NPPA (Named Patient Pharmaceutical Assessment) is a mechanism to give individual named patients access to medicines they need, but which aren’t funded on the Pharmaceutical Schedule. In 2012 NPPA replaced the three Exceptional Circumstances schemes that PHARMAC previously managed. Applications for assessment are made by a person’s prescriber, including those in the community and public hospitals. Decisions are made using PHARMAC’s nine decision criteria after obtaining clinical advice.
The number of NPPA applications received has remained similar to the previous year, and PHARMAC continues to approve more than half of the applications processed.
Applications not further considered include those where further information is sought, or where the application is withdrawn.
Outcome of NPPA applications received July 2012-June 2014
|Total||Approved||Declined||Automatic approval||Not further considered|
|Initial 2013-2014||1185||690 (58%)||23 (2%)||55 (5%)||417 (35%)|
|Initial 2012-2013||1263||758 (60%)||13 (1%)||118 (9%)||374 (30%)|
|Renewal 2013-2014||154||145 (94%)||1 (0.6%)||1 (0.6%)||8 (5%)|
|Renewal 2012-2013||73||68 (93%)||n/a||n/a||5 (7%)|
In addition to the applications processed, there were 124 applications that did not meet NPPA prerequisites. These were for a number of reasons, such as funded alternatives being available, the medicine sought being previously declined funding by PHARMAC, or the medicine being already prioritised for Schedule funding. PHARMAC provides information to applicants to explain reasons why prerequisites are not met.
As part of our wider review of Operating Policies and Procedures, we initiated a review of the NPPA policy in April 2014. The review looked at the effectiveness of the policy and sought feedback on future improvements.
The review began at our consultation event in Wellington April and sought views from a broad group of stakeholders. This feedback will feed into any decisions by the PHARMAC Boardfor future improvements to NPPA.
Last updated: 8 January 2018