Pharmac Update: Primary Care Prescribers for the week ending 27 January 2023
Fluoxetine 20 mg caps: supply issue
The brand change for fluoxetine hydrochloride 20 mg cap (from Fluox to Arrow-Fluoxetine) has occurred earlier than expected. This has created a supply issue with Arrow-Fluoxetine (Pharmacode 2450860).
The supplier of Arrow-Fluoxetine, Teva, has indicated that there will be limited supply throughout February 2023. Two large shipments are expected during February. However, it will take 1 to 2 weeks for supply to reach pharmacies after arrival in New Zealand.
This issue was caused by stock of Fluox, the previous brand, running out earlier than expected. We had anticipated Fluox would be available until 1 June 2023, when it is to be delisted.
Teva has asked that wholesalers and pharmacies order only the quantities they require. If pharmacies are having difficulty getting access to fluoxetine, we recommend they check with other wholesalers.
Weekly dispensing limit will be in place from 26 January 2023
Effective immediately, pharmacists can dispense a maximum of 7 days' supply of fluoxetine 20 mg. This is a shift from monthly dispensing. This applies to both the Arrow-Fluoxetine capsules and the Fluox dispersible tablets.
This limit will be in place until 28 February 2023. We anticipate the supply issue will be resolved by then. We will continue to monitor the situation and may remove the limit if supply is available earlier.
Pharmac is activating rule 5.5 of the General Rules of the Schedule to limit dispensing quantities for this medicine. Where appropriate, pharmacists can use their discretion and apply rule 4.2.2.
Rule 5.5 of the General Rules
We acknowledge the inconvenience that dispensing only 7 days may cause. Limiting dispensing helps distribute the supply of fluoxetine as fairly as possible. We appreciate health care professionals’ vital role in responding to this issue and apologise for any inconveniences caused.
Further information is available on the Pharmac website.
Pharmaceutical Schedule funding rules on prescribing and dispensing of Class B controlled drugs
Manatū Hauora, the Ministry of Health, have asked Pharmac to delay making a decision on the proposed changes to the Schedule funding Rules for Class B controlled drugs.
What this means:
Although the legislative changes for Class B controlled drugs came into effect on 22 December 2022, the Schedule Rules on prescribing and dispensing of Class B controlled drugs have not changed. This means a quantity sufficient to provide treatment for a period of up to 1 month in total will be subsidised.
Further information can be found on our website: Pharmaceutical Schedule Rules on prescribing and dispensing of Class B controlled drugs - Pharmac | New Zealand Government
Epipen: funded from 1 February
People can access funded EpiPens from 1 February 2023. Prescribers can write a prescription for up to two pens. Patients can register on the supplier’s website to order a free training pack and practice pen. There are also videos on how to use the pen and other resources.
Further information is available on the Pharmac website
Octreotide 50 mcg and 100 mcg per ml ampoules: supply issue
The octreotide 50 mcg/ml is temporarily out of stock and there is low stock availability for the 100 mcg/ml, due to manufacturing issues caused by a global shortage of CO2. The supplier has advised that they are expecting a shipment to arrive at the end of March 2023.
There is enough stock of the 100 mcg/ml stock in the supply chain to last to mid/late February, at standard usage rates. There is ample stock of the 500 mcg/ml presentation.
An alternative brand for the 50mcg/ml presentation is listed on the Schedule and is available for purchase. This product is not Medsafe approved so must be prescribed and dispensed in line with Section 29 of the Medicines Act.
The supplier also has the 100mcg/ml alternative in the country, however this is not currently listed. Pharmac has requested that Max Health allocate remaining stock of their funded brand to community pharmacies, as hospitals are able to purchase the alternative brand before it is listed in the Schedule. Pharmac will list this alternative as soon as possible.
Further information is available on the Pharmac website
Decision to fund the diabetes treatment liraglutide (Victoza)
In response to a global supply issue for dulaglutide (brand name Trulicity), a treatment for type 2 diabetes, we are pleased to announce that Pharmac has made a decision to fund liraglutide (brand name Victoza) as an alternative treatment.
Liraglutide will be funded for people with type 2 diabetes who meet the current eligibility criteria for GLP-1 agonists. Initial applications for the funding of liraglutide can be made for the duration of the supply issue impacting dulaglutide. Once the dulaglutide supply issue has resolved, people who have already started treatment on liraglutide will be able to continue to receive funded liraglutide.
Supply of liraglutide will be available from early-to-mid March 2023. From 1 March 2023, liraglutide will be listed on the Pharmaceutical Schedule to enable funded access to occur as soon as supply is available.
We will continue to update our website with any information regarding the supply of dulaglutide and we are continuing to work with its supplier, Eli Lilly, on stock availability.
Brand change: Paracetamol oral liquid 120 mg per 5 ml
The funded brand of paracetamol oral liquid 120 mg per 5 ml is changing to Paracetamol (Ethics). There are currently two funded brands of the lower strength paracetamol oral liquid, Paracare and Avallon.
Avallon was funded to ensure continued availability of a low strength paracetamol oral liquid over the transition period.
Key information for Paracetamol (Ethics) 120 mg per 5 ml:
o Listed from 1 January 2023
o 200 ml plastic bottles with a child-resistant cap
o Colour-free
o Strawberry-vanilla flavour
o Alcohol and sugar free
Similarities with other liquid analgesics:
The currently funded higher strength paracetamol oral liquid (Pamol 250 mg per 5 ml), and ibuprofen liquid are also colour free. Therefore, when prescribing and dispensing, this similarity may need to be specifically highlighted to patients, whānau or caregivers.
Schedule restrictions
The dispensing restrictions in place since 1 June 2022 to help manage the current stock levels will continue to apply to Paracetamol (Ethics) over the transition period, and will be reviewed at a later date.
Key dates:
1 January 2023: Paracetamol (Ethics) 120 mg per 5 ml listed
1 June 2023: Paracare 120 mg per 5 ml delisted
TBC: Avallon 120 mg per 5 ml delist date
Pregabalin Cap 150 mg: Alternative brand listed
Aspen, the supplier of Pregabalin Pfizer, has advised of a supply issue impacting its brand of pregabalin 150 mg. From 20 January 2023, Milpharm pregabalin 150 mg capsules will be funded.
We have previously communicated about a supply issue with the 25 mg and 75 mg strengths of the pregabalin, and subsequently listed the Milpharm brand of pregabalin 25 mg and 75 mg in November 2022.
Milpharm pregabalin is not currently approved by Medsafe for use in New Zealand, meaning they will need to be prescribed and supplied under Section 29 of the Medicines Act 1981. We apologise for any inconvenience this causes. In this case, it was the only way to ensure people could continue to access pregabalin 150 mg.
Further information is available on the Pharmac website.
Oestradiol (Estradot) patches: Supply issue update
There have been several disruptions to supply of the Oestradiol (branded as Estradot) patches since August 2020.
Availability of oestradiol patches as at 19 January 2022:
We understand that stocks in pharmacies and wholesalers may differ from what's shown here. This is the advice that the supplier has given to Pharmac.
25 mcg
• Estradot stock available at the supplier (pharmacode 2358840).
• Estraderm MX is out of stock (pharmacode 2645475).
50 mcg
• Estradot stock available at the supplier (pharmacode 2358867).
• Limited stock of Estradiol TDP Mylan (pharmacode 2601591) is in the supply chain.
75 mcg
• Limited stock of Estradot is available, further stock expected early February 2023 (pharmacode 2514346).
• Estradiol TDP Mylan (pharmacode 2605317) is available.
100 mcg
• Estradot stock available (pharmacode 2358883)
The alternative brands listed are not Medsafe-approved, as such they need to be prescribed and dispensed in line with Section 29 of the Medicines Act
For more information, please see the Pharmac website.
Nutricia foods products: Supply issue affecting multiple products
Nutricia continues to manage stock distribution to supply the market as consistently as possible. We have updated the stock situation as it stands on 20 December 2022. Please continue to order stock without stockpiling to ensure equitable access for all New Zealanders while buffer stocks are built up.
Please do not make prescriptions brand and/or flavour specific. This will allow flexibility for pharmacists when dispensing. If you need advice about alternative products available from Nutricia, please contact your Nutricia Representative.
Check the Pharmac website regularly for updates on products.
2022 Year in Review
Te Pātaka Whaioranga - Pharmac is excited to share our Year in Review for 2022. We put this publication together to let you know about some of the key work we’ve achieved, in collaboration with our partners, last year.
It includes:
1. how we’ve used the budget increase to fund more medicines for New Zealanders
2. how we’ve managed the supply chain in a challenging environment
3. how we’ve increased access to COVID-19 medicines in response to the pandemic
4. how we’re progressing our hospital medical devices work
5. what we’re doing in response to the independent Pharmac Review
6. plus a whole lot more, including a lived experience story about HIV and spinal muscular atrophy (SMA) and our Top 20 medicines for 2021/22.
Find the Year in Review on the Pharmac website
COVID-19: Information for prescribers
Managing supply of other medications
Please prescribe normally and encourage patients not to stockpile medicines. Pharmac, pharmacies and suppliers are working closely to maintain medicines supply, and to minimise disruption and fairly distribute any medicines in short supply.
More information about Pharmac’s response to COVID-19 is available on the Pharmac website
Resources for prescribers
• Pharmac website – COVID-19 oral antivirals: Access Criteria
• Aotearoa's COVID-19 treatment portfolio
• Access Criteria Assessment Tool