Proposal to widen access to febuxostat to treat gout
What we're proposing
From 1 February 2027, febuxostat would be funded for people with gout whose symptoms cannot be adequately controlled with allopurinol or who cannot tolerate allopurinol.
Why we're proposing this
Pharmac received a funding application to widen access to febuxostat for the second-line treatment of gout in 2015. Pharmac received advice on this application from our Pharmacology and Therapeutics Advisory Committee (PTAC) and Rheumatology Subcommittee who recommended the application be funded with a medium priority.
More detail
Pharmac initially ranked this proposal on our Options for Investment list (OFI) in 2016. As a result of the lowered cost of febuxostat through Pharmac’s annual tender process, Pharmac is proposing to progress this funding application.
These changes would give patients and clinicians two options for second-line treatment: febuxostat or probenecid. For some people, febuxostat may be the preferred option because it only needs to be taken once a day and it can be easier to adjust the dose if needed.
Details about our proposal
Access would be subject to the following amended Special Authority criteria (affected criteria shown only, additions in bold, deletions in strikethrough) as follows:
Initial application — (Gout) from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria:
Both:
- Patient has been diagnosed with gout; and
- Any of the following:
- The patient has a serum urate level greater than 0.36 mmol/l despite treatment with allopurinol at doses of at least 600 mg/day and up to 900 mg/day
and addition of probenecid at doses of up to 2 g per day or maximum tolerated dose; or- The patient has experienced intolerable side effects from allopurinol such that treatment discontinuation is required
and serum urate remains greater than 0.36 mmol/l despite use of probenecid at doses of up to 2 g per day or maximum tolerated dose; orThe patient has renal impairment such that probenecid is contraindicated or likely to be ineffective and serum urate remains greater than 0.36 mmol/l despite optimal treatment with allopurinol ; or2.4The patient has previously had an initial Special Authority approval for benzbromarone for treatment of gout.
Similar eligibility criteria would apply in Part II of Section H of the Pharmaceutical Schedule.
The Febuxostat (Teva) brand of febuxostat would continue to the funded brand of febuxostat tablets in New Zealand, there would be no changes to the Principal Supply Status arrangements notified for febuxostat tablets in May 2026.
About gout and febuxostat
Gout is a form of arthritis caused by a build-up of uric acid in the body. When uric acid levels become too high, urate crystals can form in and around the joints, leading to painful gout attacks that can cause sudden swelling, redness, tenderness, and severe pain.
Around 90% of uric acid levels are influenced by genetic factors and how effectively the kidneys remove uric acid from the body. Some genetic variants that reduce the body's ability to remove uric acid are more common in Māori and Pacific populations, contributing to a higher risk of developing gout. If uric acid levels remain elevated, urate crystals can continue to build up over time. Without effective treatment, these crystals may cause permanent joint damage and can also affect kidney health.
Febuxostat is a urate-lowering medicine used to treat gout. It works by reducing the production of uric acid, helping to dissolve existing urate crystals and prevent new crystals from forming. Taking febuxostat can help prevent gout attacks and reduce the risk of long-term joint and kidney damage caused by ongoing crystal build-up.