Source: PHARMAC
Pharmac is reviewing its Exceptional Circumstances Framework (the Framework) after people told us it is hard to understand and needs to work better.
The Framework is used when a person’s clinical situation is unusual or complex and existing funded medicines or standard funding rules are not suitable. In these cases, Pharmac can consider funding a medicine for an individual through pathways such as the Named Patient Pharmaceutical Assessment (NPPA) or Special Authority waivers.
“Most medicines are funded for groups of people, but sometimes someone’s medical situation doesn’t fit the standard pathway,” says Pharmac’s Director Pharmaceuticals Adrienne Martin. “This framework exists to make sure people with exceptional clinical needs can still be considered for access to funded treatment options.”
Pharmac says it has heard from patients, their families, clinicians, and others that the current process can be difficult to understand and navigate. Feedback has highlighted confusion about when it applies, what counts as ‘exceptional’, how decisions are made, and how outcomes are communicated.
“The framework is doing an important job, but people have told us it isn’t always clear or easy to use,” Martin says. “We want to make it easier to understand, faster to use, and more transparent, to make sure it works better for the people who rely on it.”
The review will look at the framework’s principles, criteria, and decision‑making processes, and will take a two‑stage approach, beginning with feedback on the current Framework with release of a discussion document, and followed by a second consultation later in the year on possible changes.
“Nothing will change before the review is complete, the application process will continue as usual, and new applications are still welcome,” Martin says. “Anyone who already has funding through this framework will keep their current approval.”
More information about the review and how to provide feedback is available on Pharmac’s website.
