Decision to amend access to COVID-19 antivirals and change supply and reimbursement arrangements
What we’re doing
We’re announcing a decision to make changes to access to funded COVID-19 antivirals and align the supply of these medicines with Pharmac’s usual processes.
This decision means that, from 1 September 2025, the COVID-19 antivirals nirmatrelvir with ritonavir (branded as Paxlovid) and remdesivir (branded as Veklury) will be funded for people aged 50 years or over with an active COVID-19 infection who are at high risk of hospitalisation or death from COVID-19.
This decision will improve access to these COVID-19 antivirals for people aged between 50 and 65 years who are high risk and not already eligible under the other access criteria. People who can currently access funded antivirals will continue to have access to them under the updated criteria.
This decision also means that these medicines will be funded and supplied in the same way as other medicines.
Currently, Pharmac buys COVID-19 antivirals upfront using the medicines budget, and then supplies them to pharmacies and Health NZ hospitals at no cost.
This decision will mean Pharmacies and hospitals can order what they need from wholesalers and claim back costs of the medicines from Pharmac, in line with how other medicines are funded and supplied in New Zealand.
Why we’re proposing this
The management and supply of COVID-19 treatments has been unique due to the need to respond to the global COVID-19 pandemic. Since 2023, we have been working to align the funding of COVID-19 antivirals with our usual processes.
This decision will mean that COVID-19 antivirals will be supplied and managed like all other funded medicines in New Zealand. Pharmacies will be able to purchase the medicines from wholesalers and then claim reimbursement for the cost of the medicines and fees for the dispensing of the medicine.
The terms of the agreements we have negotiated with the suppliers of Paxlovid and Veklury have enabled us to make changes to simplify the access criteria that will improve access for people who need antiviral treatments.
Any changes to the original proposal?
This decision was subject to a consultation letter dated 9 May 2025. We received feedback from people who have used COVID-19 antivirals and their families, support groups, clinicians and health sector organisations.
Proposal to amend access to COVID-19 antivirals and change supply and reimbursement arrangements
We are grateful to those who took the time to respond to our consultation. Receiving feedback forms an important part of our decision-making process and helps to ensure that the proposal can be implemented effectively.
The feedback was generally supportive of the proposal, and we heard that the majority of respondents would like access to COVID-19 antivirals to be available to more people. A small group of respondents raised concerns that the current and proposed access criteria is too broad and is based on evidence from early in the pandemic, which no longer reflects the New Zealand or global context.
We understand that evidence for COVID-19 antivirals and international recommendations for use will continue to emerge and change. We will regularly seek advice on the criteria for COVID-19 antivirals from our Anti-infectives Advisory Committee, who are local subject matter experts and consider changes to the access criteria for COVID-19 antivirals if required.
Respondents were supportive of the proposal to align the supply of COVID-19 antiviral treatments with all other funded pharmaceuticals in New Zealand. Respondents shared that this would simplify dispensing for pharmacies because they would no longer need to manage different processes for sourcing and dispensing these medicines.
Based on the feedback we received, changes have not been made to the proposal.
Who we think will be most interested
- People currently eligible for funded COVID-19 antiviral medicines
- People aged 50 to 64 years at high risk of hospitalisation or death from COVID-19
- Pharmacists, medical and nurse practitioners including general practitioners, respiratory physicians and infectious disease specialists, and primary care and hospital staff who help people access and use COVID-19 antivirals
- Wholesalers who hold stock of COVID-19 antiviral medicines
- Health New Zealand, including the National Commissioning team and the National Public Health Service
- Ministry of Health, including the Public Health Agency
- Iwi Māori Partnership Boards, hapū and whānau
- Māori and Pacific health providers and support/advocacy groups.
Detail about this decision
Access criteria for COVID-19 antivirals
The access criteria for COVID-19 antivirals will continue to be detailed on Pharmac’s website. These criteria will apply to Paxlovid in the community and hospitals, and to remdesivir in hospitals only. The criteria would be amended as follows (additions in bold and deletions in strikethrough):
COVID-19 antivirals are funded for people who meet the following criteria:
All of the following:
- Person has confirmed (or probable) symptomatic COVID-19, or has symptoms consistent with COVID-19 and is a household contact of a positive case; and
- Person’s symptoms started within the last 5 days; and
- Person does not require supplemental oxygen because of their COVID-19 infection#; and
- Any of the following:
- Person is aged 65 years or over; or
4.2 Person is Māori or Pacific ethnicity AND aged 50 years or over; or
4.3 Person is aged 50 years or over AND has not completed a primary course^ of COVID-19 vaccination; or - Person is aged 50 years or over and is considered by their healthcare professional to be at high risk of hospitalisation or death from COVID-19 due to factors not covered below; or
- Person is immunocompromised* and not anticipated to reliably mount an adequate immune response to COVID-19 vaccination or COVID-19 infection; or
- Person has had a previous admission to Critical Care or High Dependency care directly as a result of COVID-19; or
- Person has Down syndrome; or
- Person has sickle cell disease; or
- Person receives Disability Support Services funded and administered by the Ministry of Social Development (previously administered by the Ministry of Disabled People | Whaikaha); or
- Person has pre-existing high risk due to a health condition and needs direct family, whānau or external disability care most days; or
- Person has pre-existing severe frailty and/or vulnerability due to one or more severe health conditions***; or
- Person has any combination of three or more high-risk factors for severe illness from COVID-19*; and
- Person is aged 65 years or over; or
- Not to be used with other COVID-19 antiviral treatments.
Notes:
* Identifying people who are severely immunocompromised as per list hosted on the Pharmac website
** Health conditions that include severe or very advanced disease including, but not limited to, severe neurological, cardiovascular, renal and respiratory conditions
*** High-risk factors for severe illness from COVID-19 as per list hosted on the Pharmac website
# supplemental oxygen to maintain oxygen saturation >93%, or at or above baseline, for people with chronic resting hypoxia due to COVID-19 infection (excluding people with chronic resting hypoxia because of conditions other than COVID-19).
This will mean that from 1 September 2025 the criteria for COVID-19 antivirals will be changed to include all people who are 50 years or over and are considered by their healthcare professional to be at high risk of hospitalisation or death from COVID-19.
It is expected that all currently eligible people will continue to be able to receive COVID-19 antivirals as a result of this change, and small numbers of additional people not included in the current criteria would become eligible. All other aspects of the criteria will remain as they are now.
In response to the consultation on this proposal, we heard that it would be helpful for Healthcare Professionals to have some guidance on the groups of people who may be at high risk of hospitalisation or death from COVID-19 under this revised criterion.
While Pharmac as the medicines funder does not provide clinical guidance, to ensure healthcare professionals are supported through these changes, resources have been commissioned and made available to clinicians prior to 1 September 2025 to help them to identify people at high risk of severe illness from COVID-19 infection.
Paxlovid and remdesivir will continue to be funded in Health NZ Hospitals for people with persistent COVID-19 infection subject to the criteria on Pharmac’s website.
The criteria that apply to remdesivir for COVID-19 in hospitalised patients, currently included in Part II of Section H, will remain in place. However, they would be moved to the Pharmac website to ensure that all the criteria for COVID-19 are available in one place.
Access criteria for remdesivir(external link)
Schedule listings
From 1 September 2025 remdesivir (Veklury) will be listed in Section B and Part II Section H of the Pharmaceutical Schedule at the following price and subsidy (ex-manufacturer, excluding GST):
Remdesivir (Velkury)
|
CHEMICAL |
FORMULATION |
BRAND |
PACK SIZE |
PRICE AND SUBSIDY |
|---|---|---|---|---|
|
Remdesivir |
Inj 100 mg vial |
Veklury |
1 vial |
$615.23 |
Veklury will be listed in Section B of the Pharmaceutical Schedule, subject to the following note:
Note: Subsidised for patients meeting access criteria for oral antiviral treatments (as on Pharmac’s website).
Veklury will also continue to be listed in Part II of Section H of the Pharmaceutical Schedule under equivalent criteria. The criteria for COVID-19 in hospitalised patients, currently detailed in Part II of Section H, will be moved to the Pharmac website, to ensure that all of the criteria are available in one place.
Access criteria for remdesivir(external link)
The ‘Xpharm’ restriction, which prevents subsidy claims from being made, will be removed and replaced with a ‘PCT only’ restriction. This will enable only Health NZ hospital pharmacies to submit subsidy claims for Veklury.
Nirmatrelvir with ritonavir (Paxlovid)
From 1 October 2025 Pharmac-owned and supplier-owned nirmatrelvir with ritonavir (Paxlovid) will be listed in Section B and Part II Section H of the Pharmaceutical Schedule at the following price and subsidy (ex-manufacturer, excluding GST):
|
CHEMICAL |
FORMULATION |
Pharmacode |
BRAND |
PACK SIZE |
PRICE AND SUBSIDY |
|---|---|---|---|---|---|
|
Nirmatrelvir with ritonavir |
Tab 150 mg with ritonavir 100 mg |
2711613 |
Paxlovid |
30 tab |
$1,274.00 |
|
Nirmatrelvir with ritonavir |
Tab 150 mg with ritonavir 100 mg |
2635143 |
Paxlovid Pharmac |
30 tab |
$0.00 |
Paxlovid will be listed in Section B (Community) of the Pharmaceutical Schedule, subject to the following Endorsement criteria.
Subsidy by endorsement – Subsidised for patients meeting access criteria for oral COVID-19 antiviral treatments (as on Pharmac’s website) and where the prescription is endorsed accordingly. Pharmacists may annotate the prescription as endorsed when supplying by Direct Provision under the provisions of Part I of Section A(external link).
Paxlovid will be subsidised when provided by a pharmacist without a prescription, under the provisions of rule 1.3.7 of the General Rules of the Schedule(external link).
Paxlovid will also continue to be listed in Part II of Section H of the Pharmaceutical Schedule under equivalent criteria.
From 1 October 2025 The ‘Xpharm’ restriction, which prevents subsidy claims from being made, will apply to Pharmac owned Paxlovid stock (Paxlovid Pharmac brand) only.
From 1 October 2025 the ‘PCT’ restriction will apply to Paxlovid.This will allow both community and hospital pharmacies to submit subsidy claims for supplier owned Paxlovid (Pharmacode: 2711613) from the medicines budget.
From 1 December 2025, Pharmac Paxlovid stock (Paxlovid Pharmac brand) will be delisted from the Pharmaceutical Schedule as the stock will have been used or expired.
A confidential rebate would apply to Paxlovid that would reduce its net price. No rebate would apply to remdesivir.
New supply and transition arrangements
From 1 September and 1 October 2025 supply and funding of remdesivir and Paxlovid, respectively, will be the same as most other funded medicines. This means wholesalers will purchase stock of remdesivir and Paxlovid at the list price on the Pharmaceutical Schedule and then sell it to pharmacies and Health NZ Hospitals, which will dispense treatments to eligible people.
Wholesalers will be able to purchase remdesivir stock from 12 August, and Paxlovid stock from 12 September.
Paxlovid and remdesivir are currently supplied at no cost to pharmacies and Health NZ Hospitals, due to Pharmac having made alternative reimbursement arrangements. From the listing dates, pharmacies and Health NZ Hospitals purchasing stock will need to claim a subsidy:
- Community pharmacies will be able to claim for Paxlovid
- Health NZ hospital pharmacies will be able to claim for Paxlovid and remdesivir
After the listing dates for COVID-19 antivirals, there will be a short period of time where Pharmac-owned stock will remain in the supply chain. This stock can continue to be used until it has expired and will continue to be available free of charge as it is now.
From 1 October 2025, both Pharmac-owned Paxlovid stock, which will be available free of charge, and supplier-owned Paxlovid stock, which will be available for purchase, will be listed on the Pharmaceutical Schedule.
From 1 December 2025, Pharmac-owned Paxlovid stock will be delisted from the Pharmaceutical Schedule as the remaining stock will have expired.
From 1 September 2025, supplier-owned remdesivir stock will be listed on the Pharmaceutical Schedule. However, Health New Zealand Hospitals will continue to be able to order Pharmac-owned remdesivir stock from their wholesaler, which will be available free of charge until all remaining stock has been used. Pharmac-owned remdesivir should not be claimed for.
To help ensure stock is appropriately claimed for, details of the Pharmac-owned antiviral stock and the supplier-owned antiviral stock has been provided below:
Pharmac-owned Paxlovid stock (not to be claimed) – Currently available from wholesalers
|
Pharmaceutical |
Batch number |
Expiry date |
|---|---|---|
|
Nirmatrelvir with ritonavir (Paxlovid) |
LC4337 |
30 September 2025 |
|
LA6262 |
30 September 2025 |
|
|
LE2880 |
31 October 2025 |
|
|
LK1195 |
30 November 2025 |
Pharmac-owned remdesivir stock (not to be claimed) – Currently available from wholesalers
|
Pharmaceutical |
Batch number |
Expiry date |
|---|---|---|
|
Remdesivir (Veklury) |
10005729 |
31 March 2026 |
|
10007876 |
30 June 2028 |
Supplier-owned stock (can be claimed) – Available from wholesalers from listing date
|
Pharmaceutical |
Batch number |
Expiry date |
|---|---|---|
|
Nirmatrelvir with ritonavir (Paxlovid) |
LY8038 |
30 June 2026 |
|
Remdesivir (Veklury) |
10007876 |
30 June 2028 |
|
Remdesivir (Veklury) |
10011190 |
31 August 2028 |
Wholesalers will work with pharmacies and Health NZ Hospitals to ensure they receive appropriate stock.
Once it has expired, pharmacies and wholesalers may destroy any remaining Pharmac-owned Paxlovid stock in accordance with their usual processes.
Our response to what you told us
We’re really grateful for the time people took to respond to this consultation. A summary of the main themes raised in the feedback and our responses to these are outlined below:
| Feedback | Pharmac comment |
|---|---|
|
General support for the proposal |
|
|
Respondents supported additional discretion being included in the criteria and considered this would provide greater flexibility for healthcare professionals to provide treatment to people who need it, resulting in fewer hospitalisations |
We are pleased that people are supportive of the proposed changes and that they consider the changes will be of benefit. |
|
Requests to expand the eligible population for COVID-19 antivirals |
|
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Many respondents requested that access to COVID-19 antivirals explicitly includes Infection-Associated Chronic Conditions (IACCs) with a specific focus on long COVID. Respondents considered that not having these conditions noted in the criteria means that access to COVID-19 antiviral treatment can be inconsistent.
|
The access criteria for COVID-19 antivirals are based on previous clinical advice from our COVID-19 Treatments Advisory Group to identify populations that are at a high risk of poor outcomes from COVID-19 infection. Advice on access to COVID-19 antivirals for people with long COVID has been sought from our Advisory Group on several occasions, most recently in December and May 2023. December 2023 Advisory Group advice [PDF, 178 KB] May 2023 Advisory Group advice [PDF, 231 KB] Use of COVID-19 antivirals to reduce the likelihood of developing long COVID has not been recommended based on the extent, strength and quality of available evidence, which was considered to be early and limited to a small number of clinical studies. COVID-19 antivirals are not publicly funded for the prevention of long COVID in other countries and are not recommended in international guidelines. We sought updated advice from our Advisory Group and the Anti-Infective Advisory Committee in June 2025. Members considered that vaccination remains the most effective prevention for long COVID and evidence for the use of antivirals for prevention remains limited. Members considered that the proposed criteria include the majority of people most likely to experience long COVID and expanding access to include other groups was not recommended. Pharmac has not considered the funding of COVID-19 antivirals for IACCs other than long COVID before. We would welcome funding applications for these. Anyone can submit a funding application, details on how to do this are on the Pharmac website. |
|
Respondents considered that access should be widened to include a wide range of different populations considered to be at high risk of COVID-19 infection. |
The access criteria for COVID-19 antivirals are based on advice from our COVID-19 Treatments Advisory Group. We have worked to capture as many high risk groups as possible and have widened the criteria a number of times. Our clinical advisors have told us the criteria capture all people who are considered high risk from COVID-19 and have not recommended further changes for wider access. The criteria will allow access for all people aged 65 years and older and people who are 50 years and over considered by their healthcare professional to be at high risk of COVID-19 infection. The use of age as a factor reflects the clinical advice we have had that there is strong evidence that age is the most significant predictor of severe outcomes from COVID-19 infection. The criteria will also provide access to groups of people at any age including:
Based on the clinical advice we have received, additional changes have not been proposed. |
|
Requests to retain ethnicity specific aspects in the access criteria |
|
|
Respondents supported access being widened but requested that ethnicity-specific aspects be retained. Some respondents noted that Australia’s access criteria for COVID-19 antivirals provide access to Aboriginal and Torres Strait Islander people aged 30 years and above and suggested that New Zealand should consider this for Māori and Pacific People. Respondents also noted concerns that the proposed discretion in the criteria could be subject to bias and discrimination, which could disadvantage groups such as Māori and Pacific people disproportionately. |
We acknowledge that Māori and Pacific people may have experienced a higher risk of poor outcomes from COVID-19 compared to other ethnicities in New Zealand. This is supported by recommendations we received from our COVID-19 Treatments Advisory Group. Our advisors have told us that the proposed criteria continue to capture all the currently eligible groups, including Māori and Pacific people. There may be people who have the same risk from COVID-19 infection as currently eligible populations who cannot access treatment because they do not meet specific aspects of the criteria. The criteria will allow discretion for Healthcare Professionals to provide COVID-19 antivirals to people at high risk, regardless of the specific reason/s that they are high risk. To help ensure the proposal does not result in currently eligible people missing out on treatment, resources have been commissioned and will be available to clinicians prior to 1 September 2025 to help them to identify people at high risk of severe illness from COVID-19 infection. |
|
Requests to retain access for people who have not completed a primary course of vaccination |
|
|
A small number of respondents requested that people aged 50 years and over who have not received a primary course of vaccination should continue to have access to COVID-19 antivirals. |
This aspect of the criteria was implemented shortly after COVID-19 antiviral treatments became available and was intended to capture people who had not been vaccinated at a time when COVID-19 infection was rare, and natural immunity was low. We have heard from our advisors that widespread COVID-19 infection in New Zealand since the first Omicron-variant wave in March 2022 has changed this, and people who have not been vaccinated against COVID-19 would have some natural immunity from infections. This aspect of the criteria was not designed to consider the availability of optional booster vaccinations and has become less relevant over time as immunity from infection has increased. As a result, we are removing it. This is consistent with the criteria used in other countries such as Australia to manage access to COVID-19 antiviral access. |
|
Feedback that the eligible population for COVID-19 antivirals is too broad |
|
|
A small number of clinical stakeholders provided feedback that the eligibility criteria for COVID-19 treatment were already too broad and should be significantly narrowed to focus access to people at risk of progression to severe COVID-19 disease. The respondents noted that the National Institute for Health and Care Excellence (NICE) in the United Kingdom had updated its guidelines for COVID-19 antivirals on 1 May 2025 to remove certain groups including people aged 70 years or over, as their disease/risk with their infection was no longer considered to be cost effective to treat. National Institute of Care Excellence UK Update on giving COVID-19 antivirals(external link) It was considered by the responders that the risk of severe illness from COVID-19 in New Zealand is extremely low and there was no recent high-quality data to support the benefit of antiviral treatment for any patient groups. The respondents considered that the proposed changes would result in more people receiving Paxlovid who were unlikely to receive clinically meaningful benefit from treatment and who may instead face treatment-induced risk of harm. They also noted that this would incur significant cost to Health NZ and the medicines budget. It was recommended that local subject matter experts should develop a New Zealand version of the NICE criteria. |
We understand that evidence for COVID-19 antivirals and international recommendations for use will continue to emerge. To manage this, we intend to regularly seek advice on the criteria for COVID-19 antivirals from our Anti-infectives Advisory Committee, who are local subject matter experts. The criteria are not intended to widen access to additional populations but will provide greater discretion for health care professionals to treat people they consider are at high risk and are not covered by other aspects of the criteria. We understand that the current and proposed criteria may include some groups that healthcare professionals may not consider are at risk of severe illness from COVID-19. As with all other funded medicines in New Zealand, there is no requirement for prescribing these treatments to everyone who meets the criteria, and we expect they will only be prescribed where the healthcare professional considers it appropriate. We have commissioned the development of implementation resources to help healthcare professionals identify people at high risk from COVID-19 who are eligible to receive COVID-19 antivirals. |
|
Feedback on pharmacist prescribing |
|
|
Some respondents supported the ongoing need for direct from pharmacy availability, citing difficulties accessing GPs and the need to receive Paxlovid within 5 days of symptom onset. Others considered that access via pharmacy should be stopped as this could support COVID-19 antivirals being provided to people who are eligible but not at high risk of severe COVID-19 and are unlikely to benefit or may be at risk of harm. |
We have heard that direct from pharmacy access has been an important way for people to access COVID-19 antivirals, particularly for those unable to access GPs for various reasons, including people who live rurally. We have not changed this aspect of the proposal. Pharmacist prescribing has accounted for a very small proportion of overall dispensing of COVID-19 antivirals however, based on the feedback provided it has helped make sure people who need treatment can access it. COVID-19 antivirals should only be provided to eligible people who the treating healthcare professional considers to be at high risk and to benefit from treatment. Pharmacist prescribing should not change this. |
|
Supportive feedback on proposed supply and distribution arrangements |
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|
Respondents supported the proposed changes to the supply and distribution arrangements for COVID-19 antivirals noting that having multiple supply and distribution arrangements for different medicines during the COVID-19 pandemic has been challenging and time consuming for pharmacies. |
We are pleased that Pharmac’s proposal to align the funding of COVID-19 treatments is supported. We have been working on this since the funding of COVID-19 antivirals was included in the medicines budget in 2023. This proposal represents the final steps of this work and will mean that COVID-19 treatments are managed in the same way as other funded medicines. |
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Concerns raised with supply and distribution arrangements |
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Pharmacy stakeholders raised concerns that the proposal would shift cost to pharmacies because they would be required to purchase high-cost stock, which is currently provided for free, and that they would only be able to claim this cost back once stock is provided to patients. The respondents raised that this financial risk could deter some pharmacies from stocking COVID-19 antivirals. |
The current model, where stocks of Paxlovid are provided to pharmacies at no cost, was implemented to respond to the unprecedented nature of the COVD-19 pandemic and was always intended to be temporary. Pfizer will be responsible for ensuring that stock in New Zealand has an appropriate shelf-life, to allow wholesalers and pharmacies to manage stock appropriately. |
|
Pharmacy stakeholders shared that currently community pharmacies are paid for the dispensing of COVID-19 antivirals by Health NZ outside the Integrated Community Pharmacy Services Agreement (ICPSA), and that the rates paid are higher than those currently paid under the ICPSA, due to the extra work in dispensing COVID-19 antivirals. |
We have worked closely with Health NZ on this proposal. We understand that this is being addressed through the National Annual Agreement Review (NAAR) 2025 process. |
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Feedback on implementation activities |
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We received feedback that with the new discretion proposed in the criteria for people aged 50 years and older, it will be important that healthcare professionals are provided with resources to help them identify people at high risk of severe outcomes from COVID-19. It was also raised that this should be paired with other public health advice such as masking or isolating when unwell. |
We understand that it is important that healthcare professionals have information to help them identify eligible people at high risk and have commissioned development of resources to support this. |
|
Pharmacy stakeholders and wholesalers have asked for more detail on Pharmac’s plans to transition COVID-19 antivirals from Pharmac-owned stock to the usual funding and distribution model, planned for 1 September and 1 October 2025. |
Further detail on the transition arrangements has been provided in this document. Pharmac will also directly contact the respondents who provided this feedback. |
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.