Depending on the brand and the concentration, JAK inhibitors and biologics can cost more than $30,000 a year. (file image) Photo: 123rf
Some patients with severe eczema are paying thousands of dollars for new-generation treatments - but many of those worst affected are missing out.
According to dermatologists, eczema treatment in New Zealand is a decade behind, despite 6 percent of the population suffering from the chronic inflammatory skin condition - one of the highest rates in the world.
The new classes of medicine - JAK inhibitors and biologics - both work by regulating the body's immune response in some way.
One eczema sufferer in his mid-20s said starting on the JAK inhibitor upadacitinib (branded as Rinvoq) four months ago had transformed his life.
Previously, his skin was so cracked and itchy, he was unable to walk without pain at times and had to work from home.
"I was feeling itchy all the time and basically this upadacitinib medicine, it didn't entirely stop it, but it significantly reduced that feeling, which is incredible... life-changing stuff really."
The keen sportsman, who had suffered serious skin infections in the past, is paying $190 for a three-month supply on top of what his insurer pays.
Depending on the brand and the concentration, JAK inhibitors and biologics can cost more than $30,000 a year.
"I'm making decent enough money to be able to have this luxury. But I know that some people definitely can't."
Upadacitinib (Rinvoq) for moderate to severe eczema is on Pharmac's "options for investment list", which means it is a treatment it would like to fund, once its budget allowed.
The drug-funding agency said it was still assessing a second application for Upadacitinib to treat severe eczema, while the application for the biologic dupilumab (branded Dupixent) was "on hold pending availability of a supplier for the New Zealand market".
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Pharmaceuticals director Geraldine MacGibbon said the priority of Pharmac's funding choices changed "depending on the health benefits, success of negotiations with suppliers, new clinical data, and the variety of other funding applications" on its priority lists.
"Because of this we're unable to give a definitive timeframe for if, or when, we can fund treatments."
Dupilumab has been funded in Australia since 2021 and upadacitinib since 2022.
Wellington dermatologist Michael Sawchuck sees between five and eight patients every week for whom he said he would definitely prescribe these drugs if they were funded.
"They can't work, they can't go to school and they need these medications."
In rare cases, he has been able to get special approval for individual patients, including one young man who also had cancer.
For that reason, he could not have the usual immune-suppressants and light therapy did not work for his eczema.
"So I had to basically battle with Pharmac to get him Dupilumab, which would have been safe in his case, but that took six months.
"So we do get funding, but it's like pulling teeth."
Dupixent injection and pen. Photo: Dupixent
Dermatological Society incoming president Dr Scott Barker said New Zealand was more than 10 years behind in terms of recommended eczema treatment.
"If we look at what we can supply for patients, it's fitting with the 2013 guidelines for the care of eczema in the American Academy of Dermatology.
"But they've moved on from there."
Dermatological Society incoming president Dr Scott Barker. Photo: NZ Dermatological Society
However, it was not just a matter of supplying more drugs, New Zealand lacked the specialists to prescribe them, Dr Barker said.
"GPs are able to prescribe the standard medicines we have now [for severe eczema] - like Methotrexate, Ciclosporin and Azathioprine. They are actually able to but very few of them do. So it's very hard to link in the patients with the people they need to see to get the medications started."
There are currently the equivalent of just 22 full-time dermatologists in the public health system, which equates to about one specialist per 280,000 people. The ideal ratio is about one per 80,000. Some regions have no specialists.
Some of Dr Sawchuck's patients come from as far away as Invercargill to see him.
An internal Health Ministry report from two years ago said services were "untenable" due to workforce shortages, and improving them was "a matter of urgency".
Dr Barker said the Dermatological Society continued to advocate for a "hub and spoke" model, with four main centres to provide a consistent service nationwide and build medical, nursing and allied health workforce capacity.
He is hoping a meeting with Health Minister Shane Reti, which had to be cancelled on 26 June, can be rescheduled soon.