Named Patient Pharmaceutical Assessment
The new “exceptions” scheme
Dr Dilky Rasiah
Deputy Medical Director
Some Benefits and New Features of NPPA
1. Rarity no longer a criterion.
2. A new pathway for consideration of applications requiring
3. Reduction of clinician workload by the following:
publish the outcome of funding applications
PHARMAC determining which NPPA pathway to best
progress the application through
streamlined application process, apply electronically
Some Benefits and New Features of NPPA cont
• 4. Some medicines funded through NPPA while those
medicines are under consideration for Schedule
• 5. Closer alignment of NPPA and full Pharmaceutical
Schedule assessments, benefiting patient populations
History of Exceptional Circumstances (EC)
Recent: Section 48(b) NZPHD Act 2000 PHARMAC’s
role in exceptional circumstances:
• including in exceptional circumstances providing for subsidies for
the supply of pharmaceuticals not on the pharmaceutical
Past: Regional Health Authorities-Health Funding
Background to the EC Review
We undertook a review of Exceptional Circumstances for
Medicines New Zealand Strategy
Report of the High-Cost, Highly-Specialised Medicines Review
Response to criticisms of the previous EC schemes
Consultation round 1 August 2010;
Formulated draft policy;
Consultation round 2 January 2011;
Draft policy revised, approved June 2011.
The New Scheme
Named Patient Pharmaceutical Assessment (NPPA);
individuals rather than populations.
An opportunity to be heard.
Relationship to Schedule listing process.
Three possible pathways.
Prerequisites for all NPPA pathways: alternative funded
Role of Decision Criteria
Unusual Clinical Circumstances
Purpose: patients whose clinical circumstances are so
unusual that PHARMAC is unlikely, for administrative
reasons, to consider listing treatments for these
circumstances on the Schedule.
Unlikely to see other such patients.
Not a mechanism for funding for new treatments for a
group of patients.
Purpose: treatments for patients where PHARMAC is also
considering or is likely to consider the treatment for
Schedule listing, but the patient’s clinical circumstances
justify urgent assessment, prior to a decision on
Key features of : Urgency, seriousness, significant
deterioration/missed opportunity for significant
Hospital Pharmaceuticals in the Community
Purpose: to allow DHB hospitals to fund a medicine for a
patient in the community if this is more affordable for the
DHB than paying for the treatment that would otherwise
need to be provided.
Not for long-term funding of community treatments.
How will applications be made and processed?
• Applications made electronically via our website. Later
access, complete in real-time using EMR/PMS.
• Information requested from applicant.
• Role of clinical advice.
• Decisions by PHARMAC staff not advisory panel.
Providing information via Schedule, website, mailouts.
Looking forward to feedback on practical workings of NPPA.
www.pharmac.govt.nz/nppa 0800 660 050