Requesting an in-hospital Hospital Medicines List (HML) exception from 1 July 2013
Using the Named Patient Pharmaceutical Assessment (NPPA)
- Hospital Pharmaceutical in the Community (HPC) applications have not been required since 1 July 2013. Any pharmaceutical on the HML (subject to criteria) can be prescribed and dispensed by the DHB hospital pharmacy for use in-hospital or in the community (as part of a discharge plan).
- Named Patient Pharmaceutical Assessment (NPPA) form.
Rapid Assessments
- DHB hospitals should use their own Rapid Assessment processes to make NPPA decisions when treatment must start in less than five working days.
- If DHBs do not have a local Rapid Assessment process they can apply to PHARMAC and we will endeavour to make a decision within five working days.
- When Rapid Assessments are done in the DHB, any applications made and their outcomes should be reported to PHARMAC within one month.
- Rapid Assessment form which can be used in your DHB process (if your DHB doesn't have its own form) or to apply to PHARMAC.
Cancer treatments
- Cancer treatment NPPA decisions CANNOT be made locally by DHBs. All PCT (Pharmaceutical Cancer Treatment) exceptions must be applied for through PHARMAC. (Paediatric oncology/haematology NPPAs continue under the notification system.)
What are my choices from 1 July 2013 if I want to make a NPPA application for a pharmaceutical to be initiated in hospital that is not listed on the Hospital Medicines List (HML) or not listed for the indication?
Hospital NPPA flowchart - text-only version (click to expand)
- Is the pharmaceutical on the HML for this indication?
- Yes: Hospital pharmacy can dispense the pharmaceutical in the hospital and into the community (HML replaces HPC - Hospital Pharmaceutical in the Community - application not required from 1 July)
- No: Apply through NPPA
- When is treatment required?
- <5>: Apply for Rapid Assessment, either:
- Locally in my DHB (where NPPA processes are in place) - Assessed by DHB, OR
- To PHARMAC (Complete a Rapid Assessment Form) - Assessed by PHARMAC
- Declined
- Request a review**
- Approved
- My patient is treated in hospital - hospital pharmacy dispenses ($$ - DHB hospital funds the treatment)
- My patient is treated in the community - hospital pharmacy dispenses ($$ - DHB hospital continues to fund the treatment*)
- My patient is treated in hospital - hospital pharmacy dispenses ($$ - DHB hospital funds the treatment)
- Declined
- >5 working days: Apply for PHARMAC NPPA assessment
- Declined
- Request a review**
- Approved
- My patient is treated in hospital - hospital pharmacy dispenses ($$ - DHB hospital funds the treatment)
- My patient is treated in the community - community pharmacy dispenses ($$ - the PHARMAC-managed Combined Pharmaceutical Budget (CPB)*** funds the remainder of the treatment)
- My patient is treated in the community – community pharmacy dispenses ($$ - the PHARMAC-managed Combined Pharmaceutical Budget (CPB)*** funds the treatment)
- My patient is treated in hospital - hospital pharmacy dispenses ($$ - DHB hospital funds the treatment)
- Declined
- <5>: Apply for Rapid Assessment, either:
- When is treatment required?
Key
$$ = How the pharmaceutical will be funded
* If PHARMAC undertakes a Rapid Assessment it MAY decide to fund on-going treatment from the Combined Pharmaceutical Budget (CPB). PHARMAC will assess that decision on an individual basis.
** A PHARMAC review process will be available for applications that are declined. Reviews are also available for Rapid Hospital Assessments made by DHBs.
*** The CPB is managed by PHARMAC, but funded by DHBs on a population basis.
Notes
1) All NPPA pharmaceutical cancer treatment (PCT) applications MUST come to PHARMAC for assessment and are funded from the PHARMAC-managed CPB.
2) All DHB rapid hospital assessment outcomes should be reported to PHARMAC within 1 month.
For more advice about the NPPA rules and the HML:
enquiry@pharmac.govt.nz
Freephone 0800 66 00 50
Last updated: 2 November 2015