Pharmac uses its Named Patient Pharmaceutical Assessment (NPPA) process to consider whether to fund a treatment for an individual patient whose clinical circumstances are exceptional.
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High volumes causing delays (26 April 2022)
We are currently experiencing a high volume of applications.
We are prioritising applications based on clinical urgency. As such, non-urgent applications may take longer to process than usual.
Alternatives for hospitals
For treatments available in hospital but not funded in community, use Rule 3.5 of the Schedule (dispensing up to 30 days’ supply of a pharmaceutical from a DHB) wherever appropriate.
For urgent applications, where available use your DHB's rapid assessment process. The DHB rapid assessment process can be used for any treatment except rituximab, infliximab, or tocilizumab.
The emergency use rule is also always available
- Only authorised prescribers can submit NPPA applications, within their scope of practice.
- Only District Health Board (DHB) clinicians may submit Rapid Assessment NPPA applications.
Other health professionals can prepare the application, but a prescriber must be named as the applicant.
Call us on 0800 660 050 option 2
We’re happy to talk to prescribers about what sort of information we need and whether the application is likely to meet the principles of the NPPA process.
These three questions help us decide whether the application meets the principles of the NPPA policy.
The application should address these questions.
1. Does the person have exceptional clinical circumstances?
The purpose of the NPPA policy is to consider those patients whose needs can’t feasibly be met by the Pharmaceutical Schedule process.
We encourage prescribers to use NPPA if a person has an urgent clinical need or their clinical circumstances are unusual.
NPPA is for individual people. We will need to know how the patient’s circumstances differ from the wider patient population.
Pharmac will consider whether funding this person will have an implication for the wider patient population.
2. Has the person tried all existing funded alternative treatments?
The patient must have tried all suitable funded options before seeking funding for a treatment through NPPA. This may include non-pharmaceutical treatments, such as surgery, physiotherapy or lifestyle changes.
Treatments funded through NPPA must be “end of spectrum”. This means that there are no other clinically suitable funded options for the person.
NPPA cannot be used to undermine the Pharmaceutical Schedule by providing a competing pathway to access funded treatment.
3. Has Pharmac considered the treatment for funding previously?
If we’ve already considered funding this medicine for this indication, we’re unlikely to fund it through NPPA unless:
- there's something exceptional about your patient’s clinical circumstances, or
- we've approved similar NPPA applications in the past.
Call us to discuss options.
What we don't consider
Information from treatment not funded by Pharmac
In general, we won’t consider clinical benefits experienced by a non-Pharmac-funded trial (for example, self-funded treatment, treatment initiated overseas or through a clinical trial). This ensures that people who are unable to access alternative funding for their medicines are not disadvantaged.
NPPA is a pathway for consideration of funding for people with exceptional clinical circumstances. Non-clinical circumstances are not taken into account when assessing NPPA applications. For example, we do not consider the cost of time off work (lost wages). This could bias against those not in paid employment, such as the elderly and people who are chronically ill and disabled.
We do not consider patient preference for a treatment. This includes surgery, other clinical procedures, or a specific brand. There must be a clinical need, supported by good evidence, for the medicine being applied for via NPPA.
Pharmac can exercise discretion throughout the decision-making process for all NPPA applications.
Once you’ve spoken to us, gather all attachments in support of the application for your patient. The attachments should demonstrate how the patient’s circumstances are exceptional. They may include:
- clinic letters
- admission records
- management plan
- published articles of support.
We don’t need as much evidence if we have received similar applications before.
If you’re using Pharmac’s upload page, each document must be less than 5 MB. The total size for all documents must be less than 20 MB.
This section explains submitting a standard NPPA application.
For DHB hospitals seeking a rapid assessment:
Health sector portal
If you can access the Connected Health Network, you can use Pharmac’s Health Sector Portal to make the application.
You need to use Internet Explorer 8 or higher to use this system.
If you don’t have access to the Connected Health Network.
Download the relevant form
- NPPA application form [DOC, 230 KB]
- NPPA renewal form [DOC, 207 KB]
- NPPA additional information form [DOC, 174 KB]
If the full application is over 20 MB, you can still submit the application form through the upload system. But send the attachments separately.
Other ways to submit an application:
- Email NPPA@pharmac.govt.nz
- Fax 09 523 6870
PO Box 10254
After Pharmac receives the application, we assess whether it meets the principles of the NPPA Policy. That is:
- The person has exhausted all other funded alternatives
- The person’s clinical circumstances are exceptional
- Pharmac has not considered funding the medicine before
We may seek clinical advice to help us answer these questions.
If the principles are not met, we will contact the clinician who applied. We may invite them to provide more information.
If the principles are met, we then consider the application against Pharmac's Factors for Consideration. We may also seek clinical advice to help us apply the Factors.
Factors for Consideration
The Factors for Consideration help guide all Pharmac's funding decisions. In summary, we consider:
- the health need of the patient, their family and whānau
- the benefit to the patient, their family and whānau
- the health cost to the patient, their family and whānau, the wider health system and society
- the suitability of the medicine for the person, their family, whānau, society and the wider health system.
Not all factors are relevant in every decision we make. The factors provide a framework to help us deliver consistent decisions.
Once we’ve made our decision, to approve or decline, we will notify the clinician who made the application. It is the clinician’s responsibility to notify the patient.
If approved, Pharmac will also notify the nominated pharmacy.
We generally limit how long any funding approvals are granted for. If a patient needs funding to continue, the clinician will need to submit a renewal application. We recommend submitting the renewal application one month before it expires.
The application needs to address:
- the renewal criteria specified in the previous approval letter
- any other clinical update or evidence they consider relevant.
Two ways to apply for a renewal:
To submit your renewal form, you can
- submit online(external link)
- email: firstname.lastname@example.org
- fax: 09 523 6870
PO Box 10254
Phone: 0800 660 050 (option 2)
Fax: 09 523 6870
PO Box 10254
NPPA is part of Pharmac’s Exceptional Circumstances Framework.