Pharmac has advised that stock of ticagrelor 90 mg tablets may be limited due to an unexpected shipping delay. There is currently no funded alternative product available. Stock of ticagrelor may vary between pharmacies; patients should call ahead before collecting their prescription to ensure their usual pharmacy has stock. The next shipment is expected this week, but stock may take additional time to reach pharmacies.

There is a supply issue affecting stock of 10 mg and 20 mg oxycodone immediate-release tablets. Oxycodone 5 mg immediate-release tablets were previously affected by a supply issue (as reported in Bulletin 118), but stock has now arrived. Re-supply of the 10 mg and 20 mg immediate-release tablets is expected in May. Pharmac advises that 5 mg tablets and 1 mg/mL oral liquid are suitable alternatives, however, a new prescription will be required for these options. Otherwise, clinicians could consider prescribing an alternative analgesic.

From 1^st May, 2025, the supplier of fentanyl patches, Sandoz, is changing how the strength of the 12.5 microgram fentanyl patch is written on the packaging. The new packaging will read as 12 mcg, instead of 12.5 mcg, however, the dose remains the same. Changing how the dose is displayed on the packaging is accepted practice and is intended to reduce prescribing and dispensing errors (e.g. 12.5 micrograms and 125 micrograms). The old packaging will be delisted from the Pharmaceutical Schedule on 1^st November, 2025. A patient information sheet is available here.

Stock of isosorbide mononitrate 40 mg modified-release tablets (Ismo 40 Retard) is limited, due to shipping delays. Re-supply is expected by June. Pharmac advises that 60 mg modified-release tablets (Duride) may be a suitable alternative (or half a tablet for a ~30 mg dose), however, a new prescription will be required. The Duride data sheet states that the tablet can be halved without affecting the modified-release properties if the tablet is not crushed or chewed.

Pharmac has announced that loratadine (Lorafix) 10 mg tablets will go out of stock because recent batches have been rejected due to an issue affecting tablet hardness. Re-supply is expected by August. Cetirizine hydrochloride may be a suitable funded alternative, however, a new prescription will be required. A patient information leaflet is available here.

Due to supply issues affecting quetiapine 25 mg tablets (Quetapel), an alternative brand (Quetiapine Viatris; Section 29) was listed on the Pharmaceutical Schedule from 1^st April (as reported in Bulletin 120). Pharmac initially reported that the alternative brand was manufactured in the same factory as the original funded brand, but has now advised that this information was incorrect, and that it is made at a different factory. Therefore, both the packaging and tablets will look different.

Pharmacists should discuss with patients that the appearance of the blister pack of Quetiapine Viatris and tablets differs from their usual brand. The blister packaging is a different shape and colour and contains Japanese writing, and the tablets are a different colour and have writing on them. A patient information handout is available here.

Pharmac has advised of an upcoming supply issue that will affect stock of Ultraproct (fluocortolone caproate with fluocortolone pivalate and cinchocaine) suppositories and ointment due to manufacturing delays. It is expected that Ultraproct suppositories will be out of stock from May, and the ointment out of stock from September. The supply issue is likely to continue until the end of 2025. An alternative funded product, Proctosedyl (hydrocortisone with cinchocaine) is available in both formulations, however, a new prescription will be required as the active ingredient is different. A generic patient information handout is available, here.

Pharmac has announced that from 1^st May, 2025, insulin degludec and insulin aspart (Ryzodeg) will be funded without restriction for patients with type 1 and type 2 diabetes, following consultation on a proposal in March (as reported in Bulletin 119). No changes have been made to the original proposal.

Ryzodeg is an insulin co-formulation which combines the ultralong-acting insulin degludec (70%) with the rapid-acting insulin aspart (30%). It can reduce the number of insulin injections required for some patients and may improve blood glucose stability. Ryzodeg may also be an appropriate alternative for patients prescribed NovoMix 30 FlexPen, which is being discontinued; see Bulletin 119 for further information.

A new continuous glucose monitor (CGM), FreeStyle Libre 2 Plus, is being funded from 1^st May, 2025, for patients with type 1 or type 3c diabetes. The new monitor is an upgraded model of the currently funded FreeStyle Libre 2, which will be discontinued in 2026. It can be worn for an additional day (15 instead of 14), and is considered more accurate than the FreeStyle Libre 2. Patients will need a new prescription for this CGM; up to 28 FreeStyle Libre 2 Plus CGMs will be funded each year, or six per prescription.

Pharmac has announced that from 1^st May, 2025, access to upadacitinib (Rinvoq), a Janus-kinase (JAK) inhibitor, will be widened to include patients with moderate to severe ulcerative colitis, severe Crohn’s disease, moderate to severe atopic dermatitis and rheumatoid arthritis who meet eligibility criteria. This decision comes following consultation on a proposal earlier in the year, as reported in Bulletin 115. Any relevant practitioner can apply for Special Authority approval, and this will be valid for six months. View Special Authority criteria for each condition here.

Also, from 1^st May, 2025, venetoclax and azacitidine will be funded with Special Authority approval for patients with acute myeloid leukaemia, and access to ibrutinib will be widened for those with chronic lymphocytic leukaemia.