Decision to update the Pharmaceutical Schedule for ambulance medicines, and tenecteplase for pre-hospital care
What we’re doing
Following our recent consultation on updating the Pharmaceutical Schedule for ambulance medicines, and tenecteplase for pre-hospital use, we’re pleased to announce the following:
Changes to the Pharmaceutical Schedule for ambulance medicines
From 1 July 2026, we will make the following changes to the Pharmaceutical Schedule to list ambulance medicines in the Pharmaceutical Schedule:
- Publish a new section of the Pharmaceutical Schedule (Section E) which will set out:
- All ambulance medicines, including presentation, strength, pack size and brand that will be funded when ordered by ambulance service providers.
- Where each medicine should be ordered from, for example the Health NZ- contracted wholesaler supplying ambulance medicines or any community pharmacy.
- Updated rules to allow ambulance service providers to order funded medicines (that require repacking) from community pharmacies using a Bulk Supply Order (BSO).
- Changes to Section B of the Pharmaceutical Schedule to enable community pharmacists to claim for ambulance medicines that require repacking when ordered on a BSO by ambulance service providers.
Funding tenecteplase for pre-hospital care
Under this decision and following feedback on our recent decision to fund treatments in the community for trauma and medical emergencies, and ketamine for palliative care(external link), from 1 July 2026, we will also fund tenecteplase for use within emergency ambulance services and Primary Response in Medical Emergencies (PRIME) services.
Why we’re doing this
Ambulance medicines
From 1 July 2026, Pharmac will take over responsibility for funding ambulance medicines. We needed to make changes to the Schedule to enable this decision.
Creating a new section of the Schedule: Section E allows us to incorporate ambulance medicines into our existing arrangements in a clear and consistent way. Section E will list the medicines used in emergency ambulance settings and outline the specific rules that apply to emergency ambulance services.
Up until now, Health NZ and ACC have jointly funded emergency road and air ambulance services, and ambulance providers have used this funding to purchase the medicines they need.
Tenecteplase for pre-hospital care
Tenecteplase is used for the treatment of ST-elevation myocardial infarction (STEMI), a type of heart attack. Tenecteplase should be given as early as possible, and patient outcomes can be improved if it is used by PRIME providers or ambulance services if the patient is more than 90 minutes away from a hospital.
Until now, tenecteplase has been provided directly to PRIME providers and ambulance service providers from Health NZ hospitals. We have heard from ambulance and PRIME providers that direct supply would reduce logistical barriers which would be beneficial for providers and patients.
This decision means that from 1 July 2026, tenecteplase will be listed on Section B of the Pharmaceutical Schedule and funded when supplied on a Practitioner Supply Order (PSO) with an endorsement for use by PRIME services. This means that PRIME providers will be able to order tenecteplase from community pharmacies on a PSO, consistent with arrangements for the supply of other PRIME medicines.
Tenecteplase will also be funded on Section E of the Pharmaceutical Schedule for use by ambulance service providers who would order this directly from the Health NZ- contracted wholesaler supplying ambulance medicines.
Any changes to the original proposal?
This decision was subject to a consultation letter dated 12 March 2026(external link)
We appreciate the valuable feedback that we received about incorporating ambulance medicines into the Pharmaceutical Schedule and funding tenecteplase for pre-hospital care. We have used this feedback to inform our implementation approach.
We have also added seven products to Section E following consultation feedback.
Who we think will be most interested
- Ambulance service providers
- PRIME providers
- Paramedics and healthcare practitioners providing emergency care
- Pharmacists
- Healthcare professional representative groups
- Organisations supporting emergency medicine practitioners
- Health New Zealand, including Sector Operations, ACC
- Suppliers and wholesalers
Detail about this decision
Changes to Pharmaceutical Schedule rules
The Rules of the Pharmaceutical Schedule(external link) will be updated from 1 July 2026 as follows (additions in bold, deletions in strikethrough). Only relevant parts of rules with proposed changes are shown.
Part 1 – Prescribing and initiating Subsidies for Community Pharmaceuticals
1.1.6 Ambulance Service Providers for Pharmaceuticals listed in Section E of the Schedule only.
1.3.5 Bulk Supply Orders (BSO): For Pharmaceuticals to be Subsidised on a BSO, the BSO must be:
a for supply of Community Pharmaceuticals to:
i either Private Hospitals that employ a Registered Nurse, for the treatment of people under the care of that facility, or
ii to a Vaccinator for medicines that are part of an approved immunisation programme and only where specifically indicated in Section B of the Schedule, or
iii Ambulance Service Providers and only where specifically indicated for a Pharmaceutical in Section E of the Schedule.
b be on a form supplied or approved by the Ministry of Health and signed by:
i either a Hospital Care Operator, or
ii a Vaccinator for medicines that are part of an approved immunisation programme and only where specifically indicated in Section B of the Schedule, or
iii an authorised representative of an Ambulance Service Provider and only where specifically indicated for a Pharmaceutical in Section E of the Schedule.
c for a Class B Controlled Drug or for buprenorphine hydrochloride, be written on a triplicate BSO Controlled Drug Form supplied by the Ministry of Health.
d not exceed what is a reasonable Monthly allocation for the particular institution, Ambulance Service Provider or Vaccinator’s circumstances of use
e meet all the Subsidy requirements of Section B or Section E of the Schedule applicable to that Community Pharmaceutical, and
Part 6 – Funding
6.1 Subsidies for Community Pharmaceuticals
6.1.3 Where the Subsidy specified in Section E differs from the Subsidy in other sections of the Schedule for a Community Pharmaceutical, the Subsidy in Section E will apply to a Community Pharmaceutical for Ambulance Service Providers only.
Part 10 – Definitions
Ambulance Service Provider means an organisation that is contracted by Health New Zealand to deliver emergency ambulance services
Community Pharmaceutical means a Pharmaceutical listed in Sections B to D E or I of the Schedule that is eligible for a Subsidy.
Section E of the Pharmaceutical Schedule
From 1 July 2026 funded ambulance medicines will be listed in Section E of the Pharmaceutical Schedule.
Section E describes the arrangements for community pharmaceutical subsidies when these medicines are supplied to emergency ambulance providers.
Section E spreadsheet download
- Section E alphabetical [XLSX 686 KB]
Abbreviations
W = Health NZ- contracted wholesaler supplying ambulance medicines
P = Community Pharmacy
Changes to Section B of the Pharmaceutical Schedule
From 1 July 2026, we will be making the following changes to Part B of the Pharmaceutical Schedule.
New listing in Section B
|
Chemical |
Formulation |
Brand |
Pack size |
Price and subsidy |
|---|---|---|---|---|
|
Glucose [Dextrose] |
Oral soln 15 g per 80 ml sachet |
HypoPak Glucose |
per 50 |
$75.00 |
Amending restriction for ticagrelor in Section B
Additions in bold, deletions in strikethrough. Only relevant parts with proposed changes are shown.
Ticagrelor tab 90 mg
Subsidy by endorsement; can be waived by Special Authority SA2530(external link)[PDF, 25.8 KB] – Retail Pharmacy.
Subsidy by endorsement - May be supplied on BSO to Ambulance Service Providers under the provisions in Section E of the Pharmaceutical Schedule and the BSO is endorsed accordingly.
Tenecteplase
From 1 July 2026 Tenecteplase will be listed in Section B, Section E and Part II of Section H of the Pharmaceutical Schedule as follows.
|
Chemical |
Formulation |
Brand |
Pack size |
Price and subsidy |
|---|---|---|---|---|
|
Tenecteplase |
Inj 50 mg vial with diluent |
Metalyse |
1 |
$2,390.00 |
Tenecteplase would be subject to an endorsement in Section B limiting funded use to the PRIME clinical indication, as follows:
Funding restrictions
Tenecteplase inj 50 mg vial with diluent
- Up to 1 inj available on a PSO
- Only on a PSO
- Subsidised only for use within a Primary Response in Medical Emergencies (PRIME) service and the PSO is endorsed accordingly
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 and our responses to the feedback received can be seen in the table below.
Schedule changes for ambulance medicines
|
Theme |
Pharmac comment |
|
Supportive |
|
|
Support proposed changes to Pharmaceutical Schedule. Proposal supports strengthened medicine supply security, reduced financial risk and better outcomes for patients and communities. |
We appreciate the time and effort people have taken to respond to this proposal. We hear the strong support and anticipated benefits to patients and communities receiving emergency ambulance medicines. |
|
Section E |
|
|
Requests to add the following products currently used by ambulance services
|
We have amended the proposed list of medicines in Section E to include these products as they are already used by ambulance services.
|
|
Consider adding
|
Currently, there is no proprietary rocuronium pre-filled syringe available in NZ. We understand that ambulance service providers are currently unable to meet vaccine cold chain requirements (external link)and are therefore unable to carry the Boostrix vaccine. |
|
Align Section E brands with decisions that have been made in other parts of the Schedule for:
|
We have amended the proposed list of medicines in Section E to account for recent brand changes elsewhere in the Schedule. |
|
Request for ongoing dialogue for how best to add medicines under consideration for Clinical Practice Guidelines (CPG) to Section E.
|
We note potential future ambulance medicines would be aligned with CPGs and likely already funded by Pharmac for use in other settings. Requests to add these medicines to Section E would be considered a change in service model for use of these medicines rather than a new funding application. Pharmac would work with ambulance service providers to support such requests. |
|
Brand changes |
|
|
Brand changes may cause issues with how some medicines are carried by emergency ambulances. Call for brand changes to be limited and identified early.
|
Pharmac considers brand changes from time to time for reasons including improving supply resilience and as a result of competition between suppliers. Should Pharmac consider funding a different ambulance medicine brand, we need to understand the practical implications of such a change, and we would work closely with ambulance service providers to proactively identify these. |
|
Repacking of medicines |
|
|
Need for some medicines to be repacked into smaller quantities to align with emergency ambulance services CPGs. |
Section E would list all medicines funded for use by emergency ambulance services, and
|
|
Current BSO funding does not reflect the true cost of re-packing Section E medicines. Supplying medicines on a BSO limits opportunities for pharmacists to contribute to the safe and effective use of medicines.
|
We have shared this feedback with Health NZ who is responsible for pharmacy service fees under the Integrated Community Pharmacy Service Agreement (ICPSA)(external link) . We appreciate the important role pharmacists provide in medicines management. While it is ideal to have pharmacist oversight in all circumstances, the nature of medicines required for emergency care requires the medicine to be on hand ahead of patient need. Our proposal replicates current supply arrangements whereby ambulance medicines are either ordered from wholesalers (Health NZ contracted wholesaler for supply of ambulance medicines) ambulance or repacked by community pharmacy under existing arrangements with ambulance service providers. |
Tenecteplase for pre-hospital use
|
Theme |
Pharmac comment |
|
Supportive |
|
|
Support changes to allow ambulances (and PRIME providers) to directly obtain tenecteplase from wholesalers (or from community pharmacy for PRIME providers). This change would enable accurate reporting of supply and usage. |
We are pleased this part of the proposal would have a positive impact for ambulance service providers and patients. We recently received valuable feedback from our PRIME funding decision(external link) calling for improved availability of tenecteplase for PRIME providers. We are pleased to be able to progress tenecteplase for PRIME as part of this proposal. |
|
Managing high-cost medicines |
|
|
Call for Health NZ to support re-distribution of near-expiry ST-elevation myocardial infarction (STEMI) kit with hospital pharmacies, as is current practice.
|
These fibrinolytic kits are currently supplied by Health NZ hospitals directly to ambulance service providers and relevant PRIME sites. Under this proposal, tenecteplase and all other medicines used in these fibrinolytic kits would be fully funded for ambulance and PRIME use. We have shared this feedback with Health NZ. |
|
Supplying tenecteplase on a PSO represents a financial risk to community pharmacies. Clarity required about PSO endorsement to enable community pharmacist claiming.
|
We appreciate the role community pharmacists play in the supply of medicines within their communities. PSO supply of tenecteplase is consistent with how PRIME services are accessing other medicines, with 20 PRIME sites using tenecteplase for STEMI management. We therefore expect that only a small number of pharmacies will supply tenecteplase on a regular basis and need to stock this. We will support community pharmacy with practical information as part of our implementation approach for this proposal. |
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.