Proposal to fund letermovir for prevention of Cytomegalovirus infection

Medicines Consultation Closes 19 Mar

What we’re proposing

We’re asking for feedback on a proposal to fund letermovir (brand name Prevymis) for people with severe immunosuppression who need it for prevention of cytomegalovirus (CMV) infection.

Consultation closes at 5pm 19 March 2026 and feedback can be emailed to consult@pharmac.govt.nz

What would the effect be?

From 1 May 2026, letermovir (brand name Prevymis) would 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 CMV infection.

This would 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) would be able to apply for funded access through the Pharmaceutical Schedule.

Who we think will be 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

About Cytomegalovirus, stem cell transplants and severe immunosuppression

About Cytomegalovirus (CMV)

Cytomegalovirus (CMV) is a common virus that spreads through close contact. Most people are exposed to CMV during childhood, and once infected, the virus stays in the body for life. For most people, CMV is harmless. However, it can lead to serious health problems in those with weakened immune systems. This is because the virus can reactivate, and their immune system may not be strong enough to control it, which can make them very unwell.

CMV is a concern for patients undergoing an allo-HSCT because as part of the procedure people become highly immunosuppressed. CMV reactivation in people with severe immunosuppression can have life-threating consequences.

For people who have undergone an allo-HSCT, or who are severely immunosuppressed for other reasons, any level of CMV infection, including in people who do not have symptoms, is associated with an increased risk of poor outcomes from transplant and increased risk of death.

Māori and Pacific people are at higher risk of having been exposed to CMV earlier in life. They are also more likely to get blood cancers. This means they are both more likely to require an allo-HSCT and are more likely to develop CMV infection following allo-HSCT.

About allogenic haematopoietic stem cell transplants

An allogenic haematopoietic stem cell transplant (allo-HSCT; also known as a bone marrow transplant) is a procedure used to treat a range of conditions. Most commonly it is used to treat blood cancers, but it can be used for other conditions like multiple sclerosis.

The transplant process means people’s immune systems do not work as well as they normally would, leaving them vulnerable to infections like CMV which would normally not be dangerous. Additionally, after the transplant a person must take medicines that suppress the immune system to prevent their body rejecting the new stem cells. This means that the person is at very high risk of a dangerous infection throughout the process.

About severe immunosuppression

Some people will have weakened immune systems for other reasons and may be at risk of CMV reactivation. We are also proposing to fund letermovir for the small number of people who are severely immunosuppressed and cannot take other antiviral medicines.

Letermovir for CMV prevention is currently funded for a small number of people with severe immunosuppression through Pharmac’s exceptional circumstances framework (NPPA).

From 1 May 2026, healthcare professionals treating people with severe immunosuppression at risk of CMV reactivation would be able to apply for funded access to letermovir via the Pharmaceutical Schedule, rather than needing to submit applications through NPPA.

Why we’re proposing this

About letermovir

Letermovir is an oral antiviral medicine that is given to people who have previously had CMV infection. This prevents the virus reactivating and making them sick. Our clinical advisors have told us(external link) that giving people letermovir when they have undergone an allo-HSCT or are experiencing severe immunosuppression for other reasons significantly reduces their chances of developing CMV and the risks of a serious infection and complications.

More information about letermovir is available on the Medsafe datasheet.

PDF – Medsafe datasheet for letermovir(external link)

About CMV prevention (prophylaxis)

Currently, Pharmac does not currently fund any treatments to prevent CMV (called prophylaxis) after a stem cell transplant. Letermovir would be given after an allo-HSCT is completed and would help prevent people from developing CMV infection.

If significant CMV infection develops, people currently receive pre-emptive therapy (PET), consisting of other antiviral medicines, like valganciclovir or ganciclovir. However, these antiviral medicines require a person to be in-hospital and require significant hospital resource due to monitoring and infusion time.

Letermovir helps stop people developing CMV disease.  Because of this, it is expected to free up hospital resources, as well as nurse and specialist time Stem cell transplants are also 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 could reduce long hospital stays, help people return home sooner, and spend less time away from family.

Details about our proposal

From 1 May 2026, letermovir would be funded in both Health New Zealand hospitals and via community pharmacies.

Chemical

Formulation

Brand

Pack size

Price and subsidy

letermovir

Tab 240 mg

Prevymis

28

$6664.00

Wastage claimable would apply for letermovir.

The following funding restrictions would apply to letermovir in both hospitals and community:

Initial application (CMV prophylaxis - post HSCT) from any relevant practitioner; approvals valid for four months for applications meeting the following criteria:

  1. 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 must commence within 28 days of an allogeneic haematopoietic stem cell transplant; and
    4. Maximum treatment duration of 100 days post-transplant

Renewal (CMV prophylaxis - post HSCT) from any relevant practitioner; renewals valid for four months for applications meeting the following criteria:

  1. 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 must 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 from any relevant practitioner on the recommendation of an infectious disease specialist or clinical microbiologist; approvals valid for six months for applications meeting the following criteria:

  1. Both of the following:
    1. Patient has severe immunosuppression requiring prophylaxis of CMV; and
    2. One of:
      1. Patient is contraindicated to all other funded oral antiviral agents; or
      2. Patients CMV is resistant to all other funded oral antiviral agents

Note: Indications marked with * are unapproved indications

These criteria are based on the recommendation of Pharmac’s clinical advisors on the Anti-infective Advisory Committee and from consultation with specialists in HSCT management.

The renewal criteria for post-HSCT are intended to cover the rare situation where a person has received a second HSCT and thus requires a second round of letermovir. Currently this small group of people receive funding Pharmac’s exceptional circumstances framework (NPPA).

PDF – Record of the 2020 Meeting of the Anti-infective Advisory Committee(external link)

To provide feedback

Send us an email: consult@pharmac.govt.nz by 5pm 19 March 2026

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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