Page updated: 01 May 2025
Ryzodeg 70/30 insulin and Freestyle Libre 2 plus continuous glucose monitoring are now available. Ryzodeg is a co-formulation of 70% degludec insulin (ultra long-acting basal insulin) and 30% aspart insulin (rapid-acting insulin) that will only be available in 3ml cartridges for NovoPens. Due to degludec insulin having a half-life of 25 hours, Ryzodeg will be a useful option for those who tend to have only one large meal per day and/or where one injection per day is desirable, and should not be administered more than twice daily. Guidance on how to use Ryzodeg can be found here.
The Freestyle Libre 2 plus is designed as a stand-alone continuous glucose monitor (CGM) and will gradually replace the Freestyle Libre 2 model. Advantages of the Freestyle Libre 2 plus system are that it is more accurate and has longer sensor wear (15 days vs 14 days) than the older Freestyle Libre 2 system with no need to change the app or reader. It will be important to switch people currently on the Freestyle Libre 2 to the Freestyle Libre 2 plus to ensure ongoing supply.
People with type 2 diabetes can now be started on funded liraglutide (Victoza) and there is now dual funding of empagliflozin (Jardiance) and GLP1Ra for people with type 2 diabetes and heart failure. People already on Victoza and dulaglutide (Trulicity) can also continue their current regimen due to improved supply. Importantly, empagliflozin (Jardiance) is now funded for heart failure in addition to funding of GLP1Ra for type 2 diabetes. Therefore, people with T2D and heart failure should ideally be on funded empagliflozin under the heart failure special authority criteria and funded GLP1Ra under the diabetes special authority if the HbA1c remains above target.
Pharmac has announced that currently no new patients can be started on funded dulaglutide (Trulicity) or liraglutide (Victoza). People with diabetes can still self-fund these medications, but unfortunately they are expensive. Empagliflozin (Jardiance or Jardiamet in combination with metformin) is usually the best alternative if no contraindications. People with diabetes already on dulaglutide and liraglutide can continue to have them prescribed, but many pharmacies are dispensing these medications weekly due to supply shortage. NZSSD is continuing to strongly advocate that the halt on prescribing for new patients is as short as possible due to the benefits for our high-risk whaanau with diabetes. We will keep you updated and always recommend best practice wherever possible.
The shortage of dulaglutide (Trulicity) and liraglutide (Victoza) continues to worsen and many scripts may not be able to be dispensed due to lack of stock, or dispensed weekly at best. Please check that your patients are receiving their medication and if not, to try other pharmacies or consider other alternative glucose lowering therapies if appropriate. Additional glucose lowering therapies may also be required for those prescribed multiple injections of Trulicity a week who are receiving one injection. Understandably, the shortage is causing significant distress for whaanau, pharmacies and prescribers, but unfortunately the shortage is likely to last for at least another year. Pharmac will likely be required to tighten the special authority further and we will keep you updated of any changes. It is more important than ever to ensure those with diabetes who need Trulicity or Victoza the most get treatment, and that Trulicity and Victoza are not being used for weight loss alone.
Pharmac have temporarily changed the special authority for GLP1 receptor agonists (GLP1RA; dulaglutide and liraglutide) because of the worldwide shortage of GLP1RA to the below:
following funded glucose lowering agents for a period of at least 6 months, where clinically, appropriate, empagliflozin, metformin and vildagliptin AND EITHER
Please note that the change was made without full clinical consultation and we understand that the new special authority criteria may lead to confusion. To maintain consistent supply of GLP1RA we recommend:
- Ensuring that GLP1RA are used only for glycaemic control and not for weight loss
- To not switch between dulaglutide (Trulicity) and liraglutide (Victoza)
We always recommend best practice and it is important that those who need GLP1RA the most receive GLP1RA, particularly those with type 2 diabetes and cardiovascular disease. For these patients, we do not recommend trialling and/or persisting with alternative glucose lowering therapies if clinically inappropriate and/or if ongoing adverse effects. But we all have a responsibility to be clinically judicious and we continue to work with PHARMAC on possible solutions such as dual funded empagliflozin with GLP1RA, funded GP visits and pharmacy education etc., but this is a work in progress and we continue to provide an update on this page.