Questions and answers
These are questions we’ve been asked about the Hospital Medicines List through our 0800 and email advice lines, and during meetings with DHBs in the lead up to 1 July. We’ll be adding to the topics as the transition gets underway and we think a question may be common across DHB hospitals.
If you can’t find the answer to your question here email us or call 0800 66 00 50 (option 2 for HML queries).
- What can I do if I want to prescribe something that is NOT on the HML?
- We will still have stock of some products that are not listed on the HML – can we use them after 1 July?
- Will there be restrictions on some medicines in the HML?
- If we wish to prescribe an antibiotic on the HML that has an infectious diseases (ID) physician or clinical microbiologist restriction, is there a faster way to access this medicine?
- Are there some examples of protocols available to assist us in developing our own hospital protocols for HML medicines with restrictions?
- How does the HML affect products that are being funded for research/information gathering purposes (for example, through a university) in a DHB hospital?
- 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 I make a regular NPPA application and it is approved by PHARMAC, who funds the item?
- Oseltamivir is widely used by DHBs during flu season but was not listed in the HML notifications – will it be included in the future?
- During the transition period, if there is an urgent clinical need, and the pharmaceutical is not listed but available, the clinically appropriate action should be taken to treat your patient. You should let PHARMAC know if you have used a non-HML pharmaceutical so we can monitor what is happening on the ground. However we expect that no more of this item is ordered unless it is for a NPPA patient, or the item becomes listed on the HML. Call us to discuss or send an email to HML@pharmac.govt.nz.
- If you want to request that something be added to the HML in the future you can apply to PHARMAC.
- If you want to request an exception to the list for a particular patient you can apply to PHARMAC for NPPA (Named Patient Pharmaceutical Assessment).
- If you need a Rapid Assessment (that is less than five working days) and your DHB has processes in place, you can request an assessment through your local panel/protocol. You can also request Rapid Assessment by PHARMAC.
We will still have stock of some products that are not listed on the HML – can we use them after 1 July?
If that product is clinically appropriate and a prescriber wishes to prescribe it after 1 July, then yes, that stock should be used up. However, PHARMAC would expect the DHB not to purchase more of that item.
Yes, some HML medicines have prescriber-type or indication restrictions. There are a number of rules that apply to these restrictions – including the ability for prescribers outside the required prescriber-group to prescribe if there is a DHB protocol or guideline in place for that medicine. Read the guide and flowchart outlining the process.
If we wish to prescribe an antibiotic on the HML that has an infectious diseases (ID) physician or clinical microbiologist restriction, is there a faster way to access this medicine?
Yes, but only if the ID physician/clinical microbiologist and the DHB have approved a protocol to be followed. There is advice on PHARMAC’s website that covers prescribing when pharmaceuticals have restrictions.
Are there some examples of protocols available to assist us in developing our own hospital protocols for HML medicines with restrictions?
To assist hospitals in developing protocols where they don’t already exist, DHBs with current protocols have been working with PHARMAC to share their examples. DHB Chief Pharmacists/pharmacy departments are aware of what protocol examples are available or you can contact our HML advice line for more information.
How does the HML affect products that are being funded for research/information gathering purposes (for example, through a university) in a DHB hospital?
Where funding for the medicines comes from outside the DHB, DHBs have discretion to use these under a rule covering clinical trials (Rule 14).
In addition, PHARMAC may approve the use of non-HML products for such purposes where the funding comes from within the DHB.
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.
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).
Section H has historically related only to PHARMAC’s procurement role for hospital pharmaceuticals, and to the provision of medicines by DHB hospitals for use in the community. It did not indicate which medicines would be available for use within a DHB hospital.
From July 2013 Section H takes on a broader ‘formulary management’ function, and indicates which medicines (and as applicable, which brands of those medicines) will be available for use by DHB hospitals, including for use in the community.
Developing the HML has been a complex task and a lot of detailed work has gone on to get it right. However there may still be some products not included that need to be considered.
There will be a ‘transition’ phase from 1 July to allow PHARMAC to monitor what is happening on the ground and work with DHBs as the list is tested against actual practice.
The process of considering items for inclusion will be as quick and as simple as possible and there is dedicated help available at PHARMAC to work with DHBs on their queries.
Oseltamivir is widely used by DHBs during flu season but was not listed in the HML notifications – will it be included in the future?
Since the initial notification oseltamivir has been added to the HML, with a restriction, through PHARMAC’s continuing review process and can be prescribed from 1 July.
Last updated: 24 February 2016