Separately chargeable drugs list - Bupa UK/media/Files/HCP/Latest Updates from Bupa... · 15 FEBRUARY 2018 Separately Chargeable Drugs List Also known to customers as: List of advanced

15 MAY 2018

Separately Chargeable Drugs List

Also known to customers as: List of advanced therapies and specialist drugs

Please note that printed or downloaded versions of this document may be out of date. Bupa separately chargeable drugs list – 15 May 2018 Valid until 15 June 2018 © Bupa Insurance Services Limited 2018

Important information for providers only Listed below are the drugs which may be billed in addition to the charges that have been agreed as part of current hospital contracts. Drugs marked with * are those which may be charged separately when used as part of eligible treatment for cancer only.

All separately chargeable drugs require pre-authorisation, we ask providers to call Bupa Provider Services on 0345 755 3333. Lines are open 8am to 6pm, Monday to Friday and 8am to 1pm on Saturday (calls may be recorded and may be monitored).

Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD001 abciximab (ReoPro) 2mg/mL - 5mL vial injection Yes

AD565 abiraterone (Zytiga) 120 x 250mg tablets * Yes

AD896 adalimumab (Humira) 40mg/0.8ml solution for injection

Yes

AD756 afatinib (Giotrif) 28 x 20mg tablets * Yes




AD670 aflibercept (Eylea) 40mg/ml solution Yes

AD687 aflibercept (Zaltrap) 4ml (100 mg) Yes

AD688 aflibercept (Zaltrap) 8ml (200 mg) Yes

AD002 aldesleukin (Interleukin-2) (Proleukin)

18million iu vial - powder for reconstitution

* Yes

AD008 alteplase (Actilyse) 10 mg (5.8 million units)/vial injection

Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD007 alteplase (Actilyse) 50 mg (29 million units)/vial injection

Yes

AD006 alteplase (Actilyse) Powder for reconstitution - 20 mg (11.6 million units)/vial

Yes

AD010 amphotericin (AmBisome) 50mg vial - powder for reconstitution

Yes

AD566 amphotericin B lipid complex (Abelcet)

5mg/mL - 20ml vial Yes

AD012 anagrelide (Xagrid) 100 x 500 mcg capsules * Yes

AD013 anastrozole (Arimidex) 28 x 1mg tablets * Yes

AD567 anidulafungin (Ecalta) 100mg vial for iv infusion Yes

AD568 antithymocyte immunoglobulin (Thymoglobuline)

25mg powder for iv infusion Yes

AD016 aprepitant (Emend) 1 x 125mg capsule and 2 x 80mg capsules

* Yes

AD014 aprepitant (Emend) 2 x 80mg capsules * Yes

AD015 aprepitant (Emend) 5 x 125mg capsules * Yes

AD017 arsenic trioxide (Trisenox) 1mg/ml - 10mL ampoule for iv infusion

* Yes

AD656 axitinib (Inlyta) 56 x 5 mg film-coated tablets

* Yes

AD655 axitinib (Inlyta) 56 x 1 mg film-coated tablets

* Yes

AD018 azacitidine (Vidaza) 100mg vial injection - powder for reconstitution

* Yes

AD019 basiliximab (Simulect) 10mg vial injection - powder for reconsitution

Yes

AD020 basiliximab (Simulect) 20mg vial injection - powder for reconsitution

Yes

AD482 BCG (ImmuCyst) 81mg vial for bladder instillation

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD483 BCG (OncoTICE) 12.5mg vial for bladder instillation

* Yes

AD022 bendamustine hydrochloride (Levact)

100mg vial injection - powder for reconsitution

* Yes

AD021 bendamustine hydrochloride (Levact)

25mg vial injection - powder for reconsitution

* Yes

AD024 bevacizumab (Avastin) 25mg/mL - 4mL (100mg) vial for iv infusion

Yes

AD023 bevacizumab (Avastin) 25mg/mL - 16mL (400mg) vial for iv infusion

Yes

AD025 bexarotene (Targretin) 100 x 75mg capsules * Yes

AD026 bicalutamide (Casodex) 28 x 50mg tablets * Yes

AD027 bicalutamide (Casodex) 28 x 150mg tablets * Yes

AD028 bivalirudin (Angiox) 250mg vial injection - powder for reconstitution

Yes

AD029 bleomycin (Non Proprietary)

15,000 unit vial injection * Yes

AD900 blinatumomab (Blincyto) One vial of 38.5 micrograms

* Yes

AD030 bortezomib (Velcade) 3.5mg vial injection - powder for reconstitution

* Yes

AD728 bosutinib (Bosulif) 28 x 100mg tablets * Yes

AD727 bosutinib (Bosulif) 28 x 500mg tablets * Yes

AD031 botulinum A toxin (Botox) 100 unit vial injection Yes



AD561 botulinum A toxin (Dysport)

300 unit vial injection Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD034 botulinum A toxin (Dysport)

500 unit vial injection Yes

AD749 Botulinum toxin type B (NeuroBloc)

10,000 unit vial injection Yes





AD722 botulinum toxin type A (Xeomin)

100-unit vial Yes

AD721 botulinum toxin type A (Xeomin)

50-unit vial Yes

AD671 brentuximab vedotin (Adcetris)

50mg vial Yes

AD037 buserelin (Suprefact) 100 mcg/metered spray - 4 x 10g bottle

* Yes

AD036 buserelin (Suprefact) 1mg/ml - 2 x 5.5 ml vial injection

* Yes

AD035 busulfan (Busilvex) 6mg/mL - 10mL vial concentrate for iv infusion

* Yes

AD562 busulfan (Myleran) 25 x 2mg tablets * Yes

AD903 cabozantinib (Cabometyx) 60mg tablets x 28 * Yes

AD569 cabazitaxel (Jevtana) 40 mg/mL, 1.5mL vial (and solvent) for iv infusion

* Yes

AD632 calcium folinate (Calcium Folinate)

30 x 15mg tablets * Yes


10mg/mL - 30mL injection * Yes






7.5mg/mL - 2mL injection * Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required







AD570 calcium leucovorin (Refolinon)

3mg/mL - 5 x 10mL vial ampoule injections

* Yes





AD678 calcium levofolinate (Isovorin)

Solution for Injection 10 mg/ml

* Yes

AD039 capecitabine (Xeloda) 120 x 500mg tablets * Yes

AD038 capecitabine (Xeloda) 60 x 150mg tablets * Yes

AD677 capsaicin (Qutenza) 179 mg cutaneous patch * Yes

AD040 carboplatin (Non Proprietary)

10mg/mL - 15mL vial injection

* Yes



* Yes



* Yes



* Yes

AD890 carfilzomib (Kyprolis) 60 mg powder for solution for infusion

* Yes

AD044 carmustine (Gliadel) 7.7mg implant * Yes

AD045 caspofungin (Cancidas) 50mg vial - powder for iv infusion

Yes

AD046 caspofungin (Cancidas) 70mg vial - powder for iv infusion

Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD649 catumaxomab (Removab) 50-microgram prefilled syringe

* Yes

AD648 catumaxomab (Removab) 10-microgram prefilled syringe

* Yes

AD899 Ceftolozane / Tazobactam (Zerbaxa)

Ceftolozane 1g / Tazobactam 500mg (Zerbaxa) powder for solution

Yes

AD895 ceritinib (Zykadia) 750 mg taken orally once daily at the same time each day

* Yes

AD047 cetuximab (Erbitux) 5mg/mL - 100mL vial for iv infusion

* Yes

AD048 cetuximab (Erbitux) 5mg/mL - 20mL vial for iv infusion

* Yes

AD750 Characterised autologous human cartilage (ChondroCelect)

10,000 cells/µl vial Yes

AD049 chlorambucil (Leukeran) 25 x 2mg tablets * Yes

AD054 chlorpromazine (Non Proprietary)

100mg/5mL - 150mL oral solution

* Yes



* Yes


25mg/mL - 1mL ampoule injection

* Yes



* Yes







AD575 ciclosporin (Neoral) 100mg/mL - 50mL oral solution

* Yes

AD574 ciclosporin (Neoral) 30 x 100mg tablets * Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required


AD572 ciclosporin (Neoral) 30 x 25 mg tablets * Yes


AD059 cisplatin (Non Proprietary) 1mg/mL - 100mL vial injection

* Yes


* Yes


* Yes

AD065 cladribine (Leustat) 1mg/mL - 10mL vial injection

* Yes

AD066 clodronate (Bonefos) 120 x 400mg capsules * Yes

AD067 clodronate (Bonefos) 60 x 800mg tablets * Yes

AD068 clodronate (Loron 520) 60 x 520mg tablets * Yes

AD069 clofarabine (Evoltra) 1 mg/mL, 20mL vial * Yes

AD893 cobimetinib hemifumarate (Cotellic)

20mg tablets * Yes

AD592 collagenase (Xiapex) Injection 900mcg vial + solvent - powder for reconstitution

Yes

AD882 cometriq (Cabozantinib) 140 mg once daily, 20 mg X 28 capsules

* Yes

AD070 crisantaspase (Erwinase) 10 000 unit vial powder for reconstitution

* Yes

AD668 crizotinib (Xalkori) 250mg hard capsule x 60 * Yes

AD667 crizotinib (Xalkori) 200mg hard capsule x 60 * Yes

AD510 cyclizine (Valoid) 50mg/mL - 1mL ampoule injection

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD071 cyclophosphamide (Non Proprietary)



1g vial injection - powder for reconstitution

* Yes


500mg vial injection - powder for reconstitution

* Yes

AD074 cyproterone acetate (Cyprostat)


AD075 cyproterone acetate (Cyprostat)


AD076 cytarabine (DepoCyte) 50mg vial intrathecal injection

* Yes

AD082 cytarabine (Non Proprietary)

100 mg/mL - 10mL vial iv or subcutaneous injection

* Yes



* Yes



* Yes



* Yes



* Yes


20mg/mL- 5mL vial intrathecal injection

* Yes



* Yes

AD738 dabrafenib (Tafinlar) 28 x 50mg capsules * Yes

AD739 dabrafenib (Tafinlar) 28 x 75mg capsules * Yes

AD084 dacarbazine (Non Proprietary)


* Yes



* Yes



* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required



* Yes

AD089 dactinomycin (Cosmegen Lyovac)

0.5mg vial injection - powder for reconstitution

* Yes

AD640 dalteparin sodium (Fragmin)

25,000/mL - 0.5mL (12,500 unit) injection - single dose syringe

* Yes



* Yes



* Yes



* Yes



* Yes


10,000 units/mL - 1mL (10,000 unit) injection/graduated syringe

* Yes


25,000 units/mL - 4mL (100,000 unit) injection

* Yes



* Yes



* Yes



* Yes



* Yes

AD676 danaparoid sodium (Orgaran)

1250 units/mL, 0.6mL ampoule

Yes

AD901 daratumumab (Darzalex) 100mg/5ml concentrate for solution for infusion

* Yes

AD523 darbepoetin (Aranesp) 500mcg/mL - 1mL injection - prefilled syringe

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD514 darbepoetin (Aranesp) 100mcg/mL - 0.3mL injection - prefilled syringe

* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes

AD525 darbepoetin (Aranesp®SureClick)

100mcg/mL - 0.4mL prefilled injection device

* Yes



* Yes



* Yes



* Yes



* Yes



* Yes



* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required


500mcg/mL - 1mL prefilled injection device

* Yes

AD564 dasatinib (Sprycel) 30 x 140mg tablets * Yes





AD094 daunorubicin (Non Proprietary)


* Yes

AD095 daunorubicin lipid form (DaunoXome (liposomal daunorubicin))

50mg vial - concentrate for iv infusion

* Yes

AD743 decitabine (Dacogen) 50mg vial - powder for reconstitution

* Yes

AD577 degarelix acetate (Firmagon)

2 × 120-mg vial injection (with diluent)

* Yes

AD576 degarelix acetate (Firmagon)

80-mg vial injection(with diluent)

* Yes

AD587 denosumab (Prolia) 60mg/mL - 1mL prefilled syringe

* Yes

AD588 denosumab (Xgeva) 70mg/mL - 1.7mL (120mg) vial injection

* Yes

AD487 dexamethasone (Dexsol) 2mg/5mL - 150mL oral solution

* Yes

AD486 dexamethasone (Non Proprietary)



28 x 500mcg tablets * Yes


3.3mg/mL - 1mL vial injection

* Yes



* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required



AD585 dexamethasone (Ozurdex)

700 mcg in disposable applicator

Yes

AD097 dexrazoxane (Savene) 10 x 500mg vials - powder for iv infusion

* Yes

AD096 dexrazozane (Cardioxane)

500mg vial - powder for iv infusion

* Yes

AD098 dibotermin alfa (InductOs) 1.5mg/mL - 10mL vial - powder for reconstitution

Yes

AD099 diethylstilbestrol (Non Proprietary)


AD100 diethylstilbestrol (Non Proprietary)


AD101 disodium pamidronate (Aredia)


* Yes



* Yes



* Yes

AD715 disodium pamidronate (Non-proprietary)

15mg/mL, 1mL vial * Yes















15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD693 docetaxel (Non-proprietary)












AD104 docetaxel (Taxotere) 20mg/mL - 1mL vial for infusion

* Yes


* Yes


* Yes

AD532 domperidone (Motilium) 30 x 10mg tabs * Yes

AD533 domperidone (Motilium) 100 x 10mg tabs * Yes

AD107 doxorubicin (Non Proprietary)


* Yes


2mg/Ml - 100mL vial injection

* Yes


2mg/Ml - 25mL vial injection

* Yes


2mg/mL - 5mL vial injection * Yes



* Yes

AD112 doxorubicin HCl lipid form (Caelyx)

2mg/mL - 10mL vial concentrate for iv infusion

* Yes

AD113 doxorubicin HCl lipid form (Caelyx)


* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD114 doxorubicin HCl lipid form (Myocet)


* Yes

AD725 enzalutamide (Xtandi) 40mg 112-cap pack * Yes

AD118 epirubicin (Non Proprietary)

2mg/mL, 100mL vial injection

* Yes



* Yes



* Yes



* Yes

AD129 epoetin (Binocrit) 10000 units injection - prefilled syringe

* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes

AD136 epoetin (NeoRecormon) 10,000 units injection - prefilled syringe

* Yes


* Yes

AD131 epoetin (NeoRecormon) 2000 units injection - prefilled syringe

* Yes


* Yes


* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required


* Yes


* Yes


* Yes


* Yes

AD140 epoetin alfa (Eprex) 10,000 units injection - prefilled syringe

* Yes

AD139 epoetin alfa (Eprex) 1000 units injection - prefilled syringe

* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes


* Yes

AD152 eptacog alfa (NovoSeven) 1mg vial injection - powder for reconstitution

Yes

AD153 eptacog alfa (NovoSeven) 2mg vial injection - powder for reconstituton

Yes

AD154 eptacog alfa (NovoSeven) 5mg vial injection - powder for reconsitution

Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD155 eptacog alfa (NovoSeven) 8mg vial injection - powder for reconsitution

Yes

AD616 eribulin (Halaven) 440mcg/mL - 2mL vial injection

* Yes

AD158 erlotinib (Tarceva) 30 x 100mg tablets * Yes



AD160 estramustine (Estracyt) 100 x 140mg capsules * Yes

AD467 etoposide (Eposin) 20mg/mL - 25mL vial for iv infusion

* Yes

AD466 etoposide (Eposin) 20mg/mL - 5mL vial for iv infusion

* Yes

AD161 etoposide (Etopophos) 100mg vial injection - powder for reconstitution

* Yes

AD166 etoposide (Vepesid) 10 x 100mg capsules * Yes

AD165 etoposide (Vepesid) 20 x 50mg capsules * Yes

AD168 everolimus (Afinitor) 30 x 10mg tablets * Yes

AD167 everolimus (Afinitor) 30 x 5mg tablets * Yes

AD169 exemestane (Aromasin) 30 x 25mg tablets * Yes

AD170 exemestane (Aromasin) 90 x 25mg tablets * Yes

AD171 Factor IX (AlphaNine) 1000 iu vial Yes

AD172 Factor IX (AlphaNine) 1500 iu vial Yes

AD174 Factor IX (Mononine) 1000 iu vial Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD176 Factor IX (Replenine-VF) 1000 iu vial Yes

AD175 Factor IX (Replenine-VF) 500 iu vial Yes

AD491 Factor VIII (8Y) 500 iu Yes

AD594 Factor VIII (Haemate) 1000 iu injection - powder and solvent

Yes

AD593 Factor VIII (Haemate) 500 iu injection - powder and solvent

Yes

AD675 Factor VIII (Helixate Nexgen)

2000 IU powder and solvent for solution for injection

Yes



Yes



Yes



Yes

AD660 Factor VIII (Kogenate) 3000units Yes




AD666 Factor VIII (Recombinant) (Advate)


Yes



Yes



Yes



Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required



Yes



Yes

AD724 Factor VIII (Wilate) 1000 units vial Yes

AD723 Factor VIII (Wilate) 500 units vial Yes

AD884 factor IX fraction (BeneFIX)

Powder and solvent for solution for injection 250 IU

Yes



Yes



Yes



Yes



Yes

AD579 ferric carboxymaltose (Ferinject)

50mg/mL - 10mL vial Yes


50mg/mL - 2mL vial Yes


1000mg/20ml solution for injection

AD769 fidaxomicin (Dificlir) 20 x 200mg tablets Yes

AD177 filgrastim (Neupogen) 30 million units (300 mcg)/mL - 1mL vial

* Yes

AD178 filgrastim (Neupogen) 60 million units (600 mcg)/mL - 0.5mL vial

* Yes

AD179 filgrastim (Neupogen) 96 million units (960 mcg)/mL - 0.5mL vial

* Yes

AD180 filgrastim (Nivestim) 12 million units (120 mcg)/0.2 mL vial

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD181 filgrastim (Nivestim) 30 million units (300 micrograms)/0.5 mL vial

* Yes

AD182 filgrastim (Nivestim) 48 million units (480 micrograms) - 0.5 mL vial

* Yes

AD183 filgrastim (Ratiograstim) 30 million units (300 mcg)/0.5 mL vial

* Yes

AD185 filgrastim (Zarzio) 30 million-units (300 mcg)/0.5 mL vial

* Yes

AD186 filgrastim (Zarzio) 48 million-units (480 mcg)/0.5 mL vial

* Yes

AD698 fludarabine (Non-proprietary)

50mg vial * Yes

AD188 fludarabine PHOS (Fludara)






* Yes

AD686 fluocinolone acetonide (Iluvien)

190mcg intravitreal implant in applicator

Yes

AD190 fluorouracil (Efudix) 40g 5% cream * Yes

AD193 fluorouracil (Non Proprietary)


* Yes



* Yes



* Yes





* Yes



* Yes



* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD198 flutamide (Non Proprietary)


AD199 folinic acid (Sodiofolin) 50mg/mL - 2mL vial injection

* Yes

AD200 folinic acid (Sodiofolin) 50mg/mL - 8mL vial injection

* Yes

AD535 fosaprepitant (Ivemend) 150mg vial * Yes

AD203 fulvestrant (Faslodex) 50mg - 2 x 5mL injections, prefilled syringe

* Yes

AD204 gefitinib (Iressa) 30 x 250mg tablets * Yes

AD205 gemcitabine (Gemzar) 1g vial injection - powder for reconstitution

* Yes

AD206 gemcitabine (Gemzar) 200mg vial injection - powder for reconstitution

* Yes

AD701 gemcitabine (Non-proprietary)

1.5g vial * Yes


1g vial * Yes


200mg vial * Yes


2g vial * Yes

AD897 golimumab (Simponi) 100 mg/ml, 1ml solution for injection

Yes

AD681 goserelin (Zoladex) 10.8 mg implant in SafeSystem syringe applicator

Yes

AD207 goserelin (Zoladex) 3.6mg implant in SafeSystem syringe applicator

Yes

AD208 granisetron (Kytril) 10 x 1mg tablets * Yes

AD210 granisetron (Kytril) 1mg/mL - 1mL ampoule injection

* Yes

AD211 granisetron (Kytril) 1mg/mL - 3mL ampoule injection

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD209 granisetron (Kytril) 5 x 2mg tablets * Yes

AD213 haloperidol (Serenace) 30 x 1.5mg tablets * Yes

AD215 haloperidol (Serenace) 30 x 10mg tablets * Yes

AD212 haloperidol (Serenace) 30 x 500mcg capsules * Yes

AD214 haloperidol (Serenace) 30 x 5mg tablets * Yes

AD634 human prothrombin complex (Beriplex)

500iu injection - powder for reconstitution

Yes

AD633 human prothrombin complex (Beriplex)

250iu injection - powder for reconstitution

Yes

AD595 human Prothrombin Complex (Octaplex)

500 iu vial for iv infusion Yes

AD217 hydrocortisone (Colifoam) 14 x 10% foam in aerosol pack

* Yes

AD468 hydrocortisone (Efcortesol)

100mg/ml - 1ml ampoule injection

* Yes

AD469 hydrocortisone (Efcortesol)

100mg/ml - 5ml ampoule injection

* Yes

AD218 hydrocortisone (Non Proprietary)


AD219 hydrocortisone (Non Proprietary)


AD220 hydrocortisone (Solu-Cortef)


* Yes

AD221 hydrocortisone (Solu-Cortef)

100mg vial with 2mL amp water for injections

* Yes

AD222 hydroxycarbamide (Hydrea)

100 x 500mg capsules * Yes

AD223 ibandronic acid (Bondronat)

1mg/mL - 2mL ampoule concentrate for iv infusion

* Yes


1mg/mL - 6mL ampoule concentrate for iv infusion

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required



AD697 ibandronic acid (Bonviva) 150mg, 1 tab-pack * Yes

AD492 ibritumomab tiuxetan (Zevalin)

[90Y]-radiolabelled solution for iv infusion

* Yes

AD770 ibrutinib (Imbruvica) 90 x 140mg capsules * Yes

AD228 idarubicin (Zavedos) 10mg vial injection - powder for reconstitution

* Yes

AD227 idarubicin (Zavedos) 1 x 10mg capsule * Yes

AD226 idarubicin (Zavedos) 1x 5mg capsule * Yes

AD229 idarubicin (Zavedos) 5mg vial injection - powder for reconstitution

* Yes

AD764 idelalisib (Zydelig) 60 x 100mg tablets * Yes

AD765 idelalisib (Zydelig) 60 x 150mg tablets * Yes

AD230 ifosfamide (Non Proprietary)


* Yes

AD231 ifosfamide (Non Proprietary)


* Yes

AD233 imatinib (Glivec) 30 x 400mg tablets * Yes

AD232 imatinib (Glivec) 60 x 100mg tablets * Yes

AD596 imiquimod (Aldara) 5% cream - 12 sachet pack * Yes

AD234 infliximab (Remicade) 100mg vial powder for iv infusion

Yes

AD238 interferon alpha (IntronA) 25 million Units/mL - 1.5mL injection pen

Yes

AD235 interferon alpha (IntronA) 10 million units/mL - 1mL vial injection

Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD236 interferon alpha (IntronA) 10 million units/mL - 2.5mL vial injection

Yes

AD237 interferon alpha (IntronA) 15 million units/mL - 1.5mL injection pen

Yes

AD239 interferon alpha (IntronA) 50 million units/mL - 1.5mL injection pen

Yes

AD242 interferon alpha (Roferon-A)

12 million units/mL 0 .5mL prefilled syringe

Yes


18 million units/mL - 0 .5mL prefilled syringe

Yes


6 million units/mL - 0.5mL prefilled syringe

Yes


9 million units/mL - 0.5mL prefilled syringe

Yes

AD623 ipilimumab (Yervoy) 5mg/mL - 40mL vial for iv infusion

* Yes

AD622 ipilimumab (Yervoy) 5mg/mL - 10mL vial for iv infusion

* Yes

AD245 irinotecan (Campto) 20 mg/mL - 15mL vial for infusion

* Yes


* Yes


* Yes

AD705 irinotecan (Non-proprietary)








AD909 irinotecan hydrochloride trihydrate (Onivyde)

5mg/ml, 50mg vial * Yes

AD613 iron dextran (CosmoFer) 50 mg/mL - 10mL ampoule Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD612 iron dextran (CosmoFer) 50 mg/mL - 2mL ampoule Yes

AD583 iron isomaltoside 1000 (Monofer)

100 mg/mL - 10mL vial Yes


100 mg/mL - 5mL vial Yes


100 mg/mL, 1mL vial Yes

AD920 Ixazomib (Ninlaro) 3 x 2.3mg capsules Yes

AD921 Ixazomib (Ninlaro) 3 x 3mg capsules Yes

AD922 Ixazomib (Ninlaro) 3 x 4mg capsules Yes

AD768 lanreotide (Somatuline) 120mg prefilled syringe * Yes



AD250 lanreotide (Somatuline) 30mg vial injection * Yes

AD752 lapatinib (Tyverb) 105 x 250mg tablets * Yes

AD252 lapatinib (Tyverb) 84 x 250mg tablets * Yes

AD254 lenalidomide (Revlimid) 21 x 10mg capsules * Yes




AD257 lenograstim (Granocyte) 13.4 million unit (105mcg) vial injection

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD258 lenograstim (Granocyte) 33.6 million unit (263mcg) vial injection

* Yes

AD786 Lenvatinib (Lenvima) 30 x 4mg capsules * Yes

AD787 Lenvatinib (Lenvima) 30 x 10mg capsules * Yes

AD259 letrozole (Femara) 14 x 2.5mg tablets * Yes

AD260 letrozole (Femara) 28 x 2.5mg tablets * Yes

AD261 leuprorelin (Prostap 3 DCS)

11.25mg vial with 2mL vehicle filled syringe

* Yes

AD262 leuprorelin (Prostap SR DCS)

3.75mg prefilled syringe Yes

AD264 levomepromazine (Nozinan)


* Yes

AD263 levomepromazine (Nozinan)


AD746 lipegfilgrastim (Lonquex) 6mg/0.6ml vial * Yes

AD265 lomustine (CCNU) 20 x 40mg capsules * Yes

AD536 medroxyprogesterone acetate (Depo-Provera)

150mg/mL - 1mL injection - prefilled syringe

Yes

AD537 medroxyprogesterone acetate (Depo-Provera)

150mg/mL, 1mL vial Yes

AD543 medroxyprogesterone acetate (Provera)








AD272 megestrol acetate (Megace)


15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD273 melphalan (Alkeran) 25 x 2mg tablets * Yes

AD274 melphalan (Alkeran) 50mg vial injection - powder for reconstitution

* Yes

AD751 mercaptopurine (Non Proprietary)


AD279 mesna (Non Proprietary) 100mg/mL - 10mL ampoule injection

* Yes

AD278 mesna (Non Proprietary) 100mg/mL - 4mL ampoule injection

* Yes

AD276 mesna (Non Proprietary) 10 x 400mg tablets * Yes

AD277 mesna (Non Proprietary) 10 x 600mg tablets * Yes

AD478 methotrexate (Maxtrex) 100 x 10mg tablets * Yes

AD477 methotrexate (Maxtrex) 28 x 2.5mg tablets * Yes

AD283 methotrexate (Non Proprietary)


* Yes



* Yes



* Yes



* Yes



* Yes

AD285 methylprednisolone (Depo-Medrone)


* Yes



* Yes



* Yes

AD291 methylprednisolone (Medrone)


15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required







AD293 methylprednisolone (Solu-Medrone)


* Yes



* Yes



* Yes



* Yes



* Yes

AD635 methylthioninium chloride (Methylthioninium chloride Proveblue)

5mg/mL - 5 x10mL injections

Yes

AD546 metoclopramide (Maxolon)


AD547 metoclopramide (Maxolon)


* Yes

AD771 micafungin (Mycamine) 100mg vial Yes

AD679 mifamurtide (MEPACT) 4 mg powder for suspension for infusion

* Yes

AD298 mitomycin (Mitomycin C Kyowa)

10mg injection - powder for reconstitution

* Yes



* Yes



* Yes



* Yes

AD680 mitotane (Lysodren) 500mg tablets * Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD301 mitoxantrone (Non Proprietary)


* Yes

AD907 necitumumab (Portrazza) 800 mg (flat dose) on Days 1 and 8 of each 3-week cycle

* Yes

AD302 nelarabine (Atriance) 5mg/mL - 50mL vial concentrate for iv infusion

* Yes

AD889 netupitant and palonosetron (Akynzeo)

300 mg / 0.5 mg capsule * Yes

AD654 nilotinib (Tasigna) 112 x 150mg capsules * Yes

AD303 nilotinib (Tasigna) 112 x 200mg capsules * Yes

AD782 nintedanib (Vargatef) 120 x 100mg capsules * Yes

AD783 nintedanib (Vargatef) 60 x 150mg capsules * Yes

AD879 nivolumab (Opdivo) 10 mg/mL concentrate for solution infusion, 4ml vial

* Yes

AD880 nivolumab (Opdivo) 10 mg/mL concentrate for solution infusion, 10ml vial

* Yes

AD599 normal immunoglobulin (Flebogammadif)

10%, 20g - 200mL vial for iv infusion

Yes



Yes



Yes


0.5g - 10mL vial for iv infusion

Yes


10g - 200mL vial for iv infusion

Yes


2.5g - 50mL vial for iv infusion

Yes



Yes



Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD316 normal immunoglobulin (Gammagard S/D)

5 or 10% 10g with diluent for iv infusion

Yes

AD315 normal immunoglobulin (Gammagard S/D)

5 or 10% 5g with diluent for iv infusion

Yes

AD319 normal immunoglobulin (Gammaplex)


Yes


5%, 2.5g - 50mL vial for iv infusion

Yes



Yes

AD323 normal immunoglobulin (Intratect)

5% - 10g (200mL) for iv infusion

Yes



Yes


5% - 2.5g (50mL) for iv infusion

Yes



Yes

AD327 normal immunoglobulin (Kiovig)


Yes



Yes



Yes



Yes



Yes

AD338 normal immunoglobulin (Octagam)


Yes



Yes



Yes



Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required



Yes



Yes



Yes

AD330 normal immunoglobulin (Privigen)


Yes



Yes



Yes



Yes

AD343 normal immunoglobulin (Subcuvia)

0.8g (5ml) vial injection Yes

AD344 normal immunoglobulin (Subcuvia)

1.6g (10mL) vial injection Yes

AD347 normal immunoglobulin (Subgam)

1.5g vial injection Yes

AD346 normal immunoglobulin (Subgam)

750mg vial injection Yes

AD342 normal immunoglobulin (Vigam)


Yes



Yes



Yes

AD350 normal immunoglobulin (Vivaglobin)

3.2g (20mL) injection Yes

AD754 obinutuzumab (Gazyvaro) 1,000mg concentrate for solution for infusion, 40mL vial

* Yes

AD726 ocriplasmin (Jetrea) 0.5mg/0.2ml concentrate for solution for injection vial

Yes

AD351 octreotide (Sandostatin LAR)

10mg vial injection with diluent filled syringe

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required



* Yes



* Yes

AD600 ofatumumab (Arzerra) 100mg/5mL, 5mL vial (concentrate for infusion)

* Yes

AD354 ofatumumab (Arzerra) 100mg/5mL, 50mL vial (concentrate for infusion)

* Yes

AD881 olaparib (Lynparza) 400mg taken twice daily, 50 mg hard capsules, 112 hard capsules

* Yes

AD918 olaratumab (Lartruvo)

500Mg/50ml vial * Yes

AD605 ondansetron (Non Proprietary)


* Yes



* Yes



* Yes





AD554 ondansetron (Zofran) 10 x 4mg oral lyophilisates * Yes

AD555 ondansetron (Zofran) 10 x 8mg oral lyophilisates * Yes

AD549 ondansetron (Zofran) 10 x 8mg tablets * Yes

AD553 ondansetron (Zofran) 16mg suppositories * Yes

AD551 ondansetron (Zofran) 2mg/mL - 2mL ampoule injection

* Yes

AD552 ondansetron (Zofran) 2mg/mL - 4mL ampoule injection

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD548 ondansetron (Zofran) 30 x 4mg tablets * Yes

AD550 ondansetron (Zofran) 4mg/5mL - 50mL oral solution

* Yes

AD902 osimertinib (Tagrisso) 40mg tablets * Yes

AD682 oxaliplatin (Non Proprietary)

50-mg vial * Yes


100-mg vial * Yes


5mg/mL - 10mLvial concentrate for infusion

* Yes


5mg/mL - 20mL vial concentrate for infusion

* Yes


5mg/mL - 40mL vial concentrate for infusion

* Yes

AD708 paclitaxel (Non-proprietary)

6mg/mL, 16.7mL vial * Yes







AD669 paclitaxel albumin (Abraxane)

powder for reconstitution, 100-mg vial

* Yes

AD906 palbociclib (Ibrance) 125mg once daily for 21 days then 7 days off

* Yes

AD930 palbociclib (Ibrance) 75mg Capsuels * Yes

AD931 palbociclib (Ibrance) 100MG Capsuels * Yes

AD365 panitumumab (Vectibix) 20mg/mL - 20mL vial concentrate for iv infusion

* Yes

AD364 panitumumab (Vectibix) 20mg/mL - 5mL vial concentrate for iv infusion

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD366 pazopanib (Votrient) 30 X 200mg tablets * Yes

AD367 pazopanib (Votrient) 30 x 400mg tablets * Yes

AD908 pegaspargase (Oncaspar) 750iu/ml, 5ml vial * Yes

AD369 pegfilgrastim (Neulasta) 10mg/mL - 0.6mL (6mg) prefilled syringe

* Yes

AD370 peginterferon (Pegasys) 135mcg prefilled syringe Yes

AD371 peginterferon (Pegasys) 180mcg prefilled syringe Yes

AD883 pembrolizumab (Keytruda)

2 mg/kg administered intravenously over 30 minutes every 3 weeks, 50 mg vial

*

Yes

AD372 pemetrexed (Alimta) 100mg vial injection * Yes

AD373 pemetrexed (Alimta) 500 mg vial injection * Yes

AD374 pentostatin (Nipent) 10mg vial injection - powder for reconstitution

* Yes

AD685 pertuzumab (Perjeta) 420mg - 30ml vial Yes

AD878 pixantrone (Pixuvri) 29mg vial * Yes

AD586 plerixafor (Mozobil) 20 mg/mL - 1.2mL vial * Yes

AD730 pomalidomide (Imnovid) 21 x 1mg capsules * Yes




15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD735 ponatinib (Iclusig) 30 x 45mg tablets * Yes

AD734 ponatinib (Iclusig) 60 x 15mg tablets * Yes

AD375 porfimer sodium (Photofrin)


* Yes

AD916 Posaconazole (Noxafil) 200mg/5ml, 105ml * Yes

AD505 prednisolone (Deltacortril) 100 x 2.5mg tablets * Yes

AD507 prednisolone (Deltacortril) 100 x 5mg tablets * Yes

AD504 prednisolone (Deltacortril) 28 x 2.5mg tablets * Yes

AD506 prednisolone (Deltacortril) 28 x 5mg tablets * Yes

AD503 prednisolone (Deltastab) 25 mg/mL - 1mL ampoule injection

* Yes

AD495 prednisolone (Non Proprietary)






AD929 Prednisolone (non proprietary)

10mg/ml, 30ml bottle * Yes

AD379 prednisone (Lodotra) 100 x 2mg tablets * Yes





15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD382 procarbazine (Non Proprietary)


AD556 prochlorperazine (Buccastem)

10 x3mg tablets - 5 packs * Yes

AD560 prochlorperazine (Stemetil)

12.5mg/mL - 1mL ampoule injection

* Yes





* Yes



AD737 radium Ra 223 dichloride (Xofigo)

1000 kBq/mL solution vial for intravenous injection

* Yes

AD385 raltitrexed (Tomudex) 2mg vial injection - powder for reconstitution

* Yes

AD780 ramucirumab (Cyramza) 10ml vial injection * Yes

AD781 ramucirumab (Cyramza) 50ml vial injection * Yes

AD386 ranibizumab (Lucentis) 10mg/ml - 0.23mL vial - solution for injection

Yes

AD387 rasburicase (Fasturtec) 1.5mg vial for iv infusion * Yes

AD388 rasburicase (Fasturtec) 7.5mg vial for iv infusion * Yes

AD736 regorafenib (Stivarga) 84 x 40mg film-coated tablets

* Yes

AD910 riastap (Fibfinogen) 1g powder for injection Yes

AD391 rituximab (MabThera) 10mg/mL - 10mL vial for iv infusion

* Yes

AD392 rituximab (MabThera) 10mg/mL - 50mL vial for iv infusion

* Yes

AD928 rituximab (Truxima) 500mg/50ml concentrate for solution for infusion vial

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD755 rituximab (MabThera) 1400mg solution for subcutaneous injection

* Yes

AD393 romiplostim (Nplate) 250mcg vial injection - powder for reconstitution

Yes

AD741 ruxolitinib (Jakavi) 60 x 15mg tablets * Yes



AD760 sofosbuvir (Sovaldi) 28 x 400mg tablets Yes

AD400 sorafenib (Nexavar) 112 x 200mg tablets * Yes

AD761 spironolactone (Non proprietary)


AD785 strontium-89 chloride (Metastron)

150 MBq/ml solution for injection, 4mL vial

* Yes

AD403 sunitinib (Sutent) 28 x 12.5mg capsules * Yes

AD402 sunitinib (Sutent) 28 x 25mg capsules * Yes

AD401 sunitinib (Sutent) 28 x 50mg capsules * Yes

AD926 Talimogene laherparepvec (Imlygic)

100mio PFU/1ml * Yes

AD927 Talimogene laherparepvec (Imlygic)

1 mio PFU/1ml * Yes

AD409 tamoxifen (Non Proprietary)






AD481 tamoxifen (Soltamox) 10mg/5mL - 150mL oral solution

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD690 tegafur, gimeracil, oteracil (Teysuno)

20mg tegafur, 5.8mg gimeracil, 15.8mg oteracil

Yes

AD689 tegafur, gimeracil, oteracil (Teysuno)

15mg tegafur, 4.35mg gimeracil, 11.8mg oteracil

Yes

AD647 temocillin (Negaban) 1g, powder for solution for injection/infusion

* Yes

AD416 temoporfin (Foscan) 1mg/mL - 3mL vial injection * Yes

AD417 temoporfin (Foscan) 1mg/mL - 6mL vial injection * Yes

AD421 temozolomide (Temodal) 5 x 100mg capsules * Yes






AD424 temsirolimus (Torisel) 25mg/mL - 1.2mL ampoule for iv infusion

* Yes

AD426 terlipressin (Glypressin) 0.12mg/mL - 1mg vial (8.5mL) injection

Yes

AD425 terlipressin (Glypressin) 1mg vial injection - powder for reconstitution

Yes

AD427 thalidomide (Thalidomide Celgene)

28 x 50mg capsules * Yes

AD429 thiotepa (Tepadina) 100 mg vial injection - powder for reconstitution

* Yes

AD428 thiotepa (Tepadina) 15mg vial injection - powder for reconstitution

* Yes

AD608 thyrotropin alfa (Thyrogen)

900mcg/vial injection - powder for reconstitution

* Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD431 tioguanine (Lanvis) 25 x 40mg tablets * Yes

AD432 tirofiban (Aggrastat) 250mcg/mL - 50mL vial for iv infusion

Yes

AD433 tirofiban (Aggrastat) 50mcg/mL - 250mL vial for iv infusion

Yes

AD762 tolvaptan (Samsca) 10 x 15mg tablets * Yes

AD763 tolvaptan (Samsca) 10 x 30mg tablets * Yes

AD434 topotecan (Hycamtin) 10 x 1mg capsules * Yes

AD435 topotecan (Hycamtin) 10 x 250mcg capsules * Yes

AD436 topotecan (Hycamtin) 1mg vial for iv infusion * Yes

AD437 topotecan (Hycamtin) 4mg vial for iv infusion * Yes

AD438 toremifene (Fareston) 30 x 60mg tablets * Yes

AD905 trametinib (Mekinist) oral 2mg 7 or 30 pack size

* Yes

AD440 trabectedin (Yondelis) 1mg vial injection - powder for reconstitution

* Yes

AD439 trabectedin (Yondelis) 250mcg vial injection - powder for reconstitution

* Yes

AD441 trastuzumab (Herceptin) 150mg vial for iv infusion * Yes

AD729 trastuzumab (Herceptin) 600mg/5mL solution vial for subcutaneous injection

* Yes

AD744 trastuzumab emtansine (Kadcyla)

100mg vial - powder for reconstitution

* Yes

AD745 trastuzumab emtansine (Kadcyla)

160mg vial - powder for reconstitution

* Yes

AD442 treosulfan (Treosulfan) 100 x 250mg capsules * Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD443 treosulfan (Treosulfan) 1g vial injection - powder for reconstitution

* Yes

AD444 treosulfan (Treosulfan) 5g vial injection - powder for reconstitution

* Yes

AD445 tretinoin (Vesanoid) 100 x 10mg capsules * Yes

AD904 trifluridine/tipiracil (Lonsurf)

15mg/6.14mg tablets * Yes

AD609 triptorelin (Decapeptyl SR)

22.5mg vial injection - powder for suspension

* Yes



* Yes


3mg vial injection - powder for suspension

* Yes

AD449 triptorelin (Gonapeptyl Depot)


* Yes

AD591 urokinase (Syner-Kinase) 100,000 unit vial injection - powder for reconstitution

Yes


Yes


Yes

AD615 vandetanib (Caprelsa) 300mg tablets * Yes

AD614 vandetanib (Caprelsa) 100mg tablets * Yes

AD898 vedolizumab (Entyvio) 300 mg powder for concentrate for solution for infusion

Yes

AD617 vemurafenib (Zelboraf) 56 x 240mg tablets * Yes

AD911 Venetoclax (Venclyxto) 7 x 100mg tablets * Yes



15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required



AD450 verteporfin (Visudyne) 15mg vial injection - powder for reconstitution

Yes

AD451 vinblastine (Non Proprietary)


* Yes

AD453 vincristine (Non proprietary)






AD458 vindesine (Eldisine) 5mg vial injection - powder for reconstitution

* Yes

AD611 vinflunine (Javlor) 25mg/mL - 10mL vial for iv infusion

* Yes

AD610 vinflunine (Javlor) 25mg/mL - 2mL vial for iv infusion

* Yes

AD462 vinorelbine (Navelbine) 10mg/mL - 1mL vial for iv infusion

* Yes

AD463 vinorelbine (Navelbine) 10mg/mL - 5mL vial for iv infusion

* Yes

AD459 vinorelbine (Navelbine) 1 x 20mg capsule * Yes



AD719 vinorelbine (Non-proprietary)


AD720 vinorelbine (Non-proprietary)


AD753 vismodegib (Erivedge) 28 x 150mg capsules * Yes

15 MAY 2018




Bupa code

Generic name

(Brand name)

Dosage, formulation

and pack size

Cancer only

Pre-authorisation

required

AD650 voriconazole (Vfend (iv infusion))

200mg vial for iv infusion Yes

AD653 voriconazole (Vfend) 200mg/5mL - 75mL oral solution

* Yes

AD652 voriconazole (Vfend) 28 x 200mg tablets * Yes

AD651 voriconazole (Vfend) 28 x 50mg tablets * Yes

AD464 zoledronic acid (Zometa) 800mcg/mL - 5mL vial for iv infusion

* Yes

AD935 ribociclib (Kisqali) 200mg tablets * Yes

AD936 tivozanib (Fotivda) 890mcg capsules * Yes

AD937 tivozanib (Fotivda) 1340mcg capsules * Yes

AD938 domperidone (Motilium) 1mg/ml oral suspension – 200ml

* Yes

AD939 rivaroxaban (Xarelto) 20mg tablets * Yes

AD940 Venetoclax (Venclyxto) 100MG Pack 56 * Yes

Documents

Separately chargeable drugs list - Bupa UK/media/Files/HCP/Latest Updates from Bupa... · 15 FEBRUARY 2018 Separately Chargeable Drugs List Also known to customers as: List of advanced