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) 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.
This instrument commences on the day after it is registered.
This instrument is made under subsection 99ADB(4) of the National Health Act 1953.
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 |