Special Formulary for Chronic Renal Failure Patients 2012

20:00 BLOOD FORMATION COAGULATION AND THROMBOSIS

20:16.00 HEMATOPOIETIC AGENTS

DARBEPOETIN ALFA

25mcg/mL Injection

02246354 ARANESP AMG

40mcg/mL Injection

02246355 ARANESP AMG

100mcg/mL Injection

02246357 ARANESP AMG

200mcg/mL Injection

02246358 ARANESP AMG

500mcg/mL Injection

02246360 ARANESP AMG

EPOETIN ALFA

20,000IU/mL Injection

02206072 EPREX JNO

20000IU/0.5mL injection

02243239 EPREX JNO

5,000IU/mL Injection

02243400 EPREX JNO

30000IU/0.75mL Injection

02288680 EPREX JNO

1,000IU/0.5mL Prefilled Syringe

02231583 EPREX JNO

2,000IU/0.5mL Prefilled Syringe

02231584 EPREX JNO

3,000IU/0.3mL Prefilled Syringe

02231585 EPREX JNO

4,000IU/0.4mL Prefilled Syringe

02231586 EPREX JNO

6,000IU/0.6mL Prefilled Syringe

02243401 EPREX JNO

8,000IU/0.8mL Prefilled Syringe

02243403 EPREX JNO

10,000IU/mL Prefilled Syringe

02231587 EPREX JNO

40,000IU/mL Prefilled Syringe

02240722 EPREX JNO

40:00 ELECTROLYTIC, CALORIC, AND WATER BALANCE

40:08.00 ALKALINIZING AGENTS

SODIUM BICARBONATE

500mg Tablet

00392839 SANDOZ SOD BICARBONATE SDZ

40:12.00 REPLACEMENT PREPARATIONS

CALCIUM (CALCIUM GLUCONOLACTATE, CALCIUM CARBONATE)

300mg & 2940mg Effervescent Tablet

02232482 CALCIUM SANDOZ NVC

1750mg & 2327mg Effervescent Tablet

02232483 GRAMCAL NVC

CALCIUM CARBONATE

500mg Capsule

00648353 CALSAN NVC

500mg Chewable Tablet

00705373 CALCIUM WAM

00648345 CALSAN NVC

250mg Tablet

00682047 APO-CAL 250 APX

00645958 CALCIUM TEV

CALCIUM CITRATE

300mg Tablet

02231833 CALCIUM CITRATE WNP

PHOSPHORUS

500mg Effervescent Tablet

00225819 PHOSPHATE-NOVARTIS NVR

ZINC GLUCONATE

50mg Tablet

00503169 ZINC VTH

00505463 ZINC JAM

40:18.19 PHOSPHATE - REMOVING AGENTS

SEVELAMER HYDROCHLORIDE

Limited Use Benefit ( Prior approval required ).

1. patients with elevated phosphate levels OR elevated phosphate X calcium product despite dietary restriction of phosphate and use of calcium-based phosphate binders (short term elevations should be managed with aluminium based binders)
2. patients with elevated calcium levels despite discontinuation of calcium binder, and Vitamin D analogue and/or modification of dialysate calcium
3. patients with adynamic bone disease and low PTH levels (<100 pg/ml or <0.9 pmol/L) with normal or elevated calcium levels

800mg Tablet

02244310 RENAGEL GEE

56:00 GASTROINTESTINAL DRUGS

56:04.00 ANTACIDS AND ADSORBENTS

ALUMINUM HYDROXIDE

500mg Capsule

02135620 BASALJEL AXC

60mg/mL Liquid

00572527 ALUGEL ATL

64mg/mL Liquid

02125862 AMPHOJEL AXC

600mg Tablet

02124971 AMPHOJEL AXC

CALCIUM CARBONATE

500mg Tablet

01970240 TUMS GSK

750mg Tablet

01967932 TUMS EXTRA STRENGTH GSK

1000mg Tablet

02151138 TUMS ULTRA STRENGTH GSK

88:00 VITAMINS

88:12.00 VITAMIN C

VITAMIN B COMPLEX

Tablet

00123803 B COMPLEX PLUS C JAM

VITAMIN B COMPLEX WITH VITAMIN C

Tablet

02245391 DIAMINE EUR

88:28.00 MULTIVITAMIN PREPARATIONS

MULTIVITAMINS

Tablet

02244872 REPLAVITE WNP

80007498 REPLAVITE WNP

00558796 STRESS PLEX C JAM

96:00 PHARMACEUTICAL AIDS

96:00.00 PHARMACEUTICAL AIDS

NUTRITIONAL SUPPLEMENT

Liquid

09854258 NOVASOURCE RENAL NES

Liquid

09853723 NEPRO ABB

00907995 NOVASOURCE NVR

09853731 SUPLENA ABB

235mL Liquid

99002639 NEPRO ABB

99002647 SUPLENA ABB

Powder

09991056 RESOURCE BENEPROTEIN NVR

• ALUGEL
• ALUMINUM HYDROXIDE
• AMPHOJEL
• APO-CAL 250
• ARANESP
• B COMPLEX PLUS C
• BASALJEL
• CALCIUM
• CALCIUM (CALCIUM GLUCONOLACTATE, CALCIUM CARBONATE)
• CALCIUM CARBONATE
• CALCIUM CITRATE
• CALCIUM CITRATE
• CALCIUM SANDOZ
• CALSAN
• DARBEPOETIN ALFA
• DIAMINE
• EPOETIN ALFA
• EPREX
• GRAMCAL
• MULTIVITAMINS
• NEPRO
• NOVASOURCE
• NOVASOURCE RENAL
• NUTRITIONAL SUPPLEMENT
• PHOSPHATE-NOVARTIS
• PHOSPHORUS
• RENAGEL
• REPLAVITE
• RESOURCE BENEPROTEIN
• SANDOZ SOD BICARBONATE
• SEVELAMER HYDROCHLORIDE
• SODIUM BICARBONATE
• STRESS PLEX C
• SUPLENA
• TUMS
• TUMS EXTRA STRENGTH
• TUMS ULTRA STRENGTH
• VITAMIN B COMPLEX
• VITAMIN B COMPLEX WITH
• VITAMIN C
• ZINC
• ZINC GLUCONATE