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Notification of decision involving treatments for multiple sclerosis, narcolepsy, and attention deficit and hyperactivity disorder

By   /  January 11, 2019  /  Comments Off on Notification of decision involving treatments for multiple sclerosis, narcolepsy, and attention deficit and hyperactivity disorder

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Source: Pharmac

What will the effect be?

For Patients

Modafinil (Modavigil)

There will be no change for patients as this product will continue to be fully funded subject to the same restrictions as it is now.

Methylphenidate extended-release tablets (Methylphenidate ER – Teva)

An additional funded brand will be available for patients who meet the Special Authority criteria for methylphenidate hydrochloride extended-release tablets/capsules, subject to Medsafe registration of the Teva supplied brand. The currently funded brands are Concerta and Ritalin LA. Methylphenidate ER – Teva is undergoing registration with Medsafe as a generic version of the Concerta formulation.

Glatiramer acetate (Copaxone)

Glatiramer 40 mg prefilled syringe, with three times per week dosing, will be funded from 1 February 2019. Glatiramer 20 mg prefilled syringe will continue to be funded until 30 June 2019, when it will no longer be available in New Zealand.

To continue using funded glatiramer, people currently using this treatment will need to change to the new 40 mg strength before 30 June 2019. This change in strength will mean a change in the number of times people need to inject each week. People taking glatiramer will need to discuss injection frequency with their neurology clinic or doctor.

At the moment, people receive their glatiramer delivered to an address of their choice. Once people change from the 20 mg dosing to the 40 mg dosing, this direct delivery will stop. This will mean that people will need to get a prescription from their usual neurology clinic or doctor and take this prescription to their community pharmacy.

There will be no pharmacy prescription co-payment (usually $5 per prescription item) for glatiramer 40 mg until 31 December 2019.

People taking glatiramer will need to talk with the person who usually prescribes their glatiramer to decide whether the prescriptions for their glatiramer will come from their neurology clinic or from their GP. It could be a specialist or GP, depending on the individual circumstances. As with many other medicines, a single prescription will provide three months’ supply, but this medicine will need to be collected monthly from a community pharmacy. All patients will still need an annual neurology review to assess their eligibility for ongoing treatment. Prescribers can issue repeat prescriptions without having to see a patient every three months, if they consider this to be clinically appropriate, so it is not expected that patients would incur significant extra costs for frequent GP visits.

Interferon beta-1-alpha (Avonex) and Interferon beta-1-beta (Betaferon)

  • All people taking interferon beta-1-alpha (Avonex) at 5 June 2019 will receive an eight-week delivery of their medicine on 5 June 2019.
  • All people taking interferon beta-1-beta (Betaferon) at 29 May 2019 will receive an eight-week delivery of their medicine on 29 May 2019.

From then on, people taking Avonex or Betaferon will need to get a prescription from their usual prescriber every three months and take this to their usual community pharmacy.  People will collect Avonex and Betaferon each month from their usual community pharmacy.

There will be no pharmacy prescription co-payment (usually $5 per prescription item) for interferon beta-1-alpha (Avonex) or interferon beta-1-beta (Betaferon) until 31 December 2019. 

People taking interferon beta-1-alpha (Avonex) or interferon beta-1-beta (Betaferon) will need to talk with the person who usually prescribes this for them to decide whether the prescriptions will come from their neurology clinic or from their GP. It could be a specialist or GP, depending on the individual circumstances. As with many other medicines, a single prescription will provide three month’s supply, but these medicines will need to be collected monthly from a community pharmacy. All patients will still need an annual neurology review to assess their eligibility for ongoing treatment. Prescribers can issue repeat prescriptions without having to see a patient every three months, if considered clinically appropriate, so it is not expected that patients would incur significant extra costs for frequent GP visits.

For Community Pharmacies

Modafinil (Modavigil)

A new 60 tablet pack size of modafinil (Modavigil) 100 mg tablets will be funded from 1 February 2019. The currently funded 30 tablet pack size will be delisted when stocks are exhausted, which is expected to be no later than 31 August 2019.

Methylphenidate extended-release tablets (Methylphenidate ER – Teva)

There will be an additional brand of methylphenidate hydrochloride extended-release tablets (Methylphenidate ER – Teva) funded for the treatment of Attention Deficit and Hyperactivity Disorder (ADHD) from a future date to be determined, following Medsafe approval.

Multiple sclerosis treatments

Community pharmacies will access glatiramer 40 mg, interferon beta-1-alpha and interferon beta-1-beta through their usual supply channels. Any community pharmacy dispensing these products can claim reimbursement for it for patients with a valid Special Authority approval. There will be no patient pharmacy co-payments required for people picking up their dispensing of glatiramer 40 mg, interferon beta-1-alpha and interferon beta-1-beta until 31 December 2019.

Special Authority (panel approval) numbers will be issued for patients and provided to nominated pharmacies in advance of the proposed changes.

For Prescribers

There will be no significant impacts for prescribers from the modafinil or methylphenidate hydrochloride extended-release components of the proposal.

Funded access to all multiple sclerosis treatments will continue to be via application to the Multiple Sclerosis Treatment Assessment Committee (MSTAC) through the MSTAC panel coordinator. Patients will still require an annual neurology review.

The MSTAC panel coordinator will no longer be able to remind prescribers that new prescriptions and renewal applications are due, so prescribers and patients will be responsible for ensuring that patients are seen and prescriptions are issued in a timely manner, as they already do for other funded multiple sclerosis treatments. Neurologists may wish to consider whether they would prefer to continue prescribing these multiple sclerosis treatments for their patients or delegate prescribing to the patient’s GP.

A change from glatiramer (Copaxone) 20 mg to 40 mg prefilled syringes will involve a change in dosing frequency, which you will need to discuss with your patients. We have been advised by the Neurological Subcommittee of the Pharmacology and Therapeutics Advisory Committee (PTAC) that neurology nurses will be likely to conduct most of the patient education about the dosing change in main centres, but general physicians may directly support patients in provincial centres.

Direct distribution of Avonex, Betaferon and Copaxone to patients will cease so there will no longer be a requirement to submit prescriptions to PHARMAC for dispensing and direct distribution. Patients will need to request the prescriptions themselves through their usual multiple sclerosis healthcare professional (neurologist, nurse specialist, general physician or GP), and then present the script to their community pharmacy for dispensing.

There will be no changes to the access criteria (Special Authority criteria) for multiple sclerosis treatments as a result of this proposal.

For DHBs

The changes will incur pharmacy distribution costs for glatiramer, interferon beta-1-alpha and interferon beta-1-beta that are not currently payable due to the direct distribution arranged by PHARMAC. However, due to the proposed price reduction for modafinil, which would provide savings, there would likely be longer-term savings to the health sector as a result of this proposal.

Last updated: 11 January 2019

MIL OSI

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