Access to medicines not on the HML
- a guide to requesting NPPA Rapid Assessments
DHB hospitals started prescribing from a nationally consistent pharmaceutical list on 1 July 2013
The Hospital Medicines List (HML) – Part II of Section H of the Pharmaceutical Schedule - has been developed by clinicians, pharmacists and PHARMAC over the past four years. It will mean New Zealanders get access to the same hospital medicine wherever they are being treated. Over the coming months PHARMAC and DHBs will work together to check how the list is working on the ground, allowing PHARMAC to respond to feedback and make changes if required. The list will never be static. Like the Schedule already used by community prescribers, the hospital Schedule will change every month.
This Fact Sheet explains the options and steps for DHB clinicians to follow when they want to urgently request an exception to the HML to treat a particular patient (Rapid Assessment).
A) What is NPPA (Named Patient Pharmaceutical Assessment)?
PHARMAC manages two lists of pharmaceuticals:
- the Pharmaceutical Schedule for community treatments and pharmaceutical cancer treatments (PCTs), and
- the Hospital Medicines List (Section H) for in-hospital pharmaceuticals.
Sometimes a prescriber will want to use a treatment not on the Schedules (either at all, or not listed for their patient’s clinical circumstances). The process to request the use of an unlisted treatment for an individual patient is called Named Patient Pharmaceutical Assessment (NPPA).
DHB prescribers can apply for treatments to be used both in DHB Hospitals and in the community.
Non-DHB prescribers can apply only for treatments to be used in the community.
B) What is Rapid Assessment?
Rapid Assessment is a process for DHB clinicians to request the use of a non-HML medicine when a patient is expected, within five working days, to:
“experience either significant deterioration or miss the opportunity for a significant improvement in clinical outcomes (length or quality of life)”.
C) Who can request a Rapid Assessment?
If you’re a DHB prescriber wanting a patient to receive an unlisted in-hospital treatment to start in fewer than five working days for the reasons above, you will need to use the Rapid Assessment process.
D) Ways to apply for a Rapid Assessment for urgent use in DHB hospitals
Rapid Assessment applications can be approved by the DHB hospital using their own panel (for example, input from a Drug and Therapeutic Committee or another agreed internal process). Note that DHBs cannot make Rapid Assessments for Pharmaceutical Cancer Treatments (PCTs). All PCT applications must be submitted to PHARMAC for consideration.
If your DHB has a Rapid Assessment process that you can use, please use that.
- Follow your DHB’s protocols and apply using the process your DHB panel uses.
- Some DHBs may choose to use the PHARMAC Rapid Assessment form in their own Rapid Assessment processes.
- When DHBs make their own assessments they need to tell PHARMAC that this has happened. There is a monthly reporting process completed by each DHB’s Pharmacy department to provide the details to us.
If your DHB doesn’t have a Rapid Assessment process, or if there’s some reason why you can’t use your DHB’s Rapid Assessment process, you can ask PHARMAC to do the Rapid Assessment.
While PHARMAC will endeavour to make Rapid Assessment decisions as quickly as possible, we operate standard business hours and generally cannot process an application in less than 3 working days.
How to apply to PHARMAC for Rapid Assessment – get the right approvals
1. Seek permission from your DHB first. Clinicians need to inform the appropriate staff (for example, input from a Drug & Therapeutic Committee or another agreed internal process) within their own DHB and seek their permission to make the application. This should include the Pharmacy department.
This is a requirement because both supply and funding of any in hospital treatment approved under Rapid Assessment will be from the DHB hospital.
2. Complete the PHARMAC form on our website before contacting us with the request to make a Rapid Assessment decision. A completed form is needed, as without full information PHARMAC cannot consider requests.
3. Note that PHARMAC can take up to 5 days to process a Rapid Assessment application and generally cannot process an application in less than 3 working days.
These requirements also apply to regular NPPA applications for in-hospital treatments (not just Rapid Assessments) as all in-hospital treatments (with the exception of Pharmaceutical Cancer Treatments) are supplied and funded by the DHB Hospital.
In an emergency take the appropriate clinical action
If a situation is so clinically urgent that a clinician does not have time to complete a Rapid Assessment form to apply for a treatment that is not listed, but is available from the DHB hospital pharmacy, they should take the appropriate clinical action and treat the patient. PHARMAC needs to hear about these emergency decisions and they should be included in the monthly reporting from the DHB Pharmacy. However, these decisions are not Rapid Assessments.
The DHB Hospital is responsible for funding the treatment.
Funding of approved NPPA decisions
If I make a NPPA application for a Rapid Assessment and it is approved, either by my DHB or PHARMAC, who funds the item?
If a Rapid Assessment application is approved by the DHB, the hospital pharmacy dispenses and the DHB hospital funds the treatment (for patients in hospital or in the community).
If PHARMAC approves a Rapid Assessment then the hospital pharmacy dispenses to the patient in the hospital and the DHB hospital funds the treatment. Then when that patient is discharged into the community, either the DHB hospital continues to fund the treatment, or PHARMAC MAY decide to approve funding of the remainder of the treatment from the PHARMAC-managed Combined Pharmaceutical Budget (note that the CPB is funded by DHBs on a population basis). This will be decided on a case by case basis.
If I make a regular NPPA application and it is approved by PHARMAC, who funds the item?
This depends on whether the medicine is dispensed by the hospital pharmacy (DHB hospital funds) or dispensed to the patient in the community, by a community pharmacy (funded from the Combined Pharmaceutical Budget (CPB), which is managed by PHARMAC and funded by DHBs on a population basis).
More detailed information is provided on the HML pages on the PHARMAC website.
Last updated: 5 July 2018