Proposal to list mercaptopurine oral suspension

Medicines

Consultation Closed

What we’re proposing

PHARMAC is seeking feedback on a proposal to list mercaptopurine oral solution (Allmercap) 20 mg per ml from 1 June 2018, through a provisional agreement with Link Pharmaceuticals Limited.

Mercaptopurine oral solution is considered to be a more suitable formulation of mercaptopurine, compared with the currently funded tablet formulation, for young children who require low doses for the treatment of acute lymphoblastic leukaemia (ALL).

PHARMAC welcomes feedback on this proposal. To provide feedback, please submit it in writing by 5pm on Friday, 20 April 2018 to:

Andrew Park
Senior Therapeutic Group Manager
PHARMAC

Email: andrew.park@pharmac.govt.nz

What would the effect be?

Young children who require a dose of less than one full 50 mg mercaptopurine tablet per day for the treatment of their ALL would be eligible for treatment with the oral suspension.

Who we think will be interested

  • Health practitioners involved in the treatment of paediatric cancers
  • Parents and caregivers of young children with ALL
  • Hospital and community pharmacists, DHBs, suppliers and wholesalers

About mercaptopurine oral suspension

Allmercap oral liquid suspension contains 20 mg per ml mercaptopurine and is supplied in a 100 ml bottle with a bottle adaptor and both a 1 ml and 5 ml graduated measuring syringe. Allmercap has a shelf-life once opened of 56 days.

Allmercap is indicated for the treatment of ALL in paediatric patients.   More information can be found in the Medsafe datasheet.(external link)

Why we’re proposing this

Mercaptopurine is part of the standard treatment for ALL, which requires a long course of chemotherapy, but is highly curative, with the current five-year overall survival rate estimated at greater than 85%. The incidence of ALL peaks between 2 and 5 years, with >80% of childhood ALL diagnosed before 9 years of age.

Mercaptopurine 50 mg oral tablets are currently funded without restriction. However, the tablets may need to be divided and/or dissolved if part dosages are required in young children. Hospital pharmacists usually prepare these doses. 

Listing of the oral suspension would provide accurate acceptable dosing without the risks associated with breaking and/or crushing tablets.

At its meeting in August 2017, the Cancer Treatments Subcommittee of PTAC (CaTSoP) recommended that mercaptopurine oral suspension be funded for children with ALL who require a dose of less than one full 50 mg tablet per day, with a high priority. The full CaTSoP minute regarding mercaptopurine oral solution is available here [PDF, 259 KB].

Details about our proposal

  • Mercaptopurine oral suspension (Allmercap) would be listed in Section B and Part II of Section H of the Pharmaceutical Schedule from 1 June 2018 at the following price and subsidy (ex-manufacturer, excluding GST):

Chemical

Presentation

Brand

Pack size

Price and subsidy

Mercaptopurine  

Oral suspension 20 mg per ml

Allmercap

100 ml OP

$428.00

  • Allmercap would be listed in Section B of the Pharmaceutical Schedule subject to the following Special Authority criteria: