Decision to fund medicines for people with high blood pressure and bacterial infections

13 October 2026

Medicines Decision

What we’re doing

We're pleased to announce funding of treatments for people with bacterial infections and high blood pressure. The treatments include:

Ceftolozane with tazobactam (Zerbaxa) – listing of ceftolozane with tazobactam for the treatment of multi-drug resistant bacterial infections (MDROs)
Bedaquiline (Sirturo) – widening access to bedaquiline for the treatment of non-tuberculosis mycobacteria (NTM) infection
Linezolid (Zyvox) – widening access to linezolid for the treatment of NTM infection
Captopril liquid (DP-Captopril) – widening access to captopril liquid for the treatment of high blood pressure in patients with autonomic dysreflexia following spinal cord injury

What does this mean for people?

Ceftolozane with tazobactam

From 1 November 2026, ceftolozane with tazobactam will be funded for use in Health New Zealand hospitals to treat people with significant multi-drug resistant bacterial infections.

Antimicrobial resistance is when microorganisms (such as bacteria, viruses, fungi or parasites) develop resistance to the medicines used to treat them. When microorganisms become resistant to multiple antimicrobial medicines, they are often referred to as multi-drug resistant organisms (MDROs), sometimes known as ‘superbugs.’ Ceftolozane with tazobactam is expected to be used primarily for the treatment of serious infections caused by multi-drug resistant Pseudomonas aeruginosa and Enterobacterales bacteria.

We estimate that around 20-33 people per year over the next five years would receive ceftolozane with tazobactam for the treatment of multi-drug resistant infections. This number includes some people with MDRO infections who are currently accessing ceftolozane with tazobactam in Health New Zealand hospitals via Pharmac’s Named Patient Pharmaceutical Assessment (NPPA) pathway. Funding through the Pharmaceutical Schedule would mean clinicians would no longer need to submit NPPA applications for this medicine for treatment of MDROs, reducing the administrative burden and allowing them to focus more on patient care.

Bedaquiline and Linezolid

From 1 November 2026, bedaquiline and linezolid will be funded for the treatment of Nontuberculous mycobacteria (NTM) infections.

NTM are a group of bacteria found naturally in the environment that can sometimes cause serious infections, particularly in people with underlying lung disease or weakened immune systems. These infections can be difficult to treat because this type of bacteria (mycobacteria) are often resistant to many commonly used antibiotics. Without effective treatment, NTM infections can lead to persistent infection, worsening respiratory symptoms, and permanent lung damage.

Bedaquiline and linezolid are antimycobacterial medicines used as part of combination treatment regimens for some difficult-to-treat NTM infections. People with NTM infections are generally managed by specialist infectious disease services and some have previously received bedaquiline and linezolid for this condition through Pharmac’s Named Patient Pharmaceutical Application pathway. The changes formalise existing access through the Pharmaceutical Schedule, making funding arrangements more transparent and enabling people to access treatment more easily.

Approximately 11 people per year are expected to benefit from this decision in the first five years of funding.

Captopril oral liquid

From 1 November 2026, captopril oral liquid will be funded for patients experiencing episodes of high blood pressure due to autonomic dysreflexia following spinal cord injury where glyceryl trinitrate is not suitable.

Autonomic dysreflexia is a potentially life-threatening condition that can occur in people with spinal cord injuries. If not treated promptly, autonomic dysreflexia can lead to serious complications such as stroke, seizures, heart problems, or death.

Glyceryl trinitrate (GTN) is used to manage episodes of high blood pressure associated with autonomic dysreflexia. However some people do not tolerate GTN, are not able to self-administer GTN, or GTN is not suitable because they have recently taken medicines such as sildenafil and other phosphodiesterase-5 (PDE5) inhibitors. Enabling these individuals to use captopril oral liquid instead will enable them to manage these episodes at home and reduce the need for urgent hospital treatment. We estimate that up to 50 people per year over the next 5 years would receive captopril oral liquid as a result of this decision.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 15 September 2026. We received feedback from hospital and primary care clinicians, including infectious disease specialists, pharmacologists, pharmacists, and general practitioners.

We’re grateful to those who took the time to respond to our consultation. This is an important part of our decision-making process. It gives us the opportunity to listen to the voices of the community and acknowledge and respond to feedback.

Respondents raised the importance of ensuring access criteria facilitate diverse treatment journeys, specifically including longer duration of treatment for some people with NTM infections. We also received feedback on the wording and scope of the proposed access criteria for captopril oral liquid.

Following consultation Pharmac have included renewal periods/criteria for bedaquiline and linezolid. This will enable treatment beyond 12 months, where appropriate.

Pharmac have also amended the proposed schedule note for captopril oral liquid to widen access to people with spinal cord injury and autonomic dysreflexia who do not tolerate or cannot self-administer GTN (rather than just those for whom GTN is contraindicated). We have also corrected the access criteria wording to specify ‘glyceryl trinitrate’.

Who we think will be most interested

People with drug resistant or NTM infections and their whānau
People with spinal cord injuries and their whānau
Spinal support and advocacy organisations
Clinical microbiologists, respiratory physicians, and infectious disease physicians.
Community and hospital pharmacists
General practitioners and nurse practitioners
Infection control health care workers
Neurologists and general physicians involved in spinal cord injury care
Health New Zealand hospitals and other organisations who deliver services and support for people with severe or drug-resistant infections
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 from 1 November 2026 (new and affected criteria shown only, additions in bold, deletions in strikethrough).

Section B changes

Bedaquiline*

Special Authority for Subsidy

Initial application — (Non-tuberculosis mycobacteria) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria:

Both:

The person has non-tuberculosis mycobacteria (NTM) infection; and
Ministry of Health’s Tuberculosis Clinical Network has reviewed the individual case and recommends bedaquiline as part of the treatment regimen.

Renewal — (Non-tuberculosis mycobacteria) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria:

Both:

The person has non-tuberculosis mycobacteria (NTM) infection; and
Ministry of Health’s Tuberculosis Clinical Network has reviewed the individual case and continues to recommend bedaquiline as part of the treatment regimen.

*Similar changes will be made to Part II of Section H of the Pharmaceutical Schedule (hospital medicines list) for bedaquiline.

Linezolid**

Special Authority for Subsidy

Initial application — (Non-tuberculosis mycobacteria) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria:

Both:

The person has non-tuberculosis mycobacteria (NTM) infection; and
Ministry of Health’s Tuberculosis Clinical Network has reviewed the individual case and recommends linezolid as part of the treatment regimen.

Renewal — (Non-tuberculosis mycobacteria) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria:

Both:

The person has non-tuberculosis mycobacteria (NTM) infection; and
Ministry of Health’s Tuberculosis Clinical Network has reviewed the individual case and continues to recommend linezolid as part of the treatment regimen.

**No changes will be made to the hospital restriction for linezolid as the current restriction allows use to treat NTM infection.

Captopril oral liquid***

Schedule note:

Oral liquid rRestricted to children under 12 years of age (any condition) or for treatment of acute autonomic dysreflexia in any person with spinal cord injury where glyceryl trinitrate is not tolerated, not clinically suitable or cannot be self-administered.

***Similar changes will be made to Part II of Section H of the Pharmaceutical Schedule (hospital medicines list) for captopril oral liquid.

Section H (Hospital Medicines List) changes

From 1 November 2026 ceftolozane with tazobactam will be funded in Health New Zealand hospitals as follows:

Chemical	Formulation	Presentation	Brand	Pack size	Price and subsidy
Ceftolozane with tazobactam	Ceftolozane 1000 mg with tazobactam 500 mg powder for injection	20 mL vial	Zerbaxa	10 vials	$2500.00

Ceftolozane with tazobactam (Zerbaxa) will be subject to the following hospital indication restriction:

Restricted

Initiation – Multi-drug resistant organisms

Clinical microbiologist or infectious disease specialist

Either:

For the treatment of infection with a microorganism proven to be resistant to other funded antibiotics, based on microbiology reporting; or
For the treatment of infection with an organism reasonably expected to be resistant to other funded antibiotics but susceptible to ceftolozane with tazobactam

Theme	Pharmac Response
Ceftolozane with tazobactam for treatment of MDROs
Clinicians Support for the proposal, noting this medicine is well evidenced for use with very specific patient populations. People receiving this medicine would have extensive involvement of specialists in their care, and infectious disease specialists and microbiologists are familiar with it.	We are pleased to be able to progress this proposal to list ceftolozane with tazobactam for the treatment of multi-drug resistant organisms.
Clinicians Recommend Pharmac establish supply arrangements that enable access across smaller and rural hospitals, encourage microbiology laboratories to report susceptibility testing on request.	Pharmac has, alongside this listing, entered into an agreement with the supplier of ceftolozane with tazobactam to secure supply. Health NZ hospitals will be able to order and stock this medicine in the same manner as for other listed anti-infective medicines. Pharmac will provide feedback on microbiology laboratory reporting to Health NZ. Contracts for independent laboratory services and any required operating policies and procedures are managed by Health NZ. The Pharmaceutical Schedule is designed to reflect funding parameters and inclusion of the additional recommendations to laboratory providers would not be consistent with this purpose.
Bedaquiline for treatment of NTM infections
Clinicians Support for the proposal, noting support for timely access to required monitoring in the community by Health NZ would support access in the community and rural areas.	We are pleased to be able to progress this proposal to widen access to bedaquiline for the treatment of non-tuberculosis mycobacteria infections. We will be engaging with health sector stakeholders throughout the implementation of this proposal.
Clinicians Include clear renewal criteria to enable ongoing use where appropriate.	We have added renewal criteria for bedaquiline to allow for cases where a person needs to continue treatment beyond 12 months.
Clinicians Include monitoring guidance for clinicians in the special authority or prescriber information co-designed with the Tuberculosis Clinical Network.	As the funder of medicines Pharmac is responsible for determining which medicines are funded for use in hospitals and the community via the Pharmaceutical Schedule. We understand the importance of clear clinical guidelines in providing safe and efficacious treatment, however Pharmac does not produce or manage clinical care guidelines. Pharmac has engaged with our clinical advisors in designing the Special Authority criteria to ensure this aligns with current clinical practice and evidence. The development of clinical guidance to support use of the medicines included in this proposal would be the responsibility of clinicians and Health NZ hospitals.
Linezolid for treatment of NTM infections
Clinicians Support for widening access to linezolid for non-tuberculosis mycobacteria infections, noting support for timely access to required monitoring in the community by Health NZ would support access in the community and rural areas.	We are pleased to be able to progress this proposal to list linezolid for the treatment of non-tuberculosis mycobacteria infections. We will be engaging with health sector stakeholders throughout the implementation of this proposal.
Clinicians Linezolid should be funded in the community for any infection where it is recommended by an infectious disease specialist or microbiologist due to changes in recommended practice for treating some infections.	At this time Pharmac has not received a funding application for widened access to linezolid in the community under this criterion. While we understand there is a desire for wider access to linezolid for community use, this is outside the scope of this proposed change. Consideration of funding for this population would be most appropriate through a separate funding application. For information on how to make a funding application see our website(external link).
Clinicians Include clear renewal criteria to enable ongoing use where appropriate.	We have added renewal criteria for linezolid to allow for cases where a person needs to continue treatment beyond 12 months.
Clinicians Include monitoring guidance for clinicians in the special authority or prescriber information co-designed with the Tuberculosis Clinical Network.	As the funder of medicines Pharmac is responsible for determining which medicines are funded for use in hospitals and the community via the Pharmaceutical Schedule. We understand the importance of clear clinical guidelines in providing safe and efficacious treatment, however Pharmac does not produce or manage clinical care guidelines. Pharmac has engaged with our clinical advisors in designing the Special Authority criteria to ensure this aligns with current clinical practice and evidence.
Captopril for treatment of high blood pressure in patients with autonomic dysreflexia following spinal cord injury
Clinicians Support for widening access for captopril oral liquid for people living with autonomic dysreflexia, meeting a significant health need for these people where the use of nitrates is not a clinical option to treat severe hypertensive events and a fast-acting anti-hypertensive is required.	We are pleased to be able to progress this proposal to widen access to captopril oral liquid for the treatment of acute hypertensive events in people experiencing autonomic dysreflexia.
Clinicians Widen the proposed criteria to include people for whom GTN is not tolerated or cannot be practically self-administered.	Pharmac has modified the schedule note following consultation to also cover this suggested group. Captopril oral liquid will be funded for patients with spinal cord injury who cannot self-administer GTN spray, or for whom GTN spray is not tolerated or otherwise clinically unsuitable.
Clinicians Ensure dispensing arrangements enable people to maintain a usable supply at home and provide clear implementation information for patients, whānau, and clinicians.	We appreciate that dispensing arrangements need to practically support use. Captopril oral liquid is currently supplied under the terms of Pharmac’s annual tender process, which includes terms covering adequate product shelf life. Captopril oral liquid is currently supplied in the community and Pharmac has maintained the current dispensing rules for captopril oral liquid as part of this decision, this will ensure that sufficient quantity of the medicine will be able to be prescribed to ensure people have an adequate amount to address their needs.

Theme

Pharmac Response

Ceftolozane with tazobactam for treatment of MDROs

Clinicians

Support for the proposal, noting this medicine is well evidenced for use with very specific patient populations. People receiving this medicine would have extensive involvement of specialists in their care, and infectious disease specialists and microbiologists are familiar with it.

We are pleased to be able to progress this proposal to list ceftolozane with tazobactam for the treatment of multi-drug resistant organisms.

Clinicians

Recommend Pharmac establish supply arrangements that enable access across smaller and rural hospitals, encourage microbiology laboratories to report susceptibility testing on request.

Pharmac has, alongside this listing, entered into an agreement with the supplier of ceftolozane with tazobactam to secure supply. Health NZ hospitals will be able to order and stock this medicine in the same manner as for other listed anti-infective medicines.

Pharmac will provide feedback on microbiology laboratory reporting to Health NZ. Contracts for independent laboratory services and any required operating policies and procedures are managed by Health NZ. The Pharmaceutical Schedule is designed to reflect funding parameters and inclusion of the additional recommendations to laboratory providers would not be consistent with this purpose.

Bedaquiline for treatment of NTM infections

Clinicians

Support for the proposal, noting support for timely access to required monitoring in the community by Health NZ would support access in the community and rural areas.

We are pleased to be able to progress this proposal to widen access to bedaquiline for the treatment of non-tuberculosis mycobacteria infections.

We will be engaging with health sector stakeholders throughout the implementation of this proposal.

Clinicians

Include clear renewal criteria to enable ongoing use where appropriate.

We have added renewal criteria for bedaquiline to allow for cases where a person needs to continue treatment beyond 12 months.

Clinicians

Include monitoring guidance for clinicians in the special authority or prescriber information co-designed with the Tuberculosis Clinical Network.

As the funder of medicines Pharmac is responsible for determining which medicines are funded for use in hospitals and the community via the Pharmaceutical Schedule.

We understand the importance of clear clinical guidelines in providing safe and efficacious treatment, however Pharmac does not produce or manage clinical care guidelines. Pharmac has engaged with our clinical advisors in designing the Special Authority criteria to ensure this aligns with current clinical practice and evidence.

The development of clinical guidance to support use of the medicines included in this proposal would be the responsibility of clinicians and Health NZ hospitals.

Linezolid for treatment of NTM infections

Clinicians

Support for widening access to linezolid for non-tuberculosis mycobacteria infections, noting support for timely access to required monitoring in the community by Health NZ would support access in the community and rural areas.

We are pleased to be able to progress this proposal to list linezolid for the treatment of non-tuberculosis mycobacteria infections.

We will be engaging with health sector stakeholders throughout the implementation of this proposal.

Clinicians

Linezolid should be funded in the community for any infection where it is recommended by an infectious disease specialist or microbiologist due to changes in recommended practice for treating some infections.

At this time Pharmac has not received a funding application for widened access to linezolid in the community under this criterion. While we understand there is a desire for wider access to linezolid for community use, this is outside the scope of this proposed change.

Consideration of funding for this population would be most appropriate through a separate funding application. For information on how to make a funding application see our website(external link).

Clinicians

Include clear renewal criteria to enable ongoing use where appropriate.

We have added renewal criteria for linezolid to allow for cases where a person needs to continue treatment beyond 12 months.

Clinicians

Include monitoring guidance for clinicians in the special authority or prescriber information co-designed with the Tuberculosis Clinical Network.

As the funder of medicines Pharmac is responsible for determining which medicines are funded for use in hospitals and the community via the Pharmaceutical Schedule.

Captopril for treatment of high blood pressure in patients with autonomic dysreflexia following spinal cord injury

Clinicians

Support for widening access for captopril oral liquid for people living with autonomic dysreflexia, meeting a significant health need for these people where the use of nitrates is not a clinical option to treat severe hypertensive events and a fast-acting anti-hypertensive is required.

We are pleased to be able to progress this proposal to widen access to captopril oral liquid for the treatment of acute hypertensive events in people experiencing autonomic dysreflexia.

Clinicians

Widen the proposed criteria to include people for whom GTN is not tolerated or cannot be practically self-administered.

Pharmac has modified the schedule note following consultation to also cover this suggested group.

Captopril oral liquid will be funded for patients with spinal cord injury who cannot self-administer GTN spray, or for whom GTN spray is not tolerated or otherwise clinically unsuitable.

Clinicians

Ensure dispensing arrangements enable people to maintain a usable supply at home and provide clear implementation information for patients, whānau, and clinicians.

We appreciate that dispensing arrangements need to practically support use. Captopril oral liquid is currently supplied under the terms of Pharmac’s annual tender process, which includes terms covering adequate product shelf life.

Captopril oral liquid is currently supplied in the community and Pharmac has maintained the current dispensing rules for captopril oral liquid as part of this decision, this will ensure that sufficient quantity of the medicine will be able to be prescribed to ensure people have an adequate amount to address their needs.

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.