Decision to reinstate monthly dispensing for sodium valproate tablets

Medicines

Decision

PHARMAC has made a decision to remove the ‘three months dispensed all-at-once’ (‘stat’) dispensing rule from sodium valproate tablets 100 mg (Epilim Crushable) and 200 mg EC and 500 mg EC (Epilim) from 1 May 2016.

A proposal to remove stat dispensing from sodium valproate was included in a consultation letter dated 9 January 2015.

We had previously advised on 6 May 2015 that we would not be progressing the proposal at that time. However, after carefully considering a range of factors, including the consultation responses, we have now decided to reinstate monthly dispensing for sodium valproate tablets. This is expected to release significant savings that can be used to fund other pharmaceuticals.

No changes have been made to the funded access to sodium valproate tablets, which will remain fully funded without restrictions.

At this time we are not intending to progress removal of stat dispensing from any other pharmaceuticals that were included in the January 2015 consultation, including other presentations of sodium valproate.

Feedback received

We appreciate all of the feedback that we received and acknowledge the time people took to respond. All consultation responses received were considered in their entirety in making a decision on the proposed changes. The following issues were raised in relation to specific aspects of the proposal (noting that some of the responses covered the proposal in its entirety and were not limited to comments on sodium valproate tablets):

Theme Comment
Concerns about the potential for increased workload for pharmacy.  We acknowledge that this decision will result in extra dispensings for pharmacy. We estimate that it will result in about 65,000 extra dispensings per year (less than 7 per pharmacy on average). We note that this increase is minimal compared with the total overall dispensing volume. 
Concerns about the potential for reduced adherence and/or compliance with sodium valproate. We note that there is potential for poor adherence and compliance regardless of whether or not a pharmaceutical is dispensed stat.We are not aware of any evidence to support increased adherence or compliance from stat dispensing (or the reverse from its removal), and note that this is not the reason that stat dispensing is applied – it is applied in situations where it would result in savings to DHBs versus monthly dispensing.We note that the decision may result in an increase in the contact between patients and their pharmacists which could help improve compliance and adherence for some patients. 
Concerns about potential to increase patient costs. We acknowledge that the decision will result in increased inconvenience and potentially travel costs for some patients; however, patients’ pharmacy costs will be unchanged as a co-payment is only charged on the first dispensing of a three month prescription.Analysis of claims data shows that approximately half of the current patients on sodium valproate already visit their pharmacy more frequently than once every three months to collect medicines (either sodium valproate or another medicine).Sodium valproate tablets can still be dispensed stat for patients who meet at least one of the Access Exemption criteria, which are:a    have limited physical mobility;b   live and work more than 30 minutes from the nearest pharmacy by their normal form of transport;c   are relocating to another area; ord   are travelling extensively and will be out of town when the repeat prescriptions are due. 
Concerns about the impact on paediatric patients. The vast majority of paediatric patients are taking the oral liquid formulation, for which stat dispensing will remain. Less than 200 patients under the age of 10 take Epilim tablets over the course of a year.  Therefore, we consider that the decision will have minimal impact on paediatric patients.

More information

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz.