New Zealand’s COVID-19 treatments portfolio
Pharmac is securing treatments for people with an active COVID-19 infection or at high risk of infection.
On this page
14 September 2022: Access criteria for antivirals widened on 14 September 2022, molnupiravir, nirmatrelvir and ritonavir, and remdesivir
Pharmac is making sure New Zealanders can access medicines to treat and prevent COVID-19. Supplies are limited and distributed through a specific COVID-19 national model.
COVID-19 treatments are funded from a dedicated budget allocated by the Government, which means that COVID-19 treatment costs do not come from the annual budget for New Zealand’s medicines (the Combined Pharmaceutical Budget).
To date we've secured access to the following medicines.
Currently available
Availability
Available for use in Te Whatu Ora hospitals with access criteria from 1 February 2022 for people with moderate to severe COVID-19. Baricitinib is listed on Part II Section H of the pharmaceutical schedule subject to access criteria
HML listing for baricitinib(external link)
Supply and distribution
Te Whatu Ora hospitals can order supply direct from Onelink as required. Both 4 mg and 2 mg packs are available. Pharmac will continue to order additional stock to be available via Onelink as required. Hospitals will not be invoiced for supply because this stock has been purchased directly by Pharmac.
About baricitinib
Baricitinib is a JAK 1 and 2 inhibitor used for moderate to severe illness.
Baricitinib – NZ Formulary(external link)
Medsafe status
Baricitinib is not approved by Medsafe for use in New Zealand, meaning it would need to be prescribed and used in accordance with section 25 of the Medicines Act 1981.
Medsafe's update on applications for COVID-19 treatments(external link)
Information about prescribing and dispensing unapproved medicines - Medsafe(external link)
Read more
Advice: COVID-19 Treatments Advisory Group Record October 2021 [PDF, 291 KB]
Decision on access criteria for two COVID-19 treatments (26 January 2022)
Availability
Available with access criteria from 1 February 2022 for patients with mild to moderate COVID-19 at high risk of developing severe illness.
HML listing for Ronapreve(external link)
Supply and distribution
Ronapreve is available for use in Te Whatu Ora hospitals.
Te Whatu Ora hospitals may directly order stock of casirivimab with imdevimab from HealthCare Logistics as required.
It is also listed XPharm in Section B of the Pharmaceutical Schedule to enable wider use in the community setting in the future. The distribution and supply mechanism for COVID-19 treatments given by infusion or injection in the community is being considered by the Ministry of Health.
Schedule listing for Ronapreve(external link)
At this stage, Ronapreve is not be readily available in the community through primary care.
About Ronapreve
Ronapreve is a combination of 2 monoclonal antibodies (casirivimab and imdevimab) which target the spike protein on the virus and is used for the treatment of mild to moderate COVID-19.
Casirivimab and imdevimab is supplied as individual 20 ml multidose vials of casirivimab and imdevimab. Casirivimab and imdevimab can be administered via intravenous infusion or subcutaneous injection.
Ronapreve monograph – NZ Formulary(external link)
Effectiveness by variant
The supplier of Ronapreve (Roche) has advised us that Ronapreve has demonstrated significantly diminished potency against the Omicron Variant of COVID-19. Decisions regarding the use of Ronapreve should take into consideration what is known about the characteristics of the circulating SARS-CoV-2 viruses.
Ronapreve has been shown to retain its activity against all other currently circulating variants of COVID-19, including the Delta variant.
Evidence continues to emerge and is reviewed regularly
Medsafe status
Approved under s20 of the Medicines Act 1981
Ronapreve datasheet(external link)
Medsafe's update on applications for COVID-19 treatments(external link)
Read more
Advice: Record of the COVID-19 Advisory Group 21 October 2021 [PDF, 291 KB]
Decision on access criteria for two COVID-19 treatments (26 January 2022)
Media release: Pharmac confirms access criteria for COVID-19 treatments (26 January 2022)
Availability
Available from 5 May 2022 with access criteria for community and Te Whatu Ora Hospitals.
Access criteria apply (Criteria simplified on 14 September 2022)
Schedule listings
Molnupiravir (Lagevrio) was listed in the Pharmaceutical Schedule from 1 April 2022 in anticipation of supply. This ensured the medicine details were included in prescribing and software updates to support use as soon as supply was available.
Schedule listing for molnupiravir(external link)
HML listing for molnupiravir(external link)
Supply and distribution
Supply is available to order only by selected community pharmacies and DHB Hospitals. This process is being managed by the Ministry of Health. More information is available on the Ministry of Health website [PDF](external link)
Supply to community pharmacies is currently managed through one wholesaler, ProPharma. Te Whatu Ora Hospitals can order from Onelink as required.
Deliveries continue to arrive throughout 2022 and the access criteria have been designed to help to support prescribers to target treatment to those most in need and most likely to benefit.
Health care providers
Health care providers can find selected community pharmacies on the Community HealthPathways Covid-19 case management for adult’s webpage.(external link)
Note: A log-in is required.
About Molnupiravir
Molnupiravir is an oral antiviral medicine used to treat mild to moderate COVID-19. Molnupiravir inhibits virus replication in the body.
It is a 200 mg hard capsule.
Treatment with molnupiravir is recommended to be started within 5 days of first symptoms.
Due to available supply, treatment would be targeted to those people with the highest health need and most likely to benefit from treatment.
Molnupiravir for mild to moderate COVID-19 - He Ako Hiringa(external link)
Molnupiravir monograph in the NZ Formulary(external link)
Consumer information about Molnupiravir - Health Navigator(external link)
Effectiveness by variant
Preliminary evidence suggests molnupiravir is effective against the omicron variant of COVID-19.
Medsafe status
Molnupiravir is approved by Medsafe under section 23 of the Medicines Act.
Datasheet for molnupiravir (Lageviro) - Medsafe [PDF](external link)
Read more
Advice: COVID-19 Treatments Advisory Group meeting 13 December 2021 [PDF, 152 KB]
Advice: COVID-19 Treatments Advisory Group February 2022 [PDF, 71 KB]
Decision to simplify access for antiviral COVID-19 treatments (13 September 2022)
Decision: Updated Access Criteria for antiviral COVID-19 treatments (14 July 2022)
Decision on access criteria for two oral COVID-19 treatments (31 March 2022)
Updated Access Criteria for antivirals COVID-19 treatments (28 April 2022)
Media release: Pharmac simplifies criteria for antiviral COVID-19 treatments (13 September 2022)
Media release: Pharmac widens access for COVID-19 antiviral treatments (14 July 2022)
Media release: Pharmac negotiates deal for molnupiravir to treat COVID-19 (11 October 2021)
Availability
Available with access criteria for community and Te Whatu Ora Hospitals.
Read the access criteria (simplified on 14 September 2022)
Schedule listing
Nirmatrelvir with ritonavir was listed on the Pharmaceutical Schedule from 1 April 2022 in anticipation of supply.
Prescriptions must be endorsed by the prescriber that the patient meets the Access Criteria.
Schedule listing for nirmatrelvir with ritonavir(external link)
HML listing for nirmatrelvir with ritonavir(external link)
Supply and distribution
Supply is available to order only by selected community pharmacies and Te Whatu Ora Hospitals. This process is being managed by the Ministry of Health. More information is available on the Ministry of Health website [PDF](external link)
Supply to community pharmacies is currently managed through one wholesaler, ProPharma. Te Whatu Ora Hospitals can order from Onelink as required.
More deliveries will continue to arrive throughout 2022 and the access criteria have been designed to help to support prescribers to target treatment to those most in need and most likely to benefit.
Health care providers
Health care providers can find selected community pharmacies on the Community HealthPathways Covid-19 case management for adult’s webpage.(external link)
Note: A log-in is required.
Questions
For medical questions about Paxlovid, check Pfizer's website(external link)
or call Pfizer on 0800 736 363
About Paxlovid
Paxlovid is an oral antiviral medicine used to treat mild to moderate COVID-19. Paxlovid stops the virus multiplying in body. It contains two medicines, a protease inhibitor (nirmatrelvir) to block virus replication that is combined with ritonavir to slow the breakdown of nirmatrelvir.
Treatment with nirmatrelvir/ritonavir is recommended to be started within 5 days of first symptoms.
Due to available supply, treatment will be targeted to those people with the highest health need and most likely to benefit from treatment.
Paxlovid is known to cause interactions with multiple commonly prescribed medicines.
Nirmatrelvir with ritonavir – NZ Formulary monograph(external link)
Treating COVID-19 with Paxlovid - He Ako Hiringa(external link)
Paxlovid consumer information - Health Navigator(external link) (See the resources box for translations and advice for people with kidney problems)
Effectiveness by variant of COVID-19
Preliminary evidence suggests Paxlovid is effective against Omicron.
Medsafe status
Approved under section 23 of the Medicines Act with conditions on 2 March 2022.
Paxlovid datasheet(external link)
Medsafe's update on applications for COVID-19 treatments(external link)
Read more
Advice: COVID-19 Treatments Advisory Group meeting 13 December 2021 [PDF, 152 KB]
Advice: COVID-19 Treatments Advisory Group February 2022 [PDF, 71 KB]
Decision to simplify access for antiviral COVID-19 treatments (13 September 2022)
Decision: Updated Access Criteria for antiviral COVID-19 treatments (14 July 2022)
Decision on access criteria for oral COVID-19 treatments (31 March 2022)
Updated Access Criteria for antivirals COVID-19 treatments (28 April 2022)
Media release: Pharmac simplifies criteria for antiviral COVID-19 treatments (13 September 2022)
Media release: Pharmac widens access for COVID-19 antiviral treatments (14 July 2022)
Media release: Pfizer's oral COVID-19 treatment arrives in New Zealand (31 March 2022)
Availability
Available with access criteria for Te Whatu Ora Hospitals from September 2020. It is not currently listed in the Pharmaceutical Schedule.
Current access criteria (updated on 14 September 2022)
We will continually reassess these criteria as more treatments become available.
Remdesivir may be used in the outpatient setting (clinics, home care visits) where appropriate with stock managed through Te Whatu Ora.
Supply and distribution
Supply is limited due to global demand.
Te Whatu Ora hospitals can order stock direct from Onelink. Wholesale stock is held and distributed to Te Whatu Ora hospitals by Onelink in Auckland. DHBs will not be invoiced for supply because this stock has been purchased directly by Pharmac.
At this stage, remdesivir is not readily available in the community through primary care.
About remdesivir
Remdesivir is a broad-spectrum antiviral used for people with mild to moderate COVID-19 considered at high risk of developing severe disease.
Remdesivir monograph – NZ Formulary(external link)
Effectiveness by variant
Preliminary evidence suggests remdesivir is effective against the omicron variant of COVID-19.
Medsafe status
Remdesivir is currently undergoing regulatory review by Medsafe.
Medsafe's update on applications for COVID-19 treatments(external link)
As remdesivir is not approved by Medsafe for use in New Zealand, it would continue to be prescribed and used in accordance with section 25 of the Medicines Act 1981.
Information about prescribing and dispensing unapproved medicines - Medsafe(external link)
Read more
Advice: Remdesivir Advisory Group Record 24 September 2020 [PDF, 125 KB]
Decision to simplify access for antiviral COVID-19 treatments (13 September 2022)
Decision: Updated Access Criteria for antiviral COVID-19 treatments (14 July 2022)
Updated changes to access criteria for remdesivir for COVID-19 (4 March 2022)
Updated Access Criteria for antiviral COVID-19 treatments (28 April 2022)
Media release: Pharmac simplifies criteria for antiviral COVID-19 treatments (13 September 2022)
Media release: Pharmac widens access for COVID-19 antiviral treatments (14 July 2022)
Media release: Pharmac ensures earlier access to key COVID-19 treatment (28 February 2022)
Media release: Pharmac updates access criteria for remdesivir (4 March 2022)
Availability
Tixagevimab with cilgavimab was listed on the Pharmaceutical Schedule from 1 July 2022 in anticipation of supply.
Schedule listing for Evusheld(external link)
On 25 August 2022, we announced our access criteria.
Supply
Pharmac has reached an agreement with AstraZeneca for supply of an initial 20,000 courses, with the option to purchase an additional 20,000 courses.
AstraZeneca, the supplier, has advised that they plan to increase the recommended dose for tixagevimab with cilgavimab in the pre-exposure prophylaxis of COVID-19 from 300 mg (150 mg tixagevimab with 150 mg cilgavimab) to 600 mg (300 mg tixagevimab with 300 mg cilgavimab), with repeat dosing at 600 mg every six months. This increased dosing is being implemented by Astra Zeneca globally based on emerging evidence that tixagevimab with cilgavimab is less effective against currently circulating Omicron subvariants, including BA.5 which is currently dominant in New Zealand.
Distribution
The first shipments of tixagevimab with cilgavimab have arrived in New Zealand and are available for ordering by Te Whatu Ora hospitals directly from Healthcare Logistics. Of the 20,000 300 mg courses of tixagevimab with cilgavimab that Pharmac has secured, 13,500 courses have arrived in New Zealand. Of these, approximately 12,400 courses are available for ordering by Te Whatu Ora Hospitals. This stock has an expiry date of 31 December 2022.
An additional 6,500 300 mg courses are scheduled for delivery from September 2022. We expect these 6,500 courses will have extended expiry dates compared to currently available stock.
Community Supply
Tixagevimab with cilgavimab will not be immediately available in the community. Pharmac is working with Te Whatu Ora to make tixagevimab with cilgavimab available in the community. We anticipate this will be in place from late September 2022. We will provide further information closer to the time.
About tixagevimab and cilgavimab
Evusheld is a combination of 2 monoclonal antibodies targeting different aspects of spike protein on the virus. It is used preventatively for severely immunocompromised patients at risk of severe illness from COVID-19.
It is given as two separate and sequential intramuscular injections at different injection sites, one in each of the gluteal muscles.
On 30 August 2022, the Ministry of Health updated its advice on the clinical management of COVID-19 in hospitalised adults(external link) to incorporate advice about Evusheld
Information for patients about Evusheld - Health Navigator(external link)
Effectiveness by variant
Preliminary evidence indicates tixagevimab and cilgavimab is effective against the BA.2 subvariant of Omicron.
Medsafe status
Medsafe recently granted provisional approval(external link) to tixagevimab with cilgavimab for pre-exposure prophylaxis of COVID-19 at the 300mg dose (150 mg of tixagevimab and 150 mg of cilgavimab). The 600 mg dose of tixagevimab with cilgavimab is not approved by Medsafe. We understand that an application for this dose has been submitted for review.
The 600 mg dose will need to be supplied under section 25 of the Medicines Act.
Application detail - Medsafe website(external link)
Medsafe's update on applications for COVID-19 treatments(external link)
Read more
Decision on access criteria for tixagevimab with cilgavimab (Evusheld) for COVID-19
Proposal on access criteria for tixagevimab with cilgavimab (Evusheld) and sotrovimab (Xevudy)
Availability
Available in Te Whatu Ora Hospitals with access criteria from 1 October 2021 for people with moderate to severe COVID-19.
Not listed for use in the community.
HML listing for tocilizumab(external link)
Supply and distribution
Supply is now improving. Roche has advised Pharmac it expects to meet New Zealand demand for Actemra IV for the second half of 2022. This means supply management is now returning to usual systems from July 2022.
Pharmac and the supplier continue to monitor the impact of COVID-19 on the availability of tocilizumab supply.
More about the tocilizumab supply issue (Late 2021 to June 2022)
Listed on section B of the pharmaceutical schedule as a PCT only pharmaceutical to enable use and claiming in Te Whatu Ora hospitals, subject to access criteria.
Schedule listing for tocilizumab(external link)
About tocilizumab
Tocilizumab is an intravenous humanised monoclonal antibody against interleukin 6 receptor, used to help control the body’s inflammatory response in people with severe to critical COVID-19 illness.
COVID-19 treatment – NZ Formulary(external link)
Medsafe status
Tocilizumab is Medsafe-approved for the treatment of COVID-19 in hospitalised adults who are receiving systemic corticosteroids and require supplemental oxygen or mechanical ventilation (May 2022).
Tocilizumab datasheet(external link)
Medsafe's update on applications for COVID-19 treatments(external link)
Read more
Advice: Record of the Tocilizumab Advisory Group (21 April 2022) [PDF, 112 KB]
Media release: Pharmac funds tocilizumab to treat cases of COVID-19 (16 September 2021)
Tocilizumab for COVID-19 – Health Navigator website(external link)
Supply expected soon
Availability
Sotrovimab was listed on the Hospital Medicines List (HML) from 1 July 2022 in anticipation of supply being available soon.
HML listing for Sotrovimab(external link)
Following availability in New Zealand and Medsafe approval, sotrovimab would be funded subject to Access Criteria.
Pharmac is in the process of finalising this Access Criteria and expects to notify of this in due course.
Supply and distribution
Detail about the distribution arrangements for sotrovimab would be provided once supply is available and Access Criteria have been finalised.
About sotrovimab
Sotrovimab is a single monoclonal antibody administered via intravenous infusion. It targets the spike protein on the virus and is used for the treatment of COVID-19.
Effectiveness by variant
Evidence shows sotrovimab is effective against the B.A.1 subvariants of Omicron. Early data data shows it is less effective against B.A.2 and B.A.4 and B.A.5 subvariants. This is yet to be confirmed with real-world evidence.
Medsafe status
Xevudy was submitted to Medsafe for consideration in late-April 2022.
Medsafe's update on applications for COVID-19 treatments(external link)
Read more
Proposal on access criteria for tixagevimab with cilgavimab (Evusheld) and sotrovimab (Xevudy)
Looking for more information?
We've had to do things differently to make sure New Zealanders could get access to these medicines.
Our approach to funding COVID-19 treatments
We have released a large number of documents relating to COVID-19 medicines. Search our Official Information Act (OIA) responses for "covid"
Official Information Act responses
Treating and managing COVID-19
The Ministry of Health provides clinical advice for health professionals on COVID-19 treatments
Clinical management of COVID-19 in hospitalised adults - Ministry of Health(external link)
For advice on managing yourself and your whānau in the community, see Covid in the Community on the Health Navigator website(external link)
Who to contact
If you have questions about COVID-19 medicines, email enquiry@pharmac.govt.nz