National Health (Closing the Gap – PBS Co-payment Program) Special Arrangement 2016 (Cth)
National Health (Closing the Gap – PBS Co-payment Program) Special Arrangement 2016
PB 9 of 2016
made under the
National Health Act 1953
Compilation No. 1
Compilation date: 1 July 2021
Includes amendments up to: F2021L00819
Registered: 5 July 2021
About this compilation
This compilation
This is a compilation of the National Health (Closing the Gap – PBS Co-payment Program) Special Arrangement 2016 that shows the text of the law as amended and in force on 1 July 2021 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
Self-repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
Part 1General.......................................................................................................................... 1
1Name of Instrument....................................................................................................... 1
4Definitions..................................................................................................................... 1
5Pharmaceutical benefits covered by this Special Arrangement...................................... 2
6Application of Part VII of the Act................................................................................. 2
7Prescribing.................................................................................................................... 3
10Registering patients....................................................................................................... 3
10ASupply of pharmaceutical benefits under this Special Arrangement.............................. 4
11Co-payment reduction................................................................................................... 4
12Eligibility for concession and entitlement cards under the Act....................................... 6
13Payment by Commonwealth.......................................................................................... 6
14Claim for payment......................................................................................................... 7
Part 2Transitional/application provisions................................................................................ 8
15Definitions..................................................................................................................... 8
16Application of old Special Arrangement to supplies made before transition time.......... 8
17Supply of benefits prescribed under old Special Arrangement...................................... 8
18Registration of patients.................................................................................................. 8
Endnotes9
Endnote 1—About the endnotes 9
Endnote 2—Abbreviation key 10
Endnote 3—Legislation history 11
Endnote 4—Amendment history 12
Part 1General
Name of Instrument
(1) This Instrument is the National Health (Closing the Gap – PBS Co-payment Program) Special Arrangement 2016.
(2) This Instrument may also be cited as PB 9 of 2016.
Definitions
In this Instrument:
Act means the National Health Act 1953.
allowable discount has the meaning given by subsection 87(2AAAA) of the Act.
concessional beneficiary charge has the meaning given by section 99F of the Act.
CTG registering practitioner means:
(a) a PBS prescriber; or
(b) an individual who:
(i) is registered in the Aboriginal and Torres Strait Islander health profession under the Health Practitioner Regulation National Law; and
(ii) has been allocated an identification number by the Chief Executive Medicare, for the purposes of the Health Insurance Act 1973, in relation to their place or places of practice.
Note: See section 35 of the Human Services (Medicare) Regulations 1973 in relation to the allocation of identification numbers to health professionals in relation to their places of practice.
CTG supplier means an approved pharmacist, an approved medical practitioner or an approved hospital authority for a private hospital.
early supply of a specified pharmaceutical benefit has the same meaning as in section 84AAA of the Act.
entity means:
(a) a person; or
(b) a partnership; or
(c) any other unincorporated association or body; or
(d) a trust; or
(e) a part of an entity.
general patient has the meaning given by section 84 of the Act.
general patient charge has the meaning given by section 99F of the Act.
general patient reduced charge has the meaning given by section 99F of the Act.
Health Practitioner Regulation National Law has the same meaning as in Part VIIIA of the Act.
medication chart prescription has the meaning given in the Regulations.
other Special Arrangement means another Special Arrangement under section 100 of the Act.
Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.
Note Several other words and expressions used in this Instrument have the meaning they have in the Act, for example:
· approved medical practitioner
· approved pharmacist
· Chief Executive Medicare
· PBS prescriber
· pharmaceutical benefit
· private hospital
· special patient contribution
Pharmaceutical benefits covered by this Special Arrangement
(1) This Special Arrangement applies to a pharmaceutical benefit which is generally available for supply under Part VII of the Act.
(2) This Special Arrangement does not apply to a pharmaceutical benefit that can only be supplied under Part VII of the Act in accordance with another Special Arrangement under section 100 of the Act or to a pharmaceutical benefit that can only be supplied under the prescriber bag provisions of the Act.
Note Section 85AA of the Act provides that a pharmaceutical benefit that can only be supplied under Part VII of the Act in accordance with section 100 of the Act will be the subject of a subsection 85(2A) declaration (section 100 only drug), or a determination under paragraph 85(8)(a) (section 100 only pharmaceutical benefit) or paragraph 85(8)(b) (section 100 only circumstances). Section 85AAA of the Act provides that a pharmaceutical benefit that can only be supplied under Part VII of the Act under the prescriber bag provisions of the Act will be the subject of a subsection 85(2AA) declaration (prescriber bag only drug), or a determination under subsection 85(7A) (prescriber bag only pharmaceutical benefit).
Application of Part VII of the Act
(1) Each pharmaceutical benefit supplied in accordance with this Special Arrangement is supplied under Part VII of the Act.
(2) A provision of Part VII of the Act, or of regulations or other instruments made for Part VII of the Act applies subject to this Special Arrangement.
(3) This Special Arrangement does not apply to continued dispensing under subsection 89A(1) of the Act.
Prescribing
(1) A pharmaceutical benefit is prescribed for supply under this Special Arrangement in accordance with Part VII of the Act, and instruments made for Part VII of the Act, but with the modifications set out in this section.
(2) The prescription must be written for supply to a patient registered under subsection 10(2) of this Special Arrangement.
(5) This Special Arrangement does not apply to a medication chart prescription unless the person for whom the pharmaceutical benefit is prescribed is receiving treatment in or at a residential care service at which the person is receiving residential care.
Registering patients
(2) A CTG registering practitioner may register, for the supply of pharmaceutical benefits under this Special Arrangement, a patient:
(a) who is an eligible person within the meaning of the Health Insurance Act 1973;
(b) who identifies themself to the practitioner as being of Aboriginal or Torres Strait Islander descent; and
(c) whom the practitioner assesses as meeting the eligibility criteria in subsection (3); and
(d) who provides consent to receive supplies under this Special Arrangement to the practitioner.
(3) For subsection (2), the eligibility criteria are that the patient, in the opinion of the practitioner:
(b) would experience setbacks in the prevention or ongoing management of a medical condition if the patient did not adhere to a course of treatment (involving a pharmaceutical benefit) for that medical condition; and
(c) is unlikely to adhere to the course of treatment without assistance under this Special Arrangement.
(4) A registration for subsection (2) must be made using the Health Professional Online Service (HPOS) electronic channel.
(5) Despite subsection (4), a registration for subsection (2) may be made by telephone to Services Australia if, when the registration is made, for reasons outside the CTG practitioner’s control the practitioner:
(a) does not have access to functioning IT systems, including internet; or
(b) is unable to access the HPOS electronic channel.
Note: Information about HPOS can be found on the Services Australia website at
10A Supply of pharmaceutical benefits under this Special Arrangement
A pharmaceutical benefit may be supplied under this Special Arrangement by:
(a) an approved pharmacist;
(b) an approved medical practitioner; or
(c) an approved hospital authority for a private hospital.
Co-payment reduction
(1) Section 87 of the Act applies to the supply of a pharmaceutical benefit under this Special Arrangement, but with the modifications set out in this section.
Co-payment of nil
(2) The amount that a CTG supplier may charge for the supply of a pharmaceutical benefit under this Special Arrangement is nil if the patient either:
(a) would otherwise have been charged the concessional beneficiary charge or the general patient reduced charge; or
(b) is receiving a supply that is described in subsection 99(2AB) or (2B) of the Act.
Note Under the Act, a supply described in subsection 99(2AB) or (2B) of the Act is deemed to be a supply and receipt otherwise than under Part VII of the Act (other than for the purposes of Division 1A of that Part). Normally, an approved supplier does not make a claim for payment for supply of a pharmaceutical benefit. When this Special Arrangement applies, a CTG supplier may make a claim in accordance with section 14 of this Special Arrangement.
Co-payment for general patients
(3) The amount that a CTG supplier may charge for the supply of a pharmaceutical benefit under this Special Arrangement is equal to the:
(a) concessional beneficiary charge (less any allowable discount) if the patient would otherwise have been charged the general patient charge; or
(b) concessional beneficiary charge if the patient is receiving a supply that is described in subsection 99(2A) of the Act.
Note Under the Act, a supply described in subsection 99(2A) of the Act is deemed to be a supply and receipt otherwise than under Part VII of the Act (other than for the purposes of Division 1A of that Part). Normally, an approved supplier does not make a claim for payment for supply of a pharmaceutical benefit. When this Special Arrangement applies, a CTG supplier may make a claim in accordance with section 14 of this Special Arrangement.
Special patient contribution
(3A) Subsection (3B) applies where:
(a) a CTG supplier that is an approved pharmacist or approved medical practitioner supplies a pharmaceutical benefit that is a listed brand of a pharmaceutical item in relation to which a determination under subsection 85B(3) of the Act is in force; and
(b) the supplier is not entitled to be paid by the Commonwealth an amount equal to that special patient contribution under subsection 99(2AA) of the Act.
(3B) In addition to any amount that may be charged for the supply of a pharmaceutical benefit under this Special Arrangement in accordance with subsections (2) and (3), the approved pharmacist or approved medical practitioner may charge the person to whom the benefit is supplied an amount equal to the special patient contribution for the benefit.
(3C) Subsection (3D) applies where:
(a) a CTG supplier that is an approved hospital authority for a private hospital supplies a pharmaceutical benefit that is a listed brand of a pharmaceutical item in relation to which a determination under subsection 85B(3) of the Act is in force; and
(b) the supply is not an early supply of a specified pharmaceutical benefit prescribed for a patient who is the holder of an entitlement card.
(3D) In addition to any amount that may be charged for the supply of a pharmaceutical benefit under this Special Arrangement in accordance with subsections (2) and (3), the approved hospital authority may charge the person to whom the benefit is supplied an amount equal to the special patient contribution for the pharmaceutical benefit if the supply had been made by an approved pharmacist.
(3E) Nothing in this section prevents a CTG supplier that is an approved pharmacist or approved medical practitioner from charging an amount in accordance with subsection 87(4) of the Act.
The general patient safety net or concessional beneficiary safety net
(4) For the purpose of calculating an amount for the general patient safety net or concessional beneficiary safety net (within the meaning of section 99F of the Act), and despite subsections (2) and (3):
(a) if the concessional beneficiary charge or the general patient reduced charge would otherwise have applied to the supply — the amount charged is taken to be the concessional beneficiary charge or the general patient reduced charge respectively (without any allowable discount); and
(b) if the general patient charge would otherwise have applied to the supply — the amount charged is taken to be the general patient charge (without any allowable discount); and
(c) if subsection 99(2A), (2AB), or (2B) of the Act would have operated for the supply — the amount charged is taken to be the amount worked out for the pharmaceutical benefit under subsection 84C (7) of the Act; and
(d) the indexation provisions of Division 4A of Part VII of the Act apply.
Eligibility for concession and entitlement cards under the Act
Section 84C of the Act applies to a patient in accordance with subsection 11(4).
Payment by Commonwealth
(1) Section 99 of the Act applies but with the modifications set out in this section.
If the co‑payment is nil under paragraph 11(2)(a)
(2) If the amount that a CTG supplier is entitled to charge for the supply by the supplier of a pharmaceutical benefit under this Special Arrangement is nil under paragraph 11(2)(a), the supplier is entitled to be paid by the Commonwealth an amount equivalent to the concessional beneficiary charge or the general patient reduced charge in addition to what the supplier is entitled to be paid for the supply under subsection 99(2) and, where relevant, subsection 99(2AA), of the Act or subsection 99(4) of the Act.
If the co‑payment is nil under paragraph 11(2)(b)
(3) If the amount that a CTG supplier is entitled to charge for the supply by the supplier of a pharmaceutical benefit under this Special Arrangement is nil under paragraph 11(2)(b), the supplier is entitled to be paid by the Commonwealth the price of the pharmaceutical benefit under subsection 84C(7) of the Act.
If the co‑payment is for a general patient under paragraph 11(3)(a)
(4) If the amount that a CTG supplier is entitled to charge for the supply of a pharmaceutical benefit under this Special Arrangement is equal to the concessional beneficiary charge (less any allowable discount) under paragraph 11(3)(a), the supplier is entitled to be paid the difference between the concessional beneficiary charge and the general patient charge (ignoring any discount given) in addition to what the supplier is entitled to be paid for the supply under subsection 99(2) and, where relevant subsection 99(2AA), of the Act or subsection 99(4) of the Act.
If the co‑payment is for a general patient under paragraph 11(3)(b)
(5) If the amount that a CTG supplier is entitled to charge for the supply by the supplier of a pharmaceutical benefit under this Special Arrangement is equal to the concessional beneficiary charge under paragraph 11(3)(b), the supplier is entitled to be paid by the Commonwealth the amount (if any) by which the price of the pharmaceutical benefit under subsection 84C(7) of the Act exceeded the amount charged.
Claim for payment
(1) A CTG supplier who wants to receive payment from the Commonwealth for the supply of a pharmaceutical benefit under this Special Arrangement must make a claim for payment to the Chief Executive Medicare on behalf of the Secretary.
(2) The claim must be made in accordance with the rules made under subsections 98AC(4) and 99AAA(8) of the Act with the following modifications:
(a) if it is for the supply of a pharmaceutical benefit under paragraph 11(2)(b) or 11(3)(b) — in accordance with those rules, as if the supply were a supply to which Part VII of the Act applies;
(b) unless made using the manual system, must include an indicator that the claim is being made for the supply of a pharmaceutical benefit under this Special Arrangement.
Part 2 Transitional/application provisions
15 Definitions
In this Part:
transition time means the time this section commences;
old Special Arrangement means this Special Arrangement, as in force immediately before the transition time;
Note This Special Arrangement was previously known as the National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement 2016.
new Special Arrangement means this Special Arrangement, as amended by the National Health (Closing the Gap – PBS Co-payment Program) Amendment Special Arrangement 2021.
16 Application of old Special Arrangement to supplies made before transition time
Despite the amendments made by the National Health (Closing the Gap – PBS Co-payment Program) Amendment Special Arrangement 2021, the old Special Arrangement continues to apply in relation to the supply of a pharmaceutical benefit made before the transition time.
17 Supply of benefits prescribed under old Special Arrangement
Where, before the transition time, a pharmaceutical benefit was prescribed for supply under this Special Arrangement in accordance with section 7 of the old Special Arrangement, from the transition time that benefit may be supplied on the basis of that prescription as if it had been prescribed in accordance with section 7 of the new Special Arrangement.
18 Registration of patients
Despite the amendments made by the National Health (Closing the Gap – PBS Co-payment Program) Amendment Special Arrangement 2021, a person who was registered under section 10 of the old Special Arrangement is taken to be registered under section 10 of the new Special Arrangement.
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
Endnote 2—Abbreviation key
| ad = added or inserted | o = order(s) |
| am = amended | Ord = Ordinance |
| amdt = amendment | orig = original |
| c = clause(s) | par = paragraph(s)/subparagraph(s) |
| C[x] = Compilation No. x | /sub‑subparagraph(s) |
| Ch = Chapter(s) | pres = present |
| def = definition(s) | prev = previous |
| Dict = Dictionary | (prev…) = previously |
| disallowed = disallowed by Parliament | Pt = Part(s) |
| Div = Division(s) | r = regulation(s)/rule(s) |
| ed = editorial change | reloc = relocated |
| exp = expires/expired or ceases/ceased to have | renum = renumbered |
| effect | rep = repealed |
| F = Federal Register of Legislation | rs = repealed and substituted |
| gaz = gazette | s = section(s)/subsection(s) |
| LA = Legislation Act 2003 | Sch = Schedule(s) |
| LIA = Legislative Instruments Act 2003 | Sdiv = Subdivision(s) |
| (md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
| effect | SR = Statutory Rules |
| (md not incorp) = misdescribed amendment | Sub‑Ch = Sub‑Chapter(s) |
| cannot be given effect | SubPt = Subpart(s) |
| mod = modified/modification | underlining = whole or part not |
| No. = Number(s) | commenced or to be commenced |
Endnote 3—Legislation history
| Name | Registration | Commencement | Application, saving and transitional provisions |
| National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement 2016 (PB 9 of 2016) | 1 Feb 2016 (F2016L00079) | 1 Feb 2016 (s 2) | |
| National Health (Closing the Gap – PBS Co-payment Program) Amendment Special Arrangement 2021 (PB 71 of 2021) | 24 June 2021 (F2021L00819) | 1 July 2021 (s 2(1) item 1) | — |
Endnote 4—Amendment history
| Provision affected | How affected |
| Part 1 | |
| Part 1 heading........................... | ad F2021L00819 |
| s 1............................................. | am F2021L00819 |
| s 2............................................. | rep LA s 48D |
| s 3............................................. | rep LA s 48C |
| s 4............................................. | am F2021L00819 |
| s 7............................................. | am F2021L00819 |
| s 8............................................. | rep F2021L00819 |
| s 9............................................. | rep F2021L00819 |
| s 10........................................... | am F2021L00819 |
| s 10A........................................ | ad F2021L00819 |
| s 11........................................... | am F2021L00819 |
| s 13........................................... | am F2021L00819 |
| s 14........................................... | am F2021L00819 |
| Part 2 | |
| Part 2........................................ | ad F2021L00819 |
| s 15........................................... | ad F2021L00819 |
| s 16........................................... | ad F2021L00819 |
| s 17........................................... | ad F2021L00819 |
| s 18........................................... | ad F2021L00819 |
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