Seymour issues 'please explain' over oestrogen patch switch

The minister responsible for Pharmac has written to the drug-buying agency for an explanation after it it stopped funding a brand of oestrogen patches that many women believe work best.

The decision by Pharmac to switch hormone replacement therapy (HRT) patches to Mylan and stop funding Estradot by the end of next year has prompted outpouring anger from many women, who believe their health and welfare is being seriously compromised.

David Seymour said on Thursday his office had been in touch with Pharmac to raise concerns about the process.

"After the initial responses received, I have decided to write to Pharmac asking for an explanation of how we got here and specifically how patient voice was considered.

"In my letter of expectations I set clear expectations with Pharmac's engagement with patients, and for Pharmac to ensure that it considers patient voice in making each decision."

Meanwhile, a doctor prescribing HRT said Pharmac's decision could put lives at risk.

Auckland doctor Garsing Wong exclusively prescribes Estradot because he believes it is more effective, and he fears the makers may withdraw supplies from New Zealand altogether leaving women with no alternative.

"It's very concerning because for the patients that don't suit the Mylan brand, it's an absolute disaster where we go from an effective treatment to basically patients back to square one without a suitable alternative."

He told Checkpoint one of his patients was unable to function normally after switching from Estradot to Mylan because of recent supply shortages.

"As soon as she changed over and even increased the dosage, she felt bloated, aching joints, hot flushes, basically back to square one.

"She said that her sleep was disrupted, she was anxious, not herself, feeling awful. She wasn't able to perform her corporate level job as well as affecting her family life."

He currently advised patients what chemists and pharmacies still had Estradot in stock due to shortened supply, he said.

"But this is quite a different issue now that it's not going to be available. It does make me feel very concerned for my patients where if they do have the switch and it won't suit them, it will be affecting them in all aspects of their life.

"If the pharmaceutical company withdraws from New Zealand, we won't have a choice. Then our patients will be left in the lurch."

• Learn more: Helen Baxter and the importance of a consistent HRT provider

He shared the concern of some women that the decision could put lives at risk.

"When you have treatment failure it impacts your whole life, and it's going to not only impact your mood, you could feel depressed or even suicidal, but if you can't function in your job or in your relationship, of course that is going to have a far-reaching effect.

"Luckily that hasn't been the case with my patients, but I can see that happening if there wasn't an alternative."

He was concerned to only learn of the funding decision through the radio, rather than being informed directly by Pharmac.

"I do feel rather aggrieved that Pharmac have said that they've consulted practitioners. But I haven't had any personal notification.

"I think the method of just emailing us is not adequate enough, they need to consult more widely as a really concerning issue."

Need to solve ongoing shortages - Pharmac chief

Pharmac chief executive Sarah Fitt told Checkpoint it had to find a way to solve ongoing supply shortages.

"They've been causing quite a lot of stress and anxiety for people for the last couple of years, so what we were trying to do was really get a secure, ongoing supply of the medication for people."

She said Pharmac had looked at the option of funding both Mylan and Estradot but could not as Estradot's supplier Sandoz had been struggling with high demand.

"With the increasing demand, we have got very strong assurance from the Viatris, the company that makes the Mylan brand, that they could meet the demand. Sandoz have been really struggling and we know it's been causing a lot of stress for people having to chop and change brands.

"The advice we got from our technical experts was it would be much better to have one brand and that would meet the needs of most people."

For people who cannot tolerate the Mylan brand, doctors would be able to apply for Pharmac to fund Estradot for their patient, she said.

"We also funded the gel last month as well. So that is another option."

She said the clinical reason behind the decision was it is better to stay on one brand than to keep changing.

"People are chopping and changing every couple of months because there's just been multiple brands in the market and people haven't been able to get supplies and having to go to different pharmacies to get different brands."

Currently, 25 percent of the market were on Mylan patches, she said.

In Pharmac's annual tender process, consultation with users had occurred, she said.

"It would've gone out to multiple people, but as a result of that we went ahead with the tender and certainly the feedback from our tender committee and our specialist advisor committee was that they were happy that we could proceed with the Mylan.

"We've had lots of feedback over the last four years from lots of people using these products and we have heard all the concerns.

"We've got an 0800 line and lots of people dial into that to give us feedback quite regularly."

Fitt said Pharmac did not have a choice regarding the decision.

"The company cannot meet the demands of this product. We have to secure an ongoing supply for now, but also into the future.

"Going with this product was our only viable option to ensure that we could have security of supply."

Fitt said she did not accept Mylan was an inferior product for many women.

"It's being used by 70,000 people in this country. It's registered in the US, but I do hear the concerns that people have, we take those very seriously."

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