Proposal to award sole supply for apomorphine hydrochloride

Medicines

Consultation Closed

We are proposing to make changes to the funding of apomorphine hydrochloride, a medicine used to treat advanced Parkinson’s disease, through an agreement with Stada.

What we’re proposing

In summary: 

  • The Movapo brand of apomorphine 10 mg/ml, 2 ml ampoule would remain funded. 
  • A new apomorphine 10 mg/ml, 5 ml ampoule would be funded from 1 February 2020. 
  • Consumables for continuous infusion and intermittent injection would be available to patients free of charge from 1 January 2020. 
  • The infusion pump would continue to be supplied to patients, on loan, free of charge and patients would continue to receive the education and nursing support service provided by Stada. 
  • The net cost of Movapo 2 ml ampoule would be reduced from 1 January 2020 and Movapo would be the only funded brand of apomorphine hydrochloride until 30 June 2023. 

This proposal results from a competitive process for the supply of funded apomorphine. In addition to funding a new ampoule size and providing funded consumables for patients for the first time, it would free up significant funds over the next 5 years; money that PHARMAC could use to fund other medicines for New Zealanders. 

Feedback to this consultation will help us decide if this proposal should be approved. Consultation closes at 5pm on 13 November 2019 and feedback can be emailed to procurement@pharmac.govt.nz.

What would the effect be?

For patients

Patients would continue to access funded apomorphine.

Patients would continue to order their consumables from the current wholesaler; however, the cost of purchase of these would now be met by Stada as a result of the funding agreement with PHARMAC. Any patients who are accessing consumables from their hospital would be able to order them, free of charge, direct from the wholesaler.

The infusion pump would continue to be provided to patients, on loan, free of charge.

The education and nursing support service currently provided would continue to be provided to patients free of charge.

Patients would have access to a 5 ml ampoule size from 1 February 2020 (in addition to the 2 ml ampoule). This would mean that patients who are using an infusion pump would have less ampoules to open when loading their pump with their daily dose.

For community pharmacies

In addition to the current 2 ml presentation, a larger ampoule size 5ml of apomorphine hydrochloride would be subsidised from 1 February 2020 in Section B of the Pharmaceutical Schedule.

Movapo would be the only funded brand of apomorphine hydrochloride in both the community and hospital settings from 1 January 2020 until 30 June 2023.

For hospital pharmacies

From 1 February 2020, an additional 5 ml ampoule presentation would be listed in Part II of Section H in the Pharmaceutical Schedule

Movapo would be the only funded brand of apomorphine hydrochloride in both the community and hospital settings from 1 January 2020 until 30 June 2023. A discretionary variant (DV) limit of 1% would apply in DHB hospitals, meaning that only 1% of total purchases of the relevant presentation of apomorphine hydrochloride could be a brand other than Movapo.

For prescribers

Prescribers would continue to prescribe funded apomorphine hydrochloride as they do now.

From 1 February 2020 prescribers would be able to prescribe a new 5 ml ampoule size of apomorphine hydrochloride 10 mg/ml.

The education and nursing support service currently provided would continue to be provided and patient education would continue to be provided.

For DHBs

From 1 January 2020, the net cost of apomorphine hydrochloride inj 10 mg per ml, 2 ml ampoule would reduce.

The provision of continuous infusion and intermittent injection consumables would be available to patients free of charge from 1 January 2020.

Who we think will be interested

  • People currently using apomorphine and their family, whānau or caregivers
  • Consumer support groups for people living with Parkinson’s disease
  • Clinicians who treat people with Parkinson’s disease (neurologists, general practitioners, nurse specialists, clinician groups)
  • Hospital and community pharmacists, DHBs, and wholesalers
  • Suppliers of apomorphine

About apomorphine

Apomorphine is a direct acting dopamine receptor agonist, structurally related to dopamine and is typically used in the advanced stages of Parkinson’s disease. Some patients receive apomorphine as intermittent subcutaneous injections. However, as Parkinson’s progresses symptoms tend to fluctuate and, as a result, patients may switch to apomorphine continuous infusion. These patients may continue to begin the day with a bolus dose followed by a continuous infusion set by a pump (provided by the supplier). 

Apomorphine hydrochloride inj 10 mg per ml, 2 ml ampoules are currently listed in Section B and Part II of Section H of the Pharmaceutical without restrictions.

Why we’re proposing this

PHARMAC released a Request for Proposal (RFP) for the supply of apomorphine hydrochloride, infusion pumps, dedicate pump syringes (if applicable) and associated consumables in the community and DHB Hospitals on 10 May 2019. 

Read the Request for Proposal 

In September 2016, the Neurological Subcommittee provided clinical advice regarding a commercial process for apomorphine. Full details of the minutes are available on the PHARMAC website. The RFP process took the advice into account. 

Read the minutes of the subcommittee [PDF, 260 KB]

As a result of the RFP, PHARMAC has entered into a provisional agreement with Stada Pharmaceuticals Australia Pty Limited for the sole supply of apomorphine hydrochloride inj 10 mg per ml, 2 ml and 5 ml ampoules. The provision of continuous infusion and intermittent injection consumables would be available to patients free of charge from 1 January 2020. 

This proposal would release significant funds for PHARMAC to invest in other medicines for the benefit of New Zealanders. Feedback on this consultation will help us decide if this agreement should be confirmed. 

Details about our proposal

There would be no change to the brand of apomorphine hydrochloride (Movapo) inj 10 mg per ml, 2 ml ampoule in Section B and Part ll of Section H of the Pharmaceutical Schedule. A net price reduction would apply from 1 January 2020. 

From 1 February 2020 a new presentation of apomorphine hydrochloride (Movapo) inj 10 mg per ml, 5 ml ampoule, 5 inj pack, would be listed in Section B and Part ll of Section H of the Pharmaceutical Schedule. The price and subsidy would be notified should PHARMAC decide to progress the proposal following consideration of consultation feedback. 

Consumables for continuous infusion and intermittent injection would be supplied to patients free of charge. Patients who order their own consumables would continue to order them via their usual wholesaler, but the cost would be met by Stada as a requirement of the funding agreement with PHARMAC. These consumables would be delivered direct to patients. Patients who currently have consumables supplied by DHBs would be contacted by Stada representatives and full training would be given on how to order consumables. 

The following consumables would be provided free of charge:

  • Crono Syringe and Needle
  • Insulin Syringe and Needle
  • Soft-Glide Infusion Line
  • Saline Ampoules 

Infusion pumps would continue to be supplied to patients, on loan, free of charge. 

From 1 January 2020, Movapo would be awarded Sole Subsidised Supply status in the community and Hospital Supply Status (the only available brand of apomorphine in DHB Hospitals, subject to a 1% DV limit) until 30 June 2023. 

For the avoidance of doubt, Movapo 5 ml ampoule (10 mg/ml) would have community Sole Subsidised Supply status and Hospital Supply Status from the date of listing on 1 February 2020. 

To provide feedback

Send us an email: jeremy.price@pharmac.govt.nz  by 5pm 13 November 2019.

All feedback received before the closing date will be considered by PHARMAC’s Board (or its delegate) prior to making a decision on this proposal. 

Feedback we receive is subject to the Official Information Act 1982 (OIA) and 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.