Decision to fund zoster vaccine

Medicines

Decision

PHARMAC is pleased to announce the approval of an agreement with Merck Sharpe & Dohme Limited to fund the zoster vaccine (Zostavax) for the prevention of shingles (herpes zoster) from 1 April 2018.

Zoster vaccine will be listed in Section I (National Immunisation Schedule) and in Part II of Section H of the Pharmaceutical Schedule for people aged 65 years, with a 2-year catch up programme for people aged between 66 and 80 years inclusive.

Any changes to the original proposal?

This was the subject of a consultation letter dated 15 September 2017. No changes have been made to the original proposal.

Who we think will be most interested

This decision will be of interest people 65 years and over, doctors in general practice, infectious disease specialists, geriatricians, opthalmologists, public health services, nurses, vaccinators, DHBs, consumer groups focused on the elderly such as Grey Power and Age Concern, rest homes and retirement villages, as well as organisations with an interest in immunisation.

What would the effect of this decision be?

From 1 April 2018 people aged 65 years would be able to get one funded zoster vaccine from their general practitioner.

There would also be a catch-up programme where, from 1 April 2018 until 31 March 2020, people aged between 66 and 80 years old would be eligible to receive a funded zoster vaccine.

Patients will be able to get their funded zoster vaccine from their general practitioner and people who meet the funding criteria can receive the zoster vaccine at the same time as their annual influenza vaccine.

Funded zoster vaccine will not be available through community pharmacies at this point, but this may be considered in the future.

Details of this decision

PHARMAC has entered into an agreement with Merck Sharp & Dohme (New Zealand) Limited to list Zostavax.

Zostavax would be listed in Section I (National Immunisation Schedule) and Part II of Section H of the Pharmaceutical Schedule from 1 April 2018 at the following price and subsidy (ex-manufacturer, excluding GST):

Chemical Presentation Brand Pack size Subsidy Manufacturer’s price (ex GST)
Varicella zoster virus (Oka strain) live attenuated vaccine Inj 19,400 PFU vial with a prefilled diluent syringe Zostavax 1 $0.00 $152.40
Varicella zoster virus (Oka strain) live attenuated vaccine Inj 19,400 PFU vial with a prefilled diluent syringe Zostavax 10 $0.00 $1524.00

A confidential discount on the manufacturer’s price will apply to Zostavax, reducing the net price to the Funder. Subsidy and delisting protection will apply until 30 June 2021.

Vaccines are distributed differently to most other pharmaceuticals The method for ordering Zostavax will be the same as other vaccines, i.e. Zostavax will be centrally purchased by PHARMAC’s nominated agent and distributed directly to vaccinators at no cost. Zostavax will be listed “Xpharm” with a $0.00 subsidy. An Xpharm listing means that pharmacies cannot claim subsidy because PHARMAC has made alternative distribution arrangements.

Zostavax will be listed in Section I and Part II of Section H of the Pharmaceutical Schedule with the following eligibility criteria:

Section I
Funded for patients meeting either of the following criteria:

  1. One dose for all people aged 65 years; or
  2. One dose for all people aged between 66 and 80 years inclusive from 1 April 2018 and 31 March 2020.

Section H
Restricted

Initiation – people aged 65 years
Therapy limited to 1 dose
One dose for all people aged 65 years.

Initiation – people aged between 66 and 80 years
Therapy limited to 1 dose
One dose for all people aged between 66 and 80 years inclusive from 1 April 2018 and 31 March 2020.

The Ministry of Health is responsible for supporting the implementation of changes to the National Immunisation Schedule and PHARMAC will work closely with the Ministry to ensure Zostavax would be available at a similar time to the start of the seasonal influenza vaccine programme.

Other changes associated with this proposal

As part of this proposal, from 1 January 2018, there will also be a price and subsidy reduction for alendronate sodium 70 mg tablets (Fosamax) and alendronate sodium with colecalciferol 70 mg with colecalciferol 5,600 iu (Fosamax Plus) in Section B and Part II of Section H of the Pharmaceutical Schedule as follows (prices are ex-manufacturer, excluding GST):

Chemical Presentation Brand Pack size Current price and subsidy# Proposed price and subsidy
Alendronate sodium Tab 70 mg Fosamax 4 $12.90 $4.82
Alendronate sodium with colecalciferol Tab 70 mg alendronate with colecalciferol 5,600 iu Fosamax Plus 4 $12.90 $4.82
# A confidential rebate applies.

Our response to what you told us

We appreciate all the feedback we received and are grateful for the time people took to respond to this consultation. All consultation responses received by 4 October 2017 were considered in their entirety when making the decision. The table below summarises the main themes raised in feedback:

If you have any questions, 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.

Theme PHARMAC Comment
Most respondents were supportive of the proposal to fund Zostavax for 65 year olds with a 2-year catch-up programme for individuals aged 66-80. Noted.
A number of respondents requested that Zostavax be funded for individuals aged younger than or older than 65 – 80 years old.

PHARMAC's Pharmacology and Therapeutics Advisory Committee considered the cost and benefits of when to vaccinate with Zostavax on several occasions and recommended that vaccination at 65 years was the best approach.

Clinical evidence shows there is a significant difference in the efficacy of Zostavax depending on the age of the person when they are vaccinated, with vaccine efficacy dropping to 18% in people who are aged over 80 years at the time of vaccination.

Further, Zostavax efficacy wanes over time, with protective efficacy estimated to be less than 5 years. If people were vaccinated when younger than 65 years of age they may not remain protected when they are older (when the incidence of herpes zoster and its complications becomes highest).

A small number of respondents noted that influenza vaccine season is a busy time for general practice and were concerned about the resources required to administer influenza vaccine during the same appointment as the zoster vaccine. PHARMAC understands that funding zoster vaccine may lead to a busy period for general practice. It is considered that the net overall health impact of the proposal would be positive, since vaccine uptake would reduce the incidence of shingles and more serious complications in older individuals (and thus the impacts on health services). The Ministry of Health team responsible for immunisation implementation is planning for the change.
Some respondents suggested that PHARMAC should instead fund GSK’s zoster vaccine, Shringrix. PHARMAC notes that Shingrix is not currently registered by Medsafe for sale in New Zealand. Although Shingrix was registered in the USA in September 2017, it is likely to be some time before Shingrix will be available for distribution in New Zealand.
Some respondents requested that funded zoster vaccine be available via community pharmacies since pharmacies currently offer Zostavax on the private market. PHARMAC is working closely with the Ministry of Health on changes that could allow vaccines, including Zostavax, to be administered by pharmacy in the community, as is the case with the seasonal influenza vaccine. A number of wider system changes would need to be implemented to enable this, including changes to the current vaccine distribution system.