Who is eligible?
NSW residents who are patients of NSW public hospitals or authorised NSW community prescribers and prescribed s100 Highly Specialised Drugs or s100 injectable and infusible chemotherapy medicines 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 by NSW public hospitals or authorised NSW community prescribers.
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 remain the same. Changes to Section 100 co-payments in NSW do not apply to items listed under the general schedule of the Pharmaceutical Benefits Scheme (PBS).
The NSW Government will pay the co-payment for s100 Highly Specialised Drugs for eligible patients that choose to get their s100 Highly Specialised Drugs dispensed in community pharmacies under the community access arrangements of the PBS.
Since 1 July 2015, HIV antiretroviral therapy, Hepatitis B medicines and clozapine (maintenance therapy) have been listed under the community access arrangements which can be dispensed from community pharmacies. A full list of community access s100 Highly Specialised Drugs is listed on the PBS website.
The changes apply to prescriptions filled through NSW public hospitals, NSW community pharmacies and pharmacies used by NSW public hospital oncology services.
What are s100 Highly Specialised Drugs?
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 website.
What are s100 injectable and infusible chemotherapy medicines?
Injectable and infusible chemotherapy is used for the treatment of cancers in hospitals by oncology services. Oral chemotherapy, taken by mouth, which are general items on the PBS, are not affected by this commitment.
A full list of s100 injectable and infusible chemotherapy medicines is available on the PBS website.
Completing the patient consent form
Patients prescribed s100 Highly Specialised Drugs through NSW public hospitals or authorised NSW community prescribers must consent to NSW Health meeting the co-payment on their behalf.
For s100 Highly Specialised Drugs, the patient needs to sign a 12 Month Patient Consent Form. Examples of prescribing software compatible forms have been developed for Medical Director and Best Practice. 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 12 month 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.
For s100 injectable and infusible chemotherapy medicines, the consent form is signed when the prescription is filled at pharmacies used by NSW public hospital oncology services. This form indicates the patient’s agreement for the NSW Government 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.
Why are changes being made in NSW?
In March 2015, 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.
This commitment 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. A full list of conditions is available on the PBS website.
For health care professionals about HIV, visit the Australasian Society for HIV Medicine (ASHM) website.
About clozapine, please visit the websites for the two suppliers: Hospira Pty Ltd and Novartis Pharmaceuticals Australia Pty Ltd.