Exceptional Circumstances FAQs
What are the Eligibility Criteria for Exceptional Circumstances funding?
To qualify for Community Exceptional Circumstances approval one of the following entry criteria must be met:
The condition must be rare, or The reaction to alternative funded treatment must be unusual, or An unusual combination of circumstances must be present.
(Rare and unusual are considered to be in the order of less than 10 people nationally.)
The sole criterion for Hospital Exceptional Circumstances is cost-effectiveness, as the funding for Hospital Exceptional Circumstances is from the District Health Board (DHB) Hospital’s Budget:
Cancer Exceptional Circumstances applications must meet a number of criteria which are based on making sure there is equal access to pharmaceutical cancer treatments across all the DHBs.
Who applies for Exceptional Circumstances funding?
Any medical practitioner can apply for Community Exceptional Circumstances, but the Panel recommends that all applicants provide additional evidence from a specialist supporting their application.
Applications for Hospital Exceptional Circumstances and Cancer Exceptional Circumstances can only be made by hospital physicians.
How is an Exceptional Circumstances application processed?
When one of the three entry criteria is met, the application is then further examined under supplementary criteria, which assesses suitability of the medication, clinical benefit, the cost effectiveness of the treatment, and the patient's ability to pay for the treatment. Where these documented criteria are met a fully funded medication will be made available.
How often does the Exceptional Circumstances Panel meet?
The Panel meets every two weeks by teleconference to consider all Community Exceptional Circumstances applications. Urgent CEC applications may be considered via email or teleconference as required. Every reasonable effort is made to process Hospital Exceptional Circumstances applications within 48 hours of receiving them (not including weekends and public holidays). For Cancer Exceptional Circumstances every reasonable effort is made to consider and respond to applications within 72 hours.
Who are the Exceptional Circumstances Panel members?
The Exceptional Circumstances Panel is made up of six doctors with a wide range of medical expertise and experience.
Dr Howard Wilson – GP, Pharmacologist (Chair)
Dr Mel Brieseman – Medical Officer of Health, Christchurch
Dr Paul Tomlinson – Paediatrician, Southland DHB
Dr David Waite –Physician, Capital and Coast DHB
Dr Sharon Kletchko – GM, Planning and Funding, Nelson Marlborough DHB
Dr Andrew Herbert - Consultant Gastroenterologist, MidCentral DHB
What if I have a query about an Exceptional Circumstances application?
Exceptional Circumstances applications are managed by PHARMAC Panel Coordinators who can be contacted via email at 
ecpanel@pharmac.govt.nz. Or you can phone panel co-ordinators at:
Community Exceptional Circumstances: 04 916 7553
Hospital Exceptional Circumstances: 04 916 7521
Cancer Exceptional Circumstances: 04 916 7521
Page updated on 09 Apr 2008
