Health
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Hospital Circular 32/2002

Date Issued: 8 September 2002

Publication: 32/2002

Distribution: Public Hospitals

Subject: Highly Specialised Drugs Program

Purpose: To advise hospitals involved of changes to the Highly Specialised Drugs Program, effective 1 November 2002.

We have had recent advice from the Commonwealth of changes to the Highly Specialised Drugs Program, effective 1 November 2002.

1. Add Item

Tenofovir disoproxil fumarate

Treatment, in combination with other antiretroviral drugs, of HIV infection in patients who have failed or experienced treatment-limiting toxicity with their current antiretroviral regimen and for whom an effective regimen, including a regimen containing amprenavir, cannot otherwise be constructed.

6358P Tablet 300 mg 30 $525.00

Please note: this addition was effective 1 October 2002 and was notified in the Circular sent in September 2002.

2. Add Drug

Valganciclovir hydrochloride (Valcyte)

6357N Tablet 450 mg (base) 60 $2,245.80

Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome.

3. Add Brand

Disodium pamidronate (Pamisol)

6286W Concentrated injection 15 mg in 5 mL 1 $63.21 FA
6287X Concentrated injection 30 mg in 10 mL 1 $126.43 FA
6288Y Concentrated injection 60 mg in 10 mL 1 $252.86 FA
6289B Concentrated injection 90 mg in 10 mL 1 $379.29 FA

Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy.

6289B Concentrated injection 90 mg in 10 mL 1 $379.29 FA

Multiple myeloma;
Bone metastases from breast cancer.
(Bioequivalence indicator 'a' added to BL brand of above items)

4. Add Item

Efavirenz (Stocrin).

6356M Tablet 600 mg 30 $271.58
(Reimbursed price)
      $452.64
(Schedule listed price)

Treatment of HIV infection in patients with CD4 cell counts of less than 500 per cubic millimetre, or viral load of greater than 10,000 copies per mL.

Note:
These prices are based on special supply arrangements-see Pharmaceutical Benefits Pricing Authority relativity sheet for full details.

5. Price Increase

Dornase alfa (Pulmozyme)

6120D Solution for inhalation 2.5 mg (2,500 units) in 2.5 mL ampoule 30 $1,145.00

Mycophenolate mofetil (CellCept)

6208R Capsule 250 mg 300 $555.70
6209T Tablet 500 mg 150 $555.70

6. Amend Restriction

Cidofovir (Vistide)

6247T Solution for I.V. infusion 375 mg (anhydrous) in 5 mL single use vial 1 $900.00

Change from:

Treatment of sight-threatening cytomegalovirus retinitis in patients with AIDS.

Change to:

Trea4tment of cytomegalovirus retinitis in patients with AIDS.

Foscarnet sodium (Foscavir)

6134W I.V. infusion 24 mg per mL, 250 mL bottle 6 $395.00

Change from:

Treatment of sight-threatening cytomegalovirus retinitis in patients with AIDS;
Treatment of aciclovir-resistant herpes simplex virus infection in immunocompromised patients with HIV infection.

Change to:

Treatment of cytomegalovirus retinitis in patients with AIDS;
Treatment of aciclovir-resistant herpes simplex virus infection in immunocompromised patients with HIV infection.

Ganciclovir (Cymevene)

6159E Capsule 250 mg 84 $524.00
6272D Capsule 500 mg 90 $1,122.86

Change from:

Maintenance therapy, after stabilisation with intravenous ganciclovir sodium, of sight-threatening cytomegalovirus retinitis in severely immunocompromised patients;
Prophylaxis of cytomegalovirus disease in bone marrow and solid organ transplant patients at risk of cytomegalovirus disease.

Change to:

Maintenance therapy, after stabilisation with intravenous ganciclovir sodium, of cytomegalovirus retinitis in severely immunocompromised patients;
Prophylaxis of cytomegalovirus disease in bone marrow and solid organ transplant patients at risk of cytomegalovirus disease.

Ganciclovir (Vitrasert)

6256G Intravitreal implant 4.5 mg 1 $6,000.00

Change from:

Sight-threatening cytomegalovirus retinitis in severely immunocompromised patients.

Change to:

Cytomegalovirus retinitis in severely immunocompromised patients.

Ganciclovir Sodium (Cymevene)

6136Y Powder for I.V. infusion equivalent to 500 mg ganciclovir, vial 5 $280.00

Change from:

Sight-threatening cytomegalovirus retinitis in severely immunocompromised patients;
Prophylaxis of cytomegalovirus disease in bone marrow and solid organ transplant patients at risk of cytomegalovirus disease.

Change to:

Cytomegalovirus retinitis in severely immunocompromised patients;
Prophylaxis of cytomegalovirus disease in bone marrow and solid organ transplant patients at risk of cytomegalovirus disease.

7. Delete

Cyclosporin (Neoral)

6111P Capsule 25 mg 50 $75.02
6112Q Capsule 50 mg 50 $150.00
6114T Capsule 100 mg 50 $300.00

Brand items are being discontinued by manufacturer.

8. Advance Notice - Deletion

Epoetin alfa (Eprex)

6304T Injection 7,000 units in 0.7 mL pre-filled syringe 6 $756.00
6306X Injection 9,000 units in 0.9 mL pre-filled syringe 6 $953.10

Item is being discontinued by manufacturer, effective 1 February 2003.

9. Other Amendments

3.1 Patient Eligibility

Delete clause 3.1 and replace with:

Persons eligible for Commonwealth subsidy through this program must be patients in the community or attending day services (ie. not in-patients), and be an "eligible person" satisfying the following criteria from the Health Insurance Act 1973.

Eligible person means Australian resident, a person covered by a Reciprocal Health Care Agreement, or an "eligible overseas representative".

Australian resident means a person who resides permanently in Australia and is:

  1. an Australian citizen; or
  2. a person who holds a permanent visa; or
  3. a New Zealand citizen; or
  4. an applicant for permanent residence in certain circumstances (see Interim card below).

An eligible person is entitled to have one of the following Medicare cards:

  1. Medicare card (green in colour), issued to Australian permanent residents.
  2. Medicare card (blue in colour), with the words "INTERIM CARD", issued in
    certain circumstances to persons who have applied for permanent resident status.

Note: Interim cards will have an expiry date beyond which the card-holder is no longer eligible for PBS subsidy, including Highly Specialised Drugs.

  1. Medicare card (green in colour) with the words " VISITOR RHCA", issued to visitors from six of the eight countries with which Australia has Reciprocal Health Care Agreements - the UK, Malta, Italy, Sweden, Finland and the Netherlands.

Note:

  1. Australia also has Reciprocal Health Care Agreements with New Zealand and Ireland, however visitors from these countries are not issued with cards. They are eligible for PBS on presentation of their passports.
  2. Supply of drugs to persons from these eight RCHA countries is limited to the original prescription only. Repeat prescriptions are not permitted.

An eligible person who has enrolled recently in Medicare, but has not yet received a card, will have been given a receipt with a Medicare number. This receipt is evidence of eligibility.

Eligible overseas representative means:

  1. the head of a diplomatic mission or consular post, established in Australia, of those countries with which Australia has a Reciprocal Health Care Agreement except for New Zealand; or
  2. staff of those diplomatic missions or consular posts referred to in paragraph (a); or
  3. family members of persons referred to in paragraph (a) or (b).

Eligible overseas representatives will have a Medicare card (green in colour).

Effective: 1 November 2002

 

Reminders

HSDP audit certification was DUE 30th September 2002

Any changes notified by hospital circular will be updated in the Guidelines on the internet and the relevant claim forms amended. Pharmacists are encouraged to check Victoria's Highly Specialised Drugs Program website to ensure they are using the correct claim forms or to request updated copies by fax on 03-9616 7764.

Mr Peter Donnelly
Director
Funding and Financial Policy
Metropolitan Health and Aged Care Services

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