Canterbury DHB

Outpatient Prescribing

Special Authority Numbers / Named Patient Pharmaceutical Assessment (NPPA)

Medication funding in the community is an ever-changing, complex issue. Several agents routinely used in haematology require special approval for funding, mainly due to their cost. These fall into two categories:

• Special Authority – Funding is automatically approved on declaration (via Special Authority form) that the patient meets the predetermined criteria for funding (e.g. Rituximab).
• Named Patient Pharmaceutical Assessment (NPPA) – This is a mechanism to give individual named patients access to medicines they need, but which aren't funded on the Pharmaceutical Schedule. In 2012 NPPA replaced three Exceptional Circumstances schemes that PHARMAC had managed. Applications for assessment are made by a patient's prescriber and decisions are made using PHARMAC's nine decision criteria after obtaining clinical advice. Application forms for NPPAs are available on the PHARMAC website. These can be submitted electronically. Page the ward pharmacist on 8209 for advice on funding and on completing the application forms.

Controlled drugs

Class A and B controlled drugs (e.g. morphine, oxycodone, fentanyl) for an outpatient must be prescribed on a triple-copy controlled drug prescription. All 3 copies of the prescription must be presented to pharmacy. Class C controlled drugs (e.g. codeine, lorazepam) may be prescribed on a regular prescription form.

All At Once (Stat) Dispensing and Close Controls

All medicines on the Pharmaceutical Schedule belong to one of two groups:

1. A group that must be dispensed all at once (stat) for the total amount prescribed unless the prescription is clearly endorsed otherwise.
2. A group where the total amount dispensed can be no longer than monthly (for a 3-monthly prescription, this means a minimum of 3 dispensings).

Providing the patient is not in a rest home or other care facility, this can be changed. To change the default from stat to multiple dispensing you must:

• Write the number of dispensings clearly on the script (i.e. weekly or monthly) and state why. Community pharmacists are able to assess dispensing frequency (and therefore funding) based on guidelines from PHARMAC, so any information as to why increased frequency of dispensing is required helps with that assessment.

Topic Code: 5709