Decision to fund letermovir for prevention of cytomegalovirus infection

Medicines Decision

What we’re doing

From 1 May 2026, letermovir tablets (brand name Prevymis) will be funded for people who have undergone an allogenic haematopoietic stem cell transplant (allo-HSCT), or who are severely immunosuppressed, and need it to prevent cytomegalovirus (CMV) infection.

This will also mean healthcare professionals treating people with severe immunosuppression at risk of CMV reactivation who currently access letermovir via Pharmac’s exceptional circumstances framework (NPPA) will be able to apply for funded access through the Pharmaceutical Schedule.

Why we’re proposing this

We anticipate that up to 87 people will benefit from funding of letermovir in the first year growing to 90 people per year by year five.

People who receive letermovir after an allo-HSCT will have less CMV infections. CMV infections can be very harmful for patients who receive an allo-HSCT as these individuals are often immunocompromised. Preventing CMV infections is also expected to free up hospital resources, as well as nurse and specialist time.

Allo-HSCTs are only carried out in Auckland, Wellington, and Christchurch, meaning many people must travel and stay away from home for long periods while they receive treatment and their immune systems recover. If CMV infection develops, that time in hospital can be extended. Preventing CMV infection will reduce long hospital stays, helping people return home sooner and spend less time away from family.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 5 March 2026. In response to the consultation feedback we have made some minor changes to the funding restrictions to improve the clarity. We:

  • Renamed the renewal criteria to specify ‘second or subsequent HSCT’ to make the intended use case clear.
  • Added ‘CMV Active’ when referencing resistance or contraindication toother oral antivirals to clarify that it is not expected that people would need to trial medicines that are not effective against CMV.

Proposal to fund letermovir for prevention of cytomegalovirus infection

Letermovir injectable formulation

As part of the consultation process clinicians and pharmacists told us that there were situations where having only a funded tablet formulation would cause issues with proper dosing of letermovir.

They told us that Pharmac should list an alternative formulation of letermovir to address this noting that both injectable and granule formulations were available in other countries.

Pharmac is working with the supplier of letermovir to pursue supply of an injectable formulation. Our clinical advisors and consult respondents advised it is preferable that potential listing of an injectable formulation of letermovir should not delay listing of the tablet formulation.

Amendments to the funding criteria for severe immunosuppression

As part of the consultation process a hospital transplant team told us that there were rare situations where people, primarily children, who would benefit from letermovir would not meet the currently proposed funding criteria.

We have reviewed the criteria and consulted our advisors on the Anti-infective Advisory Committee. We understand from ongoing discussions with our advisors that the current criteria may not include a small number of paediatric patients who may benefit from letermovir.

We are working to develop appropriate funding criteria to include this paediatric group. We understand that while we work through this people who would not meet the current criteria, but may benefit from letermovir would be in rare clinical circumstances and would be suitable for a NPPA application.

Who we think will be most interested

  • People who have blood cancers or other conditions that may require an allogenic-haematopoietic stem cell transplant (allo-HSCT)
  • Other people who are severely immunosuppressed and may be at risk of CMV infection
  • Healthcare professionals involved in the care of people with blood cancers or other conditions that may require an allo-HSCT, or those who care of people who are severely immunosuppressed and may be at risk of CMV infection
  • Organisations with an interest in cancer treatment such as Blood Cancer NZ or other conditions that may require people to receive an allo-HSCT
  • Community and hospital pharmacies
  • Hei Āhuru Mōwai
  • The Cancer Society
  • Pharmaceutical suppliers and wholesalers

Detail about this decision

The following changes will occur in Section B and Part II of Section H of the Pharmaceutical Schedule.

Letermovir (Prevymis) tab 240 mg will be listed in the Herpesvirus Treatment subtherapeutic group of the Infections – agents for systemic therapy therapeutic group of Section B and part II of section H of the Pharmaceutical Schedule from 1 May 2026 as follows, (prices are ex-manufacturer, excl. GST):

Chemical

Formulation

Brand

Pack size

Price and subsidy

Letermovir

Tab 240 mg

Prevymis

28

$6,664.00

Wastage claimable would apply to letermovir.

Letermovir (Prevymis) tab 240 mg will be subject to the following Special Authority restrictions:

Special Authority for Subsidy

Initial application – (CMV prophylaxis - post HSCT) from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria:

All of the following:

  1. Patient has undergone an allogeneic haematopoietic stem cell transplant; and
  2. The patient has confirmed presence of cytomegalovirus-specific antibodies; and
  3. Treatment to commence within 28 days of an allogeneic haematopoietic stem cell transplant; and
  4. Maximum treatment duration of 100 days post-transplant.

Renewal – (CMV prophylaxis – second or subsequent HSCT) from any relevant practitioner. Approvals valid for 4 months for applications meeting the following criteria:

All of the following:

  1. Patient has undergone an allogeneic haematopoietic stem cell transplant; and
  2. The patient has confirmed presence of cytomegalovirus-specific antibodies; and
  3. Treatment to commence within 28 days of an allogeneic haematopoietic stem cell transplant; and
  4. Maximum treatment duration of 100 days post-transplant.

Initial application – (CMV prophylaxis - severe immunosuppression*) only from an infectious disease specialist or clinical microbiologist or any relevant practitioner on the recommendation of an infectious disease specialist or clinical microbiologist. Approvals valid for 6 months for applications meeting the following criteria:

Both:

  1. Patient has severe immunosuppression requiring prophylaxis of CMV; and
  2. Either:
    1. Patient is contraindicated to all other funded CMV active oral antiviral agents; or
    2. Patient’s CMV is resistant to all other funded CMV active oral antiviral agents.

Renewal – (CMV prophylaxis - severe immunosuppression*) only from an infectious disease specialist or clinical microbiologist or any relevant practitioner on the recommendation of an infectious disease specialist or clinical microbiologist. Approvals valid for 6 months for renewals meeting the following criteria:

Both:

  1. Patient has severe immunosuppression requiring prophylaxis of CMV; and
  2. Either:
    1. Patient is contraindicated to all other funded CMV active oral antiviral agents; or
    2. Patient’s CMV is resistant to all other funded CMV active oral antiviral agents.

Note: Indications marked with * are unapproved indications

Similar eligibility criteria will apply in Part II of Section H of the Pharmaceutical Schedule.

Our response to what you told us

We’re really grateful for the time people took to respond to this consultation. A summary of the main themes raised in feedback, our responses to the feedback received, and changes we have made after listening to you are available below and on our notification webpage.

Stakeholder group

Theme

Pharmac Staff Comment

Clinicians, Pharmacists Patient advocacy group

Supportive

We are pleased to be progressing a proposal that will benefit New Zealanders.

Specialist Clinicians

Supportive, requested minor wording changes to the funding restrictions for clarity purposes.

We have amended the proposed funding criteria to reflect this request.

Community Pharmacists

Supportive. Respondents noted that it was important that letermovir was available from community pharmacies to simplify access for people after discharge for hospital and that without the ability to claim for wastage this could impose significant financial burdens on community pharmacy due to the high list price of the medicine.

We agree that having this medicine available from community pharmacies would simplify access for patients and have included a community listing and wastage claimable to enable this.

Professional College

Strongly supportive. Respondents noted that the practical experience of members of their clinical committee was that the cost effectiveness studies for letermovir were conservative in their impact estimates and that they would anticipate significant benefits with regards to length of stay, medication complications, requirements for molecular testing and the indirect effects such as risk of additional infections, many of which are hard to quantify in such studies.

They also noted they considered the restriction of the ‘severe immunosuppression’ group to prescribed by an infectious disease specialist or clinical microbiologist a suitable safeguard to ensure appropriate use.

We are pleased to be progressing a proposal that will benefit New Zealanders and help free up hospital resources.

 

Hospital Antimicrobial Stewardship Committee, Stem Cell Transplant Team

Strongly supportive but noted that there were antimicrobial stewardship concerns around the lack of an injectable formulation in the proposal. Respondents noted post-HSCT patients can have severe mucositis and are unable to swallow tablets which can make consistent dosing a challenge. Requested funding an injectable or alternative formulation suitable for these patients.

We have reviewed the status of letermovir formulations and are looking into whether it may be possible to make a funded injectable formulation available in New Zealand.

We have discussed this with our clinical advisors and hospital transplant teams, and the consensus was that it is preferable to have the tablet formulation listed as soon as practicable rather than waiting until an injectable formulation is available.

Hospital Transplant Team

Supportive, however noted that dosing for paediatric stem cell transplants would be difficult with only the 240 mg tablet available.

We have reviewed the status of letermovir formulations and are looking into whether it may be possible to make a funded injectable formulation available in New Zealand.

We have discussed this with our clinical advisors and hospital transplant teams and the consensus was that it is preferable to have the tablet formulation listed as soon as practicable rather than waiting until an injectable formulation is available.

Hospital Transplant Team

Supportive, noting that the renewal criteria could be amended to include a further niche paediatric patient group and align with the transplant team's clinical practice.

We have reviewed the proposed criteria and consulted our advisors on the Anti-infective Advisory Committee. We understand from ongoing discussions with our advisors that the current criteria may not include a very small number of paediatric patients who would benefit from letermovir.

We are working through appropriate criteria to encompass this paediatric group. While this is ongoing, our advisors have indicated that these people may be eligible for letermovir through our NPPA pathway. For more information, see the Pharmac website for how to submit NPPA applications.

Making a NPPA application

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.