Proposal to fund ramipril

What we’re proposing

We’re proposing to fund ramipril without restriction. This would mean that ramipril could be prescribed for any relevant use.  

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor medicine used to treat high blood pressure, heart failure and kidney failure.

Currently about 350,000 people use one of the six funded ACE inhibitor medicines(external link).  

As part of Pharmac’s Annual Tender process, we have sought supply of ramipril as an alternate ACE inhibitor to provide an option for patients transitioning away from cilazapril. As the Tender process is still in progress, the brands, pricing and timings are still to be determined.

To provide feedback

Consultation is a very important step in our process. When providing consultation feedback, you might want to think about the following:

• How we can help prescribers know about the availability of ramipril
• Cilazapril tablets are planned to be discontinued in mid-2023 [note: delisting date now planned for mid 2024]

Send us an email: consult@pharmac.govt.nz by 4pm Friday 22 July 2022.

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.

What would the effect be?

It is proposed that ramipril capsules would be fully funded without restriction. This would mean that ramipril could be prescribed for any relevant use.

We anticipate that up 100,000 New Zealanders may benefit from this new medicine.

As previously communicated on 10 May 2021, we are aiming to reduce the risk of supply issues and are asking prescribers to move away from the use of cilazapril.

The clinical advice we have received indicates that ramipril may be a suitable  funded alternative to cilazapril, and as an addition to the available ACE inhibitors which patients could take.

• You can read more about cilazapril supply here

Who we think will be interested

• People with high blood pressure, heart failure, kidney disease and heart disease and their whānau.
• People currently using cilazapril (Zapril).
• Healthcare professionals who treat people with high blood pressure, heart failure, kidney disease and heart disease.
• Hospital and community pharmacists, DHBs and wholesalers.
• Suppliers of pharmaceuticals to the New Zealand market.

About ramipril

Ramipril belongs to a group of medicines called angiotensin-converting enzyme (ACE) inhibitors which are used to treat a variety of conditions.

Ramipril may be used for the following conditions:

• High blood pressure 
• Heart failure 
• Progressive kidney disease 
• The prevention of cardiovascular events in patients with heart disease

Ramipril is the second most prescribed ACE inhibitor in Australia and is a commonly prescribed medicine throughout the world.

Ramipril comes in the form of a capsule rather than a tablet form.

Other funded ACE inhibitors in New Zealand are all tablets.(external link)

Ramipril would be a Medsafe approved medicine.

Why we’re proposing this

Cilazapril (another ACE inhibitor) is used in New Zealand more than any other country. In recent years approximately 60% of patients in New Zealand on an ACE inhibitor were prescribed cilazapril. There is only one place in the world that makes the active ingredient for cilazapril. Therefore, if there were a manufacturing or supply issue that affected New Zealand’s supply, it would be difficult for us to be able to source enough cilazapril for everyone who takes it.

To reduce the risk of this happening, we have been actively supporting people to move away from using cilazapril. Our first step was to initiate educational activity to encourage the use of alternate medicines, the second step was to stop new people starting on cilazapril, this was implemented in May 2021.

To further support the transition away from cilazapril, we asked our clinical advisors about what other medicines would be appropriate. The clinical advice we received identified that ramipril would be a suitable alternative. We included ramipril in the 2020/21 Annual Invitation to Tender and would look to progress this proposal via the tender process.

We consider that the availability of ramipril would ensure that a suitable medicine would be available for New Zealanders who need it and it would also strengthen the continuity of supply of ACE inhibitors in New Zealand.

Details about our proposal

Ramipril cap 1.25 mg, 2.5 mg, 5 mg and 10 mg would be listed in Section B and in Part II of Section H of the Pharmaceutical Schedule from 1 November 2022 as follows:

Chemical	Presentation	Brand	Pack size
Ramipril	Cap 1.25 mg	TBC	30
Ramipril	Cap 2.5 mg	TBC	30
Ramipril	Cap 5 mg	TBC	30
Ramipril	Cap 10 mg	TBC	30

We anticipate ramipril would be available from November 2022 and the supplier, as a result of the tender, would hold Principal Supply Status (PSS) until 30 June 2024. There would be an Alternative Brand Allowance (ABA) of 5%, which means that 5% of ramipril purchased in hospitals and the community could be a brand that is not the listed brand.

The price and subsidy for the confirmed brand of ramipril would be notified should Pharmac decide to progress the proposal following consideration of consultation feedback. The supplier would work with wholesalers to ensure a smooth transition to the new listing.

To provide feedback

Send us an email: consult@pharmac.govt.nz by 4pm Friday 22 July 2022.

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.

Your feedback may be shared

Feedback we receive is subject to the Official Information Act 1982 (OIA). Please be aware that we may need to share your feedback, including your identity, in response to an OIA request. This applies to anyone providing feedback, whether they are providing feedback themselves or for an organisation, in a personal or professional capacity.

We can only keep feedback confidential as allowed under the OIA and other related laws. If you want any part of your feedback treated as confidential, you need to tell us. Please let us know if you want to keep part of your feedback confidential, and why. Is it commercially sensitive, confidential or proprietary, or personal information? Clearly state this and tell us which parts of your feedback you want to keep confidential for these reasons. We will consider your request under our OIA requirements.