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Medicines restricted through the Medicines Act or Misuse of Drugs Regulations

  • Clozapine
  • Danthron + poloxamer
  • Dexamphetamine
  • Methadone (for substance abuse)
  • Methylphenidate
  • Riluzole
  • Tolcapone
  • Tretinoin

Refer to Medsafe for prescribing rules for these medicines
(www.medsafe.govt.nz/profs/riss/restrict.asp)

In New Zealand a range of medications are subsidised by the government. With some exceptions (see box) any registered medical practitioner is legally able to prescribe any drug, however the subsidy in some instances is targeted at certain patient groups. The majority of medications are available without restriction.

PHARMAC uses several mechanisms to target medications at certain patient groups. This includes prescribing guidelines, specialist only prescribing or recommendation, endorsements and Special Authorities. The Pharmaceutical Schedule contains this information.

Guidelines

The PHARMAC Pharmaceutical Schedule lists all the subsidised medications and conditions relating to their funding. This is available in hard copy (updated monthly) or online at: www.pharmac.govt.nz

In some instances non-mandatory prescribing guidelines are contained in the Pharmaceutical Schedule e.g. long acting beta agonists.

Specialist only prescription

Some medicines are only subsidised if prescribed by a specialist or a specific specialist group e.g. etanercept (TNF inhibitor). Prior to March 2009 isotretinoin and acitretin were also in this category.

Specialist recommendation

Other medications may be subsidised if a specialist has recommended the treatment for a specific patient e.g. azathioprine, itraconazole. The prescriber must write on the prescription the name of the specialist and the year of the recommendation. These recommendations are valid for two years and can be renewed by a further consultation.

Both the specialist and the practitioner need to keep records of the consultation and enough of the clinical details to justify the recommendation. This means referral by telephone will need to be followed up by written consultation.

Endorsement

An endorsement requires a prescriber to write on the prescription that the patient meets the criteria for full subsidy e.g. Betaloc, azithromycin. The endorsement can be written as “certified condition”, or state the condition of the patient, as it applies to the published indications contained in the Pharmaceutical Schedule. By endorsing a prescription with the words “certified condition” the prescriber is making a declaration that the patient meets the access criteria in the Schedule.

Electronic Special Authorities

The electronic Special Authority system enables rapid processing of Special Authority applications. The system requires secure broadband internet access and a digital certificate. To register or receive further information Ministry of Health Sector Services Helpdesk can be contacted on 0800 243 666 or email: sectorservices@moh.govt.nz

There are no charges associated with registering or using the Electronic Special Authority system. However there are charges to access a Health Intranet approved network. The current certified network providers are Telecom or HealthLink. Both providers can be contacted to discuss the costs involved, Telecom on 0800 22 44 55 or HealthLink on 0800 288 887.

A digital certificate is a security feature to authenticate users. A digital certificate costs approximately $100 and the re-issue charge is $80 per certificate per year. The Ministry of Health is currently funding the digital certificates.

Special Authorities

Special Authority criteria define the patients who can receive funding for a particular medicine e.g. clopidogrel, dipyridamole.

The Special Authority on clopidogrel has been removed. For more information, see "Access to clopidogrel now widened", BPJ 31 (October, 2010).

Often patients are required to undertake a trial of a less expensive medicine (such as the requirement to trial an effective dose of risperidone before receiving funding for olanzapine), or the medicine may need to be prescribed by a defined specialist (such as medicines for HIV).

Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular individual. Once approved the prescriber is provided with a Special Authority number which must appear on the prescription to gain the subsidy.

Criteria for approval of Special Authority applications are included in the Pharmaceutical Schedule, through some PMS systems and online forms available on PHARMAC’s web site.

Exceptional Circumstances

Exceptional Circumstances (EC) is a method for funding medicines that are not otherwise funded in the community or in District Health Board hospitals. There are three schemes:

  1. Community EC – for patients with rare or unusual clinical situations (i.e. less than ten nationally)
  2. Hospital EC – enables District Health Board hospitals to dispense medicines for people being discharged from hospital
  3. Cancer EC – allows District Health Boards to fund cancer medicines that are not otherwise funded

Applying for Exceptional Circumstances

Applications for patients need to be supported by an applying practitioner and should be directed to:

Exceptional Circumstances Panel Coordinator
PHARMAC
PO Box 10-254
Wellington
Phone 04 916 7553
Fax 09 523 68770
E-mail: ecpanel@pharmac.govt.nz

Exceptional Circumstances forms are available on the PHARMAC web site:
www.pharmac.govt.nz/healthpros/EC/ECForms