Decision to increase the subsidy for methenamine (hexamine) hippurate tablets and flecainide acetate injection

8 November 2019

Medicines Decision

We’re pleased to announce a decision to increase the subsidy payable for two currently funded treatments through an agreement with Radiant Health Limited from 1 December 2019.

This means that:

methenamine (hexamine) hippurate (Hiprex) tablets, which are used for preventing recurrent urinary tract infections, will become fully funded
flecainide acetate (Tambocor) injection, which is used for the treatment and diagnosis of heart conditions, will remain fully funded

Any changes to the original proposal?

This decision was subject to a consultation letter dated 18 October 2019

The proposal was approved as consulted on without any changes. However, as a result of consultation feedback, the chemical description for hexamine hippurate will be changed to methenamine (hexamine) hippurate in the Pharmaceutical Schedule to align with current naming conventions.

No other changes were made to this proposal as a result of consultation feedback.

Who we think will be most interested

People who have recurrent urinary tract infections and their whānau
People who are being treated with flecainide acetate injection and their whānau
General physicians, physicians for the elderly, infectious diseases physicians, gynaecologists, urologists, cardiologists, intensive care specialists, other clinicians involved in the management of either acute heart arrhythmias or recurrent urinary tract infections
Community and hospital pharmacists
Primary care prescribers
Aged care residential facilities
Pharmaceutical suppliers

Our response to what you told us

We’re really grateful for the time people took to respond to this consultation.

A summary of the main themes raised in feedback, our responses to the feedback received, and changes we have made as a result of this process are set out below.

Theme	PHARMAC Response
Supportive of the proposal for methenamine (hexamine) hippurate, in particular noting a preference for use within the context of anti-microbial resistance concerns.	We note that prevention and control of anti-microbial resistance is a health priority in New Zealand and consider that this funding decision will contribute to this priority.
Noted that the current naming convention for hexamine hippurate is methenamine hippurate.	Medsafe also refers to the chemical as methenamine and we consider there would be benefit in applying consistency in nomenclature. Accordingly, the description of the chemical in the Pharmaceutical Schedule will be changed to methenamine (hexamine) hippurate.
Concern about the evidence supporting the use of methenamine (hexamine) hippurate and the risk of adverse events. Suggestion that guidance be given to prescribers regarding appropriate use of this medicine.	We note that methenamine (hexamine) hippurate has been listed on the Pharmaceutical Schedule without restriction for some time so clinicians are likely to be familiar with the product. However, in light of this feedback, we will consider the possibility of providing prescribers guidance regarding the appropriate use of this medicine as part of PHARMAC’s work promoting responsible use of medicines. We will continue to review the role of methenamine (hexamine) hippurate as part of our standard review processes.

Theme

PHARMAC Response

Supportive of the proposal for methenamine (hexamine) hippurate, in particular noting a preference for use within the context of anti-microbial resistance concerns.

We note that prevention and control of anti-microbial resistance is a health priority in New Zealand and consider that this funding decision will contribute to this priority.

Noted that the current naming convention for hexamine hippurate is methenamine hippurate.

Medsafe also refers to the chemical as methenamine and we consider there would be benefit in applying consistency in nomenclature. Accordingly, the description of the chemical in the Pharmaceutical Schedule will be changed to methenamine (hexamine) hippurate.

Concern about the evidence supporting the use of methenamine (hexamine) hippurate and the risk of adverse events. Suggestion that guidance be given to prescribers regarding appropriate use of this medicine.

We note that methenamine (hexamine) hippurate has been listed on the Pharmaceutical Schedule without restriction for some time so clinicians are likely to be familiar with the product. However, in light of this feedback, we will consider the possibility of providing prescribers guidance regarding the appropriate use of this medicine as part of PHARMAC’s work promoting responsible use of medicines.

We will continue to review the role of methenamine (hexamine) hippurate as part of our standard review processes.

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.