Frequently asked questions about co-payments for Section 100

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Consent form

Do I need to use the 3 Year Patient Consent Form for Section 100 (s100) injectable and infusible chemotherapy?

No, the 3 Year Patient Consent Form is only required for patients prescribed s100 Highly Specialised Drugs (HSDs). Patients prescribed s100 injectable and infusible chemotherapy medicine may sign a local pharmacy consent form when their prescription is filled through a pharmacy used by ºÚÁϳԹÏÍø public hospital oncology services.

Can the 3 Year Patient Consent Form be photographed and shown digitally, such as on a mobile phone?

Yes, the patient can present a photograph of their signed consent form with their prescription. All items of the consent form must be fully legible.

Do pharmacies need to store or keep a copy of the patient consent form?

No, there is no requirement for ºÚÁϳԹÏÍø community or public hospital pharmacies to store or make copies of the 3 Year Patient Consent Form for the ºÚÁϳԹÏÍø Section 100 Co-payment Program.

The patient is responsible for maintaining their consent form, including presenting it each time they have their prescription/s and any repeats dispensed at a ºÚÁϳԹÏÍø public hospital pharmacy or ºÚÁϳԹÏÍø community pharmacy. Any storage, auditing or archiving of patient consent forms is at the discretion of the health district, facility or pharmacy, in conjunction with the patient.

Patients

Am I eligible to have my co-payment paid by ºÚÁϳԹÏÍø Health if my s100 HSDs are prescribed by a private hospital prescriber and dispensed from a public hospital pharmacy?

No, the commitment only applies to patients prescribed s100 HSDs by ºÚÁϳԹÏÍø public hospital prescribers or authorised community prescribers.

I have a healthcare card. Do I have to pay the co-payment?

Patients who are charged the concessional PBS co-payment rate and meet the s100 Co-payment Program eligibility criteria will have their co-payments paid by ºÚÁϳԹÏÍø Health on their behalf for relevant medicines. Existing arrangements for ºÚÁϳԹÏÍø patients who hold a Commonwealth healthcare card for all other medicines are not affected by this change.

Will co-payments paid by ºÚÁϳԹÏÍø Health count towards the patient safety net?

Yes. Co-payments paid by ºÚÁϳԹÏÍø Health count towards the PBS patient safety net.

Are opioid dependence treatment medicines included in the s100 Co-payment P​rogram? 

No. ºÚÁϳԹÏÍø Health provides opioid dependence medicines free of charge in public services, however this is administered separately from the ºÚÁϳԹÏÍø s100 Co-payment Program. Visit ºÚÁϳԹÏÍø Health Alcohol and other drugs for further information. 

How do I know if I live in a border area for the s100 Co-payment Program?

​Border areas, or border communities, refers to ºÚÁϳԹÏÍø residents who live in a local government area that borders or is close to Victoria, Queensland or the Australian Capital Territory. Visit ºÚÁϳԹÏÍø Government​​â¶Ä‹â€‹ for information about local government areas in ºÚÁϳԹÏÍø that are considered border communities. â€‹â¶Ä‹â€‹

Pharmacies

How can ºÚÁϳԹÏÍø community pharmacies participate in the s100 Co-payment Program?

The Pharmacy Guild of Australia manages s100 HSD co-payment claims and reimbursements to community pharmacies. Community pharmacies must register with the Pharmacy Guild of Australia online portal to submit s100 co-payment claims and receive re-imbursement from ºÚÁϳԹÏÍø Health. You do not need to be a member of the Pharmacy Guild of Australia to register.

In addition to the cost of the co-payment for eligible patients, pharmacies are paid a service fee for the work associated with submitting claims on behalf of patients. The fees are $2.23 (incl GST) for each co-payment claimed and a one-off monthly administration fee of $13.42 (incl GST) for the first claim made each month.

Information on how to submit claims for the s100 Co-payment Program is available at The Pharmacy Guild of Australia.

How are community pharmacists reimbursed for the patient co-payment?

Community pharmacies submit eligible patient co-payment claims for re-imbursement to the Pharmacy Guild of Australia via their online portal. The Pharmacy Guild processes claims and reimburses pharmacists for each eligible patient co-payment and invoices ºÚÁϳԹÏÍø Health accordingly.

This arrangement ensures pharmacists can comply with the National Health Act 1953, which requires community pharmacists to charge the Pharmaceutical Benefits Scheme (PBS) co-payment for s100 HSDs. This also ensures that eligible patients can access s100 HSDs from community pharmacies, without having to pay the co-payment. Different rules for charging co-payments apply to public hospital pharmacies.

​How are ºÚÁϳԹÏÍø public hospitals reimbursed for the patient co-payment?

ºÚÁϳԹÏÍø public hospitals are reimbursed for eligible patient co-payments based on â€‹iPharmacy reports submitted to the ºÚÁϳԹÏÍø Ministry of Health.

Does ºÚÁϳԹÏÍø Health pay the co-payment for medicines listed on the s100 HSD (Public Hospital) schedule that are dispensed by a ºÚÁϳԹÏÍø community pharmacy?

​No. Prescriptions for medicines on the s100 HSD (Public Hospital) schedule​â¶Ä‹â€‹ dispensed in community pharmacy are not eligible for the co-payment to be paid by ºÚÁϳԹÏÍø Health. To have the co-payment paid by ºÚÁϳԹÏÍø Health, prescriptions for medicines on the ​â¶Ä‹ s100 HSD (Public Hospital) schedule​â¶Ä‹â€‹â€‹ must be dispensed at a ºÚÁϳԹÏÍø public hospital pharmacy. 

Which medicines can be​ dispensed in a ºÚÁϳԹÏÍø community pharmacy and have the co-payment paid by ºÚÁϳԹÏÍø Health?

Eligible patients who have a prescription for medicines listed on the s100 HSD Community Access schedule​â¶Ä‹â€‹â€‹â¶Ä‹(excluding opioid dependence medicines) may have their medicine dispensed by a ºÚÁϳԹÏÍø public hospital or ºÚÁϳԹÏÍø community pharmacy and have the co-payment paid by ºÚÁϳԹÏÍø Health.​

More information

Find out more about the s100 Co-payment Program.

ºÚÁϳԹÏÍø s100 co-payment enquiries can be emailed to: ºÚÁϳԹÏÍøH-s100CoPayment@health.nsw.gov.au
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Current as at: Friday 8 November 2024
Contact page owner: Strategic Reform and Planning