Decision to make it easier to access Mirena and Jaydess IUDs (contraceptives)

Support for the proposal

Access to contraceptives should have as few barriers as possible. This proposal would eliminate a critical barrier for people accessing highly efficacious contraceptives and improve access. It was noted that more efficient access would particularly benefit people with limited access to transport and young people who want discrete easy to access services with no delay in appointments.

We are pleased to progress a decision that will result in easier access to Mirena and Jaydess for New Zealanders.

This proposal would reduce delays for people receiving Mirena or Jaydess. Respondents noted that timely and easy access to contraceptives is vital.

Currently, in addition to the time it takes to pick up a prescription and attend a second appointment for administration, further delays can occur for a variety of reasons, including:

• Some pharmacies do not stock these IUDs due to their high cost. Extra time is required for the pharmacy to source the IUD.
• Sometimes individuals may forget to pick up their IUD and attend their administration appointment without it. They then need to book a new appointment.
• Sometimes it only becomes clear at the administration appointment what sized device is needed. If this is different to the original prescription, a new prescription and appointment is needed.

This proposal would simplify the process for clinicians to administer Mirena and Jaydess and provide consistency across funded contraceptives which would minimise confusion.

It is recognised internationally and in New Zealand that often only one appointment is clinically required for an IUD administration.

It would also free up clinician appointment time which can be scarce and is highlighted as a current barrier to accessing timely contraceptive care.

Mirena is one of the most acceptable and suitable forms of contraception and is highly efficacious. The current logistical challenges from the prescription requirement mean that some people who want to use Mirena or Jaydess are unable to.

This proposal would improve health outcomes by allowing placements of Mirena and Jaydess at a convenient time, such as during a clinic visit following an abortion.

Other funding requests

Other barriers remain in the system that need to be addressed to ensure effective and equitable access to Mirena and Jaydess. These include funding appointments to place the IUDs and better access to training for specialist General Practitioners.

We acknowledge that the cost and availability of appointments will continue to remain as barriers to accessing IUDs for many New Zealanders. Pharmac is responsible for the funding of pharmaceuticals and does not make decisions on funding of medical appointments or training. We have shared this feedback with Health New Zealand.

Request to fund Nexplanon, a contraceptive implant.

We have received a funding application for Implanon NXT. We understand that this is the same product as Nexplanon, with a different brand name.

We sought clinical advice in May 2025, the record of this meeting will be publicly available in the coming months.

Implanon NXT Application Tracker(external link)

Prioritisation: How we decide which medicines need funding first

Allowance should be made for Mirena or Jaydess to be changed more frequently than the respective five- and three-year recommendations, where clinically appropriate (e.g. endometriosis and adenomyosis).

There are currently no funding restrictions on how frequently a new Mirena or Jaydess can be placed.

Do not support the proposal

This proposal should not be progressed.

This proposal would fragment the medicine supply system. There are currently no issues with the requirement for someone collecting a prescription ahead of their appointment. Local pharmacies support general practice clinics with timely availability of Mirena and Jaydess.

We acknowledge the great work pharmacists do to support people who need Mirena and Jaydess.

This feedback is however not consistent with what we have heard from the majority of respondents, including those who work in sexual health. On balance we consider that this decision would provide benefit to individuals using these pharmaceuticals.

This proposal would increase administrative and clinical burden on general practice due to decreased medico-legal protection from no individual prescriptions, practices would need to manage stock and patient safety, continuity of care would be compromised. This pathway would undermine established practice models.

This concern was not included in any feedback we received from primary care prescribers and their representatives.

This decision will not require prescribers to use the PSO mechanism. Mirena and Jaydess will continue to also be funded on prescription. As such, general practices can choose to continue to use individual prescriptions, as per current practice, if this is preferred.

Patient safety

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.

Conversely, another responder noted that people who receive a Mirena or Jaydess at a hospital service do not have it recorded on their dispensing history either at a pharmacy or via NZePS and therefore this occurring more commonly was not of significant concern.

We sought further clinical advice on this matter from our clinical advisors, which included pharmacists, GPs and specialists. Acknowledging the concerns, their advice indicated that this proposal would not increase clinical risks to individuals receiving a Mirena or Jaydess via a PSO.

Advice indicates that there are currently other instances where an IUD dispensing is not captured in an individual’s dispensing record, such as when the IUD is placed by a hospital service provider. Our advisors were not aware of situations where this has been an issue for patient safety or care continuity. The dispensing record is not an accurate record of when or if an IUD was placed.

Lost revenue for community pharmacy

Dispensing via a PSO will result in a loss of dispensing fees and medicine margin, particularly because of the high PSO volumes proposed.

Requests were made to:

• Reduce the amount of Mirena and Jaydess on a PSO,
• Not change the amount of Jadelle available on a PSO, and
• Not fund Mirena and Jaydess on PSO.

Community pharmacies are reimbursed for PSO dispensings, however if multiple units are included in each order, this would reduce the overall dispensing fees the community pharmacy receives compared with status quo.

While we acknowledge that this change may result in a loss of revenue for community pharmacies, it will also reduce the workload required to dispense these contraceptives.

We note that with other IUDs already available on PSO, many PSO orders are for only one unit. If a similar ordering pattern occurred with Mirena and Jaydess, the financial impact to community pharmacies would be substantially less than indicated by responders.

We have shared this feedback with Health New Zealand, which is responsible for managing contracts with community pharmacies for dispensing funded medicines.

Number of devices available on a PSO

Responders provided a range of feedback regarding the maximum PSO amounts proposed, including:

• amounts should be increased for clinics doing a high number of administrations.
• amounts were higher than required for their clinics.
• amounts were appropriate.
• amounts were too high.

The PSO amount indicates the maximum number of devices that can be ordered on one order form. Prescribers will not be required to order the full amount available on PSO for any one order, they could order the amount desired for their clinic. Additionally, multiple PSO requests may be completed if more than the maximum quantity is required.

We understand from the feedback we received that for some busy sexual health clinics, these amounts would be enough for a couple of days’ use at maximum capacity. However, these volumes would likely be larger than one weeks’ demand for most practices.

Concerns regarding “wastage” of Mirena and Jaydess, where they would be dispensed but then not used. Specifically due to clinics not having appropriate mechanisms in place to manage stock and it may expire or no longer be able to be used due to temperature excursion. Noted that community pharmacies have robust mechanisms to avoid this.

Considered that this could result in significant costs to the medicines budget.

The PSO quantities are maximums, clinics can order less than the amount specified to meet their demand. Prescribers will not be required to use the PSO mechanism, Mirena and Jaydess would continue to also be funded on prescription if preferred.

Our analysis, based on similar pharmaceuticals, suggests that clinics would order only what they need (rather than the maximum amount) and as such any potential “wastage” is anticipated to be minimal.

We have been advised that under the current system wastage may currently be occurring, as improper storage could occur once an individual has collected their prescription as Mirena and Jaydess need to be stored below 30 °C.

We do not consider that the small risk of wastage should prevent progressing this proposal, that is anticipated to benefit people receiving IUDs and provide efficiencies for health care professionals.

Reasons for the proposal

Concern that the proposal was developed without appropriate inputs from all relevant stakeholders and was driven by groups with narrow interests, rather than broad clinical consensus.

Considered that community pharmacy should have been consulted in the development of the proposal and before public consultation.

Pharmac is currently working on ways to better hear from and include stakeholders in our process for funding pharmaceuticals. It’s good to understand that pharmacy stakeholders would like to input into proposals earlier in the process. We will consider this in the future where possible.

While we continue to develop in this area, public consultation is a key point where people tell us what they think of our proposals. We send our consultation to a range of stakeholders across the health system, as well as the public.

The feedback people give us is incredibly important and helps inform whether changes need to be made. In this case, we received feedback from a range of respondents including prescribers, general practice, pharmacy, and specialists. The majority of feedback was supportive of this proposal.

Noted that Mirena use in New Zealand appears consistent or greater with global use, suggesting that there is not a significant barrier to access in New Zealand.

Considered that there was no clear evidence that the prescription requirement for Mirena and Jaydess is a barrier to access, noted other barriers to access exist and questioned the need for any change.

This decision aims to make it easier for people to access Mirena and Jaydess.  

While we acknowledge that this decision would not address all barriers that may be faced by individuals, Pharmac seeks to make pharmaceuticals more accessible to all New Zealanders. We have carefully considered this proposal based on advice from New Zealand-based clinical experts that this change would improve access for New Zealanders.