NSW residents who are patients of NSW public hospitals or authorised community prescribers are not required to pay the patient co-payment for some Pharmaceutical Benefits Scheme (PBS) section 100 (s100) Highly Specialised Drugs or s100 injectable and infusible chemotherapy medicines in NSW.
It is important that you discuss this with your patients when prescribing s100 Highly Specialised Drugs or s100 injectable and infusible chemotherapy medicines in NSW.
NSW residents who are patients of NSW public hospitals or authorised community prescribers and prescribed s100 Highly Specialised Drugs (HSD) or s100 injectable and infusible chemotherapy medicines under section 100 of the National Health Act 1953 are eligible. This applies to medicines listed on the PBS under the s100 HSD Program Public Hospital schedule, s100 HSD Community Access schedule (for HIV, Hepatitis B and clozapine maintenance therapy medicines only), and injectable and infusible chemotherapy medicines listed on the PBS s100 Efficient Funding for Chemotherapy (Public Hospital) schedule.
This includes public non-admitted patients, outpatients or day patients, inpatients on discharge from public hospitals and privately referred, non-admitted patients treated by NSW public hospitals or patients of authorised community prescribers.
The s100 co-payment program applies to prescriptions filled through NSW public hospitals, NSW community pharmacies and pharmacies used by NSW public hospital oncology services.
Co-payments for s100 Highly Specialised Drugs or s100 injectable and infusible chemotherapy medicines for patients who access care in the private sector in NSW are not eligible.
The s100 co-payment program does not apply to items listed on the General schedule of the PBS, or opioid dependence treatment medicines on the s100 Community Access schedule.
The process is different for s100 Highly Specialised Drugs and s100 injectable and infusible chemotherapy medicines, as outlined below.
s100 Highly Specialised Drugs are medicines used to treat 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 is on the PBS.
A full list of s100 Highly Specialised Drugs that are listed on the Community Access schedule is on the PBS.
Prescribers must complete a 3 Year Patient Consent Form with each eligible patient in order for the patient access the s100 co-payment 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.
If the patient has 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 should complete the 3 Year Patient Consent form.
It is important that you complete and sign the 3 Year Patient Consent form and provide it to the patient. By signing the form, you are confirming that the patient meets the eligibility criteria for the program. The patient signs the form to give their agreement to have the co-payment contribution paid by the NSW Health. Should the patient's consent form become lost, damaged or illegible, the patient will need to ask you to complete a new consent form.
Examples of prescribing software compatible forms are available for Medical Director and Best Practice. These forms can be imported as a template into these programs without any modifications. More information about importing templates can be found on Medical Director and Best Practice websites. These forms can be adapted to other prescribing software by your practice where appropriate.
It is important that you complete and sign the form and provide it to the patient. By signing the form, the patient agrees to have the co-payment contribution paid by the NSW Government for a 3 year period. Should the patient's consent form become lost, damaged or illegible, it will be the responsibility of the patient to obtain a new consent form from their prescriber.
Injectable and infusible chemotherapy is used for the treatment of cancers in hospitals by oncology services. NSW Health does not pay the co-payment for chemotherapy medicines listed on the General schedule of the PBS.
A full list of s100 injectable and infusible chemotherapy medicines is available on the PBS.
For s100 injectable and infusible chemotherapy medicines, a local pharmacy consent form is signed when the prescription is filled at pharmacies used by NSW public hospital oncology services. This form also indicates the patient’s agreement for NSW Health to pay the co-payment on their behalf and acknowledges that some details will be provided to NSW Health to make the co-payment and evaluate the program. The 3 Year Patient Consent form is not required.
In March 2015, the NSW Government made the commitment to pay co-payments for some s100 Highly Specialised Drugs and s100 injectable and infusible chemotherapy medicines to help ease the financial burden for people with cancer 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. A full list of conditions is available on the PBS.
For health care professionals about HIV, visit the Australasian Society for HIV Medicine (ASHM).
For clozapine, prescribers and patients must meet the PBS eligibility requirements.
