Pūahoaho: updated information about Pharmac’s priority lists

Application priority lists

Every year we receive over 100 funding applications from health care professionals, consumer groups and suppliers. These applications include requests for new medicines and to widen access to medicines that we already fund.

We ask our clinical advisory committees to assess the available evidence and recommend whether we should fund, defer, or decline the applications. With their advice, we work to complete an assessment, including a health economic appraisal if required.

We apply the Factors for Consideration throughout our assessment of an application. The factors consider four areas: health need, health benefit, suitability, and costs and savings, which apply to the individual, the whānau, society, and the health system.

Factors for Consideration

Once the assessment is complete, we take the application to an internal Pharmac quarterly prioritisation meeting and add applications to one of the following priority lists:

• options for investment (OFI)
• only funded if cost neutral or cost saving
• recommended for decline.

Priority lists for funding application and previous Pūahoaho updates

Options for investment list

We rank applications on our options for investment (OFI) list from highest to lowest priority but keep these rankings confidential so that we can negotiate the best prices with suppliers.

As of 1 October 2024, there are 132 applications on the OFI. 

Prioritisation activity in the September quarter

During the September 2024 prioritisation quarter, we ranked 10 proposals on the OFI list, and re-prioritised 5 others. Re-prioritisation can occur due to more information becoming available, or a change in an application’s Factors for Consideration relative to other funding options. Detailed descriptions of indications available on the Application Tracker:

New proposals ranked:

• agalsidase beta(external link) for a genetic metabolism disorder called Fabry disease.
• apalutamide(external link) for a type of prostate cancer that has spread.
• bruton tyrosine kinase inhibitors (BTKi), ibrutinib(external link), acalabrutinib(external link), zanubrutinib(external link)for a type of blood cancer called chronic lymphocytic leukaemia, for people with a specific TP53 mutation, used as an initial treatment
• multivitamins with trace elements(external link) to prevent micronutrient deficiency after bariatric surgery.
• nivolumab with ipilimumab(external link) for a type of kidney cancer that has spread, to be used as an initial treatment.
• pembrolizumab(external link)for advanced bile duct cancer.
• pembrolizumab(external link)for melanoma (a form of skin cancer), to be used after surgery in combination with chemotherapy.
• teduglutide(external link)for children with short bowel syndrome.
• upadacitinib(external link)for severe Crohn's disease as a second treatment option.
• upadacitinib(external link) for moderate to severe ulcerative colitis as a second stage of treatment.

Applications re-ranked:

• bevacizumab(external link)for cervical cancer that has spread, not responded to treatment or come back after prior treatment.
• daratumumab(external link)for people with multiple myeloma where the cancer has come back or not responded to treatment, as a subcutaneous injection as a second treatment option, or as an intravenous treatment as a later stage treatment.
• daratumumab subcutaneous injection(external link)for multiple myeloma where people have received treatment previously.
• letermovir(external link) to prevent infections in people who have had a stem cell transplant.
• nivolumab(external link)for kidney cancer that has spread, as a second treatment option.

Only if cost neutral or cost saving list

If our assessment confirms an application does not provide any additional health benefit compared to treatments we already fund, it may be ranked on the only if cost-neutral or cost-saving list. We would look to fund these applications if we negotiated a deal that would be cost-neutral or cost-saving.

Prioritisation activity in the September quarter

During the September 2024 prioritisation quarter, we ranked 8 applications on the only if cost neutral or cost saving list (detailed descriptions of indications available on the Application Tracker):

• atezolizumab subcutaneous injection(external link)for non-small cell lung cancer and other cancers that intravenous atezolizumab is currently funded for.
• budesonide, glycopyrronium and formoterol (eformoterol) inhaler(external link) for adults with moderate to very severe COPD, a respiratory disease.
• cholecalciferol (Vitamin D)(external link) for vitamin D deficiency
• infliximab subcutaneous injection(external link) for all of the conditions that infliximab intravenous treatment is currently funded for.
• KetoCal 4:1 LQ(external link)a special food for people treated with a ketogenic diet.
• prasugrel(external link)for use after a heart attack or angina.
• Symbicort Rapihaler(external link) inhaler for asthma.
• zanubrutinib(external link) for a type of blood cancer called chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL) as a second treatment option. 

Recommended for decline list

There are a range of reasons a funding application may be added to the recommend for decline list. Our expert clinical advisors may have recommended that the funding application be declined, or they may have provided a positive recommendation but we’ve found:

• other more clinically preferred medicines for the same condition are now funded, making the funding application no longer relevant
• the medicine would provide no additional benefits over other treatments we already fund, or may be harmful
• the application has been superseded by another funding application
• no company is supplying the medicine in New Zealand.

When applications are added to this list, they become inactive and we stop progressing work on the application. While applications may be listed on the decline list, they are only formally declined after public consultation to ensure we haven’t missed anything important.

More about this process: Declining inactive funding applications

If we decline an application, it means the medicine would not be funded for the use requested at this time. It does not prevent us from reconsidering funding for the medicine in the future if information becomes available.

Prioritisation activity in the September quarter

During the September 2024 prioritisation quarter, we ranked 19 applications on the recommended for decline list (detailed descriptions of indications available on the Application Tracker):

• a brand of insulin pump(external link)for diabetes.
• a brand of insulin pump infusion set (steel cannula)(external link) for diabetes.
• a brand of insulin pump infusion set (teflon cannula)(external link) for diabetes.
• a brand of insulin pump reservoir(external link)for diabetes.
• atezolizumab(external link)for advanced non-small cell lung cancer as an initial treatment option alongside chemotherapy.
• atezolizumab(external link) for advanced non-small cell lung cancer as an initial treatment option.
• bruton kinase inhibitors (BTKi)(external link)for a type of blood cancer called chronic lymphocytic leukaemia (CLL), for people without a specific TP53 mutation.
• deflazacort(external link) for a neuromuscular disease called Duchenne muscular dystrophy.
• fixed-duration ibrutinib plus venetoclax(external link)for a type of blood cancer called chronic lymphocytic leukaemia (CLL), or small lymphocytic leukaemia (SLL) for people without TP53 mutation.
• Freestyle Libre flash glucose monitoring system(external link) for type 1 diabetes.
• ibrutinib(external link)for a type of blood cancer called chronic lymphocytic leukaemia (CLL), for people who have not previously received treatment.
• macitentan(external link) for a condition where there is high blood pressure in the lungs, called pulmonary arterial hypertension.
• Medtronic Guardian 3 and Guardian Connect continuous glucose monitoring system(external link)for type 1 diabetes.
• meningococcal B vaccine(external link)for all 13- to 25-year-olds to prevent meningitis.
• nivolumab(external link) for advanced non-small cell lung cancer as a second treatment option.
• nivolumab (with ipilimumab and platinum-based chemotherapy)(external link) for advanced non-small cell lung cancer as an initial treatment option with alongside chemotherapy.
• pembrolizumab(external link)for advanced non-small cell lung cancer as a second treatment option.
• tislelizumab(external link)for advanced non-small cell lung cancer as a second treatment option.
• tislelizumab (with platinum-based chemotherapy)(external link)for advanced non-small cell lung cancer as an initial treatment option with alongside chemotherapy.