40:00 Electrolytic, Caloric and Water Balance

CITRIC ACID, SODIUM CITRATE

POTASSIUM CITRATE

SODIUM BICARBONATE

LACTULOSE

BENRALIZUMAB

Limited use benefit (prior approval required).

Initial coverage criteria (12 months):

For the adjunctive treatment of severe eosinophilic asthma in adults who are inadequately controlled with high-dose inhaled corticosteroids* plus one or more additional asthma controller(s) (e.g. long-acting beta-agonist); and

• patient has had a blood eosinophil count of ≥0.15x109/L before initiation of benralizumab; and
• patient is receiving maintenance treatment with oral corticosteroids (at a dose equivalent to ≥5mg prednisone per day) prior to starting benralizumab;
• or
• patient has had a blood eosinophil count of ≥0.3x109/L within the 12-month period prior to starting benralizumab; and
• patient has experienced two or more clinically significant asthma exacerbations** within the 12-month period prior to starting benralizumab;
• and
• a baseline assessment of asthma symptom control using a validated asthma control questionnaire has been completed prior to the initiation of benralizumab; and
• patient is managed by a physician with expertise in the treatment of asthma.

Coverage for benralizumab is provided for a maximum dose of 30 mg administered subcutaneously once every 4 weeks for the first 3 doses, then once every 8 weeks thereafter.

Fasenra will not be funded as a dual therapy with another biologic for the treatment of asthma.

Patients will be permitted to switch from one biologic agent to another following an adequate trial of the first biologic agent if unresponsive to therapy, or due to serious adverse effects or contraindications. An adequate trial is defined as at a minimum the completion of induction dosing (e.g. initial coverage period). Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to therapy.

Criteria for renewal or for initial NIHB coverage in patients currently maintained on Fasenra (12 months):

• patient has not experienced an increase in clinically significant asthma exacerbations** with benralizumab treatment; and
• for patients receiving maintenance oral corticosteroids, patient's oral corticosteroid maintenance dose has decreased from the pre-treatment dose. After the first 12 months, subsequent oral corticosteroid dose should be maintained; and
• the 12-month asthma control questionnaire score has improved from baseline, where baseline represents the initiation of treatment. After the first 12 months, subsequent scores should be maintained.

* High-dose inhaled corticosteroid is defined as ≥ 500mcg of fluticasone propionate or equivalent daily.

** A clinically significant asthma exacerbation is defined as worsening of asthma such that the treating physician elected to administer systemic glucocorticoids for at least three days or the patient visited an emergency department or was hospitalized.

CALCIUM

CALCIUM GLUCONATE,VIT D

CALCIUM, VITAMIN D

ELECTROLYTES

MAGNESIUM

MAGNESIUM GLUCOHEPTONATE

MAGNESIUM GLUCONATE

POTASSIUM CHLORIDE

POTASSIUM CITRATE

SODIUM CHLORIDE

SODIUM POLYSTYRENE SULFONATE

CALCIUM POLYSTYRENE SULFONATE

SODIUM POLYSTYRENE SULFONATE

IRON (SUCROFERRIC OXYHYDROXIDE)

Limited use benefit (prior approval required).

For patients with elevated phosphate levels or elevated phosphate X calcium product despite dietary restriction of phosphate and use of calcium-based phosphate binders (short term elevations should be managed with aluminium based binders).

For patients with elevated calcium levels despite discontinuation of calcium binder, and Vitamin D analogue and/or modification of dialysate calcium.

For patients with adynamic bone disease and low PTH levels (<100 pg/ml or <0.9 pmol/L) with normal or elevated calcium levels.

LANTHANUM CARBONATE HYDRATE

Limited use benefit (prior approval required).

For patients with elevated phosphate levels or elevated phosphate X calcium product despite dietary restriction of phosphate and use of calcium-based phosphate binders (short term elevations should be managed with aluminium based binders).

For patients with elevated calcium levels despite discontinuation of calcium binder, and vitamin D analogue and/or modification of dialysate calcium.

For patients with adynamic bone disease and low PTH levels (<100 pg/ml or <0.9 pmol/L) with normal or elevated calcium levels.

SEVELAMER CARBONATE

Limited use benefit (prior approval required).

For patients with elevated phosphate levels or elevated phosphate X calcium product despite dietary restriction of phosphate and use of calcium-based phosphate binders (short term elevations should be managed with aluminium based binders).

For patients with elevated calcium levels despite discontinuation of calcium binder, and Vitamin D analogue and/or modification of dialysate calcium.

For patients with adynamic bone disease and low PTH levels (<100 pg/ml or <0.9 pmol/L) with normal or elevated calcium levels.

SEVELAMER HYDROCHLORIDE

Limited use benefit (prior approval required).

For patients with elevated phosphate levels or elevated phosphate X calcium product despite dietary restriction of phosphate and use of calcium-based phosphate binders (short term elevations should be managed with aluminium based binders).

For patients with elevated calcium levels despite discontinuation of calcium binder, and vitamin D analogue and/or modification of dialysate calcium.

For patients with adynamic bone disease and low PTH levels (<100 pg/ml or <0.9 pmol/L) with normal or elevated calcium levels.

GLUCOSE

LEVOCARNITINE

Limited use benefit (prior approval required).

For treatment of carnitine deficiency.

ETHACRYNIC ACID

FUROSEMIDE

AMILORIDE

AMILORIDE, HYDROCHLOROTHIAZIDE

TRIAMTERENE, HYDROCHLOROTHIAZIDE

HYDROCHLOROTHIAZIDE

SPIRONOLACTONE, HYDROCHLOROTHIAZIDE

CHLORTHALIDONE

INDAPAMIDE

METOLAZONE

SODIUM CHLORIDE

SULFINPYRAZONE

WATER