EIGHT INHIBITORS BYPASSING AGENT Inj 500 U ............................................................................ 1,640.00 Inj 1,000 U ......................................................................... 3,280.00 FLUCONAZOLE (amended presentation description and brand name) Powder for oral suspension oral liq 10 mg per ml ................... 34.56 IBUPROFEN Tab long-acting 800 mg – 1% DV Oct-11 to 2014 ..................... 8.12 IRON POLYMALTOSE ( price and addition of HSS) Inj 50 mg per ml, 2 ml – 1% DV Oct-11 to 2014 ...................... 19.90 METRONIDAZOLE Inj 500 mg, 100 ml ................................................................... 2.46 MOMETASONE FUROATE Lotn 0.1% ................................................................................. 4.80 Note: Elocon lotn 0.1% to be delisted 1 August 2011 100 100 1 1 1 1 Apo-Amlodipine Apo-Amlodipine Cefotaxime Sandoz Fortum DBL Ceftazidime DBL Ceftazidime

23 23 23

25 27

1 1

Klacid Mayne

28 31

60 1 1 35 ml 30 5 1 30 ml

Pytazen SR FEIBA FEIBA Diflucan POS Brufen SR Ferrum H Baxter Elocon

32 37 39 45 45

OMEPRAZOLE Cap 10 mg – 1% DV Oct-11 to 2014 ......................................... 2.91 90 Omezol Relief Cap 20 mg – 1% DV Oct-11 to 2014 ......................................... 3.78 90 Omezol Relief Cap 40 mg – 1% DV Oct-11 to 2014 ......................................... 5.57 90 Omezol Relief Note: Dr Reddy’s Omeprazole cap 10 mg, 20 mg and 40 mg to be delisted 1 October 2011 Products with Hospital Supply Status (HSS) are in bold. Expiry date of HSS period is 30 June of the year indicated unless otherwise stated

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

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

48 ONDANSETRON ( DV limit) Tab disp 4 mg – 5% DV May-11 to 2013 .................................. 1.70 Tab disp 8 mg – 5% DV May-11 to 2013 .................................. 2.00 50 PARACETAMOL WITH CODEINE (brand name change) Tab paracetamol 500 mg with codeine phosphate 8 mg – 1% DV Nov-11 to 2014 ............................................. 2.70 10 10 Dr Reddy’s Ondansetron Dr Reddy’s Ondansetron

100

Paracetamol + Codeine (Relieve) Relieve Advate Advate BeneFIX BeneFIX BeneFIX BeneFIX Rapilysin

RECOMBINANT FACTOR VIII Inj 2,000 IU ........................................................................ 1,900.00 Inj 3,000 IU ........................................................................ 2,850.00 RECOMBINANT FACTOR IX Inj 250 IU ............................................................................. 310.00 Inj 500 IU ............................................................................. 620.00 Inj 1,000 IU ....................................................................... 1,240.00 Inj 2,000 IU ....................................................................... 2,480.00 RETEPLASE Inj 10 iu vial........................................................................ 1,850.00 Note: Rapilysin to be delisted 1 October 2011 RITUXIMAB ( price) Inj 100 mg per 10 ml vial ................................................... 1,075.50 Inj 500 mg per 50 ml vial .................................................... 2,688.30 VENLAFAXINE Tab 37.5 mg ........................................................................... 18.64 Tab 75 mg .............................................................................. 37.27 Tab 150 mg ........................................................................... 45.68

1 1 1 1 1 1 2

2 1 28 28 28

Mabthera Mabthera Arrow-Venlafaxine XR Arrow-Venlafaxine XR Arrow-Venlafaxine XR

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 to General Rules

Effective 1 August 2011

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

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

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes to General Rules - effective 1 August 2011 (continued)

10 “Cancer Exceptional Circumstances” means the policies and criteria administered by PHARMAC relating to the ability to fund, from a DHB hospital’s own budget, pharmaceuticals for the treatment of cancer that are not identified as Pharmaceutical Cancer Treatments in Sections A-H of the Pharmaceutical Schedule. “Pharmaceutical Budget” means the pharmaceutical budget set for PHARMAC by the Crown for the subsidised supply of Community Pharmaceuticals and Pharmaceutical Cancer Treatments including for named patients in exceptional circumstances. “Pharmaceutical Cancer Treatment” means Pharmaceuticals for the treatment of cancer, listed in Sections A to G of the Schedule and identified therein as a “PCT” or “PCT only” Pharmaceutical that DHBs must provide access to fund, from their own budgets, for use in their hospitals, and/or in association with Outpatient services provided in their DHB Hospitals, in relation to the treatment of cancers. Pharmaceutical Cancer Treatments 8.1 DHBs are obliged to fund provide access to Pharmaceutical Cancer Treatments in accordance with the October September 2001 direction from the Minister of Health. Pharmaceutical Cancer Treatments 8.5 Some indications for Pharmaceutical Cancer Treatments listed in the Schedule are Unapproved Indications. Some of these formed part of the October 2001 direction from the Minister of Health as to pharmaceuticals and indications for which DHBs must provide funding access. As far as reasonably practicable, these Unapproved Indications are marked in the Schedule. However, PHARMAC makes no representation and gives no guarantee as to the accuracy of this information. Practitioners prescribing Pharmaceutical Cancer Treatments for such Unapproved Indications should: a) be aware of and comply with their obligations under sections 25 and 29 of the Medicines Act 1981, as applicable, and otherwise under that Act and the Medicines Regulations 1984; b) be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient (PHARMAC recommends that Practitioners obtain written consent); and c) exercise their own skill, judgment, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved Pharmaceutical Cancer Treatment or a Pharmaceutical Cancer Treatment for an Unapproved Indication.

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 .......................................................... 47 Abacavir sulphate............................................... 50 Aclasta .............................................................. 28 Advate ............................................................... 63 Alendronate sodium ..................................... 26, 50 Alendronate sodium with cholecalciferol ....... 26, 50 Allopurinol.................................................... 17, 19 Alpha tocopheryl acetate .................................... 57 Amantadine hydrochloride .................................. 48 Amino acid formula ............................................ 41 Aminoacid formula without phenylalanine ........... 60 Amlodipine................................................... 45, 62 Amoxycillin clavulanate ...................................... 47 Anastrozole ........................................................ 48 Anzatax .............................................................. 19 Apo-Allopurinol S29 ..................................... 17, 19 Apo-Amlodipine ........................................... 45, 62 Apo-Gliclazide .................................................... 46 Apo-Ipravent ................................................ 50, 59 Apo-Nicotinic Acid ............................................. 46 Apo-Pyridoxine .................................................. 46 Apo-Zopiclone.................................................... 48 Aquasun Oil Free Faces SPF30+ ........................ 56 Aqueous cream .................................................. 47 Arrow-Azithromycin ........................................... 33 Arrow-Bendrofluazide ......................................... 46 Arrow-Citalopram ............................................... 48 Arrow-Morphine LA ............................................ 18 Arrow-Nifedipine XR ........................................... 46 Arrow-Norfloxacin .............................................. 47 Arrow-Ornidazole ............................................... 18 Arrow-Ranitidine ................................................ 46 Arrow-Simva 10mg ............................................ 46 Arrow-Simva 20mg ............................................ 46 Arrow-Simva 40mg ............................................ 46 Arrow-Simva 80mg ............................................ 46 Arrow-Sumatriptan ............................................. 35 Arrow-Tramadol ................................................. 48 Arrow-Venlafaxine XR................................... 15, 63 Asacol ............................................................... 45 Avonex .............................................................. 45 Azithromycin ...................................................... 33 B Bendrofluazide ................................................... 46 BeneFIX ............................................................. 63 Betadine............................................................. 56 Bleph 10 ............................................................ 60 Blood glucose diagnostic test strip ..................... 59 Bortezomib ...................................... 19, 21, 35, 57 Brufen SR .................................................... 45, 62 BSF Apo-Clopidogrel .......................................... 58 BSF m-Captopril ................................................. 57 BSF Zapril .......................................................... 57 Budesonide with eformoterol ........................ 32, 49 Buprenorphine hydrochloride .............................. 60 C Cefotaxime......................................................... 62 Cefotaxime Sandoz ............................................ 62 Ceftazidime ........................................................ 62 Ceptolate ........................................................... 18 Cetirizine hydrochloride ...................................... 48 Champix ............................................................ 30 Chlorhexidine gluconate ..................................... 47 Cilazapril ...................................................... 18, 61 Citalopram hydrobromide ................................... 48 Clarithromycin........................................ 33, 36, 62 Clindamycin ................................................. 16, 61 Clinoril ............................................................... 61 Combivent ......................................................... 60 Concerta ............................................................ 24 Cotazym ECS ..................................................... 58 Colestid ............................................................. 50 Colestipol hydrochloride ..................................... 50 Compound electrolytes........................... 19, 46, 59 Cyproterone acetate with ethinyloestradiol .......... 47 D Dabigatran ......................................................... 15 Dalacin C ..................................................... 16, 61 Dantrium ............................................................ 50 Dantrolene sodium ............................................. 50 Darunavir ........................................................... 61 Daunorubicin ......................................... 24, 61, 62 DBL Ceftazidime................................................. 62 DBL Doxorubicin ................................................ 19 DBL Methotrexate............................................... 19 DBL Tobramycin .......................................... 47, 54 Desmopressin .................................................... 47 Desmopressin-PH&T.......................................... 47 Dexamphetamine sulphate.................................. 22 Dextrose ............................................................ 46 Diflucan ....................................................... 15, 62 Digoxin ........................................................ 19, 59 Dipyridamole...................................................... 62 Docetaxel ..................................................... 31, 48 Docetaxel Ebewe .......................................... 31, 48 Docusate sodium ............................................... 46 Doxine ............................................................... 47 Doxorubicin ....................................................... 19 Doxycycline hydrochloride.................................. 47 DP-Anastrozole .................................................. 48 Dr Reddy’s Olanzapine ....................................... 19 Dr Reddy’s Omeprazole...................................... 46 Dr Reddy’s Ondansetron .............................. 37, 63

Index

Pharmaceuticals and brands Duphalac ........................................................... 57 Duphaston ......................................................... 57 Durogesic .......................................................... 56 Dydrogesterone.................................................. 57 E Elecare .............................................................. 41 Elecare LCP ....................................................... 41 Electral .............................................................. 19 Elocon ......................................................... 45, 62 Emulsifying ointment .......................................... 47 Eformoterol fumarate.................................... 32, 49 Enerlyte ....................................................... 46, 59 Ensure Plus............................................ 40, 43, 51 Estraderm TTS 100 ............................................ 61 Estraderm TTS 25 .............................................. 61 Estraderm TTS 50 .............................................. 61 Evista................................................................. 16 Extensively hydrolysed formula..................... 41, 61 F Factor eight inhibitors bypassing agent ............... 62 FEIBA................................................................. 62 Fentanyl ............................................................. 56 Fentanyl citrate....................................... 20, 48, 59 Ferrum H...................................................... 45, 62 Fluarix ................................................................ 37 Fluconazole ...................................... 15, 26, 34, 62 Fludarabine Ebewe ............................................. 18 Fludarabine phosphate ....................................... 18 Fluvax ................................................................ 37 Forteo ................................................................ 16 Fortini ................................................................ 21 Fortini Multi Fibre................................................ 21 Fortisip .............................................................. 43 Fortisip Multi Fibre .............................................. 43 Fortum ............................................................... 62 Fosamax ...................................................... 26, 50 Fosamax Plus .............................................. 26, 50 G Gastrosoothe ..................................................... 45 Ginet 84 ............................................................. 47 Gliclazide ........................................................... 46 Glyceryl trinitrate ................................................ 47 H Habitrol .................................................. 18, 30, 57 Hyalase.............................................................. 57 Hyaluronidase .................................................... 57 Hybloc ............................................................... 57 Hyoscine n-butylbromide ................................... 45 I Ibuprofen ..................................................... 45, 62 Influenza vaccine................................................ 36 Imigran .................................................. 35, 49, 59 Interferon beta-1-alpha ....................................... 45 Ipecacuanha ...................................................... 59 Ipratropium bromide ..................................... 50, 59 Iron polymaltose .......................................... 45, 62 Itraconazole ....................................................... 58 K Ketoconazole ..................................................... 47 Ketoprofen ................................................... 48, 54 Klacid .......................................................... 33, 62 Klamycin...................................................... 33, 36 L Labetalol ............................................................ 57 Lacosamide ................................................. 20, 55 Lactulose ........................................................... 57 LA-Morph .................................................... 45, 60 Lanoxin ........................................................ 19, 59 Laxofast 50 ........................................................ 46 Laxofast 120 ...................................................... 46 Lignocaine hydrochloride ....................... 30, 54, 57 Lophlex LQ......................................................... 60 Lopresor ............................................................ 61 Lyderm .............................................................. 15 M m-Eslon ............................................................. 57 Mabthera ............................................... 24, 45, 63 Mesalazine ......................................................... 45 Mestinon............................................................ 48 Methotrexate ...................................................... 19 Methylphenidate hydrochloride ........................... 23 Methylphenidate hydrochloride extended-release ............................................. 24 Metoprolol tartrate .............................................. 61 Metronidazole .................................................... 62 Mexiletine hydrochloride ..................................... 56 Mexitil ................................................................ 56 Micelle E ............................................................ 57 Mitomycin C ...................................................... 56 Mitomycin-C S29 ............................................... 56 Modafinil ............................................................ 20 Modavigil ........................................................... 20 Mometasone furoate .................................... 45, 62 Morphine sulphate............................ 18, 45, 57, 60 Mucilaginous laxatives with stimulants ............... 50 Mycophenolate mofetil ....................................... 18 N Naltrexone hydrochloride .............................. 49, 59 Neocate ............................................................. 41 Neocate Advance ............................................... 41 Neocate LCP ...................................................... 41 Neostigmine....................................................... 48 Nicotine ........................................... 18, 30, 54, 57 Nicotinic acid ..................................................... 46

Index

Pharmaceuticals and brands Nifedipine........................................................... 46 Nitroderm TTS.................................................... 47 Norfloxacin ........................................................ 47 Normacol Plus ................................................... 50 O Oestradiol .......................................................... 61 Olanzapine ......................................................... 19 Olanzapine pamoate monohydrate ...................... 17 Olanzine ............................................................. 19 Olanzine-D ......................................................... 19 Omeprazole............................................ 15, 46, 62 Omeprazole suspension ..................................... 32 Omezol Relief ............................................... 15, 62 Ondansetron .............................. 37, 50, 56, 58, 63 Optium 5 second test ......................................... 59 Oracort .............................................................. 46 Oral feed 1.5kcal/ml ............................... 40, 43, 51 Oral feed 1.5kcal/ml (tetrapak) ........................... 40 Oral feed 2kcal/ml .............................................. 44 Oral feed with fibre 1.5 Kcal/ml........................... 43 Ornidazole.......................................................... 18 Oruvail 100 ........................................................ 54 Oruvail 200 ........................................................ 54 Oruvail SR.................................................... 48, 54 Ox-Pam ............................................................. 45 Oxazepam .......................................................... 45 Oxis Turbuhaler ............................................ 32, 49 P Paclitaxel ........................................................... 19 Paediatric oral feed 1.5kcal/ml............................ 21 Paediatric oral feed with fibre 1.5kcal/ml............. 21 Pancreatic enzyme ................................. 58, 59, 60 Pancrex V .................................................... 59, 60 Pancrex V Forte .................................................. 60 Pantocid IV ........................................................ 46 Pantoprazole ...................................................... 46 Paracare Double Strength ................................... 48 Paracetamol....................................................... 48 Paracetamol + Codeine (Relieve)....................... 63 Paracetamol with codeine ...................... 17, 54, 63 Paracetemol + Codeine (Relieve)....................... 54 Pegasys............................................................. 34 Pegasys RBV Combination Pack ........................ 34 Pegylated interferon alpha-2a ............................. 34 Pepti Junior.................................................. 41, 61 Pepti Junior Gold................................................ 41 Peptisoothe ........................................................ 46 Permethrin ................................................... 15, 47 Pharmacy Health ................................................ 18 Pharmacy services....................................... 57, 58 Povidone iodine ................................................. 56 Pradaxa ............................................................. 15 Prezista.............................................................. 61 Pyridostigmine bromide...................................... 48 PyridoxADE ........................................................ 15 Pyridoxine hydrochloride ........................ 15, 46, 56 Pytazen SR ........................................................ 62 R Raloxifene hydrochloride .................................... 16 Ranitidine hydrochloride ..................................... 46 Rapilysin ............................................................ 63 Recombinant factor IX ........................................ 63 Recombinant factor VIII ...................................... 63 Relieve................................................... 17, 54, 63 Reteplase ........................................................... 63 ReVia ........................................................... 49, 59 Ridal .................................................................. 58 Risperidone........................................................ 58 Ritalin ................................................................ 23 Ritalin LA ........................................................... 24 Ritalin SR ........................................................... 23 Rituximab .............................................. 24, 45, 63 Rubifen .............................................................. 23 Rubifen SR ........................................................ 23 S Salbutamol with ipratropium bromide.................. 60 Salicylic acid ...................................................... 60 Sebizole ............................................................. 47 Sildenafil ............................................................ 45 Simvastatin ........................................................ 46 Sodium fluoride .................................................. 49 Sporanox ........................................................... 58 Standard supplements........................................ 38 Stavudine [D4T] ................................................. 56 Sulindac............................................................. 61 Sulphacetamide sodium ..................................... 60 Sulphur .............................................................. 60 Sumatriptan ........................................... 35, 49, 59 Sunscreens, proprietary ..................................... 56 Surgam .............................................................. 48 Symbicort Turbuhaler 100/6 ......................... 32, 49 Symbicort Turbuhaler 200/6 ......................... 32, 49 Symbicort Turbuhaler 400/12 ....................... 32, 49 Symmetrel ......................................................... 48 Synacthen Depot ................................................ 47 Synermox .......................................................... 47 T Tamoxifen citrate.......................................... 50, 59 Tamoxifen Sandoz........................................ 50, 59 Tasmar .............................................................. 48 Taxotere............................................................. 31 Temgesic ........................................................... 60 Teriparatide ........................................................ 16 Tetracosactrin .................................................... 47

Index

Pharmaceuticals and brands Thalidomide ................................................. 21, 37 Thalidomide Pharmion........................................ 37 Thalomid...................................................... 21, 37 Tiaprofenic acid ................................................. 48 Tobramycin.................................................. 47, 54 Tolcapone .......................................................... 48 Tramadol hydrochloride...................................... 48 Triamcinolone acetonide .................................... 46 Triclosan............................................................ 18 Two Cal HN........................................................ 44 V Vancomycin hydrochloride ..................... 26, 47, 54 Vannair .............................................................. 49 Varenicline tartrate ............................................. 30 Velcade.................................................. 19, 21, 35 Venlafaxine .................................................. 15, 63 Viagra ................................................................ 45 Vimpat ............................................................... 20 Vitamins ............................................................ 22 Vivonex Pediatric................................................ 41 X XP Analog LCP ................................................... 60 Xylocaine ........................................................... 57 Xylocaine Viscous .............................................. 30 Z Zapril ........................................................... 18, 61 Zerit ................................................................... 56 Zetop ................................................................. 48 Ziagen................................................................ 50 Zofran ................................................................ 58 Zofran Zydis ........................................... 37, 50, 56 Zoledronic acid .................................................. 28 Zopiclone ........................................................... 48 Zyprexa Relprevv ................................................ 17

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

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

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

Metadata

Title

Schedule Update - effective 1 August 2011

Abstract

Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 August 2011 Cumulative for May, June, July and August 2011 Section H for August 2011 Contents Summary of PHARMAC decisions effective 1 August 2011 …. 3 Mental health medication brand…

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