Secure form submission


* You can also submit NPPA forms via the Connected Health Network

How to attach your form and any supporting documents

Before you start:
  • Check that the file size of each item you're going to submit is under 5 MB, and that all together they're under 20 MB. If they're bigger than that, this submission system won't accept them, so please print them and fax or post them to us:
    • Post:

      Panels
      Pharmac
      PO Box 10-254
      Wellington 6143
  • If you want to keep a "receipt" saying we've received your application, read the instructions at the bottom of this page about allowing pop-ups.

Use the buttons below to attach the application form and any relevant documents of support which may help in assessing this application. Supporting documents may include clinic letters, lab results, hospital admission record's, management plan, and any other information which may be relevant.


Select which form you are submitting

Contact email address

Email address:

Add form and supporting documents:






Please be patient. Loading the files may take a while.

I'd like to save a message saying you got my form

  • If you want to save a message saying we've received your application you'll need to ensure that your browser allows popups from www.pharmac.govt.nz.
    • From the browser menu go to: Tools, Pop-up Blocker, Pop-up Blocker Settings, Add schedule.pharmac.govt.nz (the exact menu options will depend on your browser); or
    • Consult with your IT department.
  • When you press the "Submit" button the popup will be displayed.
  • In the popup go to the browser menu: File, Save Page As (the exact menu options will depend on your browser).
  • Save a copy of your application submission.