Pharmac proposes to decline zolmitriptan after 17 years of waiting

Jump back to 2007. More than fifteen years ago, in 1991, sumatriptan was launched, the first acute medication specifically designed to treat migraine attacks by targeting a serotonin receptor found in blood vessels in the brain. It was described as miraculous. In half of patients, sumatriptan aborted attacks and reduced pain in 70%. Pain, nausea, photophobia and disability – all fading away in response to this new drug.

In 2007, seven of this new type of migraine drug, the triptans, were available worldwide. Zolmitriptan was launched in 1997, rizatriptan in 1998. But in New Zealand, only one was available: sumatriptan. Surely it was time for another triptan to be funded, for those unlucky people with migraine who didn’t respond to sumatriptan (as many as 30%). All of the seven different triptans act in slightly different ways, and people who didn’t respond to the first triptan they tried could find another one worked well. But this wasn’t an option for people in NZ.

So, in 2007, the drug company AstraZeneca made an application to Pharmac to fund zolmitriptan. Zolmitriptan is an effective and well-tolerated triptan, with the advantage of having a nasal spray formulation, which means that people with severe nausea and vomiting can still get the medication into their system. Their application was initially declined by Pharmac’s Pharmaceutical and Therapeutics Advisory Committee (PTAC), who cited cost concerns. The meeting notes also state:

Members considered that it was possible that listing zolmitriptan nasal spray could further grow the market for antimigraine drugs.

It appears PTAC at that time did not think treating migraine was a worthwhile activity. But they reconsidered in 2008, after AstraZeneca supplied additional information about zolmitriptan, and they recommended zolmitriptan be funded only if it cost the same or less than sumatriptan injections. However, it took until 2013 for Pharmac to rank and compare zolmitriptan and add it to Pharmac’s ‘cost saving or cost neutral’ priority list. It has been languishing on this waiting list ever since.

Rizatriptan was funded in 2012, finally giving New Zealanders with migraine another funded option to sumatriptan. Zolmitriptan nasal spray was available as an unfunded ‘pharmacy only’ medicine but has not been distributed in NZ for some years.

Now, on 18 December 2023, Pharmac put out a proposal to decline 94 ‘inactive’ funding applications, including the application for zolmitriptan. There’s some complicated history to this, but suffice it to say, Migraine Foundation Aotearoa New Zealand strongly opposes the removal of zolmitriptan from Pharmac’s priority list.

We’ve put together a submission arguing against Pharmac’s proposal to decline zolmitriptan but the more voices that object the better. If you want to tell Pharmac that you disagree with their proposal, email by 5 pm on Friday 9 February 2024. If you have used zolmitriptan and found it useful, that would be a great story to tell. If you haven’t, but think that another triptan option, especially a nasal spray, would be something you (or people you know) would benefit from, that’s another great story. We will make our submission public after 9 February.