Decision to fund medicines for liver and ovarian cancers, and to award Principal Supply Status for bevacizumab to Vegzelma

What we’re doing

We’re pleased to announce that we have made a decision to:

• fund bevacizumab (branded as Vegzelma), supplied by Celltrion Healthcare New Zealand Limited (Celltrion); and
• widen access to atezolizumab (branded as Tecentriq), supplied by Roche

From 1 March 2025:

• Vegzelma will be funded for:
  • recurrent respiratory papillomatosis
  • ocular conditions
  • unresectable hepatocellular carcinoma (liver cancer)
  • advanced ovarian cancer.
• Access will be widened to atezolizumab for use in combination with bevacizumab for unresectable hepatocellular carcinoma (liver cancer)

By 1 August 2025, all people with recurrent respiratory papillomatosis will need to have transitioned to the Vegzelma brand of bevacizumab.

For people with ocular conditions, ‘any brand’ of bevacizumab will continue to be funded in Health New Zealand | Te Whatu Ora hospitals. 

Vegzelma will be the main funded brand of bevacizumab in Health New Zealand | Te Whatu Ora hospitals until at least 31 August 2028.

Who we think will be most interested

• People with recurrent respiratory papillomatosis, ocular conditions, liver cancer and ovarian cancer, as well as their family, their whānau and caregivers
• Health professionals involved in the care of people with recurrent respiratory papillomatosis, ocular conditions, liver cancer and ovarian cancer
• Health New Zealand | Te Whatu Ora and Te Aho o Te Kahu | Cancer Control Agency
• Groups who support and advocate for people with these conditions
• Hospital pharmacies
• Hei Āhuru Mōwai and other health care professional groups
• Pharmaceutical suppliers and wholesalers

Any changes to the proposal?

This decision was subject to a consultation letter dated 9 December 2024.

Consultation letter

We received feedback from a wide range of stakeholders including people with cancer, their whānau, their family, clinicians and patient support groups. We’re grateful to everyone for engaging with us and we have made some changes to the proposal as a result of the feedback received. A summary of the main themes raised and our response to it is described in detail in the relevant section below.

Bevacizumab for recurrent respiratory papillomatosis and ocular conditions

Bevacizumab for liver cancer (with atezolizumab) and ovarian cancer

Bevacizumab for glioblastoma and cervical cancer

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 other health conditions. This decision is a result of this budget increase.

Questions and answers about the funding increase

Details about this decision (Vegzelma)

Bevacizumab is a type of medicine called a biologic. Vegzelma is a ‘biosimilar medicine’. This means it is a very similar version of a biologic medicine. Avastin is the reference biologic (bevacizumab), meaning that it was the first brand of bevacizumab to be made available for use. Avastin is likely the brand of bevacizumab that people are most familiar with.

More information about biological and biosimilar medicines

From 1 March 2025, the Vegzelma brand of bevacizumab will be listed in Section B and in Part II of Section H of the Pharmaceutical Schedule at the following price and subsidy (ex-manufacturer, excluding GST):

Chemical	Formulation	Brand	Pack size	Price and subsidy
Bevacizumab	Inj 25 mg per ml, 4 ml vial	Vegzelma	1	$69.00
Bevacizumab	Inj 25 mg per ml, 16 ml vial	Vegzelma	1	$276.00
Bevacizumab	Inj 1 mg for ECP	Baxter	1 mg	$0.71

Bevacizumab will be listed as a PCT only Pharmaceutical in Section B of the Pharmaceutical Schedule. This means that only Health New Zealand | Te Whatu Ora hospitals will be able to make subsidy claims.

A confidential rebate will apply to Vegzelma that will reduce the net price.

Vegzelma will have Principal Supply Status (PSS) in Health New Zealand | Te Whatu Ora hospitals, with a 10% Alternative Brand Allowance from 1 August 2025 until 31 August 2028.

Bevacizumab for recurrent respiratory papillomatosis and ocular conditions

What does this mean for people?

From 1 March 2025, Vegzelma will be funded for people with recurrent respiratory papillomatosis and ocular conditions.

Only the Vegzelma brand will be able to be claimed as a ‘PCT only’ pharmaceutical.

Recurrent respiratory papillomatosis

People with recurrent respiratory papillomatosis who are currently receiving a different brand of bevacizumab will need to change to the Vegzelma biosimilar by 1 August 2025.

From 1 August 2025, everyone receiving bevacizumab for recurrent respiratory papillomatosis will need to have transitioned to the Vegzelma brand of bevacizumab.

If someone is unable to transition to the Vegzelma brand of bevacizumab or if there are difficulties with the transition, Pharmac will consider applications to remain on a certain brand through individual applications.

Application for funding of an alternative brand of bevacizumab for an individual patient

Ocular conditions

Health New Zealand | Te Whatu Ora hospitals will be able to continue purchasing any brand of bevacizumab for people with ocular conditions, meaning there is no requirement for people who are receiving bevacizumab for ocular conditions to change brands.

Pharmac does not have a contract for Avastin (the innovator brand of bevacizumab). However, we are in contact with the supplier to understand its ongoing availability for those who need it.

Any changes to the original proposal?

We received feedback from clinicians and medical groups. We want to thank everyone for their feedback. Overall people were supportive, in particular there was support to maintain access to alternative brands of bevacizumab for people with ocular conditions. We also received some useful feedback to support the implementation of the brand change for people with recurrent respiratory papillomatosis.

We have not made any changes to the recurrent respiratory papillomatosis and ocular conditions part of this proposal. A summary of the feedback and our response to this is detailed after the Specia.

Details about this decision

Bevacizumab (Vegzelma) will be listed in Section B of the Pharmaceutical Schedule subject to the following eligibility criteria:

Similar eligibility criteria will also apply in Part II of Section H of the Pharmaceutical Schedule

From 1 March 2025, the prescriber restriction for recurrent respiratory papillomatosis will be amended. This will mean that any relevant practitioner can apply for funding of bevacizumab (Vegzelma) for this use.

The “any brand” listing of bevacizumab (bevacizumab (ocular)) will be present in Part II of Section H only and there will be no changes to the eligibility criteria for bevacizumab (ocular) indications.

Bevacizumab Hospital Indication Restriction for ocular conditions | HML(external link)

Our response to what you told us

Theme	Pharmac Comment
Recurrent respiratory papillomatosis
Had no concern regarding a change to a biosimilar brand of bevacizumab for people with recurrent respiratory papillomatosis.	We are pleased to have progressed a proposal that will continue to provide health outcomes for New Zealanders.
Highlighted there may be some situations where an alternative brand would be required, such as rapidly recurrent disease, lower airway papilloma or severe adverse events following brand change	We have established a pathway to access funding for other brands of bevacizumab for people with recurrent respiratory papillomatosis if someone is unable to transition to the Vegzelma brand of bevacizumab or if there are difficulties with the transition. This form is available on our website for prescribers. Application for funding of an alternative brand of bevacizumab for an individual patient We note that bevacizumab is currently funded on the Pharmaceutical Schedule for intra-lesional use only, not intravenous use. Some people may be accessing intravenous bevacizumab via Pharmac’s Named Patient Pharmaceutical Assessment process (NPPA). If a specific brand is required in these instances, this detail should be included in the application for consideration. NPPA applications
Queried similarities between Avastin and Vegzelma, including concentration, storage, product care, disposal, and compounding.	The Vegzelma brand is available in the same concentration as Avastin – i.e. 25 mg/ml and would be available in both 4 ml and 16 ml vials. Vegzelma would be available through wholesalers as Avastin is so there should not be any difference in sourcing time between products. The Medsafe datasheet for Vegzelma includes information about required storage, expiry and other key factors. These factors are in general very similar to Avastin. Vegzelma Datasheet [PDF] | Medsafe website(external link) Avastin Datasheet [PDF] | Medsafe website(external link)
Provided feedback on what information would be useful for prescribers/individuals to support a change, including making equivalence data available.	We have a webpage to support implementation of this brand change. This includes equivalence data provided by the supplier. In addition, resources to support the prescribing of Vegzelma such as product brochures, patient brochures, and in-use stability brochures will also be made available. Bevacizumab (Vegzelma): Health care professional information
Ocular conditions
Support for continued availability of the Avastin brand of bevacizumab for people with ocular conditions. Noting the lack of evidence currently available to support the safety and efficacy of biosimilar bevacizumab for ocular conditions.	We are pleased to be able to maintain the current funding settings for people with ocular conditions, where ‘any brand’ of bevacizumab is funded. However, as Vegzelma will be funded for people with ocular conditions as well, it will be an option for people to use.
Concern that this proposal may disincentivise the supplier of Avastin to continue to supply and lead to limited access.	We recognise that it is important for people that Avastin remain available in New Zealand.  Pharmac does not have a contract for Avastin (the innovator brand of bevacizumab). However, we are in contact with the supplier to understand its ongoing availability for those who need it.

Bevacizumab for liver cancer (with atezolizumab) and ovarian cancer

What does this mean for people?

From 1 March 2025 the Vegzelma brand of bevacizumab will be funded for people with hepatocellular carcinoma (liver cancer) in combination with atezolizumab and for people with ovarian cancer, subject to eligibility criteria.

Access to atezolizumab will also be widened from 1 March 2025 for people with hepatocellular carcinoma.

In the first year of funding, we estimate that around 70 people would benefit from access to atezolizumab in combination with bevacizumab hepatocellular carcinoma and another 70 people would benefit from bevacizumab for ovarian cancer.

Māori and Pacific people experience substantial health inequity from liver cancer. Liver cancer is one of the most common causes of cancer related death among Māori and Pacific people. Māori and Pacific people are more likely to be diagnosed with advanced disease, at a younger age and are more likely to die from liver cancer than non-Māori, non-Pacific people. We anticipate that funding atezolizumab with bevacizumab for liver cancer will improve health outcomes for Māori and Pacific people with this disease.

Any changes to the original proposal?

We’re grateful to those who took the time to respond to our consultation as it is an important part of our decision-making process. We received feedback from consumers, whānau members, patient support and advocacy groups, clinicians, and suppliers. Consultation gives us the opportunity to listen to the voices of the community and acknowledge and respond to feedback. Responses were generally supportive of the proposal, with some requests for changes to the proposed eligibility criteria, and wider access.

After considering feedback, we have amended the eligibility criteria for access to bevacizumab as follows:

Liver Cancer:

• We have added a criterion to ensure that if someone is currently accessing treatment privately and they met the eligibility criteria when they started treatment, they will be able to transition to publicly funded treatment.

Ovarian Cancer:

• We have enabled access to bevacizumab until disease progression and removed the 12 month treatment limit.
• We have enabled bevacizumab to be used in combination with a PARP inhibitor (e.g. olaparib or niraparib).

A summary of the feedback received and our responses to this is detailed below.

Details about this decision (liver cancer and ovarian cancer)

Bevacizumab

Bevacizumab will be listed in Section B of the Pharmaceutical Schedule subject to the following eligibility criteria (changes following consultation feedback, additions are in bold, deletions in strikethrough):

Similar eligibility criteria will apply in Part II of Section H of the Pharmaceutical Schedule.

Atezolizumab

From 1 March 2025, access will be widened to atezolizumab in Section B of the Pharmaceutical Schedule as follows (changes following consultation feedback, additions are in bold):

Similar eligibility criteria will apply in Part II of Section H of the Pharmaceutical Schedule.

Lenvatinib

Lenvatinib was funded for people with hepatocellular carcinoma from 1 December 2024

From 1 March 2025, the eligibility criteria for lenvatinib will be amended so people can use lenvatinib if they experience adverse effects from atezolizumab with bevacizumab. These changes will be made in Section B of the Pharmaceutical Schedule as follows:

Similar eligibility criteria will apply in Part II of Section H of the Pharmaceutical Schedule.

Our response to what you told us

Theme	Pharmac Comment
General Feedback
Expressed disappointment that the consultation period was over a holiday period, limiting ability to consult with communities and prepare a robust submission.	We appreciate that the summer holiday period is a busy time for everyone, and that this consultation period wasn’t ideal. The consultation was released on 9 December 2024 and was due to close on 6 January 2025. Following this feedback, we extended the consultation period one week further until 13 January 2025. We know that it is important to people with these cancers, their family, their whānau, and their healthcare professionals that they have funded access to these medicines as soon as possible. We need to balance having enough time for people to provide feedback and ensuring people have access to new treatments as quickly as possible. In this case we considered extending the consultation period further however, a longer consultation period would have delayed when people would have been able to access treatment. In this case we decided not to extend the consultation response deadline further so that people could access funded treatment from the start of March.
Requested removal of ‘PCT only’ listing for bevacizumab and atezolizumab on the Pharmaceutical Schedule. The feedback noted this “PCT only” requirement prevents treatment from being delivered across satellite centres and private cancer clinics.	While we understand the desire to alleviate impact on infusion services for the delivery of these medicines, removal of “PCT only” is a complex system wide issue that would require significant change across health information systems. The PCT only designation ensures that our claiming data is accurate for the purposes of rebates and forecasting. At this time, we are unable to make this change. We note that PCT only does not prevent medicines from being administered outside of Health New Zealand hospitals, however it requires the claim (and therefore dispensing to occur) to be submitted by a Health New Zealand hospital. We understand that there are already mechanisms in place where compounded pharmaceuticals are administered at sites contracted to Health NZ hospitals. We would remain responsive to requests from the sector to support implementation of this and other funding decisions for infused medicines. If there is a clinical need for these treatments to be delivered in another setting, we would work with our sector partners to support this while ensuring that reimbursement could occur.
Liver cancer (unresectable hepatocellular carcinoma)
Support for the proposal, noting: The expense of privately funding atezolizumab with bevacizumab. This funding would meet a major unmet medical need. Patients would have extended survival, giving them more time with family and loved ones. It would bring New Zealand in line with international standards of care.	We appreciate the personal stories people have shared with us about the impacts that liver cancer has for people and their whānau. We are pleased to progress a proposal that will provide improved health outcomes to New Zealanders.
Request to fund atezolizumab with bevacizumab for unresectable hepatocellular carcinoma in the second-line setting (following lenvatinib treatment).	We are aware that atezolizumab with bevacizumab is the preferred treatment option for hepatocellular carcinoma, however the need to run a competitive procurement process for bevacizumab, in line with Government Procurement Rules, meant that lenvatinib could be listed first. We do not want to disadvantage anyone who had started on lenvatinib since 1 December 2024 who would have preferred to start on atezolizumab with bevacizumab if they had been funded at the same time. We understand that people want this ongoing flexibility. However, the intent of this decision is to fund these treatments as a first-line treatment, in line with the clinical advice we received. As a result: people who started on funded lenvatinib prior to 1 March 2025 would be eligible to shift to funded atezolizumab with bevacizumab treatment. people who start funded lenvatinib after 1 March 2025 are eligible to shift to funded atezolizumab with bevacizumab treatment, provided they have experienced treatment limiting toxicity and their disease has not progressed. Access to atezolizumab with bevacizumab, as a second-line treatment after lenvatinib, will need to be considered as a separate funding application. This would allow us to fully assess the benefits and impacts of widening access under our Factors for Consideration, ensuring that we are getting the best health outcomes from our fixed budget. We would welcome a funding application for this line of treatment. Medicine Funding Application
Requested changes to eligibility criteria, including: Ensure the eligibility criteria do not exclude people who may have received atezolizumab with bevacizumab in combination with another agent as part of a clinical trial. Ensure that any people who have self-funded atezolizumab with bevacizumab but had to halt treatment due to non-health factors, are not excluded.	We have amended the proposed eligibility criteria to enable funded access for people who are currently receiving atezolizumab with bevacizumab through other funding mechanisms, provided that they met the eligibility criteria when they started treatment. For people who have halted self-funded/ clinical trial treatment for non-health related factors, these applications would be considered on a case-by-case basis through our waivers process. Details on how clinicians can apply through our waivers process is on the Pharmac website. Special Authority Waiver
Request to fund subcutaneous atezolizumab (Tecentriq SC). Noting that Tecentriq SC reduces the administration time compared to the currently funded infusion, freeing up infusion chair availability.	We have received an application for subcutaneous atezolizumab. Our clinical advisors (Cancer Treatments Advisory Committee) recommended subcutaneous atezolizumab be funded if cost neutral to the administration of atezolizumab intravenous formulation. The application is currently ranked on our “only if cost neutral or cost saving priority list”. Further information about this application is located below. Atezolizumab subcutaneous formulation | Application Tracker(external link)
Ovarian cancer
Strong support for the proposal. Consumer stories about their journeys with ovarian cancer and the benefit bevacizumab has or could provide them.	We appreciate the personal stories people have shared with us about the impact ovarian cancer has for people and their whānau. We are pleased to have progressed a proposal that will provide health outcomes to New Zealanders. We understand funding bevacizumab will improve both progression free and overall survival for people with ovarian cancer.
Requested changes to eligibility criteria: Enable access with concurrent PARP inhibitor treatment. Enable treatment for longer than 12-months.	We sought advice from the Cancer Treatments Advisory Committee (CTAC) in relation to this feedback. As a result of this feedback and the clinical advice, we have amended the criteria to: Enable bevacizumab to be used in combination with a PARP inhibitor Enabled treatment with bevacizumab until disease progression (with no restriction on treatment duration) We are pleased that these amendments will help people get the best outcomes from their treatment.
No substantial concerns about the funding of a biosimilar bevacizumab.	This is in line with the clinical advice we have received.

Bevacizumab for glioblastoma and cervical cancer

We really appreciate the engagement we have had with clinicians, consumers and advocates about the use of bevacizumab for glioblastoma (brain cancer). It’s important that we hear from people impacted by our proposals so we can be sure we are making the best decisions for New Zealanders.

The funding of bevacizumab for liver and ovarian cancers now does not prohibit the funding of bevacizumab for brain cancer or cervical cancer in the future, should we be in a position to do so.

Glioblastoma

At this time, we are unable to progress funding for bevacizumab for people with glioblastoma (brain cancer). We appreciate this outcome will be very disappointing for people, however we want to emphasise that this decision does not mean it cannot be funded in the future and we have not declined the applications for this treatment. We know that there remains a need for more funded, effective treatments for people with brain cancer.

We received a comprehensive submission about bevacizumab for brain cancer and we intend to take this feedback and evidence to our clinical advisors for further consideration.

We will continue to keep the Application Tracker updated to make it clear when we are seeking this clinical advice, the resulting record and any next steps. We will also continue to engage with these key stakeholders as this work progresses.

Bevacizumab for glioblastoma | Application Tracker(external link)

Cervical cancer

We did not receive any feedback specifically in relation to cervical cancer. However, we acknowledge the significant health need for people with cervical cancer and that not funding bevacizumab for cervical cancer now is unlikely to be the outcome people would have hoped for.

Unfortunately, we are not able to progress the funding of bevacizumab for cervical cancer as part of this proposal at this time. Bevacizumab for cervical cancer remains an option for investment, and we will continue to consider whether it is something we can progress for funding from our available budget in the future.

Bevacizumab for cervical cancer | Application Tracker(external link)

More information about why we were unable to propose funding these cancers at this time can be found in the consultation.

Consultation letter

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.