Pharmac Update: Primary Care Prescribers for the week ending 14 October 2022
Supply issue: Dulaglutide (Trulicity)
Pharmac has been informed by the supplier of dulaglutide (Trulicity), Eli Lilly that there are supply issues with the diabetes medicine due to unanticipated increases in global demand and an out of stock of another supplier’s GLP 1 receptor agonist. This may mean Aotearoa experiences constrained supply until mid-2023.
Eli Lilly has committed to maintaining supplies of Trulicity at levels that will support existing patients already on treatment in Aotearoa. They tell us that, while the supply situation remains dynamic, existing patients in Aotearoa should be able to fill their dulaglutide prescriptions without interruption.
To safeguard stock for people currently using dulaglutide, we are asking health professionals to strongly consider not starting new people on this medicine. Pharmac is actively exploring all options to minimise the impact on patients from this supply issue and we will continue to update patients and healthcare providers as further information comes to hand.
For further information please see Dulaglutide (Trulicity): Supply issue on the Pharmac website.
Cancellation of existing Humira (adalimumab) Special Authority numbers from 1 October 2022
As of 1 October 2022, Amgevita is the main funded brand of adalimumab for all uses (current and new). From this date, all existing Humira Special Authority numbers expired, and new Humira Special Authority criteria came into place. If you have submitted a Waiver request for a patient to remain on Humira and it has been approved prior to 1 October, this will not be cancelled.
Post 1 October Humira Special Authority access criteria
Repeat dispensings for Humira with an expired Special Authority will still be funded if the initial dispensing on that prescription occurred before 1 October.
• Identify patients using adalimumab and discuss the continuation of their treatment with Amgevita either when their Humira Special Authority is due for renewal, or before 1 October 2022 (whichever comes first)
• For patients who require ongoing funded access to Humira after 1 October, a new initial Special Authority must be completed
•
For patients who have not yet trialled Amgevita, but their automatically issued initial Special Authority for Amgevita has expired, a Waiver for an initial application can be completed
• Ensure you prescribe adalimumab by brand (either Amgevita or Humira)
Further information will be available on the Pharmac website. Resources to support you and your patients with this change can be found at amgevita.co.nz
Evusheld: Available to be administered in general practice
From 3 October 2022 Evusheld (tixagevimab with cilgavimab) is available for community supply and primary care administration to those who meet Pharmac’s access criteria. Evusheld is used for COVID-19 pre-exposure prophylaxis.
Guidance on Evusheld and its use is available on the He Ako Hiringa website and Ministry of Health website.
Supply issue update: Docusate sodium with sennosides (Laxsol) tablets and other laxatives
The Laxsol supply issue was caused by a lack some of the raw materials used to make the product. This issue also affects Coloxyl.
Shipments are continuing to arrive. We expect another shipment by mid October. We're working closely with the supplier to understand when Laxsol supplies will return to normal. Both the supplier and Pharmac are aware of the critical nature of this product.
Other Laxatives: Supply issues
We understand that Laxsol supply disruption is leading to knock-on stock shortages for other funded laxatives.
Konsyl-D and the alternative we listed, Macro Organic Psyllium Husk, are out of stock. Resupply of Macro Organic Psyllium Husk is expected mid September, and Konsyl-D in October. Senna (Senokot) is out of stock. Stocks of Micolette are low, new section 29 stock is arriving soon. It will take time for stock to make its way through the supply chain to individual pharmacies once it arrives in the country.
We are working closely with all suppliers concerned to speed up freight to Aotearoa where possible, or to find alternative products.
Our expert clinical advisors suggest that there may be suitable alternatives, including macrogol 3350 sachets (Molaxole) and lactulose. Where appropriate, please consider using alternatives while this supply issue persists.
Further information is available on the Pharmac website.
Paracetamol oral liquid: Brand change
From 1 September 2022, we have listed a temporary new brand of paracetamol liquid.
Supplies of Paracare (120 mg per 5 ml) are likely to run out during September. Supplies of Paracare Double Strength (250 mg per 5 ml) are likely to begin running out during October. To cover the gap before the new contracted brands can enter the market, we’ve listed the Avallon brand.
A temporary supply of a paracetamol oral liquid 120 mg per 5 ml has been organised, and a 240 mg per 5 ml strength has been listed in case it is needed in a couple of months as a contingency option. Due to increased global demand, we were not able to source a 250 mg per 5 ml product, despite our strong preference for this.
Key differences with the Avallon brand
• Flavour is strawberry-vanilla for both strengths (previously strawberry and orange)
• Colour is off-white for both strengths (previously pink and orange)
• A smaller pack size, 200 ml glass bottles with a child-resistant cap
• If the Avallon 240 mg per 5 ml paracetamol oral liquid is required, this would mean a temporary strength change to a 240 mg per 5 ml presentation. We are working on ways to support the health care sector if this is needed.
The 120 mg product has Medsafe approval. Restrictions will continue for these temporary brands to ensure everyone who needs paracetamol liquid can access this medicine. We apologise for any inconvenience this may cause.
We will communicate further with the sector if the 240 mg product is required. Further information is available on the Pharmac website
Citalopram 20 mg: Brand change
From October 2022, a new brand of citalopram, Celapram, will be funded. The current supplier, API, is leaving the New Zealand market and their PSM brand of citalopram is no longer being manufactured.
PSM citalopram is expected to begin running out in December 2022. People using PSM citalopram will need to change to Celapram sometime before December 2022 to continue to access funded treatment. From 1 March 2023, Celapram will be the only funded brand of citalopram.
The new tablets will look different, but the tablets have the same active ingredient and work in the body the same way as the currently funded citalopram, PSM citalopram.
We know that moving people from one brand to another can be difficult. To support this, we are covering the cost with a brand switch fee. This will be in place from 1 March 2023 to 1 June 2023.
Further information is available on the Pharmac website.
COVID-19: Information for prescribers
Updated Access Criteria
Check the Pharmac website to view the COVID 19 access criteria. Always check the criteria before prescribing as updates may have been made.
Pharmac website COVID 19 oral antivirals: Access Criteria
You can read all about the available and soon to be available COVID 19 treatments on our website.
Aotearoa's COVID 19 treatment portfolio
COVID-19 antiviral Access Criteria assessment tool
Use the online tool to help identify who’s eligible for funded COVID 19 antiviral treatments.
Access Criteria Assessment Tool
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.
Amoxicillin with clavulanic acid: Supply issue
Sandoz, the supplier has advised that there is a temporary delay to the supply of Curam Duo 500/125. Resupply is expected to be normal by the end of October 2022.
Further information is available on the Pharmac website
Sodium citro-tartrate (Ural) Grans: Supply issue
The supplier has advised us of a temporary delay affecting re supply of Ural sachets. The next shipment of Ural is expected by the end of October 2022.
Further information is available on the Pharmac website.
Cefuroxime axetil (Zinnat): Discontinuation
Due to a significant decline in usage of this product in Aotearoa, GSK (the supplier) has advised that it will discontinue cefuroxime (Zinnat) tablets. Existing stock of Zinnat tab is expected to be exhausted 31 August 2023. Zinnat tab will be delisted from the Pharmaceutical Schedule 1 March 2024.
Further information is available on the Pharmac website
Pregabalin 25 mg capsules: supply issue
There is a supply issue affecting the pregabalin 25 mg capsules. The supplier has advised that due to delays at the manufacturing site, exacerbated by some freight challenges in New Zealand, they may have a brief out of stock of pregabalin 25 mg capsules.
Stock was released to wholesalers last week. We continue to monitor the availability of this product.
Further information is available on the Pharmac website.
Levomepromazine (Nozinan) Injections: Supply issue
Due to delays with the manufacturer of levomepromazine hydrochloride, there is an out of stock of levomepromazine hydrochloride (Nozinan) Inj 25 mg per ml, 1 ml ampoule.
The French Formulation Nozinan s29 will be supplied until the new supplier enters the market on 1 November 2022.
Further information is available on the Pharmac website