NSW residents who are patients of NSW public hospitals or authorised community prescribers are not required to pay the patient co-payments for some section 100 (s100) Highly Specialised Drugs or s100 injectable and infusible chemotherapy medicines in NSW.
NSW Health s100 co-payments apply to eligible patients who are prescribed medicines listed on the Pharmaceutical Benefits Scheme (PBS) under the s100 Highly Specialised Drugs (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 on the PBS s100 Efficient Funding for Chemotherapy (Public Hospital) schedule.
The process is different for s100 HSD and s100 injectable and infusible chemotherapy medicines as outlined below.
NSW residents who are patients of NSW public hospitals or authorised community prescribers and are prescribed s100 Highly Specialised Drugs under section 100 of the National Health Act 1953 are eligible.
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.
This applies to prescriptions for s100 Highly Specialised Drugs filled through NSW public hospitals and some s100 Highly Specialised Drugs dispensed in community pharmacies under the PBS community access arrangements.
For community access arrangements, HIV antiretroviral therapy, Hepatitis B medicines and clozapine (maintenance therapy) are eligible for the co-payment program. These medicines can be dispensed from community pharmacies or NSW public hospitals. For more information about authorised community prescribers HIV and Hepatitis B medicines visit Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. For clozapine, prescribers and patients must meet the PBS eligibility requirements.
The authorised community prescriber does not need to be physically located in NSW for the patient to be eligible for the co-payment.
Co-payments for s100 Highly Specialised Drugs for patients who access care in the NSW private sector are not eligible.
Co-payments paid by NSW Health count towards the patient PBS safety net.
Patients prescribed s100 Highly Specialised Drugs through NSW public hospitals or authorised community prescribers must consent to NSW Health paying the co-payment on their behalf by signing a 3 Year Patient Consent Form to be eligible.
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, the doctor or prescriber should complete the 3 Year Patient Consent form.
The patient consent form must be presented each time the prescription is filled, including any repeats. By signing the form, the patient agrees to have the co-payment contribution paid by NSW Health.
The s100 co-payment program applies to prescriptions filled at NSW public hospital pharmacies and through pharmacies used by NSW public hospital oncology services.
Co-payments paid by NSW Health will count towards the patient safety net.
NSW Health does not pay the co-payment for chemotherapy medicines listed on the General schedule of the PBS.
When a patient prescription for s100 injectable and infusible chemotherapy medicines is filled at NSW public hospital pharmacies or pharmacies used by NSW public hospital oncology services, a local pharmacy consent form is signed. This consent form includes an agreement for NSW Health 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 is not affected by this program.
The NSW Government made the commitment to pay co-payments for both s100 injectable and infusible chemotherapy medicines and s100 Highly Specialised Drugs in March 2015 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.
