Named Patient Pharmaceutical Assessment (NPPA) policy review: final decision

Thank you for your engagement and input into the review of PHARMAC’s NPPA policy. We have now completed the review and are pleased to present a revised NPPA policy which will be part of our new Exceptional Circumstances Framework.

Exceptional Circumstances Framework

The new Framework makes clearer the ways that PHARMAC generally considers funding decisions in exceptional circumstances that fall outside of the Pharmaceutical Schedule funding process.  This means exceptions that are not strictly NPPA are more visible, including Special Authority waivers and Hospital Medicine Restriction waivers.  In the future, an exceptions process for hospital Medical Devices will be included within this Framework.

The NPPA Policy sits within the Exceptional Circumstances Framework and has been revised and simplified. The feedback we received was that the NPPA Policy was difficult to interpret and apply, and the application process could be cumbersome. While the intent of the NPPA Policy has not changed, we have made changes to ensure the Policy is clearer and easier to use. This includes the removal of the two current NPPA pathways; urgent assessment (UA) and unusual clinical circumstances (UCC) and the prerequisites that sit within these pathways. These have been replaced with the three core principles of the NPPA Policy. These principles will guide the application and decision-making process.

Additionally, we are streamlining and simplifying the application process. This includes developing an online application form to make the application process less onerous, and clearer supporting information to help clinicians and patients better understand the NPPA process and NPPA decisions.

The new Exceptional Circumstances Framework will come into effect mid-late 2015. This will enable PHARMAC to develop the accompanying process changes including the online application form. It will also give us time to work with key stakeholders to ensure people understand the changes before they take effect.

Consultation process

The NPPA Policy review commenced in April 2014, and included a round of public consultation which ran for four weeks.