Pharmaceuticals

On this page

  1. Introduction
  2. Pharmaceutical Reimbursement Process
  3. Evidence Based Healthcare Reports
  4. ACC News

Introduction

Pharmaceuticals are:

  • Prescription medicines, restricted medicines, or pharmacy-only medicines, as listed in Parts I, II and III of the First Schedule of the Medicines Regulations 1984, or
  • Controlled drugs as defined in the Misuse of Drugs Act 1975.

ACC pays for or contributes to the cost of pharmaceuticals that are prescribed by a treatment provider who has statutory prescribing authority when the pharmaceuticals:

  • Help a client’s treatment for personal injury, and
  • Are reasonably required.

ACC pays for a client’s pharmaceuticals by:

  1. Paying the Ministry of Health for public health acute services pharmaceuticals. These include pharmaceuticals:
  • Required by clients during acute hospital admissions or emergency department visits
  • Given by a registered medical practitioner as part of the treatment associated with a client’s outpatient visit for up to six weeks from discharge or treatment
  • Required during treatment provided by medical practitioners less than seven days from referral by another registered medical practitioner
  1. Paying the Ministry of Health for pharmaceuticals used in the community that are listed on the Pharmaceutical Schedule, and are required for:
  • Community-based acute treatment
  • Post-six-week medical outpatient services
  • Services provided as part of elective assessments/admissions and other treatment outside the public health acute period.
  1. Directly reimbursing clients or pharmacies for:
  • Co-payments on community pharmaceuticals
  • Part-charges for partly subsidised community pharmaceuticals
  • Where approved, the full cost of pharmaceuticals not on the Pharmaceutical Schedule or that do not meet its subsidy criteria.

ACC expects that subsidised pharmaceuticals will be used. Providers must not invoice ACC directly for these as they are already paid for under points 1 and 2 above.

District Health Boards should record the ACC45 Injury Claim Form number against each item when prescribing medicines. A Ministry of Health identifier should be recorded for all medical illness scripts to distinguish between accident and medical cases.

Where non-subsidised pharmaceuticals may be needed (and are not already covered by the public health acute service time period), please seek approval for funding from ACC before prescribing. Contact the client’s case manager or the Provider Helpline 0800 222 070.

When prescribing pharmaceuticals, please use the individual pharmaceutical name rather than the brand name or wording such as Voltaren or generic equivalent. Prescriptions and dispensings of pharmaceuticals should meet all appropriate legislation, service agreements and standards.

Pharmaceutical Reimbursement Process

Clients may seek reimbursement for some prescribed items. The ACC249 Request for Reimbursement of Pharmaceuticals form (DOC 113K) and Reimbursement of Pharmaceuticals fact sheet are available for their information and completion.

Please note, that non subsidised pharmaceuticals require prior funding approval. All reimbursement requests should have original dispensary receipts attached.

Evidence Based Healthcare Reports

ACC’s Evidence Based Healthcare research team has a Considered Judgement Form on the use of oral Tramadol in chronic non-malignant pain management (PDF 38K).

See a full list of Evidence Based Healthcare Reports.

ACC News

There are regular Pharmaceutical Updates in ACC News.