Decision to fund fosfomycin in the community for urinary tract infections
Update to patient numbers - 7 October
In the first year that fosfomycin is funded we expect about 3,500 people to access the medicine. When we published the decision, we included the year of people to benefit for the financial year, which was 2,600.
What we’re doing
We are pleased to announce that fosfomycin (branded as UroFos) will be funded in the community from 1 November 2024. This medicine will be funded with eligibility criteria. See the Special Authority for detail.
This decision will allow New Zealanders to access funded fosfomycin treatment in the community. It will reduce the need for people to be treated for urinary tract infections (UTIs) in the hospital.
The Government provided additional funding to Pharmac in June 2024 to fund new medicines and widen access to medicines that are already funded. The funding increase covers medicines for both cancer and non-cancer health conditions. This decision is one of many that we’re working on to put our budget increase into action.
Media release on Pharmac’s funding boost
Fosfomycin powder was already funded for use in Health New Zealand, Te Whatu Ora hospitals. We asked for tender bids for:
- current access, which would only fund it for use in hospitals, and
- widened access, which would fund it for use in the community as well as hospitals.
We have awarded a tender for widened access. This means fosfomycin will be funded in the community as well as in Health New Zealand hospitals. Pharmac has not awarded a tender for current access to fosfomycin.
We estimate that approximately 3,500 additional people in New Zealand will use fosfomycin in the first year of funding. We estimate that approximately 3,700 people will benefit each year after five years of funding.
Any changes to the original proposal?
This decision was subject to a consultation letter dated 18 July 2024.
We received feedback that highlighted the benefits this proposal has. Feedback also suggested changing the eligibility criteria.
We have made some changes to the original proposal following consultation. These changes are summarised below:
- changed the approval period from one month to two months.
- Clarified the description of UTI to include the term ‘cystitis’ and that it is caused by Escherichia coli.
- clarified that people only need to be contraindicated or experience intolerable side effects to certain antibiotics.
We are grateful to everyone who took the time to share their support and provide us with feedback. The themes raised in the consultation feedback, and our responses have been summarised at the end of this notification letter.
Who we think will be most interested
- People who experience uncomplicated UTIs, their whānau, and caregivers
- Healthcare professionals who are involved in the treatment of UTIs
- Health New Zealand I Te Whatu Ora hospitals
- Advocacy and support groups
- Pharmacies and wholesalers
- Pharmaceutical suppliers
Detail about this decision
From 1 November 2024, Te Arai’s brand of fosfomycin (UroFos) will be listed in Section B and Part II of Section H of the Pharmaceutical Schedule as follows:
|
Chemical |
Formulation |
Brand (Supplier) |
Pack size |
Price and subsidy |
|---|---|---|---|---|
|
Fosfomycin |
Powder for oral solution; 3 g sachet |
UroFos (Te Arai) |
1 |
$18.70 |
UroFos (Te Arai) will be the Principal Supply brand of fosfomycin from 1 April 2025 until 30 June 2027.
Fosfomycin will be listed in Section B of the Pharmaceutical Schedule, subject to the following eligibility criteria:
Special Authority for Subsidy
Initial application – from any relevant practitioner. Approvals valid for 2 months for applications meeting the following criteria:
Both:
- Patient has an acute, symptomatic, bacteriologically-proven uncomplicated urinary tract infection (UTI)/cystitis with Escherichia coli; and
- Either:
- Microbiological testing confirms the pathogen is resistant to all of: trimethoprim, nitrofurantoin, amoxicillin, cefaclor, cefalexin, amoxicillin with clavulanic acid, and norfloxacin; or
- The patient has a contraindication or intolerance to all of: trimethoprim, nitrofurantoin, amoxicillin, cefaclor, cefalexin, amoxicillin with clavulanic acid, and norfloxacin that the pathogen is susceptible to.
Renewal – from any relevant practitioner. Approvals valid for 2 months for applications meeting the following criteria:
Both:
- Patient has an acute, symptomatic, bacteriologically-proven uncomplicated urinary tract infection (UTI)/cystitis with Escherichia coli; and
- Either:
- Microbiological testing confirms the pathogen is resistant to all of: trimethoprim, nitrofurantoin, amoxicillin, cefaclor, cefalexin, amoxicillin with clavulanic acid, and norfloxacin; or
- The patient has a contraindication or intolerance to all of: trimethoprim, nitrofurantoin, amoxicillin, cefaclor, cefalexin, amoxicillin with clavulanic acid, and norfloxacin that the pathogen is susceptible to.
We have not changed the restriction that applies in Part II of Section H of the Pharmaceutical Schedule.
Our responses to what you told us
We are grateful for the time and care people took to respond to our consultation. A summary of the key themes raised by your feedback and our responses follows.
|
Theme |
Pharmac Comment |
|---|---|
Supportive |
|
|
Supportive of the proposal to fund fosfomycin in the community for urinary tract infections. Respondents noted that the proposal would remove some of the resource and access burden for patients. |
We are pleased to be funding fosfomycin in the community. We heard from our advisors when assessing the funding application that it would offer people easier access to treatment and reduce the burden of treating UTIs on hospitals and other health services. |
Changes to approval period |
|
|
An approval period of one month may be too short if there are delays in obtaining bacteriological culture results. Requested the eligibility criteria are lifelong and do not require renewal. This would minimise the potential delays in treatment and costs of re-testing for people with contraindications or documented intolerances. |
Based on this feedback, we have changed the approval period to two months in case there are delays in obtaining results. The eligibility criteria are time limited and require re-testing for each UTI episode to confirm that the pathogen is susceptible to fosfomycin. Our clinical advisors considered this would support anti-microbial stewardship in New Zealand. |
Changes to the wording of the eligibility criteria |
|
|
Respondents highlighted the importance of antimicrobial stewardship and suggested changes to the Special Authority wording. Respondents suggested some clarifications to the wording for the Special Authority to more clearly define the type of infection and bacteria that cause it. |
The eligibility criteria have been amended, based on this feedback. We have added a requirement for the infection to be caused by E. coli. Our clinical advisors considered the feedback we received and were supportive of the changes we have made to the eligibility criteria. |
Pharmacy Network Systems |
|
|
Requested that Pharmac support the availability of the Conporto network system. The system would allow community pharmacies to:
|
We acknowledge the benefits of having the right technology and systems in place so New Zealanders can access their medicines. Pharmac is not responsible for which pharmacy systems and software is used. |
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.