Who is eligible?
NSW residents treated by NSW public hospitals or by authorised NSW community prescribers, who 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 NSW public hospitals.
Co-payments for s100 Highly Specialised Drugs for patients who access care in the NSW private sector 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.
The co-payment is paid by the NSW Government for prescriptions filled through NSW public hospitals or community pharmacies.
Why are co-payments paid for by the NSW Government?
The NSW Government made the commitment to pay co-payments for s100 Highly Specialised Drugs in March 2015 to help ease the financial burden for people with some cancers 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.
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 available on the Pharmaceutical Benefits Scheme website.
Who is an authorised community prescriber in NSW?
An authorised community prescriber is a medical practitioner or nurse practitioner accredited and authorised to prescribe Highly Specialised Drugs in NSW.
Accreditation to be a community prescriber for HIV or Hepatitis B medicines is managed through an additional process by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. Accredited prescribers in NSW for HIV and Hepatitis B medicines are listed on the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine website.
For clozapine, prescribers and patients must meet the PBS eligibility requirements.
The prescriber does not need to be physically located in NSW for the patient to be eligible for the co-payment.
How do I fill my prescription?
Prescriptions for s100 Highly Specialised Drugs can be filled through NSW public hospital pharmacies. Some s100 Highly Specialised Drugs prescriptions can also be filled through community pharmacies.
Your doctor or community prescriber will provide you with a 12 Month Patient Consent Form to present to the pharmacist each time your prescription is filled, including any repeats. Once signed by the patient and the prescriber the form is valid for a period of 12 months. You will need to ensure that as you near the expiry of 12 months you obtain further consent from a prescriber/your doctor.
Once signed this form will allow the NSW Government to pay the co-payment contribution on your behalf. You will need to present the form each time you fill your prescription. If your patient consent form becomes lost, damaged or illegible, it is your responsibility to obtain a new consent form from your prescriber.
For urgent supplies, you should visit your nearest hospital pharmacy or call your community pharmacy ahead of time to ensure they have available stock or can order it in.
Why do I have to fill in a consent form?
When you receive a prescription for s100 Highly Specialised Drug from a NSW Public hospital prescriber or authorised NSW community prescriber, you will need to sign a consent form. This form will indicate your agreement for the NSW Government to pay the co-payment on your behalf and acknowledge that some details of the dispensing will be collected for monitoring processes. This form will indicate to the pharmacist that you are eligible.
Patients should talk to their doctor or prescriber about whether this commitment will affect them and how they normally fill prescriptions for s100 Highly Specialised Drugs.