NPPA applications

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. 

On this page

Making an application during the summer holiday 2020/21

Non-urgent applications must be received by 11 December to ensure they're processed before the end of the year. 

If you want any applications considered before Christmas, including renewal applications due to expire before the end of 2020, we recommend you submit them as soon as possible before 11 December.

Any non-urgent applications received after 11 December are unlikely to be processed until the office re-opens on Tuesday 5 January 2021.

We will continue to process all urgent applications as quickly as possible until Thursday 24 December 2020. 

The PHARMAC NPPA office will be open for applications requiring an urgent response for in-hospital treatments on:

  • Tuesday 29 December 2020
  • Wednesday 30 December 2020
  • Thursday 31 December 2020

You must use email to reach the NPPA team over this period: nppa@pharmac.govt.nz

Who can apply

Anyone can prepare the application, but a prescriber must be named as the applicant.

  • Only authorised prescribers can submit NPPA applications, within their scope of practice.
  • Only District Health Board (DHB) clinicians may submit Rapid Assessment NPPA applications.

Read about DHB rapid assessments 

Before you start

Call us on 0800 660 050 option 2

We’re happy to talk you through what sort of information we need and whether the application is likely to meet the principles of the NPPA process.

Contact details

Preparing your NPPA application

These three questions help us decide whether the application meets the principles of the NPPA policy.

Your 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.

Search the Schedule(external link)

3. Has PHARMAC considered the treatment for funding previously?

Check the Application Tracker(external link)

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.

Check the results of previous NPPA applications for the same medicine 

Read the principles in the full NPPA policy

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.

Non-clinical circumstances

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 (i.e. lost wages). This could bias against those not in paid employment, such as the elderly and people who are chronically ill and disabled.

Patient preference

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.

Gather your documentation

Once you’ve spoken to us, gather all attachments in support of your application. 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.

Submitting your NPPA application

This section explains submitting a standard NPPA application.

For DHB hospitals seeking a rapid assessment:

Follow our rapid assessment guidance for DHBs

Health sector portal

If you can access the Connected Health Network, you can use PHARMAC’s Health Sector Portal to make your application.

Note: you will get a server error message if you don't have access to the system.

Register with the Health Sector Portal to get the most from the system(external link)

You need to use Internet Explorer 8 or higher to use this system.

PDF NPPA forms

If you don’t have access to the Connected Health Network.

Download the relevant form

Submit

If your 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:

What happens next

After PHARMAC receives the application, we assess whether the application 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.

Read the list of members of our NPPA advisory panel

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.

Read the full Factors for Consideration 

Not all factors are relevant in every decision we make. The factors provide a framework to help us deliver consistent decisions.

PHARMAC’s decision

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. 

NPPA Renewals

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 your 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.

You can apply for a renewal:

through Health Sector Portal(external link)

or

download the renewal form

and apply through

Contact us

Phone: 0800 660 050 (option 2)

Email: nppa@pharmac.govt.nz

Fax: 09 523 6870

Post: NPPA
PHARMAC
PO Box 10254
Wellington 6143

Learn more

NPPA is part of PHARMAC’s Exceptional Circumstances Framework.