Decision to fund ferric derisomaltose in hospitals

17 February 2026

Medicines Decision

What we’re doing

We're pleased to announce we are funding ferric derisomaltose (Monofer) in hospitals for people who need an iron infusion and have previously experienced hypophosphataemia or other severe adverse reactions after receiving other funded iron infusions.

This decision is in response to the current supplier discontinuing the sale of iron as sucrose (Venofer) in New Zealand. We heard that iron as sucrose is an important medicine to treat a small group of people who need intravenous iron infusions.

Funding of ferric derisomaltose, as an alternative to iron as sucrose, means this group of people will have a suitable funded iron infusion available to them in public hospitals. We expect the supply of iron as sucrose will run out by mid-March 2026, and we propose to delist this medicine from the Hospital Pharmaceutical Schedule from 1 September 2026.

Why we’re proposing this

In March 2025, the supplier of iron as sucrose (Venofer) advised Pharmac that it planned to discontinue this medicine. Pharmac were able to secure iron as sucrose to supply until approximately mid-March 2026. Around 100 people in New Zealand each year receive iron as sucrose.

Currently there are three funded iron infusions available in New Zealand:

Iron as sucrose (Venofer) – (Hospital(external link) only)
Iron as ferric carboxymaltose (Ferinject) Inj 50 mg per ml, 10 ml vial – (Hospital(external link) and Community(external link))
Iron polymaltose (Ferrosig) Inj 50 mg per ml, 2 ml ampoule – (Hospital(external link) and Community(external link))

Our clinical advisors told us that iron as sucrose is an important medicine to treat people who need an iron infusion and have also experienced hypophosphataemia after either of the other two funded iron infusions (ferric carboxymaltose and iron polymaltose).

Hypophosphataemia happens when somebody has a low level of phosphate in their blood; a mineral that is important for healthy bones, muscles, and energy. Mild cases are not usually cause for concern. Severe hypophosphataemia is rare but it can be life threatening and require medical treatment.

Ferric derisomaltose has been recommended by our clinical advisors as a suitable alternative to iron as sucrose as it is unlikely to cause hypophosphataemia and is suitable for people who have previously experienced hypophosphataemia after other iron infusions. It also offers an alternative funded iron infusion for those that have experienced other severe adverse reactions to other funded iron infusions.

About ferric derisomaltose

Ferric derisomaltose is an iron infusion medicine that is prescribed and administered by a registered health professional. It is used to treat people with iron deficiency where iron tablets are insufficient or unsuitable. Iron deficiency low iron is a common medical condition that can impact people of all ages.

Ferric derisomaltose contains higher levels of iron than iron as sucrose, therefore, a higher dose of iron can be given during an infusion, meaning some people may require fewer infusions.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 20 January 2026. The proposal was originally to list ferric derisomaltose for only those people who have previously experienced iron-infusion related hypophosphataemia. Clinical advice received during the consultation told us a very small number of the patients currently receiving iron as sucrose each year may be doing so because they have experienced other types of severe adverse reactions to the other funded iron infusions.

As a result of this feedback we have decided to amend the proposed criteria and list ferric derisomaltose for those people who have previously experienced iron-infusion related hypophosphataemia or any other type of iron-infusion related severe adverse reaction.

Funding application

A clinician/consumer initiated funding application(external link) for ferric derisomaltose was submitted to Pharmac in October 2024. The application is to list ferric derisomaltose in the Community and Hospital Pharmaceutical Schedules for people with Hereditary Haemorrhagic Telangiectasia (HHT) who have iron deficiency/anaemia and require an iron infusion. People with this condition have an increased risk of experiencing hypophosphataemia after receiving other iron infusions.

The current decision is to list ferric derisomaltose only in the Hospital Schedule, as an alternative to the discontinuation of iron as sucrose. This does not widen access to people with HHT in the community..

As part of our consultation on this proposal we received feedback about how funding ferric derisomaltose as a first-line iron-infusion, for people with HHT, would help prevent this group of people from experiencing iron-infusion related hypophosphataemia. The feedback highlighted the significant impact this has on patients as well as the challenges faced by clinicians in treating hypophosphataemia under these circumstances.

We recognise this unmet health need of this group of people and the application(external link) to list ferric derisomaltose in the Community and Hospital Pharmaceutical Schedules for people with HHT will continue to progress through Pharmac’s funding process and be considered in its own right. The feedback we have received regarding use in HHT will be considered as part of this.

Who we think will be most interested

People with low iron levels who require iron infusions
Healthcare professionals involved in the care of people with iron deficiency or high iron needs
Hospital and community pharmacists
Health NZ
Pharmaceutical suppliers and wholesalers

Detail about this decision

From 1 September 2026 iron as sucrose (Venofer) inj 20 mg per ml, 5 ml ampoule, will be delisted from Part II of Section H of the Pharmaceutical Schedule. We expect the supply of iron as sucrose will run out by early March 2026.

From 1 March 2026 ferric derisomaltose will be listed in Part II of Section H of the Pharmaceutical Schedule:

Chemical	Formulation	Brand	Pack size	Proposed price
Ferric derisomaltose	Inj 500 mg per 5 ml vial	Monofer	1	$249.99

From 1 March 2026 the following restriction criteria will be applied to ferric derisomaltose in Part II of Section H of the Pharmaceutical Schedule:

Restricted
Initiation
Patient had previously developed iron-infusion related hypophosphataemia or other severe adverse reaction

Our response to what you told us

We’re grateful for the time people took to respond to this consultation. We received 15 responses from individual consumers, advocates and whanau, as well as advocacy groups and clinicians involved in managing iron deficiency and HHT. A summary of the main themes raised, our responses, and changes we have made after listening to you are available below.

Themes	Pharmac Comment
Patients and whanau We heard from several people with HHT, whanau and individual advocates who were supportive of the proposal. Feedback highlighted significant potential harm from ferric carboxymaltose, including life‑threatening hypophosphataemia, repeated hospital admissions, long‑term complications, and major impacts on work, travel, and family life. Ferric derisomaltose was viewed as a safer and more efficient option that would reduce infusion frequency, lower infection risk, decrease system costs, and improve quality of life. Respondents recommended funding ferric derisomaltose as the first‑line treatment for all HHT patients needing ongoing IV iron, not only those with documented hypophosphataemia. They also called for community access to ensure equitable care, particularly for rural patients, and urged Pharmac to advance the high‑priority application for wider HHT access.	Pharmac is pleased to be able to list ferric derisomaltose in the Hospital Schedule as a replacement for iron as sucrose. We understand that, for people who would otherwise receive iron as sucrose, this will reduce the number of infusions required and have a positive impact on people’s lives, particularly around long-term complications, time off work and family life. Pharmac acknowledges the recommendation to extend funding into the community, allowing more equitable access, particularly for rural, working, and mobility‑limited patients. The current proposal to list ferric derisomaltose was in response to the discontinuation of iron as sucrose and was expedited to ensure patients previously receiving iron as sucrose in hospital retain a viable treatment option in the same treatment setting. Further analysis needs to be completed to ensure any widening of access targets the health need appropriately. While this proposal will not extend funding into the community at this stage, Pharmac are committed to exploring this further. Pharmac is committed to progressing the application for ferric derisomaltose for HHT patients as budget allows. The feedback relating to use in HHT will be considered as part of assessing this application.
Advocacy Groups Rare Disorders NZ and HHT NZ are supportive of funding ferric derisomaltose (Monofer) in hospitals. They state the proposal does not yet meet the needs of people with HHT, who require lifelong IV iron and face high risks from ferric carboxymaltose‑induced hypophosphataemia. They urge Pharmac to allow HHT patients access to Monofer as a first line treatment, rather than only after documented hypophosphataemia following use of other iron infusions. They recommend eligibility criteria based on ferritin ≤50 µg/L or transferrin saturation ≤20%, which better reflect HHT clinical realities. They call for community as well as hospital access to reduce barriers for rural, working, and mobility‑limited patients. They highlight that a high‑priority application for Monofer in HHT has stalled for nearly a year and encourage Pharmac to progress it alongside this proposal. They emphasise strong clinical rationale, cost‑effectiveness, and quality‑of‑life benefits for this small but high‑need group.	Pharmac acknowledges the support for the current proposal and the recommendation to further widen access and fund ferric derisomaltose as a first line iron infusion option to help prevent hypophosphataemia in people with HHT. This is currently being considered under a funding application and will be progressed in its own right. Pharmac recognises there is an unmet health need for this group. Pharmac acknowledges the recommendation to extend funding into the community, allowing more equitable access, particularly for rural, working, and mobility‑limited patients. The current proposal to list ferric derisomaltose was progressed rapidly in response to the discontinuation of iron as sucrose and was pursued to ensure patients previously receiving iron as sucrose in hospital retain a viable treatment option in the same treatment setting. Further analysis needs to be completed to ensure any widening of access meets the health need appropriately. While this proposal will not extend funding into the community at this stage, as a result of this feedback Pharmac is committed to exploring this further. This feedback will be taken into consideration as part of this process. The intent of the restricted criteria is to meet the health need currently being met by iron as sucrose. Pharmac consulted on access therefore being restricted to people who have experienced hypophosphataemia or a severe reaction to other funded iron-infusions. Feedback from clinicians noted that iron as sucrose is also used by people who have experienced other types of severe reactions to iron products and supported access for this group of people. Pharmac has extended the restricted criteria to include those who have experienced a severe reaction to the other iron infusions.
Clinicians Strong support for funding ferric derisomaltose, which is seen as equally effective as ferric carboxymaltose but with a much lower risk of hypophosphataemia. Respondents recommend using ferric derisomaltose proactively to prevent hypophosphataemia for people with HHT, rather than only after harm has occurred. Community dispensing and inclusion in Section B are recommended as this would be an opportunity to help reduce current pressures on hospital infusion services and improve patient access. A clinician noted iron as sucrose is still important for haemodialysis patients needing 100 mg iron dosing and that current 500 mg vials of ferric carboxymaltose create wastage; the same issue would occur with a 500 mg Monofer vial. A 100 mg presentation of both ferric carboxymaltose and ferric derisomaltose is requested to avoid wastage. Many emphasise that ferric derisomaltose should be available to high‑risk groups such as people with HHT, who require repeated infusions and face increased risk from ferric carboxymaltose‑induced hypophosphataemia.	Pharmac is pleased to be able to list ferric derisomaltose in the Hospitals Schedule as a replacement for iron as sucrose. Widening access by funding ferric derisomaltose proactively for HHT patients is being considered via an application and Pharmac is committed to progressing this as budget allows. Only the 500 mg vials of ferric derisomaltose are currently available in New Zealand. We acknowledge this might create wastage in a small number of situations. Pharmac will work with suppliers to see if alternative vial sizes could be made available. We acknowledge there may be a very small number of patients currently receiving iron as sucrose who are doing so as they have had a severe adverse reaction (not hypophosphataemia). As a result of this feedback we have decided to extend the criteria and list ferric derisomaltose for both those people who have previously experienced iron-infusion related hypophosphataemia and those who have had an iron-infusion related severe adverse reaction.

Patients and whanau

We heard from several people with HHT, whanau and individual advocates who were supportive of the proposal.
Feedback highlighted significant potential harm from ferric carboxymaltose, including life‑threatening hypophosphataemia, repeated hospital admissions, long‑term complications, and major impacts on work, travel, and family life.
Ferric derisomaltose was viewed as a safer and more efficient option that would reduce infusion frequency, lower infection risk, decrease system costs, and improve quality of life.
Respondents recommended funding ferric derisomaltose as the first‑line treatment for all HHT patients needing ongoing IV iron, not only those with documented hypophosphataemia.
They also called for community access to ensure equitable care, particularly for rural patients, and urged Pharmac to advance the high‑priority application for wider HHT access.

Pharmac is pleased to be able to list ferric derisomaltose in the Hospital Schedule as a replacement for iron as sucrose. We understand that, for people who would otherwise receive iron as sucrose, this will reduce the number of infusions required and have a positive impact on people’s lives, particularly around long-term complications, time off work and family life.

Pharmac acknowledges the recommendation to extend funding into the community, allowing more equitable access, particularly for rural, working, and mobility‑limited patients. The current proposal to list ferric derisomaltose was in response to the discontinuation of iron as sucrose and was expedited to ensure patients previously receiving iron as sucrose in hospital retain a viable treatment option in the same treatment setting. Further analysis needs to be completed to ensure any widening of access targets the health need appropriately. While this proposal will not extend funding into the community at this stage, Pharmac are committed to exploring this further.

Pharmac is committed to progressing the application for ferric derisomaltose for HHT patients as budget allows. The feedback relating to use in HHT will be considered as part of assessing this application.

Advocacy Groups

Rare Disorders NZ and HHT NZ are supportive of funding ferric derisomaltose (Monofer) in hospitals.
They state the proposal does not yet meet the needs of people with HHT, who require lifelong IV iron and face high risks from ferric carboxymaltose‑induced hypophosphataemia.
They urge Pharmac to allow HHT patients access to Monofer as a first line treatment, rather than only after documented hypophosphataemia following use of other iron infusions.
They recommend eligibility criteria based on ferritin ≤50 µg/L or transferrin saturation ≤20%, which better reflect HHT clinical realities.
They call for community as well as hospital access to reduce barriers for rural, working, and mobility‑limited patients.
They highlight that a high‑priority application for Monofer in HHT has stalled for nearly a year and encourage Pharmac to progress it alongside this proposal.
They emphasise strong clinical rationale, cost‑effectiveness, and quality‑of‑life benefits for this small but high‑need group.

Pharmac acknowledges the support for the current proposal and the recommendation to further widen access and fund ferric derisomaltose as a first line iron infusion option to help prevent hypophosphataemia in people with HHT. This is currently being considered under a funding application and will be progressed in its own right. Pharmac recognises there is an unmet health need for this group.

Pharmac acknowledges the recommendation to extend funding into the community, allowing more equitable access, particularly for rural, working, and mobility‑limited patients. The current proposal to list ferric derisomaltose was progressed rapidly in response to the discontinuation of iron as sucrose and was pursued to ensure patients previously receiving iron as sucrose in hospital retain a viable treatment option in the same treatment setting. Further analysis needs to be completed to ensure any widening of access meets the health need appropriately. While this proposal will not extend funding into the community at this stage, as a result of this feedback Pharmac is committed to exploring this further. This feedback will be taken into consideration as part of this process.

The intent of the restricted criteria is to meet the health need currently being met by iron as sucrose. Pharmac consulted on access therefore being restricted to people who have experienced hypophosphataemia or a severe reaction to other funded iron-infusions. Feedback from clinicians noted that iron as sucrose is also used by people who have experienced other types of severe reactions to iron products and supported access for this group of people. Pharmac has extended the restricted criteria to include those who have experienced a severe reaction to the other iron infusions.

Clinicians

Strong support for funding ferric derisomaltose, which is seen as equally effective as ferric carboxymaltose but with a much lower risk of hypophosphataemia.
Respondents recommend using ferric derisomaltose proactively to prevent hypophosphataemia for people with HHT, rather than only after harm has occurred.
Community dispensing and inclusion in Section B are recommended as this would be an opportunity to help reduce current pressures on hospital infusion services and improve patient access.
A clinician noted iron as sucrose is still important for haemodialysis patients needing 100 mg iron dosing and that current 500 mg vials of ferric carboxymaltose create wastage; the same issue would occur with a 500 mg Monofer vial. A 100 mg presentation of both ferric carboxymaltose and ferric derisomaltose is requested to avoid wastage.
Many emphasise that ferric derisomaltose should be available to high‑risk groups such as people with HHT, who require repeated infusions and face increased risk from ferric carboxymaltose‑induced hypophosphataemia.

Pharmac is pleased to be able to list ferric derisomaltose in the Hospitals Schedule as a replacement for iron as sucrose.

Widening access by funding ferric derisomaltose proactively for HHT patients is being considered via an application and Pharmac is committed to progressing this as budget allows.

Only the 500 mg vials of ferric derisomaltose are currently available in New Zealand. We acknowledge this might create wastage in a small number of situations. Pharmac will work with suppliers to see if alternative vial sizes could be made available.

We acknowledge there may be a very small number of patients currently receiving iron as sucrose who are doing so as they have had a severe adverse reaction (not hypophosphataemia). As a result of this feedback we have decided to extend the criteria and list ferric derisomaltose for both those people who have previously experienced iron-infusion related hypophosphataemia and those who have had an iron-infusion related severe adverse reaction.

Themes

Pharmac Comment

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.