A Pharmac-initiated funding application for ciclosporin 0.05% eye preparation to treat severe keratoconjunctivitis sicca has been added to its Options for Investment (OFI) list.

The application was made following recommendations from the agency’s clinical advisors. As far back as 2016, Pharmac’s committee had recommended ciclosporin preparation at a strength higher than 0.05% be funded on the Pharmaceutical Schedule for the treatment of severe vernal or atopic keratoconjunctivitis sicca with a high priority with an amended Special Authority. It also recommended ciclosporin 0.05% preparation be funded for the treatment of severe keratoconjunctivitis sicca with a low priority. In Australia, Ikervis (ciclosporin 1mg/ml) drops are funded via the Pharmaceutical Benefits Scheme.

“It’s something we would like to fund, subject to budget availability,” a Pharmac representative told NZ Optics. “In the meantime, prescribers can still apply for a Named Patient Pharmaceutical Assessment (NPPA) for individual patients whose clinical circumstances are exceptional. NPPA applications must be made by a prescriber, not patients.”

In November 2021, dry eye specialist Professor Jennifer Craig, from the Ocular Surface Laboratory at Auckland University, said New Zealand’s ophthalmologists would welcome the drops being funded. However, her concern was wider accessibility of the commercial form of ciclosporin runs the risk of clinicians prescribing it where it isn’t properly indicated, she said.

“Because we don’t have many suitable treatments, it would tend to become the default – but not necessarily the appropriate – treatment. This would blow out Pharmac’s budget, if they could even be persuaded to fund it, and ultimately I think they would withdraw funding of ciclosporin entirely, which would be a tragedy for those who are truly dependent on it.”

To combat this, Pharmac’s subcommittee recommended, in 2011, that the prescribing of ciclosporin eye ointment and eye drops be subject to recommendation by an ophthalmologist.