Decision to fund ramipril for people with high blood pressure
What we’re doing
We are pleased to announce a decision to fund ramipril through an agreement with Viatris Ltd from 1 December 2022.
Ramipril belongs to a group of medicines called angiotensin-converting enzyme (ACE) inhibitors which are used to treat a variety of conditions.
Ramipril may be used for the following conditions:
- High blood pressure
- Heart failure
- Progressive kidney disease
- The prevention of cardiovascular events in patients with heart disease
Ramipril will be funded without restriction. This means it can be prescribed for any relevant use.
Why we are doing this
Cilazapril (another ACE inhibitor) is used in New Zealand more than any other country. In recent years approximately 60% of people in New Zealand receiving an ACE inhibitor were prescribed cilazapril. There is only one place in the world that makes the active ingredient for cilazapril, which means that if there were a supply issue that affected cilazapril, it would be difficult for us to be able to find an alternative for everyone who takes it.
To reduce the impact of this, we have been actively supporting people to move away from using cilazapril. Our first step was to initiate educational activity to encourage the use of alternate medicines, the second step, in May 2021, was to stop new people starting on cilazapril. To further support the transition away from cilazapril, we asked our clinical advisors about what other medicines would be appropriate. The clinical advice we received identified that ramipril would be a suitable alternative.
We included ramipril in the 2020/21 Annual Invitation to Tender and have secured a supply of ramipril via the tender process.
We consider that the availability of ramipril will ensure that a suitable alternate to cilazapril will be available for New Zealanders who need it. It will also strengthen the continuity of supply of ACE inhibitors in New Zealand.
Any changes to the original proposal?
No changes were made to the original proposal following consultation. This decision was subject to a consultation letter dated 6 July 2022. We received feedback from consumers, clinicians, professional societies, and advocacy groups.
We want to thank everyone who took the time to provide us with their feedback.
We took time to consider the matters raised during consultation before making a decision.
What does this mean for people and prescribers
This decision means that from 1 December 2022 people with hypertension and other conditions, including those who are currently prescribed cilazapril (Zapril) will have access to an alternate ACE inhibitor.
You can read more about the new funded brand on the Medsafe datasheet(external link) and Consumer Medical Information(external link)
Who we think will be most interested
- People who are prescribed ACE inhibitors for the treatment of hypertension/heart failure/kidney disease and their family, whānau and caregivers
- Healthcare professionals involved in providing care for and supporting people who require treatment for hypertension/heart failure/kidney disease
- Hospital and community pharmacists, Te Whatu Ora and wholesalers.
- Suppliers of pharmaceuticals to the New Zealand market
Detail about this decision
Ramipril
Ramipril (Tryzan) capsules will be listed in Section B and Part II of Section H of the Pharmaceutical Schedule from 1 December 2022 at the following price and subsidy (ex-manufacturer, excluding GST). Ramipril (Tryzan) will have principal supply status with a DV limit of 5% from 1 May 2023 to 30 June 2024:
| Chemical | Presentation | Brand (Supplier) | Pack Size | Subsidy and price (ex-man., ex. GST) |
|---|---|---|---|---|
| Ramipril | cap 1.25 mg | Tryzan (Viatris) | 30 | $2.30 |
| Ramipril | cap 2.5 mg | Tryzan (Viatris) | 30 | $2.20 |
| Ramipril | cap 5 mg | Tryzan (Viatris) | 30 | $2.25 |
| Ramipril | cap 10 mg | Tryzan (Viatris) | 30 | $2.35 |
Our response to what you told us
We are really grateful for the time people and organisations have taken to respond to the consultation.
A summary of the main themes raised in feedback, and our responses, are set out in the table below.
| Theme | Pharmac Comment |
|---|---|
| Support for funding | |
| General support for the funding of ramipril noting that it would be a welcome addition to the other available ACE inhibitors | We are pleased to be funding a new ACE inhibitor which will benefit the health of New Zealanders. |
| Having an ACE inhibitor in the form of a capsule was a welcome addition and offered an alternative to the current tablet presentations of other ACE inhibitors | We appreciate that there is a value placed on having access to an alternative presentation to other funded ACE inhibitors |
| Feedback on related products | |
| Queried whether Pharmac would be purchasing a titration pack in addition to the standard dose pack sizes | There is currently no Medsafe approved ramipril titration pack. We would be open to considering the funding of a titration pack should it become available. |
| Queried when cilazapril will be delisted | At this stage it is intended that cilazapril(external link) will be delisted in mid 2024 [Originally mid 2023]. The exact timing will be subject to how quickly patient transition is achieved and the impact on available stock. We will be sure to keep the information regarding the availability of cilazapril on our website updated with any changes to this. |
| A request for alternative ACE/Thiazide products to be funded following the withdrawal of the Accuretic brand of quinapril / hydrochlorothiazide. Specifically, a request for a product featuring a longer acting thiazide like chlorthalidone. | Losartan/hydrochlorothiazide(external link) is a fully funded alternative to quinapril/hydrochlorothiazide. We are actively investigating other ACE/Thiazide products. |
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 660 050.