Proposal to amend access to COVID-19 antivirals and change supply and reimbursement arrangements

What we’re proposing

We’re seeking feedback on a proposal to make changes to access criteria for funded COVID-19 antivirals and align the supply of these medicines with Pharmac’s usual processes.

The funded COVID-19 antivirals are nirmatrelvir with ritonavir (branded as Paxlovid) and remdesivir (branded as Veklury).

This proposal would mean that, from 1 September 2025, COVID-19 antivirals would be funded for all people 50 years of age or over with active infection who are at high risk of hospitalisation or death from COVID-19.

The terms of the agreements we have negotiated with the suppliers of Paxlovid and Veklury have enabled us to consider changes to the access criteria that would improve access for people who need antiviral treatments.

The proposal also means that these medicines would be funded through the Pharmaceutical Schedule in the same way as other medicines. Pharmacies would be able to purchase the medicines from wholesalers and then claim reimbursement for the cost of the medicines and the dispensing fee.

We are interested in any feedback on this proposal, but we are particularly interested to hear how these changes could be successfully implemented.

Consultation closes at 5:00pm, Friday, 30 May and feedback can be emailed to consult@pharmac.govt.nz or provided through our webform.

Who we think will be 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.

What would the effect be?

Changes to access criteria for nirmatrelvir with ritonavir (Paxlovid) and for remdesivir

From 1 September 2025, the access criteria for COVID-19 antivirals would change. This would mean that all people aged 50 years or older with COVID-19 who are considered by their health care practitioner to be at high risk of hospitalisation or death from COVID-19 infection would be able to access funded antivirals if they need them.

This would replace the existing criteria, which currently provide access to funded COVID-19 antivirals for people from the age of 65 years, or from 50 years if they are Māori, Pacific, or unvaccinated. These groups would continue to be able to receive COVID-19 antivirals when they need them under the new access criteria.

People of any age would still be able to access funded COVID-19 antivirals if they meet other access criteria, as they can now – the other criteria would remain unchanged.

The proposed change would improve access to COVID-19 antivirals for people aged between 50 years and 65 years who are not already eligible under the other access criteria.

The criteria reflect evidence throughout the pandemic that age remains by far the strongest risk factor for hospitalisation and death when people have active COVID-19 infection.

Evidence for the effectiveness of COVID-19 treatments is expected to continue to emerge. The proposed changes to the access criteria would enable health professionals to use their clinical expertise, including knowledge of epidemiology and risk factors, to provide antivirals for COVID-19 to eligible people most likely to benefit.

More information about the proposed changes to the access criteria is available in the Details about our Proposal section below.

Changes to ordering, claims, and dispensing

The management of COVID-19 antivirals would move to the usual supply chain arrangements for funded pharmaceuticals in New Zealand from the following dates:

• 1 September 2025 for remdesivir
• 1 October 2025 for nirmatrelvir with ritonavir (Paxlovid)

From these dates wholesalers would purchase stock from the supplier at the list price on the Pharmaceutical Schedule. Pharmacies and Health NZ hospitals would order stock from wholesalers and claim the cost back from Pharmac. The cost would continue to come from Pharmac’s medicines budget.

Previously, Pharmac purchased the stock of COVID-19 antivirals upfront from the medicines budget, and then supplied it to pharmacies and Health NZ hospitals at no cost.

We have worked closely with Health NZ on the development of this proposal. Health NZ would continue to be responsible for the payment of service fees to community pharmacies for dispensing COVD-19 antivirals.

More information about the proposed funding and supply arrangements is included in the Details about our Proposal section below.

Pharmac would work with wholesalers, pharmacies and Health NZ to manage any remaining Pharmac owned stock of COVID-19 antivirals after 1 September and 1 October 2025.

Why we’re proposing this

The management and supply of COVID-19 treatments was 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.

We have negotiated new provisional agreements with the suppliers of Paxlovid and remdesivir, Pfizer and Gilead respectively, which has meant we have been able to progress changes to the access criteria and supply arrangements.

Our clinical advisors have told us that the proposed changes to criteria would allow all the currently eligible populations, and some additional people aged 50-64 years at high risk, to access COVID-19 antivirals.

Details about our proposal

From 1 September 2025 remdesivir (Veklury) would be listed in Section B and Part II Section H of the Pharmaceutical Schedule at the following price and subsidy (ex-manufacturer, excluding GST):

From 1 October 2025 nirmatrelvir with ritonavir (Paxlovid) would be listed in Section B and Part II Section H of the Pharmaceutical Schedule at the following price and subsidy (ex-manufacturer, excluding GST):

A confidential rebate would apply to Paxlovid that would reduce its net price. No rebate would apply to remdesivir.

Schedule listings

Nirmatrelvir with ritonavir (Paxlovid)

Paxlovid would be listed in Section B (Community) of the Pharmaceutical Schedule, subject to the following Endorsement criteria.

Paxlovid would 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.

Paxlovid would also continue to be listed in Part II of Section H of the Pharmaceutical Schedule under equivalent criteria.

The ‘Xpharm’ restriction, which prevents subsidy claims from being made, would be removed and replaced with a ‘PCT’ restriction.

This would allow both community and hospital pharmacies to submit subsidy claims for Paxlovid.

Remdesivir (Velkury)

Remdesivir would 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).

Remdesivir would 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(external link), would be moved to the Pharmac website, to ensure that all of the criteria are available in one place.

The ‘Xpharm’ restriction, which prevents subsidy claims from being made, would be removed and replaced with a ‘PCT only’ restriction. This would enable only Health NZ hospital pharmacies to submit subsidy claims for remdesivir.

Access criteria for COVID-19 antivirals

The access criteria for COVID-19 antivirals would continue to be detailed on Pharmac’s website.

Access criteria for COVID-19 antivirals

These criteria would apply to Paxlovid in the community and hospitals and to remdesivir in the hospital. The criteria would be amended as follows (additions in bold and deletions in strikethrough):

Paxlovid and remdesivir would continue to be funded in Health NZ Hospitals for people with persistent COVID-19 infection subject to the criteria on Pharmac’s website.

Access criteria for COVID-19 antivirals

The criteria that apply to remdesivir for COVID-19 in hospitalised patients, currently included in Part II of Section H(external link), would remain in place. However, they would be moved to the Pharmac website to ensure that all of the criteria for COVID-19 antivirals are available in one place.

New supply arrangements

From 1 September and 1 October 2025 supply and funding of remdesivir and Paxlovid, respectively, would be the same as most other funded medicines. This means wholesalers would 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 would dispense treatments to eligible people.

Wholesalers would be able to purchase remdesivir stock from 12 August, and Paxlovid stock from 12 September.

At present, Paxlovid and remdesivir are 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 would need to purchase stock and claim a subsidy:

• Community pharmacies would be able to claim for Paxlovid
• Health NZ hospital pharmacies would be able to claim for Paxlovid and remdesivir

There may be Pharmac-owned stock remaining in the supply chain after the listing dates Pharmac would work with wholesalers, pharmacies and Health NZ to manage this stock.

To provide feedback

Send us an email: consult@pharmac.govt.nz by 30 May 2025 at 5pm or through our online form.

If you would prefer to provide your feedback in another format, such as over the phone, please contact 021 959 034

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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