Published: 28 May, 2020

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Best Practice Bulletin: Issue 1

Contents

• Update on influenza vaccination stocks
• Temporary removal of spirometry requirement for funding of some COPD inhalers
• Update on oral contraception supply issues
• Benzbromarone out of stock and likely to be delisted in the future
• New BPACNZRx prescribing software
• Update Series cardiovascular module is complete and ready-to-go

Update on influenza vaccination stocks

With the high demand for influenza vaccination this year, the Ministry of Health and PHARMAC have obtained 360,000 doses of influenza vaccine from the Northern Hemisphere. The vaccine, Influvac Tetra (Saison 19/20), contains two of the same strains of influenza as Afluria Quad (the current Southern Hemisphere vaccine), and one that is closely related (see Table 1). As Influvac Tetra (Saison 19/20) may offer less protection than Afluria Quad, it is only approved for use in healthy people aged 3–64 years and is not funded. Patients who are eligible for funded vaccination should receive Afluria Quad.

For information on who is eligible for funded influenza vaccination, see: https://bpac.org.nz/2020/flu.aspx

Table 1. Strains of inactivated influenza virus included in the Northern and Southern hemisphere influenza vaccines

A factsheet on the Influvac Tetra (Saison 19/20) for health professionals is available here

Temporary removal of spirometry requirement for funding of some COPD inhalers

From 1 June, 2020, COPD diagnosis by spirometry will no longer be necessary for the following medicines to be funded: glycopyrronium (Seebri-Breezhaler), tiotropium bromide (Spiriva and Spiriva Respimat) and umeclidinium (Incruse Ellipta). Once the risk of exposure to COVID-19 is clinically negligible, the spirometry requirement will be reinstated, i.e. the COPD diagnosis must include spirometry and the prescription be endorsed accordingly.

Further information on the change for each product can be found on the PHARMAC website.

Update on oral contraception supply issues

Noriday supply issues resolved: there is now sufficient stock to meet demand.

Shortage of Microlut (levonorgestrel): An alternative brand, Microlut SCT, will be available in late May until early August, when Microlut is expected to be back in stock. Microlut SCT contains the same active ingredient and dose as Microlut (levonorgestrel 30 micrograms) and is made by the same company, however, the packaging and product information are slightly different.

Information for community pharmacists: Microlut SCT stock contains four 28-day blisters per original pack. Pharmacists will need to repackage Microlut SCT into boxes containing three 28-day blisters to fill patient prescriptions.

Norimin temporarily unavailable: The supplier of Norimin 28, a combined oral contraceptive (COC), has advised that stock is likely to run out by the middle of June, but supply will be restored by mid-July, 2020. An alternative product, Necon, has been listed on the Pharmaceutical Schedule. Necon contains the same active ingredients as Norimin (ethinyloestradiol 35 micrograms with norethisterone 500 micrograms), but has different packaging and product information to Norimin. Necon is an unapproved medicine in New Zealand.

Information for community pharmacists: Necon is supplied under Section 29 of the Medicines Act 1981. Generic substitution is not allowed. If patients have a repeat prescription owing for Norimin they will need to go back to their prescriber to discuss options and get a new prescription.

Marvelon discontinued: The supplier of Marvelon, a COC, has discontinued supply and there will be no further orders coming to New Zealand. Patients will need to be switched to another contraceptive.

For further information on these changes, see: https://www.pharmac.govt.nz/information-for/enquiries/oral-contraceptives-supply-updates/

For further information on selecting a contraceptive, see: www.bpac.org.nz/2019/contraception/options.aspx

Benzbromarone out of stock and likely to be delisted in the future

Benzbromarone is a third-line urate-lowering treatment (ULT), funded with Special Authority approval for the long-term management of gout. As of 14 May 2020, PHARMAC has reported that all brands of benzbromarone 50 mg and 100 mg tablets are out of stock at wholesaler level and it is difficult to source globally. Some pharmacies may still have some remaining stock of benzbromarone. PHARMAC has indicated that it is “likely we will delist benzbromarone from the Pharmaceutical Schedule”, although no date is currently set for this.

How should this news influence prescribing? Currently, only around 130 people in New Zealand are prescribed benzbromarone. In light of this stock issue and the potential delisting of benzbromarone in the future:

• No new patients should be started on benzbromarone
• Practitioners should transition patients currently using benzbromarone to another ULT as soon as possible.

For more information on gout management, see our recent article, or keep an eye out for our Update Series gout topic which will be released soon.

New BPACNZRx prescribing software

We have recently launched BPACNZRx, a unique prescribing module based on medicines information from the New Zealand Formulary (NZF). The module fully integrates into Medtech 32, and in the near-future Medtech Evolution, and includes seamless access to the New Zealand ePrescribing Service.

Main features include:

• Transfer of the patient's existing prescribed medicines into BPACNZRx
• Access to both adult and child NZF monograph and safety information at the time of prescribing
• A patient-specific medical warning system that considers multiple factors, including current medicine(s), allergies and other important notes; warnings are ordered by severity and prescribing is blocked if the patient has an associated medical warning marked “severe”
• Consideration of drug-to-drug interaction(s) utilising Stockley’s Drug Interaction engine; less severe drug-to-drug interactions can be suppressed at the prescriber’s discretion
• Guaranteed to be no more expensive than MIMS and you can switch straight away and not start paying until your current MIMS license expires

To find out more or to sign-up your practice, click here. Alternatively, you can email contact@bpacnzrx.org or phone 0800 728 247.

Update Series cardiovascular module is complete and ready-to-go

Bpac^nz’s Primary Care Update Series is a comprehensive education package that keeps GPs, nurses and other primary healthcare professionals up to date on the management of conditions they encounter in everyday practice. The series is not just a means of refreshing your knowledge and professional skillset with an established and trusted organisation; it also counts for CPD requirements by viewing/listening to resources, and/or completing educational assessments, e.g. case study quizzes. Since its inception, we have been excited by the interest and traction it’s had across New Zealand primary care.

In case you missed it, our first theme, cardiovascular disease, is now complete and ready-to-go, with the first topic free. Subscribers can either purchase this as a complete module, or pick-and-choose the topics that interest them the most (atrial fibrillation, heart failure, TIA/stroke and hypertension). Next up, we will be investigating the musculoskeletal system.

Don’t worry, bpac^nz’s regular articles that you are familiar with will continue to be available and published free-of-charge on our website.

For more information on the Update Series, or to sign up, see here.

This Bulletin is supported by the South Link Education Trust

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