Rules of the Schedule Ngā Ture o te Rārangi Rongoā

Section A contains the restrictions and other general rules that apply to Subsidies for Community Pharmaceuticals and the Giving of Hospital Pharmaceuticals.

On this page

Preamble

In order to receive a Subsidy for a Community Pharmaceutical, all relevant requirements of these rules must be observed in each case. Similarly, all relevant requirements must be met if a Hospital Pharmaceutical is to be Given.

These rules only relate to eligibility for Subsidy for Community Pharmaceuticals and the circumstances in which a Hospital Pharmaceutical may be Given. Users of these rules should be aware that there are other requirements relating to the prescribing, dispensing, and Giving, of Pharmaceuticals including legislative and regulatory requirements, as well as contractual obligations.

As required by section 23(7) of the Act, in performing any of its functions in relation to the supply of Pharmaceuticals, a DHB must not act inconsistently with the Pharmaceutical Schedule.

Community Pharmaceuticals that are not Prescription Medicines, will only be Subsidised on a Prescription if the requirements relating to the prescribing and dispensing of Pharmaceuticals including legislative and regulatory requirements, as well as contractual obligations, are met, as they apply to Prescription Medicines,

Defined terms are capitalised. Part 10 of these rules contains a list of definitions.

Pharmaceutical Schedule Rules valid from 1 September 2021

Previous versions of the rules

Part 1 – Prescribing and initiating Subsidies for Community Pharmaceuticals

1.1  Initiating Subsidies: Subsidies for Community Pharmaceuticals may be initiated by any of the following:

1.1.1 Authorised Prescribers for Prescriptions and Practitioner’s Supply Orders (PSO). Specific limitations may apply and these are in addition to any regulatory or scope of practice limitations.

a  Prescriptions written by a Pharmacist Prescriber or a Registered Nurse Prescriber for a Community Pharmaceutical will only be Subsidised where they are for either:

i  a Community Pharmaceutical classified as a Prescription Medicine and which a Pharmacist Prescriber or a Registered Nurse Prescriber is permitted under regulations to prescribe, or

ii  any other Community Pharmaceutical that is a Restricted Medicine (also referred to as a Pharmacist Only Medicine), a Pharmacy Only Medicine or a General Sales Medicine.

1.1.2 Hospital Care Operators only for Bulk Supply Orders (BSO).

1.1.3 Quitcard Providers only for nicotine patches, nicotine lozenges or nicotine gum, and when written on a Quitcard.

1.1.4 Vaccinators for vaccines, only in accordance with an agreement between the relevant Contractor and the DHB, and only for direct administration of a vaccine to a patient.

1.1.5 Pharmacists, by Direct Provision, only where specifically indicated in Section B of the Schedule, unless dispensing on Prescription, Quitcard or Supply Order.

1.2  Periods of supply for Subsidy: For Community Pharmaceuticals, periods of supply are as follows (note that legislative and regulatory requirements regarding periods of supply must also be met):

1.2.1  Only a quantity sufficient to provide treatment for a period of up to 3 Months will be Subsidised, and only if the Prescription under which the Community Pharmaceutical has been dispensed was presented to the Contractor within 3 Months of the date on which the Prescription was written, subject to the following exceptions:

a  Class B Controlled Drugs: Only a quantity sufficient to provide treatment for a period of up to 1 Month in total (or up to 5 days when prescribed by a Dentist) will be Subsidised.

b  Oral Contraceptives: The Prescriber must specify on the Prescription the period of treatment for which the oral contraceptive is to be supplied. To be eligible for Subsidy, this period must not exceed 6 Months. Where the Oral Contraceptive is prescribed for non-contraceptive indications, then the Subsidised period of supply is up to 3 Months per Prescription.

c  Nicotine Replacement Therapy on Quitcard: Only a quantity sufficient to provide treatment for a period of up to 3 Months with nicotine patches, lozenges or gum will be eligible for Subsidy.

1.3  Mechanisms for claiming Community Pharmaceutical Subsidies: Subsidies for Community Pharmaceuticals may be paid against a Prescription (including DHB Hospital chart), PSO, BSO, Quitcard and Direct Provision. Requirements to be eligible for Subsidy are set out below:

1.3.1  Prescriptions must meet all legislative and regulatory requirements and:

a  must not be used for Pharmaceuticals identified as “Only on a PSO”, and

b  must meet all the requirements of the Schedule applicable to that Pharmaceutical.

1.3.2  Practitioners Supply Orders (PSO): For Pharmaceuticals to be Subsidised on a PSO:

a  the PSO must:

i  be on a form supplied or approved by the Ministry of Health

ii  be personally signed and dated by the Prescriber

iii  include the Prescriber’s address, and

iv  specify the Community Pharmaceuticals and quantities

b  for a Class B Controlled Drug or for buprenorphine hydrochloride must be written on a triplicate PSO Controlled Drug Form supplied by the Ministry of Health

c  all the requirements of Section B of the Schedule applicable to the Community Pharmaceutical must be met

d  the Pharmaceutical must be identified in the Schedule as being Subsidised on a PSO and only be supplied in such quantities as set out in the Schedule (subject to the PSO for Rural Areas and Rheumatic Fever Prevention Programme rules in 1.3.3 and 1.3.4)

e  Pharmaceuticals will only be Subsidised to ensure they are available for emergency use, teaching and demonstration purposes, and for provision to certain patient groups where an individual Prescription is not practicable, and

f  Pharmaceuticals will not be Subsidised when supplied on a PSO to:

i  Armed Forces or Prisons unless specified in Section B of the Schedule, or

ii  DHB Hospitals or clinics, with the exception of antipsychotic injections for DHB mental health day clinics.

1.3.3  Practitioners Supply Orders for Rural Areas: Any Community Pharmaceutical may be supplied on a PSO provided rule 1.3.2 and all other applicable requirements are met, and:

a  the Prescriber's normal practice is in a Rural Area, or if the Prescriber is a locum for another Prescriber, then that other Prescriber’s normal practice is in such an area, and

b  the quantities ordered are reasonable for up to 1 Month's supply under the conditions normally existing in the practice. (The Prescriber may be called on to justify the amounts of Community Pharmaceuticals ordered.)

1.3.4  Practitioners Supply Orders for the Rheumatic Fever Prevention Programme (RFPP): RFPP exceptions to PSO quantity limits are identified in Section B of the Schedule under the specific Community Pharmaceutical. The following additional requirements must be met:

a  the RFPP provider name must be written on the PSO, and

b  the total quantity ordered must not exceed the RFPP limit specified in Section B of the Schedule.

1.3.5  Bulk Supply Orders (BSO): For Pharmaceuticals to be Subsidised on a BSO, the BSO must:

a  be for supply of Community Pharmaceuticals to Private Hospitals that employ a Registered Nurse, for the treatment of people under the care of that facility

b  be on a form supplied or approved by the Ministry of Health and signed by a Hospital Care Operator

c  for a Class B Controlled Drug or for buprenorphine hydrochloride, be written on a triplicate BSO Controlled Drug Form supplied by the Ministry of Health

d  not exceed what is a reasonable Monthly allocation for the particular institution

e  meet all the Subsidy requirements of Section B of the Schedule applicable to that Community Pharmaceutical, and

f  not be supplied to Armed Forces or Prisons unless specified in Section B of the Schedule.

1.3.6  Quitcards: Quitcards supplied by the Ministry of Health provide for a Subsidy on nicotine patches, nicotine lozenges or nicotine gum.

1.3.7  Direct Provision: Subsidies for pharmaceuticals denoted as being eligible for Direct Provision may be generated without a PSO, Prescription or Quitcard.

1.4  Alternative mechanisms: A DHB may fund a Community Pharmaceutical outside of the mechanisms established in the Schedule, provided that:

1.4.1  specific prior agreement is obtained from PHARMAC for such funding

1.4.2  any funding restrictions set out in the Schedule for those Community Pharmaceuticals are applied, and