Exceptional Drugs List

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The Joint NSW Health Funds / Private Hospitals Pharmacy Working Party was initially formed in 1996 to consider issues relating to the provision of pharmaceutical services in private hospitals in NSW, particularly the issue of the Exceptional Drugs List (EDL). Following implementation in NSW the EDL was extended to Queensland.

The primary role of the EDL Committee is to maintain the list in line with PBS and contemporary practice changes rather than seek to expand it. The Exceptional Drugs List is an important reference tool and it is recommended that the EDL be subject to negotiation with individual health funds and private hospitals as one element of the fund-hospital contract.

Key activities of the EDL Committee

  • Maintain the EDL as an industry resource document for the private health sector
  • Review the EDL regularly and provide feedback to the industry on relevant PBS amendments affecting the list
  • Consider applications from hospitals and health funds in relation to Exceptional Drugs
  • Maintain a regime for Individual Patient Usage (IPU) assessment and review of usage
  • Conduct relevant surveys to improve understanding regarding drugs in use within the private sector
  • Provide technical advice to Government and industry peak bodies and nominate appropriate personnel to relevant external committees (e.g. Highly Specialised Drugs Working Party – HSDWP)
  • Provide an educational role for the sector and a forum to address private sector issues associated with Exceptional Drugs and the PBS including the Highly Specialised Drugs Program
  • To review and disseminate relevant information from the Australian Drug Evaluation Committee (ADEC), the Therapeutic Goods Administration (TGA) and any other relevant agencies
  • Engage with suppliers and providers where appropriate to review current practice

Criteria for inclusion

In considering items for inclusion on the EDL the Committee will consider the following criteria:

  • Cost
  • Frequency of Use
  • Other Funding Options
  •  New Technology
  • Coding System for Identification
  •  Appropriateness of Use
  •  Intrinsic to the Episode of Care

The Exceptional Drugs List is designed for use in NSW and QLD Private Hospitals.  View the current documentation.

Additional documentation to be read in parallel to the EDL: