Proposal to widen access to bortezomib for the treatment of Waldenström’s macroglobulinemia

What we’re proposing

Tell us what you think about this proposal to widen access to bortezomib for the treatment of Waldenström’s macroglobulinemia (WM) in both the first line and relapsed/refractory settings.

This proposal is a result of including bortezomib in our annual invitation to tender (ITT) process.

If approved, changes to access would be funded from 1 February 2026.

Impact of the proposal

We estimate that around 50 people would benefit from bortezomib in the first year of funding, increasing to 70 in year five.

We have heard from New Zealand haematologists that having bortezomib available would provide another treatment option for a condition that has a poor prognosis for those who relapse or are intolerant to currently funded bendamustine with rituximab (BR).

We understand that even if these changes are made there will remain a significant unmet health need for people with Waldenström’s macroglobulinemia and its subtype Bing-Neel syndrome.

Consultation closes at 5pm, Tuesday 16 December 2025 and feedback can be submitted via our online form.

What would the effect be?

From 1 February 2026 access to bortezomib would be widened to include people with Waldenström’s macroglobulinemia. This would mean that people could receive bortezomib as a first line treatment or in the relapsed or refractory setting.

It is estimated that the currently funded treatment, bendamustine with rituximab, is not clinically suitable for approximately 40% of people with Waldenström’s macroglobulinemia. Bortezomib would become available as a first-line treatment for these people, as well as a second-line treatment for those with Waldenström’s macroglobulinemia who relapse or are refractory to bendamustine and rituximab.

Who may be interested

  • People with Waldenström’s macroglobulinemia, their family, whānau, friends and caregivers
  • Healthcare professionals involved in the care of people with Waldenström’s macroglobulinemia
  • Te Whatu Ora – Health New Zealand hospitals and other organisations who deliver services and support for people, and their whānau who are affected by Waldenström’s macroglobulinemia
  • People or groups with an interest in treatments for Waldenström’s macroglobulinemia
  • Pharmacies and wholesalers
  • Pharmaceutical suppliers

About Waldenström’s macroglobulinemia and bortezomib

Waldenström’s macroglobulinemia (WM) is a rare, slow-growing type of non-Hodgkin lymphoma that affects B cells in the bone marrow. These abnormal cells produce excess immunoglobulin M (IgM), which can make blood thick. This cancer can lead to symptoms like fatigue, bleeding, and vision problems. Our clinical advisors noted that WM is a progressive, incurable disease that results in reduced function and quality of life, leading to early death.

There is estimated to be approximately 20 to 50 cases in New Zealand per year, with our advisors noting 40 to 70 individuals per year could be eligible for treatment of newly diagnosed or relapsed/refractory WM.

Bortezomib is currently funded for plasma cell dyscrasias, not including Waldenström’s macroglobulinaemia. Pharmac notes bortezomib is not currently Medsafe approved for the treatment of WM.

Patient advocates & clinicians have advised us that there are other, more effective, treatments that they would like funded. This includes both ibrutinib and Zanubrutinib for which Pharmac has received funding applications for the treatment of WM. 

Why we’re proposing this

Following this year’s annual tender process, we are now in a position to consider widening access to bortezomib for people with Waldenström’s macroglobulinemia.

About the annual tender process

A funding application for this treatment was received in 2021 and subsequently received a positive funding recommendation from CTAC in October 2022.

Application to fund bortezomib for Waldenström's macroglobulinemia(external link)

Details about our proposal

From 1 February 2026 bortezomib would be listed in Section B and Part II of Section H of the Pharmaceutical Schedule, as follows (new criteria shown only):

Special Authority for Subsidy

Initial application — (Waldenström Macroglobulinaemia) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria:

Both:

  1. The patient has Waldenström Macroglobulinaemia/Lymphoplasmacytic Lymphoma requiring treatment; and
  2. The patient has not received prior bortezomib treatment

Renewal — (Waldenström Macroglobulinaemia) from any relevant practitioner. Approvals valid for 12 months where there is no evidence of clinical disease progression and the patient is benefiting from treatment

Bortezomib is Medsafe approved for multiple myeloma. Other uses have not been approved by Medsafe. Prescribing bortezomib outside of the Medsafe approved indications would need to follow Section 25 of the Medicines Act 1981(external link).

To provide feedback

Fill out our online form by 5pm, Tuesday 16 December, 2025 to provide feedback.

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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