Drug Benefit List 2010

10:00 ANTINEOPLASTIC AGENTS

10:00.00 ANTINEOPLASTIC AGENTS

ALTRETAMINE

50mg Capsule

2126230 HEXALEN LIL

ANASTROZOLE

1mg Tablet

2224135 ARIMIDEX AZC

BICALUTAMIDE

50mg Tablet

2296063 APO-BICALUTAMIDE APX

2184478 CASODEX AZC

2274337 CO BICALUTAMIDE COB

2302403 GEN-BICALUTAMIDE GEN

2270226 NOVO-BICALUTAMIDE NOP

2275589 PMS-BICALUTAMIDE PMS

2311038 PRO-BICALUTAMIDE PDL

2277700 RATIO-BICALUTAMIDE RPH

2276089 SANDOZ-BICALUTAMIDE SDZ

BUSERELIN ACETATE

1mg/mL Injection

2225166 SUPREFACT SAC

1mg/mL Nasal Solution

2225158 SUPREFACT SAC

6.3mg/Implant Subcutaneous Injection

2228955 SUPREFACT DEPOT 2 MONTHS SAC

9.45mg/Implant Subcutaneous Injection

2240749 SUPREFACT DEPOT 3 MONTHS SAC

BUSULFAN

2mg Tablet

4618 MYLERAN GSK

CAPECITABINE

150mg Tablet

2238453 XELODA HLR

500mg Tablet

2238454 XELODA HLR

CHLORAMBUCIL

2mg Tablet

4626 LEUKERAN GSK

CYCLOPHOSPHAMIDE

25mg Tablet

2241795 PROCYTOX BAT

50mg Tablet

344885 CYTOXAN BMS

2241796 PROCYTOX BAT

CYPROTERONE ACETATE

50mg Tablet

704431 ANDROCUR BEX

2245898 APO-CYPROTERONE APX

2229723 GEN-CYPROTERONE GEN

ERLOTINIB HYDROCLORIDE

Limited use benefit (prior approval required).

Treatment of non-small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy regimen, and whose EGFR expression status is positive or unknown.

100mg Tablet

2269015 TARCEVA HLR

150mg Tablet

2269023 TARCEVA HLR

ETOPOSIDE

50mg Capsule

616192 VEPESID BMS

EXEMESTANE

25mg Tablet

2242705 AROMASIN PFI

FLUDARABINE PHOSPHATE

10mg Tablet

2246226 FLUDARA BEX

FLUTAMIDE

250mg Tablet

2238560 APO-FLUTAMIDE APX

637726 EUFLEX SCH

2230089 NOVO-FLUTAMIDE NOP

2239388 PDL-FLUTAMIDE PDL

2230104 PMS-FLUTAMIDE PMS

GOSERELIN ACETATE

3.6mg/Depot Injection

2049325 ZOLADEX AZC

10.8mg/Depot Injection

2225905 ZOLADEX LA AZC

HYDROXYUREA

500mg Capsule

2247937 APO-HYDROXYUREA APX

2242920 GEN-HYDROXYUREA GEN

500mg Tablet

465283 HYDREA BMS

IMATINIB MESYLATE

Limited use benefit (prior approval required).

1. For the treatment of patients with chronic myeloid leukemia in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alpha therapy.
2. For the treatment of patients with gastrointestinal stromal tumour.
3. For newly diagnosed adult patients with Philadelphia chromosome-positive chronic myeloid leukemia (CML).

100mg Tablet

2253275 GLEEVEC NVR

400mg Tablet

2253283 GLEEVEC NOV

INTERFERON ALFA-2B

6,000,000IU/mL Injection

2238674 INTRON A SCH

10,000,000IU/mL Injection

2238675 INTRON A SCH

10,000,000IU/Vial Injection

2223406 INTRON A SCH

15,000,000IU/mL Injection

2240693 INTRON A SCH

18,000,000IU/Vial Injection

2231651 INTRON A SCH

25,000,000IU/mL Injection

2240694 INTRON A SCH

50,000,000IU/mL Injection

2240695 INTRON A SCH

LETROZOLE

2.5mg Tablet

2231384 FEMARA NVR

2348969 LETROZOLE CBT

2309114 PMS-LETROZOLE PMS

2344815 SANDOZ LETROZOLE SDZ

LEUPROLIDE ACETATE

3.75mg/Vial Injection

884502 LUPRON DEPOT ABB

7.5mg/Vial Injection

836273 LUPRON DEPOT ABB

11.25mg/Vial Injection

2239834 LUPRON DEPOT ABB

22.5mg/Vial Injection

2248240 ELIGARD SAC

2230248 LUPRON DEPOT ABB

30mg/Vial Injection

2248999 ELIGARD SAC

2239833 LUPRON DEPOT ABB

45mg/Vial Injection

2268892 ELIGARD SAC

LOMUSTINE

10mg Capsule

360430 CEENU BMS

LOMUSTINE

40mg Capsule

360422 CEENU BMS

100mg Capsule

360414 CEENU BMS

MEGESTROL ACETATE

40mg/mL Suspension

2168979 MEGACE BMS

40mg Tablet

2195917 APO-MEGESTROL APX

2223104 MEGESTROL PDL

2185415 NU-MEGESTROL NXP

160mg Tablet

2195925 APO-MEGESTROL APX

731323 MEGACE BMS

2223112 MEGESTROL PDL

2185423 NU-MEGESTROL NXP

MELPHALAN

2mg Tablet

4715 ALKERAN GSK

MERCAPTOPURINE

50mg Tablet

4723 PURINETHOL NOP

METHOTREXATE SODIUM

10mg/mL Injection

2182947 METHOTREXATE MAY

25mg/mL Injection

2182777 METHOTREXATE MAY

2182955 METHOTREXATE MAY

2099705 NOVO-METHOTREXATE NOP

2.5mg Tablet

2182963 APO-METHOTREXATE APX

2170698 METHOTREXATE WAY

2244798 RATIO-METHOTREXATE RPH

10mg Tablet

2182750 METHOTREXATE MAY

MITOTANE

500mg Tablet

463221 LYSODREN BMS

NILUTAMIDE

50mg Tablet

2221861 ANANDRON SAC

PROCARBAZINE HCL

50mg Capsule

12750 NATULAN SIG

RITUXIMAB

Limited use benefit (prior approval required).

Prescribed by a rheumatologist for treatment of adult patients with severely active rheumatoid arthritis who have failed to respond to a trial of an anti-TNF agent. Treatment should be combined with methotrexate. Rituximab should not be used in combination with anti-TNF agents.

Treatment beyond six months will only be considered for patients who have achieved a response. (Please refer to Appendix A).

10mg/mL Injection

2241927 RITUXAN HLR

SUNITINIB MALATE

Limited use benefit (Prior approval required)

Criteria for initial six month coverage of Sutent:
For patients with histologically proven unresectable or recurrent/metastatic GIST who have failed or are unable to tolerate imatinib therapy. Sunitinib will not be funded concomitantly with imatinib.

Criteria for assessment at every six months:
There is no objective evidence of disease progression.

12.5mg Capsule

2280795 SUTENT PFI

25mg Capsule

2280809 SUTENT PFI

50mg Capsule

2280817 SUTENT PFI

TAMOXIFEN CITRATE

10mg Tablet

812404 APO-TAMOX APX

2088428 GEN-TAMOXIFEN GEN

851965 NOVO-TAMOXIFEN NOP

2237459 PMS-TAMOXIFEN PMS

1926624 TAMOFEN SAC

2296721 TAMOXIFEN PDL

20mg Tablet

812390 APO-TAMOX APX

2089858 GEN-TAMOXIFEN GEN

2048485 NOLVADEX D AZC

851973 NOVO-TAMOXIFEN NOP

2237460 PMS-TAMOXIFEN PMS

1926632 TAMOFEN SAC

2296748 TAMOXIFEN PDL

TEMOZOLOMIDE

Limited use benefit (prior approval required).

For:

1. treatment of adult patients with glioblastoma multiforme or anaplastic astrocytoma, and documented evidence of recurrence or progression after standard therapy (resection, radiotherapy, and chemotherapy).
2. treatment of adult patients with newly diagnosed glioblastoma multiforme concomitantly with radiotherapy and then as maintenance treatment.

5mg Capsule

2241093 TEMODAL SCH

20mg Capsule

2241094 TEMODAL SCH

100mg Capsule

2241095 TEMODAL SCH

250mg Capsule

2241096 TEMODAL SCH

THIOGUANINE

40mg Tablet

282081 LANVIS GSK

TRETINOIN

10mg Capsule

2145839 VESANOID HLR

TRIPTORELIN PAMOATE

3.75mg/Vial Injection

2240000 TRELSTAR WAT

11.25mg/Vial Injection

2243856 TRELSTAR LA WAT

VINCRISTINE SULFATE

1mg/mL Injection

2143305 VINCRISTINE SULFATE NOP

2183013 VINCRISTINE SULFATE MAY