Agreements for influenza vaccine approved

Medicines

Decision

PHARMAC is pleased to announce the approval of agreements with GlaxoSmithKline (GSK) and Abbott Laboratories (Abbott) for the supply of influenza vaccine for the 2014, 2015 and 2016 influenza seasons.

This was the subject of a consultation letter dated 20 August 2013[1].

In summary, GSK will supply 250,000 doses of Fluarix each season, and the remainder of the funded market demand in each season will be met with Influvac, supplied by Abbott.

All brands of influenza vaccine subsidised for eligible patients and for vaccines directly purchased by DHB Hospitals, will be subject to a confidential rebate arrangement.

Details of the decisions

Following a request for proposals issued in April 2013, PHARMAC has entered into agreements with Abbott and GSK for the supply of influenza vaccine. We anticipate ordering and delivery practices will broadly be the same as in the past, with Healthcare Logistics continuing to be the distributor for both brands.

We will provide more details of how ordering for these vaccines will be managed closer to the start of the funded influenza vaccine season.

Fluarix

The listing of the Fluarix brand of influenza vaccine in Section I (National Immunisation Schedule) of the Pharmaceutical Schedule will remain. Fluarix will be newly listed in Part II of Section H of the Pharmaceutical Schedule from 1 January 2014 as follows:

Chemical and presentation Brand
(Supplier)
Pack size Subsidy and price
(ex-man., ex. GST)
Influenza vaccine inj 45 mcg in 0.5 ml syringe Fluarix
(GSK)
10 $90.00

Influvac and Influvac Junior

The Influvac brand of influenza vaccine will be listed in Section I (National Immunisation Schedule) and Part II of Section H of the Pharmaceutical Schedule from 1 January 2014 as follows:

Chemical and presentation Brand
(Supplier)
Pack size Subsidy and price
(ex-man., ex. GST)
Influenza vaccine inj 45 mcg in 0.5 ml syringe Influvac
(Abbott)
10 $90.00

The Influvac Junior brand of influenza vaccine is contracted but will not be listed in Section I (National Immunisation Schedule) and Part II of Section H of the Pharmaceutical Schedule from 1 January 2014. The National Influenza Specialist Group (NSIG) noted that listing this product could potentially cause confusion. The Influvac Junior could be listed in later years.

Fluvax

The Fluvax brand of influenza vaccine will be delisted from Section I (National Immunisation Schedule) of the Pharmaceutical Schedule on 1 January 2014:

Chemical and presentation Brand Supplier Pack size
Influenza vaccine inj Fluvax CSL 10

Feedback received

We appreciate all of the feedback that we received and acknowledge the time people took to respond. All consultation responses received by 3 September 2013 were considered in their entirety in making a decision on the proposed changes.

The following issues were raised in relation to specific aspects of the proposal:

Theme Comment

Need for Influvac Junior is not obvious and may lead to reduced immunogenicity amongst infants, toddlers and children.

The current funding criteria allow children aged four years and under with respiratory illness to have funded access to an influenza vaccination. We appreciate that the adult dose influenza vaccine is not appropriate for children and an amount has to be discarded (i.e. half).

Choice of vaccine for occupational health use within DHBs.

 

PHARMAC is not responsible for the choice of vaccine made by the occupational health departments within DHBs. 

 

DHBs are eligible for the rebate on all DHB purchases of the influenza vaccine contracted by PHARMAC which would include occupational health usage.

All vaccines should have the longer needle length (25mm).

PHARMAC staff will continue to work with suppliers to standardise appropriate needle length.

Longer needle length would not suit all ages and having pre-filled syringes without a fixed needle would be preferred.

The Centres for Disease Control and Prevention, Ministry of Health New Zealand and the World Health Organisation support the longer needle length for effective intramuscular delivery and reduced reactogenecity. [2],[3],[4]

Influvac and Influvac Junior may not be appropriate for children, due to issues around febrile reactions.

Fluarix would remain listed as a result of this proposal. PHARMAC would seek further advice from the Immunisation Subcommittee as to the need to manage use of Fluarix stock to ensure there are sufficient supplies for children.  

Introduction of a junior dose would require considerable education and training, to reduce risk of under-vaccinating.

 

Inflvuac Junior will not be listed in the Pharmaceutical Schedule from 1 January 2014. The Influvac Junior could be listed in later years.  

PHARMAC should widen the criteria for those who can claim for funded Influenza vaccine to include Nurse Practitioners, Authorised Vaccinators (Nurses) and Approved Vaccinators (Pharmacists); this will improve access for some hard-to-engage populations.

The decision to widen the pool of vaccinators who can claim an immunisation benefit is a matter for the Ministry of Health and would require a change to the claims system overall.

More information

If you have any questions about this decision, you can call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 66 00

[2] Centers for Disease Control and Prevention (CDC). Administering Vaccines: Dose, Route, Site, and Needle Size. 2009. http://www.immunize.org/catg.d/p3085.pdf(external link) Accessed 13 August 2013;

[3] Ministry of Health. 2011. Immunisation Handbook 2011 (pp. 59-65). Wellington: Ministry of Health.

[4] World Health Organization (WHO). Module 6: Holding an immunization session. In: Immunization in Practice: A practical resource guide for Health workers. 2004 Update. 2004. http://whqlibdoc.who.int/publications/2004/9241546514_(Module6).pdf(external link) Accessed 13 August 2013