Consultation on proposed 2022/23 Invitation to Tender: For healthcare professionals

Medicines Tender Closes 25 Aug

Te Pātaka Whaioranga – Pharmac is seeking feedback from healthcare professionals, medical groups, hospital pharmacies, and other interested parties on the contents of the 2022/23 Invitation to Tender.

We’re particularly interested in feedback on:

  • the appropriateness of a brand change for products included in the draft tender list
  • any particular usability or suitability requirements that should be considered when evaluating potential products
  • whether or not there are any particular clinical situations or patient circumstances for these products that might require delaying or avoiding a brand change
  • whether or not there would be any clinical issues or other consequences that should prevent us from either enabling all-at-once dispensing or removing any remaining funding restrictions.

Please contact us if you wish to discuss the proposals contained in this consultation.

We are also seeking feedback from the pharmaceutical industry and people who take medicines.

Although this consultation has been widely distributed, should you consider that a particular person, group, or agency should receive it and/or future tender documents, please let us know or share it with them directly.

All tender documents and consultations are available from the Pharmac website

Download a PDF version of this consultation

Consultation closes 5pm (New Zealand standard time) Thursday 25 August 2022

Email feedback to tender@pharmac.govt.nz

All feedback received before the closing date will be considered by Pharmac’s Board or its delegate before finalising the 2022/23 Invitation to Tender.

Your feedback may be shared

Feedback we receive is subject to the Official Information Act 1982 (OIA). We will consider any request to have information withheld in accordance with our obligations under the OIA. Anyone providing feedback, whether 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.

About the tender

Pharmac’s annual tender is used to contract for supply of medicines that are already funded in New Zealand and are no longer under patent.

The tender helps to secure the ongoing supply of medicines and generates savings that can be used to fund new medicines. Each year, a portion of the medicines on the Schedule is included in the annual tender. This means that, although the tender is run annually, the list of medicines included in it changes from year to year. Typically, each medicine is put out to tender every three years.

Before we run the annual tender, we seek feedback from clinicians, patient advocacy groups, the pharmaceutical industry, and others. This helps ensure that:

  • tendering is appropriate for each medicine
  • we are alerted to any potential issues when considering a change in brand for a particular product.

We get expert advice on every decision we make from Pharmac’s Tender Clinical Advisory Committee.

The committee is made up of medical practitioners, nurse practitioners, and pharmacists. We’ll also seek further advice from specialists in particular fields, such as oncology, psychiatry, and neurology, as appropriate.

What the tender means

If we award a tender for a medicine to a pharmaceutical supplier, then that supplier’s brand becomes the principal brand of that medicine. It would likely be the only brand of that medicine funded in the Schedule (Principal Supply Status) until 30 June 2026.

If that brand was already the only funded brand, there would be no noticeable difference for most people, although the price that Pharmac (or hospitals) pay may change.

If that brand was not currently listed on the Schedule, we would change from the old brand to the new one over time. This involves:

  • We would inform the sector of the upcoming change, at least 1 month before any changes occurred.
  • Then the new brand would be listed in the Schedule, meaning that both the old and new brands would be available and funded.
  • Five months later, the old brand would be removed from the Schedule.

Access to other brands

We expect that most people will start on, or transition to, the new brand easily. However, we know that people’s experiences will differ. The alternative brand allowance lets us support people who may experience, or are at heightened risk of, adverse clinical outcomes from a brand change. This may mean either:

  • moving back to the old brand after adverse side effects or reduction in efficacy after trialling the new brand
  • having a longer period of time in which to change brands
  • allowing some patients to avoiding switching altogether.

The tender gives Pharmac the flexibility to fund alternative brands in different ways. In hospitals, for example:

  • In hospitals, we expect to continue to use the Discretionary Variance provisions in the Schedule. This lets hospitals purchase alternative brands up to a certain percent of volume, typically 5 percent.
  • In the community, alternative brands could be funded through:
    • listing (or maintaining the listing of) other brands under strict Special Authority criteria, or
    • managing case-by case approvals through our exceptional circumstances framework.

While Pharmac can fund alternative brands, continued supply of a particular alternative brand cannot always be guaranteed. It is helpful to understand what products might need greater access to alternative brands before we run the tender.

We are keen to understand:

  • which medicines, indications, or patient groups might need funding for an alternative brand and, if so, why?
  • whether or not you consider that clinical destabilisation can be objectively determined in those circumstances and, if so, how?

Other potential changes

Because the tender can result in substantial price reductions, it often means that savings made can be used to fund new medicines. However, these price reductions can also lead to other changes for the tendered products. For example:

  • if the product is currently partially funded (people pay a part-charge in addition to the prescription co-payment), it could become fully funded after the tender
  • we may make it easier for people to have their prescriptions filled all at once (rather than in monthly lots) by adding a product to the ‘stat’ dispensing list
  • if funding criteria apply to a product (for example, a Special Authority restriction, endorsement, or prescriber-type restriction), we might change or remove funding restrictions to enable more people to use it.

We are interested in your feedback on the clinical appropriateness of these potential changes. You can see the Pharmaceutical Schedule for all dispensing and funding restrictions: schedule.pharmac.govt.nz/latest/Schedule.pdf(external link)

The tender list

The list of medicines that we are proposing to include in this year’s Invitation to Tender is attached below.

Most of the items in the tender have been included in the annual tender before. However, the following products that have not been tendered previously.

  • Cyproterone acetate with ethinyloestradiol – Tab 2 mg with ethinyloestradiol 35 mcg
  • Macrogol 3350 with sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid – Powder for oral soln
  • Metaraminol tartrate – Inj 0.5 mg per ml, 5 ml
  • Metaraminol tartrate – Inj 0.5 mg per ml, 20 ml
  • Metaraminol tartrate – Inj 1 mg per ml, 10 ml
  • Triamcinolone acetonide – Inj 40 mg per ml, 1 ml preservative-free

Medicines have been listed in groups according to the therapeutic group classification system used in the Pharmaceutical Schedule. Below is a list of these groups, and the corresponding page numbers. Medicines with indications that may apply to multiple therapeutic groups only appear in one group.

Therapeutic group

Pages

Alimentary Tract and Metabolism

7-8

Blood and Blood Forming Organs

8

Cardiovascular System

8-9

Dermatologicals

9-10

Genito-Urinary System

10-11

Hormone Preparations

11

Infections – Agents for Systemic Use

11-13

Musculoskeletal System

13

Nervous System

13-15

Oncology and Immunosuppressants

15-16

Sensory Organs

16-17

Information provided for each medicine

For each medicine (as defined by chemical name, form, and strength), we have provided:

  • the current ex-manufacturer subsidy per unit of measure as of 1 July 2022
  • the number of subsidised or partially subsidised units sold in the community in the year ending 30 June 2022
  • an estimate of the annual community market value at current subsidies (estimated by multiplying the volume of units subsidised in the year ending 30 June 2022 by the relevant listed unit subsidy as of 1 July 2022)
  • comments specifically relating to the tender item and/or its current listing on the Pharmaceutical Schedule.

Hauora Arotahi Māori health areas of focus

Pharmac is continually working to develop and implement advances in Hauora Arotahi to support equitable health outcomes for Māori.

Pharmac’s Māori health areas of focus voiced by whānau Māori are available here.

The draft 2022/23 tender includes treatments for mental health, diabetes, heart health (such as medicines to treat high blood pressure and prevent stroke), respiratory health, and cancer (lung and breast), outlined in tables below.

Chemical Name

Line Item

Cancer – lung and breast

Anastrozole

Tab 1 mg

Gemcitabine hydrochloride

Inj 1 g

Paclitaxel

Inj 100 mg

Inj 300 mg

Tamoxifen citrate

Tab 10 mg

Tab 20 mg

 

Chemical Name

Line Item

Heart health – high blood pressure and stroke

Ambrisentan

Tab 5 mg

Tab 10 mg

Amlodipine

Tab 2.5 mg

Tab 5 mg

Tab 10 mg

Bisoprolol fumarate

Tab 2.5 mg

Tab 5 mg

Tab 10 mg

Clonidine

TDDS 2.5 mg, 100 mcg per day

TDDS 5 mg, 200 mcg per day

TDDS 7.5 mg, 300 mcg per day

Indapamide

Tab 2.5 mg

Losartan

Tab 12.5 mg

Tab 25 mg

Tab 50 mg

Tab 100 mg

 

Chemical Name

Line Item

Mental health

Amitriptyline

Tab 10 mg

Tab 25 mg

Tab 50 mg

Diazepam

Tab 2 mg

Tab 5 mg

Escitalopram

Tab 10 mg

Tab 20 mg

Olanzapine

Tab 2.5 mg

Tab 5 mg

Tab 10 mg

Orodispersible tab 5 mg

Orodispersible tab 10 mg

Quetiapine

Tab 25 mg

Tab 100 mg

Tab 200 mg

Tab 300 mg

Risperidone

Tab 0.5 mg

Tab 1 mg

Tab 2 mg

Tab 3 mg

Tab 4 mg

 

Explanation of terms, symbols, and abbreviations

Most terms and abbreviations used are self-explanatory. “Tab” means tablet, “cap” means capsule, “liq” means liquid, “inj” means injection, “suppos” means suppository, “grans” mean granules and “OP” means original pack to be dispensed.

Symbols used in the draft tender list:

Symbol

Explanation

Underlined

Medicine line items where a sole supply or principal supply contract is in force are underlined. The price and subsidy for these medicines are fixed until 30 June 2022 unless otherwise stated in the comments column and a listing of a new brand could only occur after that date.

C

To be tendered for Principal Supply Status (community medicines).

H

To be tendered for Principal Supply Status (hospital medicines).

PCT

Pharmaceuticals Te Whatu Ora - Health New Zealand hospitals may claim a subsidy through Section B of the Pharmaceutical Schedule. 

+

Pharmac has been advised of the existence of a patent.

*

There is no fully funded product available for this line item (in relation to community supply).

@

Additional Stock Pharmaceuticals (ASP). The supplier of the successful tender bid would be required to hold additional stock.

#

A rebate currently exists.

Packaging preferences

In the last tender, we began introducing stronger packaging preferences for medicines for pack sizes and packaging types (such as bottles or blister packs). These changes support our focus on environmental sustainability and helping pharmacy workflow. This year we have included such preferences for 33 products. Details are included alongside affected products in Appendix One.

Key dates

  • 21 July 2022 – Consultation begins
  • 25 August 2022 – Consultation closes
  • September 2022 - Tender Clinical Advisory Committee meets
  • November 2022 – final Invitation to Tender released
  • January 2023 – earliest tender results announced