Prescribing in DHB hospitals from 1 July 2013

About the Hospital Medicines List (HML)

What has changed?

On 1 July 2013 the Hospital Medicines List (HML) was introduced to District Health Board (DHB) hospitals. It replaced the different formularies and preferred medicines lists used in different hospitals with a nationally consistent list. It has been developed with input from across the health sector to ensure it meets clinical needs across the country.

The list has been introduced in response to the Government’s decision for PHARMAC to take on funding responsibility for all DHB hospital pharmaceuticals, as part of providing consistent treatment to patients throughout New Zealand. This builds on PHARMAC’s role to manage Pharmaceutical Cancer Treatments (PCTs) funding on DHBs behalf, which we have done for some time.

The HML also includes national prescribing criteria and restricts the use of some listed medicines to particular prescribers and indications.

Medicines not listed, or not listed for a particular indication, cannot be used unless one of the exceptions rules applies - such as an approved Named Patient Pharmaceutical Assessment (NPPA).

DHBs continue to manage the funding for medicines within hospitals. Over time, PHARMAC will take over this role, and manage the budget as it does now for community prescribed medicines through the Combined Pharmaceutical Budget (CPB). Introducing the HML has also been about getting better alignment of funding and access between hospitals and the community.

Where can I find out what’s on the HML?

The interactive version of the HML is now available on the PHARMAC website. This version is updated monthly and provides access to the latest information available. It can be searched by both chemical and brand name, as well as therapeutic groups.

The HML is also available in hardcopy and the second edition of the HML was published and sent to DHBs in early November. As part of standard PHARMAC process, the HML is updated monthly with changes and additions. These are notified in the online version and in printed Updates which are sent in the last week of each month, in line with community listings.

PHARMAC has worked hard to make swift decisions on medicines that have been added to the list since 1 July 2013, where there may have been a mistake or an omission identified. When new medicines are added to the HML, we follow the usual PHARMAC application processes.

Anyone can apply to have changes (or changes to restrictions) and additions made by using the application form on the PHARMAC website.

How is the HML being implemented?

July marked the start of a transition period for hospitals to implement the HML for all prescribing.

The transition period has given DHBs time to adjust to the new environment and provide feedback to help us monitor and be responsive to what is happening on the ground. This has included looking at how both the HML and its rules are applied to actual prescribing situations.

We have also set up a dedicated HML queries management process to support DHBs during the transition. Contact details are over the page.

To ensure appropriate clinical decisions can be made for patients, the transition phase has been flexible, making allowances for clinical decision-making in urgent situations. We continue to advise hospitals to take the clinically appropriate action in an urgent situation and to let PHARMAC know about the situation afterwards to feed into our monitoring.

However, the transition is happening in the context of prescribers ultimately needing to use the HML for all prescribing activity.

When a prescriber makes a decision to use a pharmaceutical in the course of their DHB practice, they are doing so on behalf of the relevant DHB. They must therefore comply with the Pharmaceutical Schedule Rules as set out in Section H of the Schedule, as required by legislation, the Crown Funding Agreement and related policies.

This means that only pharmaceuticals listed in the HML should be used, because the HML is part of the Pharmaceutical Schedule.

To find out more:

Go to www.pharmac.govt.nz/medicines/hospital-pharmaceuticals

To contact PHARMAC or ask an HML question

• Email: HML@pharmac.govt.nz
• Phone: 0800 66 00 50 (press 2)
• Fax: 64 4 974 7819