Co-payments for Section 100

NSW Health pays patient co-payments for some Section 100 (s100) drugs and medicines to help ease the financial burden for people with cancer and other chronic conditions.

These conditions include HIV, schizophrenia, hepatitis, Crohn’s disease, ulcerative colitis, cystic fibrosis, psoriatic and rheumatoid arthritis, severe allergic asthma and rare diseases, particularly those affecting children, including juvenile idiopathic arthritis.

Eligibility criteria

All of the following eligibility criteria must be met for the co-payment to be paid by NSW Health.

NSW residents who are patients of:

NSW public hospitals, or
authorised community prescribers in NSW (for HIV and Hepatitis B medicines, and clozapine maintenance therapy), or
an interstate specialist/prescriber where the NSW resident lives in a border area.

Patient prescriptions under section 100 of the National Health Act 1953 for:

s100 Highly Specialised Drugs (HSD) (Public Hospital), or
s100 HSD Community Access (excluding opioid dependence medicines), or
s100 injectable and infusible chemotherapy medicines.

Prescriptions filled through NSW:

public hospitals, or
community pharmacies, or
pharmacies used by NSW public hospital oncology services.

More information about authorised community prescribers is found on the ASHM website. For clozapine, prescribers and patients must meet the Pharmaceutical Benefits Scheme (PBS) eligibility requirements.

Patients must provide consent for NSW Health to make s100 co-payments on their behalf.

Co-payments for patients accessing care in the private sector in NSW are not eligible for this program. Medicines listed on the PBS Community Access schedule for opioid dependence treatment are not eligible for the s100 co-payment program.

s100 medicine classifications

The s100 co-payment program only applies to the co-payment for Pharmaceutical Benefits Scheme medicines. The Commonwealth Government is responsible for listing medicines on the PBS schedules. Refer to the PBS to check the status of a medicine, as the list may change over time.

NSW Health will pay the co-payment for eligible patients for prescriptions for:

s100 Highly Specialised Drugs (HSD) listed under the s100 HSD Public Hospital schedule on the PBS that are filled by NSW public hospital pharmacies
s100 HSD listed under the s100 HSD Community Access schedule on the PBS (excluding opioid dependence medicines) that are filled by NSW public hospital or NSW community pharmacies.
s100 injectable or infusible chemotherapy drugs listed under the s100 Efficient Funding of Chemotherapy schedule on the PBS that are filled by NSW public hospital pharmacies or pharmacies used by NSW public hospital oncology services.

The co-payment paid by NSW Health also counts towards the patient safety net.

Evaluation of the NSW s100 Co-payment Program

In 2022 the NSW Ministry of Health completed an evaluation of the s100 Co-payment Program. The aim was to assess the implementation of the s100 policy from 2016 to 2021 and the extent to which the policy has contributed to improved outcomes.

Using insights and feedback from a broad range of stakeholders, the evaluation showed the program has eased the financial burden for patients and awareness of the program has increased over time. The program has saved NSW patients with cancer and other chronic conditions $43.5 million in s100 medication co-payments over five years.

Please email NSWH-s100CoPayment@health.nsw.gov.au for a copy of the summary report.