Decision to fund cetuximab for head and neck cancer

Medicines

Decision

We’re pleased to announce our decision to fund cetuximab (Erbitux) from 1 February 2018 for the treatment of patients with locally advanced, non-metastatic, squamous cell cancer of the head and neck; subject to certain clinical criteria being met.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 15 November 2017.

The proposal will be implemented as consulted on with the exception of amendment to the Special Authority criteria to allow application by a medical practitioner on the recommendation of a medical oncologist (rather than only by a medical oncologist).

Who we think will be most interested

  • Oncologists
  • Patients who have or may develop head and neck cancer and their supporters
  • Hospital pharmacists
  • Organisations with an interest in cancer treatment

Detail about this decision

The following changes will occur in Section B and Part II of Section H of the Pharmaceutical Schedule.

  • Cetuximab (Erbitux) will be listed in Section B and in Part II of Section H of the Pharmaceutical Schedule from 1 February 2018 at the following prices and subsidies (ex-manufacturer, excluding GST):
    Presentation Pack size Price and subsidy
    Inj 5 mg per ml, 20 ml vial 1 $364.00
    Inj 5 mg per ml, 100 ml vial 1 $1,820.00
    Inj 1 mg for ECP 1 mg $3.82
  • A confidential rebate will apply to Erbitux that will reduce its net price to the Funder.
  • Erbitux will be listed in the Pharmaceutical Schedule as a Pharmaceutical Cancer Treatment only (PCT only – Specialist), meaning that only DHB hospitals will be able to claim for its use.
  • Erbitux will be listed in Section B of the Pharmaceutical Schedule, for claiming purposes only, subject to the following Special Authority criteria:

Special Authority for Subsidy

Initial application - only from a medical oncologist or medical practitioner on the recommendation of a medical oncologist. Approvals valid for 6 months for applications meeting the following criteria:

All of the following:

  1. Patient has locally advanced, non-metastatic, squamous cell cancer of the head and neck, and
  2. Patient is contraindicated to, or is intolerant of, cisplatin, and
  3. Patient has good performance status, and
  4. To be administered in combination with radiation therapy.
  • The same restrictions will apply in Part II of Section H of the Pharmaceutical Schedule (the Hospital Medicines List; HML).

Our response to what you told us

We’re really grateful for the time people took to respond to this consultation. The table below summarises the main themes raised in feedback, our responses to the feedback received, and changes we have made after listening to you.

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 66 00 50.

Feedback theme PHARMAC response

Cetuximab in combination with radiotherapy is highly beneficial and will increase the chance of cure for patients with head and neck cancer.

Noted.

Requests for amendment to the access criteria to include patients who would otherwise receive cisplatin, and for those with recurrent or metastatic disease.

We would welcome funding applications for use of cetuximab to treat these patient groups.

Requests to allow Special Authority application from other clinician groups.

The Special Authority criteria have been amended following consideration of this feedback.

This proposal would have a significant impact on infusion services; would require development of protocols for the use of cetuximab and clinical staff training.

We note the impact on the health system resulting from listing of new chemical and from extra infusions. Despite these costs and resourcing impacts, we consider the funding of cetuximab to be a good investment in health outcomes.

Request for PHARMAC involvement in a nationally consistent approach to health service provision.

PHARMAC is a funding body and does not have a role in health service provision.

We will pass this feedback on to the Ministry of Health Cancer team and DHBs.

Request for improvements to the type and timing of information provided regarding PHARMAC funding proposals.

We are happy to continue to work with the health sector to improve our communications about the estimated impact of funding proposals wherever possible.

We are grateful for the specific suggestions from the respondent on how we could do better in our engagement.