From 1 October 2015, NSW residents who are patients of NSW public hospitals or authorised community prescribers in NSW are not required to pay the patient co-payments for Section 100 (s100) Highly Specialised Drugs or s100 injectable and infusible chemotherapy medicines in NSW.

From 1 April 2016, patients will be able to consent for a period of 12 months.

The changes apply regardless of whether prescriptions are filled through NSW public hospitals, NSW community pharmacies or pharmacies used by NSW public hospital oncology services. Co-payments paid by the NSW Government will count towards the patient safety net.

There are no changes to co-payments for patients accessing care in the private sector in NSW.

Why are co-payments being paid by the NSW Government?

The NSW Government made the commitment to pay co-payments for 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 change 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, and severe allergic asthma and rare diseases, particularly those affecting children, including juvenile idiopathic arthritis.

The Commonwealth Government is responsible for listing medicines on the schedules under the Pharmaceutical Benefits Scheme (PBS). This list will change from time to time. The status of medicines can be checked on the Pharmaceutical Benefits Scheme website.

Section 100 Highly Specialised Drugs

Who is eligible?

The changes apply to:

  • NSW residents who are patients of NSW public hospitals or authorised community prescribers in NSW and are prescribed s100 Highly Specialised Drugs under Section 100 of the National Health Act 1953.
  • This includes public non-admitted patients, outpatients or day patients, inpatients on discharge from public hospitals and privately referred, non-admitted patients treated in public NSW hospitals.

The changes apply regardless of whether prescriptions for s100 Highly Specialised Drugs are filled through NSW public hospitals or community pharmacies.

The NSW Government will pay the co-payment for HIV antiretroviral therapy, Hepatitis B medicines and clozapine (maintenance therapy) which can now be dispensed in the community pharmacy setting, following Commonwealth Government changes from 1 July 2015.

Co-payments paid by the NSW Government will count towards the patient safety net.

How will the changes be implemented?

Patients prescribed s100 Highly Specialised Drugs through NSW public hospitals or authorised community prescribers in NSW will be advised of the commitment and provided with an opportunity to consent to NSW Health meeting the co-payment on their behalf by signing a consent form valid for 12 months.

Eligible patients who have an existing patient consent form for their s100 Highly Specialised Drug prescription/s can use that form until their final repeat and then seek a 12 month patient consent form next time they visit their prescriber/doctor.

Patient Consent Form for s100 Highly Specialised Drugs Prescriptions RTF version of Patient Consent Form for s100 Highly Specialised Drugs Prescriptions

The form needs to be presented with the prescription/s for s100 Highly Specialised Drugs each time the prescription/s are filled, including any repeats. By signing the form, the patient agrees to have the co-payment contribution paid by the NSW Government over a 12 month period from the date the patient signs the form. Patients will need to ensure that as they near the expiry of 12 months a new patient consent form will need to be obtained from a prescriber/ doctor.​

View the Co-payment Changes Factsheet for s100 Highly Specialised Drugs.

Section 100 injectable and infusible chemotherapy medicines

Who is eligible?

The changes apply to:

  • NSW residents who are patients of NSW public hospitals and are prescribed s100 injectable and infusible chemotherapy medicines in NSW under Section 100 of the National Health Act 1953. Oral chemotherapy, taken by mouth, which are general items on the PBS are not affected by this commitment.
  • This includes public non-admitted patients, outpatients or day patients, inpatients on discharge from public hospitals and privately referred, non-admitted patients treated in public NSW hospitals.

The changes apply regardless of whether prescriptions are filled at NSW public hospital pharmacies or through pharmacies used by NSW public hospital oncology services. Co-payments paid by the NSW Government will count towards the patient safety net.

How will the changes be implemented?

When patient prescriptions for s100 injectable and infusible chemotherapy medicines are filled through pharmacies used by NSW public hospital oncology services, a consent form is signed. This consent form now includes an agreement for the NSW Government to pay the co-payment on behalf of the patient. The process for supplying s100 injectable and infusible chemotherapy medicines to public patients in NSW public hospitals will otherwise continue as usual.

View the Co-payment Changes Factsheet for s100 Injectable and Infusible Chemotherapy Medicines.

Privacy

NSW Health is committed to safeguarding the privacy of patient information, and has implemented measures to comply with its obligations under the Health Records and Information Privacy Act 2002.

Information for patients including Privacy Leaflet for Patients and other privacy resources can be found on the NSW Health website at Patient Privacy.

The NSW Health Privacy Manual for Health Information outlines NSW Health’s obligations and responsibilities in regard to privacy and health information.

Material for prescribers and medical practitioners

Community pharmacies

The Pharmacy Guild of Australia has adapted the 6CPA Registration and Claiming Portal for community pharmacies to seek reimbursement for eligible patients that are not charged a co-payment for their Section 100 Highly Specialised Drugs.

More information and resources, including guides and frequently asked questions can be found on the Pharmacy Guild of Australia (NSW Branch) website.

Material for community pharmacies

More information

If you have further enquires or need more information on the changes to co-payments in NSW, please email NSWs100copayment@moh.health.nsw.gov.au.​​​​​​​​​​​​​​​​​

Page Updated: Monday 5 September 2016