Update New Zealand Pharmaceutical Schedule Effective 1 April 2016 Cumulative for January, February, March and April 2016

Transcription

1 Pharmaceutical Management Agency Update New Zealand Pharmaceutical Schedule Effective 1 April 2016 Cumulative for January, February, March and April 2016

2 Contents Summary of PHARMAC decisions effective 1 April Update on sumatriptan injection... 5 Testosterone (Andriol) undecanoate capsules 40 mg... 5 Clarithromycin (Klacid) granules for oral liquid change of strength... 6 Fluphenazine decanoate (Modecate) inj 25 mg per ml, 2 ml new listing... 6 Prednisolone acetate (Pred Mild) eye drops 0.12%, 5 ml discontinuation... 6 Metoprolol succinate (Metoprolol AFT CR) long-acting tab 90 pack... 7 Enteral feed (Osmolite) 1Kcal/ml 250 ml and 500 ml discontinuation... 7 Actavis Bimatoprost eye drops 0.03% 3 ml delay... 7 News in brief... 7 Tender News... 8 Looking Forward... 8 Sole Subsidised Supply Products cumulative to April New Listings Changes to Restrictions, Chemical Names and Presentations Changes to Subsidy and Manufacturer s Price Changes to Brand Name Delisted Items Items to be Delisted Index

3 New listings (page 24) Metoprolol succinate (Metoprolol AFT CR) tab long-acting 190 mg, 90 tab pack size Clarithromycin (Klacid) grans for oral liq 250 mg per 5 ml, 50 ml Maximum of 500 mg per prescription, can be waived by Special Authority, wastage claimable Ergotamine tartrate with caffeine (Cafergot S29) tab 1 mg with caffeine 100 mg S29 and wastage payable Fluphenazine decanoate (Modecate) inj 25 mg per ml, 2 ml S29, wastage applied, available on a PSO Pharmacy services (BSF Ethics Lisinopril, BSF PSM Citalopram, BSF Zusdone and BSF Sumatriptan Sun Pharma) brand switch fee may only be claimed once per patient Oral elemental feed 1kcal/ml (Vivonex TEN) powder (unflavoured), 80 g OP Special Authority Hospital pharmacy [HP3] Changes to restrictions, chemical names and presentation (page 31) Omeprazole (Dr Reddy s Omeprazole) inj 40 mg ampoule with diluent amended presentation description Lisinopril (Ethics Lisinopril) tab 5 mg, 10 mg and 20 mg addition of Brand Switch Fee Citalopram hydrobromide (PSM Citalopram) tab 20 mg addition of Brand Switch Fee Sumatriptan (Sun Pharma) inj 12 mg per ml, 0.5 ml prefilled pen, 2 OP amended presentation description and addition of Brand Switch Fee Ziprasidone (Zusdone) cap 20 mg, 40 mg, 60 mg and 80 mg addition of Brand Switch Fee Bee venom allergy treatment (Venomil) maintenance kit 6 vials 120 mcg freeze dried venom, with diluent amended presentation description Wasp venom allergy treatment (Venomil) treatment kit (paper wasp venom) 6 vials 120 mcg freeze dried venom, with diluent, and treatment kit (yellow jacket venom) 6 vials 120 mcg freeze dried venom, with diluent amended presentation description Increased subsidy (page 47) Summary of PHARMAC decisions EFFECTIVE 1 APRIL 2016 Omeprazole (Dr Reddy s Omeprazole) inj 40 mg ampoule with diluent Decreased subsidy (page 47) Misoprostol (Cytotec) tab 200 mg Furosemide [frusemide] (Frusemide-Claris) inj 10 mg per ml, 2 ml ampoule 3

4 Summary of PHARMAC decisions effective 1 April 2016 (continued) Desmopressin acetate (Minirin) tab 100 mcg and 200 mcg Etoposide (Hospira and Vepesid) inj 20 mg per ml, 5 ml vial Etoposide (Baxter) inj 1 mg for ECP Polyvinyl alcohol eye drops 1.4%, 15 ml OP (Vistil) and eye drops 3%, 15 ml OP (Vistil Forte) 4

5 Pharmaceutical Schedule - Update News 5 Update on sumatriptan injection Actavis has informed us that the alternative sumatriptan injection, Sun-Pharma sumatriptan prefilled pen, is anticipated to arrive in New Zealand in late March In the meantime Actavis has been able to secure a short term supply of sumatriptan vials, (section 29), manufactured by Fresenius Kabi. The PHARMAC website will be updated with an expected delivery date as soon as it is received. The vials will be available for patients directly from GP practices. This is only intended for short-term supply ahead of the Sun-Pharma sumatriptan arriving. For patients who are familiar with using the Arrow-Sumatriptan injection, using a vial and syringe will be significantly different. As the vial presentation is only intended for short term supply and because of the additional support required to safely administer sumatriptan vials, we have made arrangements for Actavis to deliver the sumatriptan vials directly to GP practices. More information regarding this supply can be found on the PHARMAC website. PHARMAC recommends that patients contact their doctor regarding suitable alternative treatment options during this global shortage. Testosterone (Andriol) undecanoate capsules 40 mg Merck Sharp & Dohme (MSD) has advised PHARMAC of manufacturing issues affecting the global supply of Andriol Testocaps, its brand of testosterone undecanoate 40 mg capsules. MSD anticipates that the New Zealand market will be re-supplied in September PHARMAC has written to prescribers regarding this matter, noting the other testosterone formulations that are fully subsidised. We recommend patients speak to their doctor about alternative treatment options.

6 6 Pharmaceutical Schedule - Update News Clarithromycin (Klacid) granules for oral liquid change of strength From 1 April 2016, clarithromycin (Klacid) granules for oral liquid 250 mg per 5 ml, 50 ml, will be listed fully funded in the Pharmaceutical Schedule. Clarithromycin (Klacid) granules for oral liquid 125 mg per 5 ml, 70 ml, will be delisted 1 October PHARMAC expects supplies of this strength will be exhausted before 1 October Please note this change of strength. Clinicians should continue to calculate the correct dose based on the recommended dose/kg. You can find more information on recommended dosages at Fluphenazine decanoate (Modecate) inj 25 mg per ml, 2 ml new listing Fluphenazine decanoate inj 25 mg per ml, 2 ml (Modecate) will be listed fully subsidised on the Pharmaceutical Schedule from 1 April This strength of Modecate will be supplied under section 29 of the Medicines Act 1981 and the Wastage Rule will apply to all dispensings. This strength will also be subsidised on a Practitioners Supply Order (PSO), with a maximum of 5 inj per PSO. PSOs will need to include the names of the patients receiving these injections in order to fulfil section 29 obligations. The listing is to cover potential out of stocks of the other funded strengths of fluphenazine decanoate injections and is intended to be temporary. Prednisolone acetate (Pred Mild) eye drops 0.12%, 5 ml discontinuation PHARMAC has been notified by the supplier that prednisolone acetate (Pred Mild) eye drops 0.12%, 5 ml OP will be discontinued from 1 April PHARMAC is currently seeking alternative supply and requesting further clinical advice on alternative therapies.

7 Pharmaceutical Schedule - Update News 7 Metoprolol succinate (Metoprolol AFT CR) long-acting tab 90 pack Metoprolol succinate (Metoprolol - AFT CR) tab long-acting 190 mg tab, 90 tablet pack, will be listed fully subsidised from 1 April Monthly dispensing on all strengths of metoprolol succinate long-acting tabs will continue for the foreseeable future. Enteral feed (Osmolite) 1Kcal/ml 250 ml and 500 ml discontinuation PHARMAC has been notified by the supplier that enteral feed 1Kcal/ml liquid 250 ml (Osmolite) and 500 ml (Osmolite RTH) will be discontinued from 1 April The products will be delisted from the Pharmaceutical Schedule 1 October Funded alternatives are listed on the Pharmaceutical Schedule. Actavis Bimatoprost eye drops 0.03% 3 ml delay PHARMAC has been notified of a delay in the arrival of Actavis Bimatoprost eye drops 0.03% 3 ml OP. The listing date will be delayed from 1 April to 1 May As a result, PHARMAC will also delay the reference pricing for Lumigan to 1 July 2016 and Sole Supply until October News in brief Zopiclone (Zopiclone Actavis) 7.5 mg tablet, 30 pack size, will be delisted 1 May The 30 pack size was temporarily listed on the Pharmaceutical Schedule due to a brief supply issue of the 500 tab pack size, which has now been resolved. From 1 April 2016, Ieflunomide (Arava) 100 mg tab will be delisted from the Pharmaceutical Schedule. This strength has been discontinued and no claims have been made for this presentation since May 2011.

8 Tender News Sole Subsidised Supply changes effective 1 May 2016 Chemical Name Presentation; Pack size Sole Subsidised Supply brand (and supplier) Desferrioxamine mesilate Inj 500 mg vial; 10 inj Desferal (Novartis) Nystatin Oral liq 100,000 u per ml; 24 ml OP m-nystatin (Multichem) Oxycodone hydrochloride Inj 10 mg per ml, 1 ml ampoule; 5 inj OxyNorm (MundiPharma) Oxycodone hydrochloride Inj 10 mg per ml, 2 ml ampoule; 5 inj OxyNorm (MundiPharma) 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. Decisions for implementation 1 May 2016 Metoprolol succinate (Metoprolol AFT CR) tab long-acting mg, 47.5 mg, 95 mg and 190 mg, 30 tab pack price and subsidy decrease Decisions for future implementation 1 May 2016 Cinacalcet (Sensipar) tab 30 mg new listing with Special Authority Intra-uterine device (Load 375) IUD 35.5 mm length x 19.6 mm width new listing, only on a PSO Sodium phenylbutyrate (Pheburane) grans 483 mg per g, 174 g OP new listing with Special Authority Sodium valproate tab 100 mg (Epilim Crushable), and tab 200 mg EC and 500 mg EC (Epilim) removal of Stat dispensing 8

9 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Abacavir sulphate Tab 300 mg Oral liq 20 mg per ml Ziagen Acarbose Tab 50 mg & 100 mg Glucobay Acetazolamide Tab 250 mg Diamox Acetylcysteine Inj 200 mg per ml, 10 ml ampoule DBL Acetycysteine Aciclovir Tab dispersible 200 mg, 400 mg & 800 mg Lovir 2016 Acitretin Cap 10 mg & 25 mg Novatretin Adult diphtheria and tetanus vaccine Inj 2 IU diphtheria toxoid with 20 IU tetanus toxoid in 0.5 ml ADT Booster Allopurinol Tab 100 mg & 300 mg Apo-Allopurinol Alprazolam Tab 250 mcg, 500 mcg & 1 mg Xanax 2016 Amantadine hydrochloride Cap 100 mg Symmetrel Aminophylline Inj 25 mg per ml, 10 ml ampoule DBL Aminophylline Amiodarone hydrochloride Inj 50 mg per ml, 3 ml ampoule Cordarone-X 2016 Amisulpride Oral liq 100 mg per ml Tab 100 mg, 200 mg & 400 mg Solian 2016 Amitriptyline Tab 10 mg, 25 mg & 50 mg Arrow-Amitriptyline Amlodipine Tab 2.5 mg, 5 mg & 10 mg Apo-Amlodipine Amorolfine Nail soln 5% MycoNail Amoxicillin Inj 250 mg, 500 mg & 1 g vials Cap 250 mg & 500 mg Ibiamox Apo-Amoxi 2016 Aprepitant Cap 2 x 80 mg and 1 x 125 mg Emend Tri-Pack Ascorbic acid Tab 100 mg Cvite 2016 Aspirin Tab 100 mg Tab dispersible 300 mg Ethics Aspirin EC Ethics Aspirin Atenolol Tab 50 mg & 100 mg Mylan Atenolol Atropine sulphate Eye drops 1%, 15 ml OP Atropt Azathioprine Tab 50 mg Azamun 2016 Azithromycin Grans for oral liq 200 mg per 5 ml (40 mg per ml) Tab 250 mg & 500 mg Bacillus calmette-guerin vaccine Baclofen Bendroflumethiazide [bendrofluazide] Inj Mycobacterium bovis BCG (Bacillus Calmette-Guerin), Danish strain 1331, live attenuated, vial with diluent Inj 0.05 mg per ml, 1 ml ampoule Tab 10 mg Tab 2.5 mg & 5 mg Zithromax Apo-Azithromycin 2016 BCG Vaccine Lioresal Intrathecal Pacifen Arrow- Bendrofluazide 2016 *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. 9

10 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Benzathine benzylpenicillin Benzylpenicillin sodium [penicillin G] Inj 900 mg (1.2 million units) in 2.3 ml syringe Bicillin LA Inj 600 mg (1 million units) vial Sandoz Betahistine dihydrochloride Tab 16 mg Vergo 16 Betamethasone dipropionate with calcipotriol Betamethasone valerate Crm 0.1% Oint 0.1% Betaxolol Bezafibrate Gel 500 mcg with calcipotriol 50 mcg per g Oint 500 mcg with calcipotriol 50 mcg per g Eye drops 0.25%, 5 ml OP Eye drops 0.5%, 5 ml OP Tab 200 mg Tab long-acting 400 mg Daivobet Beta Cream Beta Ointment Betoptic S Betoptic Bezalip Bezalip Retard Bicalutamide Tab 50 mg Bicalaccord Bisacodyl Suppos 10 mg Tab 5 mg Lax-Suppositories Lax-Tab Bisoprolol fumarate Tab 2.5 mg, 5 mg & 10 mg Bosvate Boceprevir Cap 200 mg Victrelis 2016 Bosentan Tab 62.5 mg & 125 mg Mylan-Bosentan Brimonidine tartrate Eye drops 0.2%, 5 ml OP Arrow-Brimonidine Bupropion hydrochloride Tab modified-release 150 mg Zyban 2016 Cabergoline Tab 0.5 mg Dostinex Calamine Crm, aqueous, BP Lotn, BP Pharmacy Health PSM Calcitonin Inj 100 iu per ml, 1 ml ampoule Miacalcic Calcium carbonate Tab 1.25 g (500 mg elemental) Arrow-Calcium Calcium folinate Inj 50 mg Calcium Folinate Ebewe Candesartan cilexetil Tab 4 mg, 8 mg, 16 mg & 32 mg Candestar Capecitabine Tab 150 mg & 500 mg Capecitabine Winthrop Carbomer Ophthalmic gel 0.3%, 0.5 g Poly-Gel 2016 Carvedilol Tab 6.25 mg, 12.5 mg & 25 mg Dicarz Cefaclor monohydrate Cefalexin Cap 250 mg Grans for oral liq 125 mg per 5 ml Grans for oral liq 25 mg per ml Grans for oral liq 50 mg per ml Cap 500 mg 2016 Ranbaxy-Cefaclor 2016 Cefalexin Sandoz Cephalexin ABM Cefazolin Inj 500 mg & 1 g vial AFT *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.

11 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Ceftriaxone Inj 500 mg & 1 g vial Ceftriazone-AFT 2016 Cetirizine hydrochloride Oral liq 1 mg per ml Histaclear Cetomacrogol Crm BP healthe Chloramphenicol Eye drops 0.5%, 10 ml OP Chlorafast Chlorhexidine gluconate Soln 4% wash Handrub 1% with ethanol 70% Mouthwash 0.2% healthe Ciclopirox olamine Nail soln 8% Apo-Ciclopirox Cilazapril Tab 0.5 mg, 2.5 mg & 5 mg Zapril 2016 Cilazapril with hydrochlorothiazide Tab 5 mg with hydrochlorothiazide 12.5 mg Apo-Cilazapril/ Hydrochlorothiazide Ciprofloxacin Tab 250 mg, 500 mg & 750 mg Cipflox Citalopram hydrobromide Tab 20 mg PSM Citalopram Clarithromycin Tab 250 mg & 500 mg Apo-Clarithromycin Clindamycin Cap hydrochloride 150 mg Inj phosphate 150 mg per ml, 4 ml Clindamycin ABM Dalacin C Clobetasol propionate Crm & oint 0.05% Clobetasol BNM 2016 Clomiphene citrate Tab 50 mg Serophene 2016 Clomipramine hydrochloride Tab 10 mg & 25 mg Apo-Clomipramine Clonidine Patch 2.5 mg, 100 mcg per day Patch 5 mg, 200 mcg per day Patch 7.5 mg, 300 mcg per day Catapres TTS 1 Catapres TTS 2 Catapres TTS 3 Clonidine hydrochloride Tab 25 mcg Clonidine BNM Clopidogrel Tab 75 mg Arrow - Clopid 2016 Clotrimazole Crm 1%, 20 g OP Vaginal crm 1% with applicators Vaginal crm 2% with applicators Clomazol 2016 Coal tar Soln Midwest 2016 Codeine phosphate Tab 15 mg, 30 mg & 60 mg PSM 2016 Colchicine Tab 500 mcg Colgout 2016 Compound electrolytes Powder for oral soln Enerlyte 2016 Crotamiton Crm 10% Itch-Soothe Cyclizine hydrochloride Tab 50 mg Nauzene Cyclopentolate hydrochloride Eye drops 1%, 15 ml OP Cyclogyl Cyproterone acetate Tab 50 mg & 100 mg Procur Cyproterone acetate with ethinyloestradiol Tab 2 mg with ethinyloestradiol 35 mcg and 7 inert tablets Ginet Dapsone Tab 25 mg & 100 mg Dapsone *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. 11

12 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Desmopressin acetate Nasal spray 10 mcg per dose Desmopressin-PH&T Dexamethasone Tab 0.5 mg & 4 mg Eye drops 0.1%, 5 ml OP Eye oint 0.1%, 3.5 g OP Dexmethsone Maxidex Dexamethasone phosphate Inj 4 mg per ml, 1 ml & 2 ml ampoule Max Health 2016 Dexamethasone with neomycin sulphate and polymyxin B sulphate Eye drops 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per ml, 5 ml OP Eye oint 0.1% with neomycin sulphate 0.35% and polymyxin B sulphate 6,000 u per g, 3.5 g OP Maxitrol Dexamfetamine sulfate Tab 5 mg PSM Dextrose with electrolytes Soln with electrolytes; 1,000 ml OP Pedialyte-Bubblegum 2016 Diclofenac sodium Tab EC 25 mg & 50 mg Tab long-acting 75 mg & 100 mg Inj 25 mg per ml, 3 ml ampoule Suppos 12.5 mg, 25 mg, 50 mg & 100 mg Eye drops 0.1%, 5 ml OP Diclofenac Sandoz Apo-Diclo SR Voltaren Voltaren Ophtha Dihydrocodeine tartrate Tab long-acting 60 mg DHC Continus 2016 Dimethicone Diphtheria, tetanus and pertussis vaccine Diphtheria, tetanus, pertussis and polio vaccine Diphtheria, tetanus, pertussis, polio, hepatitis B and haemophilus influenzae type B vaccine Crm 10% pump bottle Crm 5% pump bottle Inj 2 IU diphtheria toxoid with 20 IU tetanus toxoid, 8 mcg pertussis toxoid, 8 mcg pertussis filamentous haemagluttinin and 2.5 mcg pertactin in 0.5 ml syringe Inj 30 IU diphtheria toxoid with 40 IU tetanus toxoid, 25 mcg pertussis toxoid, 25 mcg pertussis filamentous haemagluttinin, 8 mcg pertactin and 80 D-antigen units poliomyelitis virus in 0.5 ml Inj 30 IU diphtheria toxoid with 40 IU tetanus toxoid, 25 mcg pertussis toxoid, 25 mcg pertussis filamentous haemagluttinin, 8 mcg pertactin, 80 D-AgU polio virus, 10 mcg hepatitis B surface antigen in 0.5 ml syringe and inj 10 mcg haemophilus influenza healthe Dimethicone 10% healthe Dimethicone 5% 2016 Boostrix Infanrix IPV Infanrix-hexa Docusate sodium Tab 50 mg & 120 mg Coloxyl Domperidone Tab 10 mg Prokinex Donepezil hydrochloride Tab 5 mg & 10 mg Donepezil-Rex 12 *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.

13 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Dorzolamide with timolol Eye drops 2% with timolol 0.5%, 5 ml OP Arrow-Dortim Doxazosin Tab 2 mg & 4 mg Apo-Doxazosin Doxycycline Tab 100 mg Doxine Efavirenz Tab 50 mg, 200 mg & 600 mg Stocrin Emulsifying ointment Oint BP AFT Enalapril maleate Tab 5 mg, 10 mg & 20 mg Ethics Enalapril Entacapone Tab 200 mg Entapone Epoetin alfa [erythropoietin alfa] Inj 1,000 iu in 0.5 ml, syringe Inj 2,000 iu in 0.5 ml, syringe Inj 3,000 iu in 0.3 ml, syringe Inj 4,000 iu in 0.4 ml, syringe Inj 5,000 iu in 0.5 ml, syringe Inj 6,000 iu in 0.6 ml, syringe Inj 8,000 iu in 0.8 ml, syringe Inj 10,000 iu in 1 ml, syringe Inj 40,000 iu in 1 ml, syringe Eprex 28/2/18 Ergometrine maleate Inj 500 mcg per ml, 1 ml ampoule DBL Ergometrine Erlotinib Tab 100 mg & 150 mg Tarceva Escitalopram Tab 10 mg & 20 mg Air Flow Products 2016 Ethinyloestradiol Tab 10 mcg NZ Medical and Scientific Etidronate disodium Tab 200 mg Arrow-Etidronate Exemestane Tab 25 mg Aromasin Ezetimibe Tab 10 mg Ezemibe Ezetimibe with simvastatin Felodipine Fentanyl Tab 10 mg with simvastatin 10 mg Tab 10 mg with simvastatin 20 mg Tab 10 mg with simvastatin 40 mg Tab 10 mg with simvastatin 80 mg Tab long-acting 2.5 mg, 5 mg & 10 mg Inj 50 mcg per ml, 2 ml & 10 ml ampoule Patch 12.5 mcg per hour Patch 25 mcg per hour Patch 50 mcg per hour Patch 75 mcg per hour Patch 100 mcg per hour Zimybe Plendil ER Boucher and Muir Fentanyl Sandoz Ferrous fumarate Tab 200 mg (65 mg elemental) Ferro-tab Ferrous sulphate Oral liq 30 mg (6 mg elemental) per 1 ml 2016 Ferodan 2016 Finasteride Tab 5 mg Finpro *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. 13

14 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Flucloxacillin Inj 1 g vial Grans for oral liq 25 mcg per ml Grans for oral liq 50 mcg per ml Cap 250 mg & 500 mg Inj 250 mg vial & 500 mg vial Flucloxin AFT Staphlex Flucloxin Fluconazole Cap 50 mg, 150 mg & 200 mg Ozole Fludarabine phosphate Tab 10 mg Fludara Oral Fluorometholone Eye drops 0.1% FML Fluorouracil sodium Crm 5% Efudix Fluoxetine hydrochloride Fluticasone propionate Cap 20 mg Tab dispersible 20 mg, scored Metered aqueous nasal spray, 50 mcg per dose Arrow-Fluoxetine 2016 Flixonase Hayfever & Allergy Folic acid Tab 0.8 mg & 5 mg Apo-Folic Acid Furosemide [frusemide] Tab 40 mg Tab 500 mg Fusidic acid Crm 2% Oint 2% Diurin 40 Urex Forte DP Fusidic Acid Cream Foban Gemfibrozil Tab 600 mg Lipazil 2016 Gentamicin sulphate Inj 40 mg per ml, 2 ml ampoule Pfizer Gliclazide Tab 80 mg Glizide Glipizide Tab 5 mg Minidiab Glucose [dextrose] Glycerol Glyceryl trinitrate Inj 50%, 10 ml ampoule Inj 50%, 90 ml bottle Suppos 3.6 g Liquid Patch 25 mg, 5 mg per day Patch 50 mg, 10 mg per day 2016 Biomed PSM healthe Glycerol BP Nitroderm TTS 5 Nitroderm TTS 10 Granisetron Tab 1 mg Granirex Haemophilus influenzae type B vaccine Haloperidol Hepatitis A vaccine Hepatitis B recombinant vaccine Inj 10 mcg vial with diluent syringe Act-HIB Tab 500 mcg, 1.5 mg & 5 mg Oral liq 2 mg per ml Inj 5 mg per ml, 1 ml Inj 1440 ELISA units in 1 ml syringe Inj 720 ELISA units in 1 ml syringe Inj 5 mcg per 0.5 ml vial Inj 10 mg per 1 ml vial Inj 40 mg per 1 ml vial Serenace 2016 Havrix Havrix Junior HBvaxPRO 14 *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.

15 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Human papillomavirus (6,11,16 and 18) vaccine [HPV] Hydrocortisone Hydrocortisone acetate Hydrocortisone and paraffin liquid and lanolin Hydrocortisone with miconazole Inj 120 mcg in 0.5 ml syringe Gardasil Tab 5 mg & 20 mg Powder Inj 100 mg vial Rectal foam 10%, CFC-free (14 applications), 21.1 g OP Lotn 1% with paraffin liquid 15.9% and lanolin 0.6% Douglas ABM Solu-Cortef 2016 Colifoam DP Lotn HC Crm 1% with miconazole nitrate 2% Micreme H Hydrogen peroxide Soln 3% (10 vol) Pharmacy Health Hydroxocobalamin Inj 1 mg per ml, 1 ml ampoule Neo-B12 Hydroxychloroquine Tab 200 mg Plaquenil Hyoscine hydrobromide Patch 1.5 mg Scopoderm TTS 2016 Ibuprofen Tab long-acting 800 mg Tab 200 mg Oral liq 20 mg per ml Brufen SR Ibugesic Fenpaed 2016 Imatinib mesilate Cap 100 mg Imatinib-AFT Imiquimod Crm 5%, 250 mg sachet Apo-Imiquimod Cream 5% Indapamide Tab 2.5 mg Dapa-Tabs 2016 Ipratropium bromide Aqueous nasal spray, 0.03% Nebuliser soln, 250 mcg per ml, 1 ml Nebuliser soln, 250 mcg per ml, 2 ml Univent 2016 Iron polymaltose Inj 50 mg per ml, 2 ml ampoule Ferrum H Isoniazid Tab 100 mg Tab 100 mg with rifampicin 150 mg Tab 150 mg with rifampicin 300 mg PSM Rifinah Isosorbide mononitrate Tab 20 mg Ismo-20 Ispaghula (psyllium) husk Powder for oral soln Konsyl-D 2016 Itraconazole Cap 100 mg Itrazole 2016 Ketoconazole Shampoo 2% Sebizole Lactulose Oral liq 10 g per 15 ml Laevolac 2016 Lamivudine Tab 100 mg Oral liq 5 mg per ml Tab 150 mg Oral liq 10 mg per ml; 240 ml OP Zeffix Zeffix Lamivudine Alphapharm 3TC 2016 Lansoprazole Cap 15 mg & 30 mg Lanzol Relief Latanoprost Eye drops 0.005%, 2.5 ml OP Hysite *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. 15

16 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Letrozole Tab 2.5 mg Letrole Levonorgestrel Lidocaine [lignocaine] hydrochloride Subdermal implant (2 x 75 mg rods) Tab 1.5 mg Jadelle Postinor-1 31/12/ Oral (viscous) soln 2% Xylocaine Viscous Lisinopril Tab 5 mg, 10 mg & 20 mg Ethics Lisinopril Lithium carbonate Tab 250 mg & 400 mg Cap 250 mg Lithicarb FC Douglas Lodoxamide Eye drops 0.1%, 10 ml OP Lomide Loperamide hydrochloride Cap 2 mg Diamide Relief 2016 Loratadine Oral liq 1 mg per ml Tab 10 mg LoraPaed Lorafix Lorazepam Tab 1 mg & 2.5 mg Ativan Losartan potassium Losartan potassium with hydrochlorothiazide Macrogol 400 and propylene glycol Macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride Tab 12.5 mg, 25 mg, 50 mg & 100 mg Tab 50 mg with hydrochlorothiazide 12.5 mg Eye drops 0.4% and propylene glycol 0.3%, 0.4 ml Powder for oral soln g with potassium chloride 46.6 mg, sodium bicarbonate mg and sodium chloride mg Losartan Actavis Arrow-Losartan & Hydrochlorothiazide Systane Unit Dose 2016 Lax-Sachets Magnesium sulphate Inj 2 mmol per ml, 5 ml ampoule DBL Mask for spacer device Small e-chamber Mask Measles, mumps and rubella vaccine Inj 1000 TCID50 measles, TCID50 mumps and 1000 TCID50 rubella vial with diluent 0.5 ml vial M-M-R II Mebeverine hydrochloride Tab 135 mg Colofac Medroxyprogesterone acetate Tab 2.5 mg, 5 mg, 10 mg & 100 mg Inj 150 mg per ml, 1 ml syringe Provera Depo-Provera Megestrol acetate Tab 160 mg Apo-Megestrol Meningococcal C conjugate vaccine Meningococcal (groups a,c,y and w-135) congugate vaccine 2016 Inj 10 mcg in 0.5 ml syringe Neisvac-C Inj 4 mcg of each meningococcal polysaccharide conjugated to a total of approximately 48 mcg of diphtheria toxoid carrier per 0.5 ml vial Menactra Mercaptopurine Tab 50 mg Puri-nethol 2016 Mesalazine Enema 1 g per 100 ml Suppos 1 g Pentasa Pentasa 16 *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.

17 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Metformin hydrochloride Methadone hydrochloride Methotrexate Tab immediate-release 850 mg Tab immediate-release 500 mg Tab 5 mg Oral liq 2 mg per ml Oral liq 5 mg per ml Oral liq 10 mg per ml Tab 2.5 mg & 10 mg Inj 100 mg per ml, 50 ml Inj 25 mg per ml, 2 ml & 20 ml Inj prefilled syringe 7.5 mg, 10 mg, 15 mg, 20 mg, 25 mg & 30 mg Metformin Mylan Metchek Methatabs Biodone Biodone Forte Biodone Extra Forte Trexate Methotrexate Ebewe Hospira Methotrexate Sandoz 2016 Methylprednisolone Tab 4 mg & 100 mg Medrol Methylprednisolone (as sodium succinate) Inj 40 mg vial Inj 125 mg vial Inj 500 mg vial Inj 1 g vial Solu-Medrol Methylprednisolone acetate Inj 40 mg per ml, 1 ml vial Depo-Medrol Methylprednisolone acetate with lidocaine [lignocaine] Metoclopramide hydrochloride Inj 40 mg per ml with lidocaine [lignocaine] 1 ml vial Tab 10 mg Inj 5 mg per ml, 2 ml ampoule Depo-Medrol with Lidocaine Metamide Pfizer Miconazole Oral gel 20 mg per g Decozol Miconazole nitrate Crm 2% Vaginal crm 2% with applicator Multichem Micreme Mirtazapine Tab 30 mg & 45 mg Apo-Mirtazapine Mitomycin C Inj 5 mg vial Arrow 2016 Moclobemide Tab 150 mg & 300 mg Apo-Moclobemide Mometasone furoate Morphine hydrochloride Morphine sulphate Crm 0.1%, 15 g OP & 50 g OP Oint 0.1%, 15 g OP & 50 g OP Lotn 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 immediate-release 10 mg & 20 mg Inj 5 mg per ml, 1 ml ampoule Inj 10 mg per ml, 1 ml ampoule Inj 15 mg per ml, 1 ml ampoule Inj 30 mg per ml, 1 ml ampoule Cap long-acting 10 mg, 30 mg, 60 mg and 100 mg Tab long-acting 10 mg, 30 mg, 60 mg & 100 mg Elocon Alcohol Free Elocon RA-Morph Sevredol DBL Morphine Sulphate m-eslon Arrow-Morphine LA Morphine tartrate Inj 80 mg per ml, 1.5 ml & 5 ml Hospira *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. 17

18 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Mycophenolate mofetil Cap 250 mg Tab 500 mg Cellcept 2016 Nadolol Tab 40 mg & 80 mg Apo-Nadolol Naltrexone hydrochloride Tab 50 mg Naltraccord 2016 Naphazoline hydrochloride Eye drops 0.1%, 15 ml OP Naphcon Forte Naproxen Tab 250 mg Tab 500 mg Tab long-acting 750 mg Tab long-acting 1 g Noflam 250 Noflam 500 Naprosyn SR 750 Naprosyn SR 1000 Neostigmine metilsulfate Inj 2.5 mg per ml, 1 ml ampoule AstraZeneca Nevirapine Tab 200 mg Nevirapine Alphapharm Nicotine Patch 7 mg, 14 mg & 21 mg Lozenge 1 mg & 2 mg Gum 2 mg & 4 mg (Fruit, Classic & Mint) Habitrol Nicotinic acid Tab 50 mg & 500 mg Apo-Nicotinic Acid Nifedipine Tab long-acting 30 mg & 60 mg Adefin XL Nitrazepam Tab 5 mg Nitrodos Norethisterone Tab 350 mcg Noriday 28 Norfloxacin Tab 400 mg Arrow-Norfloxacin Norethisterone Tab 5 mg Primolut N Nortriptyline hydrochloride Tab 10 mg & 25 mg Norpress 2016 Octreotide Inj 50 mcg per ml, 1 ml vial Inj 100 mcg per ml, 1 ml vial Inj 500 mcg per ml, 1 ml vial DBL Oestradiol valerate Tab 1 mg & 2 mg Progynova Olanzapine Tab 2.5 mg, 5 mg & 10 mg Tab orodispersible 5 mg & 10 mg Zypine Zypine ODT Omeprazole Cap 10 mg, 20 mg & 40 mg Omezol Relief Ondansetron Tab disp 4 mg Tab disp 8 mg Tab 4 mg & 8 mg Dr Reddy s Ondansetron Ondansetron ODT- DRLA Onrex Oxazepam Tab 10 mg & 15 mg Ox-Pam Oxybutynin Oxycodone hydrochloride Oral liq 5 mg per 5 ml Tab 5 mg Inj 50 mg per ml, 1 ml ampoule Cap immediate-release 5 mg, 10 mg & 20 mg 2016 Apo-Oxybutynin 2016 OxyNorm 18 *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.

19 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Oxytocin Oxytocin with ergometrine maleate Pamidronate disodium Pancreatic enzyme Pantoprazole Paracetamol Paracetamol with codeine Inj 5 iu per ml, 1 ml ampoule Inj 10 iu per ml, 1 ml ampoule Inj 5 iu with ergometrine maleate 500 mcg per ml Inj 3 mg per ml, 10 ml vial Inj 6 mg per ml, 10 ml vial Inj 9 mg per ml, 10 ml vial Cap EC 10,000 BP u lipase, 9,000 BP u amylase and 210 BP u protease Cap EC 25,000 BP u lipase, 18,000 BP u amylase and 1,000 BP u protease Tab EC 20 mg Tab EC 40 mg Suppos 125 mg & 250 mg Suppos 500 mg Tab 500 mg Oral liq 120 mg per 5 ml Oral liq 250 mg per 5 ml Tab paracetamol 500 mg with codeine phosphate 8 mg Paraffin liquid with wool fat Eye oint 3% with wool fat 3%, 3.5 g OP Oxytocin BNM Syntometrine Pamisol Creon Creon Pantoprazole Actavis 20 Pantoprazole Actavis 40 Gacet Paracare Pharmacare Paracare Paracare Double Strength Paracetamol + Codeine (Relieve) 2016 Poly-Visc Paroxetine hydrochloride Tab 20 mg Loxamine 2016 Peak flow meter Pegylated interferon alfa-2a Low range Normal range Inj 135 mcg prefilled syringe Inj 180 mcg prefilled syringe Inj 135 mcg prefilled syringe 4 with ribavirin tab 200 mg 112 Inj 135 mcg prefilled syringe 4 with ribavirin tab 200 mg 168 Inj 180 mcg prefilled syringe 4 with ribavirin tab 200 mg 112 Inj 180 mcg prefilled syringe 4 with ribavirin tab 200 mg 168 Mini-Wright AFS Low Range Mini-Wright Standard Pegasys Pegasys RBV Combination Pack Perindopril Tab 2 mg & 4 mg Apo-Perindopril Permethrin Pethidine hydrochloride Crm 5%, 30 g OP Lotn 5%, 30 ml OP Tab 50 mg & 100 mg Inj 50 mg per ml, 1 ml & 2 ml Lyderm A-Scabies PSM DBL Pethidine Hydrochloride Phenobartitone Tab 15 mg & 30 mg PSM *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. 19

20 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Phenoxymethylpenicillin (penicillin V) Phenytoin sodium Pilocarpine hydrochloride Cap 250 mg & 500 mg Grans for oral liq 125 mg per 5 ml & 250 mg per 5 ml Inj 50 mg per ml, 2 ml ampoule Inj 50 mg per ml, 5 ml ampoule Eye drops 1%, 15 ml OP Eye drops 2%, 15 ml OP Eye drops 4%, 15 ml OP Cilicaine VK AFT 2016 Hospira Isopto Carpine Pindolol Tab 5 mg, 10 mg & 15 mg Apo-Pindolol 2016 Pine tar with trolamine laurilsulfate and fluorescein Soln 2.3% with trolamine laurilsulfate and fluorescein sodium Pinetarsol Pioglitazone Tab 15 mg, 30 mg & 45 mg Vexazone Pizotifen Tab 500 mcg Sandomigran Pneumococcal (PCV13) vaccine Pneumococcal (PPV23) polysaccharide vaccine Inj 30.8 mcg in 0.5 ml syringe Prevenar 13 Inj 575 mcg in 0.5 ml prefilled syringe (25 mcg of each 23 pneumococcal serotype) Pneumovax 23 Poliomyelitis vaccine Inj 80D antigen units in 0.5 ml syringe IPOL Poloxamer Oral drops 10%, 30 ml OP Coloxyl Potassium chloride Tab long-acting 600 mg (8mmol) Span-K Potassium iodate Tab 253 mcg (150 mcg elemental iodine) NeuroTabs Pramipexole hydrochloride Tab 0.25 mg & 1 mg Ramipex 2016 Pravastatin Tab 20 mg & 40 mg Cholvastin Pregnancy tests HCG urine Cassette EasyCheck Procaine penicillin Inj 1.5 g in 3.4 ml syringe Cilicaine Prochlorperazine Tab 5 mg Antinaus Promethazine hydrochloride Pyridoxine hydrochloride Quetiapine Quinapril Quinapril with hydrochlorothiazide Oral liq 1 mg per ml Tab 10 mg & 25 mg Tab 25 mg Tab 50 mg Tab 25 mg, 100 mg, 200 mg & 300 mg Tab 5 mg Tab 10 mg Tab 20 mg Tab 10 mg with hydrochlorothiazide 12.5 mg Tab 20 mg with hydrochlorothiazide 12.5 mg Allersoothe Vitamin B6 25 Apo-Pyridoxine Quetapel Arrow-Quinapril 5 Arrow-Quinapril 10 Arrow-Quinapril 20 Accuretic 10 Accuretic *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.

21 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Ranitidine Tab 150 mg & 300 mg Oral liq 150 mg per 10 ml Ranitidine Relief Peptisoothe Rifabutin Cap 150 mg Mycobutin 2016 Rifampicin Cap 150 mg & 300 mg Tab 600 mg Oral liq 100 mg per 5 ml Rifadin Rifaximin Tab 550 mg Xifaxan Risperidone Tab 0.5 mg, 1 mg, 2 mg, 3 mg & 4 mg Oral liq 1 mg per ml Actavis Risperon Rizatriptan Tab orodispersible 10 mg Rizamelt Ropinirole hydrochloride Tab 0.25 mg, 1 mg, 2 mg and 5 mg Apo-Ropinirole 2016 Rotavirus live reassortant oral vaccine Salbutamol Salbutamol with ipratropium bromide Oral susp G1, G2, G3, G4, P1(8) 11.5 million CCID50 Nebuliser soln, 1 mg per ml, 2.5 ml ampoule Nebuliser soln, 2 mg per ml, 2.5 ml ampoule Oral liq 400 mcg per ml Nebuliser soln, 2.5 mg with ipratropium bromide 0.5 mg per vial, 2.5 ml ampoule RotaTeq Asthalin Ventolin 2016 Duolin Sertraline Tab 100 mg Arrow-Sertraline 2016 Sildenafil Tab 25 mg, 50 mg & 100 mg Vedafil Simvastatin Tab 10 mg Tab 20 mg Tab 40 mg Tab 80 mg Arrow-Simva 10mg Arrow-Simva 20mg Arrow-Simva 40mg Arrow-Simva 80mg Sodium chloride Inj 23.4%, 20 ml ampoule Biomed 2016 Sodium citrate with sodium lauryl sulphoacetate Enema 90 mg with sodium lauryl sulphoacetate 9 mg per ml, 5 ml Micolette 2016 Sodium citro-tartrate Grans effervescent 4 g sachets Ural Sodium cromoglycate Eye drops 2% Rexacrom Sodium hyaluronate [hyaluronic acid] Sodium polystyrene sulphonate Eye drops 1 mg per ml, 10 ml OP Hylo-Fresh 2016 Powder Resonium A Somatropin Inj cartridges 5 mg, 10 mg & 15 mg Omnitrope 31/12/17 Spacer device 220 ml (single patient) e-chamber Turbo Spironolactone Tab 25 mg & 100 mg Spiractin 2016 Sulphasalazine Tab 500 mg Tab EC 500 mg Salazopyrin Salazopyrin EN 2016 *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. 21

22 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Sumatriptan Tab 50 mg & 100 mg Arrow-Sumatriptan 2016 Tacrolimus Cap 0.5 mg, 1 mg & 5 mg Tacrolimus Sandoz 31/10/18 Tamsulosin hydrochloride Cap 400 mcg Tamsulosin-Rex 2016 Temazepam Tab 10 mg Normison Temozolomide Cap 5 mg, 20 mg, 100 mg & 250 mg Temaccord 2016 Tenoxicam Tab 20 mg Reutenox 2016 Terazosin Tab 1 mg, 2 mg & 5 mg Arrow 2016 Terbinafine Tab 250 mg Dr Reddy s Terbinafine Testosterone cypionate Inj 100 mg per ml, 10 ml vial Depo-Testosterone Testosterone undecanoate Cap 40 mg Andriol Testocaps Tetrabenazine Tab 25 mg Motetis 2016 Timolol Tobramycin Tramadol hydrchloride Eye drops 0.25%, 5 ml OP Eye drops 0.5%, 5 ml OP Eye drops 0.25%, gel forming; 2.5 ml OP Eye drops 0.5%, gel forming; 2.5 ml OP Eye drops 0.3%, 5 ml OP Eye oint 0.3%, 3.5 g OP Cap 50 mg Tab sustained-release 100 mg Tab sustained-release 150 mg Tab sustained-release 200 mg Arrow-Timolol Timoptol XE 2016 Tobrex Arrow-Tramadol Tramal SR 100 Tramal SR 150 Tramal SR 200 Tranexamic acid Tab 500 mg Cyklokapron 2016 Tretinoin Crm 0.5 mg per g ReTrieve 2016 Triamcinolone acetonide Paste 0.1% Oint 0.02% Crm 0.02% Inj 10 mg per ml, 1 ml ampoule Inj 40 mg per ml, 1 ml ampoule Kenalog in Orabase Aristocort Aristocort Kenacort-A 10 Kenacort-A 40 Trimethoprim Tab 300 mg TMP Tropicamide Eye drops 0.5%, 15 ml OP Eye drops 1%, 15 ml OP Mydriacyl Urea Crm 10% healthe Urea Cream 2016 Ursodeoxycholic acid Cap 250 mg Ursosan Valganciclovir Tab 450 mg Valcyte Vancomycin Inj 500 mg Mylan Varicella vaccine [chicken pox vaccine] Inj 2,000 PFU vial with diluent Varilix Verapamil hydrochloride Tab 80 mg Isoptin 22 *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.

23 Sole Subsidised Supply Products cumulative to April 2016 Generic Name Presentation Brand Name Expiry Date* Vitamin B complex Tab, strong, BPC Bplex 2016 Vitamins Tab (BCP cap strength) Mvite 2016 Voriconazole Tab 50 mg & 200 mg Vttack Zidovudine [AZT] Zidovudine [AZT] with lamivudine April changes are in bold type Cap 100 mg Oral liq 10 mg per ml Retrovir 2016 Tab 300 mg with lamivudine 150 mg Alphapharm Zinc sulphate Cap mg (50 mg elemental) Zincaps Ziprasidone Cap 20 mg, 40 mg, 60 mg & 80 mg Zusdone Zopiclone Tab 7.5 mg Zopiclone Actavis *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. 23

24 New Listings Effective 1 April METOPROLOL SUCCINATE Tab long-acting 190 mg Metoprolol - AFT CR 92 CLARITHROMYCIN Maximum of 500 mg per prescription; can be waived by Special Authority see SA1131 Grans for oral liq 250 mg per 5 ml Wastage claimable see rule ml Klacid 138 ERGOTAMINE TARTRATE WITH CAFFEINE Tab 1 mg with caffeine 100 mg Cafergot S29 S29 Wastage claimable see rule FLUPHENAZINE DECANOATE Safety medicine; prescriber may determine dispensing frequency Inj 25 mg per ml, 2 ml Up to 5 inj available on a PSO Modecate S29 Wastage claimable see rule PHARMACY SERVICES May only be claimed once per patient Brand switch fee fee BSF Ethics Lisinopril BSF PSM Citalopram BSF Zusdone BSF Sumatriptan Sun Pharma a) The Pharmacode for BSF Ethics Lisinopril is b) The Pharmacode for BSF PSM Citalopram is c) The Pharmacode for BSF Zusdone is d) The Pharmacode for BSF Sumatriptan Sun Pharma is ORAL ELEMENTAL FEED 1KCAL/ML Special Authority see SA1377 Hospital pharmacy [HP3] Powder (unflavoured) g OP Vivonex TEN Effective 1 March CHOLECALCIFEROL Cap 1.25 mg (50,000 iu) Maximum of 12 cap per prescription Vit.D3 43 NONACOG GAMMA [RECOMBINANT FACTOR IX] [Xpharm] For patients with haemophilia, whose funded treatment is managed by the Haemophilia Treaters Group in conjunction with the National Haemophilia Management Group. Inj 250 iu vial RIXUBIS Inj 500 iu vial RIXUBIS Inj 1,000 iu vial...1, RIXUBIS Inj 2,000 iu vial...2, RIXUBIS Inj 3,000 iu vial...3, RIXUBIS 46 HEPARINISED SALINE Inj 10 iu per ml, 5 ml Becton Dickinson PosiFlush S29 Wastage claimable see rule Patients pay a manufacturer s surcharge when the Manufacturer s Price is greater than the Subsidy 24 S29 Unapproved medicine supplied under Section 29 safety cap reimbursed Sole Subsidised Supply

25 New Listings effective 1 March 2016 (continued) 53 METOPROLOL SUCCINATE Tab long-acting mg Metoprolol - AFT CR Tab long-acting 47.5 mg Metoprolol - AFT CR Tab long-acting 95 mg Metoprolol - AFT CR 195 FLUTICASONE FUROATE WITH VILANTEROL Powder for inhalation 100 mcg with vilanterol 25 mcg dose OP Breo Ellipta 197 TIOTROPIUM BROMIDE Special Authority see SA1568 Retail pharmacy Tiotropium treatment will not be subsidised if patient is also receiving treatment with subsidised inhaled glycopyrronium or umeclidinium. Soln for inhalation 2.5 mcg per dose dose OP Spiriva Respimat 197 UMECLIDINIUM Subsidy by endorsement a) Umeclidinium powder for inhalation 62.5 mcg per dose is subsidised only for patients who have been diagnosed as having COPD using spirometry, and the prescription is endorsed accordingly. b) Umeclidinium will not be subsidised if patient is also receiving treatment with subsidised inhaled glycopyrronium or tiotropium bromide. Powder for inhalation 62.5 mcg per dose dose OP Incruse Ellipta 197 LONG-ACTING MUSCARINIC ANTAGONISTS WITH LONG-ACTING BETA-ADRENOCEPTOR AGONISTS Note: Combination long acting muscarinic antagonist and long acting beta-2 agonist will not be subsidised if patient is also receiving treatment with a combination inhaled corticosteroid and long acting beta-2 agonist. SA1584 Special Authority for Subsidy Initial application only from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient has been stabilised on a long acting muscarinic antagonist; and 2 The prescriber considers that the patient would receive additional benefit from switching to a combination product. Renewal only from any relevant practitioner. Approvals valid for 2 years for applications meeting the following criteria: Both: 1 Patient is compliant with the medication; and 2 Patient has experienced improved COPD symptom control (prescriber determined). 197 GLYCOPYRRONIUM WITH INDACATEROL Special Authority see SA1584 Retail pharmacy Powder for inhalation 50 mcg with indacaterol 110 mcg dose OP Ultibro Breezhaler 197 TIOTROPIUM BROMIDE WITH OLODATEROL Special Authority see SA1584 Retail pharmacy Soln for inhalation 2.5 mcg with olodaterol 2.5 mcg dose OP Spiolto Respimat 197 UMECLIDINIUM WITH VILANTEROL Special Authority see SA1584 Retail pharmacy Powder for inhalation 62.5 mcg with vilanterol 25 mcg dose OP Anoro Ellipta 206 PHARMACY SERVICES May only be claimed once per patient Brand switch fee fee BSF Arrow-Dortim BSF Zopiclone Actavis a) The Pharmacode for BSF Arrow-Dortim is b) The Pharmacode for BSF Zopiclone Actavis is Three months supply may be dispensed at one time if endorsed certified exemption by the prescriber or pharmacist Three months or six months, as applicable, dispensed all-at-once 25

26 New Listings effective 1 February LEVETIRACETAM Tab 250 mg Everet Tab 500 mg For levetiracetam oral liquid formulation refer Everet Tab 750 mg Everet Tab 1,000 mg Everet 139 RIZATRIPTAN Tab orodispersible 10 mg Rizamelt Note this is an additional pack size. 146 DIMETHYL FUMARATE Special Authority see SA1559 Retail pharmacy Wastage claimable see rule Cap 120 mg Tecfidera Cap 240 mg...2, Tecfidera SA1559 Special Authority for Subsidy Special Authority approved by the Multiple Sclerosis Treatment Assessment Committee (MSTAC). Applications will be considered by MSTAC at its regular meetings and approved subject to eligibility according to the Entry and Stopping criteria (below). Application details may be obtained from PHARMAC s website or: The coordinator Phone: Multiple Sclerosis Treatment Assessment Committee Facsimile: PHARMAC PO Box mstaccoordinator@pharmac.govt.nz Wellington Completed application forms must be sent to the coordinator for MSTAC and will be considered by MSTAC at the next practicable opportunity. Notification of MSTAC s decision will be sent to the patient, the applying clinician and the patient s GP (if specified). Entry Criteria 1) Diagnosis of multiple sclerosis (MS) must be confirmed by a neurologist. Diagnosis must include MRI confirmation; and 2) patients must have Clinically Definite Relapsing Remitting MS with or without underlying progression; and 3) patients must have: a) EDSS score and: Experienced at least 1 significant relapse of MS in the previous 12 months or 2 significant relapses in the past 24 months; and Evidence of new inflammatory activity on an MR scan within the past 24 months, any of the following: i. a gadolinium enhancing lesion; or ii. a Diffusion Weighted Imaging positive lesion; or iii. a T2 lesion with associated local swelling; or iv. a prominent T2 lesion that clearly is responsible for the clinical features of a recent relapse; or v. new T2 lesions compared with a previous MR scan; and 4) A significant relapse must: a) be confirmed by the applying neurologist or general physician (the patient may not necessarily have been seen by them during the relapse but the neurologist/physician must be satisfied that the clinical features were characteristic and met the specified criteria); b) be associated with characteristic new symptom(s)/sign(s) or substantial worsening of previously experienced symptom(s)/sign(s); c) last at least one week; d) start at least one month after the onset of a previous relapse; continued... Patients pay a manufacturer s surcharge when the Manufacturer s Price is greater than the Subsidy 26 S29 Unapproved medicine supplied under Section 29 safety cap reimbursed Sole Subsidised Supply

27 New Listings effective 1 February 2016 (continued) continued... e) be severe enough to change either the EDSS or at least one of the Kurtzke Functional System scores by at least 1 point; f) be distinguishable from the effects of general fatigue; and g) not be associated with a fever (T>37.5 C); and 5) applications must be made by the patient s neurologist or general physician; and 6) patients must have no previous history of lack of response to dimethyl fumarate; and 7) patients must have not previously had intolerance to dimethyl fumarate; and 8) patients must not be co-prescribed beta interferon or glatiramer acetate. Stopping Criteria Any of the following: 1) Confirmed progression of disability that is sustained for six months. Progression of disability is defined as progress by any of the following EDSS points: a) from starting at EDSS 0 increasing to (i.e. stopping on reaching) EDSS 3.0; or b) 1.0 to 3.0, or c) 1.5 to 3.5; or d) 2.0 to 4.0; or e) 2.5 to 4.5; or f) 3.0 to 4.5; or g) 3.5 to 4.5; or h) 4.0 to ) increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment) (see note); or 3) intolerance to dimethyl fumarate; or 4) non-compliance with treatment, including refusal to undergo annual assessment. Note: Switching between natalizumab, fingolimod, dimethyl fumarate and teriflunomide is permitted provided the EDSS stopping criteria are not met. Switching to interferon or glatiramer acetate is only permitted provided the EDSS stopping criteria are not met and both fingolimod and natalizumab are either not tolerated or treatment with both agents would be clinically inappropriate. Continued relapses on treatment would be expected to lead to a switch of treatment provided the stopping criteria are not met. If a relapse has resulted in an increased EDSS score that potentially may lead to discontinuation of treatment according to stopping criteria, a period of 6 months is allowed from the start of the relapse for recovery to occur. 146 TERIFLUNOMIDE Special Authority see SA1560 Retail pharmacy Wastage claimable see rule Tab 14 mg...1, Aubagio SA1560 Special Authority for Subsidy Special Authority approved by the Multiple Sclerosis Treatment Assessment Committee (MSTAC). Applications will be considered by MSTAC at its regular meetings and approved subject to eligibility according to the Entry and Stopping criteria (below). Application details may be obtained from PHARMAC s website or: The coordinator Phone: Multiple Sclerosis Treatment Assessment Committee Facsimile: PHARMAC PO Box mstaccoordinator@pharmac.govt.nz Wellington Completed application forms must be sent to the coordinator for MSTAC and will be considered by MSTAC at the next practicable opportunity. Notification of MSTAC s decision will be sent to the patient, the applying clinician and the patient s GP (if specified). continued... Three months supply may be dispensed at one time if endorsed certified exemption by the prescriber or pharmacist Three months or six months, as applicable, dispensed all-at-once 27

28 New Listings effective 1 February 2016 (continued) continued... Entry Criteria 1) Diagnosis of multiple sclerosis (MS) must be confirmed by a neurologist. Diagnosis must include MRI confirmation; and 2) patients must have Clinically Definite Relapsing Remitting MS with or without underlying progression; and 3) patients must have: a) EDSS score and: Experienced at least 1 significant relapse of MS in the previous 12 months or 2 significant relapses in the past 24 months; and Evidence of new inflammatory activity on an MR scan within the past 24 months, any of the following: i. a gadolinium enhancing lesion; or ii. a Diffusion Weighted Imaging positive lesion; or iii. a T2 lesion with associated local swelling; or iv. a prominent T2 lesion that clearly is responsible for the clinical features of a recent relapse; or v. new T2 lesions compared with a previous MR scan; and 4) A significant relapse must: a) be confirmed by the applying neurologist or general physician (the patient may not necessarily have been seen by them during the relapse but the neurologist/physician must be satisfied that the clinical features were characteristic and met the specified criteria); b) be associated with characteristic new symptom(s)/sign(s) or substantial worsening of previously experienced symptom(s)/sign(s); c) last at least one week; d) start at least one month after the onset of a previous relapse; e) be severe enough to change either the EDSS or at least one of the Kurtzke Functional System scores by at least 1 point; f) be distinguishable from the effects of general fatigue; and g) not be associated with a fever (T>37.5 C); and 5) applications must be made by the patient s neurologist or general physician; and 6) patients must have no previous history of lack of response to teriflunomide; and 7) patients must have not previously had intolerance to teriflunomide; and 8) patients must not be co-prescribed beta interferon or glatiramer acetate. Stopping Criteria Any of the following: 1) Confirmed progression of disability that is sustained for six months. Progression of disability is defined as progress by any of the following EDSS points: a) from starting at EDSS 0 increasing to (i.e. stopping on reaching) EDSS 3.0; or b) 1.0 to 3.0; or c) 1.5 to 3.5; or d) 2.0 to 4.0; or e) 2.5 to 4.5; or f) 3.0 to 4.5; or g) 3.5 to 4.5; or h) 4.0 to ) increasing relapse rate over 12 months of treatment (compared with the relapse rate on starting treatment) (see note); 3) intolerance to teriflunomide; or 4) non-compliance with treatment, including refusal to undergo annual assessment. Note: Switching between natalizumab, fingolimod, dimethyl fumarate and teriflunomide is permitted provided the EDSS stopping criteria are not met. Switching to interferon or glatiramer acetate is only permitted provided the EDSS stopping criteria are not met and both fingolimod and natalizumab are either not tolerated or treatment with both agents would be clinically inappropriate. continued... Patients pay a manufacturer s surcharge when the Manufacturer s Price is greater than the Subsidy 28 S29 Unapproved medicine supplied under Section 29 safety cap reimbursed Sole Subsidised Supply