Pharmac declines application for wider range of triptans

After nearly 10 years, Pharmac finally published its decision for funding a wider range of triptans.

Nearly 10 years ago, in July 2012, Pharmac received an application for a wider range of triptan medications to be funded for people living with migraine.

Only two triptans are funded and available in New Zealand – sumatriptan and rizatriptan. Both are short-acting.

Globally, there are seven triptans available to treat a migraine attack. Sumatriptan, almotriptan, eletriptan, rizatriptan and zolmitriptan are short-acting triptans, naratriptan is a medium-acting triptan and frovatriptan is a long-acting triptan. Frovatriptan can be particularly effective for treating menstrual migraine, which is often less responsive to other acute migraine medications.

Zolmitriptan is given via a nasal spray, which can be useful for people with migraine who have associated nausea and vomiting, as it doesn’t need to be absorbed in the stomach. Zolmitriptan nasal spray has previously been accessible as an unfunded, pharmacist-only medicine in New Zealand but is not currently available.

In February 2014, nearly two years after the application was received by Pharmac, the Pharmacology and Therapeutics Advisory Committee (PTAC), recommended that the application to fund additional triptan medications should be declined.

However, the final decision by Pharmac for funding languished on Pharmac’s to-do list for many years. In March 2022, in an effort to provide clarity to New Zealanders about its decision for inactive funding applications, which this application now was (find out more about why it was inactive here), Pharmac announced that it had declined the application to fund additional triptan medications.

While it helps to finally know the decision, it’s hard not to be frustrated with the 10 year delay from application to final decision.

For the estimated 642,000 people in New Zealand affected by migraine, this means we continue to receive substandard access to proper migraine medications. Research shows us that the 30–40% of people who do not find relief from one triptan may respond to another. But in New Zealand, if sumatriptan and rizatriptan are ineffective for someone with migraine, there are no other migraine-specific abortive medications available to take during a migraine attack.

Many people with migraine resort to using opioids, such as tramadol or codeine, to help during an attack. However, opioids aren’t the preferred medications to help with migraine long-term, as they don’t work well, can make migraine headaches worse, including increasing the frequency and severity of pain, and can cause dependence, addiction and other side effects. Opioids may be used as a short term rescue option but should not be used more than 9 days per month.

Migraine Foundation Aotearoa New Zealand is reviewing the minutes of the 2014 meeting. We will compare with the latest research and aim to submit an up-to-date, evidence-based application to Pharmac to re-consider funding of additional triptans, to give New Zealanders with migraine access to the same breadth of treatment options available other countries, including the Australia and the UK .