Decision to widen access to sunitinib for kidney cancer and change the funded brand

Medicines Decision

We are pleased to announce that from 1 February 2025, access to sunitinib will be widened for metastatic renal cell carcinoma (kidney cancer) with good prognosis.

As part of this decision:

  • the funded brand of sunitinib will change from Sunitinib Pfizer to Sunitinib Rex from 1 October 2025. Sunitinib Rex will have PSS from 1 March 2026 to 30 June 2027, meaning it will be the main funded brand during that time.
  • the eligibility criteria for pazopanib will be adjusted to allow for use when sunitinib cannot be tolerated.

The Government provided additional funding to Pharmac in June 2024 to fund new medicines and widen access to medicines that are already funded. The funding boost covers medicines for both cancer and non-cancer health conditions. This decision is a result of that budget increase.

Questions and answers about the funding boost

Who we think will be interested

  • People with cancer and their whānau and caregivers
  • Health professionals involved in the care of people with kidney cancer
  • Groups who support and advocate for people with kidney cancer
  • Health New Zealand I Te Whatu Ora and Te Aho o Te Kahu | Cancer Control Agency
  • Hospital pharmacies
  • Pharmaceutical suppliers and wholesalers

What does this mean for people?

From 1 February 2025, access to sunitinib will be widened for people with metastatic renal cell carcinoma (kidney cancer) with good prognosis. We will also adjust the eligibility criteria for pazopanib so that people can access a similar medicine if they are unable to tolerate sunitinib.

We anticipate that about 30 more people will receive sunitinib or pazopanib each year because of this decision.

From 1 October 2025, the funded brand of sunitinib will change from Sunitinib Pfizer to Sunitinib Rex. Sunitinib Rex will have Principal Supply Status from 1 March 2026 to 30 June 2027, meaning it will be the main funded brand during that time.

Our clinical advisors and other stakeholders told us that this brand change would be clinically appropriate, particularly as the current funded brand is also a generic medicine.

Any changes to the original proposal

This decision was subject to a consultation letter released on 12 July 2024.

We’re grateful to those who took the time to respond to our consultation. This is an important part of our decision-making process. It gives us the opportunity to listen to the voices of the community and acknowledge and respond to feedback. The feedback received was supportive of the proposal, and we have not made any changes.

Details about this decision

Widened access 

The eligibility criteria for sunitinib will be changed in Section B of the Pharmaceutical Schedule from 1 February 2025 as follows:

Initial application – (RCC) only from a relevant specialist or any relevant practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria:

All of the following:

  1. The patient has metastatic renal cell carcinoma of predominantly clear cell histology; and
  2. Any of the following:
    1. The patient is treatment naïve; or
    2. The patient has only received prior cytokine treatment; or
    3. The patient has only received prior treatment with an investigational agent within the confines of a bona fide clinical trial with has Ethics Committee approval; or
    4. Both:
      1. The patient has discontinued pazopanib within 3 months of starting treatment due to intolerance; and
      2. The cancer did not progress whilst on pazopanib; and
  1. The patient has an ECOG performance score of 0-2; and
  2. Sunitinib to be used for a maximum of 2 cycles.

Renewal – (RCC) only from a relevant specialist or any relevant practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications where there is no evidence of disease progression.

The eligibility criteria for pazopanib will be changed in Section B of the Pharmaceutical Schedule from 1 February 2025 as follows:

Initial application – only from a relevant specialist or any relevant practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications meeting the following criteria:

Either:

  1. All of the following:
    1. The patient has metastatic renal cell carcinoma of predominantly clear cell histology; and
    2. Either:
      1. The patient is treatment naïve; or
      2. The patient has only received prior cytokine treatment; and
    3. The patient has an ECOG performance score of 0-2; and
    4. The patient has intermediate or poor prognosis defined as:
      Any of the following:
      1. Lactate dehydrogenase level > 1.5 times upper limit of normal; or
      2. Haemoglobin level < lower limit of normal; or
      3. Corrected serum calcium level > 10 mg/dL (2.5 mmol/L); or
      4. Interval of < 1 year from original diagnosis to start of systemic therapy; or
      5. Karnofsky performance score of less than or equal to 70; or
      6. 2 or more sites of organ metastasis; and
      7. Pazopanib to be used for a maximum of 3 months; or
  2. All of the following:
    1. The patient has metastatic renal cell carcinoma; and
    2. The patient has discontinued sunitinib within 3 months of starting treatment due to intolerance; and
    3. The cancer did not progress whilst on sunitinib; and
    4. Pazopanib to be used for a maximum of 3 months.

Renewal – (RCC) only from a relevant specialist or any relevant practitioner on the recommendation of a relevant specialist. Approvals valid for 3 months for applications where there is no evidence of disease progression.

Similar changes will be made to Part II of Section H of the Pharmaceutical Schedule from 1 February 2025.

Brand change

Rex’s brand of sunitinib (brand name Sunitinib Rex) will be listed in both Section B and Part II of Section H of the Pharmaceutical Schedule from 1 October 2025 as follows:

Chemical and presentation

Brand (Supplier)

Pack Size

Current price and subsidy (Sunitinib Pfizer)

(ex-man., ex. GST)

Proposed subsidy and price (Sunitinib Rex)

(ex-man., ex. GST)

List date

Principal Supply Status date

Sunitinib cap 12.5 mg

Sunitinib Rex (Rex)

28

$208.38

$103.11

1 October 2025

1 March 2026

Sunitinib cap 25 mg

Sunitinib Rex (Rex)

28

$416.77

$203.15

1 October 2025

1 March 2026

Sunitinib cap 50 mg

Sunitinib Rex (Rex)

28

$694.62

$343.19

1 October 2025

1 March 2026

Sunitinib Rex will have Principal Supply Status from 1 March 2026 until 30 June 2027, meaning that it will be the main funded brand of sunitinib during that time.

Sunitinib Pfizer will be delisted from both Section B and Part II of Section H of the Pharmaceutical Schedule on 1 March 2026.

Our response to what you told us

Theme

Pharmac Comment

Requested wider access to sunitinib in second line for people who have self-funded other first line treatments.

We are currently consulting on a proposal to further widen access to sunitinib (closes Friday 24 January 2025) so it can be used at any stage of metastatic renal cell carcinoma treatment. If approved, access would be further widened from 1 April 2025.

Requested longer time periods to review for intolerance

We appreciate this feedback.

The criteria proposed were recommended by our clinical advisors [PDF, 636 KB]. The criteria are consistent with the previous criteria for access to sunitinib and pazopanib for those with intermediate or poor prognosis, which enabled people to move between treatments if they experienced intolerance. We have not amended this part of the criteria as a result of this feedback.

Requested that renewal criteria for no evidence of disease progression be removed.

We appreciate this feedback. The renewal criteria were recommended by our clinical advisors [PDF, 636 KB].

We are not able to consider treatment with sunitinib or pazopanib after disease progression as part of this proposal. And as a result, we have not amended the criteria at this time.

We would however be happy to consider a funding application for the continued use of these treatments after disease progression if there is evidence available to support their use in this setting.

More information about how to submit a funding application

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 660 050.