Apotex, the supplier of Apo-Selegiline (the funded brand of selegiline hydrochloride 5mg tablet), is leaving the New Zealand market. In its announcement,1 Pharmac says it has been unable to find an alternative long-term supplier for selegiline but that a six-month supply of an alternative brand of selegiline hydrochloride 5mg tablet (Eldepryl; Aspen) has been secured to allow time for patients with Parkinson’s disease (PD) to be transitioned to an alternative treatment. No new patients can be started on selegiline from 1 August 2021; after this date existing users will need their selegiline prescriptions endorsed to receive subsidised supplies.
In addition, Pharmac has announced a decision to fully fund rasagiline mesilate 1mg tablets (Azilect; Teva) without restriction from 1 August 2021.2 Rasagiline, like selegiline, is from the monoamine oxidase B (MAO-B) inhibitor class of agents, and is newly funded in New Zealand for people with PD. Both agents are used to treat the symptoms of PD by slowing the enzymatic breakdown of dopamine. Clinical advice received from members of the Neurological Subcommittee of PTAC is that rasagiline mesilate may be a suitable alternative treatment for people currently using selegiline hydrochloride.2
Rasagiline is new to the Pharmaceutical Schedule; however, it is not yet approved by Medsafe – the manufacturer (Teva) is committed to working towards gaining approval. Until this occurs, rasagiline will need to be prescribed and supplied under Section 29 of the Medicines Act 1981.3
Moving patients from one treatment to another due to a change in funding may present difficulties. Pharmac acknowledges this and will cover one GP patient co-payment fee for patients transitioning from selegiline to an alternative funded treatment. This reimbursement to practitioners is in place from 1 August 2021 to 28 February 2022.1
Below is a summary of the proposed timeline of changes over the next few months, and some reminders to help primary care facilitate the transition for patients currently using selegiline.