Schedule Update - effective 1 October 2011 (text extract)

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Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 October 2011

Cumulative for September and October 2011 Section H cumulative for August, September and October 2011

Contents

Summary of PHARMAC decisions effective 1 October 2011 .......................... 3 Special Authority approvals by dietitians....................................................... 5 Close Control rule amendment...................................................................... 5 Trastuzumab and sunitinib – amended Special Authority criteria .................. 6 Acitretin – alternate brand listed ................................................................... 6 Extension of varenicline Special Authority approval period ........................... 6 Clarithromycin tablets - pharmacist approval to substitute ........................... 7 Timolol maleate eye drops 0.25% - amended listing date ............................. 7 Digoxin mid month listing of alternate pack sizes ......................................... 8 New Listing – Fluconazole 50 mg capsules .................................................... 8 Sustanon – out-of-stock situation ................................................................. 8 News in Brief ................................................................................................. 9 Tender News ................................................................................................ 10 Looking Forward ......................................................................................... 10 Sole Subsidised Supply products cumulative to October 2011 .................... 11 New Listings ................................................................................................ 20 Changes to Restrictions ............................................................................... 22 Changes to Subsidy and Manufacturer’s Price............................................. 40 Changes to General Rules............................................................................ 44 Changes to Brand Name ............................................................................. 47 Changes to Sole Subsidised Supply ............................................................. 48 Delisted Items ............................................................................................. 49 Items to be Delisted .................................................................................... 51 Section H changes to Part II ........................................................................ 53 Section H changes to Part III........................................................................ 60 Section H changes to General Rules ............................................................ 60 Index ........................................................................................................... 63

Summary of PharmaC decisions

effeCtIve 1 OCtOber 2011 New listings (page 20) • Losartan (Lostaar) tab 12.5 mg, 25 mg, 50 mg and 100 mg – Special Authority – Retail pharmacy • Losartan with hydrochlorothiazide (Arrow-Losartan & Hydrochlorothiazide) tab 50 mg with hydrochlorothiazide 12.5 mg – Special Authority – Retail Pharmacy • Acitretin (Novatretin) cap 10 mg and 25 mg – Special Authority – Retail pharmacy • Levothyroxine (Synthroid) tab 25 μg and 50 μg, 90 tab pack • Clarithromycin (Apo-Clarithromycin) tab 250 mg – Maximum of 500 mg per prescription; can be waived by Special Authority • Ciprofloxacin (Cipflox) tab 250 mg and 500 mg – Up to 5 tab available on a PSO • Ciprofloxacin (Cipflox) tab 750 mg – Retail pharmacy-Specialist • Fluconazole (Ozole) cap 50 mg – Retail pharmacy-Specialist • Allopurinol (Apo-Allopurinol) tab 100 mg, 1,000 tab pack, and tab 300 mg, 500 tab pack • Paracetamol (Ethics Paracetamol) oral liq 120 mg per 5 ml – up to 200 ml available on PSO – Not in combination • Timolol maleate (Arrow-Timolol) eye drops 0.25%, 5 ml OP Changes to restrictions (pages 22-27) • Varenicline tartrate (Champix) tab 0.5mg and tab 1 mg – amended Special Authority approval period • Sunitinib (Sutent) cap 12.5 mg, 25 mg and 50 mg – amended Special Authority criteria • Trastuzumab inj 150 mg and 440 mg vial (Herceptin), and 1 mg for ECP (Baxter) – amended Special Authority criteria • Special Foods and multivitamin Special Authority forms – addition of dietitian applicant type • Oral Feed (Ensure Plus, Fortisip, Fortisip Multi Fibre and Two Cal HN) – removal of repeat rule • Clarithromycin (Klacid) tab 500 mg – removal of maximum 14 tab per prescription and amended endorsement (effective 14 September 2011) Increased subsidy (page 40) • Sodium chloride (Multichem) inj 0.9%, 10 ml • Betamethasone valerate (Beta Cream and Beta Ointimet) crm 0.1% and oint 0.1% • Co-trimoxazole (Trisul) tab trimethoprim 80 mg and sulphamethoxazole 400 mg

Summary of PharmaC decisions – effective 1 September 2011 (continued) • Dothiepin hydrochloride (Dopress) tab 75 mg and cap 25 mg Decreased subsidy (page 40) • Omeprazole (Dr Reddy’s Omeprazole) cap 10 mg, 20 mg and 40 mg • Budesonide (Budenocort) powder for inhalation 200 μg per dose and 400 μg per dose

Pharmaceutical Schedule - Update News

Special Authority approvals by dietitians

From 1 October 2011 dietitians will be able to complete initial and renewal applications for Special Authority approvals for patients under their care. Dietitians will only be able to apply for Special Authorities for Special Foods listed in Section D of the Pharmaceutical Schedule and multivitamins (Paediatric Seravit) powder and vitamins (Vitabdeck) cap (fat soluble vitamins A, D, E K). At this stage only manual (paper) applications will be able to be processed. It is anticipated that later this year dietitians will be able to complete electronic Special Authority applications. General Practitioners may reapply for Special Authority renewals for their patients on the recommendation of a dietitian. General Practitioners must include the name of the dietitian and the date contacted on the Special Authority renewal. There are no changes for vocationally registered General Practitioners.

Close Control rule amendment

The Close Control rule in the Pharmaceutical Schedule will be amended from 1 October 2011. PHARMAC and DHBs consulted on proposed changes to the Close Control Rule in February 2011. The resulting changes to the Close Control Rule are relatively minor, and are as follows: • Removing the need to write “Close Control” or “CC” for monthly dispensing into Community Residential Care and Age Related Residential Care provided the patient’s NHI and name of the institution or facility is included on the prescription. • Allowing patients in Age Related Residential Care or Community Residential Care to have an initial trial period (determined by the prescriber) for new medicines or a change of dose. This is a new issue raised during the consultation process. • Differentiating the use of Trial Close Control (a one-off shorter dispensing period for new medicines or a change in dose) from ongoing Close Control by annotating the prescription with “Close Control Trial”, “CCT” or “Trial Period” and also noting the period of supply specified. • Amending the format of the current Close Control rule definition to make it easier to read. These changes will be effective from 1 October 2011. All other aspects of the Close Control Rule remain the same.

Pharmaceutical Schedule - Update News

Trastuzumab and sunitinib – amended Special Authority criteria

Some minor amendments have been made to the Special Authority criteria applying to trastuzumab and sunitinib from 1 October 2011. The changes are for clarification purposes and are expected to reduce confusion and administrative burden for prescribers and pharmacists; they are not expected to materially change the funded access to either of these pharmaceuticals. Please refer to pages 22-23 for further information.

Acitretin – alternate brand listed

An alternate brand of acitretin (Novatretin) 10 mg and 25 mg capsules will be subsidised from 1 October 2011. A valid Special Authority approval will be required for patients to gain subsidy. The Neotigason brand of acitretin capsules will remain subsidised at its current subsidies until 1 July 2012.

Extension of varenicline Special Authority approval period

PHARMAC has received a number of requests to grant additional Special Authority approvals for varenicline where the original Special Authority expired prior to the patient’s full course of medication being dispensed. In most of these cases the patient’s prescription was also no longer valid to access subsidy as more than 90 days had passed, but by the time a new prescription was issued the Special Authority had expired. Hence, the expiry date of the Special Authority approval will be extended from three to five months from 1 October 2011 to give patients in this situation more time to return to their clinician and get another prescription before the Special Authority expires. This change does not extend the subsidised length of treatment, which remains at a maximum of 3 months’ subsidy for each Special Authority approval.

Pharmaceutical Schedule - Update News

Clarithromycin tablets - pharmacist approval to substitute

Due to stock shortages on clarithromycin (Klacid and Klamycin) 250 mg tablets, pharmacists were approved to substitute the clarithromycin 500 mg tablets for the 250 mg tablets from 14 September 2011 until further notice. Prescriptions need to be annotated by the pharmacist and will need to be endorsed accordingly. Please refer to the PHARMAC facsimile of 14 September 2011 located on the PHARMAC website for further details. (www.pharmac.govt.nz) The listing date of Apo-Clarithromycin 250 mg tablets has been brought forward to 1 October 2011. We have been informed that Apotex’s stock will be available from mid October.

Timolol maleate eye drops 0.25% - amended listing date

The listing date for timolol maleate (ArrowTimolol) eye drops 0.25%, 5 ml OP, has been brought forward one month to 1 October 2011. PHARMAC notified the market in April 2011, via a Tender notification fax, that it would be listed from 1 November 2011. This earlier listing will allow subsidy earlier and avoid a potential out-of-stock, as the incumbent supplier, Apotex (NZ) Ltd, is low on stock of timolol maleate eye drops 0.25%, 5 ml OP. The rest of the transition timelines for timolol maleate (Arrow-Timolol) eye drops 0.25%, 5 ml OP, remain unchanged from those previously notified. Arrow-Timolol eye drops 0.5%, 5 ml OP will subsidised from 1 November 2011 as previously notified.

Pharmaceutical Schedule - Update News

Digoxin mid month listing of alternate pack sizes

New pack sizes of digoxin tablets 62.5 µg and 250 µg (Lanoxin PG and Lanoxin) were fully subsidised from 9 September 2011. The new pack sizes being a 200 tablet bottle for Lanoxin PG 62.5 µg and a 100 tablet blister pack for the Lanoxin are subsidised in addition to those currently subsidised. These packs may be particularly useful for patients who have difficulty removing tablets from the current blister packs.

New Listing – Fluconazole 50 mg capsules

The listing date of Douglas’ fluconazole 50 mg capsules, Ozole, has been brought forward from 1 November 2011 to 1 October 2011. The reference price, delisting and sole supply dates remain unchanged. This earlier listing will allow subsidy earlier and avoid a potential out-of-stock, as the incumbent supplier, Mylan, is low on stock. We have been informed that Douglas’ stock will be available from 1 October 2011.

Sustanon – out-of-stock situation

Due a global manufacturing issue Sustanon ampoules (testosterone esters) will be out-of-stock until late 2011. Merck Sharpe and Dohme (MSD) are handling this situation with the help of Pzifer’s DepoTestosterone (testosterone cypionate) long-acting injection. Please note that Depo-Testosterone is a 10 ml multi-dose vial containing 100 mg per ml (1000 mg per vial) of testosterone cypionate. Full prescribing information is available on the Medsafe website at: http://www. medsafe.govt.nz/profs/datasheet/d/ Depotestosteroneinj.pdf For more information and assistance contact MSD’s Medical Services Manager Mischa Winnard on (09) 523-6107.

Pharmaceutical Schedule - Update News

News in Brief

• Levothryroxine (Synthroid) 25 µg and 50 µg tablets will be supplied in a 90 tablet pack size from 1 October 2011. The 1,000 tablet pack sizes will remain listed until supply is exhausted and the delisting of these pack sizes will be notified via the Update. • Due to a delay in the production of stock for the New Zealand market, the listing of all strengths of pramipexole hydrochloride (Dr Reddy’s Pramipexole) tablets has been delayed until further notice. • Mylan has increased the price of its sulindac (Daclin) tablets 100 mg and 200 mg from 12 October 2011. The subsidy for these presentations is not increasing to match the price. However, patients with a valid Special Authority approval will continue to access sulindac fully subsidised.

tender News

Sole Subsidised Supply changes – effective 1 November 2011

Chemical Name Amlodipine Amlodipine Dipyridamole Ibuprofen Iron polymaltose Morphine sulphate Morphine sulphate Morphine sulphate Morphine sulphate Oxazepam Oxazepam Presentation; Pack size Tab 5 mg; 100 tab Tab 10 mg; 100 tab Tab long-acting 150 mg; 60 tab Tab long-acting 800 mg; 30 tab Inj 50 mg per ml, 2 ml; 5 inj Tab long-acting 10 mg; 10 tab Tab long-acting 30 mg; 10 tab Tab long-acting 60 mg; 10 tab Tab long-acting 100 mg; 10 tab Tab 10 mg; 100 tab Tab 15 mg; 100 tab Sole Subsidised Supply brand (and supplier) Apo-Amlodipine (Apotex) Apo-Amlodipine (Apotex) Pytazen SR (Douglas) Brufen SR (Abbott) Ferrum H (Aspen) Arrow-Morphine LA (Arrow) Arrow-Morphine LA (Arrow) Arrow-Morphine LA (Arrow) Arrow-Morphine LA (Arrow) Ox-Pam (Douglas) Ox-Pam (Douglas)

Looking forward

This section is designed to alert both pharmacists and prescribers to possible future changes to the Pharmaceutical Schedule. It may also assist pharmacists, distributors and wholesalers to manage stock levels. Possible decisions for implementation 1 November 2011 • Atorvastatin (Dr Reddy’s Atorvastatin) tab 10 mg, 20 mg and 40 mg and 80 mg – New listing • Pravastatin (Cholvastin and Pravachol) tab 10 mg , 20 mg and 40 mg – removal of Special Authority for Subsidy

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Abacabir sulphate Acarbose Aciclovir Amantadine hydrochloride 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 Cap 100 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 Crm Tab 100 mg Tab 100 mg Tab dispersible 300 mg Tab 50 mg & 100 mg Inj 600 µg, 1 ml Tab 50 mg Inj 50 mg Tab 500 mg Tab 10 mg Tab 2.5 mg & 5 mg Scalp app 0.1% Eye drops 0.5% Eye drops 0.25% Tab 5 mg Crm, aqueous, BP Lotn, BP Inj 100 iu per ml, 1 ml 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

Brand Name Expiry Date*

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

Aqueous cream Ascorbic acid Aspirin Atenolol Atropine sulphate Azathioprine Azithromycin Baclofen Bendrofluazide Betamethasone valerate Betaxolol hydrochloride Bisacodyl Calamine Calcitonin Calcitriol Captopril Cefaclor monohydrate Ceftriaxone sodium

AFT Vitala-C Ethics Aspirin EC Ethics Aspirin Atenolol Tablet USP AstraZeneca Imuprine Imuran Arrow-Azithromycin Pacifen ArrowBendrofluazide Beta Scalp Betoptic Betoptic S Lax-Tab healthE API Miacalcic Airflow m-Captorpril Capoten Ranbaxy-Cefaclor Veracol Aspen Ceftriaxone

2014 2013 2013 2012 2012 2013 2012 2012 2014 2012 2014 2013 2012 2014 2012 2013 2013 2013

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

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Cephalexin monohydrate Cetomacrogol Cetirizine hydrochloride Chloramphenicol Chlorhexidine gluconate Ciclopiroxolamine Cilazapril Cilazapril with hydrochlorothiazide Citalopram hydrobromide Clobetasol propionate

Presentation

Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Crm BP Tab 10 mg Eye drops 0.5% Eye oint 1% Soln 4% Handrub 1% with ethanol 70% Nail soln 8% Tab 0.5 mg, 2.5 mg & 5 mg Tab 5 mg with hydrochlorothiazide 12.5 mg Tab 20 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 Powder for soln for oral use 4.4 g Crm 10% Tab 50 mg Tab 50 mg Tab 50 mg & 100 mg Tab 2 mg with ethinyloestradiol 35 μg and 7 inert tabs Nasal spray 10 μg per dose Eye oint 0.1% Eye drops 0.1% Inj 4 mg per ml, 1 ml & 2 ml

Brand Name Expiry Date*

Cefalexin Sandoz Cefalexin Sandoz PSM Zetop Chlorafast Chlorsig Orion healthE Batrafen Zapril Inhibace Plus Arrow-Citalopram Dermol Dermol Dermol Catapres-TTS-1 Catapres-TTS-2 Catapres-TTS-3 Catapres Dixarit Catapres Apo-Clopidogrel Clomazol Clomazol Midwest Colgout Electral Itch-Soothe Nausicalm Cycloblastin Siterone Ginet 84 DesmopressinPH&T Maxidex Maxidex Hospira 2012 2013 2014 2012 2014 2012 2012 2013 2013 2014 2012

Clonidine

2012

Clonidine hydrochloride

2012

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

2013 2013 2013 2013 2013 2012 2012 2013 2012 2014 2014 2014 2013 2013

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Dexamethasone with neomycin and polymyxin b sulphate

Presentation

Eye oint 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per g Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml Inj 50%, 10 ml Soln with electrolytes

Brand Name Expiry Date*

Maxitrol Maxitrol 2014

Dextrose Dextrose with electrolytes

Biomed Pedialyte – Fruit Pedialyte – Bubblegum Pedialyte – Plain Voltaren Voltaren Ophtha Voltaren Diclofenac Sandoz DHC Continus Dilzem Cardizem CD Laxofast 50 Laxofast 120 Laxsol Donepezil-Rex Apo-Doxazosin Doxine AFT Arrow-Enalapril Clexane Comtan E-Mycin Loxalate NZ Medical and Scientific Arrow-Etidronate Aromasin Felo 5 ER Felo 10 ER Mylan Fentanyl Patch

2014 2013

Diclofenac sodium

Inj 25 mg per ml, 3 ml Eye drops 1 mg per ml Suppos 12.5 mg, 25 mg, 50 mg & 100 mg 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 Cap 50 mg Cap 120 mg Tab 50 mg with total sennosides 8 mg Tab 5 mg & 10 mg Tab 2 mg & 4 mg Tab 100 mg Oint BP Tab 5 mg, 10 mg & 20 mg Inj 20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg & 150 mg Tab 200 mg Tab 400 mg 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

2014

2012 2013 31/12/11

Dihydrocodeine tartrate Diltiazem hydrochloride

Docusate sodium Docusate sodium with sennosides Donepezil hydrochloride Doxazosin mesylate Doxycycline hydrochloride Emulsifying ointment Enalapril Enoxaparin sodium (low molecular weight heparin) Entacapone Erythromycin ethyl succinate Escitalopram Ethinyloestradiol Etidronate disodium Exemestane Felodipine Fentanyl

2014 2013 2012 2014 2014 2014 2012 2012 2012 2012 2013 2012 2012 2014 2012 2013

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Fentanyl citrate Ferrous sulphate Flucloxacillin sodium

Presentation

Inj 50 μg per ml, 2 ml & 10 ml 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 Tab 80 mg Liquid TDDS 5 mg & 10 mg Tab 600 μg 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% Lotn 1% with wool fat hydrous 3% and mineral oil Inj 1 mg per ml, 1 ml Tab 200 mg Tab 10 mg Oral liq 100 mg per 5 ml Tab 2.5 mg

Brand Name Expiry Date*

Boucher and Muir Ferodan AFT AFT AFT FML Fluox Fluox Flutamin Flixonase Hayfever & Allergy Frusemide-Claris Diurin 40 Foban Foban Nupentin Lipazil Pfizer Apo-Gliclazide healthE Nitroderm TTS Lycinate Serenace Serenace Serenace Solu-Cortef Douglas Colifoam Micreme H DP Lotn HC ABM Hydroxocobalamin Plaquenil Gastrosoothe Fenpaed Dapa-Tabs 2012 2013 2012

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

2012 2013 2013 31/1/13 2013 2012 2013 31/7/12 2013 2012 2014 2013 2014 2013

Hydrocortisone Hydrocortisone acetate Hydrocortisone with miconazole Hydrocortisone with wool fat and mineral oil Hydroxocobalamin Hydroxychloroquine sulphate Hyoscine N-butylbromide Ibuprofen Indapamide

2013 2012 2012 2013 2014 2012 2012 2014 2013 2013

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Ipratropium bromide

Presentation

Aqueous nasal spray, 0.03%, 15 ml OP 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 Shampoo 2% 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) Viscous soln 2% 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 Eye drops 0.1% Cap 2 mg Oral liq 1 mg per ml Tab 10 mg Tab 1 mg & 2.5 mg Liq 0.5% Shampoo 1% Tab 135 mg Tab 160 mg Tab 50 mg Suppos 500 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

Brand Name Expiry Date*

Univent Univent Ismo 20 Corangin Oratane Itrazole Sebizole Laevolac 3TC 3TC Hysite Letara Jadelle Xylocaine Viscous Xylocaine EMLA EMLA Arrow-Lisinopril Lomide Diamide Relief Lorapaed Loraclear Hayfever Relief Ativan A-Lices A-Lices Colofac Apo-Megestrol Purinethol Asacol Pentasa Apotex Methatabs Biodone Biodone Forte Biodone Extra Forte 2012 2014 2013 2013 2014 2012 2013 2014 2013 2013 2012 2012 31/12/13 2014 2013 2013 2013

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

Lisinopril Lodoxamide trometamol Loperamide hydrochloride Loratadine

Lorazepam Malathion Mebeverine hydrochloride Megestrol acetate Mercaptopurine Mesalazine Metformin hydrochloride Methadone hydrochloride

2013 2013 2014 2012 2013 2014 2012 2012 2013 2012

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Methotrexate Methylprednisolone Methylprednisolone sodium succinate

Presentation

Inj 25 mg per ml, 2 ml & 20 ml Tab 2.5 mg & 10 mg 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 Inj 5 mg per ml, 2 ml 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 Eye drops 0.1% Tab 250 mg Tab 500 mg Tab 50 mg Inj 2.5 mg per ml, 1 ml Oral suspension 10 mg per ml Tab 200 mg

Brand Name Expiry Date*

Hospira Methoblastin Medrol Solu-Medrol Solu-Medrol Solu-Medrol Solu-Medrol Pfizer Metamide Apo-Moclobemide m-Mometasone m-Mometasone RA-Morph RA-Morph RA-Morph RA-Morph m-Elson Sevredol Hospira Konsyl-D Naphcon Forte Noflam 250 Noflam 500 Naltraccord AstraZeneca Viramune Suspension Viramune Habitrol Habitrol Habitrol Apo-Nicotinic Acid Arrow-Norfloxacin Noriday 28 Nilstat Nilstat Nilstat Midwest Dr Reddy’s Omeprazole 2014 2014 2012 2014 2013 2014 2013 2012 2012 2012

Metoclopramide hydrochloride Moclobemide Mometasone furoate Morphine hydrochloride

2014 2012 2012 2012

Morphine sulphate

2013 2012 2013 2013 2014 2012 2013 2014 2012

Morphine tartrate Mucilaginous laxatives Naphazoline hydrochloride Naproxen Natrexone hydrochloride Neostigmine Nevirapine

Nicotine

Gum 2 mg & 4 mg (classic, fruit, mint) Lozenge 1 mg & 2 mg Patch 7 mg, 14 mg & 21 mg Tab 50 mg & 500 mg Tab 400 mg Tab 350 µg Oral liq 100,000 u per ml Cap 500,000 u Tab 500,000 u Powder Inj 40 mg

2014

Nicotinic acid Norfloxacin Norethisterone Nystatin

Omeprazole

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Ondansetron

Presentation

Tab disp 4 mg & 8 mg Tab 4 mg & 8 mg

Brand Name Expiry Date*

Dr Reddy’s Ondansetron Dr Reddy’s Ondansetron Syntocinon Syntocinon Syntometrine Pantocid IV Dr Reddy’s Pantoprazole Paracare Double Strength Lacri-Lube Loxamine Pegasys Pegasys Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Pegasys RBV Combination Pack Permax Lyderm A-Scabies Cilicaine VK AFT AFT Apo-Pindolol Pizaccord Sandomigran Coloxyl Span-K Redipred Innovacon hCG One Step Pregnancy Test Promethazine Winthrop Elixir 2012 2012 2012 2014 2012 2012 2012 2012 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 Inj 40 mg Tab 20 mg & 40 mg Oral liq 250 mg per 5 ml Eye oint with soft white paraffin Tab 20 mg Inj 135 µg prefilled syringe Inj 180 µg prefilled syringe Inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 Inj 135 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 Inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 112 Inj 180 µg prefilled syringe x 4 with ribavirin tab 200 mg x 168 Tab 0.25 mg & 1 mg Crm 5% Lotn 5% Cap potassium salt 250 mg & 500 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 250 mg per 5 ml Tab 5 mg, 10 mg & 15 mg Tab 15 mg, 30 mg & 45 mg Tab 500 µg Oral drops 10% Tab long-acting 600 mg Oral liq 5 mg per ml Cassette Oral liq 5 mg per 5 ml

2012

Pantoprazole

2014 2013 2014 2013 2013 31/12/12

Paracetamol Paraffin liquid with soft white paraffin Paroxetine hydrochloride Pegylated interferon alpha-2A

Pergolide Permethrin Phenoxymethylpenicillin (Pencillin V)

2014 2014 2013

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

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Pyridostigmine bromide Pyridoxine hydrochloride Quinine sulphate Ranitidine hydrochloride Rifabutin Ropinirole hydrochloride Roxithromycin Salbutamol

Presentation

Tab 60 mg Tab 25 mg Tab 50 mg Tab 300 mg Oral liq 150 mg per 10 ml Tab 150 mg & 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 Tab 10 mg Tab 20 mg Tab 40 mg Tab 80 mg Inj 23.4%, 20 ml Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml Grans effervescent 4 g sachets Eye drops 2% Nasal spray, 4% Inj cartridge 16 iu (5.3 mg) Inj cartridge 36 iu (12 mg) Tab 80 mg & 160 mg Tab 25 mg & 100 mg Inj 12 mg per ml, 0.5 ml Tab 50 mg & 100 mg Tab 20 mg Cap 400 µg Tab 1 mg, 2 mg & 5 mg Cap 40 mg Inj 250 μg Inj 1 mg per ml, 1 ml

Brand Name Expiry Date*

Mestinon PyridoxADE Apo-Pyridoxine Q 300 Peptisoothe Arrow-Ranitidine Mycobutin Ropin ArrowRoxithromycin Salapin Asthalin Asthalin Duolin 2014 2014 2012 2014 2013 2013 2012 2013 2012 2012

Salbutamol with ipratropium bromide Selegiline hydrochloride Sertraline Simvastatin

Apo-Selegiline Arrow-Sertraline Arrow-Simva 10mg Arrow-Simva 20mg Arrow-Simva 40mg Arrow-Simva 80mg Biomed Micolette Ural Rexacrom Rex Genotropin Genotropin Mylan Spirotone Arrow-Sumatriptan Arrow-Sumatriptan Genox Tamsulosin-Rex Arrow Arrow-Testosterone Synacthen Synacthen Depot

2012 2013 2014

Sodium chloride Sodium citrate with sodium lauryl sulphoacetate Sodium citro-tartrate Sodium cromoglycate Somatropin Sotalol Spironolactone Sumatriptan Tamoxifen citrate Tamsulosin hydrochloride Terazosin hydrochloride Testosterone undecanoate Tetracosactrin

2013 2013 2013 2013 2012 31/12/12 2012 2013 2013 2014 2013 2013 2012 2014

Sole Subsidised Supply Products – cumulative to October 2011

Generic Name

Timolol maleate Tobramycin

Presentation

Tab 10 mg Eye drops 0.3% Eye oint 0.3% Inj 40 mg per ml, 2 ml Tab 100 mg Cap 50 mg Crm 0.02% Oint 0.02% 0.1% in Dental Paste USP Tab 500 mg Eye drops 0.5% & 1% Cap 5 mg Eye drops 0.25% Inj 500 mg Tab 40 mg & 80 mg Tab, strong, BPC Tab (BPC cap strength) Cap 100 mg Oral liq 10 mg per ml Tab 7.5 mg

Brand Name Expiry Date*

Apo-Timol Tobrex Tobrex DBL Tobramycin Tasmar Arrow-Tramadol Aristocort Aristocort Oracort Cycklokapron Mydriacyl Navoban Enuclene Mylan Isoptin B-PlexADE MultiADE Retrovir Retrovir Apo-Zopiclone 2012 2014

Tolcapone Tramadol hydrochloride Triamcinolone acetonide

2014 2014 2014

Tranexamic acid Tropicamide Tropisetron Tyloxapol Vancomycin hydrochloride Verapamil hydrochloride Vitamin B complex Vitamins Zidovudine [AZT] Zopiclone October changes in bold

2013 2014 2012 2014 2014 2014 2013 2013 2013 2014

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Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings

Effective 1 October 2011

49 LOSARTAN – Special Authority see SA0911 – Retail pharmacy ❋ Tab 12.5 mg ............................................................................ 2.88 ❋ Tab 25 mg ............................................................................... 3.20 ❋ Tab 50 mg ............................................................................... 5.22 Tab 50 mg with hydrochlorothiazide 12.5 mg ............................ 4.89 ❋ Tab 100 mg ............................................................................. 8.68 ACITRETIN – Special Authority see SA0954 – Retail pharmacy Cap 10 mg ............................................................................. 38.66 Cap 25 mg ............................................................................. 83.11 LEVOTHYROXINE ❋ Tab 25 µg ................................................................................ 3.89 ‡ Safety cap for extemporaneously compounded oral liquid preparations. ❋ Tab 50 µg ................................................................................ 4.05 ‡ Safety cap for extemporaneously compounded oral liquid preparations. 90 90 90 30 90 60 60 90 90 ✔ Lostaar ✔ Lostaar ✔ Lostaar ✔ Arrow-Losartan & Hydrochlorothiazide ✔ Lostaar ✔ Novatretin ✔ Novatretin ✔ Synthroid ✔ Synthroid

76 80 82

CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA1131 Tab 250 mg ............................................................................. 4.19 14 ✔ Apo-Clarithromycin CIPROFLOXACIN Tab 250 mg – Up to 5 tab available on a PSO ............................ 2.20 Tab 500 mg – Up to 5 tab available on a PSO ............................ 3.00 Tab 750 mg – Retail pharmacy-Specialist ................................. 5.15 FLUCONAZOLE Cap 50 mg – Retail pharmacy-Specialist ................................... 4.77 ALLOPURINOL ❋ Tab 100 mg ........................................................................... 15.90 ❋ Tab 300 mg ........................................................................... 16.75 PARACETAMOL ❋‡ Oral liq 120 mg per 5 ml ......................................................... 2.21 a) Up to 200 ml available on a PSO b) Not in combination TIMOLOL MALEATE ❋ Eye drops 0.25% ...................................................................... 2.08 28 28 28 28 1,000 500 500 ml ✔ Cipflox ✔ Cipflox ✔ Cipflox ✔ Ozole ✔ Apo-Allopurinol ✔ Apo-Allopurinol ✔ Ethics Paracetamol

84 112 115

167

5 ml OP

✔ Arrow-Timolol

Effective 9 September 2011

49 DIGOXIN ❋ Tab 62.5 µg – Up to 30 tab available on a PSO .......................... 5.56 ❋ Tab 250 µg – Up to 30 tab available on a PSO ........................... 6.05 200 100 ✔ Lanoxin PG ✔ Lanoxin

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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New Listings - effective 1 September 2011

45 PRAVASTATIN – Special Authority see SA0932 – Retail pharmacy See prescribing guideline Tab 20 mg ............................................................................... 5.44 Tab 40 mg ................................................................................ 9.28 CANDESARTAN – Special Authority see SA0933 – Retail pharmacy ❋ Tab 4 mg – No more than 1.5 tab per day ............................... 48.66 ❋ Tab 8 mg – No more than 1.5 tab per day ................................ 57.90 ❋ Tab 16 mg – No more than 1 tab per day ................................. 70.62 ❋ Tab 32 mg – No more than 1 tab per day .............................. 115.50 FINASTERIDE – Special Authority see SA0928 – Retail pharmacy Tab 5 mg ................................................................................. 5.10 LEVOTHYROXINE ❋ Tab 100 µg .............................................................................. 4.21 ‡ Safety cap for extemporaneously compounded oral liquid preparations. TERBINAFINE Tab 250 mg ............................................................................. 1.78 30 30 90 90 90 90 30 90 ✔ Cholvastin ✔ Cholvastin ✔ Candestar ✔ Candestar ✔ Candestar ✔ Candestar ✔ Rex Medical ✔ Synthroid

48 70 76 84

✔ Dr Reddy’s Terbinafine

96 153

MEFENAMIC ACID – Additional subsidy by Special Authority see SA1038 – Retail pharmacy ❋ Cap 250 mg ............................................................................. 1.25 50 (9.16) Ponstan BICALUTAMIDE – Special Authority see SA0941 – Retail pharmacy Tab 50 mg .............................................................................. 10.00 28 ✔ Bicalaccord

▲

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

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

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Changes to Restrictions

Effective 1 October 2011

139 VARENICLINE TARTRATE – Special Authority see SA1161 1135 – 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 ➽ SA1161 1135 Special Authority for Subsidy Initial application from any relevant practitioner. Approvals valid for 5 3 months for applications meeting the following criteria: All of the following: 1 Short-term therapy as an aid to achieving abstinence in a patient who has indicated that they are ready to cease smoking; and 2 The patient is part of, or is about to enrol in, a comprehensive support and counselling smoking cessation programme, which includes prescriber or nurse monitoring; and 3 Either: 3.1 The patient has tried but failed to quit smoking after at least two separate trials of nicotine replacement therapy, at least one of which included the patient receiving comprehensive advice on the optimal use of nicotine replacement therapy; or 3.2 The patient has tried but failed to quit smoking using bupropion or nortriptyline; and 4 The patient has not used funded varenicline in the last 12 months; and 5 Varenicline is not to be used in combination with other pharmacological smoking cessation treatments and the patient has agreed to this; and 6 The patient is not pregnant; and 7 The patient will not be prescribed more than 3 months’ funded varenicline (see note). Renewal from any relevant practitioner. Approvals valid for 5 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. 152 SUNITINIB – Special Authority see SA1162 1055 – Retail pharmacy Cap 12.5 mg ..................................................................... 2,315.38 Cap 25 mg ........................................................................ 4,630.77 Cap 50 mg ........................................................................ 9,261.54 28 28 28 ✔ Sutent ✔ Sutent ✔ Sutent

➽ SA1162 1055 Special Authority for Subsidy Initial application only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 The patient has metastatic renal cell carcinoma; and 2 Either 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 October 2011 (continued)

continued... 3 4 5 2.1 The patient is sunitinib treatment naive; or 2.2 The patient received sunitinib prior to 1 November 2010 and disease has not progressed; and The patient has good performance status (WHO/ECOG grade 0-12); and The disease is of predominant clear cell histology; and The patient has intermediate or poor prognosis based on the NCCN clinical practice guidelines for kidney cancer defined as: Any of the following: 5.1 Lactate dehydrogenase level > 1.5 times upper limit of normal; or 5.2 Haemoglobin level < lower limit of normal; or 5.3 Corrected serum calcium level > 10 mg/dL (2.5 mmol/L) ; or 5.4 Interval of < 1 year from original diagnosis to the start of systemic therapy; or 5.5 Karnofsky performance score of ≤ 70; or 5.6 ≥ 2 sites of organ metastasis; and Sunitinib to be used for a maximum of 2 cycles.

Renewal only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 No evidence of disease progression; and 2 The treatment remains appropriate and the patient is benefiting from treatment. Notes: Sunitinib treatment should be stopped if disease progresses. Poor prognosis patients are defined as having at least 3 of criteria 5.1-5.6. Intermediate prognosis patients are defined as having 1 or 2 of criteria 5.1-5.6 NCCN clinical practice guidelines for kidney cancer are available at http://www.nccn.org/professionals/ physician_gls/f_guidelines.asp 157 TRASTUZUMAB – PCT only – Specialist – Special Authority see SA1163 1017 Inj 150 mg vial .................................................................. 1,350.00 1 Inj 440 mg vial .................................................................. 3,875.00 1 Inj 1 mg for ECP ....................................................................... 9.36 1 mg ✔ Herceptin ✔ Herceptin ✔ Baxter

➽ SA1163 1017 Special Authority for Subsidy Initial application — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: where Both: 1 Tthe patient has metastatic breast cancer expressing HER-2 IHC 3+ or FISH+ (including FISH or other current technology); and 2 Trastuzumab to be discontinued at disease progression. Renewal — (metastatic breast cancer) only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 The cancer has not progressed at any time point during the previous 12 months whilst on trastuzumab. Initial application — (early breast cancer) 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: All of the following: 1 The patient has early breast cancer expressing HER 2 IHC 3+ or ISH + (including FISH or other current technology); and 2 Maximum cumulative dose of 106 mg/kg (12 months’ treatment); and continued...

▲

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

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

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continued... 3 Any of the following: 3.1 9 weeks’ concurrent treatment with adjuvant chemotherapy is planned; or 3.2 12 months’ concurrent treatment with adjuvant chemotherapy is planned; or 3.3 12 months’ sequential treatment following adjuvant chemotherapy is planned; or 3.4 Other treatment regimen, in association with adjuvant chemotherapy, is planned. Note: For patients with previous Special Authority approvals for a maximum cumulative dose of 20 mg/kg (9 weeks treatment) granted after 1 April 2009 the approval period has been extended to allow claims for a maximum cumulative dose of 106 mg/kg (12 months treatment). Renewal — (early breast cancer)* only from a relevant specialist or medical practitioner on the recommendation of a relevant specialist. Approvals valid for 12 months for applications meeting the following criteria: 1 The patient has metastatic breast cancer expressing HER-2 IHC 3+ or ISH+ (including FISH or other current technology); and 2 Either: 2.1 Both: 2.2.1 The patient received prior adjuvant trastuzumab treatment for early breast cancer; and 2.2.2 Trastuzumab to be discontinued at disease progression; or 2.2 The cancer has not progressed at any time point during the previous 12 months whilst on trastuzumab. Note: *For patients with relapsed HER-2 positive disease who have previously received adjuvant trastuzumab for early breast cancer. 178 SECTION D: SPECIAL FOODS EXPLANATORY NOTES Who can apply for Special Authority? Initial Applications:Only from a dietitian, relevant specialist or a vocationally registered general practitioner. Reapplications: Only from a dietitian, relevant specialist or a vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or a vocationally registered general practitioner. Other general practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and the date contacted. All applications must be made on an official form available from the PHARMAC website www.pharmac.govt.nz. All applications must include specific details as requested on the form relating to the application. A supporting letter may be included if desired. Applications must be forwarded to: Ministry of Health Sector Services Private Bag 3015 WHANGANUI 4540 Freefax 0800 100 131 180 SPECIAL FOODS Special Foods – applies to all Special Authority application forms in Section D of the Pharmaceutical Schedule. Special Authority for Subsidy Initial application —only from a dietitian, relevant specialist or vocationally registered general practitioner. Renewal —only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, relevant specialist or vocationally registered general practitioner. General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and date contacted.

Changes to Restrictions - effective 1 October 2011 (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 October 2011 (continued)

196 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 Note – this is a change to the initial application criteria for transition from Old Form (SA0603) only. The remainder of the Special Authority criteria remains consistent with other Special Authority changes detailed above. ➽ SA1111 Special Authority for Subsidy Initial application — (Transition from Old Form (SA0603)) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, 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; and 4 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and the date contacted. 197 EXTENSIVELY HYDROLYSED FORMULA – Special Authority see SA1112 – Hospital pharmacy [HP3] Powder .................................................................................. 15.21 450 g OP ✔ Pepti Junior Gold 19.01 ✔ Pepti Junior Note – this is a change to the initial application criteria for transition from Old Form (SA0603) only. The remainder of the Special Authority criteria remains consistent with other Special Authority changes detailed above. ➽ SA1112 Special Authority for Subsidy Initial application — (Transition from Old Form (SA0603)) only from a dietitian, relevant specialist, vocationally registered general practitioner or general practitioner on the recommendation of a dietitian, 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 formula under Special Authority form SA0603; and 1.2 The infant is to be trialled on, or transitioned to, an extensively hydrolysed formula; and 1.3 General Practitioners must include the name of the dietitian, relevant specialist or vocationally registered general practitioner and the date contacted; or 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 dietitian, relevant specialist or vocationally registered general practitioner and the date contacted.

▲

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

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

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Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 October 2011 (continued)

191 ORAL FEED 1.5KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] a) Note - 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 (1.26) Fortisip Liquid (chocolate) – Higher subsidy of up to $1.33 per 237 ml with Endorsement .................................................................. 0.72 200 ml OP (1.26) Ensure Plus 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 (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 up to $1.33 per 237 ml with Endorsement ..................................................... 0.72 200 ml OP (1.26) Ensure Plus 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 .................................................................. 0.72 200 ml OP (1.26) Ensure Plus 0.85 237 ml OP (1.33) Ensure Plus 0.72 200 ml OP (1.26) Fortisip 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

193

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 October 2011 (continued)

192 ORAL FEED WITH FIBRE 1.5 KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] a) Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube. The prescription must be endorsed accordingly. b) Repeats for Fortisip Multi Fibre will be fully subsidised where the initial dispensing was before 1 April 2011. 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

Effective 14 September 2011

28 CLARITHROMYCIN Tab 500 mg – Subsidy by endorsement .................................. 23.30 14 ✔ Klamycin a) Maximum of 14 tab per prescription a) If the prescription is for clarithromycin 250 mg tablets and the prescription is dispensed from 14 September 2011 and the prescription meets the restrictions for clarithromycin 250 mg tablets then the prescription can be endorsed accordingly. b) Subsidised only if prescribed for helicobacter pylori eradication and prescription is endorsed accordingly. Note: the prescription is considered endorsed if clarithromycin is prescribed in conjunction with a proton pump inhibitor and either amoxycillin or metronidazole. Note: Pharmacists may endorse the prescription if it is prescribed for the 250 mg tablets and is for an amount of 500 mg or less, or has a valid Special Authority approval.

Effective 1 September 2011

26 BUDESONIDE Cap 3 mg – Special Authority see SA1155 0913 – Retail pharmacy ............................................................. 166.50 90 ✔ Entocort CIR

➽ SA1155 0913 Special Authority for Subsidy Initial application – (Crohn's disease) from any relevant practitioner. Approvals valid for 6 3 months for applications meeting the following criteria: Both: 1 Mild to moderate ileal, ileocaecal or proximal Crohn’s disease; and 2 Any of the following: 2.1 Diabetes; or 2.2 Cushingoid habitus; or 2.3 Osteoporosis where there is significant risk of fracture; or 2.4 Severe acne following treatment with conventional corticosteroid therapy; or 2.5 History of severe psychiatric problems associated with corticosteroid treatment; or 2.6 History of major mental illness (such as bipolar affective disorder) where the risk of conventional corticosteroid treatment causing relapse is considered to be high; or 2.7 Relapse during pregnancy (where conventional corticosteroids are considered to be contraindicated). Initial application – (collagenous and lymphocytic colitis (microscopic colitis)) from any relevant practitioner. Approvals valid for 6 months for patients with diagnosis of microscopic colitis (collagenous or lymphocytic colitis) by colonoscopy with biopsies. continued...

▲

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

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

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Changes to Restrictions - effective 1 September 2011 (continued)

continued... Initial application – (gut graft versus host disease) from any relevant practitioner. Approvals valid for 6 months for patients with gut graft versus host disease following allogenic bone marrow transplantation* Note: Indication marked with * is an Unapproved Indication. Renewal from any relevant practitioner. Approvals valid for 6 3 months where the treatment remains appropriate and the patient is benefiting from treatment. The patient may not have had more than 1 prior approval in the last year. Note: Clinical trials for Entocort CIR use beyond three months demonstrated no improvement in relapse rate. 81 BENZYLPENICILLIN SODIUM (PENICILLIN G) Inj 1 mega u Inj 600 mg – Up to 5 inj available on a PSO ............................................................................ 11.50

✔ Sandoz

ADALIMUMAB – Special Authority see SA1156 1059 – Retail pharmacy Inj 40 mg per 0.8 ml prefilled pen ....................................... 1,799.92 2 ✔ HumiraPen Inj 40 mg per 0.8 ml prefilled syringe ................................. 1,799.92 2 ✔ Humira ➽ SA1156 1059 Special Authority for Subsidy Initial application - (rheumatoid arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with at least two of the following (triple therapy): sulphasalazine, prednisone at a dose of at least 7.5 mg per day, azathioprine, intramuscular gold, or and hydroxychloroquine sulphate (at maximum tolerated doses); and 2.5 Either Any of the following: 2.5.1 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with therapy at the maximum tolerated dose of cyclosporin alone or in combination with another agent; or 2.5.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with intramuscular gold; or 2.5.3 Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate another agent; and 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 2.6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.7 Either: 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 September 2011 (continued)

continued... 2.7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months. Initial application — (Crohn’s disease) only from a gastroenterologist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient has severe active Crohn’s disease; and 2 Any of the following: 2.1 Patient has a Crohn’s Disease Activity Index (CDAI) score of greater than or equal to 300; or 2.2 Patient has extensive small intestine disease affecting more than 50 cm of the small intestine; or 2.3 Patient has evidence of short gut syndrome or would be at risk of short gut syndrome with further bowel resection; or 2.4 Patient has an ileostomy or colostomy, and has intestinal inflammation; and 3 Patient has tried but had an inadequate response to, or has experienced intolerable side effects from, prior systemic therapy with immunomodulators at maximum tolerated doses (unless contraindicated) and corticosteroids; and 4 Surgery (or further surgery) is considered to be clinically inappropriate. Initial application — (severe chronic plaque psoriasis) only from a dermatologist. Approvals valid for 4 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for severe chronic plaque psoriasis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for severe chronic plaque psoriasis; or 2 All of the following: 2.1 Either: 2.1.1 Patient has "whole body" severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 2.1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2.2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and 2.3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 2.4 The most recent PASI assessment is no more than 1 month old at the time of application. Note: "Inadequate response" is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. Initial application - (ankylosing spondylitis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 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 September 2011 (continued)

continued... 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for ankylosing spondylitis; or 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 Patient's ankylosing spondylitis has not responded adequately to treatment with two or more non steroidal anti-inflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist; and 2.5 Either: 2.5.1 Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following a score of at least 1 on each of the lumbar flexion and lumbar side flexion measurements of the Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober’s test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right); or 2.5.2 Patient has limitation of chest expansion by at least 2.5 cm below the following average normal values corrected for age and gender (see Notes); and 2.6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of initial application. Average normal chest expansion corrected for age and gender: 18-24 years - Male: 7.0 cm; Female: 5.5 cm 25-34 years - Male: 7.5 cm; Female: 5.5 cm 35-44 years - Male: 6.5 cm; Female: 4.5 cm 45-54 years - Male: 6.0 cm; Female: 5.0 cm 55-64 years - Male: 5.5 cm; Female: 4.0 cm 65-74 years - Male: 4.0 cm; Female: 4.0 cm 75+ years - Male: 3.0 cm; Female: 2.5 cm Initial application - (psoriatic arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for etanercept for psoriatic arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from etanercept; or 1.2.2 The patient has received insufficient benefit from etanercept to meet the renewal criteria for etanercept for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.3 Patient has tried and not responded to at least three months of sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses); and 2.4 Either: 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 15 active, swollen, tender joints; or continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy Unapproved medicine supplied under Section 29 ‡ safety cap reimbursed Sole Subsidised Supply

S29

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 September 2011 (continued)

continued... 2.5 2.4.2 Patient has persistent symptoms of poorly controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and Any of the following: 2.5.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months.

Renewal - (rheumatoid arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Either: 3.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 3.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 4 Either: 4.1 Adalimumab to be administered at doses no greater than 40 mg every 14 days; or 4.2 Patient cannot take concomitant methotrexate and requires doses of adalimumab higher than 40 mg every 14 days to maintain an adequate response. Renewal — (Crohn’s disease) only from a gastroenterologist or Practitioner on the recommendation of a gastroenterologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a gastroenterologist; or 1.2 Applicant is a Practitioner and confirms that a gastroenterologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Either: 2.1.1 CDAI score has reduced by 100 points from the CDAI score when the patient was initiated on adalimumab; or 2.1.2 CDAI score is 150 or less; or 2.2 Both: 2.2.1 The patient has demonstrated an adequate response to treatment but CDAI score cannot be assessed; and 2.2.2 Applicant to indicate the reason that CDAI score cannot be assessed; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Renewal — (severe chronic plaque psoriasis) only from a dermatologist or Practitioner on the recommendation of a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a dermatologist; or 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 September 2011 (continued)

continued... 1.2 Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Both: 2.1.1 Patient had "whole body" severe chronic plaque psoriasis at the start of treatment; and 2.1.2 Following each prior adalimumab treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-adalimumab treatment baseline value; or 2.2 Both: 2.2.1 Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and 2.2.2 Either: 2.2.2.1 Following each prior adalimumab treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 2.2.2.2 Following each prior adalimumab treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre adalimumab treatment baseline value; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Note: A treatment course is defined as a minimum of 12 weeks adalimumab treatment

Renewal — (ankylosing spondylitis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Following 12 weeks of adalimumab treatment, BASDAI has improved by 4 or more points from preadalimumab baseline on a 10 point scale, or by 50%, whichever is less; and 3 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 4 Adalimumab to be administered at doses no greater than 40 mg every 14 days. Renewal - (psoriatic arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with adalimumab treatment; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 2.2 The patient demonstrates at least a continuing 50% 30% improvement in active joint count from baseline and a clinically significant response to prior adalimumab treatment in the opinion of the treating physician; and 3 Adalimumab to be administered at doses no greater than 40 mg every 14 days

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 September 2011 (continued)

102 ETANERCEPT – Special Authority see SA1157 1060 – Retail pharmacy Inj 25 mg .............................................................................. 949.96 Inj 50 mg autoinjector ......................................................... 1,899.92 Inj 50 mg prefilled syringe................................................... 1,899.92 4 4 4 ✔ Enbrel ✔ Enbrel ✔ Enbrel

➽ SA1157 1060 Special Authority for Subsidy Initial application - (juvenile idiopathic arthritis) only from a named specialist or rheumatologist. Approvals valid for 4 months for applications meeting the following criteria: All of the following: 1 To be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2 Patient diagnosed with Juvenile Idiopathic Arthritis (JIA); and 3 Patient has had severe active polyarticular course JIA for 6 months duration or longer; and 4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-20 mg/m² weekly or at the maximum tolerated dose) in combination with either oral corticosteroids (prednisone 0.25 mg/kg or at the maximum tolerated dose); and or a full trial of serial intra-articular corticosteroid injections; and 5 Patient has tried and not responded to at least three months of oral or parenteral methotrexate (at a dose of 10-15 mg/m² weekly or at the maximum tolerated dose) in combination with one other disease-modifying agent; and 56 Both: 56.1 Either: 56.1.1 Patient has persistent symptoms of poorly-controlled and active disease in at least 20 active, swollen, tender joints; or 56.1.2 Patient has persistent symptoms of poorly-controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, shoulder, cervical spine, hip; and 56.2 Physician's global assessment indicating severe disease. Initial application - (rheumatoid arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for rheumatoid arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for rheumatoid arthritis; or 2 All of the following: 2.1 Patient has had severe and active erosive rheumatoid arthritis for six months duration or longer; and 2.2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 2.3 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.4 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with at least two of the following (triple therapy): sulphasalazine, prednisone at a dose of at least 7.5 mg per day, azathioprine, intramuscular gold, or and hydroxychloroquine sulphate (at maximum tolerated doses); and 2.5 Either Any of the following: 2.5.1 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with therapy at the maximum tolerated dose of cyclosporin alone or in combination with another agent; or 2.5.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate in combination with intramuscular gold; 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 September 2011 (continued)

continued... 2.5.3 Patient has tried and not responded to at least three months of therapy at the maximum tolerated dose of leflunomide alone or in combination with oral or parenteral methotrexate another agent; and 2.6 Either: 2.6.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 active, swollen, tender joints; or 2.6.2 Patient has persistent symptoms of poorly controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.7 Either: 2.7.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.7.2 C-reactive protein levels not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months.

Initial application — (severe chronic plaque psoriasis) only from a dermatologist. Approvals valid for 4 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for severe chronic plaque psoriasis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for severe chronic plaque psoriasis; or 2 All of the following: 2.1 Either: 2.1.1 Patient has "whole body" severe chronic plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of greater than 15, where lesions have been present for at least 6 months from the time of initial diagnosis; or 2.1.2 Patient has severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot, where the plaque or plaques have been present for at least 6 months from the time of initial diagnosis; and 2.2 Patient has tried, but had an inadequate response (see Note) to, or has experienced intolerable side effects from, at least three of the following (at maximum tolerated doses unless contraindicated): phototherapy, methotrexate, cyclosporin, or acitretin; and 2.3 A PASI assessment has been completed for at least the most recent prior treatment course (but preferably all prior treatment courses), preferably while still on treatment but no longer than 1 month following cessation of each prior treatment course; and 2.4 The most recent PASI assessment is no more than 1 month old at the time of application. Note: "Inadequate response" is defined as: for whole body severe chronic plaque psoriasis, a PASI score of greater than 15, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment; for severe chronic plaque psoriasis of the face, hand or foot, at least 2 of the 3 PASI symptom subscores for erythema, thickness and scaling are rated as severe or very severe, and the skin area affected is 30% or more of the face, palm of a hand or sole of a foot, as assessed preferably while still on treatment but no longer than 1 month following cessation of the most recent prior treatment. Initial application - (ankylosing spondylitis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for ankylosing spondylitis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2011 (continued)

continued... 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for ankylosing spondylitis; or 2 All of the following: 2.1 Patient has a confirmed diagnosis of ankylosing spondylitis for more than six months; and 2.2 Patient has low back pain and stiffness that is relieved by exercise but not by rest; and 2.3 Patient has bilateral sacroiliitis demonstrated by plain radiographs, CT or MRI scan; and 2.4 Patient's ankylosing spondylitis has not responded adequately to treatment with two or more non steroidal anti-inflammatory drugs (NSAIDs), in combination with anti-ulcer therapy if indicated, while patient was undergoing at least 3 months of an exercise regime supervised by a physiotherapist; and 2.5 Either: 2.5.1 Patient has limitation of motion of the lumbar spine in the sagittal and the frontal planes as determined by the following a score of at least 1 on each of the lumbar flexion and lumbar side flexion measurements of the Bath Ankylosing Spondylitis Metrology Index (BASMI) measures: a modified Schober’s test of less than or equal to 4 cm and lumbar side flexion measurement of less than or equal to 10 cm (mean of left and right); or 2.5.2 Patient has limitation of chest expansion by at least 2.5 cm below the following average normal values corrected for age and gender (see Notes); and 2.6 A Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 6 on a 0-10 scale. Notes: The BASDAI must have been determined at the completion of the 3 month exercise trial, but prior to ceasing NSAID treatment. The BASDAI measure must be no more than 1 month old at the time of initial application. Average normal chest expansion corrected for age and gender: 18-24 years - Male: 7.0 cm; Female: 5.5 cm 25-34 years - Male: 7.5 cm; Female: 5.5 cm 35-44 years - Male: 6.5 cm; Female: 4.5 cm 45-54 years - Male: 6.0 cm; Female: 5.0 cm 55-64 years - Male: 5.5 cm; Female: 4.0 cm 65-74 years - Male: 4.0 cm; Female: 4.0 cm 75+ years - Male: 3.0 cm; Female: 2.5 cm Initial application - (psoriatic arthritis) only from a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: Either: 1 Both: 1.1 The patient has had an initial Special Authority approval for adalimumab for psoriatic arthritis; and 1.2 Either: 1.2.1 The patient has experienced intolerable side effects from adalimumab; or 1.2.2 The patient has received insufficient benefit from adalimumab to meet the renewal criteria for adalimumab for psoriatic arthritis; or 2 All of the following: 2.1 Patient has had severe active psoriatic arthritis for six months duration or longer; and 2.2 Patient has tried and not responded to at least three months of oral or parenteral methotrexate at a dose of at least 20 mg weekly or a maximum tolerated dose; and 2.3 Patient has tried and not responded to at least three months of sulphasalazine at a dose of at least 2 g per day or leflunomide at a dose of up to 20 mg daily (or maximum tolerated doses); and 2.4 Either: 2.4.1 Patient has persistent symptoms of poorly controlled and active disease in at least 20 15 active, swollen, tender joints; or 2.4.2 Patient has persistent symptoms of poorly controlled and active disease in at least four active joints from the following: wrist, elbow, knee, ankle, and either shoulder or hip; and 2.5 Any of the following: continued...

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2011 (continued)

continued... 2.5.1 Patient has a C-reactive protein level greater than 15 mg/L measured no more than one month prior to the date of this application; or 2.5.2 Patient has an elevated erythrocyte sedimentation rate (ESR) greater than 25 mm per hour; or 2.5.3 ESR and CRP not measured as patient is currently receiving prednisone therapy at a dose of greater than 5 mg per day and has done so for more than three months.

Renewal - (juvenile idiopathic arthritis) only from a named specialist, rheumatologist or Practitioner on the recommendation of a named specialist or rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a named specialist or rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a named specialist or rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Subsidised as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Either: 3.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count and an improvement in physician's global assessment from baseline; or 3.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count and continued improvement in physician's global assessment from baseline. Renewal - (rheumatoid arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Treatment is to be used as an adjunct to methotrexate therapy or monotherapy where use of methotrexate is limited by toxicity or intolerance; and 3 Either: 3.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 3.2 On subsequent reapplications, the patient demonstrates at least a continuing 30% improvement in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; and 4 Etanercept to be administered in doses no greater than 50 mg ever 7 days. Renewal — (severe chronic plaque psoriasis) only from a dermatologist or Practitioner on the recommendation of a dermatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a dermatologist; or 1.2 Applicant is a Practitioner and confirms that a dermatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Either: 2.1 Both: 2.1.1 Patient had "whole body" severe chronic plaque psoriasis at the start of treatment; and 2.1.2 Following each prior etanercept treatment course the patient has a PASI score which is reduced by 75% or more, or is sustained at this level, when compared with the pre-treatment baseline value; or 2.2 Both: 2.2.1 Patient had severe chronic plaque psoriasis of the face, or palm of a hand or sole of a foot at the start of treatment; and continued... Patients pay a manufacturer’s surcharge when the Manufacturer’s Price is greater than the Subsidy

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Restrictions - effective 1 September 2011 (continued)

continued... Following each prior etanercept treatment course the patient has a reduction in the PASI symptom subscores for all 3 of erythema, thickness and scaling, to slight or better, or sustained at this level, as compared to the treatment course baseline values; or 2.2.2.2 Following each prior etanercept treatment course the patient has a reduction of 75% or more in the skin area affected, or sustained at this level, as compared to the pre treatment baseline value; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. Note: A treatment course is defined as a minimum of 12 weeks of etanercept treatment Renewal — (ankylosing spondylitis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Following 12 weeks of etanercept treatment, BASDAI has improved by 4 or more points from pre-treatment baseline on a 10 point scale, or by 50%, whichever is less; and 3 Physician considers that the patient has benefited from treatment and that continued treatment is appropriate; and 4 Etanercept to be administered at doses no greater than 50 mg every 7 days. Renewal - (psoriatic arthritis) only from a rheumatologist or Practitioner on the recommendation of a rheumatologist. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Either: 1.1 Applicant is a rheumatologist; or 1.2 Applicant is a Practitioner and confirms that a rheumatologist has provided a letter, email or fax recommending that the patient continues with etanercept treatment; and 2 Either: 2.1 Following 3 to 4 months’ initial treatment, the patient has at least a 50% decrease in active joint count from baseline and a clinically significant response to treatment in the opinion of the physician; or 2.2 The patient demonstrates at least a continuing 50% 30% improvement in active joint count from baseline and a clinically significant response to prior etanercept treatment in the opinion of the treating physician; and 3 Etanercept to be administered at doses no greater than 50 mg every 7 days. 128 OLANZAPINE Tab 2.5 mg – Special Authority (Zyprexa brand only) see SA0741 below – Retail pharmacy .................................... 2.00 (51.07) Tab 5 mg – Special Authority (Zyprexa brand only) see SA0741 below – Retail pharmacy .................................... 3.85 (101.21) 2.2.2 Either: 2.2.2.1

✔ Dr Reddy’s Olanzapine ✔ Olanzine Zyprexa ✔ Dr Reddy’s Olanzapine ✔ Olanzine Zyprexa

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 September 2011 (continued)

continued... Tab 10 mg – Special Authority (Zyprexa brand only) see SA0741 below – Retail pharmacy .................................... 6.35 (204.49) 28 ✔ Dr Reddy’s Olanzapine ✔ Olanzine Zyprexa

➽ SA0741 Special Authority for Subsidy Initial application only from a psychiatrist. Approvals valid for 2 years for applications meeting the following criteria: Any of the following: 1 Patient presents with first episode schizophrenia or related psychoses; or 2 Both: 2.1 Patient suffering from schizophrenia and related psychoses or acute mania in bipolar disorder who is likely to benefit from antipsychotic treatment; and 2.2 Either: 2.2.1 An effective dose of risperidone had been trialled and has been discontinued because of unacceptable side effects; or 2.2.2 An effective dose of risperidone had been trialled and has been discontinued because of inadequate clinical response after 4 weeks; or 3 The patient has suffered from an acute episode of schizophrenia or bipolar mania and has been treated with olanzapine short-acting intra-muscular injection. Renewal only from a psychiatrist. Approvals valid for 2 years where the treatment remains appropriate and the patient is benefiting from treatment. Note: Initial prescriptions to be written by psychiatrists or psychiatric registrars and subsequent prescriptions can be written by General Practitioners. 131 OLANZAPINE Wafer 5 mg – Special Authority see SA0739 – Retail pharmacy ................................................... 6.36 28 (102.19) Zyprexa Zydis Wafer 10 mg – Special Authority see SA0739 – Retail pharmacy ................................................... 8.76 28 (204.37) Zyprexa Zydis ➽ SA0739 Special Authority for Subsidy Initial application only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: All of the following: 1 The patient meets the current criteria for standard olanzapine tablets; and 2 The patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; or the patient is non-adherent to oral therapy with standard olanzapine tablets; and 3 The patient is under direct supervision for administration of medicine. Renewal only from a psychiatrist. Approvals valid for 1 year for applications meeting the following criteria: Both: 1 The patient is unable to take standard olanzapine tablets, or once stabilized refuses to take olanzapine tablets; and 2 The patient is under direct supervision for administration of medicine. Note: Initial prescriptions to be written by psychiatrists and subsequent prescriptions can be written by psychiatric registrars or General Practitioners.

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 September 2011 (continued)

149 THALIDOMIDE – PCT only – Specialist – Special Authority see SA1124 Only on a controlled drug form Cap 50 mg ........................................................................... 490.00 504.00 Cap 100 mg ...................................................................... 1,008.00

28 28

✔ Thalidomide Pharmion ✔ Thalomid ✔ Thalomid

▲

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 October 2011

29 43 59 82 97 118 OMEPRAZOLE ( subsidy) ❋ Cap 10 mg ............................................................................... 0.97 ❋ Cap 20 mg ............................................................................... 1.26 ❋ Cap 40 mg ............................................................................... 1.86 SODIUM CHLORIDE ( subsidy) Inj 0.9%, 10 ml – Up to 5 inj available on a PSO ....................... 16.10 BETAMETHASONE VALERATE ( subsidy) ❋ Crm 0.1% ................................................................................. 3.20 ❋ Oint 0.1% ................................................................................. 3.20 CO-TRIMOXAZOLE ( subsidy) ❋ Tab trimethoprim 80 mg and sulphamethoxazole 400 mg – Up to 30 tab available on a PSO .......................................... 20.97 30 30 30 ✔ Dr Reddy’s Omeprazole ✔ Dr Reddy’s Omeprazole ✔ Dr Reddy’s Omeprazole ✔ Multichem ✔ Beta Cream ✔ Beta Ointment

50 50 g OP 50 g OP

500

✔ Trisul

SULINDAC – Additional subsidy by Special Authority see SA1038 – Retail pharmacy ( price) ❋ Tab 100 mg ............................................................................. 5.32 100 (17.10) Daclin ❋ Tab 200 mg ............................................................................. 6.72 100 (30.20) Daclin DOTHIEPIN HYDROCHLORIDE ( subsidy) Tab 75 mg ............................................................................. 10.50 Cap 25 mg ............................................................................... 6.17 100 100 ✔ Dopress ✔ Dopress

135

TRIAZOLAM ( price) Tab 125 µg .............................................................................. 5.10 100 (7.25) ‡ Safety cap for extemporaneously compounded oral liquid preparations. Tab 250 µg .............................................................................. 4.10 100 (8.70) ‡ Safety cap for extemporaneously compounded oral liquid preparations. BUDESONIDE ( subsidy) Powder for inhalation, 200 µg per dose .................................. 15.20 Powder for inhalation, 400 µg per dose .................................. 25.60

Hypam Hypam

160

200 dose OP ✔ Budenocort 200 dose OP ✔ Budenocort

Effective 1 September 2011

28 38 39 HYOSCINE N-BUTYLBROMIDE ( subsidy) ❋ Inj 20 mg, 1 ml – Up to 5 inj available on a PSO ......................... 9.57 CALCIUM CARBONATE ( subsidy) ❋ Tab eff 1.75 g (1 g elemental).................................................... 6.21 ZINC SULPHATE ( subsidy) ❋ Cap 137.4 mg (50 mg elemental) ............................................ 11.00

S29

5 30 100

✔ Buscopan ✔ Calsource ✔ Zincaps

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

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 September 2011 (continued)

42 57 PROTAMINE SULPHATE ( price) ❋ Inj 10 mg per ml, 5 ml ............................................................ 22.40 (95.87) CLOTRIMAZOLE ( subsidy) ❋ Crm 1% ..................................................................................... 0.54 a) Only on a prescription b) Not in combination MICONAZOLE NITRATE ( subsidy) ❋ Crm 2% .................................................................................... 0.46 a) Only on a prescription b) Not in combination 10 Artex 20 g OP ✔ Clomazol

15 g OP

✔ Multichem

HYDROCORTISONE ( subsidy) ❋ Crm 1% – Only on a prescription ............................................ 14.00 500 g ✔ Pharmacy Health 25 g ✔ ABM ❋ Powder – Only in combination ................................................. 44.00 Up to 5% in a dermatological base (not proprietary Topical Corticosteriod – Plain) with or without other dermatological galenicals. BETAMETHASONE VALERATE WITH FUSIDIC ACID ( price) Crm 0.1% with fusidic acid 2%. ................................................. 3.49 (10.45) a) Maximum of 15 g per prescription b) Only on a prescription 15 g OP Fucicort

TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN – Only on a prescription ( subsidy) ❋ Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium .......................................................... 3.05 500 ml ✔ Pinetarsol 5.82 1,000 ml ✔ Pinetarsol IMIQUIMOD – Special Authority see SA0923 – Retail pharmacy ( subsidy) Crm 5% ................................................................................... 62.00 ERGOMETRINE MALEATE ( subsidy) Inj 500 µg per ml, 1 ml – Up to 5 inj available on a PSO ........... 31.00 NORETHISTERONE ( subsidy) ❋ Tab 5 mg – Up to 30 tab available on a PSO ............................ 26.50 MEBENDAZOLE – Only on a prescription ( subsidy) Tab 100 mg ........................................................................... 24.19 AMOXYCILLIN ( subsidy) Inj 250 mg .............................................................................. 12.96 Inj 500 mg ............................................................................. 15.08 Inj 1 g – Up to 5 inj available on a PSO..................................... 21.94 BENZYLPENICILLIN SODIUM (PENICILLIN G) ( subsidy) Inj 600 mg – Up to 5 inj available on a PSO.............................. 11.50 12 5 100 24 10 10 10 10 ✔ Aldara ✔ DBL Ergometrine ✔ Primolut N ✔ De-Worm ✔ Ibiamox ✔ Ibiamox ✔ Ibiamox ✔ Sandoz

65 70 76 79 81

▲

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 September 2011 (continued)

82 FLUCLOXACILLIN SODIUM ( subsidy) Inj 250 mg .............................................................................. 10.86 Inj 500 mg ............................................................................. 11.32 Inj 1 g – Up to 5 inj available on a PSO..................................... 14.28 PROCAINE PENICILLIN ( subsidy) Inj 1.5 mega u – Up to 5 inj available on a PSO ...................... 123.50 MORPHINE SULPHATE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO ................ 5.51 Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 4.79 Inj 15 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 5.01 Inj 30 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 5.30 118 PETHIDINE HYDROCHLORIDE ( subsidy) a) Only on a controlled drug form b) No patient co-payment payable Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 5.51 Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .............. 5.83 127 128 LITHIUM CARBONATE ( subsidy) Cap 250 mg ............................................................................. 9.42 OLANZAPINE ( subsidy) Tab 2.5 mg .............................................................................. 2.00 (51.07) Tab 5 mg .................................................................................. 3.85 (101.21) Tab 10 mg ................................................................................ 6.35 (204.49) OLANZAPINE ( subsidy) Wafer 5 mg ............................................................................... 6.36 (102.19) Wafer 10 mg ............................................................................. 8.76 (204.37) TEMAZEPAM ( subsidy) Tab 10 mg ................................................................................ 1.27 ‡ Safety cap for extemporaneously compounded oral liquid preparations. CYCLOPHOSPHAMIDE ( subsidy) Inj 1 g – PCT – Retail pharmacy-Specialist ............................... 26.70 Inj 2 g – PCT only – Specialist ................................................. 56.90 10 10 10 5 ✔ Flucloxin ✔ Flucloxin ✔ Flucloxin ✔ Cilicaine

82 117

5 5 5 5

✔ DBL Morphine Sulphate ✔ DBL Morphine Sulphate ✔ DBL Morphine Sulphate ✔ DBL Morphine Sulphate

5 5

✔ DBL Pethidine Hydrochloride ✔ DBL Pethidine Hydrochloride ✔ Douglas

100 28

Zyprexa 28 Zyprexa 28 Zyprexa 28 Zyprexa Zydis 28 Zyprexa Zydis 25 ✔ Normison

131

135

141

1 1

✔ Endoxan ✔ Endoxan

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 September 2011 (continued)

142 CALCIUM FOLINATE ( subsidy) Tab 15 mg – PCT – Retail pharmacy-Specialist ....................... 82.45 FLUDARABINE PHOSPHATE – PCT only – Specialist ( subsidy) Inj 50 mg for ECP .................................................................. 105.00 CETIRIZINE HYDROCHLORIDE ( subsidy) ❋‡ Oral liq 1 mg per ml ................................................................ 3.52 AMINOPHYLLINE ( subsidy) ❋ Inj 25 mg per ml, 10 ml – Up to 5 inj available on a PSO .......... 53.75 FUSIDIC ACID ( price) Eye drops 1% ............................................................................ 4.50 (11.52) ACETAZOLAMIDE ( subsidy) ❋ Tab 250 mg ........................................................................... 17.03 10 ✔ DBL Leucovorin Calcium

143 159 164 166

50 mg OP ✔ Baxter 200 ml 5 5 g OP Fucithalmic 100 ✔ Diamox ✔ Cetirizine - AFT ✔ DBL Aminophylline

168 180

CARBOHYDRATE SUPPLEMENT – Special Authority see SA1090 – Hospital pharmacy [HP3] ( subsidy) Powder .................................................................................... 5.29 400 g OP ✔ Polycal

▲

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 October 2011

14 Close Control means dispensing: • in quantities less than one 90 Day Lot (or for oral contraceptives, less than one 180 Day Lot) for a Community Pharmaceutical referred to in Section F Part I, or • in quantities less than a Monthly Lot for any other Community Pharmaceutical, where any of A), or B) or C) apply. • This Close Control rule defines patient groups or medicines which are eligible for more frequent dispensing periods and the conditions that must be met to enable any claim for payment for additional dispensing to be made. A. Frequency of dispensing for persons in residential care Pharmaceuticals can be dispensed in quantities of not less than 28 days to: • any person whose placement in a Residential Disability Care institution is funded by the Ministry of Health or a DHB; or • a person assessed as requiring long term residential care services and residing in an age related residential care facility; on the request of the person, their agent or caregiver or community residential service provider, provided the following conditions are met: I. the quantity or period of supply to be dispensed at any one time is not less than 28 days’ supply (except under conditions outlined in B.i below); and II. the prescribing Practitioner or dispensing pharmacist has 1) included the name of the patient’s residential placement or facility on the prescription; and 2) included the patient’s NHI number on the prescription; and 3) specified the maximum quantity or period of supply to be dispensed at any one time. Any person meeting the criteria above who is being initiated onto a new medicine or having their dose changed is able to have their medicine dispensed in accordance with B.i below. B. Flexible periods of supply for trial periods or safety The Schedule specifies for community patients a default length of dispensing (monthly/three monthly) for each pharmaceutical. Prescribers can request, and pharmacists may dispense, a higher frequency of dispensing in the following circumstances: If the prescribing Practitioner has met the prescribing conditions set out in B.iii below, and the pharmaceutical or patient fits within the provisions of B.i and B.ii below, a pharmacist may dispense more frequently than the Schedule default period of supply. i) Trial Periods The Community Pharmaceutical has been prescribed for a patient who requires close monitoring due to recent initiation onto, or dose change for, the Community Pharmaceutical (applicable to the patient’s first changed Prescription only); or ii) Safety 1) the Community Pharmaceutical is any of the following: a. a tri-cyclic antidepressant; or b. an antipsychotic; or c. a benzodiazepine; or d. a Class B Controlled Drug; or 2) the Community Pharmaceutical has been prescribed for a patient who: a. is not a resident in a Penal Institution, or one of the residential placements or facilities referenced in clause A above; and

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

S29

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to General Rules – effective 1 October 2011 (continued)

continued... b. in the opinion of the prescribing Practitioner, is intellectually impaired or frail, infirm or unable to manage their medicine without additional support.

For B.i and B.ii all of the following conditions must be met: iii) The prescribing Practitioner has: 1) endorsed each Community Pharmaceutical on the Prescription clearly with the words “Close Control” or “CC”; and 2) initialled the endorsement in their own handwriting; and 3) specified the maximum quantity or period of supply to be dispensed at any one time. 4) For trial periods each Community Pharmaceutical on the Prescription must be endorsed with either “Close Control Trial”, “CCT” or Trial Period and the period of supply included e.g. CC Trial 1 week. C. Pharmaceutical Supply Management More frequent dispensing may be required from time to time to manage stock supply issues or emergency situations. Pharmacists may dispense more frequently than the Schedule would otherwise allow when all of the following conditions are met: i) PHARMAC has approved and notified pharmacists to annotate prescriptions for a specified Community Pharmaceutical(s) “Close Control” without prescriber endorsement for a specified time; and ii) the dispensing pharmacist has: 1) clearly annotated each of the approved Community Pharmaceuticals that appear on the prescription with the words “Close Control” or “CC”; and 2) initialled the annotation in their own handwriting; and 3) has complied with maximum quantity or period of supply to be dispensed at any one time, as specified by PHARMAC at the time of notification. If a dispensing frequency is expressly stated in the Medicines Act, Medicines Regulations or Pharmacy Services Agreement a pharmacy can dispense at that specified dispensing frequency. However, no claim shall be made to any DHB for subsidised payment for dispensing fees in any case where dispensing occurs more frequently than authorised by the provisions of the Schedule. “Close Control” means the dispensing of a Community Pharmaceutical, in accordance with a Prescription, in quantities less than one 90 Day Lot (or for oral contraceptives, less than one 180 Day Lot) for a Community Pharmaceutical referred to in Section F Part I, or in quantities less than a Monthly Lot for any other Community Pharmaceutical, where any of a), b) or c) apply. a) All of the following conditions are met: i) the Community Pharmaceutical has been prescribed for a patient who: 1) is not a resident in a Penal Institution, Rest Home or Residential Disability Care Institution; and 2) either of the following: i) in the opinion of the prescribing Practitioner is: a) frail; or b) infirm; or c) unable to manage their medication without additional support; or d) intellectually impaired; or e) requires close monitoring due to recent initiation onto, or dose change for, the Community Pharmaceutical (applicable to the patient’s first changed Prescription only); and f) requires that Community Pharmaceutical to be dispensed in a smaller quantity than that for which it is currently funded, or ii) the Community Pharmaceutical is any of the following: a) a tri-cyclic antidepressant; or b) an antipsychotic; or 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 General Rules – effective 1 October 2011 (continued)

continued... c) a benzodiazepine; or d) a Class B Controlled Drug; and ii) the prescribing Practitioner has: A) endorsed each Community Pharmaceutical on the Prescription clearly with the words “Close Control” or “CC”; and B) initialled the endorsement in their own handwriting; and C) specified the maximum quantity or period of supply to be dispensed at any one time. b) All of the following conditions are met: i) The Community Pharmaceutical is prescribed for a patient who is a resident in a Rest Home or Residential Disability Care Institution; and A) the quantity or period of supply to be dispensed at any one time is not less than 28 days’ supply; and B) the prescriber or pharmacist has written the name of the Rest Home or Residential Disability Care Institution on the prescription; and C) the prescriber or pharmacist has: 1) written on the Prescription the words “Close Control” or “CC” (this applies to all medicines prescribed on the prescription), and 2) initialled the endorsement/annotation in their own handwriting; and 3) specified the maximum quantity or period of supply to be dispensed at any one time. c) All of the following conditions are met: i) where PHARMAC has approved and notified pharmacists to annotate prescriptions for a specified Community Pharmaceutical(s) “Close Control” without prescriber endorsement for a specified time; and ii) the dispensing pharmacist has: A) clearly annotated each of the approved Community Pharmaceuticals that appear on the prescription with the words “Close Control” or “CC”; and B) initialed the annotation in their own handwriting; and C) specified the maximum quantity or period of supply to be dispensed at any one time, as specified by PHARMAC at the time of notification.

Effective 1 September 2011

25 4.6 Substitution Where a Practitioner has prescribed a brand of a Community Pharmaceutical that has no Subsidy or has a Manufacturer’s Price that is greater than the Subsidy and there is an alternative fully subsidised Community Pharmaceutical available, a Contractor may dispense the fully subsidised Community Pharmaceutical, subject to unless either or both of the following circumstances apply: a) the Contractor having received a general Authority to Substitute from the Practitioner in relation to the particular medicine or medicines in general; or there is a clinical reason why substitution should not occur; or b) the Practitioner having indicated their Authority to Substitute on the prescription; or the prescriber has marked the prescription with a statement such as ‘no brand substitution permitted’. c) the Practitioner having given their Authority to Substitute in relation to the particular prescription. Such an Authority to Substitute is valid whether or not there is a financial implication for the Pharmaceutical Budget. When dispensing a subsidised alternative brand, the Contractor must annotate and sign initial the prescription and inform the patient of the brand change.

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Brand Name

Effective 1 September 2011

59 70 HYDROCORTISONE ❋ Crm 1% – Only on a prescription ............................................ 14.00 ERGOMETRINE MALEATE Inj 500 µg per ml, 1 ml – Up to 5 inj available on a PSO ........... 31.00 MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Inj 5 mg per ml, 1 ml – Up to 5 inj available on a PSO ................ 5.51 Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 4.79 Inj 15 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 5.01 Inj 30 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 5.30 500 g ✔ Pharmacy Health PSM ✔ DBL Ergometrine Mayne

117

5 5 5 5

✔ DBL Morphine Sulphate Mayne ✔ DBL Morphine Sulphate Mayne ✔ DBL Morphine Sulphate Mayne ✔ DBL Morphine Sulphate Mayne

118

PETHIDINE HYDROCHLORIDE a) Only on a controlled drug form b) No patient co-payment payable Inj 50 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 5.51 Inj 50 mg per ml, 2 ml – Up to 5 inj available on a PSO .............. 5.83

5 5

✔ DBL Pethidine Hydrochloride Mayne ✔ DBL Pethidine Hydrochloride Mayne ✔ DBL Leucovorin Calcium Mayne ✔ DBL Aminophylline Mayne

142

CALCIUM FOLINATE Tab 15 mg – PCT – Retail pharmacy-Specialist ....................... 82.45

164

AMINOPHYLLINE ❋ Inj 25 mg per ml, 10 ml – Up to 5 inj available on a PSO. ......... 53.75

▲

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 Sole Subsidised Supply

Effective 1 October 2011

For the list of new Sole Subsidised Supply products effective 1 October 2011 refer to the bold entries in the cumulative Sole Subsidised Supply table pages 11-19.

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 October 2011

44 COMPOUND ELECTROLYTES Powder for soln for oral use 5 g – Up to 10 sach available on a PSO .................................................................................... 2.24 NAPROXEN SODIUM ❋ Tab 550 mg ............................................................................. 9.95 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)

10 100

✔ Enerlyte ✔ Synflex

97 116

5 Hospira 5 Hospira

139

NICOTINE Nicotine will not be funded Close Control in amounts less than 4 weeks of treatment. Gum 2 mg (Classic) – Up to 384 piece available on a PSO ....... 14.97 96 Gum 2 mg (Fruit) – Up to 384 piece available on a PSO .......... 14.97 96 Gum 2 mg (Mint) – Up to 384 piece available on a PSO ........... 14.97 96 Gum 4 mg (Classic) – Up to 384 piece available on a PSO ....... 20.02 96 Gum 4 mg (Fruit) – Up to 384 piece available on a PSO .......... 20.02 96 Gum 4 mg (Mint) – Up to 384 piece available on a PSO ........... 20.02 96 THALIDOMIDE – PCT only – Specialist – Special Authority see SA1124 Cap 50 mg ........................................................................... 490.00 28

✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Habitrol ✔ Thalidomide Pharmion

149

Effective 1 September 2011

41 CLOPIDOGREL Tab 75 mg ............................................................................... 5.05 Note – Apo-Clopidogrel tab 75 mg, 90 tablet pack, remains subsidised. DIGOXIN ❋ Tab 62.5 µg – Up to 30 tab available on a PSO .......................... 6.94 Note – Lanoxin PG tab 62.5 µg, 240 tablet pack, remains subsidised. 28 ✔ Apo-Clopidogrel

49 64

250

✔ Lanoxin PG

SULPHUR Precipitated – Only in combination ............................................ 6.50 100 g ✔ ABM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain, refer, page 171 2) With or without other dermatological galenicals. CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA1131 Tab 250 mg ............................................................................. 5.53 10 ✔ Klacid Note – Klacid tab 250 mg, 14 tablet pack, remains subsidised. RITONAVIR – Special Authority see SA1025 – Retail pharmacy Cap 100 mg ......................................................................... 121.27 Three months supply may be dispensed at one time if endorsed “certified exemption” by the prescriber. 84 ✔ Norvir

▲

❋ 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 September 2011 (continued)

97 125 NAPROXEN SODIUM ❋ Tab 275 mg ............................................................................. 5.69 SUMATRIPTAN Inj 12 mg per ml, 0.5 ml – Maximum of 10 inj per prescription ............................................................... 36.00 (80.00) 120 ✔ Sonaflam

2 OP Imigran ✔ ReVia

139 143

NALTREXONE HYDROCHLORIDE – Special Authority see SA0909 – Retail pharmacy Tab 50 mg ........................................................................... 123.00 30

CLADRIBINE – PCT only – Specialist Inj 2 mg per ml, 5 ml ............................................................ 873.00 1 ✔ Litak S29 Note – Litak inj 2 mg per ml, 5 ml delist has been revoked. Litak will remain subsidised. TAMOXIFEN CITRATE ❋ Tab 20 mg ............................................................................... 5.25 (6.66) IPRATROPIUM BROMIDE Aqueous nasal spray, 0.03% .................................................... 8.06 (12.66) METHYL HYDROXYBENZOATE Powder .................................................................................. 10.00 SODIUM BICARBONATE Powder BP – Only in combination ............................................. 9.80 (11.99) Only in extemporaneously compounded omeprazole suspension. 60 Tamoxifen Sandoz 30 ml OP Apo-Ipravent 25 g 500 g ✔ ABM ✔ ABM Biomed

155 164

177 177

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 January 2012

29 OMEPRAZOLE ❋ Cap 10 mg ............................................................................... 0.97 ❋ Cap 20 mg ............................................................................... 1.26 ❋ Cap 40 mg ............................................................................... 1.86 30 30 30 ✔ Dr Reddy’s Omeprazole ✔ Dr Reddy’s Omeprazole ✔ Dr Reddy’s Omeprazole

Effective 1 March 2012

45 PRAVASTATIN – Special Authority see SA0932 – Retail pharmacy See prescribing guideline Tab 10 mg .............................................................................. 27.46 LEVOTHYROXINE ❋ Tab 100 µg ............................................................................ 46.75 ‡ Safety cap for extemporaneously compounded oral liquid preparations. Note – Synthroid tab 100 µg, 90 tab pack, listed 1 September 2011.

30 1,000

✔ Pravachol ✔ Synthroid

96 112

MEFENAMIC ACID – Additional subsidy by Special Authority see SA1038 – Retail pharmacy ❋ Cap 250 mg ............................................................................. 2.50 100 (18.33) Ponstan ALLOPURINOL ❋ Tab 300 mg .............................................................................. 4.03 20.15 100 500 ✔ Apo-Allopurinol S29

S29

✔ Apo-Allopurinol S29

S29

113

SELEGILINE HYDROCHLORIDE ❋ Tab 5 mg ................................................................................ 16.06

100

✔ Apo-Selegiline S29

S29

135

MIDAZOLAM Note: Midazolam injection will be funded if prescribed for intranasal administration for use in palliative care. Note that only the Hypnovel brand is currently indicated for intranasal administration. Tab 7.5 mg ............................................................................. 10.38 100 (25.00) Hypnovel ‡ Safety cap for extemporaneously compounded oral liquid preparations CARBOHYDRATE SUPPLEMENT – Special Authority see SA1090 – Hospital pharmacy [HP3] Powder .................................................................................. 36.50 5,000 g ✔ Morrex Maltodextrin 182.50 25,000 g ✔ Morrex Maltodextrin ORAL FEED 1 KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] Powder (chocolate) .................................................................. 4.22 400 g OP Powder (strawberry) ................................................................. 4.22 400 g OP Powder (vanilla) ....................................................................... 4.22 400 g OP ✔ Ensure ✔ Ensure ✔ Ensure

180

190

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Items to be Delisted – effective 1 March 2012 (continued)

191 ORAL FEED 1.5KCAL/ML – Special Authority see SA1104 – Hospital pharmacy [HP3] Additional subsidy by endorsement is available for patients being bolus fed through a feeding tube. The prescription must be endorsed accordingly. Liquid (coffee latte) – Higher subsidy of up to $1.33 per 237 ml with Endorsement ..................................................... 0.85 237 ml OP (1.33) 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

Section H page ref

Price (ex man. excl. GST) $ Per

Brand or Generic Manufacturer

Section H changes to Part II

Effective 1 October 2011

16 ACITRETIN Cap 10 mg ............................................................................. 38.66 Cap 25 mg ............................................................................. 83.11 60 60 Novatretin Novatretin

ALLOPURINOL Tab 100 mg – 1% DV Dec-11 to 2014 .................................... 15.90 1,000 Apo-Allopurinol Tab 300 mg – 1% DV Dec-11 to 2014 .................................... 16.75 500 Apo-Allopurinol Note – Apo-Allopurinol tab 100 mg, 250 tab pack, and tab 300 mg, 100 tab pack, to be delisted 1 December 2011. BUDESONIDE ( price) Powder for inhalation, 200 µg per dose .................................. 15.20 Powder for inhalation, 400 µg per dose .................................. 25.60 200 dose 200 dose Budenocort Budenocort

CIPROFLOXACIN Tab 250 mg – 1% DV Dec-11 to 2014 ...................................... 2.20 28 Cipflox Tab 500 mg – 1% DV Dec-11 to 2014 ...................................... 3.00 28 Cipflox Tab 750 mg – 1% DV Dec-11 to 2014 ...................................... 5.15 28 Cipflox Note – Rex Medical ciprofloxacin tab 250 mg, 500 mg and 750 mg to be delisted 1 December 2011. CLARITHROMYCIN Tab 250 mg – 1% DV Jan-12 to 2014 ....................................... 4.19 Note – Klamycin tab 250 mg to be delisted 1 January 2012. DOTHIEPIN HYDROCHLORIDE ( price) Tab 75 mg ............................................................................. 10.50 Cap 25 mg ............................................................................... 6.17 FENTANYL CITRATE Inj 10 μg per ml, 50 ml prefilled syringe – 1% DV Dec-11 to 2014 ................................................. 165.00 Inj 20 μg per ml, 50 ml prefilled syringe – 1% DV Dec-11 to 2014 ................................................. 185.00 Inf 10 µg per ml, 50 ml premixed bag – 1% DV Dec-11 to 2014 ................................................ 210.00 Inf 10 µg per ml, 100 ml premixed bag – 1% DV Dec-11 to 2014 ................................................. 210.00 FLUCONAZOLE Cap 50 mg – 1% DV Jan-12 to 2014......................................... 4.77 Note – Fluconazole (Pacific) cap 50 mg to be delisted 1 January 2012. LOSARTAN Tab 12.5 mg – 1% DV Dec-11 to 2014 .................................... 2.88 Tab 25 mg – 1% DV Dec-11 to 2014 ........................................ 3.20 Tab 50 mg – 1% DV Dec-11 to 2014 ....................................... 5.22 Tab 50 mg with hydrochlorothiazide 12.5 mg – 1% DV Dec-11 to 2014 ...................................................... 4.89 Tab 100 mg – 1% DV Dec-11 to 2014 ...................................... 8.68 14 Apo-Clarithromycin

100 100

Dopress Dopress

10 10 10 10 28

Biomed Biomed Biomed Biomed Ozole

90 90 90 30 90

Lostaar Lostaar Lostaar Arrow-Losartan & Hydrochlorothiazide Lostaar

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 October 2011 (continued)

46 MORPHINE SULPHATE (new listing) Inf 1 mg per ml, 100 ml premixed bag – 1% DV Dec-11 to 2014 .................................................. 165.00 MORPHINE SULPHATE ( price and addition of HSS) Inj 1 mg per ml, 10 ml prefilled syringe – 1% DV Dec-11 to 2014 .................................................... 39.50 Inj 1 mg per ml, 50 ml prefilled syringe – 1% DV Dec-11 to 2014 .................................................... 79.50 Inj 2 mg per ml, 30 ml prefilled syringe – 1% DV Dec-11 to 2014 .................................................. 135.00

Biomed

10 10 10

Biomed Biomed Biomed Ethics Paracetamol

PARACETAMOL Oral liq 120 mg per 5 ml – 20% DV Dec-11 to 2014 .................. 2.21 500 ml Note – Paracare Junior oral liq 120 mg per 5 ml to be delisted 1 December 2011. SODIUM CHLORIDE ( price) Inj 0.9%, 10 ml ....................................................................... 16.10 50

Multichem

Effective 1 September 2011

16 17 ACETAZOLAMIDE ( price and addition of HSS) Tab 250 mg – 1% DV Nov-11 to 2014 .................................... 17.03 AMINOPHYLLINE ( price, amended brand name and addition of HSS) Inj 25 mg per ml, 10 ml – 1% DV Nov-11 to 2014 ................... 53.75 AMOXYCILLIN ( price and addition of HSS) Inj 250 mg – 1% DV Nov-11 to 2014 ...................................... 12.96 Inj 500 mg – 1% DV Nov-11 to 2014 ...................................... 15.08 Inj 1 g – 1% DV Nov-11 to 2014 ............................................. 21.94 100 5 Diamox DBL Aminophylline Mayne Ibiamox Ibiamox Ibiamox

10 10 10

BACILLUS CALMETTE-GUERIN (BCG) VACCINE (addition of note) Note: Subsidised only for bladder cancer. Note: Any BCG injection containing equal to or greater than 500 million CFU is considered a DV Pharmaceutical. Inj 2-8 × 100 milliion CFU – 1% DV Jan-11 to 2013 ............ 187.37 1 OncoTICE BENZYLPENICILLIN SODIUM (PENICILLIN G) (amended chemical and presentation descriptions,  price and addition of HSS) Inj 600 mg 1 mega u – 1% DV Nov-11 to 2014 ....................... 11.50 10 Sandoz BICALUTAMIDE Tab 50 mg – 1% DV Nov-11 to 2014 ...................................... 10.00 Note – Bicalox tab 50 mg to be delisted 1 November 2011 28 Bicalaccord

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 September 2011 (continued)

21 BUPIVACAINE HYDROCHLORIDE WITH ADRENALINE Inj 0.25% with 1:400,000 adrenaline, 20 ml – 1% DV Nov-11 to 2014 (new listing) ................................. 135.00 Inj 0.5% with 1:200,000 adrenaline, 20 ml – 1% DV Nov-11 to 2014 ( price and addition of HSS) ........ 115.00

5 5

Marcain with Adrenaline

Marcain with Adrenaline Note: Marcain with Adrenaline inj 0.25% with 1:400,000 of adrenaline, 10 ml to be delisted 1 November 2011 21 BUPIVACAINE HYDROCHLORIDE WITH FENTANYL ( price and addition of HSS) Inf 0.125% with 2 µg fentanyl per ml, 100 ml bag – 1% DV Nov-11 to 2014 .................................................. 210.00 10 Inf 0.125% with 2 µg fentanyl per ml, 200 ml bag – 1% DV Nov-11 to 2014 .................................................. 210.00 10 Inj 0.125% with 2 μg fentanyl per ml, 15 ml prefilled syringe – 1% DV Nov-11 to 2014 ........................................ 72.00 10 Inj 0.125% with 2 μg fentanyl per ml, 20 ml prefilled syringe – 1% DV Nov-11 to 2014 ........................................ 92.00 10 CALCIUM CARBONATE ( price and addition of HSS) Tab eff 1.75 g (1 g elemental) – 1% DV Nov-11 to 2014............ 6.21 CALCIUM FOLINATE ( price, amended brand name and addition of HSS) Tab 15 mg – 1% DV Nov-11 to 2014 ...................................... 82.45 CANDESARTAN Tab 4 mg ................................................................................ 48.66 Tab 8 mg ............................................................................... 57.90 Tab 16 mg ............................................................................. 70.62 Tab 32 mg ........................................................................... 115.50 CEFOTAXIME Inj 1 g – 1% DV Nov-11 to 2014 ............................................. 15.58 Note: Cefotaxime Sandoz inj 1 g to be delisted 1 November 2011 CETIRIZINE HYDROCHLORIDE ( price and addition of HSS) Oral liq 1 mg per ml – 1% DV Nov-11 to 2014 ........................... 3.52 CLADRIBINE Inj 2 mg per ml, 5 ml ............................................................ 873.00 CLOTRIMAZOLE ( price and addition of HSS) Crm 1% – 1% DV Nov-11 to 2014 ............................................. 0.54 CYCLOPHOSPHAMIDE ( price and addition of HSS) Inj 1 g – 1% DV Nov-11 to 2014 ............................................. 26.70 Inj 2 g – 1% DV Nov-11 to 2014 ............................................. 56.90 30 10

Bupafen Bupafen Biomed Biomed Calsource DBL Leucovorin Calcium Mayne Candestar Candestar Candestar Candestar DBL Cefotaxime

21 22

90 90 90 90 10

23 24 25 26

200 ml 1 20 g 1 1

Cetirizine - AFT Litak Clomazol Endoxan Endoxan

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 September 2011 (continued)

27 DALTEPARIN SODIUM (pack size change) Inj 12,500 iu per 0.5 ml prefilled syringe ............................... 169.00 10 Fragmin Inj 15,000 iu per 0.6 ml prefilled syringe ............................... 210.00 10 Fragmin Inj 18,000 iu per 0.72 ml prefilled syringe ............................. 250.00 10 Fragmin Note – Fragmin inj prefilled syringe 12,500 iu per 0.5 ml, 15,000 iu per 0.6 ml and 18,000 iu per 0.72 ml, 5 inj pack, to be delisted 1 November 2011 EMULSIFYING OINTMENT Oint BP 100 g – 1% DV Nov-11 to 2014 .................................... 1.95 Note: AFT emulsifying oint BP 100 g to be delisted 1 November 2011 100 g Jaychem

ERGOMETRINE MALEATE ( price, amended brand name and addition of HSS) Inj 500 µg per ml, 1 ml – 1% DV Nov-11 to 2014 .................... 31.00 5 FINASTERIDE Tab 5 mg – 1% DV Nov-11 to 2014 ......................................... 5.10 Note – Fintral tab 5 mg to be delisted 1 November 2011 FLUCLOXACILLIN SODIUM ( price and addition of HSS) Inj 250 mg – 1% DV Nov-11 to 2014 ...................................... 10.86 Inj 500 mg – 1% DV Nov-11 to 2014 ...................................... 11.32 Inj 1 g – 1% DV Nov-11 to 2014 ............................................. 14.28 FUSIDIC ACID ( price) Eye drops 1% ......................................................................... 11.52 HYDROCORTISONE ( price and addition of HSS) Powder – 1% DV Nov-11 to 2014 ........................................... 44.00 HYDROCORTISONE ( price, amended brand name and addition of HSS) Crm 1%, 500 g – 1% DV Nov-11 to 2014 ................................ 14.00 Note: DV Limit applies to pack sizes of greater than 100 g.

DBL Ergometrine Mayne Rex Medical

10 10 10 5g 25 g 500 g

Flucloxin Flucloxin Flucloxin Fucithalmic ABM Pharmacy Health PSM

34 36 36

37 37 42 42 45

HYOSCINE N-BUTYLBROMIDE ( price and addition of HSS) Inj 20 mg per ml, 1 ml – 1% DV Nov-11 to 2014 ....................... 9.57 IMIQUIMOD ( price and addition of HSS) Crm 5%, sachet – 1% DV Nov-11 to 2014 ............................... 62.00 LITHIUM CARBONATE Cap 250 mg – 1% DV Nov-11 to 2014 ...................................... 9.42 MEBENDAZOLE ( price and addition of HSS) Tab 100 mg – 1% DV Nov-11 to 2014 .................................... 24.19 MICONAZOLE NITRATE ( price and addition of HSS) Crm 2% – 1% DV Nov-11 to 2014 ............................................. 0.46

5 12 100 24 15 g

Buscopan Aldara Douglas De-Worm Multichem

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 September 2011 (continued)

46 MORPHINE SULPHATE ( price, amended brand name and addition of HSS) Inj 5 mg per ml, 1 ml – 1% DV Nov-11 to 2014 ......................... 5.51 Inj 10 mg per ml, 1 ml – 1% DV Nov-11 to 2014 ....................... 4.79 Inj 15 mg per ml, 1 ml – 1% DV Nov-11 to 2014 ....................... 5.01 Inj 30 mg per ml, 1 ml – 1% DV Nov-11 to 2014 ....................... 5.30 5 5 5 5 DBL Morphine Sulphate Mayne DBL Morphine Sulphate Mayne DBL Morphine Sulphate Mayne DBL Morphine Sulphate Mayne Primolut N Ensure Plus

47 49

NORETHISTERONE ( price and addition of HSS) Tab 5 mg – 1% DV Nov-11 to 2014 ........................................ 26.50 ORAL FEED 1.5KCAL/ML Liquid (coffee latte) ................................................................... 1.33 Note: Ensure Plus (coffee latte) to be delisted 1 November 2011

100 237 ml

PETHIDINE HYDROCHLORIDE ( price, amended brand name and addition of HSS) Inj 50 mg per ml, 1 ml – 1% DV Nov-11 to 2014 ....................... 5.51 5 Inj 50 mg per ml, 2 ml – 1% DV Nov-11 to 2014 ....................... 5.83 5

DBL Pethidine Hydrochloride Mayne DBL Pethidine Hydrochloride Mayne Cholvastin Cholvastin Cilicaine Provive MCT-LCT 1% Provive MCT-LCT 1% Provive MCT-LCT 1% Pfizer

PRAVASTATIN Tab 20 mg – 1% DV Nov-11 to 2014 ........................................ 5.44 Tab 40 mg – 1% DV Nov-11 to 2014 ........................................ 9.28 PROCAINE PENICILLIN ( price and addition of HSS) Inj 1.5 mega u – 1% DV Nov-11 to 2014 ............................... 123.50 PROPOFOL ( price) Inj 1%, 20 ml ............................................................................ 7.60 Inj 1%, 50 ml ............................................................................ 4.00 Inj 1%, 100 ml .......................................................................... 7.60 SODIUM CHLORIDE ( price and addition of HSS) Soln 0.9% for irrigation, 30 ml – 1% DV Nov-11 to 2014 ......... 19.50

30 30 5 5 1 1 30

52 53

57 58

STANDARD SUPPLEMENT ORAL FEED 1.0KCAL/ML Powder (chocolate) .................................................................. 4.22 400 g Ensure Powder (strawberry) ................................................................. 4.22 400 g Ensure Powder (vanilla) ........................................................................ 4.22 400 g Ensure Note: Ensure powder chocolate, strawberry and vanilla 400 g to be delisted 1 November 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 September 2011 (continued)

59 TAR WITH TRIETHANOLAMINE LAURYL SULPHATE AND FLUORESCEIN ( price and addition of HSS) Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium – 1% DV Nov-11 to 2014 ........................ 3.05 500 ml Pinetarsol 5.82 1,000 ml Pinetarsol TEMAZEPAM ( price and addition of HSS) Tab 10 mg – 1% DV Nov-11 to 2014 ........................................ 1.27 TERBINAFINE Tab 250 mg – 1% DV Nov-11 to 2014 ...................................... 1.78 Note – Apo-Terbinafine tab 250 mg to be delisted 1 November 2011 63 ZINC SULPHATE ( price and addition of HSS) Cap 137.4 mg (50 mg elemental) – 1% DV Nov-11 to 2014 .... 11.00 100 Zincaps 25 14 Normison Dr Reddy’s Terbinafine

59 59

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: Daunorubicin 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 ................... 34.56 100 100 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

Pytazen SR FEIBA FEIBA Diflucan POS

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)

37 39 45 45 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 30 5 1 30 ml Brufen SR Ferrum H Baxter Elocon

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 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 10 10 Dr Reddy’s Ondansetron Dr Reddy’s Ondansetron

PARACETAMOL WITH CODEINE (brand name change) Tab paracetamol 500 mg with codeine phosphate 8 mg – 1% DV Nov-11 to 2014 ............................................. 2.70

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

1 1 1 1 1 1 2

2 1

Mabthera Mabthera

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)

62 VENLAFAXINE 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

Section H changes to Part III

Effective 1 September 2011

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

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

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Brand or Generic Manufacturer

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

“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.

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

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Brand or Generic Manufacturer

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

14 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 Acitretin ....................................................... 20, 53 Advate ............................................................... 59 Aldara .......................................................... 41, 56 Acetazolamide ............................................. 43, 54 Adalimumab....................................................... 28 Allopurinol.............................................. 20, 51, 53 Amino acid formula ............................................ 25 Aminophylline ........................................ 43, 47, 54 Amlodipine......................................................... 58 Amoxycillin .................................................. 41, 54 Apo-Allopurinol ............................................ 20, 53 Apo-Allopurinol S29 ........................................... 51 Apo-Amlodipine ................................................. 58 Apo-Clarithromycin ...................................... 20, 53 Apo-Clopidogrel ................................................. 49 Apo-Ipravent ...................................................... 50 Apo-Selegiline S29 ............................................. 51 Arrow-Losartan & Hydrochlorothiazide ......... 20, 53 Arrow-Timolol .................................................... 20 Arrow-Venlafaxine XR......................................... 60 B Bacillus calmette-guerin (BCG) vaccine .............. 54 BeneFIX ............................................................. 59 Benzylpenicillin sodium (penicillin G) ...... 28, 41, 54 Beta Cream ........................................................ 40 Betamethasone valerate ..................................... 40 Betamethasone valerate with fusidic acid ............ 41 Beta Ointment .................................................... 40 Bicalaccord .................................................. 21, 54 Bicalutamide ................................................ 21, 54 Brufen SR .......................................................... 59 Budenocort .................................................. 40, 53 Budesonide ............................................ 27, 40, 53 Bupafen ............................................................. 55 Bupivacaine hydrochloride with adrenaline .......... 55 Bupivacaine hydrochloride with fentanyl ............. 55 Buscopan .................................................... 40, 56 C Calcium carbonate ....................................... 40, 55 Calcium folinate ..................................... 43, 47, 55 Calsource .................................................... 40, 55 Candesartan................................................. 21, 55 Candestar .................................................... 21, 55 Carbohydrate supplement............................. 43, 51 Cefotaxime................................................... 55, 58 Cefotaxime Sandoz ............................................ 58 Ceftazidime ........................................................ 58 Cetirizine - AFT............................................. 43, 55 Cetirizine hydrochloride ................................ 43, 55 Champix ............................................................ 22 Cholvastin .................................................... 21, 57 Cilicaine ....................................................... 42, 57 Cipflox ......................................................... 20, 53 Ciprofloxacin ................................................ 20, 53 Cladribine..................................................... 50, 55 Clarithromycin............................ 20, 27, 49, 53, 58 Clomazol...................................................... 41, 55 Clopidogrel ........................................................ 49 Clotrimazole ................................................. 41, 55 Co-trimoxazole ................................................... 40 Compound electrolytes....................................... 49 Cyclophosphamide ...................................... 42, 55 D Daclin ................................................................ 40 Dalteparin sodium .............................................. 56 Daunorubicin ..................................................... 58 DBL Aminophylline ................................. 43, 47, 54 DBL Cefotaxime ................................................. 55 DBL Ceftazidime................................................. 58 DBL Ergometrine .................................... 41, 47, 56 DBL Leucovorin Calcium ........................ 43, 47, 55 DBL Morphine Sulphate .......................... 42, 47, 57 DBL Pethidine Hydrochloride .................. 42, 47, 57 De-Worm ..................................................... 41, 56 Diamox ........................................................ 43, 54 Diflucan ............................................................. 58 Digoxin ........................................................ 20, 49 Dipyridamole...................................................... 58 Dopress ....................................................... 40, 53 Dothiepin hydrochloride................................ 40, 53 Dr Reddy’s Olanzapine ................................. 37, 38 Dr Reddy’s Omeprazole................................ 40, 51 Dr Reddy’s Ondansetron .................................... 59 Dr Reddy’s Terbinafine ................................. 21, 58 E Elecare .............................................................. 25 Elecare LCP ....................................................... 25 Elocon ............................................................... 59 Emulsifying ointment .......................................... 56 Enbrel ................................................................ 33 Endoxan....................................................... 42, 55 Enerlyte ............................................................. 49 Ensure ................................................... 51, 57, 60 Ensure Plus...................................... 26, 52, 57, 60 Entocort CIR ...................................................... 27 Ergometrine maleate .............................. 41, 47, 56 Etanercept.......................................................... 33 Ethics Paracetamol ...................................... 20, 54 Extensively hydrolysed formula........................... 25 F Factor eight inhibitors bypassing agent ............... 58 FEIBA................................................................. 58 Fentanyl citrate............................................. 49, 53

Index

Pharmaceuticals and brands Ferrum H............................................................ 59 Finasteride ................................................... 21, 56 Flucloxacillin sodium .................................... 42, 56 Flucloxin ...................................................... 42, 56 Fluconazole ........................................... 20, 53, 58 Fludarabine phosphate ....................................... 43 Fortisip ........................................................ 26, 60 Fortisip Multi Fibre ........................................ 27, 60 Fortum ............................................................... 58 Fragmin ............................................................. 56 Fucicort ............................................................. 41 Fucithalmic .................................................. 43, 56 Fusidic acid.................................................. 43, 56 H Habitrol .............................................................. 49 Herceptin ........................................................... 23 Humira............................................................... 28 HumiraPen ......................................................... 28 Hydrocortisone ...................................... 41, 47, 56 Hyoscine n-butylbromide ............................. 40, 56 Hypam ............................................................... 40 Hypnovel ........................................................... 51 I Ibiamox........................................................ 41, 54 Ibuprofen ........................................................... 59 Imigran .............................................................. 50 Imiquimod ................................................... 41, 56 Ipratropium bromide ........................................... 50 Iron polymaltose ................................................ 59 K Klacid .......................................................... 49, 58 Klamycin............................................................ 27 L Lanoxin .............................................................. 20 Lanoxin PG .................................................. 20, 49 Levothyroxine ........................................ 20, 21, 51 Litak ............................................................ 50, 55 Lithium carbonate ........................................ 42, 56 Losartan ...................................................... 20, 53 Lostaar ........................................................ 20, 53 M Marcain with Adrenaline ..................................... 55 Mebendazole................................................ 41, 56 Mefenamic acid ........................................... 21, 51 Methyl hydroxybenzoate ..................................... 50 Mabthera ........................................................... 59 Metronidazole .................................................... 59 Miconazole nitrate ........................................ 41, 56 Midazolam ......................................................... 51 Mometasone furoate .......................................... 59 Morphine sulphate............................ 42, 47, 54, 57 Morrex Maltodextrin ........................................... 51 N Naltrexone hydrochloride .................................... 50 Naproxen sodium ......................................... 49, 50 Neocate ............................................................. 25 Neocate Advance ............................................... 25 Neocate LCP ...................................................... 25 Nicotine ............................................................. 49 Norethisterone ............................................. 41, 57 Normison ..................................................... 42, 58 Norvir ................................................................ 49 Novatretin .................................................... 20, 53 O Olanzapine ............................................. 37, 38, 42 Olanzine ....................................................... 37, 38 Omeprazole............................................ 40, 51, 59 Omezol Relief ..................................................... 59 OncoTICE........................................................... 54 Ondansetron ...................................................... 59 Oral feed 1.5kcal/ml ............................... 26, 52, 57 Oral feed 1 kcal/ml ............................................. 51 Oral feed 2 kcal/ml ............................................. 26 Oral feed with fibre 1.5 Kcal/ml........................... 27 Ozole ........................................................... 20, 53 P Paracetamol................................................. 20, 54 Paracetamol + Codeine (Relieve)....................... 59 Paracetamol with codeine .................................. 59 Pepti Junior........................................................ 25 Pepti Junior Gold................................................ 25 Pethidine hydrochloride .......................... 42, 47, 57 Pinetarsol..................................................... 41, 58 Polycal............................................................... 43 Ponstan ....................................................... 21, 51 Pravachol........................................................... 51 Pravastatin ............................................. 21, 51, 57 Primolut N.................................................... 41, 57 Procaine penicillin ........................................ 42, 57 Propofol ............................................................. 57 Protamine sulphate ............................................ 41 Provive MCT-LCT 1% ......................................... 57 Pytazen SR ........................................................ 58 R Rapilysin ............................................................ 59 Recombinant factor ix ........................................ 59 Recombinant factor viii....................................... 59 Reteplase ........................................................... 59 ReVia ................................................................. 50 Ritonavir ............................................................ 49 Rituximab .......................................................... 59 S Selegiline hydrochloride ..................................... 51 Sodium bicarbonate ........................................... 50

Index

Pharmaceuticals and brands Sodium chloride ..................................... 40, 54, 57 Sonaflam ........................................................... 50 Special food supplement .................................... 60 Standard supplement oral feed 1.0kcal/ml .......... 57 Sulindac............................................................. 40 Sulphur .............................................................. 49 Sumatriptan ....................................................... 50 Sunitinib ............................................................ 22 Sustagen Hospital Formula ................................. 60 Sutent ................................................................ 22 Synflex............................................................... 49 Synthroid ............................................... 20, 21, 51 T Tamoxifen citrate................................................ 50 Tamoxifen Sandoz.............................................. 50 Tar with triethanolamine lauryl sulphate and fluorescein ......................................... 41, 58 Temazepam ................................................. 42, 58 Terbinafine ................................................... 21, 58 Thalidomide ................................................. 39, 49 Thalidomide Pharmion.................................. 39, 49 Thalomid............................................................ 39 Timolol maleate.................................................. 20 Trastuzumab ...................................................... 23 Triazolam ........................................................... 40 Trisul ................................................................. 40 Two Cal HN........................................................ 26 V Varenicline tartrate ............................................. 22 Venlafaxine ........................................................ 60 Vivonex Pediatric................................................ 25 Z Zincaps ........................................................ 40, 58 Zinc sulphate................................................ 40, 58 Zyprexa .................................................. 37, 38, 42 Zyprexa Zydis ............................................... 38, 42

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 October 2011

Abstract

Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 October 2011 Cumulative for September and October 2011 Section H cumulative for August, September and October 2011 Contents Summary of PHARMAC decisions effective 1 October 2011 ….. 3 Special Authority…

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