PHARMAC increases access to heart treatments

Decisions by PHARMAC will see easier access to treatments for people at risk of heart attack or stroke because of raised cholesterol levels.

Raised cholesterol increases people’s risk of suffering from heart attack or stroke from fatty deposits narrowing blood vessels. Heart disease continues to be a leading cause of illness and premature death in New Zealand, with higher rates among Maori and Pacific people than the general population.

Cholesterol-lowering medicines help lower people’s risk of heart attack and stroke, and two recent decisions by PHARMAC provide wider access to treatments.

From 1 September PHARMAC has removed the restrictions on who is eligible for funding for the statin drug atorvastatin, as part of a new savings agreement.

And from 1 October, PHARMAC will also provide greater access to the cholesterol absorption inhibitor ezetimibe (Ezetrol), plus the ezetimibe/simvastatin combination product (Vytorin). The agreement with Merck Sharp & Dohme (MSD) will see the price of ezetimibe reduce by up to a half.

The changes in access will give general practitioners the ability to prescribe ezetimibe, and also widen the type of people who would be eligible for treatment. For atorvastatin, the significantly reduced cost means the restriction on prescribing could be removed.

“As the price of these drugs has come down, this has given us opportunities to make them available for greater numbers of patients,” says Dr Moodie. “Higher prices meant having to target access to those patients with greatest need. More than 300,000 New Zealanders are currently prescribed statins and for many of these people atorvastatin will now be an option.”

Ezetimibe will continue to be restricted to people whose cholesterol levels haven’t reduced sufficiently using statin drugs alone. PHARMAC estimates about 18,000 people will be using ezetimibe within three years.

“This will continue the clinical practice in New Zealand of using statins as a first-line treatment for people with raised cholesterol,” Dr Moodie says. “Statins are generally effective in lowering cholesterol and well tolerated. However, for some people they aren’t enough to meet cholesterol targets so that is where ezetimibe can be used as an add-on treatment.”

Also included in the agreement are the antidepressant mianserin (Tolvon) and the hormonal treatment oestriol (Ovestin). Access is being widened to mianserin so it is available for people who haven’t responded to other antidepressants and there is a price reduction for oestriol.

With new money available to spend on medicines, PHARMAC estimates the new agreement with MSD will lead to an $8 million increase in DHB spending on pharmaceuticals over five years.