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Application Forms

This form is to be filled by Consultants when exceptional medicinal treatment is being requested for their patients. The information submitted should be such as to enable the compilation of a holistic drug-related assessment intended for individual patient funding. This assessment is to include comparative clinical efficacy with standard therapy/other treatment options and, reasons for exceptionally and budgetary impact. Any additional information deemed necessary to substantiate the request should be attached with the completed form and sent via email to: dpa.health@gov.mt
Application is to be submitted by the marketing authorisation holders (MAHs) to the Directorate for Pharmaceutical Affairs (DPA), when requesting the inclusion (i) of a new medicinal product on to the Government Formulary List, or (ii) of new indication/s for products already available on the list. The request will eventually be presented for discussion and recommendation by the GFLAC (Government Formulary List Advisory Committee) and the ACHCB (Action Committee on Health Care Benefits) committees.
Application is to be submitted by the clinicians working within the Government Health Services to the Directorate for Pharmaceutical Affairs (DPA), when requesting the inclusion (i) of a new medicinal product on to the Government Formulary List, or (ii) of new indication/s for products already available on the list. The request is to be endorsed by the Clinical Chairperson of the particular department. The request will eventually be presented for discussion and recommendation by the GFLAC (Government Formulary List Advisory Committee) and the ACHCB (Action Committee on Health Care Benefits) committees.
Application is to be submitted by the clinicians working within the Government Health Services, as an attachment to the 'Clinician request for the inclusion of a medicinal product on the Government Formulary List (T02)' form.
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 

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