Sustagen Hospital Formula list price increase and change to part charge

Medicines

Consultation Closed

What we’re proposing

PHARMAC is seeking feedback on a proposal to increase the list price of oral feed powder (Sustagen Hospital Formula) in Section D and Part II of Section H of the Pharmaceutical Schedule from 1 April 2018.

There would be no change to the current funding criteria. Fully subsidy would continue for patients who meet Special Authority and endorsement criteria. A rebate would apply.

Patients who currently pay a part charge and do not meet criteria for full subsidy would need to pay more for each can of Sustagen Hospital Formula. PHARMAC is interested in feedback relating to the clinical need of these patients that may be adversely affected by this proposal.

Consultation closes at 5 pm on Tuesday, 6 March 2018 and responses can be emailed to matthew.tyson@pharmac.govt.nz.

What would the effect be?

From 1 April 2018, the list price of Sustagen Hospital Formula would increase from $14.90 to $26.00 per 840 g can (ex-manufacturer, ex-GST).

Partially funded patients

Sustagen Hospital Formula is subject to Special Authority criteria for Standard Supplements. Patients that meet these criteria currently pay a part charge.

The subsidy from a valid Standard Supplements Special Authority would remain the same at $9.54 per 840 g can.

Patients that meet Special Authority criteria but do not meet the additional subsidy requirement by endorsement (see below) would need to pay a higher part charge per can. These patients could continue to access fully funded Ensure and Fortisip. There would be no changes for Ensure or Fortisip listings.

Fully funded patients

A higher subsidy by endorsement would still apply for patients that meet additional criteria that other oral feed powders (Ensure and Fortisip) are not clinically appropriate due to fat intolerance, fat malabsorption and chyle leak.

There would be no cost impact on the funder as a rebate would apply to reduce the net price to the funder for fully funded patients.

Who we think will be interested

This proposal will be of interest to:

  • Patients currently taking Sustagen Hospital Formula
  • Dietitians, gastroenterologists, community and hospital prescribers and general practitioners.
  • Hospital and community pharmacists, DHBs, suppliers and wholesalers.

About Sustagen Hospital Formula

Sustagen Hospital Formula is an oral powdered supplement used to increase calorie intake in patients. Sustagen Hospital Formula has lower levels of fat which makes it suitable for patients with fat intolerance, fat malabsorption or chyle leak.

Why we're proposing this?

PHARMAC received a price increase notification from Nestle (the supplier of Sustagen Hospital Formula) in late 2017. PHARMAC sought clinical advice from members of the Special Foods Subcommittee regarding the impact of this proposed change. Clinical advisors considered that full subsidy should be maintained only for those patients that currently received full subsidy – those with fat malabsorption, fat intolerance or chyle leak.

PHARMAC’s clinical advisors also considered that patients accessing partially subsidised Sustagen Hospital Formula would be able to transition to other fully funded oral feed powders such as Ensure or Fortisip.

Details about our proposal

From 1 April 2018, the list price of Sustagen Hospital Formula would increase from $14.90 to $26.00 per 840 g can in Section D and Part II of Section H of the Pharmaceutical Schedule as per below (ex-manufacturer, excluding GST):

Chemical Presentation Brand Pack size Current Subsidy and Price Proposed Subsidy and Price
Ora Feed Powder (Vanilla/Chocolate) Powder Sustagen Hospital Formula 840 g OP $9.54
($14.90)
$9.54
($26.00)

A rebate would apply to reduce the net price to the funder for fully funded patients.

In the community

There are no proposed changes to the current Special Authority criteria for Standard Supplements (SA1554), these can be found on PHARMAC’s website.

There are also no proposed changes to the higher subsidy by endorsement criteria to enable full community subsidy as per below:

‘additional subsidy by endorsement is available for patients with fat malabsorption, fat intolerance or chyle leak. The prescription must be endorsed accordingly’.

Patients that meet both the Special Authority for Standard Supplements criteria and the endorsement criteria, would continue to access fully funded Sustagen Hospital Formula and would not be impacted by this proposal.

Important note

For patients who access partially funded Sustagen Hospital Formula:

  • Patients would experience a significantly larger part charge per can due to the increase in manufacturer’s price.
  • The resulting part charge is based on the difference between the price and the subsidy, plus any additional pharmacy charges.

We are interested in feedback relating to the clinical need of patient groups that currently access partially funded Sustagen Hospital Formula that may be adversely affected by this proposal. We will consider this feedback with our clinical advisors before making our decision.

In DHB Hospitals

DHB Hospitals would purchase Sustagen Hospital Formula at the new price and would receive a rebate on all purchases making the impact of this proposed change cost neutral.

To provide feedback

PHARMAC welcomes feedback on this proposal. To provide feedback, please submit it in writing by Tuesday, 6 March 2018 to:

Matthew Tyson
Therapeutic Group Manager
PHARMAC
PO Box 10254
Wellington 6143 

Email: matthew.tyson@pharmac.govt.nz

Fax: 04 460 4995

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.