Decision to fund a new type of insulin for the management of diabetes

11 April 2025

Medicines Decision

What we’re doing

We’re pleased to announce a decision to fund a new type of insulin called ‘Ryzodeg’ for people with diabetes from 1 May 2025 through an agreement with Novo Nordisk Pharmaceuticals Ltd.

Ryzodeg helps people with diabetes manage their blood sugar levels. It is a combination of two medicines, insulin degludec (a long-acting insulin) and insulin aspart (a rapid-acting insulin). It will be funded without restrictions, so it can be prescribed for people with diabetes who need it.

As part of the agreement there will also be a reduction in the net price of insulin aspart (brand name NovoRapid – PenFill / FlexPen)

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 boost covers medicines for both cancer and non-cancer health conditions. This proposal is one of many that we have been working on to put our budget increase into action.

Questions and answers on Pharmac’s budget increase

What does this mean for people?

From 1 May 2025, Ryzodeg will be funded without restriction to be used by people with either type 1 or type 2 diabetes who need it. Ryzodeg will provide another funded insulin option for people to use.

As this medicine is a long acting type of insulin, we expect that the majority of people who use this medicine would be people living with type 2 diabetes.

We estimate that around 8,000 people would benefit from Ryzodeg in the first year, increasing to 18,000 after five years of funding.

The currently listed biphasic insulin aspart (branded as NovoMix30) is scheduled for discontinuation at some point in 2026. For some people Ryzodeg may be a suitable replacement for NovoMix30.

Ryzodeg will be able to be accessed in the same manner as other currently listed insulin products.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 10 March 2025. We received feedback from people who use insulin, clinicians, medical colleges, and other groups of people involved in the health care of people living with diabetes.

We are grateful to those who took the time to respond to our consultation. Receiving feedback forms an important part of our decision-making process and helps to ensure that the proposal is likely to benefit the identified population in the manner intended.

This feedback on the proposal was supportive of the proposal. We have not made any changes to the proposal following the consultation, however we have been made aware of some concerns regarding the discontinuation of NovoMix30 and we intend to work to address these between now and its discontinuation.

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

Who we think will be most interested

People with diabetes who are insulin dependent and their whānau, families, caregivers and partners.
Organisations with an interest in diabetes treatment(s)
Groups who advocate for and support people with diabetes
Healthcare professionals in primary and secondary care who are involved in supporting people with insulin dependent diabetes
Health New Zealand | Te Whatu Ora
Pharmaceutical suppliers and wholesalers

Details about this decision

Insulin degludec with insulin aspart (Ryzodeg) will be listed in Section B and Part II of Section H of the Pharmaceutical Schedule from 1 May 2025 as follows:

Chemical	Presentation	Brand	Pack Size	Price and subsidy
Insulin degludec with insulin aspart	Inj degludec 70 u with insulin aspart 30 u, 100 u per ml, 3 ml cartridge	Ryzodeg 70/30 Penfill	5	$80.00

A confidential rebate will apply to Ryzodeg that will reduce its net price.

Ryzodeg will have protection from delisting and subsidy reduction until 30 April 2028.

As part of the agreement with the supplier, there will also be a reduction to the net price of all currently funded presentations of insulin aspart (NovoRapid – Penfill/Flexpen). These will also have protection from delisting and subsidy reduction until 30 April 2028.

Our response to what you told us

We ’re really grateful for the time people took to respond to this consultation. Responses were largely supportive of the proposal.

Theme	Pharmac Staff Comment
Supportive of the proposal, respondents considered that: it would provide insulin dependent people with diabetes with a convenient alternative to currently listed insulin products. funding effective options to manage the expected increase in the incidence of diabetes will benefit both patients and general practice teams Ryzodeg would be a good alternative for children and young people who may be struggling with other insulin regimes funding insulin options that reduce the burden on people to take medicine frequently will help them to manage their condition more effectively. the benefits of the Ryzodeg include: simplified dosing regimen lower risk of hypoglycaemia - smoother pharmacodynamic profile better glycaemic control greater flexibility	We appreciate the supportive feedback and are pleased to be progressing a proposal that would improve the lives of people with insulin dependent diabetes. This aligns with the advice we have received that funding Ryzodeg would provide a meaningful improvement for many people living with diabetes who may experience difficulty managing their insulin requirements with currently funded insulin products.
Respondents raised concerns that the planned discontinuation of NovoMix30 would result in reduced options for people. Concerns were raised the proposed presentation of Ryzodeg being limited to the PenFill cartridge-based system only, rather than including the FlexPen prefilled pen injector. Specifically that some people with dexterity or cognitive issues may struggle with the cartridges and would prefer the ease of the FlexPen presentation.	The supplier of NovoMix30 (Novo Nordisk) has informed Pharmac that the discontinuation of NovoMix30 likely to occur sometime after December 2025. We understand from our advisors that Ryzodeg, along with other currently listed insulin presentations, would provide suitable options for people to support this discontinuation. However, we appreciate the feedback regarding the proposed presentation for Ryzodeg, we note that many people may prefer a prefilled FlexPen type injector. The supplier has indicated that the FlexPen presentation of Ryzodeg is not currently available for supply in New Zealand. We will continue to work with the supplier to determine whether the FlexPen option can be made available in New Zealand.
We received feedback that it would be desirable to include a Brand Switch Fee as part of the implementation plan to enable pharmacists to support the listing and transition from over insulins.	We have received advice that as Ryzodeg uses the same ratio in its formulation as NovoMix30 people would require minimal support in moving to Ryzodeg. However, we will work with the supplier, clinical groups such as New Zealand Society for Study of Diabetes (NZSSD) and Diabetes NZ to ensure that people moving to Ryzodeg have sufficient support and information available to ensure a smooth transition. At this stage we will not be implementing a Brand Switch Fee as part of the listing of Ryzodeg.
We have received feedback that the listing of Ryzodeg should be accompanied by a patient monitoring and pharmacovigilance process to ensure patient safety.	Medsafe is the government agency with responsibility for ensuring the safety of medicines in New Zealand. We will however continue to monitor the use and uptake of Ryzodeg and consult with our clinical advisors and other groups who support people with diabetes to ensure that the listing of Ryzodeg would support meeting the health needs of people living with diabetes.
We received feedback that having access to an ultra-rapid acting insulin would be of greater benefit to people living with diabetes than the proposed funding of insulin degludec / insulin aspart (Ryzodeg). It was noted that with the widespread use of insulin pumps that this type of insulin would be most compatible.	We appreciate this feedback and we recognise that access to an ultra-rapid acting insulin would help support the growing number of people with type 1 diabetes using insulin pumps. Our clinical advisors told us that the funding of Ryzodeg would primarily benefit people living with type 2 diabetes and it would support addressing an important health need for those people, particularly in light of the planned discontinuation of NovoMix30. Currently there is no Medsafe approved ultra-rapid acting insulin available, and we have not received a funding applications for this type of insulin. We welcome a funding application from any interested parties, the details as to how to do this are located here: How to submit a funding application We would be able to consider this, once there is an ultra-rapid acting insulin under consideration by Medsafe. We will engage with the suppliers of ultra-rapid acting insulins to determine whether there is interest in supplying to the New Zealand market.
We received feedback from several respondents regarding the need for implementation support for people switching from other insulins, primarily in relation to patient focused information resources.	We anticipate that given the time between the listing of Ryzodeg and the discontinuation of NovoMix30, the wider health sector would be able to support people with diabetes using insulin to change their insulin. We intend to work closely with the supplier, Novo Nordisk, Diabetes New Zealand and other stakeholders to ensure that prescribers and patients have access to information to support the transition from other insulin products.

Theme

Pharmac Staff Comment

Supportive of the proposal, respondents considered that:

it would provide insulin dependent people with diabetes with a convenient alternative to currently listed insulin products.
funding effective options to manage the expected increase in the incidence of diabetes will benefit both patients and general practice teams
Ryzodeg would be a good alternative for children and young people who may be struggling with other insulin regimes
funding insulin options that reduce the burden on people to take medicine frequently will help them to manage their condition more effectively.
the benefits of the Ryzodeg include:
- simplified dosing regimen
- lower risk of hypoglycaemia - smoother pharmacodynamic profile
- better glycaemic control
- greater flexibility

We appreciate the supportive feedback and are pleased to be progressing a proposal that would improve the lives of people with insulin dependent diabetes.

This aligns with the advice we have received that funding Ryzodeg would provide a meaningful improvement for many people living with diabetes who may experience difficulty managing their insulin requirements with currently funded insulin products.

Respondents raised concerns that the planned discontinuation of NovoMix30 would result in reduced options for people.

Concerns were raised the proposed presentation of Ryzodeg being limited to the PenFill cartridge-based system only, rather than including the FlexPen prefilled pen injector. Specifically that some people with dexterity or cognitive issues may struggle with the cartridges and would prefer the ease of the FlexPen presentation.

The supplier of NovoMix30 (Novo Nordisk) has informed Pharmac that the discontinuation of NovoMix30 likely to occur sometime after December 2025.

We understand from our advisors that Ryzodeg, along with other currently listed insulin presentations, would provide suitable options for people to support this discontinuation.

However, we appreciate the feedback regarding the proposed presentation for Ryzodeg, we note that many people may prefer a prefilled FlexPen type injector.

The supplier has indicated that the FlexPen presentation of Ryzodeg is not currently available for supply in New Zealand. We will continue to work with the supplier to determine whether the FlexPen option can be made available in New Zealand.

We received feedback that it would be desirable to include a Brand Switch Fee as part of the implementation plan to enable pharmacists to support the listing and transition from over insulins.

We have received advice that as Ryzodeg uses the same ratio in its formulation as NovoMix30 people would require minimal support in moving to Ryzodeg.

However, we will work with the supplier, clinical groups such as New Zealand Society for Study of Diabetes (NZSSD) and Diabetes NZ to ensure that people moving to Ryzodeg have sufficient support and information available to ensure a smooth transition.

At this stage we will not be implementing a Brand Switch Fee as part of the listing of Ryzodeg.

We have received feedback that the listing of Ryzodeg should be accompanied by a patient monitoring and pharmacovigilance process to ensure patient safety.

Medsafe is the government agency with responsibility for ensuring the safety of medicines in New Zealand.

We will however continue to monitor the use and uptake of Ryzodeg and consult with our clinical advisors and other groups who support people with diabetes to ensure that the listing of Ryzodeg would support meeting the health needs of people living with diabetes.

We received feedback that having access to an ultra-rapid acting insulin would be of greater benefit to people living with diabetes than the proposed funding of insulin degludec / insulin aspart (Ryzodeg). It was noted that with the widespread use of insulin pumps that this type of insulin would be most compatible.

We appreciate this feedback and we recognise that access to an ultra-rapid acting insulin would help support the growing number of people with type 1 diabetes using insulin pumps.

Our clinical advisors told us that the funding of Ryzodeg would primarily benefit people living with type 2 diabetes and it would support addressing an important health need for those people, particularly in light of the planned discontinuation of NovoMix30.

Currently there is no Medsafe approved ultra-rapid acting insulin available, and we have not received a funding applications for this type of insulin. We welcome a funding application from any interested parties, the details as to how to do this are located here:

How to submit a funding application

We would be able to consider this, once there is an ultra-rapid acting insulin under consideration by Medsafe. We will engage with the suppliers of ultra-rapid acting insulins to determine whether there is interest in supplying to the New Zealand market.

We received feedback from several respondents regarding the need for implementation support for people switching from other insulins, primarily in relation to patient focused information resources.

We anticipate that given the time between the listing of Ryzodeg and the discontinuation of NovoMix30, the wider health sector would be able to support people with diabetes using insulin to change their insulin.

We intend to work closely with the supplier, Novo Nordisk, Diabetes New Zealand and other stakeholders to ensure that prescribers and patients have access to information to support the transition from other insulin 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.