Proposal to support access to budesonide with eformoterol inhalers

What we’re proposing

We’re seeking feedback on a proposal to support better access to budesonide with eformoterol inhalers.

From 1 August we are proposing to:

• enable three months’ supply of some budesonide with eformoterol inhalers to be collected at the same time instead of people having to collect them monthly.
• increase the way some budesonide with eformoterol inhalers can be accessed, by making them available in clinics through a Practitioners Supply Order (PSO). This is so people initiating AIR therapy(external link) or requiring emergency treatment and needing to learn how to use budesonide with eformoterol inhalers, can do so during their health care appointments.

We estimate that this proposal would improve access to some budesonide with eformoterol inhalers for 120,000 people in the first year.

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 consultation is the last related to the Government’s funding boost. Pharmac will continue to assess applications to fund new medicines and make more medicines available to New Zealanders as budget allows.

Questions and answers on Pharmac’s budget increase

We want to hear your feedback about our proposal. Consultation closes at 4pm Friday 9^th May 2025. Feedback can be emailed to consult@pharmac.govt.nz or submitted via our online form. 

What would the effect be

From 1 August 2025, people who receive budesonide with eformoterol inhalers would be able to receive three months of supply at one time. This would remove the need for people to collect their inhalers from their pharmacy each month. We understand this would provide people with greater flexibility in accessing their medicine supply and support improved adherence.

From 1 August 2025, some budesonide with eformoterol inhalers would be available on a Practitioners Supply Order to enable prescribers to ensure they are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where an individual prescription is not practicable.

We understand that some budesonide with eformoterol inhalers are used as  immediate relievers for asthma symptoms. Currently the only inhaled asthma reliver available on a PSO is salbutamol. If this proposal was approved, clinicians and people with asthma would have another inhaled treatment option for immediate relief of asthma symptoms available in the clinic setting.

We understand that making some budesonide with eformoterol inhalers available on a PSO and enabling three monthly (also known as ‘stat’) dispensing would support ongoing implementation of the NZ Adolescent and Adult Asthma Guidelines.(external link)

Who we think will be interested

• People with asthma, their whānau and caregivers
• Respiratory specialists, general practitioners, pharmacists, clinical nurse specialists, and other health professionals involved in the care of people with asthma
• Groups who support and advocate for people with asthma
• Health NZ | Te Whatu Ora
• Community and Hospital pharmacies
• Pharmaceutical suppliers and wholesalers

About asthma, budesonide with eformoterol, AIR therapy, three-monthly dispensing and PSO

Asthma is a very common and sometimes severe chronic lung disease characterised by inflammation, subsequent narrowing of the airways and reversible airway obstruction. The defining features of asthma include a history of respiratory symptoms such as wheezing, shortness of breath, chest tightness and coughing that vary over time and in intensity, and variable expiratory airflow limitation.

Budesonide with eformoterol is one of a range of inhalers currently funded for the treatment of asthma.

Budesonide with eformoterol inhalers

Budesonide is a type of inhaled corticosteroid (ICS) while eformoterol is a type of long -acting beta adrenoceptor agonist (LABA). Combining these treatments in an inhaler has become the recommended maintenance and reliver treatment for a considerable number of people with asthma as per the NZ Adolescent and Adult Asthma Guidelines. (external link) 

Since the publication of the guidelines the use of budesonide with eformoterol has increased substantially with people changing from salbutamol (SABA) only or inhaled corticosteroid plus salbutamol therapies (ICS/SABA).

The currently funded brands of budesonide with eformoterol combination ICS/LABA inhalers are Symbicort Turbuhaler, DuoResp Spiromax (dry powder inhalers) and Vannair (metered dose inhaler).

• See the Medsafe datasheets for Vannair [PDF](external link), DuoResp [PDF](external link) and Symbicort [PDF](external link) for more information.
• The following presentations are Medsafe approved for SMART/AIR Therapy – Symbicort 100/6 Turbuhaler, Symbicort 200/6 Turbuhaler, DuoResp Spiromax 200/6.

AIR/SMART therapy

The NZ Adolescent and Adult Asthma Guidelines(external link) provide simple, practical and evidence-based recommendations for the diagnosis, assessment and management of asthma in adolescents and adults (aged 12 and over) in a quick reference format.

It introduces the terminology ‘anti-inflammatory reliever (AIR)’ therapy to describe the use of budesonide/formoterol as a reliever medication, taken as-needed with or without regular maintenance budesonide/ formoterol therapy.

This approach encompasses and extends the ‘Single combination ICS/LABA inhaler Maintenance And Reliever Therapy’ (SMART) approach - The combined budesonide/formoterol inhaler taken regularly, with an additional dose taken as-needed to relieve symptoms in moderate and severe asthma.

Three-monthly dispensing

Pharmaceuticals identified on the Community Pharmaceutical Schedule (Section B) with the ❋ symbol are able to be dispensed all at once, which is generally 90 days (three months). We anticipate that enabling three-monthly dispensing for some presentations of budesonide with eformoterol inhalers would provide greater flexibility for people to access their inhalers.

Practitioners Supply Order (PSO)

The PSO list is a list of pharmaceuticals which can be ordered by any prescriber (within their scope of practice). The purpose of the PSO mechanism is to ensure that stock is available for all general practices for:

• emergency use,
• teaching and demonstration purposes,
• provision to certain patient groups where an individual prescription is not practical, or
• products that require specialist administration.

We note that salbutamol and ipratropium inhalers are currently available on PSO.

Why we’re proposing this

Currently budesonide with eformoterol inhalers are funded on prescription and people need to collect their treatment every month.

We have heard from healthcare professionals that enabling three-monthly dispensing would allow patients to receive their prescribed inhaler amount at their first dispensing instead of returning to the pharmacy to collect repeats. Three-monthly dispensing is proposed to reduce barriers for some people, enabling them to have inhalers available where they are most likely to use them, supporting adherence to treatment. 

We have also heard from healthcare professionals and advocacy groups, who have indicated strong support for all brands of budesonide with eformoterol being available on PSO, to help support a transition towards AIR and SMART therapies. Support and alignment to the asthma guidelines is why we are proposing making these changes for some budesonide with eformoterol inhalers only and not looking at making changes to other inhalers at this time. We are only proposing to make the changes to the 100/6 and 200/6 budesonide/eformoterol inhalers because these strengths are used in AIR and SMART therapies.

Dispensing the budesonide with eformoterol inhalers that are used in AIR and SMART therapies in greater quantities than one month supply (three-monthly dispensing) was recommended for funding by the Respiratory Advisory Committee in October 2021.

Our clinical advisors noted that, based on the 2020 updates to the NZ asthma guidelines for mild-moderate asthma, Pharmac has been requested to make a change to enable an increase in the dispensing quantities, frequencies and funding of budesonide with eformoterol inhalers to align with this shift in treatment paradigm.

The Subcommittee considered that a change to enable three-monthly dispensing for the budesonide with eformoterol inhalers that are used for AIR and SMART therapies would help facilitate this change and align with the new guidelines.

In addition, the Subcommittee also considered that enabling primary care providers to provide budesonide with eformoterol inhalers that are used in AIR and SMART therapies on a practitioner’s supply order would help facilitate implementation of the 2020 update to the NZ Adolescent and Adult Asthma guidelines. We also note that this change would avoid people requiring emergency treatment being provided a salbutamol only inhaler by their health-care provider, which doesn’t align with the asthma guidelines.

Application tracker | Budesonide with eformoterol Inhalers on STAT and PSO(external link)

Respiratory disease (including asthma) is highlighted in the Government Policy Statement on Health 2024-2027(external link) as one of five non-communicable diseases that needs to be prevented and reduced.  

Details about our proposal

From 1 August 2025, budesonide with eformoterol would be listed in Section B of the Pharmaceutical Schedule as follows (stat and PSO quantities shown in bold):

To provide feedback

Send us an email: consult@pharmac.govt.nz or complete our online form by 4pm Friday 9 May 2025.

All feedback received before the closing date will be considered by Pharmac’s Board (or its delegate) prior to making a decision on this proposal.

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