This is the text extract for Proposal to amend Section H rule 8.6 - closes 5pm 16 January 2009, browse documents here.

10 December 2008

Consultation on proposal to amend Section H rule 8.6 to allow DHB’s to dispense up to 30 days medication.

PHARMAC is seeking feedback on a proposal to amend rule 8.6 of Section H of the Pharmaceutical Schedule. The rule change would allow DHB hospitals to dispense up to 30 days of discharge medication for patients. This letter outlines the proposal and how you can provide your feedback on it. Proposal Summary Rule 8.6 of Section H of the Pharmaceutical Schedule permits DHB Hospitals to fund from their own budgets pharmaceuticals that are listed in Sections A-G of the Pharmaceutical Schedule without Hospital Exceptional Circumstances approval in a quantity that does not exceed 5 days supply; provided the condition that it is supplied is consistent with any restriction applying to it. PHARMAC is proposing to amend rule 8.6 of Section H of the Pharmaceutical Schedule to permit up to 30 days supply of any pharmaceutical listed in Sections A-G of the Pharmaceutical Schedule from their own budgets, provided the DHB has a PHARMAC approved dispensing for discharge policy. If the DHB does not have an approved dispensing for discharge policy they may only supply up to 5 days supply. If this proposal is approved, the amendment would take effect from 1 March 2009. Why are we proposing this? PHARMAC has been approached by a DHB wanting to dispense up to 30 days supply of medicines to their in-patients so that when discharged from hospital the patient would take the remainder of their medicine home. This means that they would not be given a discharge prescription to be dispensed at a community pharmacy. The current rules of Section H of the Pharmaceutical Schedule do not permit DHB’s to dispense more than 5 days medication for their patients for use in the community without an HEC application unless it is specifically listed in Section H, Part IV of the Pharmaceutical Schedule relating to Discretionary Community Supply. The request to amend this rule follows a 6 month pilot at the DHB. By restricting the rule amendment to allow only those DHB’s that have a PHARMAC approved dispensing for discharge policy, it leaves the individual DHB to make an informed decision about implementing the rule or not. Feedback sought We welcome your feedback on this proposal. To provide feedback on this proposal please submit it by 5 pm, Friday 16 January 2009 to: Kaye Wilson Schedule Analyst PHARMAC Email: kaye.wilson@pharmac.govt.nz Fax: (04) 460 4995

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PO Box 10-254, Wellington 6143 We also invite any person or group to contact PHARMAC should you wish to have a meeting to discuss this consultation. What will happen then? All of the submissions we receive before the deadline will be considered by PHARMAC’s Board (or Chief Executive, acting under delegated authority) when making a decision on whether to implement this proposal. If the proposal is approved, it is anticipated that the proposed changes would take effect from 1 March 2009. Details of the proposal Proposed amendments to Section H, Part I, of the Pharmaceutical Schedule are as follows (deletions shown in strikethrough, additions in bold):

8. Discretionary Community Supply Pharmaceuticals 8.1 Discretionary Community Supply Pharmaceuticals are deemed to include every medicine, therapeutic medical device, or related product or related thing listed in Section H Part IV of the Schedule. 8.2 PHARMAC may, in its discretion, list any pharmaceutical that is not a Community Pharmaceutical as a Discretionary Community Supply Pharmaceutical, including a pharmaceutical that PHARMAC is made aware of by HPAC, the Exceptional Circumstances Panel, a DHB Hospital or relevant hospital personnel. 8.3 A DHB Hospital may use its discretion to purchase Discretionary Community Supply Pharmaceuticals for use in the community, provided that, if the patient being treated with a Discretionary Community Supply Pharmaceutical usually resides in a district other than that within the jurisdiction of the DHB initiating the treatment, then the DHB initiating the treatment must either agree to fund any on-going treatment required once the patient has returned to his/her usual DHB, or obtain written consent from the DHB or DHBs in which the patient will reside following the commencement of treatment. 8.4 The funding of a Discretionary Community Supply Pharmaceutical for use in the community will be sourced from the relevant DHB’s own budget. For the avoidance of doubt, the Discretionary Community Supply Pharmaceutical is not a Community Pharmaceutical and funding is not available for Discretionary Community Supply Pharmaceuticals from the Pharmaceutical Budget. 8.5 Subject to rule 8.6, DHB Hospitals must not fund for use in the community, any pharmaceuticals that are not Discretionary Community Supply Pharmaceuticals unless they have been approved under Hospital Exceptional Circumstances. 8.6 DHB Hospitals may fund from their own budgets, any Pharmaceutical that is listed in Sections A-G of the Pharmaceutical Schedule without Hospital Exceptional Circumstances (HEC) approval provided that: (a) the condition for which that Pharmaceutical is supplied is consistent with any restrictions applying to that Pharmaceutical in Section A-G of the Pharmaceutical Schedule; and (b) either i) the quantity supplied does not exceed that sufficient for up to 5 days treatment, or one original pack, where inappropriate to provide less, or

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ii) where the DHB Hospital has a PHARMAC approved dispensing for discharge policy, the quantity supplied is consistent with the policy and does not exceed that sufficient for up to 30 days treatment.

Background The Hospital Pharmaceuticals Advisory Committee (HPAC) considered a proposal for DHB hospital pharmacies dispensing up to 30 days supply of discharge medicines. HPAC did not support changing the 5 day rule to be a 30 day allowance, however the proposed rule has since been reworded so that only those DHB’s with a PHARMAC approved dispensing for discharge policy may dispense, at the expense of their own budgets, up to 30 days supply. DHB SIG has also been consulted on the rule amendment and considered this proposal was a local decision, so were permissive.

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