Health Professionals Section
Special Authority Forms
PDFs of special authority forms can be found at the Pharmac website: http://www.pharmac.govt.nz/special_authority_forms.asp
Direct links to Special Authority Forms for specific medications and products relevant to diabetes and related conditions can be found below (in alphabetical order) :
Acarbose - SA0490:
http://www.pharmac.govt.nz/special_authority_forms/SA0490.pdf
Atorvastatin - SA0788:
http://www.pharmac.govt.nz/special_authority_forms/SA0788.pdf
Candesartan - SA0862:
http://www.pharmac.govt.nz/special_authority_forms/SA0862.pdf
Diabetic Products (Diasip, Diason, Glucerna, Glucerna RTH, Resource Diabetic, Resource Diabetic RTH) - SA0594:
http://www.pharmac.govt.nz/special_authority_forms/SA0594.pdf
Ezetimibe - SA0796:
http://www.pharmac.govt.nz/special_authority_forms/SA0796.pdf
Ezetimibe w/ Simvastatin (Vytorin) - SA0826:
http://www.pharmac.govt.nz/special_authority_forms/SA0826.pdf
Insulin Glargine - SA0834:
http://www.pharmac.govt.nz/special_authority_forms/SA0834.pdf
Losartan - SA0862:
http://www.pharmac.govt.nz/special_authority_forms/SA0862.pdf
Losartan - Tab 50 mg with hydrochlorothiazide 12.5 mg (Hyzar) - SA0703:
http://www.pharmac.govt.nz/special_authority_forms/SA0703.pdf
Pioglitazone - SA0859:
http://www.pharmac.govt.nz/special_authority_forms/SA0859.pdf
Pravastatin - SA0849:
http://www.pharmac.govt.nz/special_authority_forms/SA0849.pdf