Exceptional Circumstances Framework ‘go-live’ notification

31 August 2015

Medicines Hospital devices Decision

PHARMAC is pleased to announce that our new Exceptional Circumstances Framework has now been implemented. The Exceptional Circumstances Framework includes a revised Named Patient Pharmaceutical Assessment (NPPA) Policy, and makes applying easier.

Exceptional Circumstances Framework

Pathways through the Exceptional Circumstances Framework.

Exceptional Circumstances Framework - text

Named Patient Pharmaceutical Assessment (NPPA)

NPPA application submitted to PHARMAC
Application assessed by PHARMAC against the core principles of NPPA Policy
Assessment by PHARMAC against the nine decision criteria
Approve/decline funding for treatment
PHARMAC published outcome of decision if appropriate

Named Patient Pharmaceutical Assessment (NPPA) (Rapid Assessment for DHB hospitals)

NPPA Rapid Hospital Assessment considered by DHB for particularly urgent cases
Application assessed by DHB against the core principles of NPPA Policy
Assessment by DHB against the nine decision criteria
Approve/decline funding for treatment
DHB to report decision to PHARMAC

Other Exceptional Circumstances

Special Authority waiver or Hospital Medicine Restriction waiver
Assessment by PHARMAC (or DHB for Rapid Hospital Assessments) against the nine decision criteria
Approve/decline funding for treatment

Hospital Medical Devices Exceptional Circumstances (future state)

Assessment by PHARMAC (or DHB for Rapid Hospital Assessments) against the nine decision criteria
Approve/decline funding for treatment

PHARMAC maintains the ability to exercise discretion throughout the decision-making processes for all exceptional circumstances.

We have streamlined and simplified the application process. This includes a new online application form which is only accessible via the Connected Health Network (CHN). It includes a number of great features to make the application process easier. For people who do not have access to the CHN, a simplified, user-friendly form is available in Microsoft Word format. You can find more details about the Exceptional Circumstances Framework, including the new application forms here. We have also produced clearer supporting information on the process for clinicians and patients.

The new framework clarifies the ways that PHARMAC generally considers funding decisions in exceptional circumstances that fall outside of the Pharmaceutical Schedule funding process. This means exceptions that sit outside the NPPA policy are more visible, including Special Authority waivers and Hospital Medicine Restriction waivers. In the future, an exceptions process for hospital medical devices would 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 NPPA pathways; urgent assessment (UA) and unusual clinical circumstances (UCC) and the prerequisites that sat 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.

Exceptional Circumstances Framework ‘go-live’ notification [PDF, 202 KB]