Decision to fund the oral contraceptive pill desogestrel (Cerazette)

Overwhelming support for the proposal. Many people shared their personal stories of their experience with contraception which included desogestrel. Respondents noted that:

• This medicine is already widely prescribed in Aotearoa NZ.
• Cost for the patient is currently a major barrier to access.
• Increased access to contraceptives and reproductive health services would help to reduce unplanned pregnancies.
• The twelve hour vs three hour treatment window is highly beneficial and more user friendly.
• Some respondents noted that they found desogestrel to have better tolerability and fewer side effects than funded alternatives. It also offers reliable ovulation suppression.
• This would provide an effective option for people for whom oestrogen is contraindicated. As well as people for whom long-acting reversible contraceptive options (such as IUDs) were inappropriate (either clinically, culturally and/or due to personal choice).
• Some responders noted concern about the efficacy of funded alternatives.
• Current inequities exist as many people aren’t able to self-fund desogestrel. This proposal would improve equitable access.
• Funding desogestrel aligns with Pharmac’s commitment to equity and improved health outcomes.

We are thankful to everyone who shared their personal stories with us, highlighting the importance and impact of funding desogestrel. We are pleased to progress a proposal that would provide improved health outcomes for New Zealanders.

Responders highlighted the benefit that desogestrel can provide in the treatment of a range of conditions include endometriosis, premenstrual syndrome, polycystic ovary syndrome, heavy menstrual bleeding, period pain in adolescence, and for use as a part of menopausal hormone treatment.

Respondents highlighted that progestogen-only contraceptives are recommended as first-line treatment of endometriosis and that desogestrel would likely be used in this setting.

Desogestrel would be funded without restriction so could be prescribed for any relevant use.

Desogestrel is Medsafe approved for oral contraception. Other uses have not been approved by Medsafe. Prescribing desogestrel outside of the Medsafe approved indications would need to follow Section 25 of the Medicines Act 1981.

Medsafe Website | Section 25 of the Medicines Act 1981(external link)

A respondent considered that up to 230,000 people may use desogestrel – higher than the estimated 43,000. This figure is based on the likely number of people in New Zealand with endometriosis and many people with endometriosis are likely to use desogestrel once cost barriers are removed.

As desogestrel will be open listed, it will be funded for anyone with a valid prescription. There would be no restriction on the number of people who could access funding for desogestrel.

43,000 people is based on estimates of people shifting from other funded treatments and those shifting from private funding. This figure is an estimate only.

Considered that most people using norethisterone would shift to desogestrel.

This is in line with the clinical advice we have received and our estimates of the market movement.

People with endometriosis have highlighted the lack of available treatment options for the management of their symptoms – especially when surgery is not the first or most suitable option.

People shared that there are often various contraceptive methods tried in the journey to diagnosis and finding a treatment that helps in the management of symptoms. People shared that desogestrel has been effective in treating their symptoms.  People also noted that desogestrel could be used pre- and post-surgery.

We would like to thank everyone for sharing their personal stories with us, and describing the benefit desogestrel has, or could have on their lives. 

Desogestrel would be funded without restriction so it could be prescribed for any relevant use.

Desogestrel is Medsafe approved for oral contraception. Other uses have not been approved by Medsafe. Prescribing desogestrel outside of the Medsafe approved indications would need to follow Section 25 of the Medicines Act 1981.

Medsafe Website | Section 25 of the Medicines Act 1981(external link).

Pleased to see more options available to ease pressure on supply of other contraceptives. Noted the disruptions to patients with recent supply issues, including tolerance issues with alternatives.

We acknowledge the substantial disruption that supply issues have on individuals and healthcare professionals.

We are pleased to be funding a product which would help to build greater supply resilience in this portfolio, to ensure that New Zealanders continue to have access to these medicines.

Responders highlighted that many prescribers are very familiar with desogestrel and are unlikely to require further education support. Noted that resources such as Sexual Wellbeing Aotearoa website, New Zealand Formulary (NZF) and Best Practice Advocacy Centre (BPAC) have resources which include information on desogestrel.

Some responders highlighted a range of additional resources may be useful for both people taking desogestrel and healthcare professionals, including:

• Information (for prescribers and users) about desogestrel such as mechanism of action, use, the possibility that periods may stop, contraindications, side effects. User information should also be presented in a culturally and religiously sensitive manner (i.e. Whānau-centred, acknowledging cultural aspects of cessation of periods).
• Primary care updates potentially through social media platforms, and webinars.

We are thankful for all the feedback received around how we can best support patients and healthcare professionals to use desogestrel.  We have created an implementation plan with activities that enable us to action this feedback.

Some of these actions include:

• Communications to relevant stakeholders including NZF and Health Pathways via email and through Pharmac’s primary care update.
• An update on the Pharmac website,
• A dedicated webpage on Healthify
• An information section to be featured in NZ Doctor.

Request to enable pharmacist prescribers and accredited community pharmacists to supply desogestrel under standing orders or future prescribing pathways. This would significantly improve access to contraception and ease the burden on general practice.

Desogestrel, like many other oral contraceptives, is able to be legally supplied by pharmacists in specific circumstances without the need for a prescription.

This funding pathway is not currently under consideration by Pharmac. However, we remain open to consideration of direct supply by pharmacists in the future, and will engage with our sector partners on this matter.

Request to fund the contraceptive implant, Implanon. Noted that it is better tolerated than current funded Jadelle, provides better bleeding control and superior insertion and removal.

We have recently received a funding application for Implanon. The next step in our process is to seek clinical advice. We will keep our Application Tracker updated as this progresses.

Application Tracker | Implanon(external link)

From application to funded medicine: Pharmac's process