Decision to improve access to budesonide with eformoterol inhalers
What we’re doing
We’re pleased to announce a decision to support access to budesonide with eformoterol inhalers. From 1 August 2025 the following changes will be implemented:
- Three months’ supply of some budesonide with eformoterol inhalers can be collected all at once instead of people having to collect them monthly.
- Some budesonide with eformoterol inhalers will be accessible in general practice clinics through a Practitioners Supply Order (PSO). PSO supply means a prescriber has access to a medicine for emergency use, teaching and demonstration or giving to someone where an individual prescription is not practical.
We estimate that this decision will improve access to budesonide with eformoterol inhalers for 120,000 people in the first year.
The Government provided additional funding to Pharmac in June 2024 to fund new medicines and widen access to medicines that are already funded. The funding boost covers medicines for both cancer and non-cancer health conditions. This decision is the last related to the Government’s funding boost is one of many that we have worked on to put our budget increase into action.
Questions and answers on Pharmac’s budget increase
Any changes to the original proposal?
This decision was subject to a consultation letter dated 17 April 2025.
Proposal to support access to budesonide with eformoterol inhalers
We are grateful to the health care professionals, consumers and advocacy groups who provided extensive feedback to our consultation. This decision includes no changes to the original proposal.
Who may be most interested
- People with asthma, their whānau and caregivers
- Respiratory specialists, general practitioners, pharmacists, clinical nurse specialists, and other health professionals involved in the care of people with asthma
- Groups who support and advocate for people with asthma
- Health NZ | Te Whatu Ora
- Community and Hospital pharmacies
- Pharmaceutical suppliers and wholesalers
Details about this decision
For people accessing budesonide with eformoterol inhalers
From 1 August 2025, people using some budesonide with eformoterol inhalers will be able to receive three months’ supply all at once. This will remove the need for people to collect their inhalers from their pharmacy each month. We understand this will provide people with greater flexibility in accessing their medicine supply and support improved adherence.
For health care professionals
From 1 August 2025, some budesonide with eformoterol inhalers will be available on a Practitioners Supply Order (PSO), for prescribers to ensure that they are available for emergency use, teaching and demonstration purposes, or where an individual prescription is not practicable.
We understand that some budesonide with eformoterol inhalers are used as relievers for asthma symptoms. Currently the only asthma reliever inhaler available on a PSO is salbutamol. With this decision, clinicians and people with asthma will have another treatment for asthma symptoms available in the clinic setting.
We understand that making some budesonide with eformoterol inhalers available on a PSO and enabling three monthly dispensing (also known as ‘stat’) will support ongoing implementation of the NZ Adolescent and Adult Asthma Guidelines.(external link)
The currently funded brands of budesonide with eformoterol inhalers are Symbicort Turbuhaler, DuoResp Spiromax (dry powder inhalers) and Vannair (metered dose inhaler).
We are only making these changes to the 100mcg budesonide with 6mcg eformoterol fumarate (100/6) and 200mcg budesonide with 6mcg eformoterol fumarate (200/6) formulation of inhalers because these strengths are used in AIR and SMART therapies.
Schedule changes
From 1 August 2025, budesonide with eformoterol would be listed in Section B of the Pharmaceutical Schedule as follows (stat and PSO quantities shown in bold, affected presentations shown only):
BUDESONIDE WITH EFORMOTEROL
❋Powder for inhalation 160 mcg with 4.5 mcg eformoterol fumarate per dose (equivalent to 200 mcg budesonide with 6 mcg eformoterol fumarate metered dose) – Up to 120 doses available on PSO |
$41.50 120 dose OP ✔ DuoResp Spiromax |
❋Aerosol inhaler 100 mcg with eformoterol fumarate 6 mcg – Up to 120 doses available on PSO |
$18.23 120 dose OP ✔ Vannair |
❋Powder for inhalation 100 mcg with eformoterol fumarate 6 mcg – Up to 120 doses available on PSO |
$33.74 120 dose OP ✔ Symbicort Turbuhaler 100/6 |
❋Aerosol inhaler 200 mcg with eformoterol fumarate 6 mcg – Up to 120 doses available on PSO |
$21.40 120 dose OP ✔ Vannair |
❋Powder for inhalation 200 mcg with eformoterol fumarate 6 mcg – Up to 120 doses available on PSO |
$33.74 120 dose OP ✔ Symbicort Turbuhaler 200/6 |
No changes will be made in Part II of Section H of the Pharmaceutical Schedule.
What you told us
Thank you to the people who took time to respond to this consultation. A summary of the main themes raised in feedback and our responses to the feedback can be seen in the table below.
Theme |
Pharmac Comment |
---|---|
All-at-once dispensing of budesonide with eformoterol |
|
Support for the proposal |
|
Supportive, not having to collect budesonide with eformoterol every month and risk running out is very positive. Monthly dispensing can be prohibitive for patients with transport, financial or mobility issues, and people run the risk of having no asthma reliever medication on hand. Enhancing access to budesonide/eformoterol will facilitate the implementation of the New Zealand adolescent and adult asthma guidelines. The widespread uptake of ICS/formoterol reliever and/or maintenance therapy in adolescents and adults with asthma in New Zealand has been temporally associated with a reduction in hospital admissions for asthma, particularly in Māori. The proposal will likely lead to further reductions in hospitalisations for asthma, and further reduce inequities in asthma outcomes. |
We are pleased to be able to progress a decision that supports access to medicines and the implementation of the New Zealand adolescent and adult asthma guidelines,(external link) reduces inequities, and improves the health outcomes of New Zealanders. |
Supportive, respondents suggesting following the Australian model and having these inhalers available over the counter with no requirement for a prescription. |
We note that the Australian model for accessing budesonide with eformoterol inhalers differs to New Zealand model. However, making the suggested changes requires a change in prescription classification which is not the role of Pharmac. At this time, we are not looking to propose any additional changes to access. |
Do not support all-at-once dispensing |
|
Medical waste is likely to increase as a result of enabling all-at-once dispensing, as the number of unused inhalers that are dispensed will inevitably increase |
We acknowledge there could be an increase in inhaler usage as a result of this decision and have taken this into account as part of our assessment. Our assessment is that this decision will improve adherence to treatment helping to reduce the number of severe asthma exacerbations, which will benefit the health of many New Zealanders. |
Monthly dispensing allows regular intervention to ensure adherence, inhaler technique and patient safety and this proposal would reduce this oversight. |
Pharmac acknowledges the important role pharmacists have within the health system and appreciate the value that regular intervention has in ensuring someone can use their inhaler appropriately and effectively. As part of this decision, we still expect nearly all dispensings will occur at community pharmacies. While we are not aware of any data that describe how frequently people currently receive support for their inhaler technique, we note that there will be an opportunity every three months to support adherence and safety. |
Negative impact on financial operations of community pharmacies and poorer inventory control. Stat dispensing would result in a loss of dispensing fees. |
While we acknowledge that this change may result in a loss of revenue for community pharmacies, it will also likely reduce the workload required to dispense these medicines. We note that there are many other medicines that are currently available dispensed as stat and/or on a PSO, including other inhalers, and consider that pharmacies are experienced at managing stock in these situations. We have shared this feedback with HNZ, which is responsible for managing contracts with community pharmacies for dispensing funded medicines. |
Other Funding Requests |
|
Stat dispensing should be extended to all preventer inhalers |
Pharmac is only making changes to some presentations of budesonide with eformoterol inhalers at this time. This is to align with and support implementation of the New Zealand adolescent and adult asthma guidelines,(external link) that outline the use of budesonide/eformoterol inhalers for symptom relief in a similar way to salbutamol (which is currently available on stat dispensing). This is in line with the clinical advice we have received. |
Budesonide with eformoterol on a PSO |
|
Support for the proposal |
|
Supportive, respondents noted prescribers need to be able to access budesonide/eformoterol 100 mcg/6 mcg and 200 mcg/6 mcg inhalers in a clinical setting for a number of reasons:
|
We are pleased to be able to progress a decision for widened access to medicines that will improve the health outcomes of New Zealanders.
|
Do not support budesonide with eformoterol on PSO |
|
Raised concerns with lack of individual patient records when medicines are supplied by PSO. Notes that shared digital records are fundamental for accessing vital information when required. Considers that supply not being linked to an individual through a centralised patient record poses risks to patient safety and care continuity. |
Pharmac recognises the important role pharmacists have in patient care, including clinical review, patient counselling, safety checks and adherence support. The purpose of the PSO mechanism is to ensure that stock is available for all general practices for:
It is anticipated that only a small fraction of total use of budesonide with eformoterol (around 5%) will be from inhalers accessed via a PSO, largely for teaching purposes. We note that salbutamol is currently available on a PSO and we consider that budesonide with eformoterol should be similarly available as it is the recommended reliever treatment for a considerable number of people with asthma as per the asthma guidelines. |
Considers that there is currently no place for budesonide with eformoterol inhalers in the emergency management of acute severe asthma. Salbutamol via a metered dose inhaler or nebuliser remains the recommended treatment depending on severity. |
We acknowledge that salbutamol offers a suitable treatment option for certain people in an emergency setting. The evidence-based New Zealand adolescent and adult asthma guidelines, along with our clinical advisory committee, recommend budesonide with eformoterol as the preferred inhaler reliever therapy, rather than salbutamol inhalers or an alternative short-acting beta-agonist inhaler. Having this formulation available will not preclude the use of nebulised salbutamol where appropriate. |
Dispensing via a PSO will result in a loss of dispensing fees and medicine margin. |
We acknowledge that community pharmacies are reimbursed for dispensings and have discussed this issue with the Pharmacy Guild. Our analysis is that enabling PSO is likely to have a neutral financial impact as community pharmacy will still receive a dispensing fee. The vast majority of inhalers are expected to be dispensed at community pharmacy. |
Equity is a foundational principle of the health system, yet shifting inhaler access to clinics under PSOs could unintentionally disadvantage groups already experiencing barriers to care. Pharmacies are often embedded within the communities they serve, allowing them to provide culturally appropriate, low-barrier services that support whānau in a way that traditional models of care may not. |
Pharmac recognises the important role pharmacies hold within their communities and the health system. These changes are being made to provide people with greater access to their asthma treatments, with their community pharmacy still playing a critical role in providing care. Our clinical advisors have indicated that enabling ‘all-at-once dispensing’ and enabling access via a PSO will improve equity of access through reducing barriers, allowing people to better adhere to treatment guidelines. Pharmac staff note the PSO form only allows for one inhaler to be provided at a time and isn’t intended to replace how people receive their regular prescriptions for budesonide with eformoterol inhalers. |
Other Funding Requests |
|
Propose that all ICS/LABAs be made available on PSO |
Pharmac is making these changes to only some presentations of budesonide with eformoterol inhalers at this time to align with and support implementation of the New Zealand adolescent and adult asthma guidelines(external link), where our clinical advisors have recommended budesonide with eformoterol inhalers be funded for stat dispensing and on the PSO. |
If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 660 050.