Improving access to treatments in the community for trauma and medical emergencies, and ketamine for palliative care

What we’re proposing

We want to hear from you about a proposal to improve access to treatments in the community.

Trauma and emergency treatments

Trauma and medical emergencies are mostly managed in public hospitals, and in the community by ambulance services.

Hospitals and ambulance services have access to medicines for the management of trauma and medical emergencies. Other community services providing emergency care do not have the same access to these funded medicines.

This proposal aims to fund the same medicines for all services in the community that provide trauma and medical emergency care.

Ketamine for palliative care

This proposal also aims to fund ketamine for intractable pain in people receiving palliative care in the community.

Giving feedback

Consultation closes at 5pm, Friday 19 December 2025 and feedback can be emailed to consult@pharmac.govt.nz  

Why we’re proposing this

Funded medicines available in the community and in Health NZ hospitals are often different because the severity of people’s health needs can vary, and this might be reflected in where people are treated.

Trauma and emergency treatments

When someone experiences a serious injury or medical emergency, they need urgent care no matter where they are. This means the way we provide medicines in these situations might need to change.

Getting fast emergency care can be especially challenging for people living in rural areas of New Zealand, where ambulances can take longer to arrive and hospitals may be further away.

Currently, some trauma and emergency services in the community don’t have the same access to funded medicines as Health NZ hospitals and ambulance services. This can affect people’s ability to get the medicines they need, when they need it.

Primary Response in Medical Emergency (PRIME)

Primary Response in Medical Emergency (PRIME) services are provided by specially trained GPs and nurses from rural general practice, who are first responders for trauma and medical emergencies in rural areas where ambulance services are not readily available.

PRIME treatment protocols are aligned with standing orders for paramedics. Standing orders allow paramedics to provide specific medicines required as part of trauma or emergency services.

There are currently a handful of treatments covered by PRIME treatment protocols that are not funded for rural general practices providing PRIME services. We have heard from PRIME providers that this is a problem they would like to resolve.

Home birthing services

Community lead maternity carers (LMCs) manage antenatal care, home births, postnatal care and any obstetric complications or emergencies that may subsequently arise.

Postpartum haemorrhage (PPH) or abnormal bleeding after birth is an obstetric emergency that needs to be managed promptly and effectively to reduce the risk of complications and death.

PPH can occur in any setting providing maternity services. Hospitals and emergency ambulance services have access to funded intravenous tranexamic acid used to treat PPH.

LMCs managing homebirths in the community do not currently have immediate access to funded intravenous tranexamic acid which is recommended in the national Postpartum Haemorrhage guideline for the treatment of PPH. We have heard from the College of Midwives that the availability of funded intravenous tranexamic acid would improve equity of access and outcomes for people who experience PPH in the community.

Ketamine for palliative care

People receive palliative care in hospital and in many different community settings.

Ketamine is currently funded without restrictions in Health NZ hospitals, but is not funded in the community. This means ketamine is not funded for the treatment of intractable pain in people receiving palliative care in hospice, rest homes or those living at home.

Currently these people would need to be admitted to hospital to access funded ketamine treatments. This can be a barrier for some people living rurally, those without transport options, or for people who would prefer to receive palliative care at home.

What would the effect be?

This proposal supports health care practitioners who provide trauma and medical emergency care to people living in rural and remote New Zealand, reducing the geographical inequities for this level of care.

This proposal supports delivery of care in the community.

Under this proposal

• Health care practitioners delivering trauma and medical emergency care in the community would have the same access to funded treatments as Health NZ hospitals and ambulance services.

• Lead maternity carers providing maternity services in the community would have access to funded intravenous tranexamic acid for the treatment of post-partum haemorrhage.

• People in the community receiving palliative care within rest homes, hospices and in their own homes would have access to funded ketamine for the treatment of intractable pain.

From 1 March 2026, the proposal would:

• enable PRIME practitioners in rural general practice to access the following funded treatments for the delivery of PRIME services on a PSO:
  • Droperidol inj 2.5 mg per ml (1 ml ampoule)
  • Glucose inj 5% (100 ml bag)
  • Glucose inj 10% (500 ml bag)
  • Ketamine inj 100 mg per ml (2 ml vial)
  • Methoxyflurane solution for inhalation 99.9% (3 ml bottle and plastic inhaler, and 3 ml bottles)
  • Tranexamic acid inj 100 mg per ml (10 ml ampoule)
  • Enoxaparin inj 100 ml per ml (1 ml syringe)
• enable Lead Maternity Carers managing maternity services in the community to access funded tranexamic acid injection 10 mg per ml (10 ml ampoule) for the treatment of post-partum haemorrhage on a PSO.
• fund ketamine inj 100 mg per ml (2 ml vial) for intractable pain in people receiving palliative care in the community. 

Impact to health sector

This proposal would improve access to funded trauma and medical emergency treatments for providers delivering this care in rural areas. It would ensure all practitioners providing trauma and emergency care have access to the same treatments.

Practices providing PRIME services would no longer have to navigate different arrangements for funded medicines to deliver PRIME services. Practices would be able to order the medicines in this proposal from community pharmacies on a Practitioner Supply Order (PSO).

The proposed PRIME treatments are aligned with the presentations used by paramedics. This standardisation aims to reduce clinical risk when PRIME providers and ambulance paramedics work together.

Funding intravenous tranexamic acid for the treatment of PPH in the community means that all lead maternity carers would have access to this medicine as part of their emergency kit.

Funding ketamine for intractable pain in palliative care in the community means that practitioners would no longer need to apply for funding through Named Patient Pharmaceutical Assessment (NPPA) exceptional circumstances pathway for this indication.

Ketamine injection is not Medsafe approved for subcutaneous use or for intractable pain in palliative care. It would need to be prescribed and used in accordance with section 25 of the Medicines Act 1981.

More about section 25 of the Medicines Act 1981 on the Medsafe website(external link).

Other clinical indications for these treatments

Trauma and medical emergency treatments

We are aware that there are other clinical indications for the proposed treatments in the community outside of trauma and medical emergency care.

We consider these clinical indications are outside the scope of this proposal.

We are not proposing to fund these treatments for use in indications outside of trauma and emergency care at this time.

Ketamine

We are only proposing to fund ketamine for PRIME services and intractable pain in palliative care.

Any other clinical indications for funding ketamine in the community are outside the scope of this proposal.

Who we think will be interested

• People who live in rural New Zealand
• People receiving palliative care services
• Rural health care practitioners who provide PRIME services
• Ambulance services
• Midwives and health care practitioners providing community maternity services
• Healthcare practitioners involved in hospice and palliative care provision
• Organisations supporting rural health care practitioners
• Organisations supporting home births
• Pharmacies and wholesalers
• Pharmaceutical suppliers

Trauma and medical emergency treatments

All proposed trauma and medical emergency treatments have established use in medical and emergency treatment protocols managed by Hato Hone St John (HHStJ). They are all currently funded in Section H of the Pharmaceutical Schedule.

ST-elevation myocardial infarction (STEMI)

Fibrinolytic kits for the treatment of ST-elevation myocardial infarction (STEMI), a type of heart attack, include tenecteplase, enoxaparin, heparin, clopidogrel, and intravenous metoprolol. These kits are currently supplied by Health NZ hospitals directly to PRIME sites that are equipped to diagnose and manage STEMI.

Heparin, clopidogrel, and intravenous metoprolol are already funded with no restrictions in the community.

Under this proposal and pending broader technical changes, enoxaparin (already funded in the community for specific clinical indications) would also be funded on PSO for PRIME providers.

Tenecteplase

At this time, current arrangements for supply of tenecteplase from Health NZ hospitals to PRIME sites would continue as they are now. We understand that aligning the supply of funded tenecteplase with other treatments in this proposal would be beneficial for PRIME providers. We continue to work with suppliers of tenecteplase to understand if this is possible.

Details about our proposal

All pharmaceuticals under this proposal would be listed in Section B of the Pharmaceutical Schedule from 1 March 2026, as shown below.

Methoxyflurane (Penthrox) would also be listed in Part II of Section H of the Pharmaceutical Schedule from 1 March 2026, as shown below.

CHEMICAL	FORMULATION	BRAND	PACK SIZE	PRICE AND SUBSIDY
Droperidol	Inj 2.5 mg per ml, 1 ml ampoule	Droperidol Medsurge	10	$26.68
Glucose [Dextrose]	Inj 5%, 100 ml bag	Fresenius Kabi	50	$95.00
Glucose [Dextrose]	Inj 10%, 500 ml bag	Baxter Glucose 10%	18	$126.00
Enoxaparin sodium	Inj 100 mg in 1 ml syringe	Clexane	10	$70.91
Methoxyflurane	Soln for inhalation 999.9 mg per g, 3 ml bottle with inhaler device and activated carbon chamber	Penthrox	1	$54.00
Methoxyflurane	Soln for inhalation 999.9 mg per g, 3 ml bottle	Penthrox	10	$276.00
Tranexamic acid	Inj 100 mg per ml, 10 ml ampoule	Tranexamic-AFT	5	$7.99
Ketamine	Inj 100 mg per ml, 2 ml vial	Ketalar	5	$36.23

We have reached a provisional agreement with Douglas Pharmaceuticals to list methoxyflurane in Section B and Part II of Section H of the Pharmaceutical Schedule. The provisional agreement is subject to consultation and approval by the Pharmac Board or its delegate.

All treatments would be funded on Practitioner Supply Order (PSO).

Ketamine would be funded on PSO, prescription, and Bulk Supply Order (BSO).

All community pharmaceuticals under this proposal would be subject to an endorsement limiting funded use to relevant clinical indications, as follows:

We anticipate two enoxaparin inj 100 mg per ml syringes would be a sufficient quantity for each STEMI fibrinolytic kit. For all other products, we have aligned the proposed PSO quantities with the current pack size, to avoid the need for dispensing partial packs.

No wastage would be claimable for any treatments under this proposal.

To provide feedback

Send us an email by 5pm, Friday 19 December to consult@pharmac.govt.nz

Or complete 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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