Special Authority forms - September 2021

Applicants can download individual Special Authority applications forms below or:

Sector Services contact details

  • For enquires regarding the processing of paper based or declined applications, please contact Sector Operations on 0800 855 066.
  • For access to, or incidents relating to the Electronic Special Authority system, please contact Sector Operations on email onlinehelpdesk@health.govt.nz

Individual Special Authority forms

 (Sort by: Therapeutic Group / Chemical Name)
Alimentary Tract and Metabolism
SA1986 - Alglucosidase Alfa (1 page, 18 KB)
SA2042 - Arginine (1 page, 16 KB)
SA1987 - Betaine (1 page, 16 KB)
SA1886 - Budesonide - Cap 3 mg Controlled Release (2 pages, 23 KB)
SA2039 - Coenzyme Q10 (1 page, 16 KB)
SA1320 - Diazoxide (1 page, 15 KB)
SA2068 - Empagliflozin; Empagliflozin with metformin hydrochloride (1 page, 18 KB)
SA1840 - Ferric carboxymaltose (2 pages, 22 KB)
SA2065 - GLP-1 Agonists (1 page, 18 KB)
SA1988 - Galsulfase (1 page, 17 KB)
SA1329 - Glyceryl trinitrate Oint 0.2% (1 page, 15 KB)
SA1623 - Idursulfase (1 page, 17 KB)
SA1985 - Insulin Pump Consumables (4 pages, 31 KB)
SA1603 - Insulin Pumps (5 pages, 34 KB)
SA1695 - Laronidase (1 page, 17 KB)
SA2040 - Levocarnitine (1 page, 16 KB)
SA1691 - Methylnaltrexone bromide (1 page, 16 KB)
SA1546 - Multivitamin renal (Clinicians Renal Vit) (1 page, 16 KB)
SA1036 - Multivitamins (Paediatric Seravit) (1 page, 15 KB)
SA2041 - Riboflavin (1 page, 16 KB)
SA1461 - Rifaximin (1 page, 16 KB)
SA1989 - Sapropterin dihydrochloride (1 page, 17 KB)
SA1599 - Sodium benzoate (1 page, 15 KB)
SA1990 - Sodium phenylbutyrate (1 page, 16 KB)
SA2053 - Sodium picosulfate (1 page, 16 KB)
SA1880 - Taliglucerase alfa (6 pages, 306 KB)
SA2043 - Taurine (1 page, 16 KB)
SA1739 - Ursodeoxycholic Acid (2 pages, 23 KB)
SA1720 - Vitabdeck (1 page, 15 KB)
Blood and Blood Forming Organs
SA1743 - Eltrombopag (2 pages, 22 KB)
SA1969 - Emicizumab (1 page, 17 KB)
SA1646 - Enoxaparin sodium (1 page, 17 KB)
SA1259 - Filgrastim (1 page, 18 KB)
SA1775 - Hypoplastic and Haemolytic (2 pages, 23 KB)
SA1912 - Pegfilgrastim (1 page, 16 KB)
SA1955 - Ticagrelor (2 pages, 23 KB)
Cardiovascular System
SA1702 - Ambrisentan (18 pages, 585 KB)
SA1991 - Bosentan (2 pages, 23 KB)
SA1728 - Eplerenone (1 page, 16 KB)
SA1696 - Epoprostenol (18 pages, 585 KB)
SA1045 - Ezetimibe (1 page, 17 KB)
SA1046 - Ezetimibe with Simvastatin (1 page, 17 KB)
SA1321 - Hydralazine (1 page, 15 KB)
SA1705 - Iloprost (18 pages, 585 KB)
SA1474 - Midodrine (1 page, 16 KB)
SA1327 - Propranolol (1 page, 16 KB)
SA1905 - Sacubitril with valsartan (1 page, 17 KB)
SA1992 - Sildenafil (2 pages, 23 KB)
Dermatologicals
SA2024 - Acitretin (1 page, 16 KB)
SA2023 - Isotretinoin (1 page, 16 KB)
SA1225 - Ivermectin (2 pages, 23 KB)
SA1970 - Pimecrolimus (1 page, 16 KB)
Genito-Urinary System
SA0500 - Combined oral contraceptives; Progestogen-only contraceptives (1 page, 17 KB)
SA0928 - Finasteride (1 page, 16 KB)
SA1083 - Potassium Citrate (1 page, 16 KB)
SA1032 - Tamsulosin (1 page, 15 KB)
Hormone Preparations - Systemic Excluding Contraceptive Hormones
SA2070 - Cabergoline (1 page, 16 KB)
SA1618 - Cinacalcet (1 page, 17 KB)
SA1609 - Progesterone (1 page, 16 KB)
SA1199 - Propylthiouracil (1 page, 16 KB)
SA2032 - Somatropin (7 pages, 45 KB)
SA2031 - Zoledronic acid inj 4 mg per 5 ml, vial (1 page, 17 KB)
Infections - Agents for Systemic Use
SA1318 - Albendazole (1 page, 15 KB)
SA1651 - Antiretrovirals (2 pages, 23 KB)
SA1683 - Azithromycin (1 page, 18 KB)
SA1857 - Clarithromycin (1 page, 17 KB)
SA1994 - Emtricitabine with tenofovir disoproxil (2 pages, 23 KB)
SA1359 - Fluconazole oral liquid (1 page, 16 KB)
SA1322 - Itraconazole (1 page, 16 KB)
SA1685 - Lamivudine (1 page, 15 KB)
SA1605 - Ledipasvir with sofosbuvir (5 pages, 663 KB)
SA1355 - Minocycline hydrochloride Tab 50 mg (1 page, 15 KB)
SA1740 - Moxifloxacin (2 pages, 22 KB)
SA1689 - Paromomycin (1 page, 16 KB)
SA2034 - Pegylated Interferon alfa-2A (4 pages, 31 KB)
SA1285 - Posaconazole (1 page, 17 KB)
SA1684 - Primaquine (1 page, 16 KB)
SA1328 - Pyrimethamine (1 page, 15 KB)
SA1331 - Sulfadiazine (1 page, 15 KB)
SA1332 - Tetracycline (1 page, 15 KB)
SA1993 - Valganciclovir (2 pages, 22 KB)
SA1273 - Voriconazole (1 page, 16 KB)
Musculoskeletal System
SA1963 - Benzbromarone (1 page, 15 KB)
SA1289 - Capsaicin (1 page, 15 KB)
SA1777 - Denosumab (1 page, 20 KB)
SA2054 - Febuxostat (1 page, 18 KB)
SA1779 - Raloxifene (1 page, 19 KB)
SA1139 - Teriparatide (1 page, 17 KB)
SA1780 - Zoledronic acid inj 0.05 mg per ml, 100 ml (3 pages, 30 KB)
Nervous System
SA0987 - Aprepitant (1 page, 16 KB)
SA1149 - Dexamfetamine Sulfate (2 pages, 21 KB)
SA1998 - Hyoscine (Scopolamine) (1 page, 16 KB)
SA1125 - Lacosamide (1 page, 17 KB)
SA1666 - Melatonin (1 page, 17 KB)
SA1964 - Methylphenidate Hydrochloride (Rubifen; Rubifen SR; Ritalin; Ritalin SR; Methylphenidate ER - Teva) (2 pages, 22 KB)
SA1965 - Methylphenidate Hydrochloride Extended Release (Concerta; Ritalin LA) (1 page, 17 KB)
SA1999 - Modafinil (1 page, 16 KB)
SA2051 - Multiple Sclerosis (2 pages, 23 KB)
SA1408 - Naltrexone (1 page, 16 KB)
SA1428 - Olanzapine depot injection (1 page, 17 KB)
SA1429 - Paliperidone depot injection (1 page, 17 KB)
SA1386 - Phenobarbitone (1 page, 15 KB)
SA1403 - Riluzole (1 page, 16 KB)
SA1427 - Risperidone microspheres (1 page, 17 KB)
SA1488 - Rivastigmine patches (1 page, 16 KB)
SA1330 - Stiripentol (1 page, 16 KB)
SA1203 - Suboxone (2 pages, 21 KB)
SA0906 - Topical local anaesthetics (EMLA; LMX4) (1 page, 16 KB)
SA1845 - Varenicline tartrate (1 page, 17 KB)
SA1997 - Vigabatrin (1 page, 18 KB)
Oncology Agents and Immunosuppressants
SA2003 - Abiraterone acetate (1 page, 17 KB)
SA2049 - Adalimumab (17 pages, 89 KB)
SA1772 - Aflibercept (2 pages, 23 KB)
SA1870 - Alectinib (1 page, 16 KB)
SA1467 - Azacitidine (1 page, 17 KB)
SA2046 - Bendamustine hydrochloride (2 pages, 24 KB)
SA1889 - Bortezomib (1 page, 16 KB)
SA1697 - Cetuximab (1 page, 16 KB)
SA1805 - Dasatinib (1 page, 17 KB)
SA2000 - Erlotinib (1 page, 17 KB)
SA2048 - Etanercept (13 pages, 67 KB)
SA2008 - Everolimus (1 page, 17 KB)
SA1895 - Fulvestrant (1 page, 16 KB)
SA2001 - Gefitinib (1 page, 17 KB)
SA1460 - Imatinib mesylate (Glivec) for treatment of gastrointestinal stromal tumour (GIST) (2 pages, 390 KB)
SA2050 - Infliximab (15 pages, 76 KB)
SA2035 - Lapatinib (1 page, 16 KB)
SA2047 - Lenalidomide (2 pages, 22 KB)
SA1896 - Mepolizumab (1 page, 18 KB)
SA1725 - Mercaptopurine (1 page, 15 KB)
SA1489 - Nilotinib (1 page, 17 KB)
SA2006 - Nivolumab (2 pages, 24 KB)
SA1627 - Obinutuzumab (1 page, 18 KB)
SA2072 - Octreotide long-acting (2 pages, 24 KB)
SA1883 - Olaparib (1 page, 17 KB)
SA1744 - Omalizumab (3 pages, 27 KB)
SA1894 - Palbociclib (Ibrance) (1 page, 17 KB)
SA1190 - Pazopanib (1 page, 18 KB)
SA1979 - Pegaspargase (1 page, 16 KB)
SA2007 - Pembrolizumab (2 pages, 24 KB)
SA1679 - Pemetrexed (2 pages, 22 KB)
SA1606 - Pertuzumab (1 page, 17 KB)
SA1976 - Rituximab (Mabthera) (3 pages, 28 KB)
SA2061 - Rituximab (Riximyo) (18 pages, 91 KB)
SA1890 - Ruxolitinib (1 page, 17 KB)
SA2044 - Secukinumab (3 pages, 29 KB)
SA1596 - Siltuximab (1 page, 16 KB)
SA2005 - Sirolimus (Rapamune) (3 pages, 28 KB)
SA2002 - Sunitinib (2 pages, 24 KB)
SA1745 - Tacrolimus (1 page, 16 KB)
SA1741 - Temozolomide (2 pages, 22 KB)
SA1124 - Thalidomide (1 page, 16 KB)
SA1977 - Tocilizumab (7 pages, 42 KB)
SA1632 - Trastuzumab (3 pages, 26 KB)
SA1871 - Trastuzumab emtansine (1 page, 17 KB)
SA1868 - Venetoclax (1 page, 18 KB)
Respiratory System and Allergies
SA1367 - Bee or wasp venom allergy treatment (1 page, 16 KB)
SA1978 - Dornase Alfa (1 page, 17 KB)
SA1558 - Icatibant (1 page, 16 KB)
SA2017 - Ivacaftor (1 page, 17 KB)
SA1584 - Long-Acting Muscarinic Antagonists with Long-Acting Beta-Adrenoceptor Agonists (1 page, 16 KB)
SA2012 - Nintedanib (1 page, 17 KB)
SA2013 - Pirfenidone (1 page, 17 KB)
Sensory Organs
SA1680 - Dexamethasone 700 mcg ocular implants (2 pages, 22 KB)
SA1981 - Ketorolac trometamol (1 page, 16 KB)
SA0895 - Pilocarpine - Eye drops 2% single dose (1 page, 16 KB)
SA1715 - Prednisolone sodium phosphate (1 page, 16 KB)
SA1388 - Preservative Free Ocular Lubricants (1 page, 16 KB)
Various
SA1492 - Deferasirox (1 page, 17 KB)
SA1480 - Deferiprone (1 page, 15 KB)
Special Foods
SA1940 - Amino acid formula (Alfamino Junior; Elecare; Neocate) (4 pages, 29 KB)
SA1930 - Carbohydrate (Moducal; Polycal) (2 pages, 22 KB)
SA1376 - Carbohydrate and Fat (Duocal Super Soluble Powder) (1 page, 17 KB)
SA1095 - Diabetic products (Diason RTH; Glucerna Select RTH; Diasip; Glucerna Select; Resource Diabetic) (1 page, 16 KB)
SA1953 - Enteral liquid peptide formula (Nutrini Peptisorb; Nutrini Peptisorb Energy) (1 page, 17 KB)
SA1557 - Extensively hydrolysed formula (Aptamil Gold+Pepti Junior; Aptamil AllerPro SYNEO 1; Aptamil AllerPro SYNEO 2) (2 pages, 22 KB)
SA1523 - Fat (Calogen; Liquigen; MCT oil (Nutricia)) (2 pages, 22 KB)
SA1525 - Fat Modified Products (Monogen) (1 page, 16 KB)
SA1106 - Food Thickeners (Karicare Food Thickener; Nutilis) (1 page, 16 KB)
SA1108 - Foods and Supplements For Inborn Errors Of Metabolism (Easiphen Liquid; Loprofin Mix; Loprofin; Minaphlex; MSUD Maxamaid; MSUD Maxamum; Phlexy 10; PKU Anamix Junior LQ; PKU Lophlex LQ; PKU Anamix Infant; XP Maxamaid; XP Maxamum; XMET Maxamum) (1 page, 16 KB)
SA1729 - Gluten Free Foods (Bakels Gluten Free Health Bread Mix; Horleys Bread Mix; Horleys Flour; NZB Low Gluten Bread Mix; Orgran; Healtheries Simple Baking Mix) (1 page, 16 KB)
SA1195 - High Calorie Products (Two Cal HN; Nutrison Concentrated) (2 pages, 21 KB)
SA1197 - High fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (KetoCal) (1 page, 16 KB)
SA1110 - Infant Formulae - For Williams Syndrome (Locasol) (1 page, 16 KB)
SA1098 - Paediatric Product For Children Awaiting Liver Transplant (Heparon Junior) (1 page, 16 KB)
SA1099 - Paediatric Product For Children With Chronic Renal Failure (Kindergen) (1 page, 16 KB)
SA1379 - Paediatric Products (Nutrini; Pediasure; Fortini) (1 page, 17 KB)
SA1196 - Paediatric enteral feed with fibre 0.75 kcal/ml (Nutrini Low Energy Multi Fibre) (1 page, 16 KB)
SA1698 - Paediatric oral/enteral feed 1 kcal/ml (Infatrini) (1 page, 17 KB)
SA1524 - Protein (Protifar; Promod; Resource Beneprotein) (1 page, 16 KB)
SA1101 - Renal Products (Nepro; NovaSource Renal; Renilon 7.5; Suplena) (1 page, 16 KB)
SA1377 - Specialised And Elemental Products (Alitraq; Elemental 028 Extra; Peptisorb; Vital; Vivonex TEN) (1 page, 17 KB)
SA1859 - Standard Supplements (Ensure; Fortisip; Isosource; Jevity; Nutrison; Osmolite; Sustagen) (7 pages, 39 KB)