Non-subsidised pharmaceuticals

MSD must check if the client qualifies for Disability Allowance.

The client may have allowable health and disability costs for Temporary Additional Support if they do not qualify for Disability Allowance because:

• they do not meet the Disability Allowance income limit or
• their disability will last less than 6 months or
• they are certain refugees, protected persons or residence applicants

To determine if the cost of a non-subsidised pharmaceutical can be included in as an allowable cost for Temporary Additional Support, it is necessary to consider:

• the availability of another suitable subsidised or partly subsidised pharmaceutical item and
• if funding from PHARMAC under their Named Patient Pharmaceutical Assessment Policy has been applied for and if so, whether the application has been accepted or declined and the reasons for it being declined (this was previously known as the Exceptional Circumstances Panel Policy)

The cost of the non-subsidised pharmaceutical can be included as an additional expense for Temporary Additional Support if the client's registered medical practitioner or nurse practitioner verifies the client's disability and their need for the pharmaceutical item. They must verify the item is essential and there are no suitable subsidised or partly subsidised alternatives.

The certificate must also confirm the treatment is beneficial and of therapeutic value and that the costs are:

• additional and
• ongoing and
• directly related to the client's disability

The client will need to provide a letter from their registered medical practitioner or nurse practitioner confirming the following information:

• the reasons for prescribing the non-subsidised pharmaceutical and
• there is not suitable subsidised or partly subsidised alternative and
• the medication is essential and directly related to the client's disability and
• if PHARMAC funding has been applied for and declined, the reasons for this decision and
• if there is no suitable subsidised or partly subsidised alternative, and if PHARMAC funding has not been applied for, the reasons why funding has not been requested

Note MSD should refer applications for non-subsidised pharmaceuticals to the Regional Health Advisor and Regional Disability Advisor [no link find out why] . They will assess if the application qualifies.

It’s not always necessary for an application to PHARMAC for funding to be lodged.

If the client's registered medical practitioner or nurse practitioner confirms funding has not been applied for because they are aware that PHARMACs criteria will not be met, the cost of the non-subsidised pharmaceutical can be included as an allowable cost for Temporary Additional Support.

The registered medical practitioner or nurse practitioner must still verify there is not a suitable subsidised or partly subsidised alternative, and the pharmaceutical item is essential and directly related to the client's disability.