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Published: 3rd July, 2026
Contents
New from bpacnz – Upfront: Making sense of medicines access criteria
Most medicines on the Pharmaceutical Schedule can be prescribed without restriction, i.e. they are funded for any patient. However, in some cases access criteria such as Special Authorities define the groups of patients eligible for funded treatment. This is to ensure that the available budget stretches to fund medicines for people who are most likely to benefit. Although it can sometimes feel like a barrier to prescribing, access criteria are not clinical instructions - whether a medicine is appropriate for a patient and how it is prescribed should be determined by the prescriber. In recent years, Pharmac has made changes to access criteria for some medicines to “cut the red tape”, reducing administrative burden and improving access to funded medicines. These changes include removing clinical information, prescriber restrictions, Special Authority renewal requirements and in some cases, removing criteria entirely. In this Upfront article, we take a closer look at what access criteria are, why they exist and how they should (and should not) be used to influence prescribing in primary care.
Read the article here
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- Pharmac will fund a new brand of methylphenidate, Rubifen LA, from 1st October, 2026, following consultation (as reported in Bulletin 137). This brand is a generic version of Ritalin LA but will have the same Special Authority criteria as Ritalin, Rubifen, Rubifen SR, Methylphenidate ER – Teva and Methylphenidate Sandoz XR. The funding start date for Rubifen LA in the original proposal was 1st July, but this was pushed out to ensure stock availability.
- Stock of dexamfetamine (Noumed) 5 mg tablets has arrived in the country following a recent out of stock period (as reported in Bulletin 144)
- The monitoring period for the Medsafe Alert Communication relating to GLP-1 receptor agonists and vision loss closes Sunday, 26th July. See Bulletin 140 for further information.
- A decision has been made by Pharmac to update its Operating Policies and Procedures Manual, following consultation (as reported in Bulletin 147). Read more about the decision here.
- The Medical Council of New Zealand has announced a decision on the framework regulating physician associates following consultation (as reported in Bulletin 138). They are now seeking feedback on the professional standards for physician associates; consultation closes Thursday, 16th July. Read more here.
Rosuvastatin Special Authority to be removed
Pharmac has announced that the requirement for Special Authority approval for funded access to rosuvastatin is being removed. From 1st October, 2026, all strengths of rosuvastatin will be funded without restriction; this will mean that anyone who needs rosuvastatin can receive funded treatment. This follows the Rosuvastatin Viatris brand receiving Principal Supply Status from March, 2027, as part of Pharmac’s 2025/26 Tender process.
Rosuvastatin is a high-potency statin that is indicated for the prevention of hypercholesterolemia and cardiovascular events in high-risk patients. It is currently funded with Special Authority approval for Māori and Pacific peoples at increased risk of cardiovascular disease and second-line for patients who cannot achieve target LDL-C levels with the maximum tolerated dose of atorvastatin and/or simvastatin. International guidelines generally recommend rosuvastatin or atorvastatin as first-line lipid-lowering treatments for most patients.
As part of this change, the pack size of Rosuvastatin Viatris will increase from the currently available 30 tablets to 90 tablets next year. The 90 tablet pack size will be listed on the Pharmaceutical Schedule from 1st February, 2027, and the 30 tablet pack size will be delisted on 1st August, 2027. N.B. There is currently a supply issue affecting Rosuvastatin Viatris (see: Medicine news).
For further information on the role of rosuvastatin in lipid-lowering treatment, see: https://bpac.org.nz/2022/rosuvastatin.aspx (this resource will be updated to reflect these changes closer to the time)
Medicine news
The following news relating to medicine supply has recently been announced. These items are selected based on their relevance to primary care and where issues for patients are anticipated, e.g. no alternative medicine available or changing to the alternative presents issues. Information about medicine supply is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Limited supply of all strengths of candesartan + temporary switch to monthly dispensing
A manufacturing-related supply issue affecting candesartan 4 mg tablets (Candestar - as reported in Bulletin 145) has now been expanded to include all tablet strengths*. Several alternative brands have been listed on the Pharmaceutical Schedule and will be available at different stages. Some brands are not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act. The Candestar brand is expected to be available again by the end of 2026. Check the Pharmaceutical Schedule and Pharmac website for updates.
In a recent email, Pharmac also announced that dispensing of candesartan has been temporarily switched to monthly since 1st July, 2026, to ensure ongoing availability and equitable distribution during this supply issue. A date for returning to stat dispensing is not currently known.
* Supply of 4 mg tablets is particularly limited
Information sheets for patients about the supply issue are available on the Pharmac website.
New supply issue affecting isosorbide mononitrate
Stock of isosorbide mononitrate 40 mg tablets (Ismo 40 Retard), used for the prophylaxis of angina, is low again due to manufacturing delays. This follows a previous supply issue that was resolved in May (last reported in Bulletin 147). A re-supply date is currently unknown.
Clinical advice remains that 60 mg modified-release tablets (Duride) may be a suitable alternative (or half a tablet for ~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 it is not crushed or chewed.
Konsyl-D (psyllium husk) supply issue
Konsyl-D (psyllium husk) is out of stock with the supplier (Arrotex). Re-supply is expected in July, but it may take up to three weeks to reach pharmacies. Some stock may still be available in the supply chain. Pharmac advises that alternative products are available over the counter, however, patients would need to pay for these as they are not funded.
Perindopril temporarily switched to monthly dispensing
Dispensing of all strengths of perindopril tablets (Coversyl), an ACE inhibitor used for a range of cardiovascular conditions, has been temporarily switched to monthly since 1st July, 2026, to extend current stock while awaiting an updated version of the medicine. A date for returning to stat dispensing is not currently known.
New brand of rosuvastatin listed
Supply issues affecting rosuvastatin are ongoing due to manufacturing disruptions (last reported in Bulletin 144). Stock of Rosuvastatin Viatris, the original funded brand, is not available and stock of the alternative, Rosuvastatin Sandoz, is reported to be exhausted by August. Another alternative brand, Rosuvastatin Mylan, has been listed on the Pharmaceutical Schedule since 1st July in response. This brand has Medsafe approval and can be prescribed as usual. Reassure patients that the new brand has the same active ingredient as Rosuvastatin Viatris, but the tablet appearance and packaging may be different. Supply of rosuvastatin is expected to return to normal from September, 2026.
Medsafe Alert Communication: Dexcom G7 sensors (continuous glucose monitors)
Medsafe has published an Alert Communication about a Product Alert affecting two lots of G7 Continuous Glucose Monitoring System (Dexcom G7) sensors: lot numbers 1725204004 and 1725069002. The affected sensors have not been distributed in New Zealand by the company that supplies Dexcom G7 sensors, i.e. this issue does not apply to sensors supplied on prescription, and there is no evidence to-date that the affected sensors are in the country. However, there is a risk that Dexcom G7 sensors purchased from overseas websites, e.g. USA, might be affected. Medsafe is therefore advising people who have purchased a Dexcom G7 sensor from an overseas website to check the lot or serial number of their sensor to determine whether it is affected.
Read more
The affected sensors were not intended for sale, however, were stolen during the disposal process in the USA and have since been sold through unauthorised supply channels to third parties. The risks associated with use include skin infections and inaccurate or lost blood glucose readings, potentially leading to missed detection of hypo- and hyperglycaemia.
People who have purchased affected sensors should be advised not to use them and to dispose of them. They should also be advised to seek medical attention if they develop symptoms of inflammation or infection, e.g. redness, swelling or pain at the insertion site. Affected sensors should be replaced immediately or a blood glucose meter used instead; people can request a replacement sensor by phoning Dexcom Technical Support (0508 634 103).
Medsafe strongly advises people against purchasing medicines and medical devices from unknown overseas sources, due to concerns regarding safety and efficacy. Encourage patients self-funding CGMs without a prescription to purchase them from reputable retailers and to verify product authenticity from a source independent of the website where it is being sold.
Further information about how to identify affected CGM sensors is available here
Where are we at with flu vaccinations?
The 2026 Influenza Immunisation Programme launched in April (as reported in Bulletin 144) with a target of at least 75% of adults aged 65 years or over to be vaccinated this flu season. As of 28th June, 55% of this group have received an influenza vaccination, compared to 58% at the same time in 2025. Vaccination rates for Māori (45%), Pacific (45%) and Asian peoples (46%) aged 65 years or over are also marginally lower compared to last year and lower than the overall target. In total, more than 1.1 million vaccinations have been administered since the start of the 2026 Immunisation Programme. The Ministry of Health, Manatū Hauora, publishes data on uptake of vaccinations by district, updated weekly; check out how your area is doing here.
Encourage influenza vaccination opportunistically during routine appointments and ensure patients who meet eligibility criteria for funded vaccination are aware that they can receive a flu vaccine for free. Influvac Tetra (quadrivalent vaccine) is the sole funded influenza vaccine for children aged six months and over and adults who meet eligibility criteria (which has not changed from last year). For further information, including a summary of available vaccines and eligibility criteria, click here.
Influenza vaccines available in New Zealand this year include coverage for circulating influenza A (H3N2) variants, including strains related to super‑K which contributed to the recent severe influenza season reported in the Northern Hemisphere.
Increased risk of highly pathogenic “bird flu” possible in New Zealand
In a recent Public Health Advisory notice, Health New Zealand, Te Whatu Ora, is making clinicians aware of the potential arrival of a highly pathogenic strain of avian influenza (HPAI H5N1, clade 2.3.4.4b). This strain was detected in Western and South Australia, and it is expected to arrive in New Zealand eventually. The overall public health risk for New Zealand is low. Human infections are rare but have been reported following direct contact with infected animals, animal materials, e.g. bird faeces, or environments contaminated with animal materials. Currently there is no evidence of human-to-human transmission.
Read more
The epidemiological criteria for avian influenza currently includes close contact or exposure to (within ten days before symptom onset):
- Animals, animal fluids or faeces, or their environments suspected to be infected with avian influenza; or
- Humans with suspected or confirmed avian influenza infection, or their clinical samples
Influenza PCR testing is recommended for patients who meet these criteria and have relevant symptoms, e.g. headache, fatigue, upper or lower respiratory tract symptoms, fever, gastrointestinal symptoms, muscle or joint pain. Collect viral swabs to send for influenza PCR testing. Record the patient’s symptoms and exposure history on the laboratory request and urgently notify suspected cases to the Medical Officer of Health.
Further information for healthcare professionals on avian influenza, including epidemiological criteria and recommended testing, is available from the Communicable Disease Control Manual, here
NZF updates for July
Significant changes to the NZF in the July, 2026, release include:
- Contraception and conception, pregnancy and patient advice updated for benzodiazepines with information that exposure during pregnancy may increase miscarriage risk: clobazam, clonazepam, diazepam, lorazepam, midazolam, temazepam and alprazolam (section 29, unapproved medicine; not funded)
- Updated renal impairment advice (use of eGFR rather than creatinine clearance) and cautions for metformin
- Updated indications and dosing regimens for cefalexin to align with Te Whata Kura – National Antibiotic Guidelines
- Full monograph revision for rivaroxaban; contraindications, cautions and patient advice updated
- Updated excipients, dose regimen and monitoring information for carbamazepine
- Updated pregnancy advice for cetirizine hydrochloride: manufacturer advises use with caution due to limited human data, however not expected to cause harm to fetus and animal studies do not indicate any harmful effects; cetirizine or loratadine are preferred non-sedating antihistamines in pregnancy
- Updated cautions, renal impairment advice, dose regimen for control of bleeding and patient advice for desmopressin acetate
- Updated pre-treatment screening, monitoring information and patient advice for hydroxychloroquine sulfate
- Hypersensitivity to polysorbate 80 added as a contraindication to infliximab. Adverse effects have also been updated.
- Updated fluconazole dose regimen for dermatomycoses (including tinea pedis, corporis, cruris, pityriasis versicolor and dermal candidiasis)
- Updated therapeutic notes for:
You can read about all the changes in the July release, here. Also read about any significant changes to the NZF for Children (NZFC), here.
CPD Corner: Upcoming Goodfellow Unit webinars + latest podcast episodes from The Specialist GP
Upcoming Goodfellow Unit webinars
The Goodfellow Unit, University of Auckland, is hosting several free access webinars in July. Webinars are often recorded and available to watch at a later date. Upcoming webinars include:
- Injectables for weight loss, presented by Endocrinologist Professor Jeremy Krebs. This webinar will be held on Tuesday, 7th July, from 7:30 pm. Click here to register.
- Managing lumbar and cervical spine presentations, presented by Orthopaedic Surgeon Dr Otis Shirley. This webinar will be held on Tuesday, 14th July, from 7:30 pm. Click here to register.
- A new era of Hepatitis B: Eliminating HBV, presented by Professor Ed Gane. This webinar will be held on Tuesday, 21st July, from 7:30 pm. Click here to register.
- COVID vaccination and antivirals in 2026, presented by General Medicine and Infectious Diseases Physician Dr Hasan Bhally. This webinar will be held on Tuesday, 28th July, from 7:30 pm. Click here to register.
Latest episodes from The Specialist GP
‘The Specialist GP' is a New Zealand–based podcast for primary care health professionals, created and hosted by Dr Louise Kuegler. Recent episodes include:
- Vitamin D supplementation in pregnancy and infancy with Professor Ben Wheeler. This episode covers who should receive vitamin D supplementation during pregnancy and infancy as well as identifying at-risk groups, preventing deficiency and recognising vitamin D deficiency and nutritional rickets in clinical practice.
- Antibiotics in Early Life: “What Are We Changing for the Future?” with Professor Wayne Cutfield. This episode discusses how early antibiotic exposure influences the developing microbiome, potential long-term health implications and practical approaches to support appropriate antibiotic prescribing in children.
- Clinician burnout with Dr Jo Prendergast. This episode covers the definitions of burnout in healthcare, common warning signs, systemic causes and strategies for prevention.
Paper of the Week: Treatment narratives – what to know when you don’t know
Most people want an explanation for why something occurs—a justification that they are experiencing symptom “A” because they have condition “B”. Ideally, the expected course of illness follows the restitution narrative: patient presents with a pattern of symptoms that can be recognised and diagnosed, and that diagnosis leads to treatment and eventually a “cure”. Unfortunately, not all patients fit this narrative. For every patient you can explain to that “your foot hurts because you have a build-up of uric acid crystals in your metatarsophalangeal joint and we can prescribe you medicine to treat this”, there is another who is living with chronic debilitating symptoms that cannot be explained, e.g. “your foot hurts but we don’t know why or how to prevent it at the moment”. Without a diagnosis, access to potential treatments and support may be restricted. This can lead to feelings of invalidation and abandonment for some patients and helplessness for clinicians. There is also a risk that patients may eventually lose trust in healthcare professionals.
What strategies should primary care clinicians use when working with patients in whom a diagnosis or explanation for their symptoms proves elusive? An article published in the Australian Journal of General Practice discusses one way to approach and support patients in this situation. When the restitution narrative is no longer suitable, healthcare professionals must work with patients to develop a new narrative for their symptoms. This involves establishing the patient’s beliefs and understanding of their symptoms and the impact they have on them. Clinicians must be prepared to challenge ideas, provide additional information and compromise to reach a shared illness narrative, while not undermining the patient’s trust. If the goal of returning to a similar quality of life as before the illness is no longer attainable, primary care clinicians need to refocus and help patient establish their “new normal” and learn how to move forward.
What are some common features of cases or situations you have been involved with in which you (or a healthcare team you were part of) were unable to reach a diagnosis for a patient? What strategies did you use when discussing the inability to give them a diagnosis? If a patient has eventually received a diagnosis, how did their approach to treatment change?
Read more
The impact of an anonymous illness
- Major trauma or chronic illness has a significant impact on a person’s identity, relationships and their purpose and priorities, and not having a diagnosis makes this more challenging
- A diagnosis is crucial because it validates a patient’s symptoms, gives them a prognosis and provides a simple/recognisable explanation about their illness to inform others, and garner support
- This is not, however, always the case - different conditions and diagnoses elucidate responses that range from empathy and support to stigma and shame
- For some patients, a lack of a diagnosis contributes to feelings of isolation and disengagement from friends and family/whānau. “When you say ‘I have cancer’, people make the effort to support you through the illness. When you say ‘they don’t know what’s wrong with me’, you are met with silence.”
Finding common ground
- Problems can arise when there are differences between the clinician’s and patient’s concept and understanding of their undiagnosed chronic illness
- Where possible, aim to establish a mutual understanding of the illness narrative. This may require compromise from both the patient and healthcare professional:
- Listen to the patient’s narrative (this may include expectations around treatments)
- Ask questions and avoid challenging their narrative until you understand why the patient has certain beliefs
- Confirm your understanding of the patient’s beliefs and ideas and ensure no red flags or obvious causes have been missed
- Establish the impact that life events have on the patient’s symptoms, e.g. do the symptoms worsen with stress?
- Summarise where you and the patient agree and where you may differ in your understanding. Is the patient open to change? Consider whether additional information (e.g. investigation to rule out a cause) could be used to challenge a specific belief.
- Motivational interviewing techniques could be employed at this stage, e.g. “…based on my understanding, I think it’s unlikely that “X” is related to “Y”, however, there are other causes of “X”. We can talk through a few of those other causes of “X” together now and I will arrange some tests that could rule out “Y” as well. Is that something you’d be willing to consider?”
- Work with the patient to confirm a shared narrative that promotes autonomy, is beneficial (while minimising harms) and includes fair and appropriate treatment
- Set boundaries (if required). Reinforce what you can and cannot provide the patient within your legal and ethical obligations.
Seeing things differently
- Reframing the patient’s view of their body and health can promote understanding. For example, patients could be encouraged to think of their bodies as:
- Machines. Like machines, parts of our bodies can get worn out or break, the wrong fuel can be put in the tank, our bodies might not be used in the correct way or damaged by external (or environmental) threats. The healthcare professional can be thought of as a mechanic or engineer. This metaphor has scientific context and can aid acceptance of uncertainty.
- Part of an ecosystem. Circumstances and contexts influence whether an ecosystem thrives or not. Biopsychosocial factors such as discrimination, isolation and disconnection can influence health in a similar way that temperature and competition can alter natural habitats.
Avoiding pitfalls
- Patients’ inherent need for an explanation puts them at risk of psychological and financial exploitation. The reach of social media has further compounded this problem.
- New syndromes are constantly being proposed to explain combinations of symptoms, and while this may provide “answers”, validation and belonging for some people, there is often limited effective treatment options and little overall change in the patient’s clinical situation
- The health and wellness industry lends itself to individuals who empower patients by offering non-evidence-based or pseudoscientific treatments. This industries’ primary motivation is often financial, and patients may be unaware of this, or desperate enough to look past it.
- Primary care clinicians must challenge these ideas without undermining the patient’s trust in conventional medicine
Handling health uncertainty
- The doctor–patient relationship is crucial; prioritise validating patients’ experiences to avoid undermining trust
- Acknowledge the patient’s feelings and the impact this is having on their lives (“it’s not just all in their head…”), try to understand the patient’s views and opinions and offer “helpful alternatives”
- Suggested alternative narrative fragments to discuss with patients include:
- Medical ‘cold cases’ – like a detective’s cold case, there are clues and evidence, but what they mean currently eludes us
- Unknown vs imaginary – the patient’s symptoms and impact on their quality of life is real, but we don’t know enough about the causes yet, e.g. the difference between a giant squid (real, but not well understood) and the Loch Ness monster*
- Being a pioneer – medicine is always moving forward, and new discoveries are being made. We can hopefully find an answer in the future but currently we are in unknown territory.
* Although possibly controversial, for the purposes of this metaphor we will assume that the Loch Ness monster is imaginary!
Ultimately, patients are just wanting to make sense of what is happening to them. When you don’t have the answers, the simplest, but most important, thing is to reassure them that you will keep looking together.
The restitution narrative was first described in Arthur Frank’s book “The Wounded Storyteller”. With a background in sociology and drawing on his own experience, he proposed that stories and understanding about illness follow one of three narratives: restitution where illness is viewed as a temporary state that can be fixed, chaos where illness is completely disruptive to life and quest where illness is a transformational journey. Professor Meagan Brennan, a GP in Australia, has written about how these narratives can be understood in the clinical context: read here.
Stone L, King D, Pearson LM. Navigating invisible illness: Medically unexplained symptoms and the power of narratives. Aust J Gen Pract 2026;55:353–8. doi:10.31128/AJGP-12-25-7930.
This Bulletin is supported by the South Link Education Trust
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