Proposal to fund prasugrel tablets

From 1 February 2027, prasugrel 5 mg and 10 mg tablets would be listed in Section B and in Part II of Section H of the Pharmaceutical Schedule for use in the community and Health New Zealand Hospitals, subject to Special Authority criteria.  

Why we’re proposing this 

Pharmac currently lists ticagrelor 90 mg tablets in Section B and in Part II of Section H of the Pharmaceutical Schedule subject to Special Authority criteria. Pharmac received an application to fund prasugrel as an alternative P2Y12 inhibitor to ticagrelor for Acute Coronary Syndrome, STEMI or non-STEMI. The application received a High priority recommendation for funding from the Cardiovascular Specialist Advisory Committee.  

Prasugrel may be a more suitable treatment option than ticagrelor for some people. Clinical evidence suggests it may provide greater protection against another heart attack or other serious cardiovascular events without increasing the risk of major bleeding. Prasugrel is also taken once daily rather than twice daily, which may support better treatment adherence.  

Prasugrel was funded by Pharmac between 2012 and 2021 before being discontinued by its supplier and subsequently delisted from the pharmaceutical schedule. Prasugrel was included in the 2025/26 Invitation to Tender process, with a view to progressing the funding application. This proposal would allow prasugrel to be made available in New Zealand again. 

Details about our proposal 

From 1 February 2027, prasugrel would be listed in Section B and in Part II of Section H of the Pharmaceutical Schedule as follows: 

Pricing for prasugrel and brand information would be shared following any decision on this proposal. 

It is proposed that prasugrel would be listed in Section B of the Pharmaceutical Schedule subject to the following Special Authority criteria. Similar restriction criteria would be included for prasugrel in Part II of Section H of the Pharmaceutical Schedule. 

Initial application — (acute coronary syndrome) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: 

Both: 

1. Patient has recently (within the last 60 days) been diagnosed with an ST-elevation or a non-ST-elevation acute coronary syndrome; and 
2. Fibrinolytic therapy has not been given in the last 24 hours and is not planned. 

Renewal — (subsequent acute coronary syndrome) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria:

Both: 

1. Patient has recently (within the last 60 days) been diagnosed with an ST-elevation or a non-ST-elevation acute coronary syndrome; and 
2. Fibrinolytic therapy has not been given in the last 24 hours and is not planned. 

Initial application — (Percutaneous coronary intervention with stent deployment) from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: 

All of the following: 

1. Patient has undergone a percutaneous coronary intervention; and 
2. Patient has had a stent deployed in the previous 4 weeks; and 
3. Patient is clopidogrel-allergic**, or there is a documented poor response or likely poor response to clopidogrel. 

Renewal — (Percutaneous coronary intervention with stent deployment) from any relevant practitioner. Approvals valid for 6 months for applications meeting the following criteria: 

All of the following: 

1. Patient has undergone a percutaneous coronary intervention; and 
2. Patient has had a stent deployed in the previous 4 weeks; and 
3. Patient is clopidogrel-allergic**, or there is a documented poor response or likely poor response to clopidogrel.  

Initial application — (Stent thrombosis) from any relevant practitioner. Approvals valid without further renewal unless notified, where patient has experienced cardiac stent thrombosis whilst on clopidogrel. 

Note:** Clopidogrel allergy is defined as a history of anaphylaxis, urticaria, generalised rash or asthma (in non-asthmatic patients) developing soon after clopidogrel is started and is considered unlikely to be caused by any other treatment. 

If this proposal is approved, the above changes would also be made to the Special Authority criteria for ticagrelor.