Published: 8 July, 2020


What’s happening with monthly dispensing?

In March, 2020, PHARMAC announced that medicines should be dispensed monthly (or three-monthly for oral contraceptives) due to concerns about the supply chain during the COVID-19 pandemic.

Currently, no date has been set for a return to three monthly stat dispensing, however, work is progressing towards this goal and PHARMAC will give at least three weeks’ notice of any change*. Due to ongoing global issues affecting manufacturing and supply it is likely that some medicines will need to continue to be dispensed monthly; it is anticipated that these supply issues may continue for the rest of 2020 and even beyond.

If necessary, pharmacists may still make exceptions to the current monthly dispensing requirements, based on rule 4.4.2 of the Pharmaceutical Schedule, e.g. for people who have mobility issues, live in rural areas, are older or are immunocompromised.

*On 9/7/20 it was announced that there would be a return to stat dispensing on 1 August, 2020 (with some restrictions).

Gemfibrozil tablets discontinued

PHARMAC has announced that the fibrate gemfibrozil is to be discontinued and stocks will likely be exhausted during early July, 2020. This is because the supplier (Douglas) is unable to obtain the raw material for manufacture. No other manufacturer of gemfibrozil has been able to be found to supply the New Zealand market. Approximately 800 patients taking gemfibrozil will be affected by this discontinuation.

Patients taking gemfibrozil will need to be changed to another lipid-lowering treatment. PHARMAC will reimburse general practices for the cost of this consultation – the co-payment waiver reimbursement form is available here.

For more information on lipid-lowering treatments, see “Prescribing statins to reduce cardiovascular risk

New guidelines for young people with type 2 diabetes

Australasian guidelines for the screening, assessment and management of type 2 diabetes in children and adolescents have just been released and are available here. This guidance has been developed to provide consensus on how to detect young people at risk of type 2 diabetes and how to manage them once diagnosed. A key aim of the guidelines is to address the challenges and specifics of care for children from Indigenous populations in both Australia and New Zealand who are at higher risk.

For more information on diabetes in younger people, see “A rising tide of type 2 diabetes in younger people: what can primary care do?

Cilazapril + hydrochlorothiazide discontinuation

As previously reported, the combination tablet cilazapril with hydrochlorothiazide is no longer being supplied, due to withdrawal of the manufacturer, Apotex, from the New Zealand market. There are no other brands of this medicine available. From 1 March, 2020, cilazapril + hydrochlorothiazide was not funded for new patients. Patients already receiving this medicine could continue to do so with an endorsed prescription. However, patients should now be in the process of changing to an alternative medicine regimen (or already changed). It is now expected that stocks of cilazapril + hydrochlorothiazide will run out in September, 2020.

A new topic on managing hypertension is available in the bpacnz Primary Care Update Series

Paper of the week: Māori are more likely to experience NSAID-related harm

In our feature paper this week, we review a New Zealand retrospective cohort study conducted by researchers at bpacnz and Waitemata/Auckland DHBs. Although widely used in New Zealand, non‐steroidal anti‐inflammatory drugs (NSAIDs) are associated with a number of serious adverse effects, including upper gastrointestinal bleeding, acute kidney failure and heart failure. A retrospective cohort study using national pharmaceutical dispensing and hospital admissions data from 2007 – 2015 was used to assess ethnic disparities in the risk of hospitalisation for NSAID-related adverse effects in New Zealand.

Main findings:

  • The risk of upper gastrointestinal bleeding, heart failure and acute kidney failure associated with NSAID use in New Zealand varies according to patient ethnicity
  • Māori and Pacific patients were more likely to be hospitalised for upper gastrointestinal bleeding (rate ratios [RRs], 2.54 and 3.17, respectively) and heart failure (RRs, 2.48 and 1.97, respectively), and Māori were more likely to be hospitalised for acute kidney failure (RR, 1.46), during NSAID treatment than Europeans
  • The relative risk of upper gastrointestinal bleeding and heart failure associated with NSAIDs was greatest in Māori and Pacific patients aged under 60 years

Tomlin A, Woods D, Lambie A, et al. Ethnic inequality in non‐steroidal anti‐inflammatory drug‐associated harm in New Zealand: A national population‐based cohort study. Pharmacoepidemiol Drug Saf. 2020;1–9. Abstract available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/pds.5028

N.B. We prefer to review open-access papers, however, made an exception in this case due to the subject interest and relevance to the New Zealand population.


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