Change of access to funded Nicotine Replacement Therapy and the Emergency Contraceptive Pill

The proposal relates to two products that pharmacists can already sell to patients without a prescription:

• nicotine replacement therapy (NRT)
• the emergency contraceptive pill (levonorgestrel tablets) (ECP)

The proposal involves making amendments to the Pharmaceutical Schedule rules to allow pharmacists to independently authorise subsidy for certain pharmaceuticals. It does not involve any changes to prescribing rights or pharmacist scope of practice.

Some DHBs have established their own arrangements for the provision of NRT and the ECP through pharmacies in their area, outside of the Pharmaceutical Schedule. The proposed change would enable nationally standardised provision of these products through pharmacies across New Zealand.

Consultation closes at 5 pm on Friday, 18 August 2017 and can be emailed to consult@pharmac.govt.nz.

For patients

Patients would have an additional means of accessing these funded products.

For people wanting to quit smoking, the proposal would provide further opportunities for quit attempts by increasing the range of options for access to funded NRT, and in some cases, reducing the number of steps to get funded NRT.

For women seeking emergency contraception, the proposal would increase the number of options for timely access to the ECP. Pharmacies offering the service may be open at times when other healthcare providers are closed and may also be able to provide the ECP without women needing to make an appointment. This is important as the emergency contraceptive pill is most effective when taken as soon as possible, preventing:

• 95% of expected pregnancies when taken within 24 hours of intercourse
• 85% if taken within 24–48 hours
• 58% if taken within 48–72 hours

Should the change proceed, there may be a service charge for patients to obtain NRT or ECP at the pharmacy in addition to the co-payment. The service charge amount would depend on any agreements pharmacists reach with their DHB.

For community pharmacists

Community pharmacists would be able to claim for funded NRT and the ECP provided to patients without a prescription. This would not require any changes to prescribing rights or pharmacist scope of practice. Note that ECP can only be supplied without a prescription by a pharmacist who has completed an education programme accredited by the Pharmacy Council.

Individual DHBs would be able to decide whether to fund pharmacist consultation services for these products.

For prescribers (and existing providers of products in this proposal)

Existing mechanisms for access to these funded products would remain. NRT would continue to be available on prescription, Quitcard and Practitioner’s Supply Order (PSO). ECP would continue to be available on prescription and PSO.

For DHBs

The proposed change would better enable DHBs to implement pharmacy-based programmes for these products.

This proposal will be of interest to:

Community pharmacists, general practitioners, prescribers, sexual and reproductive health services, NRT providers, DHBs, PHOs, suppliers and wholesalers, people who may need to access nicotine replacement therapy or the emergency contraceptive pill.

NRT includes nicotine patches, lozenges and gum. Nicotine is classified in these forms as a general sale medicine. NRT is currently funded for up to three months’ supply on a prescription written by a doctor or prescriber authorised to prescribe NRT, and on a Quitcard written by a Quitcard provider.

The emergency contraceptive pill (levonorgestrel) is classified as a restricted (pharmacist-only) medicine and is currently funded on prescription (maximum 2 tablets) and PSO (maximum 5 tablets).

The Pharmaceutical Schedule provides for Government subsidy for a wide range of pharmaceuticals, many of which are not classified as prescription medicines. While a pharmacist may sell a number of these products without a prescription, they can generally only claim a Government subsidy on the basis of a prescription from a doctor or another health professional (or, in the case of NRT, when presented with a Quitcard). 

The New Zealand Health Strategy Road Map of Actions 2016 includes the guiding principles of:

• Collaborative health promotion, rehabilitation, and disease and injury prevention by all sectors
• Timely and equitable access for all New Zealanders to a comprehensive range of health and disability services, regardless of ability to pay.

The pharmacist workforce is well placed to support collaborative health promotion, and one example of this is the provision of NRT, however accessing NRT directly from a pharmacist is currently dependent on the patient’s ability to self-fund this. Should this proposal be accepted, enabling pharmacists to provide funded NRT may decrease barriers to accessing smoking cessation support.

Similarly, the pharmacist workforce already provides access to emergency contraception but this is through sale, or through dispensing the funded product on the prescription of another provider. Should this proposal be accepted, timely access to the subsidised emergency contraceptive pill could be facilitated for a larger number of women.

In addition, the proposed changes would assist DHBs in the development of pharmacy-based programmes for these products in a more consistent way across the country. 

From 1 October 2017, we propose to enable pharmacists to provide subsidised access to these pharmaceuticals that are already subsidised in the Pharmaceutical Schedule:

• Nicotine patches, lozenges and gum (nicotine replacement therapy - NRT)
• Levonorgestrel 1.5 mg tablets (the emergency contraceptive pill - ECP).

We propose making several changes to the wording of Section A of the Pharmaceutical Schedule to give effect to this proposal. These changes would define two ways of accessing subsidised pharmaceuticals:

1. Those with prescribing rights; and
2. Those with the right to provide a range of subsidised products (such as Quitcard providers, vaccinators and pharmacists).

The proposed broad changes to wording of the rules are as outlined below:

• We would add a new definition of Prescribers into the rules, being those with legal prescribing rights, which includes medical practitioners, dentists, optometrists, nurse practitioners, midwives and designated prescribers, such as pharmacist prescribers, registered nurse prescribers and dietitians.
• The existing term Practitioners would relate to all prescribers, as well as those who do not have prescribing rights but may authorise a subsidy: Quit Card providers, vaccinators and pharmacists.
• Existing references to Practitioners would be amended to Prescribers for rules that relate to prescribing.
• This change would also clarify that only prescribers would be able to write Practitioner’s Supply Orders.
• A new rule would enable subsidised provision of products by a pharmacist for those products specified as such in Section B of the Schedule, and that supply should be consistent with the same rules that would apply to a prescription, such as period of supply and dispensing frequency.
• Minor amendments would be made to the rules relating to Quit Cards and Vaccinators to reflect the above changes.

Send us an email: consult@pharmac.govt.nz by 5 pm on Friday, 18 August 2017.

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.

Feedback we receive is subject to the Official Information Act 1982 (OIA) and we will consider any request to have information withheld in accordance with our obligations under the OIA. Anyone providing feedback, where on their own account or on behalf of an organisation, and whether in a personal or professional capacity, should be aware that the content of their feedback and their identity may need to be disclosed in response to an OIA request.

We are not able to treat any part of your feedback as confidential unless you specifically request that we do, and then only to the extent permissible under the OIA and other relevant laws and requirements. If you would like us to withhold any commercially sensitive, confidential proprietary, or personal information included in your submission, please clearly state this in your submission and identify the relevant sections of your submission that you would like it withheld. PHARMAC will give due consideration to any such request.