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Listed below are the drugs which may be billed in addition to the charges that have been agreed as part of your contract. * Drugs which may be charged separately when used as part of eligible treatment for cancer only. For pre-authorisation for separately chargeable drugs, please call 08457 553 333 (calls may be recorded for monitoring or training 10 mg (5.8 million units)/vial injection 500mg vials - powder for reconsititution Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 10 000 unit vial powder for reconstitution AD070 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 10 x 500mg vials - powder for iv infusion AD097 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 8000 units injection - prefilled syringe 1000 units injection - prefilled syringe 2000 units injection - prefilled syringe 10000 units injection - prefilled syringe 3000 units injection - prefilled syringe 6000 units injection - prefilled syringe 4000 units injection - prefilled syringe 5000 units injection - prefilled syringe 3000 units injection - prefilled syringe 4000 units injection - prefilled syringe 5000 units injection - prefilled syringe 6000 units injection - prefilled syringe 20,000 units injection - prefilled syringe 30,000 units injection - prefilled syringe 10,000 units injection - prefilled syringe Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 2000 units injection - prefilled syringe 5000 units injection - prefilled syringe 1000 units injection - prefilled syringe 10,000 units injection - prefilled syringe 2000 units injection - prefilled syringe 30,000 units injection - prefilled syringe 4000 units injection - prefilled syringe 20,000 units injection - prefilled syringe 40,000 units injection - prefilled syringe 6000 units injection - prefilled syringe 8000 units injection - prefilled syringe 3000 units injection - prefilled syringe Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 30 million units (300 mcg)/mL - 1mL vial AD177 48 million - units (480 mcg)/0.8 mL vial Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 2mg/mL - 500mL sugar free oral solution AD216 1x 50mg implant and implantation device TBC Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 [90Y]-radiolabelled solution for iv infusion AD492 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 50 million units/mL - 1.5mL injection pen AD239 10 million units/mL - 1mL vial injection 25 Million Units/mL - 1.5mL injection pen AD238 10 million units/mL - 2.5mL vial injection AD236 15 million units/mL - 1.5mL injection pen AD237 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 33.6 million unit (263mcg) vial injection 13.4 million unit (105mcg) vial injection Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Methylthioninium chloride Proveblue Clinical Support Team Methylthioninium chloride Proveblue Clinical Support Team 2mg injection - powder for reconstitution AD297 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 5 or 10% 2.5g with diluent for iv infusion AD314 5 or 10% 10g with diluent for iv infusion 5 or 10% 0.5g with diluent for iv infusion AD313 5 or 10% 5g with diluent for iv infusion Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 20mg/mL - 20mL vial concentrate for iv AD365 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 10mg/mL - 0.6mL (6mg) prefilled syringe AD369 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 42x375mg film-coated tablets - 1 bottle TBC Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Injection, powder for recon - 25,000 unit TBC Injection, powder for recon - 10000 unit TBC Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012 Bupa Separately Chargeable Drugs List V2012.8 23rd July 2012

Source: http://www.bupa.co.uk/jahia/webdav/site/bupacouk/shared/Documents/PDFs/healthcare-professionals/POL%20updates%2019_07/July%20SCDL-%20Providers%20On%20Line.pdf