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?

  • 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*)
        • >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)
Hospital NPPA flowchart (1 page, 78 KB) - single-page, more legible PDF version of the flowchart below (updated August 2013)

Flowchart showing the processes for assessing pharmaceuticals for dispensing in hospitals in particular cases where the pharmaceutical isn't on the Hospital Medicines List for this indication.

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