Drug Benefit List 2012

10:00 ANTINEOPLASTIC AGENTS

ALTRETAMINE

50mg Capsule

02126230 HEXALEN LIL

ANASTROZOLE

1mg Tablet

02224135 ARIMIDEX AZC

BICALUTAMIDE

50mg Tablet

02296063 APO-BICALUTAMIDE APX

02184478 CASODEX AZC

02274337 CO BICALUTAMIDE COB

02302403 MYLAN-BICALUTAMIDE MYL

02275589 PMS-BICALUTAMIDE PMS

02311038 PRO-BICALUTAMIDE PDL

02277700 RATIO-BICALUTAMIDE RPH

02276089 SANDOZ-BICALUTAMIDE SDZ

02270226 TEVA-BICALUTAMIDE TEV

BUSERELIN ACETATE

1mg/mL Injection

02225166 SUPREFACT SAC

1mg/mL Nasal Solution

02225158 SUPREFACT SAC

6.3mg/Implant Subcutaneous Injection

02228955 SUPREFACT DEPOT 2 MONTHS SAC

9.45mg/Implant Subcutaneous Injection

02240749 SUPREFACT DEPOT 3 MONTHS SAC

BUSULFAN

2mg Tablet

00004618 MYLERAN GSK

CAPECITABINE

150mg Tablet

02238453 XELODA HLR

500mg Tablet

02238454 XELODA HLR

CHLORAMBUCIL

2mg Tablet

00004626 LEUKERAN GSK

CYCLOPHOSPHAMIDE

25mg Tablet

02241795 PROCYTOX BAT

50mg Tablet

02241796 PROCYTOX BAT

CYPROTERONE ACETATE

50mg Tablet

00704431 ANDROCUR BEX

02245898 APO-CYPROTERONE APX

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

02269015 TARCEVA HLR

150mg Tablet

02269023 TARCEVA HLR

ETOPOSIDE

50mg Capsule

00616192 VEPESID BMS

EXEMESTANE

25mg Tablet

02242705 AROMASIN PFI

FLUDARABINE PHOSPHATE

10mg Tablet

02246226 FLUDARA BEX

FLUTAMIDE

250mg Tablet

02238560 APO-FLUTAMIDE APX

00637726 EUFLEX SCH

02230104 PMS-FLUTAMIDE PMS

02230089 TEVA-FLUTAMIDE TEV

GOSERELIN ACETATE

3.6mg/Depot Injection

02049325 ZOLADEX AZC

10.8mg/Depot Injection

02225905 ZOLADEX LA AZC

HYDROXYUREA

500mg Capsule

02247937 APO-HYDROXYUREA APX

00465283 HYDREA BMS

02343096 HYDROXYUREA SAN

02242920 MYLAN-HYDROXYUREA MYL

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

02253275 GLEEVEC NVR

400mg Tablet

02253283 GLEEVEC NVR

INTERFERON ALFA-2B

6,000,000IU/mL Injection

02238674 INTRON A SCH

10,000,000IU/mL Injection

02238675 INTRON A SCH

10,000,000IU/Vial Injection

02223406 INTRON A SCH

15,000,000IU/mL Injection

02240693 INTRON A SCH

18,000,000IU/Vial Injection

02231651 INTRON A SCH

25,000,000IU/mL Injection

02240694 INTRON A SCH

50,000,000IU/mL Injection

02240695 INTRON A SCH

LETROZOLE

2.5mg Tablet

02358514 APO-LETROZOLE APX

02231384 FEMARA NVR

02347997 LETROZOLE TEV

02348969 LETROZOLE COB

02373424 MAR-LETROZOLE MAR

02322315 MED-LETROZOLE GMP

02372169 MYL-LETROZOLE MYL

02309114 PMS-LETROZOLE PMS

02372282 RAN-LETROZOLE RBY

02344815 SANDOZ LETROZOLE SDZ

LEUPROLIDE ACETATE

3.75mg/Vial Injection

00884502 LUPRON DEPOT ABB

7.5mg/Vial Injection

00836273 LUPRON DEPOT ABB

11.25mg/Vial Injection

02239834 LUPRON DEPOT ABB

22.5mg/Vial Injection

02248240 ELIGARD SAC

02230248 LUPRON DEPOT ABB

30mg/Vial Injection

02248999 ELIGARD SAC

02239833 LUPRON DEPOT ABB

45mg/Vial Injection

02268892 ELIGARD SAC

LOMUSTINE

10mg Capsule

00360430 CEENU BMS

40mg Capsule

00360422 CEENU BMS

100mg Capsule

00360414 CEENU BMS

MEGESTROL ACETATE

40mg/mL Suspension

02168979 MEGACE BMS

40mg Tablet

02195917 MEGESTROL AAP

02185415 NU-MEGESTROL NXP

160mg Tablet

02195925 MEGESTROL AAP

02185423 NU-MEGESTROL NXP

MELPHALAN

2mg Tablet

00004715 ALKERAN GSK

MERCAPTOPURINE

50mg Tablet

00004723 PURINETHOL TEV

METHOTREXATE SODIUM

10mg/mL Injection

02182947 METHOTREXATE MAY

25mg/mL Injection

02182777 METHOTREXATE MAY

02182955 METHOTREXATE MAY

02099705 NOVO-METHOTREXATE TEV

2.5mg Tablet

02182963 APO-METHOTREXATE APX

02170698 METHOTREXATE WAY

02244798 RATIO-METHOTREXATE RPH

10mg Tablet

02182750 METHOTREXATE MAY

MITOTANE

500mg Tablet

00463221 LYSODREN BMS

NILUTAMIDE

50mg Tablet

02221861 ANANDRON SAC

PROCARBAZINE HCL

50mg Capsule

00012750 MATULAN 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

02241927 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

02280795 SUTENT PFI

25mg Capsule

02280809 SUTENT PFI

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.

50mg Capsule

02280817 SUTENT PFI

TAMOXIFEN CITRATE

10mg Tablet

00812404 APO-TAMOX APX

02088428 MYLAN-TAMOXIFEN MYL

02237459 PMS-TAMOXIFEN PMS

00851965 TEVA-TAMOXIFEN TEV

20mg Tablet

00812390 APO-TAMOX APX

02089858 MYLAN-TAMOXIFEN MYL

02048485 NOLVADEX D AZC

02237460 PMS-TAMOXIFEN PMS

00851973 TEVA-TAMOXIFEN TEV

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

02241093 TEMODAL SCH

20mg Capsule

02241094 TEMODAL SCH

100mg Capsule

02241095 TEMODAL SCH

140mg Capsule

02312794 TEMODAL FRS

180mg Capsule

02312816 TEMODAL FRS

250mg Capsule

02241096 TEMODAL SCH

THIOGUANINE

40mg Tablet

00282081 LANVIS GSK

TRETINOIN

10mg Capsule

02145839 VESANOID HLR

TRIPTORELIN PAMOATE

3.75mg/Vial Injection

02240000 TRELSTAR WAT

11.25mg/Vial Injection

02243856 TRELSTAR LA WAT

VINCRISTINE SULFATE

1mg/mL Injection

02143305 VINCRISTINE SULFATE TEV

02183013 VINCRISTINE SULFATE MAY