Proposal to change the funding criteria for HIV medicines
What we’re proposing
We are proposing to remove funding restrictions and enable more flexible supply arrangements for antiretroviral medicines used for HIV. This would make these medicines easier to access and is intended to improve treatment for New Zealanders living with HIV, reduce barriers to urgent care, and support more equitable health outcomes across the country.
We are proposing to:
- remove the funding criteria (Special Authority and Hospital Indication restrictions) for all antiretroviral medicines for HIV
- enable all at once dispensing (known as STAT or 3 monthly dispensing) for all antiretroviral medicines for HIV
- enable access to two HIV medicines (emtricitabine with tenofovir disoproxil and dolutegravir) on the practitioners supply order (PSO) list to allow immediate access to these medicines for people who might have been exposed to HIV.
We want to hear your feedback about our proposal. Consultation closes at 4pm Monday 20th October 2025. Feedback can be emailed to consult@pharmac.govt.nz or submitted via our online form.
About antiretroviral medicines and HIV
About HIV
Human immunodeficiency virus (HIV) is a virus that attacks the body’s immune system. If left untreated, it can lead to AIDS (acquired immunodeficiency syndrome). With effective antiretroviral treatment, people living with HIV can live long, healthy lives.
About antiretrovirals
Antiretrovirals are medicines used for HIV in a number of different circumstances, including Treatment, Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP).
Treatment of HIV occurs when a person with confirmed HIV receives a prescription for 2-4 antiretroviral medicines to supress the virus. Treatment is life-long.
Post-Exposure Prophylaxis (PEP) is used when a person who may have been exposed to HIV receives treatment with 2-3 antiretroviral medicines within a 72-hour period of their possible exposure. Receiving PEP early can greatly reduce or eliminate the chance of a person acquiring HIV.
Pre-Exposure Prophylaxis (PrEP) of HIV is when people who do not have HIV, but may be at risk of exposure, take antiretroviral medicines before any possible exposure to reduce their risk of acquiring HIV.
About PSO (Practitioners Supply Order)
The PSO list is a list of pharmaceuticals that can be ordered and held by any prescriber (within their scope of practice). The purpose of the PSO is to ensure that stock is available for prescribers for:
- emergency or urgent use,
- teaching and demonstration purposes,
- provision to certain patient groups where an individual prescription is not practical, or
- products that require specialist administration.
About STAT (3 monthly dispensing)
Pharmaceuticals identified on the Community Pharmaceutical Schedule (Section B) with the ❋ symbol can be dispensed all at once, which is generally 90 days (three months) at a time, compared to most pharmaceuticals which can only be dispensed for one month’s supply at a time. Emtricitabine with tenofovir disoproxil is already able to be dispensed in volumes of three months, while other antiretrovirals are currently on monthly dispensing.
What would the effect be?
Removing the funding criteria for HIV medicines:
From 1 December 2025, the Special Authority and Hospital Indication restrictions for all antiretroviral medicines used for HIV treatment and prevention would be removed. This would mean that these medicines would be listed on the pharmaceutical schedule without restriction.
Pharmac funding restrictions are criteria used by Pharmac to ensure that certain medicines are targeted to people who would benefit most from them. It sets out specific criteria that must be met before a medicine can be funded.
We have proposed this change to ensure that everyone who needs antiretrovirals can access funded treatment as easily as possible. Access without funding restrictions supports the different healthcare journeys that New Zealanders’ experience and may help reduce potential inequities in accessing funded medicines.
Enabling STAT dispensing for HIV medicines
From 1 December 2025, people who receive medicines for treatment or prophylaxis of HIV would be able to receive up to three months’ supply at one time, regardless of the specific medicine(s) or combination of medicines they are receiving. This would mean that pharmacies and people can have more flexibility around when people collect their medicines.
Placing two HIV medicines on a Practitioners Supply Order
From 1 December 2025, two antiretroviral medicines (emtricitabine with tenofovir disoproxil and dolutegravir) would be available on a Practitioners Supply Order (PSO) to enable prescribers to ensure they are available for emergency/urgent use.
The PSO for these medicines would be restricted to Post-Exposure Prophylaxis (PEP) of HIV only.
Placing emtricitabine with tenofovir disoproxil and dolutegravir on PSO for PEP would mean that these medicines could be ordered and kept on hand, rather than requiring individual prescriptions and dispensings for each person, making them readily available for timely use when people require preventative treatment.
Who we think will be interested
- People living with HIV, their whānau, friends, and caregivers
- Health care professionals involved in the care of people with HIV
- Health NZ hospitals and other organisations who deliver services and support for people, and their whānau who are affected by HIV
- People or groups with an interest in treatments for HIV
- Pharmacies and wholesalers
Why we’re proposing this
Removing the funding criteria for HIV medicines
Clinicians have told us the current Special Authority criteria for HIV medicines are complex and can be confusing for people and healthcare workers, especially where treatment needs to be started urgently, like for Post-Exposure Prophylaxis (PEP).
The current funding criteria also do not restrict access to people who have, or require prophylaxis for, HIV, who are considered the only people who would use these medicines.
Because of this, we are proposing the removal of funding criteria for these medicines to make sure that people who would benefit from them, are able to access them as easily as possible.
Enabling STAT dispensing for HIV medicines
Advocacy groups for people living with HIV have highlighted to us that STAT dispensing would make it easier for people to manage their medicines in some circumstances.
We have heard from healthcare professionals that enabling three-monthly dispensing would mean patients may not have to return to the pharmacy to collect repeats every month. Long-term use of these medicines is critical to successful HIV treatment and three-monthly dispensing would help reduce access barriers for people receiving these medicines.
Placing two HIV medicines on PSO
Our clinical advisors have told us that when PEP is appropriate, the sooner it is started the more effective it is. This change will support faster access for people after a potential exposure event.
Prescribers of Post-Exposure Prophylaxis (PEP) and advocacy groups for people living with HIV have told us that the current funding restrictions for PEP can cause delays in people accessing these medicines. At present, everyone who needs it is eligible for funded PEP and this will not change. These medicines are generally only prescribed by infectious disease or sexual health clinicians and may not be routinely stocked by all pharmacies, which can cause difficulty and delays when people need them. Allowing supply via PSO could help avoid these delays and mean that people could access PEP, more quickly
Prescribers who expect to encounter people needing PEP, such as prescribers working in specialist sexual health services, will be able to have a course of PEP on-hand to immediately give to patients.
Details about our proposal
From 1 December 2025 the following changes to the Pharmaceutical Schedule would be made:
- The Special Authority and Hospital Indication restriction would be removed from the Antiretroviral subtherapeutic group in Sections B and Part II of Section H of the Pharmaceutical Schedule.
- Notes applying to antiretroviral medicines would be removed, except where noted below.
- The Special Authority and Hospital Indication restriction would be removed from the HIV prophylaxis and Treatment subtherapeutic group in Section B and Part II of Section H of the Pharmaceutical Schedule.
- The subsidy by endorsement rule would be removed from emtricitabine with tenofovir disoproxil in Section B of the Pharmaceutical Schedule.
- STAT (three-monthly) dispensing would be applied to all medicines in the antiretroviral subtherapeutic group in Section B of the Pharmaceutical schedule.
- The Practitioners Supply order (PSO) rule – ‘Up to 30 tab available on a PSO’ would be applied to both emtricitabine with tenofovir disoproxil and dolutegravir in Section B of the Pharmaceutical Schedule.
- The note for dolutegravir in Section B of the Pharmaceutical Schedule would be amended as follows: (additions in bold)
Note:
On a PSO for HIV Post-Exposure Prophylaxis (PEP) use only.
- The note for emtricitabine with tenofovir disoproxil in Section B of the Pharmaceutical Schedule would be amended as follows: (additions in bold)
Note:
On a PSO for HIV Post-Exposure Prophylaxis (PEP) use only.
To provide feedback
We want to hear your feedback about our proposal. Consultation closes at 4pm Monday 20th October 2025. Feedback can be emailed to consult@pharmac.govt.nz or submitted via our online form.
All feedback received before the closing date will be considered by Pharmac’s Board (or its delegate) prior to making a decision on this proposal.
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