How the Factors for Consideration affect Named Patient Pharmaceutical Assessment (NPPA)
Who can make a NPPA application?
- Only authorised prescribers may submit NPPA applications, within their scope of practice.
- Only District Health Board (DHB) clinicians may submit Rapid Assessment NPPA applications.
A Rapid Assessment approval allows a DHB hospital to fund a treatment, which is otherwise prohibited.
Where can I apply for a NPPA application?
There are two ways you can complete a NPPA application:
What are the core principles of the NPPA policy?
NPPA considers funding for medicines for individual patients to treat their exceptional circumstances. The three core principles must be met before PHARMAC will consider an application. The following questions help us determine this:
- Does the person have exceptional clinical circumstances?
- Has the person tried all existing funded alternative treatments?
- Has PHARMAC considered the treatment for funding previously?
Further information and a copy of the NPPA policy are available.
Will the Factors for Consideration be used to make NPPA funding decisions?
Yes – from 1 July 2016 PHARMAC will use the Factors for Consideration to support all funding decisions, including those for named patients.
How do the new Factors for Consideration affect the NPPA policy and decision-making?
The three core principles of the NPPA policy will remain the same.
From 1 July 2016, NPPA applications meeting the core principles will be assessed against the Factors for Consideration.
My NPPA application was declined using the Decision Criteria. Will I be able to reapply when the Factors come into effect?
From 1 July 2016, you can resubmit any NPPA application previously declined under the Decision Criteria.
Declined applications should not be confused with applications that were not progressed to a decision because they did not meet the core principles of the NPPA Policy.
The implementation of the Factors for Consideration may result in information regarding an individual’s circumstances becoming a relevant matter to take into account for a decision. For an application to be reconsidered using the Factors for Consideration, you must provide relevant evidence regarding an individual’s circumstances.
My patient’s illness has a high impact on their family/whanau. Will this be taken into account?
The Factors ensure that PHARMAC will consider the health need of the family, whānau and wider society in the context of the named patient’s disease or illness.
It is not the impact of the family or whānau social situation, health condition or other factors, on the named patient. Relevant considerations under this factor must be able to be explicitly linked to the named patient’s illness or disease.
For example, an individual patient has severe coughing and the treating physician is applying for funding for a medicine to treat the coughing. The patient's spouse also has a disease. The spouse's health needs caused by their disease would not be a relevant consideration when considering whether to fund a treatment for the patient with coughing. In contrast, if the spouse’s health was being affected by them experiencing sleepless nights due to the patient's coughing and if treating the patient’s coughing might improve the spouse’s disease, this could be taken into account.
How will PHARMAC consider the health needs of groups experiencing health disparities for a NPPA application?
This Factor will be considered, in NPPA applications for a treatment for an illness or disease, when that illness or disease results in poorer health outcomes for population groups experiencing health disparities. It will be considered regardless of whether the named patient is a member of that particular population group.
Will the Māori Health Factors be considered for a NPPA application?
The ethnicity of the named patient will not be taken into account. PHARMAC will consider the health needs of Māori when the NPPA application is for a treatment for a disease or illness which results in poorer health outcomes for Māori when compared with non-Māori. This will be considered regardless of whether the named patient is Māori.
Where can I find out more?
Information about the Factors is available.
Supporting information is also available, for a more in-depth look at what the Factors will mean.
If you have any questions in general about the Factors for Consideration, please email firstname.lastname@example.org
For any NPPA-specific questions, please email email@example.com
Last updated: 16 July 2020