You may have seen the notice from Pharmac allowing new special authority applications for liraglutide (Victoza) from 1 March 2025.
Both dulaglutide (Trulicity™) and Liraglutide (Victoza™) can be initiated for new patients who meet the special authority criteria from 1 July 2025.
PHARMAC criteria states that patients must have an HbA1c of greater than 53mmol/mol despite regular clinically appropriate use of metformin, empagliflozin and vildagliptin for at least 6 months.
Clinicians are encouraged to exercise their clinical judgement when deciding if persevering with all the stated medications remains clinically appropriate. If waiting the stated 6 months is in your clinical opinion not clinically appropriate, then GLP-1 agonists can be initiated sooner. For example, if empagliflozin is contraindicated or not tolerated then it is reasonable to initiate GLP-1 agonists within the 6-month timeframe if the patient’s HbA1c remains above target on metformin and vildagliptin.
However, to ensure adequate and continuous supply of these medications to whānau we are recommending that those presently stabilised on liraglutide (Victoza™) are NOT switched to dulaglutide (Trulicity™) unless there is a clinical justification for the switch.
Please also note that funded GLP-1 agonists cannot to be given in combination with funded empagliflozin (Jardiance™) or empagliflozin with metformin hydrochloride (Jardiamet™) unless whaanau are receiving funded empagliflozin or empagliflozin with metformin hydrochloride under special authority for heart failure. Others may choose to self-fund empagliflozin or empagliflozin with metformin hydrochloride and have it in combination with funded a GLP-1 agonist.
Remember to stop the vildagliptin when starting dulaglutide (Trulicity™).
Empagliflozin can now be prescribed under special authority for people with chronic heart failure with reduced ejection fraction (HFrEF), those patients with T2DM who meet the HFrEF criteria can also be prescribed Liraglutide if they meet the special authority criteria for T2DM.
Please contact your diabetes lead if you have any questions regarding this.
Comment from Dr Jo Scott-Jones, clinical director
You can use your diabetes clinical dashboard to quickly identify the people who are eligible for GLRP1 but who have never been prescribed a GLRP1A.
To do this, go to the the patient report and choose the filter "eligible for GLRP1A" > click "yes" > find the filter "prescribed GLRP1A" > click "no" - hey presto, you will have your list of NHIs to review.
If you have too many patients identified by this (there are 5,189 eligible but not prescribed aged over 25 across the whole network so this might be a lot) - you could use the other filters to look at your Māori population first.
The dashboards are not perfect of course, so think about it when you have someone in front of you, but as a next iteration in your Quality Improvement Plan PDSA cycle, this might be a really good exercise.
Kathy joined Pinnacle earlier this month as clinical diabetes specialist for Waikato, replacing the role previously held by Anne Waterman.
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