15 February 2021: OIA response | Information for decision to restrict access to hydroxychloroquine

15 February 2021 

Dear [name and contact details withheld] 

REQUEST FOR INFORMATION 

Thank you for your request dated 1 February 2021 under the Official Information Act 1982 (OIA) for information relating to the decision to restrict access to hydroxychloroquine in 2020.  You wrote: 

I would like any information held by Pharmac in relation to their announcement on 24th March 2020 in regards to restricting funded access to Hydroxychloroquine to 'registered indications' only. (cf. https://pharmac.govt.nz/news-and-resources/covid19/covid-19-hydroxychloroquine/(external link))

Specifically, I would like to know:

  • What information (reports, studies, public announcements) was evaluated in relation to this decision
  • What review period (if any) is in place relating to this decision (eg, has the stance been re-evaluated, is there a formal process in place to re-evaluate)
  • Are doctors still able to prescribe Hydroxychloroquine on an un-funded basis for uses not considered 'registered indications', and will patients prescribed Hydroxychloroquine be able to fill such prescriptions
  • What other Pharmac-funded drugs are currently subject to similar restrictions; eg, drugs where Pharmac is specifically restricting funded access to 'registered indications' only

The decision to restrict funded access of hydroxychloroquine came as a result of correspondence with the supplier, Sanofi, that advised they would be unable to ensure continuity of supply as a result of increased global demand to access hydroxychloroquine. In the week prior to implementing the restrictions on hydroxychloroquine, prescribing had more than doubled from its long-term average. It was noted that suppliers of generic brands of hydroxychloroquine were also experiencing increased demand globally and were experiencing difficulty maintaining continuity of supply.

PHARMAC does not have a specific review period in place for the restrictions on hydroxychloroquine. PHARMAC amended the restrictions on hydroxychloroquine in May 2020 (to include relevant dermatological conditions) and September 2020 (to include sarcoidosis) following feedback from the sector. In June 2020 we noted the restrictions would remain in place at least until the end of the year. We continue to monitor the situation and work with the supplier of hydroxychloroquine to ensure continued supply for New Zealanders.

Doctors are able to prescribe hydroxychloroquine for unregistered indications if they consider the treatment suitable however, it is advised to use caution in using hydroxychloroquine off-label in the management of COVID-19. We refer you to the Medsafe website where a letter from the supplier of Plaquenil (Sanofi) is made publicly available which informs healthcare professionals about the off-label use of Plaquenil in the context of COVID-19: https://medsafe.govt.nz/safety/DHCPLetters/PlaquenilMay2020.pdf(external link)

The current restriction allows pharmacists to annotate prescriptions where there is a record of prior dispensing of hydroxychloroquine. This means that all patients previously treated with hydroxychloroquine (for any indication) prior to the introduction of the restrictions are able to continue to access funded treatment. 

As part of New Zealand’s response to COVID-19, PHARMAC amended funding and dispensing criteria for a range of pharmaceuticals to support the health sector and maintain continuity of supply. Some of the temporary changes remained in place until 31 January 2021 while, following consultation in June 2020 and notification in August 2020, others have remained permanent. 

There are many medicines listed in the Pharmaceutical Schedule which are subject to subsidy by endorsement restrictions however, no other medicines have had subsidy by endorsement restrictions applied as a result of the COVID-19 pandemic. These restrictions are considered against PHARMAC’s Factors for Consideration, which guides all our decisions. 

We trust that this information answers your queries. We are making our information more freely available, so we will now publish selected OIA responses (excluding personal details) on our website. Please get in touch with us if you have any questions about this. 

Yours sincerely

Rachel Read
Manager, Policy and Government Services