Commonwealth Coat of Arms of Australia

 

 

 

PB 22 of 2024

 

National Health (Weighted average disclosed price – April 2024 reduction day) Amendment Determination 2024

 

I, ADRIANA PLATONA, First Assistant Secretary, Technology Assessment and Access Division, Department of Health and Aged Care, delegate of the Minister for Health and Aged Care, make this determination under subsection 99ADB(4) of the National Health Act 1953.

Dated:    27    February 2024

 

 

 

 

 

 

 

 

 

Adriana Platona

First Assistant Secretary

Technology Assessment and Access Division

Department of Health and Aged Care

 

 

 

1 Name of Instrument

(1)     This instrument is the National Health (Weighted average disclosed price – April 2024 reduction day) Amendment Determination 2024.

(2)     This instrument may also be cited as PB 22 of 2024.

2 Commencement

This instrument commences on the day after it is registered.

3 Authority

This instrument is made under subsection 99ADB(4) of the National Health Act 1953.

4 Amendments to PB 127 of 2023

Schedule 1 amends the National Health (Weighted average disclosed price – April 2024 reduction day) Determination 2023 (PB 127 of 2023).

 

 

Schedule 1 Amendments

 

[1]  Schedule 1

omit:

142

Dasatinib

Tablet 100 mg

Oral

Dasatinib ARX

#######

143

Dasatinib

Tablet 100 mg

Oral

Dasatinib Dr.Reddy's

#######

144

Dasatinib

Tablet 100 mg

Oral

Dasatinib SUN

#######

145

Dasatinib

Tablet 100 mg

Oral

DASATINIB-TEVA

#######

146

Dasatinib

Tablet 100 mg

Oral

Sprycel

#######

147

Dasatinib

Tablet 100 mg

Oral

TE-DASATINIB

#######

148

Dasatinib

Tablet 20 mg

Oral

Dasatinib ARX

#######

149

Dasatinib

Tablet 20 mg

Oral

Dasatinib Dr.Reddy's

#######

150

Dasatinib

Tablet 20 mg

Oral

Dasatinib SUN

#######

151

Dasatinib

Tablet 20 mg

Oral

DASATINIB-TEVA

#######

152

Dasatinib

Tablet 20 mg

Oral

Sprycel

#######

153

Dasatinib

Tablet 20 mg

Oral

TE-DASATINIB

#######

154

Dasatinib

Tablet 50 mg

Oral

Dasatinib ARX

#######

155

Dasatinib

Tablet 50 mg

Oral

Dasatinib Dr.Reddy's

#######

156

Dasatinib

Tablet 50 mg

Oral

Dasatinib SUN

#######

157

Dasatinib

Tablet 50 mg

Oral

DASATINIB-TEVA

#######

158

Dasatinib

Tablet 50 mg

Oral

Sprycel

#######

159

Dasatinib

Tablet 50 mg

Oral

TE-DASATINIB

#######

160

Dasatinib

Tablet 70 mg

Oral

Dasatinib ARX

#######

161

Dasatinib

Tablet 70 mg

Oral

Dasatinib Dr.Reddy's

#######

162

Dasatinib

Tablet 70 mg

Oral

Dasatinib SUN

#######

163

Dasatinib

Tablet 70 mg

Oral

DASATINIB-TEVA

#######

164

Dasatinib

Tablet 70 mg

Oral

Sprycel

#######

165

Dasatinib

Tablet 70 mg

Oral

TE-DASATINIB

#######

 

 

 

insert:

142

Dasatinib

Tablet 100 mg

Oral

Dasatinib ARX

$1770.45

143

Dasatinib

Tablet 100 mg

Oral

Dasatinib Dr.Reddy's

$1770.45

144

Dasatinib

Tablet 100 mg

Oral

Dasatinib SUN

$1770.45

145

Dasatinib

Tablet 100 mg

Oral

DASATINIB-TEVA

$1770.45

146

Dasatinib

Tablet 100 mg

Oral

Sprycel

$1770.45

147

Dasatinib

Tablet 100 mg

Oral

TE-DASATINIB

$1770.45

148

Dasatinib

Tablet 20 mg

Oral

Dasatinib ARX

$1074.89

149

Dasatinib

Tablet 20 mg

Oral

Dasatinib Dr.Reddy's

$1074.89

150

Dasatinib

Tablet 20 mg

Oral

Dasatinib SUN

$1074.89

151

Dasatinib

Tablet 20 mg

Oral

DASATINIB-TEVA

$1074.89

152

Dasatinib

Tablet 20 mg

Oral

Sprycel

$1074.89

153

Dasatinib

Tablet 20 mg

Oral

TE-DASATINIB

$1074.89

154

Dasatinib

Tablet 50 mg

Oral

Dasatinib ARX

$1770.45

155

Dasatinib

Tablet 50 mg

Oral

Dasatinib Dr.Reddy's

$1770.45

156

Dasatinib

Tablet 50 mg

Oral

Dasatinib SUN

$1770.45

157

Dasatinib

Tablet 50 mg

Oral

DASATINIB-TEVA

$1770.45

158

Dasatinib

Tablet 50 mg

Oral

Sprycel

$1770.45

159

Dasatinib

Tablet 50 mg

Oral

TE-DASATINIB

$1770.45

160

Dasatinib

Tablet 70 mg

Oral

Dasatinib ARX

$2191.93

161

Dasatinib

Tablet 70 mg

Oral

Dasatinib Dr.Reddy's

$2191.93

162

Dasatinib

Tablet 70 mg

Oral

Dasatinib SUN

$2191.93

163

Dasatinib

Tablet 70 mg

Oral

DASATINIB-TEVA

$2191.93

164

Dasatinib

Tablet 70 mg

Oral

Sprycel

$2191.93

165

Dasatinib

Tablet 70 mg

Oral

TE-DASATINIB

$2191.93

 

 

[2]  Schedule 1

omit:

417

Lenalidomide

Capsule 15 mg

Oral

Cipla Lenalidomide

#######

418

Lenalidomide

Capsule 15 mg

Oral

Lenalide

#######

419

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide Dr.Reddy's

#######

420

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide Sandoz

#######

421

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide Viatris

#######

422

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide-Teva

#######

423

Lenalidomide

Capsule 15 mg

Oral

Revlimid

#######

424

Lenalidomide

Capsule 25 mg

Oral

Cipla Lenalidomide

#######

425

Lenalidomide

Capsule 25 mg

Oral

Lenalide

#######

426

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide Dr.Reddy's

#######

427

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide Sandoz

#######

428

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide Viatris

#######

429

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide-Teva

#######

430

Lenalidomide

Capsule 25 mg

Oral

Revlimid

#######

 

insert:

417

Lenalidomide

Capsule 15 mg

Oral

Cipla Lenalidomide

$1067.96

418

Lenalidomide

Capsule 15 mg

Oral

Lenalide

$1067.96

419

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide Dr.Reddy's

$1067.96

420

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide Sandoz

$1067.96

421

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide Viatris

$1067.96

422

Lenalidomide

Capsule 15 mg

Oral

Lenalidomide-Teva

$1067.96

423

Lenalidomide

Capsule 15 mg

Oral

Revlimid

$1067.96

424

Lenalidomide

Capsule 25 mg

Oral

Cipla Lenalidomide

$1397.25

425

Lenalidomide

Capsule 25 mg

Oral

Lenalide

$1397.25

426

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide Dr.Reddy's

$1397.25

427

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide Sandoz

$1397.25

428

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide Viatris

$1397.25

429

Lenalidomide

Capsule 25 mg

Oral

Lenalidomide-Teva

$1397.25

430

Lenalidomide

Capsule 25 mg

Oral

Revlimid

$1397.25

 

 

[3]  Schedule 1

omit:

714

Sunitinib

Capsule 25 mg

Oral

ARX-Sunitinib

#######

715

Sunitinib

Capsule 25 mg

Oral

Sunitinib MSN

#######

716

Sunitinib

Capsule 25 mg

Oral

Sunitinib Sandoz

#######

717

Sunitinib

Capsule 25 mg

Oral

Sutent

#######

718

Sunitinib

Capsule 37.5 mg

Oral

ARX-Sunitinib

#######

719

Sunitinib

Capsule 37.5 mg

Oral

Sunitinib MSN

#######

720

Sunitinib

Capsule 37.5 mg

Oral

Sunitinib Sandoz

#######

721

Sunitinib

Capsule 37.5 mg

Oral

Sutent

#######

722

Sunitinib

Capsule 50 mg

Oral

ARX-Sunitinib

#######

723

Sunitinib

Capsule 50 mg

Oral

Sunitinib MSN

#######

724

Sunitinib

Capsule 50 mg

Oral

Sunitinib Sandoz

#######

725

Sunitinib

Capsule 50 mg

Oral

Sutent

#######

 

insert:

714

Sunitinib

Capsule 25 mg

Oral

ARX-Sunitinib

$1170.80

715

Sunitinib

Capsule 25 mg

Oral

Sunitinib MSN

$1170.80

716

Sunitinib

Capsule 25 mg

Oral

Sunitinib Sandoz

$1170.80

717

Sunitinib

Capsule 25 mg

Oral

Sutent

$1170.80

718

Sunitinib

Capsule 37.5 mg

Oral

ARX-Sunitinib

$1754.71

719

Sunitinib

Capsule 37.5 mg

Oral

Sunitinib MSN

$1754.71

720

Sunitinib

Capsule 37.5 mg

Oral

Sunitinib Sandoz

$1754.71

721

Sunitinib

Capsule 37.5 mg

Oral

Sutent

$1754.71

722

Sunitinib

Capsule 50 mg

Oral

ARX-Sunitinib

$2370.50

723

Sunitinib

Capsule 50 mg

Oral

Sunitinib MSN

$2370.50

724

Sunitinib

Capsule 50 mg

Oral

Sunitinib Sandoz

$2370.50

725

Sunitinib

Capsule 50 mg

Oral

Sutent

$2370.50

 

 

 

 

 

[4]  Schedule 1

omit:

210

Dorzolamide with timolol

Eye drops containing dorzolamide 20 mg (as hydrochloride) with timolol 5 mg (as maleate) per mL, 5 mL

Application to the Eye

Cosdor

$5.91

211

Dorzolamide with timolol

Eye drops containing dorzolamide 20 mg (as hydrochloride) with timolol 5 mg (as maleate) per mL, 5 mL

Application to the Eye

Cosopt

$5.91

212

Dorzolamide with timolol

Eye drops containing dorzolamide 20 mg (as hydrochloride) with timolol 5 mg (as maleate) per mL, 5 mL

Application to the Eye

Vizo-PF Dorzolatim

$5.91

 

 

[5]  Schedule 1

omit:

504

Levonorgestrel with ethinylestradiol

Pack containing 21 tablets 100 micrograms-20 micrograms and 7 inert tablets

Oral

Femme-Tab ED 20/100

$4.57

 

 

[6]  Schedule 1

omit:

445

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

APO-Levetiracetam

$46.64

446

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Keppra

$46.64

447

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Kerron

$46.64

448

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Levetiracetam GH

$46.64

449

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Levetiracetam-AFT

$46.64

450

Levetiracetam

Tablet 1 g

Oral

APO-Levetiracetam

$19.98

451

Levetiracetam

Tablet 1 g

Oral

Keppra

$19.98

452

Levetiracetam

Tablet 1 g

Oral

Kevtam 1000

$19.98

453

Levetiracetam

Tablet 1 g

Oral

Levactam

$19.98

454

Levetiracetam

Tablet 1 g

Oral

Levecetam 1000

$19.98

455

Levetiracetam

Tablet 1 g

Oral

Levetiracetam GH

$19.98

456

Levetiracetam

Tablet 1 g

Oral

Levetiracetam Mylan

$19.98

457

Levetiracetam

Tablet 1 g

Oral

Levetiracetam SZ

$19.98

458

Levetiracetam

Tablet 1 g

Oral

Levi 1000

$19.98

459

Levetiracetam

Tablet 1 g

Oral

NOUMED LEVETIRACETAM

$19.98

460

Levetiracetam

Tablet 250 mg

Oral

APO-Levetiracetam

$7.20

461

Levetiracetam

Tablet 250 mg

Oral

Keppra

$7.20

462

Levetiracetam

Tablet 250 mg

Oral

Kevtam 250

$7.20

463

Levetiracetam

Tablet 250 mg

Oral

Levactam

$7.20

464

Levetiracetam

Tablet 250 mg

Oral

Levecetam 250

$7.20

465

Levetiracetam

Tablet 250 mg

Oral

Levetiracetam GH

$7.20

466

Levetiracetam

Tablet 250 mg

Oral

Levetiracetam Mylan

$7.20

467

Levetiracetam

Tablet 250 mg

Oral

Levetiracetam SZ

$7.20

468

Levetiracetam

Tablet 250 mg

Oral

Levi 250

$7.20

469

Levetiracetam

Tablet 250 mg

Oral

NOUMED LEVETIRACETAM

$7.20

470

Levetiracetam

Tablet 500 mg

Oral

APO-Levetiracetam

$11.99

471

Levetiracetam

Tablet 500 mg

Oral

Keppra

$11.99

472

Levetiracetam

Tablet 500 mg

Oral

Kevtam 500

$11.99

473

Levetiracetam

Tablet 500 mg

Oral

Levactam

$11.99

474

Levetiracetam

Tablet 500 mg

Oral

Levecetam 500

$11.99

475

Levetiracetam

Tablet 500 mg

Oral

Levetiracetam GH

$11.99

476

Levetiracetam

Tablet 500 mg

Oral

Levetiracetam Mylan

$11.99

477

Levetiracetam

Tablet 500 mg

Oral

Levetiracetam SZ

$11.99

478

Levetiracetam

Tablet 500 mg

Oral

Levi 500

$11.99

479

Levetiracetam

Tablet 500 mg

Oral

NOUMED LEVETIRACETAM

$11.99

 

[7]  Schedule 2

after:

813

Domperidone

Tablet 10 mg

Oral

Motilium

$4.00

 

insert:

813A

Dorzolamide with timolol

Eye drops containing dorzolamide 20 mg (as hydrochloride) with timolol 5 mg (as maleate) per mL, 5 mL

Application to the Eye

Cosdor

$7.93

813B

Dorzolamide with timolol

Eye drops containing dorzolamide 20 mg (as hydrochloride) with timolol 5 mg (as maleate) per mL, 5 mL

Application to the Eye

Cosopt

$7.93

813C

Dorzolamide with timolol

Eye drops containing dorzolamide 20 mg (as hydrochloride) with timolol 5 mg (as maleate) per mL, 5 mL

Application to the Eye

Vizo-PF Dorzolatim

$7.93

 

 

 

[8]  Schedule 2

after:

1127

Fluorouracil

Injection 500 mg in 10 mL

Injection

Fluorouracil Accord

$4.00

 

insert:

1127A

Fluoxetine

Capsule 10 mg (Medreich) (S19A)

Oral

Fluoxetine Capsules 10 mg (Medreich, UK)

$42.70

 

 

 

[9]  Schedule 2

after:

 

1324

 

Hydromorphone

Oral solution containing hydromorphone hydrochloride 1 mg per mL, 1 mL

 

Oral

Hydromorphone hydrochloride oral solution, USP (Medsurge)

 

$299.00

 

insert:

1324A

 

Hydromorphone

Oral solution containing hydromorphone hydrochloride 1mg per mL, 1mL (S19A)

 

Oral

Hydromorphone hydrochloride oral solution, USP (Medsurge)

$373.43

 

1324B

 

Hydromorphone

Oral solution containing hydromorphone hydrochloride 1 mg per mL, 1 mL (S19A) (Pharmascience)

 

Oral

 

pms-HYDROmorphone

$373.43

 

 

 

[10]   Schedule 2

after:

1551

Lercanidipine

Tablet containing lercanidipine hydrochloride 20 mg

Oral

Zircol 20

$4.00

 

insert:

1551A

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

APO-Levetiracetam

$58.00

1551B

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Keppra

$58.00

1551C

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Kerron

$58.00

1551D

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Levetiracetam GH

$58.00

1551E

Levetiracetam

Oral solution 100 mg per mL, 300 mL

Oral

Levetiracetam-AFT

$58.00

1551F

Levetiracetam

Tablet 1 g

Oral

APO-Levetiracetam

$24.85

1551G

Levetiracetam

Tablet 1 g

Oral

Keppra

$24.85

1551H

Levetiracetam

Tablet 1 g

Oral

Kevtam 1000

$24.85

1551I

Levetiracetam

Tablet 1 g

Oral

Levactam

$24.85

1551J

Levetiracetam

Tablet 1 g

Oral

Levecetam 1000

$24.85

1551K

Levetiracetam

Tablet 1 g

Oral

Levetiracetam GH

$24.85

1551L

Levetiracetam

Tablet 1 g

Oral

Levetiracetam Mylan

$24.85

1551M

Levetiracetam

Tablet 1 g

Oral

Levetiracetam SZ

$24.85

1551N

Levetiracetam

Tablet 1 g

Oral

Levi 1000

$24.85

1551O

Levetiracetam

Tablet 1 g

Oral

NOUMED LEVETIRACETAM

$24.85

1551P

Levetiracetam

Tablet 250 mg

Oral

APO-Levetiracetam

$8.95

1551Q

Levetiracetam

Tablet 250 mg

Oral

Keppra

$8.95

1551R

Levetiracetam

Tablet 250 mg

Oral

Kevtam 250

$8.95

1551S

Levetiracetam

Tablet 250 mg

Oral

Levactam

$8.95

1551T

Levetiracetam

Tablet 250 mg

Oral

Levecetam 250

$8.95

1551U

Levetiracetam

Tablet 250 mg

Oral

Levetiracetam GH

$8.95

1551V

Levetiracetam

Tablet 250 mg

Oral

Levetiracetam Mylan

$8.95

1551W

Levetiracetam

Tablet 250 mg

Oral

Levetiracetam SZ

$8.95

1551X

Levetiracetam

Tablet 250 mg

Oral

Levi 250

$8.95

1551Y

Levetiracetam

Tablet 250 mg

Oral

NOUMED LEVETIRACETAM

$8.95

1551Z

Levetiracetam

Tablet 500 mg

Oral

APO-Levetiracetam

$14.91

1551AA

Levetiracetam

Tablet 500 mg

Oral

Keppra

$14.91

1551AB

Levetiracetam

Tablet 500 mg

Oral

Kevtam 500

$14.91

1551AC

Levetiracetam

Tablet 500 mg

Oral

Levactam

$14.91

1551AD

Levetiracetam

Tablet 500 mg

Oral

Levecetam 500

$14.91

1551AE

Levetiracetam

Tablet 500 mg

Oral

Levetiracetam GH

$14.91

1551AF

Levetiracetam

Tablet 500 mg

Oral

Levetiracetam Mylan

$14.91

1551AG

Levetiracetam

Tablet 500 mg

Oral

Levetiracetam SZ

$14.91

1551AH

Levetiracetam

Tablet 500 mg

Oral

Levi 500

$14.91

1551AI

Levetiracetam

Tablet 500 mg

Oral

NOUMED LEVETIRACETAM

$14.91

 

 

[11]  Schedule 2

after:

1560

Levodopa with carbidopa

Tablet 250 mg-25 mg (as monohydrate)

Oral

Sinemet

$21.77

 

insert:

1560A

Levonorgestrel with ethinylestradiol

Pack containing 21 tablets 100 micrograms-20 micrograms and 7 inert tablets

 

Oral

 

Femme-Tab ED 20/100

 

$5.68

 

 

 

[12]  Schedule 2

after:

1877

 

Morphine

Oral solution containing morphine hydrochloride trihydrate 10 mg per mL, 1 mL

 

Oral

Ordine 10

$15.79

 

insert:

1877A

 

Morphine

Oral solution containing morphine hydrochloride trihydrate 10 mg per mL, 1 mL (S19A)

 

Oral

 

Morphini HCl Streuli

$49.92

 

 

[13]  Schedule 2

after:

 

2725

 

Salbutamol

Nebuliser solution 2.5 mg (as sulfate) in 2.5 mL single dose units, 20

 

Inhalation

 

Ventolin Nebules

 

$4.00

 

insert:

2726A

 

Salbutamol

Nebuliser solution 2.5 mg (as sulfate) in 2.5 mL single dose units, 20 (S19A)

 

Inhalation

 

pms-SALBUTAMOL

$17.81

 

 

[14]  Schedule 2

omit:

68

Ambrisentan

Tablet 10 mg

Oral

Ambrisentan Mylan

#######

69

Ambrisentan

Tablet 10 mg

Oral

Ambrisentan Viatris

#######

70

Ambrisentan

Tablet 10 mg

Oral

Cipla Ambrisentan

#######

71

Ambrisentan

Tablet 10 mg

Oral

PULMORIS

#######

72

Ambrisentan

Tablet 10 mg

Oral

Volibris

#######

73

Ambrisentan

Tablet 5 mg

Oral

Ambrisentan Mylan

#######

74

Ambrisentan

Tablet 5 mg

Oral

Ambrisentan Viatris

#######

75

Ambrisentan

Tablet 5 mg

Oral

Cipla Ambrisentan

#######

76

Ambrisentan

Tablet 5 mg

Oral

PULMORIS

#######

77

Ambrisentan

Tablet 5 mg

Oral

Volibris

#######

 

insert:

68

Ambrisentan

Tablet 10 mg

Oral

Ambrisentan Mylan

$1652.15

69

Ambrisentan

Tablet 10 mg

Oral

Ambrisentan Viatris

$1652.15

70

Ambrisentan

Tablet 10 mg

Oral

Cipla Ambrisentan

$1652.15

71

Ambrisentan

Tablet 10 mg

Oral

PULMORIS

$1652.15

72

Ambrisentan

Tablet 10 mg

Oral

Volibris

$1652.15

73

Ambrisentan

Tablet 5 mg

Oral

Ambrisentan Mylan

$1652.15

74

Ambrisentan

Tablet 5 mg

Oral

Ambrisentan Viatris

$1652.15

75

Ambrisentan

Tablet 5 mg

Oral

Cipla Ambrisentan

$1652.15

76

Ambrisentan

Tablet 5 mg

Oral

PULMORIS

$1652.15

77

Ambrisentan

Tablet 5 mg

Oral

Volibris

$1652.15

 

 

[15]  Schedule 2

omit:

753

Dexamethasone

Intravitreal injection 700 micrograms

Implantation

Ozurdex

#######

 

insert:

753

Dexamethasone

Intravitreal injection 700 micrograms

Implantation

Ozurdex

$1091.84

 

 

[16]  Schedule 2

omit:

817

Dosulepin

Tablet containing dosulepin hydrochloride 75 mg

Oral

Dosulepin Viatris 75

del

818

Dosulepin

Tablet containing dosulepin hydrochloride 75 mg

Oral

Dothep 75

del

 

insert:

817

Dosulepin

Tablet containing dosulepin hydrochloride 75 mg

Oral

Dosulepin Viatris 75

$2.89

818

Dosulepin

Tablet containing dosulepin hydrochloride 75 mg

Oral

Dothep 75

$2.89

 

 

[17]  Schedule 2

omit:

987

Everolimus

Tablet 10 mg

Oral

Afinitor

#######

 

insert:

987

Everolimus

Tablet 10 mg

Oral

Afinitor

$1593.40

 

 

[18]  Schedule 2

omit:

1318

Hydrocortisone

Tablet 20 mg

Oral

Hydrocortisone Viatris 20

del

1319

Hydrocortisone

Tablet 20 mg

Oral

Hysone 20

del

 

insert:

1318

Hydrocortisone

Tablet 20 mg

Oral

Hydrocortisone Viatris 20

$19.20

1319

Hydrocortisone

Tablet 20 mg

Oral

Hysone 20

$19.20

 

 

[19]  Schedule 2

omit:

1552

Levodopa with carbidopa

Intestinal gel containing levodopa 20 mg with carbidopa monohydrate 5 mg per mL, 100 mL

Intra-intestinal

Duodopa

#######

 

insert:

1552

Levodopa with carbidopa

Intestinal gel containing levodopa 20 mg with carbidopa monohydrate 5 mg per mL, 100 mL

Intra-intestinal

Duodopa

$1442.00

 

 

[20]  Schedule 2

omit:

1962

Norethisterone with ethinylestradiol

Pack containing 21 tablets 1 mg-35 micrograms and 7 inert tablets

Oral

Norimin-1 28 Day

del

 

insert:

1962

Norethisterone with ethinylestradiol

Pack containing 21 tablets 1 mg-35 micrograms and 7 inert tablets

Oral

Norimin-1 28 Day

$5.56

 

 

[21]  Schedule 2

omit:

2340

Plerixafor

Injection 24 mg in 1.2 mL

Injection

Mozobil

#######

2341

Plerixafor

Injection 24 mg in 1.2 mL

Injection

Plerixafor ARX

#######

 

insert:

2340

Plerixafor

Injection 24 mg in 1.2 mL

Injection

Mozobil

$4016.84

2341

Plerixafor

Injection 24 mg in 1.2 mL

Injection

Plerixafor ARX

$4016.84

 

 

[22]  Schedule 2

omit:

2345

Pomalidomide

Capsule 3 mg

Oral

Pomalidomide Sandoz

#######

2346

Pomalidomide

Capsule 3 mg

Oral

Pomalyst

#######

2347

Pomalidomide

Capsule 3 mg

Oral

Pomolide

#######

2348

Pomalidomide

Capsule 4 mg

Oral

Pomalidomide Sandoz

#######

2349

Pomalidomide

Capsule 4 mg

Oral

Pomalyst

#######

2350

Pomalidomide

Capsule 4 mg

Oral

Pomolide

#######

 

insert:

2345

Pomalidomide

Capsule 3 mg

Oral

Pomalidomide Sandoz

$1865.72

2346

Pomalidomide

Capsule 3 mg

Oral

Pomalyst

$1865.72

2347

Pomalidomide

Capsule 3 mg

Oral

Pomolide

$1865.72

2348

Pomalidomide

Capsule 4 mg

Oral

Pomalidomide Sandoz

$2487.62

2349

Pomalidomide

Capsule 4 mg

Oral

Pomalyst

$2487.62

2350

Pomalidomide

Capsule 4 mg

Oral

Pomolide

$2487.62

 

 

[23]  Schedule 2

omit:

 

2953

 

Tobramycin

Capsule containing powder for oral inhalation 28 mg (for use in podhaler)

Inhalation by Mouth

 

TOBI podhaler

#######

 

insert:

 

2953

 

Tobramycin

Capsule containing powder for oral inhalation 28 mg (for use in podhaler)

Inhalation by Mouth

 

TOBI podhaler

 

$2282.85

 

 

[24]  Schedule 2

omit:

 

3017

 

Trastuzumab

Solution for subcutaneous injection containing trastuzumab 600 mg in 5 mL

 

Injection

 

Herceptin SC

#######

 

insert:

 

3017

 

Trastuzumab

Solution for subcutaneous injection containing trastuzumab 600 mg in 5 mL

 

Injection

 

Herceptin SC

 

$1470.22