Decision to fund ceftriaxone in the community for suspected meningococcal disease

Medicines

Decision

PHARMAC has widened funded access to ceftriaxone to enable its use for the treatment of suspected meningococcal disease in the community. This change will be activated from 1 December 2018.

Following clinical advice received from the Ministry of Health and the Anti-Infective Subcommittee of PTAC, the following changes will be made to the listing of ceftriaxone injection in Section B of the Pharmaceutical Schedule:

  • the criteria for subsidy by endorsement will include the treatment of suspected meningococcal disease in any patient;
  • the number of vials of ceftriaxone available via a Practitioner’s Supply Order will increase from 5 vials to 10 vials.

This decision requires out of cycle changes to the Pharmaceutical Schedule. 

For the avoidance of doubt, there are no restrictions on the use of ceftriaxone injection in the hospital setting.

Who we think will be most interested

  • Community based prescribers and pharmacists
  • Members of the public

Detail about this decision

The following changes will occur in Section B of the Pharmaceutical Schedule from 1 December 2018 (changes in bold and strikethrough):

Ceftriaxone – Subsidy by endorsement

    1. Up to 510 Inj available on a PSO
    2. Subsidised only if prescribed for a dialysis or cystic fibrosis patient, or the treatment of gonorrhoea, or the treatment of pelvic inflammatory disease, or the treatment of suspected meningococcal disease, meningitis in patients who have a known allergy to penicillin, and the prescription or PSO is endorsed accordingly.

Details for Pharmacy

The Ministry of Health Sector Operations Group will be able to process claims for ceftriaxone inj 500 mg and 1 g vial as per normal.

Updating your software

These are the instructions from the sector and software vendors:

RxOne users: this listing will be automatically updated by RxOne. If for some unforeseen circumstance it does not happen, please refer to the e-Noticeboard on the RxOne Start Menu for instructions.

Toniq users: This late change is included in the automatic 1st December medicine update.

Why we're doing this

PHARMAC has been working closely with the Ministry of Health on options to protect the Northland community from meningococcal disease, particularly the meningococcal W (MenW) strain.

Earlier this week the Minister of Health announced a vaccination campaign targeting under five-year olds and 13 to 19-year olds will be implemented in Northland in response to the MenW outbreak that has been declared in the region. For more details see www.health.govt.nz/news-media/news-items/targeted-vaccination-programme-meningococcal-disease(external link)  and www.northlanddhb.org.nz/home/meningococcal/(external link).

PHARMAC has secured stock (over 20,000 doses) of Menactra to vaccinate these priority age groups and continues to assess requirements for further vaccine.

The Ministry of Health has also updated the recommended antibiotic for treatment of suspected meningococcal disease (meningitis or sepsis) via primary care.  This is because the MenW strain has been shown to have lower susceptibility to penicillin, but it has shown no resistance to ceftriaxone to date. Early treatment of meningococcal infection with either ceftriaxone or penicillin is of benefit, especially if there will be a delay for the patient to reach the Emergency Department.

Ceftriaxone is the preferred first-line treatment for all individuals and the maximum adult dose is 2 g daily (requiring 2 x 1 g vials).  Prior to our decision, ceftriaxone could currently only be given to patients allergic to penicillin who do not have a documented history of anaphylaxis to penicillin and only 5 vials were available on a PSO.

This decision to widen access to ceftriaxone in the community setting for the treatment of all suspected meningococcal disease and to increase the quantity available via a PSO will improve access to urgent treatment. This change will occur from 1 December 2018.

Feedback

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 66 00 50.