Asthma and chronic obstructive pulmonary disease sufferers could be forced to fork out extra for their next inhaler with Covid-19 delaying the manufacture and shipping of a puffer used by thousands.
The Duolin inhaler, which was used by 24,000 people last year, has been out of stock throughout the country since mid-September.
In the meantime, those who use the inhaler are advised the equivalent is a combination of an Atrovent and a salbutamol inhaler.
But for those who use the puffer, the change in medications will cost more, take more time and could take a toll on their health.
One woman, who has been out of work for the past seven months because of Covid, was told she had to get a new prescription from her doctor when she tried to pick up a repeat prescription from her pharmacy.
With money already tight, the extra $55 for a GP appointment and $10 for the two new inhalers was an expense she could do without.
But, she was fortunate it would not have a major impact on her health.
"I'm lucky that my asthma is very well managed," said the woman, who refused to be named.
"I'm lucky as I've probably got a week left on my inhaler. If you were in a situation where you lost your inhaler and didn't have a spare on hand, it's going to create a lot of problems."
The woman, who had been an asthmatic for 32 years, said she was on a good combination of drugs and no longer had asthma attacks but expected she would notice the change.
"I could be quite wheezy and out of breath for a few days," she said.
She was most concerned that many people would not be aware of the shortage of that inhaler or the other medications affected by Covid-19 and believed there should be a system to inform people who used them.
Pharmac director of operations Lisa Williams said she recognised it could cause difficulties for some but using the two inhalers meant people were still getting the medicine they needed.
"We understand that the alternative is less convenient and means a patient may incur two co-payments."
But she said Duolin users did not have to go back to their prescriber because the pharmacy could implement the alternative when they collected their prescription.
The supplied had informed Pharmac that Duolin was expected to be back in stock early next week, she said,
Pharmac's website listed a shortage of seven medications and eight others that were totally out of stock. Among those medications were anti-depressants, blood pressure medications and painkillers.
"There's some serious implications for the health of New Zealanders. If somebody can't get their anti-depressants, that's not good."