The Pharmaceutical Benefits Scheme (PBS) co-payment for some section 100 (s100) Highly Specialised Drugs are paid by NSW Health for NSW residents who are patients of NSW public hospitals or authorised community prescribers, and that choose to get their medicines dispensed in NSW public hospitals or community pharmacies under the community access arrangements of the PBS.
This means that eligible patients do not need to pay the patient co-payment for some s100 Highly Specialised Drugs.
NSW residents, treated by NSW public hospitals or by authorised community prescribers, who are prescribed Highly Specialised Drugs under section 100 of the National Health Act 1953 are eligible. This applies to medicines listed on the PBS website under the s100 Highly Specialised Drug Program Public Hospital schedule, and Community Access schedule (for HIV, Hepatitis B and clozapine maintenance therapy medicines only).
This includes public non-admitted patients, outpatients or day patients, inpatients on discharge from public hospitals and privately referred, non-admitted patients treated in NSW public hospitals.
The co-payment is paid by NSW Health for prescriptions filled through NSW public hospitals or community pharmacies.
Co-payments for s100 Highly Specialised Drugs for patients who access care in the NSW private sector are not eligible for the s100 co-payment program.
The NSW s100 co-payment program does not apply to items listed on the general schedule of the PBS, or opioid dependence treatment medicines listed on the s100 Community Access schedule.
The NSW Government made the commitment to pay co-payments for some s100 Highly Specialised Drugs and s100 injectable and infusible chemotherapy medicines in March 2015 to help ease the financial burden for people with some cancers and other chronic conditions.
The s100 co-payment program benefits people living with cancer, as well as those with conditions such as HIV, patients with organ and tissue transplants, 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.
s100 Highly Specialised Drugs are medicines used to treat some chronic conditions. Due to the clinical complexities and risks associated with s100 Highly Specialised Drugs, supply is generally restricted to public and private hospitals with appropriate specialist facilities, however some can be accessed through community pharmacies. Authorisation from the Commonwealth Government is required to prescribe or dispense s100 Highly Specialised Drugs.
A full list of s100 Highly Specialised Drugs that are listed on the Community Access schedule is available on the PBS.
An authorised community prescriber is a medical practitioner or nurse practitioner accredited and authorised to prescribe Highly Specialised Drugs. More information about authorised community prescribers for HIV and Hepatitis B medicines can be found on Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. For clozapine, prescribers and patients must meet the PBS eligibility requirements.
The prescriber does not need to be physically located in NSW for the patient to be eligible for the co-payment.
Prescriptions for s100 Highly Specialised Drugs can be filled through NSW public hospital pharmacies. Some s100 Highly Specialised Drugs prescriptions can also be filled through NSW community pharmacies as part of the community access arrangements.
You and your doctor or authorised community prescriber will need to complete and sign the 3 Year Patient Consent Form. Once signed by you and your doctor or prescriber, the consent form is valid for 3 years. When the consent form expires, you will need to complete a new consent from with your doctor or prescriber before you fill your new prescription to be eligible.
Once signed, this form will allow NSW Health to pay the co-payment contribution on your behalf. If your patient consent form becomes lost, damaged or illegible, you need to complete a new consent form with your prescriber.
You will need to present the form to your pharmacist each time you fill your prescription, including when you get repeats.
For urgent medication supplies, you should visit your nearest hospital pharmacy or call your community pharmacy ahead of time to ensure they have available stock or can order it in.
The consent form indicates your agreement for NSW Health to pay the co-payment on your behalf and acknowledges that some details will be collected to process the co-payment claim and to evaluate the s100 co-payment program. This form will also indicate to the pharmacist that you are eligible for the program.
Patients who do not complete the consent form and provide it to their pharmacist may be required to pay the co-payment for their medicines.
Prescriptions for s100 Highly Specialised Drugs require a Patient Consent form to allow NSW Health to pay the co-payment contribution on your behalf. The 3 Year Patient Consent form is valid for 3 years from the date of signing and is available to your prescriber from 1 January 2023.
If you have a signed 12 month patient consent form this can be used for the s100 co-payment program until it expires (12 months from the date of signing). For consent forms that require renewal after 1 January 2023, you and your doctor or prescriber should complete the 3 Year Patient Consent form.
NSW Health is committed to safeguarding the privacy of personal information and complying with its privacy obligations.
For more information on how NSW Health manages your personal information visit Privacy statement.
Talk to your doctor or prescriber about whether you are eligible for this program, and whether it will affect you and how you normally fill your prescriptions for s100 Highly Specialised Drugs.
