COVID-19: Medicines with amended access criteria

New Zealand's COVID-19 lockdown made it harder for people to see their doctor or go to hospital. In response, PHARMAC made changes to access criteria for some medicines. These changes helped people get the medicines they need.

We recognise the health sector remains under pressure responding to COVID-19

We do not plan to make changes to access criteria for the rest of 2020. New Zealand's response to COVID-19 continues to evolve. To continue supporting the health sector, we aim to be as agile as possible. We want New Zealanders to keep accessing the funded medicines they need.

We will not change Special Authority criteria before 1 February 2021. Prescribers will have at least a month's notice of any Special Authority changes.

Some changes became permanent

Nine of the temporary changes now remain in place permanently. All these changes will help patients access the medicines they need more easily.   

Sacubitril with valsartan

On advice from the health sector, we've provided flexibility for prescribers when an echocardiogram (ECHO) is impractical. Before April 2020 patients were required to have an ECHO before a doctor could prescribe sacubitril. 

During the COVID-19 lockdown, we temporarily removed the requirement for an ECHO because it was difficult for patients to get an ECHO.   

Pembrolizumab and nivolumab 

During the COVID-19 lockdown, we made changes to give prescribers more discretion to decide the medicine dose for their patients.  We made this change permanent.

Adalimumab, etanercept, infliximab and rituximab  

We have made the special authority criteria clearer that the prescriber can use their discretion when deciding how to evaluate “joint counts”. "Joint counts" are how prescribers assess whether the medicine is improving the patient’s arthritis.

Dornase alpha

We are maintaining the following changes: 

  • removed the need for spirometry in patients over 5 years old
  • removed some specific requirements about where patients are treated
  • relaxed some of the renewal requirements.  

In November 2020, we also changed how to apply for funded dornase alfa

Retail Pharmacy – Specialist  

The “Retail Pharmacy – Specialist” restriction required a specialist to provide a recommendation every 2 years for some funded medicines. On 1 April 2020, we temporarily removed this restriction from 24 medicines because the COVID-19 lockdown made it difficult to obtain specialist recommendations.

After consultation with the health sector, we are permanently removing the “retail pharmacy -specialist” restriction from all 24 medicines.   

You can find the full definition of “Retail Pharmacy – Specialist” in Rule 2.1 of the Schedule.

Read Rule 2.1 of the Pharmaceutical Schedule 

More information  

We consulted on these changes in June. The feedback was broadly supportive of reversing some of the temporary changes and broadly supportive of the timeframe we proposed. 

Consultation relating to Schedule changes made in response to COVID-19 (closed: 3 July 2020)

Read the notification relating to these changes

Who to contact

If you have questions about any of these changes, email enquiry@pharmac.govt.nz