Primary Care Clinical Digest PRIMARY CARE CLINICAL DIGEST
October 8th, 2022
What is in this Issue?
1. Monkeypox (MPX) update for primary care by Care in the Community Including funding table for Primary Care
2. Pharmac Update: Primary Care Prescribers for the week ending 30 September 2022
3. Te Whatu Ora COVID 19 Care in the Community update for primary care
4. Medicinal cannabis products that meet the minimum quality standard
5. Te Whatu Ora Redeployment of Air Filtration Units To Providers
6. National Cervical Screening Programme (NCSP) Sector Update October
7. Accuretic stock situation: Supply withdrawn on 31st October 2022
8. Information about upcoming events: MelNet 2022 webinar programme.
9. 2022 Special Ukraine Visa Holders Monkeypox (MPX) update for primary care by Care in the Community – Including funding table for Primary Care
• On Thursday 6/10/22 Te Whatu Ora has confirmed two new cases of Monkeypox (MPX), which are New Zealand’s first cases of community transmission. The Care in the Community team has been working on a funding model for primary care re: MPX, please see attached funding model and letter to sector.
• For more information on yesterday’s announcement by Te Whatu Ora, please see here
• The COVID 19 Care in the Community team has shared the attached MPX funding information about Monkeypox (MPX) with PHOs.
Pharmac Update: Primary Care Prescribers for the week ending 30 September 2022
• Supply issue: Dulaglutide (Trulicity)
o 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.
o 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.
o 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.
o 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
o From 1 October 2022, Amgevita will be the main funded brand of adalimumab for all uses (current and new). From this date, all existing Humira Special Authority numbers will expire, and new Humira Special Authority criteria will come 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.
o Post 1 October Humira Special Authority access criteria
• Supply issue update: Docusate sodium with sennosides (Laxsol) tablets and other laxatives
o 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 being released as they arrive. PHARMAC expect some stock to be released to wholesalers on 25 September 2022. 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.
o Supplies of docusate sodium (Coloxyl) 50 mg remain constrained. 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.
• Paracetamol oral liquid: Brand change
o From 1 September 2022, PHARMAC have listed a temporary new brand of paracetamol liquid.
o 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.
o 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. PHARMAC are working on ways to support the health care sector if this is needed.
o 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. PHARMAC apologises for any inconvenience this may cause.
o PHARMAC will communicate further with the sector if the 240 mg product is required.
• COVID 19: Information for prescribers
o Pharmac has widened access to the three antiviral treatments it funds for treating early COVID 19: nirmatrelvir with ritonavir (Paxlovid), molnupiravir (Lagevrio) and remdesivir, an infusion treatment (Veklury). Always check the criteria before prescribing as updates may have been made.
o Use the online tool to help identify who’s eligible for funded COVID 19 antiviral treatments. Access Criteria Assessment Tool
o 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.
• Pregabalin 25 mg capsules: supply issue
o 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 Aotearoa, they may have a brief out of stock of pregabalin 25 mg capsules.
o There is still stock in the supply chain with wholesalers. Aspen expects the next delivery to arrive in early October 2022. It will take time for the shipment to clear quality assurance and make its way through the supply chain to pharmacies.
• Ondansetron dispersible tablets 4 mg and 8 mg: Supply issue
o Due to freight delays, there may be a brief out of stock of ondansetron 4 mg and 8 mg dispersible tablets from
Te Whatu Ora COVID 19 Care in the Community update for primary care
mid September 2022. Some stock may remain in the supply chain. They expect their next shipment to arrive in late September 2022.
o To help make the existing stock last longer, we have put these tablets on monthly dispensing from 1 October 2022. The film coated tablets are not affected by this issue (Onrex brand).
• Nutricia foods products: Supply issue affecting multiple products
o Most of the supply issues affecting Nutricia special foods products have been resolved. There will however continue to be supply issues for some products throughout 2022.
• COVID 19 Care in the Community
o Primary care has been invited to join the rollout of the COVID 19 Pre exposure Prophylaxis (PrEP) medicine Evusheld from today, 3 October 2022. Information about the rollout and a claiming guide was shared with the sector last week. Please contact COVID19CareintheCommunity@health.govt.nz with any questions.
o Updated clinical information about COVID 19 reinfection, rebound, persistent infection and long COVID has been circulated to support primary care clinicians with COVID 19 patients. This information is also available on your local HealthPathways page
• COVID 19 Clinical Care Module update
o The Care in the Community support team has reduced its operating hours to Monday to Friday between 9am to 5.30pm, and will be available to help you with any CitC, BCMS/CCCM or NCTS feedback, questions, or issues during those hours. They can be emailed at CITC@contacttracing.health.nz during these hours. If you have queries or concerns regarding these programmes on the weekend, the NCTS service desk will continue to operate on Saturday and Sunday and can be reached via ncts.servicedesk@health.govt.nz or 0800 223 987.
• COVID 19 response
o Manatū Hauora Ministry of Health’s website has published a report, COVID 19 Mortality in Aotearoa New Zealand: Inequities in Risk, which showed being up to date with vaccination is the single best way to reduce the risk of dying from COVID 19 and age is the single biggest determinant in the risk of death from COVID 19.
o Guidance for health professionals about mask wearing in healthcare settings was updated last week. New ‘Please wear a mask here’ posters can be downloaded from Unite Against COVID 19’s resource toolkit.
Medicinal cannabis products that meet the minimum quality standard
• The Misuse of Drugs (Medicinal Cannabis) Regulations 2019 (the Regulations) set the minimum quality standard that medicinal cannabis products and ingredients must meet before they can be supplied in New Zealand. Importers, manufacturers, and suppliers must apply for assessment and provide evidence to the Medicinal Cannabis Agency to verify that their products meet the minimum quality standard.
• Medleaf Medium THC Afghan Haze has been verified as meeting the minimum quality standard.
• More information on the products can be found on the Ministry of Health website
Te Whatu OraRedeployment of Air Filtration Units To Providers
Since February 2021, the Ministry of Health has purchased a number of Air Filtration Units (AFUs) to support the Managed Isolation and Quarantine Response. As these have now closed we have some units available that we can now offer to our Providers.
Information on the units:
o The units include an advanced HEPA filter to aid in providing additional air filtration support.
o These are IPC devices specifically designed to combine HEPA filtration with a patented system of active 24/7/365 protection against a range of pathogens (viral & bacterial, also mould, fungi, endospores etc).
o ActivePure is the key technology in the units and is cleared by the FDA as a Class II medical device.
o The units are plug & play into a power source and very flexible the units are being used across critical hygiene areas, corridors, rooms, operating theatres, ICU, ED, offices, staff break areas/lunch rooms, meeting rooms etc.
o The units need to be serviced & maintained on an annual cycle (all taken care of under the NZHP contract and ActivePure staff throughout NZ).
These AFU’s provide air management support in line with WHO Guidelines for Ventilation for COVID 19, as well as the Supplementary standard issued by the Dental Council.
Link here to the WHO guidelines
The distribution of these AFUs is being treated as a donation, with no associated capital costs or charges. There will however be an ongoing cost of ownership, including insurance and future maintenance.
National Cervical Screening Programme (NCSP) Sector Update –October
We have negotiated an annual maintenance arrangement for $650 per unit or a discounted monthly fee of $45 per unit depending on the option selected. This fee covers replacement of all Original Equipment Manufacturer consumables annually to ensure the 5 year warranty. It will be the responsibility of the Provider coordinate with the supplier (Big Blue) for provision of maintenance and payment of associated costs.
Please could all requests be sent to covid.healthsupplychain@health.govt.nz by 19th October 2022 to confirm the quantity of AFUs requested.
After this date, the Ministry will proceed with alternative deployment options for unallocated stock.
• Read the October Newsletter
• RE: HPV testing. The Parliamentary Review Committee has completed their report which will be tabled in Parliament soon and will be publicly available. We will share the report as soon as it is available.
• July 2023 remains the target date for the move to HPV Primary Screening.
Accuretic stock situation: Supply withdrawn on 31st October 2022
• PHARMAC would like to update you on the Accuretic (quinapril with hydrochlorothiazide) stock situation, This follows recent advice from Medsafe and Pharmac’s Accuretic notification outlining the need for health care prescribers to transition their patients from Accuretic to an alternate anti hypertensive medication.
• PHARMAC have now been informed by the supplier of Accuretic (Pfizer) that, following further discussions with Medsafe, they(Pfizer) intend to withdraw any remaining stock from distributers on the 31st of October 2022. Prior to this date Accuretic will still be able to be prescribed, although its dispensing will depend on the levels of stock remaining. Pfizer has advised that pharmacies and wholesalers will be able to return any unused stock of Accuretic at the end of the transition period. Pharmacies should discuss the returns process with their wholesaler.
• PHARMAC would advise prescribers to transition any of their patients who are still on Accuretic to an alternate medication with a degree of urgency. The ability of prescribers to claim for first consultation costs in relation to transitioning patients from Accuretic to an alternative will remain in place to assist this process until it is delisted.
Information about upcoming events: MelNet 2022 webinar programme
• Pharmac intends to delist Accuretic from the Pharmaceutical Schedule from 1st December 2022.
• Melanoma Quality Statements: a MelNet webinar series. 27 October 1 December 2022
o Hosted by MelNet, this free six part webinar series will improve your awareness and understanding of best practice melanoma care across all aspects of the patient journey.
o Tune in weekly over the course of six weeks for presentations on each of the quality statements outlined in the second edition of the 'Quality Statements to Guide Melanoma Diagnosis and Treatment in New Zealand'. New Zealand skin cancer experts will talk through significant updates made to clinical content as part of the 2022 review and provide practical examples to support your understanding of the statement’s application to day to day practice. This interactive series will also provide you the opportunity to have your questioned answered live during the sessions.
o CME endorsement for the series is being sought from RNZCGP.
o All healthcare professionals are warmly invited to attend.
o More information and to register
• Dermoscopy made easy: an online course for beginners. Saturday 12 November 2022 from 8.00 am 12.30 pm
o Join Adjunct Associate Professor Amanda Oakley at this beginners’ ‘Dermoscopy made easy’ online course and increase your confidence in the diagnosis of typical benign skin lesions whether you own a dermatoscope or not.
o Using a series of regional, close up and dermoscopic images, this 4 hour workshop will overview the common elements of dermatoscopy and the clinical and dermatoscopic characteristics of benign and malignant lesions.
o A must do course for all health practitioners who play a role in the opportunistic discovery of melanoma and non melanoma skin cancer as part of their everyday practice.
Update on Community Isolation & Quarantine (CIQ) and Welfare services run by Whakarongorau Aotearoa
o CME endorsement for the series is being sought from RNZCGP.
o The cost to attend the course is $285.
o More information and to register
Please see below changes in Community Isolation & Quarantine (CIQ) and Welfare services run by Whakarongorau Aotearoa.
• The Government’s 12 September announcement to remove the COVID 19 Protection Framework has meant changes for our organisation re the provision of COVID services.
• The CIQ and Welfare services that we have provided to DHBs on behalf of Te Whatu Ora have steadily declining volumes, with fewer than 50 contacts required most days, and this volume is anticipated to further reduce under the new settings.
• With the level of response no longer required from us for home isolation support, and with the subsequent reduction in staffing and funding for this, from 1 October 2022 we will cease the CIQ and Welfare services we had previously provided.
• We will of course continue to support the people of Aotearoa through the provision of the free COVID Vaccination Healthline and the COVID Healthline services, in addition to our usual Healthline service. We can also be available to surge again, to assist with responding to any future COVID variant, if requested by Te Whatu Ora.
• Please advise your teams of those services and their operating hours:
o Healthline 0800 611 116, 24/7
o COVID Healthline 0800 358 5453, 24/7
o COVID Vaccination Healthline 0800 28 29 26 (8am 8pm, 7 days)
2022 Special Ukraine Visa Holders
• Te Whatu Ora will be sending out formal comms regarding the health initiative to the health sector and the Ukrainian community early next week.
• As part of this, PHO CEs will also be sent an email with a detailed letter outlining the health response, and a letter of agreement to formalise the contractual agreement.
