Schedule Update - effective 1 November 2011 (text extract)

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Pharmaceutical Management Agency

Update

New Zealand Pharmaceutical Schedule

Effective 1 November 2011

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

Contents

Summary of PHARMAC decisions effective 1 November 2011 ....................... 3 Reducing administrative burden.................................................................... 5 Close Control – patients unable to manage their medication ........................ 6 Paracetamol 500 mg tablet brand change .................................................... 6 Clarithromycin 500 mg tablets – restriction reinstated .................................. 7 Pravastatin – removal of Special Authority .................................................... 7 Ketostix – new listing .................................................................................... 7 News in Brief ................................................................................................. 8 Tender News .................................................................................................. 9 Looking Forward ......................................................................................... 10 Sole Subsidised Supply products cumulative to November 2011 ................ 11 New Listings ................................................................................................ 20 Changes to Restrictions ............................................................................... 23 Changes to Subsidy and Manufacturer’s Price............................................. 43 Changes to General Rules............................................................................ 47 Changes to Brand Name ............................................................................. 53 Changes to Sole Subsidised Supply ............................................................. 54 Delisted Items ............................................................................................. 55 Items to be Delisted .................................................................................... 58 Section H changes to Part II ........................................................................ 61 Section H changes to Part III........................................................................ 68 Section H changes to General Rules ............................................................ 69 Index ........................................................................................................... 71

Summary of PharmaC decisions

effeCtive 1 NOvemBer 2011 New listings (page 20) • Clarithromycin (Apo-Clarithromycin) tab 500 mg – Subsidy by endorsement – Maximum of 14 tab per prescription • Sodium nitroprusside (Ketostix) test strip, 50 strip OP – Maximum of 50 strip per prescription • Fluconazole (Ozole) cap 150 mg – Subsidy by endorsement – Maximum of 1 cap per prescription • Fluconazole (Ozole) cap 200 mg – Retail pharmacy - Specialist • Paracetamol (Parafast) tab 500 mg – Up to 30 tab available on a PSO • Megestrol acetate (Megace) tab 160 mg – Retail pharmacy - Specialist • Timolol maleate (Arrow-Timolol) eye drops 0.5%, 5 ml OP Changes to restrictions (pages 23-42) • Clarithromycin (Apo-Clarithromycin) tab 500 mg – removal of endorsement for dispensing 250 mg tablets – Maximum of 14 tab per prescription • Sodium nitroprusside (Ketostix) test strip – amended maximum strip per prescription to 50 test strips • Poloxamer (Coloxyl) oral drops 10% - addition of rule not funded for use in the ear • Potassium iodate (NeuroKare) tab 256 µg (150 µg elemental iodine) – amended presentation description • Phytomenadione (Konakion MM) inj 2 mg per 0.2 ml and 10 mg per ml, 1 ml – removal of restriction may be administered orally. Note oral administration remains subsidised under new General Rule changes • Sodium chloride inf and inj – addition of not funded for use as a nasal drop. Only funded for nebuliser use when in conjunction with an antibiotic intended for nebuliser use • Pravastatin (Pravachol and Cholvastin) tab 10 mg, 20 mg and 40 mg – removal of Special Authority • Dexamethasone sodium phosphate (Hospira) inj 4 mg per ml, 1 ml and 2 ml – addition of rule will not be funded for oral use • Efavirnez (Stocrin) tab 50 mg – addition of Section 29 • Midazolam (Hypnovel and Pfizer) inj 1 mg per ml 5 ml and 5 mg per ml, 3 ml – removal of restriction midazolam will be funded if prescribed for intranasal administration. Note intranasal administration remains subsidised under new General Rule changes • Eye preparations therapeutic subgroup – addition of eye preparations are only funded for use in the eye. The exception is pilocarpine eye drops 1%, 2% and 4% which is subsidised for oral use pursuant to the Standard Formulae

Summary of PharmaC decisions – effective 1 November 2011 (continued) Decreased subsidy (page 43) • Pravastatin (Pravachol) tab 20 mg and 40 mg • Finasteride (Fintral) tab 5 mg • Terbinafine (Apo-Terbinafine) tab 250 mg • Bicalutamide (Bicalox) tab 50 mg

Pharmaceutical Schedule - Update News

Reducing administrative burden

Some minor amendments are being made to the Pharmaceutical Schedule General Rules to help reduce the administrative burden for both pharmacists and prescribers. The changes will come into effect from 1 November 2011. Pharmacists will be able to annotate a prescription where they have evidence that a patient is eligible for subsidy via Specialist recommendation, without requiring a counter signature or endorsement from the prescriber. Where the pharmacy has an electronic record of an endorsement from a previous prescription written by the same prescriber, i.e. Specialist recommendation, then the pharmacy may annotate the prescription accordingly. Where an Specialist recommendation has not been completed by the prescriber and the pharmacy has no record of a previous Specialist recommendation, pharmacists may obtain the name of the recommending Specialist verbally and annotate and initial the script with the requirements for subsidy i.e. Specialist name and date of recommendation along with a note that the prescriber has been contacted. Pharmacists will be able to amend the presentation of the pharmaceutical dispensed, without requiring a signature from the prescriber, even where it is an increased cost to DHBs. This can only occur when it is not practicable to dispense the presentation prescribed. Any annotation would not be able to override any other Schedule restriction. This rule change is intended to allow pharmacists to provide a funded product when an out of stock occurs for a particular presentation of the product without requiring the prescriber’s

signature or notification from PHARMAC. Pharmacists will be required to annotate the prescription with the reason for the amendment for audit purposes. The intent of this change is to reduce the administrative burden for pharmacists and prescribers and its effects on the market are to be monitored. Part II 2.2 of the General Rules will be removed. This will result in certain pharmaceuticals having restrictions added on what uses they will not be subsidised for. These new subsidy restrictions follow the intent of the current rules that are applied under Part II of the General Rules. Please refer to pages 23-24 for further information.

Pharmaceutical Schedule - Update News

Close Control – patients unable to manage their medication

Last month we introduced some minor changes to the Close Control rule. These have been received favourably by both prescribers and pharmacy. We would like to clarify the intent of Close Control where a patient is unable to manage their medicines without additional support. These patients, in the opinion of the prescribing Practitioner, are intellectually impaired, frail, infirm or unable to manage their medicines. The intent of this part of the Close Control Rule is to reduce the risk of medicines non-adherence for people living in their own homes and the consequential increased use of Age Related Residential Care services. It is also designed to reduce the risk of overdosing for those patients taking complex medicines and who often have periods of confusion and/or disorientation particularly for people who live alone. We have received some feedback on the changes and have developed an updated flow diagram and frequently asked questions. A copy has been included in the mailing of this Update. If you require further hard copies these can be ordered from www. pharmaconline.co.nz or alternatively they can be downloaded from the PHARmAC website.

Paracetamol 500 mg tablet brand change

As a result of a new tender agreement, Parafast paracetamol 500 mg tablets will become the sole subsidised brand of paracetamol 500 mg tablets from 1 April 2012. Parafast paracetamol 500 mg tablets will be subsidised from 1 November 2011. Neither Parafast paracetamol 500 mg tablets nor the currently funded Pharmacare tablets are film coated. However, Parafast tablets are round whereas Pharmacare tablets are capsule shaped. Parafast tablets are scored and are supplied in 1,000 tablet packs (blisters of 10 tablets).

Pharmaceutical Schedule - Update News

Clarithromycin 500 mg tablets – restriction reinstated

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

Pravastatin – removal of Special Authority

The Special Authority restriction that applies to pravastatin 10 mg, 20 mg and 40 mg tablets will be removed from 1 November 2011. We have awarded a tender for pravastatin 20 mg and 40 mg tablets to Douglas Pharmaceuticals’ brand (Cholvastin), resulting in a substantial price reduction on these two strengths. Sigma have informed us that it will be discontinuing the 10 mg strength. Removing the Special Authority restriction will remove the requirement for prescribers to complete Special Authority applications and will also provide an additional therapy choice.

Ketostix – new listing

A new pack size of sodium nitroprusside (Ketostix) 50 test strip pack will be fully subsidised from 1 November 2011. This follows the upcoming discontinuation of the 20 test strip pack. Ketostix will continue not to be subsidised on a Bulk Supply Order. The subsidised quantity restriction has been increased from 20 to 50 test strips to accommodate the larger pack size. Once the 50 test strip bottle has been opened they must be kept at 15-30°C and used within six months.

Pharmaceutical Schedule - Update News

News in Brief

• The listing date of Dr Reddy’s brand of atorvastatin 10 mg, 20 mg, 40 mg and 80 mg tablets has been delayed from 1 November 2011 until further notice. Please note that this listing is an alternate brand and does not affect the subsidy for Lipitor. We will notify the market when we have a confirmed listing date. • The listing date of Sandoz’s amoxycillin clavulanate tablets, Curam, has been delayed from 1 November 2011 until further notice. Douglas’s amoxycillin clavulanate tablets will continue to be listed and fully subsidised until they are reference priced to Curam. We will notify the market when we have confirmation of listing, reference pricing, sole supply and delisting dates. • The brand name of Abbott Laboratories ferrous sulphate long-acting 325 mg tablets, Ferro-Gradumet, is changing to Ferrograd from 1 November 2011. This is to align the New Zealand brand name with the Australian one. • The strength of potassium iodate (NeuroKare) tablets is being modified in the Pharmaceutical Schedule from 1 November 2011. The corrected strength of NeuroKare tablets is 256 µg containing 150 µg elemental iodine. There has been a discrepancy between the product labelling, the Pharmaceutical Schedule and the medsafe Product Detail information. These have now been aligned to state the same strength information. • Bristol Myers Squibb's brand of megestrol acetate tablet 160 mg (megace) will be listed, fully subsidised, from 1 November 2011 until further notice due to a potential supply issue with the current sole subsidised brand, Apo-megestrol (Apotex). • PHARMAC has been informed that the Stocrin, efavirenz, tablet 50 mg pack supplied to New Zealand by mSD, is not registered by medsafe and has been supplied under Section 29 since it was listed in 2008. From 1 November 2011 Stocrin tablet 50 mg will appear in the Pharmaceutical Schedule as being an unregistered brand. PHARmAC will encourage the supplier to register the Stocrin 50 mg pack it is supplying in New Zealand.

tender News

Sole Subsidised Supply changes – effective 1 December 2011

Chemical Name Acetazolamide Aminophylline Amoxycillin Amoxycillin Amoxycillin Benzylpenicillin sodium (Penicillin G) Calcium carbonate Calcium folinate Cetirizine hydrochloride Clotrimazole Ergometrine maleate Flucloxacillin sodium Flucloxacillin sodium Flucloxacillin sodium Hydrocortisone Hydrocortisone Hyoscine-N-butylbromide Imiquimod Lithium carbonate Mebendazole Miconazole nitrate Morphine sulphate Morphine sulphate Morphine sulphate Morphine sulphate Norethisterone Pethidine hydrochloride Presentation; Pack size Tab 250 mg; 100 tab Inj 25 mg per ml, 10 ml; 5 inj Inj 250 mg; 10 inj Inj 500 mg; 10 inj Inj 1 g; 10 inj Inj 600 mg; 10 inj Tab eff 1.75 g (1 g elemental), 30 tab Tab 15 mg; 10 tab Oral liq 1 mg per ml; 200 ml Crm 1%, 20 g OP Inj 500 µg per ml, 1 ml; 5 inj Inj 250 mg; 10 inj Inj 500 mg; 10 inj Inj 1 g; 10 inj Crm 1%; 500 g Powder; 25 g Inj 20 mg, 1 ml; 5 inj Crm 5%; 12 sachets Cap 250 mg; 100 cap Tab 100 mg; 24 tab Crm 2%, 15 g OP Inj 5 mg per ml, 1 ml; 5 inj Inj 10 mg per ml, 1 ml; 5 inj Inj 15 mg per ml, 1 ml; 5 inj Inj 30 mg per ml, 1 ml; 5 inj Tab 5 mg; 100 tab Inj 50 mg per ml, 1 ml; 5 inj Sole Subsidised Supply brand (and supplier) Diamox (Aspen) DBL Aminophylline (Hospira) Ibiamox (Douglas) Ibiamox (Douglas) Ibiamox (Douglas) Sandoz (Sandoz) Calsource (Novartis Consumer) DBL Leucovorin Calcium (Hospira) Cetirizine – AFT (AFT) Clomazol (Multichem) DBL Ergometrine (Hospira) Flucloxin (Douglas) Flucloxin (Douglas) Flucloxin (Douglas) Pharmacy Health (API) ABM (ABM) Buscopan (Boehringer Ingelheim) Aldara (Douglas) Douglas (Douglas) De-Worm (Multichem) Multichem (Multichem) DBL Morphine Sulphate (Hospira) DBL Morphine Sulphate (Hospira) DBL Morphine Sulphate (Hospira) DBL Morphine Sulphate (Hospira) Primolut N (Bayer) DBL Pethidine Hydrochloride (Hospira)

Chemical Name Pethidine hydrochloride Procaine penicillin Tar with triethanolamine lauryl sulphate and fluorescein Temazepam Zinc sulphate

Presentation; Pack size Inj 50 mg per ml, 2 ml; 5 inj Inj 1.5 mega u; 5 inj Soln 2.3% with triethanolamine lauryl sulphate and fluorescein sodium; 500 ml & 1,000 ml Tab 10 mg; 25 tab Cap 137.4 mg (50 mg elemental); 100 cap

Sole Subsidised Supply brand (and supplier) DBL Pethidine Hydrochloride (Hospira) Cilicaine (Aspen) Pinetarsol (Douglas) Normison (Aspen) Zincaps (Aspen)

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 December 2011 • Betamethasone with calcipotriol (Daivobet) oint 500 µg with calcipotriol 50 µg, 30 g OP, and gel 500 µg with calcipotriol 50 µg, 30 g OP – new listing • Calcipotriol (Daivonex) crm (30 g OP and 100 g OP), oint and soln – price and subsidy decrease • Dentist prescriptions – period of supply extended for prescription medicines, not controlled drugs. • Fusidic acid (Fucithalmic) eye drops 1%, 5 g OP – price reduction to match subsidy • Lignocaine with or without chlorhexidine (Pfizer) gel 2% urethral syringes – addition of endorsement “only subsidised for urethral administration” • Spacer device 230 ml, single patient (Space Chamber Plus) – new listing • Mask for spacer device, size 2 (Foremount Child’s Silicone Mask) – price and subsidy decrease and brand name change • Peak flow meter, low range and normal range (Breath-Alert) – price and subsidy decrease • Spacer device autoclavable, 230 ml, autoclavable (Spacer Chamber) – amendment to PSO restriction

Sole Subsidised Supply Products – cumulative to November 2011

Generic Name

Abacavir sulphate Acarbose Aciclovir Amantadine hydrochloride Amitriptyline Amlodipine 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 Tab 5 mg & 10 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 Apo-Amlodipine Alphamox Ospamox Curam Curam 2014 2012 2013 2014 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 November 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 Desmopressin-PH&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 November 2011

Generic Name Presentation Brand Name Expiry Date*

Maxitrol Maxitrol 2014 Dexamethasone with neomycin Eye oint 0.1% with neomycin sulphate and polymyxin b 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 Dextrose Dextrose with electrolytes Inj 50%, 10 ml Soln with electrolytes

Biomed Pedialyte – Fruit Pedialyte – Bubblegum Pedialyte – Plain Voltaren Voltaren Ophtha Voltaren Diclofenac Sandoz DHC Continus Dilzem Cardizem CD Pytazen SR 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

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 Tab long-acting 150 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

2014

2012 2013 31/12/11

Dihydrocodeine tartrate Diltiazem hydrochloride

Dipyridamole 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

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

Sole Subsidised Supply Products – cumulative to November 2011

Generic Name

Fentanyl

Presentation

Transdermal patch 12.5 µg per hour, 25 µg per hour, 50 µg per hour, 75 µg per hour, 100 µg per hour 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

Brand Name Expiry Date*

Mylan Fentanyl Patch 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 2013

Fentanyl citrate Ferrous sulphate Flucloxacillin sodium

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

2013 2012 2012 2013 2014 2012 2012 2014

Sole Subsidised Supply Products – cumulative to November 2011

Generic Name

Ibuprofen Indapamide Ipratropium bromide

Presentation

Tab long-acting 800 mg Oral liq 100 mg per 5 ml Tab 2.5 mg Aqueous nasal spray, 0.03%, 15 ml OP Nebuliser soln, 250 µg per ml, 1 ml & 2 ml Inj 50 mg per 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

Brand Name Expiry Date*

Brufen SR Fenpaed Dapa-Tabs Univent Univent Ferrum H 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 2012 2014 2013 2013 2014 2014 2012 2013 2014 2013 2013 2012 2012 31/12/13 2014 2013 2013 2014 2013 2013 2013

Iron polymaltose 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

2013 2013 2014 2012 2013 2014 2012 2012

Sole Subsidised Supply Products – cumulative to November 2011

Generic Name

Methadone hydrochloride

Presentation

Tab 5 mg Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Inj 25 mg per ml, 2 ml & 20 ml Tab 2.5 mg & 10 mg Tab 4 mg & 100 mg 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 Tab long-acting 10 mg, 30 mg, 60 mg & 100 mg 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*

Methatabs Biodone Biodone Forte Biodone Extra Forte 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 Arrow-Morphine LA 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 2014 2014 2012 2012 2013 2013 2014 2012 2013 2014 2012 2013 2012

Methotrexate Methylprednisolone Methylprednisolone sodium succinate

2013 2012 2012 2012

Metoclopramide hydrochloride Moclobemide Mometasone furoate Morphine hydrochloride

2014 2012 2012 2012

Morphine sulphate

2013

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

2014

Nicotinic acid Norfloxacin Norethisterone

Sole Subsidised Supply Products – cumulative to November 2011

Generic Name

Nystatin

Presentation

Oral liq 100,000 u per ml Cap 500,000 u Tab 500,000 u Powder Inj 40 mg Tab disp 4 mg & 8 mg Tab 4 mg & 8 mg

Brand Name Expiry Date*

Nilstat Nilstat Nilstat Midwest Dr Reddy’s Omeprazole Dr Reddy’s Ondansetron Dr Reddy’s Ondansetron Ox-Pam 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 2012 2012 2012 2014 2014 2013 2014

Omeprazole

Ondansetron

2013

Oxazepam Oxytocin

Tab 10 mg & 15 mg Inj 5 iu per ml, 1 ml Inj 10 iu per ml, 1 ml Inj 5 iu with ergometrine maleate 500 µg per ml, 1 ml Inj 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%

2014 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

Sole Subsidised Supply Products – cumulative to November 2011

Generic Name

Potassium chloride Prednisone sodium phosphate Pregnancy tests – hCG urine Promethazine hydrochloride Pyridostigmine bromide Pyridoxine hydrochloride Quinine sulphate Ranitidine hydrochloride Rifabutin Ropinirole hydrochloride Roxithromycin Salbutamol

Presentation

Tab long-acting 600 mg Oral liq 5 mg per ml Cassette Oral liq 5 mg per 5 ml 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

Brand Name Expiry Date*

Span-K Redipred Innovacon hCG One Step Pregnancy Test Promethazine Winthrop Elixir Mestinon PyridoxADE Apo-Pyridoxine Q 300 Peptisoothe Arrow-Ranitidine Mycobutin Ropin ArrowRoxithromycin Salapin Asthalin Asthalin Duolin 2012 2012 2012 2012 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

2012 2013 2014

Sodium chloride Sodium citrate with sodium lauryl sulphoacetate Sodium citro-tartrate Sodium cromoglycate Somatropin Sotalol Spironolactone Sumatriptan Tamoxifen citrate

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

Sole Subsidised Supply Products – cumulative to November 2011

Generic Name

Tamsulosin hydrochloride Terazosin hydrochloride Testosterone undecanoate Tetracosactrin Timolol maleate Tobramycin

Presentation

Cap 400 µg Tab 1 mg, 2 mg & 5 mg Cap 40 mg Inj 250 µg Inj 1 mg per ml, 1 ml 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*

Tamsulosin-Rex Arrow Arrow-Testosterone Synacthen Synacthen Depot 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 2013 2013 2012 2014 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 November changes in bold

2013 2014 2012 2014 2014 2014 2013 2013 2013 2014

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New Listings

Effective 1 November 2011

28 CLARITHROMYCIN Tab 500 mg – Subsidy by endorsement .................................. 10.95 14 ✔ Apo-Clarithromycin a) Maximum of 14 tab per prescription b) Subsidised only if prescribed for helicobacter pylori eradication and prescription is endorsed accordingly. Note: the prescription is considered endorsed if clarithromycin is prescribed in conjunction with a proton pump inhibitor and either amoxycillin or metronidazole. SODIUM NITROPRUSSIDE – Maximum of 50 strip per prescription ❋ Test strip – Not on a BSO ........................................................ 14.14 50 strip OP ✔ Ketostix

31 84

FLUCONAZOLE Cap 150 mg – Subsidy by endorsement ................................... 0.91 1 ✔ Ozole a) Maximum of 1 cap per prescription b) Patient has vaginal candida albicans and the Practitioner considers that a topical imidazole (used intravaginally) is not recommended and the prescription is endorsed accordingly. Cap 200 mg – Retail pharmacy-Specialist ............................... 13.34 28 ✔ Ozole PARACETAMOL ❋ Tab 500 mg – Up to 30 tab available on a PSO .......................... 9.38 MEGESTROL ACETATE – Retail pharmacy-Specialist Tab 160 mg ............................................................................ 57.92 TIMOLOL MALEATE ❋ Eye drops 0.5% ........................................................................ 2.08 1,000 30 5 ml OP ✔ Parafast ✔ Megace ✔ Arrow-Timolol

115 153 167

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

CLARITHROMYCIN – Maximum of 500 mg per prescription; can be waived by Special Authority see SA1131 Tab 250 mg ............................................................................. 4.19 14 ✔ Apo-Clarithromycin

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

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

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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 October 2011 (continued)

82 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

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

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

New listings - effective 1 September 2011 (continued)

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

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 November 2011

28 CLARITHROMYCIN Tab 500 mg – Subsidy by endorsement .................................. 10.95 14 ✔ Apo-Clarithromycin 23.30 ✔ 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. SODIUM NITROPRUSSIDE – Maximum of 50 20 strip per prescription ❋ Test strip – Not on a BSO ........................................................ 14.14 14.14 POLOXAMER – Only on a prescription Not funded for use in the ear ❋ Oral drops 10% ........................................................................ 3.78 POTASSIUM IODATE Tab 256 268 µg (150 µg elemental iodine) .............................. 7.55 Note – Amendment to potassium iodate strength only. PHYTOMENADIONE Inj 2 mg per 0.2 ml – Up to 5 inj available on a PSO ................... 8.00 May be administered orally. Inj 10 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 9.21 May be administered orally. Note – Refer to news stories on page 5 50 strip OP ✔ Ketostix 20 strip OP ✔ Ketostix

31 34 38

30 ml OP 90

✔ Coloxyl ✔ NeuroKare

5 5

✔ Konakion MM ✔ Konakion MM

SODIUM CHLORIDE Not funded for use as a nasal drop. Only funded for nebuliser use when in conjunction with an antibiotic intended for nebuliser use Inf 0.9% – Up to 2,000 ml available on a PSO ........................... 3.06 500 ml ✔ Baxter 4.06 1,000 ml ✔ Baxter Only if prescribed on a prescription for renal dialysis, maternity or post-natal care in the home of the patient, or on a PSO for emergency use. (500 ml and 1,000 ml packs) Inj 23.4%, 20 ml ..................................................................... 31.25 5 ✔ Biomed Inj 0.9%, 5 ml – Up to 5 inj available on a PSO ......................... 10.85 50 ✔ Multichem 15.50 ✔ Pfizer Inj 0.9%, 10 ml – Up to 5 inj available on a PSO ....................... 16.10 50 ✔ Multichem 15.50 ✔ Pfizer Inj 0.9%, 20 ml ......................................................................... 4.72 6 ✔ Pharmacia 11.79 30 ✔ Pharmacia 8.41 20 ✔ Multichem

▲

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 October 2011 (continued)

45 PRAVASTATIN – Special Authority see SA0932 below – Retail pharmacy See prescribing guideline below Tab 10 mg ............................................................................. 27.46 30 ✔ Pravachol Tab 20 mg ............................................................................... 5.44 30 ✔ Cholvastin (42.58) Pravachol Tab 40 mg ............................................................................... 9.28 30 ✔ Cholvastin (65.31) Pravachol ➽ SA0932 Special Authority for Subsidy Initial application —(Confirmed HIV/AIDS) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria: All of the following: 1 Patient has dyslipidaemia and an absolute 5 year cardiovascular risk of 15% or greater; and 2 Confirmed HIV infection; and 3 Patient is being treated with an HIV protease inhibitor. DEXAMETHASONE SODIUM PHOSPHATE Dexamethasone sodium phosphate injection will not be funded for oral use ❋ Inj 4 mg per ml, 1 ml – Up to 5 inj available on a PSO .............. 21.50 5 ❋ Inj 4 mg per ml, 2 ml – Up to 5 inj available on a PSO .............. 31.00 5 EFAVIRENZ – Special Authority see SA1025 – Retail pharmacy Tab 50 mg ........................................................................... 158.33 Note – addition of Section 29 to Stocrin tab 50 mg only. 30

72 90

✔ Hospira ✔ Hospira ✔ Stocrin 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. Inj 1 mg per ml, 5 ml .............................................................. 10.75 10 ✔ Hypnovel (14.73) Pfizer Inj 5 mg per ml, 3 ml .............................................................. 11.90 5 ✔ Hypnovel (19.64) Pfizer Note – Refer to news stories on page 5. EYE PREPARATIONS Eye preparations are only funded for use in the eye. The exception is pilocarpine eye drops 1%, 2% and 4% which are subsidised for oral use pursuant to the Standard Formulae. Note – the above restriction applies to all eye drops, except pilocarpine eye drops 1%, 2% and 4%, listed in the Eye Preparations therapeutic subgroup as listed on pages 166 to 170 of the Pharmaceutical Schedule.

166

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 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 October 2011 (continued)

continued... 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 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 3 The patient has good performance status (WHO/ECOG grade 0-12); and 4 The disease is of predominant clear cell histology; and 5 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 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 October 2011 (continued)

continued... 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 6 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 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). 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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Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

continued... 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)

▲

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 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. 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 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

▲

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 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... 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... 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...

▲

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... 2.7.1 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... 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 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...

▲

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... 2.4.2 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.

2.5

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... 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... 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

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... 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... 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... 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...

▲

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... 1.2.2 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... 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... 2.5.1 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...

▲

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... 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... 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... 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.

▲

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)

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

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 November 2011

39 45 CHARCOAL ( price) ❋ Tab 300 mg ............................................................................. 7.13 (9.77) PRAVASTATIN ( subsidy) See prescribing guideline Tab 20 mg ............................................................................... 5.44 (42.58) Tab 40 mg ............................................................................... 9.28 (65.31) 100 Red Seal

30 Pravachol 30 Pravachol ✔ Fintral

70 84

FINASTERIDE – Special Authority see SA0928 – Retail pharmacy ( subsidy) Tab 5 mg .................................................................................. 5.10 30 TERBINAFINE ( subsidy) Tab 250 mg ........................................................................... 12.75 (25.50) 100

Apo-Terbinafine ✔ Bicalox

153

BICALUTAMIDE – Special Authority see SA0941 – Retail pharmacy ( subsidy) Tab 50 mg ............................................................................. 10.71 30

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

▲

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 (continued)

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 42 57 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 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 5 30 100 10 Artex 20 g OP ✔ Clomazol ✔ Buscopan ✔ Calsource ✔ Zincaps

15 g OP

✔ Multichem

HYDROCORTISONE ( subsidy) 500 g ✔ Pharmacy Health ❋ Crm 1% – Only on a prescription ............................................ 14.00 ❋ Powder – Only in combination ................................................. 44.00 25 g ✔ ABM 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

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)

64 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 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 Three months supply may be dispensed at one time if endorsed “certified exemption” by the prescriber. 12 5 100 24 10 10 10 10 10 10 10 5 ✔ Aldara ✔ DBL Ergometrine ✔ Primolut N ✔ De-Worm ✔ Ibiamox ✔ Ibiamox ✔ Ibiamox ✔ Sandoz ✔ Flucloxin ✔ Flucloxin ✔ Flucloxin ✔ Cilicaine

65 70 76 79 81

81 82

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

▲

❋ 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)

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 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 ........................................................................... 17.03 100 28 Zyprexa 28 Zyprexa 28 Zyprexa 28 Zyprexa Zydis 28 Zyprexa Zydis 25 ✔ Normison ✔ Douglas

131

135

141

1 1 10

✔ Endoxan ✔ Endoxan ✔ DBL Leucovorin Calcium

142

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

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 General Rules

Effective 1 November 2011

13 “Annotation” means written annotation of a prescription by a dispensing pharmacist in the pharmacist’s own handwriting following confirmation from the Prescriber if required, and “Annotated” has a corresponding meaning. The Annotation must include the details specified in the Schedule, including the date the prescriber was contacted (if applicable) and be initialled by the dispensing pharmacist. “Hospital Pharmacy-Specialist” means that the Community Pharmaceutical is not eligible for Subsidy unless it is supplied by a hospital or pharmacy contracted to the Funder to dispense as a hospital pharmacy to an Outpatient either a) on a prescription signed by a Specialist, or b) where the treatment with the Community Pharmaceutical has been recommended by a Specialist, on the Prescription of a Practitioner which is either: a) to an Outpatient; and b) Prescription signed by a Specialist; or if the treatment of an Outpatient with the Community Pharmaceutical has been recommended by a Specialist, on the Prescription of a Practitioner i) endorsed with the words “recommended by [name of specialist and year of authorisation]” and signed by the Practitioner, or ii) Annotated by the dispensing pharmacist, following verbal confirmation from the Practitioner of the name of the Specialist and date of recommendation, with the words “recommended by [name of specialist and date of authorisation], confirmed by [Practitioner]”. Where the Contractor has an electronic record of such an Endorsement or Annotation from a previous prescription for the same Community Pharmaceutical written by a prescriber for the same patient, they may annotate the prescription accordingly. “As recommended by a Specialist” to be interpreted as: a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written; c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the specialist and the General Practitioner must keep a written record of the consultation. For the purposes of the definition it makes no difference whether or not the Specialist is employed by a hospital. “Retail Pharmacy-Specialist” means that the Community Pharmaceutical is only eligible for Subsidy if it is either: a) supplied on a Prescription or Practitioner’s Supply Order signed by a Specialist, or, b) in the case of treatment recommended by a Specialist, supplied on a Prescription or Practitioner’s Supply Order and either: i) endorsed with the words “recommended by [name of Specialist and year of authorisation]” and signed by the Practitioner, or ii) Annotated by the dispensing pharmacist, following verbal confirmation from the Practitioner of the name of the Specialist and date of recommendation, with the words “recommended by [name of specialist and year of authorisation], confirmed by [Practitioner]”. Where the Contractor has an electronic record of such an Endorsement or Annotation from a previous prescription for the same Community Pharmaceutical written by a prescriber for the same patient, they may annotate the prescription accordingly. “As recommended by a Specialist” to be interpreted as: a) follows a substantive consultation with an appropriate Specialist; b) the consultation to relate to the Patient for whom the Prescription is written; c) consultation to mean communication by referral, telephone, letter, facsimile or email; d) except in emergencies consultation to precede annotation of the Prescription; and e) both the Specialist and the General Practitioner must keep a written record of consultation.

▲

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 November 2011 (continued)

19 2.1 Community Pharmaceuticals eligible for Subsidy include every medicine, therapeutic medical device or related product, or related thing listed in Sections B to G of the Schedule, and every preparation (having an inert base) of any of them, is hereby declared to be a Community Pharmaceutical for the purposes of the Schedule, subject to: 2.1.1 clauses 2.2 and 2.23 of the Schedule; and 2.1.2 clauses 3.1 to 4.4 of the Schedule; and 2.1.3 the conditions (if any) specified in Sections B to G of the Schedule; 2.2 The following medicines, therapeutic medical devices, or related products or related things are not eligible for Subsidy: 2.2.1 substances, or combinations of substances, ordered for any purpose other than: a) treatment of a patient’s medical or dental condition; or b) pregnancy tests; or c) the prevention of sexually transmitted disease; or d) contraception. 2.2.2 substances and combinations of substances packed under pressure in aerosol cans or other similar devices, unless it is specified in Sections B to G of the Schedule that they may be so packed; 2.2.3 electrode jellies; 2.2.4 eye drops packed in single-dose units, unless it is specified in Sections B to G of the Schedule that they may be so packed; 2.2.5 insect repellents and similar preparations; 2.2.6 oral preparations in long-acting form, unless it is specified in Sections B to G of the Schedule that they may be in such a form; 2.2.7 substances or combinations of substances in lozenge or similar form, unless it is specified in Sections B to G of the Schedule that they may be in such a form; 2.2.8 machine-spread plasters; 2.2.9 preparations prescribed as foods, unless they are specified in Section D of the Schedule; 2.2.10 substances, combinations of substances, or articles, in the form of proprietary medicines or proprietary articles, unless they are deemed or declared to be Pharmaceuticals elsewhere in the Schedule; 2.2.11 shampoos, other than extemporaneously prepared medicated shampoos, or shampoos specified in Sections B to G of the Schedule intended for the treatment of a patient’s medical condition; 2.2.12 toilet preparations; 2.2.13 tooth pastes and powders; 2.2.14 lubricating jellies and catheter lubricants; 2.2.15 sterile diluents for nebulising solutions; 2.2.16 substances in a form intended to enable delivery by transdermal diffusion or osmosis or by the insertion of any solid object or substance into the eye cavity, unless it is specified in Sections B to G of the Schedule that they may be in such a form; 2.2.17 substances in a form intended for intravenous delivery (other than by injection), unless it is specified in Sections B to G of the Schedule that they may be in such a form; 2.2.18 substances packed in pre-loaded syringes known as Min-I-Jets, unless it is specified in Sections B to G of the Schedule that they may be so packed; 2.2.19 Community Pharmaceuticals prescribed as cough mixtures, unless they are specified in Sections B to G of the Schedule otherwise than in combination with other ingredients; 2.2.20 vitamin preparations in capsule form, unless they are specified in Sections B to G of the Schedule; 2.2.21 substances prescribed for use as irrigating solutions, unless it is specified in Sections B to G of the Schedule that they may be prescribed for such use. 2.23 No claim by a Contractor for payment in respect of the supply of Community Pharmaceuticals will be allowed unless the Community Pharmaceuticals so supplied: 2.23.1 comply with the appropriate standards prescribed by regulations for the time being in force under the Medicines Act 1981; 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 General Rules – effective 1 November 2011 (continued)

continued... 2.23.2 in the absence of any such standards, comply with the appropriate standards for the time being prescribed by the British Pharmacopoeia; or 2.23.3 in the absence of the standards prescribed in clauses 2.23.1 and 2.23.2, comply with the appropriate standards for the time being prescribed by the British Pharmaceutical Codex; or 2.23.4 in the absence of the standards prescribed in clauses 2.23.1, 2.23.2 and 2.23.3, are of a grade and quality not lower than those usually applicable to Community Pharmaceuticals intended to be used for medical purposes.

4.7 Alteration to Presentation of Pharmaceutical Dispensed A Contractor, when dispensing a subsidised Community Pharmaceutical, may alter the presentation of a Pharmaceutical dispensed to another subsidised presentation but may not alter the dose, frequency and/ or total daily dose. This may only occur when it is not practicable for the contractor to dispense the requested presentation. If the change will result in additional cost to the DHBs, then annotation of the prescription by the dispensing pharmacist must occur stating the reason for the change, and the Contractor must initial the change for the purposes of Audit. a) the Practitioner must authorise and initial the alteration; or b) in cases where PHARMAC has approved and notified in writing such a change in dispensing of a named Pharmaceutical due to an out of stock event or short supply, the Contractor must annotate and initial the alteration. 4.8 Amendment of Schedule PHARMAC may amend the terms of the Schedule from time to time by notice in writing given in such manner as PHARMAC thinks fit, and in accordance with such protocols as agreed with the Pharmacy Guild of New Zealand (Inc) from time to time.

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. 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... 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 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 continued... dispensing occurs more frequently than authorised by the provisions of the Schedule. 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 General Rules – effective 1 October 2011 (continued)

continued... “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 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.

▲

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 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 November 2011

38 FERROUS SULPHATE ❋ Tab long-acting 325 mg (105 mg elemental) ............................. 1.01 (4.26) 5.06 (15.58) 30 Ferrograd Ferro-Gradumet 150 Ferrograd Ferro-Gradumet

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

142

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

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Changes to Brand Names – effective 1 September 2011 (continued)

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

Changes to Sole Subsidised Supply

Effective 1 November 2011

For the list of new Sole Subsidised Supply products effective 1 November 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 November 2011

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

300 500 ml

✔ Pancrex V

39 44 63

PSM 250 ✔ Lanoxin

SALICYLIC ACID Powder – Only in combination ................................................ 15.00 500 g ✔ ABM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain or collodion flexible, 2) With or without other dermatological galenicals. 3) Maximum 20 g or 20 ml per prescription when prescribed with white soft paraffin or collodion flexible. SULPHUR Precipitated – Only in combination ............................................. 6.35 100 g (9.25) PSM 1) Only in combination with a dermatological base or proprietary Topical Corticosteroid – Plain 2) With or without other dermatological galenicals. BUPRENORPHINE HYDROCHLORIDE – Only on a controlled drug form Inj 0.3 mg per ml, 1 ml ............................................................. 7.42 (9.38) MORPHINE SULPHATE a) Only on a controlled drug form b) No patient co-payment payable Tab long-acting 10 mg .............................................................. 1.80 Tab long-acting 30 mg .............................................................. 3.15 (3.60) Tab long-acting 60 mg .............................................................. 7.20 Tab long-acting 100 mg ............................................................ 7.85 (8.50) 5 Temgesic

114

117

10 10 10 10

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

▲

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

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

Check your Schedule for full details Schedule page ref

Subsidy (Mnfr’s price) $

Per

Brand or Generic Mnfr ✔ fully subsidised

Delisted Items – effective 1 November 2011 (continued)

161 SALBUTAMOL WITH IPRATROPIUM BROMIDE Aerosol inhaler, 100 µg with ipratropium bromide, 20 µg per dose ................................................................... 13.50 SULPHACETAMIDE SODIUM ❋ Eye drops 10% .......................................................................... 4.41

200 dose OP ✔ Combivent 15 ml OP ✔ Bleph 10

163 192

AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority SA1108 – Hospital pharmacy [HP3] Liquid (berry) .......................................................................... 15.65 62.5 ml OP ✔ Lophlex LQ 31.20 125 ml OP ✔ Lophlex LQ Liquid (citrus) ......................................................................... 15.65 62.5 ml OP ✔ Lophlex LQ 31.20 125 ml OP ✔ Lophlex LQ Liquid (orange) ........................................................................ 15.65 62.5 ml OP ✔ Lophlex LQ 31.20 125 ml OP ✔ Lophlex LQ Infant formula ....................................................................... 174.72 400 g OP ✔ XP Analog LCP

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

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

Delisted Items – effective 1 October 2011 (continued)

149 THALIDOMIDE – PCT only – Specialist – Special Authority see SA1124 Cap 50 mg ........................................................................... 490.00 28 ✔ Thalidomide Pharmion

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 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 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) 84 120 ✔ Norvir ✔ Sonaflam

92 97 125

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

▲

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 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 February 2012

45 PRAVASTATIN See prescribing guideline Tab 20 mg ............................................................................... 5.44 (42.58) Tab 40 mg ............................................................................... 9.28 (65.31) FINASTERIDE – Special Authority see SA0928 – Retail pharmacy Tab 5 mg .................................................................................. 5.10 TERBINAFINE Tab 250 mg ........................................................................... 12.75 (25.50) PARACETAMOL WITH CODEINE ❋ Tab paracetamol 500 mg with codeine phosphate 8 mg ............. 2.45 BICALUTAMIDE – Special Authority see SA0941 – Retail pharmacy Tab 50 mg ............................................................................. 10.71

30 Pravachol 30 Pravachol 30 100 Apo-Terbinafine 100 30 ✔ ParaCode ✔ Bicalox ✔ Fintral

70 84

118 153

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

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

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

113 SELEGILINE HYDROCHLORIDE ❋ Tab 5 mg ................................................................................ 16.06 100 ✔ Apo-Selegiline S29

S29

135

MIDAZOLAM Tab 7.5 mg ............................................................................. 10.38 (25.00) ‡ Safety cap for extemporaneously compounded oral liquid preparations

100 Hypnovel

180

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

190

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

Effective 1 May 2012

31 84 185 SODIUM NITROPRUSSIDE – Maximum of 50 strip per prescription ❋ Test strip – Not on a BSO ........................................................ 14.14 ORNIDAZOLE Tab 500 mg ........................................................................... 12.38 20 strip OP ✔ Ketostix 10 ✔ Tiberal

PAEDIATRIC ORAL FEED 1.5KCAL/ML – Special Authority see SA1100 – Hospital pharmacy [HP3] Liquid (strawberry) ................................................................... 1.60 200 ml OP ✔ NutriniDrink Liquid (vanilla) .......................................................................... 1.60 200 ml OP ✔ NutriniDrink PAEDIATRIC ORAL FEED WITH FIBRE 1.5KCAL/ML – Special Authority see SA1100 – Hospital pharmacy [HP3] Liquid (chocolate) .................................................................... 1.60 200 ml OP ✔ NutriniDrink Multifibre Liquid (strawberry) ................................................................... 1.60 200 ml OP ✔ NutriniDrink Multifibre Liquid (vanilla) .......................................................................... 1.60 200 ml OP ✔ NutriniDrink Multifibre AMINOACID FORMULA WITHOUT PHENYLALANINE – Special Authority see SA1108 – Hospital pharmacy [HP3] Liquid (tropical) ...................................................................... 30.00 250 ml OP ✔ Easiphen

185

195

▲

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 May 2012 (continued)

195 AMINOACID FORMULA WITH MINERALS WITHOUT PHENYLALANINE – Special Authority see SA1108 – Retail pharmacy Powder .................................................................................. 23.38 100 g OP ✔ Metabolic Mineral Mixture

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 November 2011

25 32 CLARITHROMYCIN Tab 500 mg – 1% DV Jan-12 to 2014 ..................................... 10.95 14 Apo-Clarithromycin

FLUCONAZOLE Cap 150 mg – 1% DV Jan-12 to 2014....................................... 0.91 1 Ozole Cap 200 mg – 1% DV Jan-12 to 2014..................................... 13.34 28 Ozole Note – Fluconazole (Pacific) cap 150 mg and cap 200 mg to be delisted 1 January 2012. MEGESTROL ACETATE Tab 160 mg ............................................................................ 57.92 POLYETHYLENE GLYCOL WITH SODIUM SULPHATE ( price) Powder, sachets...................................................................... 14.31 REMIFENTANIL HYDROCHLORIDE Inj 1 mg vial - 1% DV Jan-12 to 2014 ..................................... 27.95 Inj 2 mg vial - 1% DV Jan-12 to 2014 ..................................... 41.80 Note – Ultiva inj 1 mg vial and inj 2 mg vial to be delisted 1 January 2012. ZOPICLONE Tab 7.5 mg – 1% DV Jan-12 to 2014 ....................................... 1.90 Note – Apo-Zopiclone tab 7.5 mg, 500 pack, to be delisted 1 January 2012. 30 4 5 5 Megace Klean Prep Remifentanil-AFT Remifentanil-AFT

42 51 54

Apo-Zopiclone

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. 14 Apo-Clarithromycin

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)

29 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 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 .................................................. 135.00 100 100 Dopress Dopress

10 10 10 10 28

Biomed Biomed Biomed Biomed Ozole

90 90 90 30 90

Lostaar Lostaar Lostaar Arrow-Losartan & Hydrochlorothiazide Lostaar

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

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

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 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 28 Bicalaccord

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 30 10

Bupafen Bupafen Biomed Biomed Calsource DBL Leucovorin Calcium Mayne

21 22

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)

22 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 90 90 90 90 10 Candestar Candestar Candestar Candestar DBL Cefotaxime

23 24 25 26

200 ml 1 20 g 1 1

Cetirizine - AFT Litak Clomazol Endoxan Endoxan

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

DBL Ergometrine Mayne Rex Medical

10 10 10 5g

Flucloxin Flucloxin Flucloxin Fucithalmic

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 Part II - effective 1 September 2011 (continued)

36 36 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. 37 37 42 42 45 46 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 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 12 100 24 15 g 5 5 5 5 Buscopan Aldara Douglas De-Worm Multichem DBL Morphine Sulphate Mayne DBL Morphine Sulphate Mayne DBL Morphine Sulphate Mayne DBL Morphine Sulphate Mayne Primolut N Ensure Plus 25 g 500 g ABM Pharmacy Health PSM

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

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)

52 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 Cholvastin Cholvastin Cilicaine Provive MCT-LCT 1% Provive MCT-LCT 1% Provive MCT-LCT 1% Pfizer

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 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 25 14 Normison Dr Reddy’s Terbinafine

59 59

ZINC SULPHATE ( price and addition of HSS) Cap 137.4 mg (50 mg elemental) – 1% DV Nov-11 to 2014 .... 11.00

100

Zincaps

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 ......................................... 2.37 100 100 1 1 Apo-Amlodipine Apo-Amlodipine Cefotaxime Sandoz Fortum

23 23

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)

23 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 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 1 1 DBL Ceftazidime DBL Ceftazidime

25 27

1 1

Klacid Mayne

28 31

60 1 1 35 ml 30 5 1 30 ml

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

32 37 39 45 45

OMEPRAZOLE Cap 10 mg – 1% DV Oct-11 to 2014 ......................................... 2.91 90 Omezol Relief Cap 20 mg – 1% DV Oct-11 to 2014 ......................................... 3.78 90 Omezol Relief Cap 40 mg – 1% DV Oct-11 to 2014 ......................................... 5.57 90 Omezol Relief Note: Dr Reddy’s Omeprazole cap 10 mg, 20 mg and 40 mg to be delisted 1 October 2011 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

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 Part II - effective 1 August 2011 (continued)

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

2 1 28 28 28

Mabthera Mabthera 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.

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

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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)

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

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

Index

Pharmaceuticals and brands A Acitretin ....................................................... 20, 61 Advate ............................................................... 68 Aldara .......................................................... 45, 65 Acetazolamide ............................................. 46, 63 Adalimumab....................................................... 31 Allopurinol.............................................. 21, 58, 61 Amino acid formula ............................................ 28 Aminoacid formula with minerals without phenylalanine .................................................. 60 Aminoacid formula without phenylalanine ..... 56, 59 Aminophylline ........................................ 46, 54, 63 Amlodipine......................................................... 66 Amoxycillin .................................................. 45, 63 Apo-Allopurinol ............................................ 21, 61 Apo-Allopurinol S29 ........................................... 58 Apo-Amlodipine ................................................. 66 Apo-Clarithromycin ................................ 20, 23, 61 Apo-Clopidogrel ................................................. 57 Apo-Ipravent ...................................................... 57 Apo-Selegiline S29 ............................................. 59 Apo-Terbinafine............................................ 43, 58 Apo-Zopiclone.................................................... 61 Arrow-Losartan & Hydrochlorothiazide ......... 20, 62 Arrow-Timolol .............................................. 20, 21 Arrow-Venlafaxine XR......................................... 68 B Bacillus calmette-guerin (bcg) vaccine ............... 63 BeneFIX ............................................................. 68 Benzylpenicillin sodium (penicillin g) ...... 31, 45, 63 Beta Cream ........................................................ 43 Betamethasone valerate ..................................... 43 Betamethasone valerate with fusidic acid ............ 44 Beta Ointment .................................................... 43 Bicalaccord .................................................. 22, 63 Bicalox......................................................... 43, 58 Bicalutamide .................................... 22, 43, 58, 63 Bleph 10 ............................................................ 56 Blood glucose diagnostic test strip ..................... 55 Brufen SR .......................................................... 67 Budenocort .................................................. 44, 61 Budesonide ............................................ 30, 44, 61 Bupafen ............................................................. 63 Bupivacaine hydrochloride with adrenaline .......... 63 Bupivacaine hydrochloride with fentanyl ............. 63 Buprenorphine hydrochloride .............................. 55 Buscopan .................................................... 44, 65 C Calcium carbonate ....................................... 44, 63 Calcium folinate ..................................... 46, 53, 63 Calsource .................................................... 44, 63 Candesartan................................................. 21, 64 Candestar .................................................... 21, 64 Carbohydrate supplement............................. 46, 59 Cefotaxime................................................... 64, 66 Cefotaxime Sandoz ............................................ 66 Ceftazidime .................................................. 66, 67 Cetirizine - AFT............................................. 46, 64 Cetirizine hydrochloride ................................ 46, 64 Champix ............................................................ 24 Charcoal ............................................................ 43 Cholvastin .............................................. 21, 24, 66 Cilicaine ....................................................... 45, 66 Cipflox ......................................................... 21, 61 Ciprofloxacin ................................................ 21, 61 Cladribine..................................................... 57, 64 Clarithromycin...................... 20, 23, 30, 57, 61, 67 Clomazol...................................................... 44, 64 Clopidogrel ........................................................ 57 Clotrimazole ................................................. 44, 64 Combivent ......................................................... 56 Co-trimoxazole ................................................... 43 Coloxyl .............................................................. 23 Compound electrolytes....................................... 56 Cyclophosphamide ...................................... 46, 64 D Daclin ................................................................ 43 Dalteparin sodium .............................................. 64 Daunorubicin ..................................................... 67 DBL Aminophylline ................................. 46, 54, 63 DBL Cefotaxime ................................................. 64 DBL Ceftazidime................................................. 67 DBL Ergometrine .................................... 45, 53, 64 DBL Leucovorin Calcium ........................ 46, 53, 63 DBL Morphine Sulphate .......................... 45, 53, 65 DBL Pethidine Hydrochloride .................. 45, 53, 65 De-Worm ..................................................... 45, 65 Dexamethasone sodium phosphate .................... 24 Diamox ........................................................ 46, 63 Diflucan ............................................................. 67 Digoxin .................................................. 21, 55, 57 Dipyridamole...................................................... 67 Dopress ....................................................... 43, 62 Dothiepin hydrochloride................................ 43, 62 Dr Reddy’s Olanzapine ................................. 40, 41 Dr Reddy’s Omeprazole................................ 43, 58 Dr Reddy’s Ondansetron .................................... 67 Dr Reddy’s Terbinafine ................................. 21, 66 E Easiphen ............................................................ 59 Efavirenz ............................................................ 24 Elecare .............................................................. 28 Elecare LCP ....................................................... 28 Elocon ............................................................... 67

Index

Pharmaceuticals and brands Emulsifying ointment .......................................... 64 Enbrel ................................................................ 36 Endoxan....................................................... 46, 64 Enerlyte ............................................................. 56 Ensure ................................................... 59, 66, 68 Ensure Plus...................................... 29, 59, 65, 68 Entocort CIR ...................................................... 30 Ergometrine maleate .............................. 45, 53, 64 Etanercept.......................................................... 36 Ethics Paracetamol ...................................... 21, 62 Extensively hydrolysed formula........................... 28 F Factor eight inhibitors bypassing agent ............... 67 FEIBA................................................................. 67 Fentanyl citrate............................................. 56, 62 Ferrograd ........................................................... 53 Ferro-Gradumet.................................................. 53 Ferrous sulphate ................................................ 53 Ferrum H............................................................ 67 Finasteride ....................................... 21, 43, 58, 64 Fintral .......................................................... 43, 58 Flucloxacillin sodium .................................... 45, 64 Flucloxin ...................................................... 45, 64 Fluconazole ................................ 20, 21, 61, 62, 67 Fludarabine phosphate ....................................... 46 Fortisip ........................................................ 29, 68 Fortisip Multi Fibre ........................................ 30, 68 Fortum ............................................................... 66 Fragmin ............................................................. 64 Fucicort ............................................................. 44 Fucithalmic .................................................. 46, 64 Fusidic acid.................................................. 46, 64 H Habitrol .............................................................. 56 Herceptin ........................................................... 26 Humira............................................................... 31 HumiraPen ......................................................... 31 Hydrocortisone ...................................... 44, 53, 65 Hyoscine n-butylbromide ............................. 44, 65 Hypam ............................................................... 44 Hypnovel ..................................................... 24, 59 I Ibiamox........................................................ 45, 63 Ibuprofen ........................................................... 67 Imigran .............................................................. 57 Imiquimod ................................................... 45, 65 Ipecacuanha ...................................................... 55 Ipratropium bromide ........................................... 57 Iron polymaltose ................................................ 67 K Ketostix.................................................. 20, 23, 59 Klacid .......................................................... 57, 67 Klamycin...................................................... 23, 30 Klean Prep ......................................................... 61 Konakion MM..................................................... 23 L LA-Morph .......................................................... 55 Lanoxin ........................................................ 21, 55 Lanoxin PG .................................................. 21, 57 Levothyroxine ........................................ 20, 21, 58 Litak ............................................................ 57, 64 Lithium carbonate ........................................ 46, 65 Lophlex LQ......................................................... 56 Losartan ...................................................... 20, 62 Lostaar ........................................................ 20, 62 M Mabthera ........................................................... 68 Marcain with Adrenaline ..................................... 63 Mebendazole................................................ 45, 65 Mefenamic acid ........................................... 22, 58 Megace........................................................ 20, 61 Megestrol acetate......................................... 20, 61 Metabolic Mineral Mixture................................... 60 Methyl hydroxybenzoate ..................................... 57 Metronidazole .................................................... 67 Miconazole nitrate ........................................ 44, 65 Midazolam ................................................... 24, 59 Mometasone furoate .......................................... 67 Morphine sulphate...................... 45, 53, 55, 62, 65 Morrex Maltodextrin ........................................... 59 N Naltrexone hydrochloride .................................... 57 Naproxen sodium ......................................... 56, 57 Neocate ............................................................. 28 Neocate Advance ............................................... 28 Neocate LCP ...................................................... 28 NeuroKare.......................................................... 23 Nicotine ............................................................. 56 Norethisterone ............................................. 45, 65 Normison ..................................................... 46, 66 Norvir ................................................................ 57 Novatretin .................................................... 20, 61 NutriniDrink ........................................................ 59 NutriniDrink Multifibre ......................................... 59 O Olanzapine ............................................. 40, 41, 46 Olanzine ....................................................... 40, 41 Omeprazole............................................ 43, 58, 67 Omezol Relief ..................................................... 67 OncoTICE........................................................... 63 Ondansetron ...................................................... 67 Optium 5 second................................................ 55 Oral feed 1.5kcal/ml ............................... 29, 59, 65 Oral feed 1 kcal/ml ............................................. 59

Index

Pharmaceuticals and brands Oral feed 2kcal/ml .............................................. 29 Oral feed with fibre 1.5 Kcal/ml........................... 30 Ornidazole.......................................................... 59 Ozole ............................................... 20, 21, 61, 62 P Paediatric oral feed 1.5kcal/ml............................ 59 Paediatric oral feed with fibre 1.5kcal/ml............. 59 Pancreatic enzyme ............................................. 55 Pancrex V .......................................................... 55 Paracetamol........................................... 20, 21, 62 Paracetamol + Codeine (Relieve)....................... 67 Paracetamol with codeine ............................ 58, 67 ParaCode ........................................................... 58 Parafast ............................................................. 20 Pepti Junior........................................................ 28 Pepti Junior Gold................................................ 28 Pethidine hydrochloride .......................... 45, 53, 65 Phytomenadione ................................................ 23 Pinetarsol..................................................... 45, 66 Poloxamer ......................................................... 23 Polycal............................................................... 46 Polyethylene glycol with sodium sulphate ........... 61 Ponstan ....................................................... 22, 58 Potassium iodate ............................................... 23 Pravachol............................................... 24, 43, 58 Pravastatin ................................. 21, 24, 43, 58, 66 Primolut N.................................................... 45, 65 Procaine penicillin ........................................ 45, 66 Propofol ............................................................. 66 Protamine sulphate ............................................ 44 Provive MCT-LCT 1% ......................................... 66 Pytazen SR ........................................................ 67 R Rapilysin ............................................................ 68 Recombinant factor ix ........................................ 68 Recombinant factor viii....................................... 68 Relieve............................................................... 67 Remifentanil-AFT................................................ 61 Remifentanil hydrochloride ................................. 61 Reteplase ........................................................... 68 ReVia ................................................................. 57 Ritonavir ............................................................ 57 Rituximab .......................................................... 68 S Salbutamol with ipratropium bromide.................. 56 Salicylic acid ...................................................... 55 Selegiline hydrochloride ..................................... 59 Sodium bicarbonate ........................................... 57 Sodium chloride ............................... 23, 43, 62, 66 Sodium nitroprusside ............................. 20, 23, 59 Sonaflam ........................................................... 57 Special food supplement .................................... 68 Standard supplement oral feed 1.0kcal/ml .......... 66 Stocrin S29 ........................................................ 24 Sulindac............................................................. 43 Sulphacetamide sodium ..................................... 56 Sulphur ........................................................ 55, 57 Sumatriptan ....................................................... 57 Sunitinib ............................................................ 25 Sustagen Hospital Formula ................................. 68 Sutent ................................................................ 25 Synflex............................................................... 56 Synthroid ............................................... 20, 21, 58 T Tamoxifen citrate................................................ 57 Tamoxifen Sandoz.............................................. 57 Tar with triethanolamine lauryl sulphate and fluorescein ......................................... 45, 66 Temazepam ................................................. 46, 66 Temgesic ........................................................... 55 Terbinafine ....................................... 21, 43, 58, 66 Thalidomide ................................................. 42, 56 Thalidomide Pharmion.................................. 42, 56 Thalomid............................................................ 42 Tiberal ............................................................... 59 Timolol maleate............................................ 20, 21 Trastuzumab ...................................................... 26 Triazolam ........................................................... 44 Trisul ................................................................. 43 Two Cal HN........................................................ 29 V Varenicline tartrate ............................................. 24 Venlafaxine ........................................................ 68 Vivonex Pediatric................................................ 28 X XP Analog LCP ................................................... 56 Z Zincaps ........................................................ 44, 66 Zinc sulphate................................................ 44, 66 Zopiclone ........................................................... 61 Zyprexa .................................................. 40, 41, 46 Zyprexa Zydis ............................................... 41, 46

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 November 2011

Abstract

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

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