Decision to delist efavirenz tablets from the Pharmaceutical Schedule

Supportive, noting that Pharmac had communicated the likely discontinuation and provided a short-term alternative supply to enable people living with HIV and clinicians time to move to other antiretroviral regimens.

We appreciate the supportive feedback around the management of this discontinuation.

Requested that further time be given to allow people to change medicines due to the difficulties in accessing antiretroviral prescribers.

To provide additional time for impacted people to change to alternative treatments we have secured an additional 9 months supply of efavirenz.

We are now delisting Efavirenz Milpharm tablets from 1 November 2026, although at current usage rates stock is expected to be depleted in April 2026.

Highlighted that there may be a small number of people who would no longer be able to construct an antiviral regimen, due to a combination of contraindications and/or resistance. Specifically, people who need non-integrase inhibitor (INSTI) / non-protease inhibitor (PI) combinations.

Noted that a larger number of people are currently receiving treatment with the fixed dose combination of efavirenz, emtricitabine and tenofovir (Atripla). They also noted it was desirable to maintain access to all individual components of the fixed dose combination in use to support ongoing use if there are supply issues or requirements for a temporary regimen or dosage adjustment.

We appreciate there may be some people who struggle to find a suitable alternative antiretroviral combination.

There is no intent to change the funding of the combination tablet containing efavirenz, emtricitabine and tenofovir (Atripla). However, we appreciate that it can be beneficial to have individual components of combinations funded in some clinical circumstances.

Our clinical advisors have told us that there are funded treatments available that people currently receiving efavirenz can move to.

We understand that there may be a small group of people currently receiving efavirenz who would have no funded alternatives available. We expect the number of people in this group to be very small. Should there be no suitable funded alternative for people, we would consider applications for access for individual patients through Pharmac’s Exceptional Circumstances Framework - NPPA. This would apply to ongoing access to an efavirenz product, and could apply to other treatments, if there are no funded alternatives available. We will work with healthcare professionals caring for people in this situation so that they can access funded medicines to meet the needs of their patients. We encourage any prescribers in this situation to contact NPPA@Pharmac.govt.nz if have any queries about this process.

People had concerns that this represented a reduction in the number of available antiretroviral treatments and there was limited visible progress on funding more antiretroviral medicines for HIV.

Noted a desire for access to a newer Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI), specifically doravirine or rilpivirine, which would be clinically preferred options to efavirenz.

We understand that a reduction in the number of funded antiretrovirals is not desirable. However, in this case the product is being globally discontinued and we have not been able to secure ongoing supply of a Medsafe approved product. Our clinical advisors have told us that other funded antiretroviral medicines would meet the needs of the vast majority of people currently receiving this medicine.

We have not yet received an application for doravirine and at present there are no Medsafe approved medicines containing this chemical. However, we would welcome an application for doravirine alongside a submission to Medsafe for regulatory approval.

How to submit a funding application

We received an application for rilpivirine(external link) in 2012. This was recommended to be funded by the Pharmacology and Therapeutics Advisory Committee (PTAC) in 2013 if it was cost neutral to efavirenz. This application was declined in 2021 as cost neutral funding was unable to be achieved. A decline decision means the medicine is no longer being considered for funding for the use requested. However, this does not prevent us from reconsidering funding for this medicine in the future given this new information.

Record of PTAC meeting on February 2013 [PDF, 191 KB]

2021 Decision to decline various funding applications

We have engaged with the supplier of rilpivirine to find out if it is interested in reactivating its rilpivirine application.

People told us that HIV was a disease that still had significant stigma, and adherence to treatment was critical for long term disease control, and because of this changes to their HIV medicines could cause significant anxiety and distress.

We understand that having to change medicines is not easy. In response to the feedback, we have secured an additional 9 months supply of efavirenz to provide additional time for impacted people to change to alternative treatments.

People asked if Pharmac had a process or plan for informing people on efavirenz and ensuring they are supported in transitioning to alternative treatments.

We previously contacted antiretroviral prescribers and pharmacists who have dispensed efavirenz in the last 12 months regarding the proposed discontinuation.

We will contact prescribers of antiretrovirals again to make sure that they are aware of the discontinuation, so they are able to support transitioning their patients receiving efavirenz to alternative medicines.

We understand from our clinical advisors that almost all people currently receiving efavirenz would be able to move to other funded antiretroviral medicines. However, there may be a small number of people who are unable to move to another funded treatment. Ongoing funding of efavirenz or other HIV medicines would be considered through Pharmac’s Exceptional Circumstances Framework - NPPA.

Pharmac as a funding agency is not properly positioned or equipped to advise or publish clinical guidance on how clinicians should manage this transition.

We heard from prescribers that it would be helpful to receive information on which of their patients are receiving efavirenz so they can ensure nobody is missed.

We will contact prescribers that have prescribed efavirenz in the last 12 months to ensure they know about the discontinuation and can support transitioning their patients receiving efavirenz to alternative medicines. We have secured an additional supply of efavirenz to provide additional time for people to change to alternative treatments.

We do not have access to information that can identify individuals receiving medicines. If National Health Index (NHI) numbers are needed to identify impacted people, these can be requested from the Ministry of Health by emailing: data-enquiries@health.govt.nz

Requested the addition of wastage claimable to the listing of efavirenz to avoid pharmacies having to bear any wastage costs associated with the discontinuation.

Efavirenz Milpharm is a Section 29 product, this means that Pharmacies are able to claim wastage on the product. As a result, the wastage claimable rule already applies.