Proposal to fund betamethasone dipropionate with calcipotriol (Enstilar) foam spray for psoriasis

Medicines

Consultation Closed

We are seeking feedback on a proposal to fund a new topical psoriasis medicine, betamethasone dipropionate with calcipotriol foam spray (Enstilar) from 1 April 2020, through a provisional agreement with Leo Pharma.

The proposal also includes changes to pack sizes and prices for the following currently funded medicines:

  • Calcipotriol ointment 50 mcg per g (Daivonex) – 120 g pack would replace 100 g pack from 1 July 2020
  • Sodium fusidate [fusidic acid] 250 mg tablets (Fucidin) – 36 tablet pack would replace the 12 tablet pack from 1 December 2020
  • Hydrocortisone butyrate lipocream 0.1% (Locoid Lipocream) – 100 g pack would remain listed and 30 g pack would be delisted.

See below for further details on this proposal, including how to provide feedback.

Consultation closes at 5 pm on Monday, 3 February 2020 and feedback can be emailed to consult@pharmac.govt.nz.

Who we think will be interested

  • People who have psoriasis and their whānau
  • Dermatologists and general practitioners
  • Other prescribers of medicines in the proposal
  • Community and hospital pharmacies.

What would the effect be?

For patients

Betamethasone dipropionate with calcipotriol foam spray (Enstilar)

People with psoriasis would have funded access to a new presentation of a topical treatment. Currently, PHARMAC funds gel and ointment formulations of betamethasone with calcipotriol. Enstilar is a foam spray, which provides faster absorption into the skin than the gel and ointment formulations and may be a more suitable formulation for some patients. We estimate that about 12,000 patients could benefit in the first year of Enstilar being funded. People currently using the ointment and gel formulations may want to discuss with their doctor about changing to the foam spray.

Other medicines in this proposal

People would continue to have funded access to current treatments and may receive a larger pack size. 

For prescribers, community pharmacies and hospital pharmacies

A foam spray presentation of betamethasone dipropionate with calcipotriol (Enstilar) would be available.

The pack sizes of calcipotriol ointment 50 mcg per g (Daivonex) and sodium fusidate [fusidic acid] 250 mg tablets (Fucidin) would increase.

The 30 g pack size of hydrocortisone butyrate lipocream 0.1% (Locoid Lipocream) would be delisted but the 100 g pack size would remain funded. The majority of dispensed prescriptions for Locoid Lipocream are for the 100 g pack size.

What these medicines are used for

Betamethasone dipropionate with calcipotriol foam spray (Enstilar)

This medicine contains a combination of calcipotriol, a vitamin D analogue, and betamethasone dipropionate, a potent topical corticosteroid. It is indicated for the topical treatment of psoriasis vulgaris (also known as chronic plaque psoriasis). This is the most common type of psoriasis and presents as red or silvery scaly and thickened areas of skin, particularly on elbows, knees, trunk and lower back. The plaques can join together to cover large areas of the body, and itch can be severe. There is no cure for psoriasis; symptoms are managed using various treatments including topical medicines such as betamethasone with calcipotriol, phototherapy, systemic therapies and biologics.

Calcipotriol ointment 50 mcg per g (Daivonex)

Calcipotriol is a vitamin D analogue and is indicated for the topical treatment of psoriasis. It is currently funded with no restrictions.

Sodium fusidate [fusidic acid] 250 mg tablets (Fucidin)

Oral sodium fusidate [fusidic acid] is an antibiotic used for the treatment of staphylococcal infections. It is also used in combination with other antibiotics to treat methicillin-resistant staphylococcal infections (MRSA). It is funded only if prescribed or recommended by an infectious disease physician or clinical microbiologist.

Hydrocortisone butyrate lipocream 0.1% (Locoid Lipocream)

This is a potent topical corticosteroid used to manage skin conditions such as eczema, dermatitis and psoriasis. It is currently funded with no restrictions.

Why we’re proposing this

A funding application for betamethasone dipropionate with calcipotriol foam spray (Enstilar) was reviewed by the Pharmacology and Therapeutics Advisory Committee (PTAC) in November 2018. PTAC recommended that the combination foam spray be funded only if cost-neutral to the Combined Pharmaceutical Budget compared to the currently funded gel formulation of betamethasone dipropionate with calcipotriol.

More information, including links to the PTAC meeting record, can be found on the PHARMAC Application Tracker(external link).

PHARMAC has reached a provisional agreement with the supplier, Leo Pharma, to list Enstilar on the Pharmaceutical Schedule and reduce the cost of some other products supplied by Leo Pharma that are already listed.  

Details about our proposal


Betamethasone dipropionate with calcipotriol foam spray (Enstilar)

From 1 April 2020, betamethasone dipropionate with calcipotriol foam spray (Enstilar) would be listed without restrictions in both Section B and Part II of Section H of the Pharmaceutical Schedule at the following price and subsidy (ex-manufacturer, excluding GST):

Chemical

Formulation

Brand

Pack size

Proposed price and subsidy

Betamethasone dipropionate with calcipotriol

Foam spray 500 mcg with calcipotriol 50 mcg per g

Enstilar

60 g OP

$59.95

A confidential rebate would apply to Enstilar that would reduce the net price to the Funder.

Enstilar would have protection from delisting and subsidy reduction until 31 December 2022. This protection would not preclude other brands of betamethasone dipropionate with calcipotriol from being listed during this period.


Calcipotriol ointment 50 mcg per g (Daivonex)

From 1 July 2020, a new 120 g pack size of calcipotriol oint 50 mcg per g (Daivonex) would be listed without restrictions in both Section B and Part II of Section H of the Pharmaceutical Schedule at the following price and subsidy (ex-manufacturer, excluding GST):

Chemical

Formulation

Brand

Pack size

Proposed price and subsidy

Calcipotriol

Oint 50 mcg per g

Daivonex

120 g OP

$40.00

Daivonex would have protection from delisting and subsidy reduction until 31 December 2022. This protection would not preclude other brands of calcipotriol from being listed during this period.

The 120 g pack would replace the 100 g pack as the supplier is discontinuing the 100 g pack size. This means that the 100 g pack outlined below would be delisted at a future date to be confirmed, but not before 1 January 2021, to allow sufficient time for stock of the 100 g pack to be depleted by wholesalers and pharmacies.

Chemical

Formulation

Brand

Pack size

Current price and subsidy

Calcipotriol

Oint 50 mcg per g

Daivonex

100 g OP

$45.00

Sodium fusidate [fusidic acid] 250 mg tablets (Fucidin)

Sodium fusidate [fusidic acid] 250 mg tablets (Fucidin) would remain listed in both Section B and Part II of Section H of the Pharmaceutical Schedule subject to the following existing funding endorsement restriction:

Prescriptions must be written by, or on the recommendation of, an infectious disease physician or clinical microbiologist.

From 1 December 2020, a 36 tablet pack would be listed in Section B and Part II of Section H of the Pharmaceutical Schedule, at the following price and subsidy (ex-manufacturer, excluding GST):

Chemical

Formulation

Brand

Pack size

Proposed price and subsidy

Sodium fusidate [fusidic acid]

Tab 250 mg

Fucidin

36

$67.85

From 1 December 2020, the wastage rule would be applied to the 36 tablet pack in Section B of the Pharmaceutical Schedule.

Fucidin would have protection from delisting and subsidy reduction until 31 December 2022. This protection would not preclude other brands of sodium fusidate [fusidic acid] from being listed during this period.

The 12 tablet pack of Fucidin outlined below would be discontinued by the supplier and would be delisted at a future date to be confirmed, but not before 1 December 2021, to allow sufficient time for stock of the 12 tablet pack to be depleted by wholesalers and pharmacies.

Chemical

Formulation

Brand

Pack size

Current price and subsidy

Sodium fusidate [fusidic acid]

Tab 250 mg

Fucidin

12

$34.50

Hydrocortisone butyrate lipocream 0.1% (Locoid Lipocream)

Hydrocortisone butyrate (Locoid Lipocream) lipocream 0.1%, 100 g OP would remain listed in both Section B and Part II of Section H of the Pharmaceutical Schedule at the current price and subsidy below (ex-manufacturer, excluding GST):

Chemical

Formulation

Brand

Pack size

Current price and subsidy

Hydrocortisone butyrate

Lipocream 0.1%

Locoid Lipocream

100 g OP

$6.85

From 1 April 2020, a confidential rebate would apply to Locoid Lipocream 100 g that would reduce the net price to the Funder.

Locoid Lipocream would have protection from delisting and subsidy reduction until 31 December 2022. This protection would not preclude other brands of hydrocortisone butyrate from being listed during this period.

The 30 g pack of Locoid Lipocream outlined below would be discontinued by the supplier and delisted at a future date to be confirmed but not before 1 October 2020 to allow sufficient time for stock of the 30 g pack to be depleted by wholesalers and pharmacies.

Chemical

Formulation

Brand

Pack size

Current price and subsidy

Hydrocortisone butyrate

Lipocream 0.1%

Locoid Lipocream

30 g OP

$3.42

To provide feedback

Send us an email: consult@pharmac.govt.nz 5 pm on Monday, 3 February 2020.

All feedback received before the closing date will be considered by PHARMAC’s Board (or its delegate) prior to making a decision on this proposal.

Feedback we receive is subject to the Official Information Act 1982 (OIA) and we will consider any request to have information withheld in accordance with our obligations under the OIA. Anyone providing feedback, whether on their own account or on behalf of an organisation, and whether in a personal or professional capacity, should be aware that the content of their feedback and their identity may need to be disclosed in response to an OIA request.

We are not able to treat any part of your feedback as confidential unless you specifically request that we do, and then only to the extent permissible under the OIA and other relevant laws and requirements. If you would like us to withhold any commercially sensitive, confidential proprietary, or personal information included in your submission, please clearly state this in your submission and identify the relevant sections of your submission that you would like it withheld. PHARMAC will give due consideration to any such request.