The Rainbow Mental Health Survey is now live!

    Compiled by Amanda Ashley
    February 2018

    Version 1.0

    Sources:

    http://www.pharmac.govt.nz/2018/02/01/Schedule.pdf
    http://www.pharmac.govt.nz/2018/02/01/HML.pdf
    https://www.pharmac.govt.nz/news/notification-2016-06-10-oestradiol-patches/

     



    Community Pharmaceutical costs met by the Government

    Most of the cost of a subsidised prescription for a Community Pharmaceutical is met by the Government through the Combined Pharmaceutical Budget. The Government pays a subsidy for the Community Pharmaceutical to pharmacies, and a fee covering distribution and pharmacy dispensing services. The subsidy paid to pharmacies does not necessarily represent the final cost to Government of subsidising a particular Community Pharmaceutical. The final cost will depend on the nature of PHARMAC's contractual arrangements with the supplier. Fully subsidised medicines are identified with a ✔ in the product's Schedule listing.

     

    Patient costs

    Everyone who is eligible for publicly funded health and disability services should in most circumstances pay only a $5 co-payment for subsidised medicines, although co-payments can vary from $0 to $15. Where the price of a Pharmaceutical is higher than the subsidy, a patient may pay a manufacturer's surcharge in addition to the co-payment. A patient may also pay additional fees for services such as after-hours dispensing and special packaging. Patients can check whether they are eligible for publicly funded health and disability services by referring to the Guide to eligibility on the Ministry of Health's website. DHBs have a list of eligible providers in their respective regions. Any provider/prescriber not specifically listed by a DHB as an approved provider/prescriber should be regarded as not approved. For more information on patient co-payments or eligibility please visit http://www.moh.govt.nz.

     

    KEY:

     
    ✔ Fully subsidised brand of a given medicine. Brands without the tick are not fully subsidised and may cost the patient a manufacturer's surcharge‡ safety cap

    ▲ Three months dispensed all-at-once or, in the case of oral contraceptives, six months dispensed all-at-once, unless the medicine meets the Dispensing Frequency Rule criteria.

    ❋Three months or six months, as applicable, dispensed all-at-once if endorsed “certified exemption” by the prescriber or pharmacist

    ‡ Safety cap required for oral liquid formulations, including extemporaneously compounded preparations.

    OP Original Pack – subsidy is rounded up to a multiple at whole packs.

    (S29) This medicine is an unapproved medication supplied under Section 29 of the Medicines Act 1981.

    HP3 Subsidised when dispensed from a pharmacy that has a contract to dispense Special Foods.

    HP4 Subsidised when dispensed from a pharmacy that has a contract to dispense from the Monitored Therapy Variation.

     

    “Restricted Medicine”, means any Pharmaceutical listed in Part II of Schedule 1 of the Medicines Regulations 1984.

    “Retail Pharmacy-Specialist”, means that the Community Pharmaceutical is only eligible for Subsidy if it is either:

    1. a) supplied on a Prescription or Practitioner's Supply Order signed by a Specialist, or,
    2. b) in the case of treatment recommended by a Specialist, supplied on a Prescription or Practitioner's Supply Order and either:
    3. i) endorsed with the words “recommended by [name of Specialist and year of authorisation]” and signed by the Prescriber, or
    4. ii) endorsed with the word ‘protocol’ which means “initiated in accordance with DHB hospital approved protocol”, or

      iii) Annotated by the dispensing pharmacist, following verbal confirmation from the Prescriber of the name of the Specialist and date of recommendation, with the words “recommended by [name of specialist and year of authorisation], confirmed by [Prescriber]”. Where the Contractor has an electronic record of such an Endorsement or Annotation from a previous prescription for the same Community Pharmaceutical written by a prescriber for the same patient, they may annotate the prescription accordingly.

      “As recommended by a Specialist” to be interpreted as either:

    a)

    1. i) follows a substantive consultation with an appropriate Specialist;
    2. ii) the consultation to relate to the Patient for whom the Prescription is written;

      iii) consultation to mean communication by referral, telephone, letter, facsimile or email;
      iv) except in emergencies consultation to precede annotation of the Prescription; and
      v) both the Specialist and the General Practitioner must keep a written record of consultation; or
      b) treatment with the Community Pharmaceutical has been initiated in accordance with a DHB hospital approved protocol.




    Pharmaceutical Schedule

    Community Pharmaceuticals that are subsidised by the Government and to show the amount of the subsidy paid to contractors, as well as the manufacturer's price and any access conditions that may apply;


    Androgen Agonists and Antagonists

    Spironolactone - (Potassium Sparing Diuretics)
    Price (ex manufacturer. excl. GST) $  / Per

    ❋ Tab 25 mg . ......... ......... ......... .......................................... 4.38 / 100 ✔ Spiractin

    ❋ Tab 100 mg ....................................................................... 11.80 / 100 ✔ Spiractin

    ‡ Oral liq 5 mg per ml .............................................................30.00 / 25 ml OP ✔ Biomed

     

    Cyproterone Acetate – Retail pharmacy-Specialist

    Tab 50 mg .........................................................................................15.87 / 50 ✔ Procur

    Tab 100 mg .......................................................................................30.40 / 50 ✔ Procur

     

    Spironolactone, an antiandrogen commonly used by trans women in the United States, has been associated with a greater likelihood of seeking breast augmentation. Other antiandrogens such as GnRH analogues, cyproterone acetate, and 5-alpha reductase inhibitors, are not associated with this outcome.
    – There is not as of yet sufficient evidence to indicate that progestogens, such as progesterone, medroxyprogesterone acetate, or cyproterone acetate, enhance the extent of breast development in trans women.



    Testosterone

    Transdermal patch, 2.5 mg per day...................................................80.00 / 60 ✔ Androderm

    Patch 5 mg per day ...........................................................................80.00 / 30 ✔ Androderm
    (Androderm Transdermal patch, 2.5 mg per day to be delisted 1 March 2018)

     

    Testosterone Cipionate – Retail pharmacy-Specialist

    Inj 100 mg per ml, 10 ml vial..............................................................76.50 / 1 ✔ Depo-Testosterone

     

    Testosterone Esters – Retail pharmacy-Specialist

    Inj 250 mg per ml, 1 ml......................................................................12.98 / 1 ✔ Sustanon Ampoules

     

    Testosterone Undecanoate – Retail pharmacy-Specialist

    Cap 40 mg.........................................................................................16.80 / 60 ✔ Andriol Testocaps

    Inj 250 mg per ml, 4 ml vial................................................................86.00 / 1 ✔ Reandron 1000

     




    Hormone Replacement Therapy - Systemic Prescribing Guideline 

    HRT should be taken at the lowest dose for the shortest period of time necessary to control symptoms. Patients should be reviewed 6 monthly in line with the updated *NZGG “Evidence-based Best Practice Guideline on Hormone Replacement Therapy March 2004”. 

    NOTE: *The New Zealand Guidelines Group (NZGG) was an independent, not-for-profit organisation, set up in 1999 to promote the use of evidence in the delivery of health and disability services. The NZGG went into voluntary liquidation in mid-2012. The current guidelines "Good Practice Guide for Health Professionals" for Gender Reassignment Health Services for Trans People within New Zealand are the 2012 Middlemore Document. Please note that this document is extremely out of date and work is underway to replace it.

     

    Oestrogens (Oestradiol) – See prescribing guideline above.
    Price (ex manufacturer. excl. GST) $  / Per

    ❋ Tab 1 mg .............................................................................................4.12 / 28 OP (11.10) Estrofem

    ❋ Tab 2 mg .............................................................................................4.12 / 28 OP (11.10) Estrofem

    ❋ Patch 25 mcg per day..........................................................................6.12 / 8 ✔ Estradot
    a) No more than 2 patch per week b) Only on a prescription

    ❋ Patch 50 mcg per day..........................................................................7.04 / 8 ✔ Estradot 50 mcg
    a) No more than 2 patch per week b) Only on a prescription

    ❋ Patch 75 mcg per day..........................................................................7.91 / 8 ✔ Estradot
    a) No more than 2 patch per week b) Only on a prescription

    ❋ Patch 100 mcg per day........................................................................7.91 / 8 ✔ Estradot
    a) No more than 2 patch per week b) Only on a prescription

     

    Oestradiol Valerate – See prescribing guideline above
    Price (ex manufacturer. excl. GST) $  / Per

    ❋ Tab 1 mg ...........................................................................................12.36 / 84 ✔ Progynova

    ❋ Tab 2 mg ...........................................................................................12.36 / 84 ✔ Progynova

    NOTE: 

    • Delestrogen (Par Pharmacetical)
    • Estradiol Valerate (Perrigo)
    • Depo-Estradiol (Pfizer)

    Are not available in New Zealand. It is possible to import these yourself however you must have a prescription for them and the cost is fairly high (Aprox $200 ~ $300 for a three month supply)

     

    Oestrogens – See prescribing guideline above

    Price (ex manufacturer. excl. GST) $  / Per

    ❋ Conjugated, equine tab 300 mcg.........................................................3.01 / 28 (11.48) Premarin
    ❋ Conjugated, equine tab 625 mcg.........................................................4.12 / 28 (11.48) Premarin

     Can't believe they still sell this!

     

    Progestogens (MEDROXYPROGESTERONE ACETATE) – See prescribing guideline above Price (ex manufacturer. excl. GST) $  / Per

    ❋ Tab 2.5 mg .............................................................3.75 / 30 ✔ Provera 7.00 / 56 ✔ Provera (S29)
    ❋ Tab 5 mg ................................................................14.00 / 100 ✔ Provera
    ❋ Tab 10 mg ..............................................................7.15 / 30 ✔ Provera

     Also conjugated equine Oestrogen! (This is Depo-Provera the birth control)

    GnRH Analogues 

    Goserelin

    Implant 3.6 mg, syringe .....................................................................66.48 / 1 ✔ Zoladex

    Implant 10.8 mg, syringe .................................................................177.50 / 1 ✔ Zoladex

     

     

     

     

    Hospital Medicines List (HML)


    Hospital Pharmaceuticals that may be used in DHB Hospitals, as well as any access conditions that may apply; and the Pharmaceuticals, including Medical Devices, used in DHB Hospitals for which national prices have been negotiated by PHARMAC.

     

    Androgen Agonists and Antagonists 

    Spironolactone
    Price (ex manufacturer. excl. GST) $  / Per

    Tab 25 mg – 1% DV Oct-16 to 2019...............................4.38 / 100 Spiractin

    Tab 100 mg – 1% DV Oct-16 to 2019............................ 11.80 / 100 Spiractin

    Oral liq 5 mg per ml ..................................................... 30.00 / 25 ml Biomed

     

     

    Hormone Replacement Therapy

    Oestradiol
    Price (ex manufacturer. excl. GST) $  / Per

    Patch 25 mcg per day – 1% DV Oct-16 to 2019..........................................6.12 / 8 Estradot

    Patch 50 mcg per day – 1% DV Oct-16 to 2019..........................................7.04  / 8 Estradot

    Patch 75 mcg per day – 1% DV Mar-17 to 2019 ........................................7.91 / 8 Estradot

    Patch 100 mcg per day – 1% DV Oct-16 to 2019........................................7.91 / 8 Estradot

     

     

    Oestradiol Valerate
    Price (ex manufacturer. excl. GST) $  / Per

    Tab 1 mg – 1% DV Jun-15 to 2018 .. ..........................,...............................12.36 / 84 Progynova

    Tab 2 mg – 1% DV Jun-15 to 2018 .............................................................12.36 / 84 Progynova

    NOTE: 

    • Delestrogen (Par Pharmacetical)
    • Estradiol Valerate (Perrigo)
    • Depo-Estradiol (Pfizer)

    Are not available in New Zealand. It is possible to import these yourself however you must have a prescription for them and the cost is fairly high (Aprox $200 ~ $300 for a three month supply)

     

     

     

     

    GnRH Analogues

    Goserelin

    Implant 3.6 mg, syringe – 1% DV Dec-16 to 2019.......................................66.48 / 1 Zoladex

    Implant 10.8 mg, syringe – 1% DV Dec-16 to 2019.....................................177.50 / 1 Zoladex

     

     

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