{"id":"F2024L01277","name":"National Health (Additional Community Supply Support Payment) Determination 2024","slug":"national-health-additional-community-supply-support-payment-determination-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":105402,"registerId":"commonwealth-F2024L01277-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n  (1) This instrument is the National Health (Additional Community Supply Support Payment) Determination 2024.\n  (2) This instrument may also be cited as PB 94 of 2024.","sortOrder":0},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\n  This instrument is made under paragraph 98B(1)(b) of the National Health Act 1953.","sortOrder":1},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"#### 4 Definitions\n\n  (1) In this instrument:\n\n> Act means the National Health Act 1953.\n\n> increased maximum quantity of a pharmaceutical benefit means the maximum quantity or number of units of the benefit or the pharmaceutical item in the benefit that may, in one prescription, be directed to be supplied on any one occasion, for a relevant purpose, under a determination of the Minister under paragraph 85A(2)(a) of the Act.\n\n> increased maximum quantity prescription means a prescription directing, for a relevant purpose, the supply on any one occasion of the increased maximum quantity of a pharmaceutical benefit.\n\n> relevant purpose, for a pharmaceutical benefit, means a purpose, mentioned in Schedule 4 to the National Health (Listing of Pharmaceutical Benefits) Instrument 2024 for a purposes code (within the meaning of that instrument) specified in Schedule 1 to that instrument for the benefit, that includes the phrase “The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient”.\n\n  (2) An expression that is used in this instrument and in Part VII of the Act has the same meaning in this instrument as it has in that Part.\n\n> Note: Examples of such expressions include the following:\n\n    (a) ACSS eligible supply;\n    (b) ACSS payment;\n    (c) approved pharmacist;\n    (d) pharmaceutical benefit;\n    (e) pharmaceutical item;\n    (f) Schedule equivalent.","sortOrder":2},{"sectionNumber":"5","sectionType":"section","heading":"ACSS eligible supplies","content":"#### 5 ACSS eligible supplies\n\n  For the purposes of subparagraph 98B(1)(b)(i) of the Act, a supply by an approved pharmacist of a pharmaceutical benefit is an ACSS eligible supply unless the supply is made in accordance with any of the following special arrangements under section 100 of the Act:\n    (a) the National Health (Botulinum Toxin Program) Special Arrangement 2025;\n    (b) the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2024;\n    (c) the National Health (Growth Hormone Program) Special Arrangement 2025;\n    (d) the National Health (Highly Specialised Drugs Program) Special Arrangement 2021;\n    (e) the National Health (IVF Program) Special Arrangement 2025;\n    (f) the National Health (Take Home Naloxone) Special Arrangement 2019.","sortOrder":3},{"sectionNumber":"6","sectionType":"section","heading":"Amount of ACSS payment","content":"#### 6 Amount of ACSS payment\n\n  (1) For the purposes of subparagraph 98B(1)(b)(ii) of the Act, the amount of the ACSS payment for each ACSS eligible supply is:\n    (a) if paragraph (b) of this subsection does not apply—$1.21; or\n    (b) if subsection (2) or (3) of this section applies to the supply—the sum of:\n    (i) the amount mentioned in paragraph (a) of this subsection; and\n    (ii) $4.91.\n\n> Note: An approved pharmacist who wants to receive an ACSS payment must make a claim for the payment under section 99AAA of the Act. Entitlement to the payment is also subject to any applicable conditions determined under section 98C of the Act and the conditions set out in section 99AAAB of the Act.\n\n  (2) This subsection applies to an ACSS eligible supply of a pharmaceutical benefit if:\n    (a) the ACSS eligible supply is made upon an increased maximum quantity prescription directing the supply of:\n    (i) the benefit; or\n    (ii) another pharmaceutical benefit that is Schedule equivalent to the benefit; and\n    (b) the ACSS eligible supply is of the increased maximum quantity of the benefit.\n  (3) This subsection applies to an ACSS eligible supply of a pharmaceutical benefit if:\n    (a) the ACSS eligible supply is made to a person in accordance with section 89A of the Act (which deals with supplies of pharmaceutical benefits without a prescription); and\n    (b) the immediately preceding supply to the person of the benefit, or of another pharmaceutical benefit that is Schedule equivalent to the benefit, was made upon an increased maximum quantity prescription directing the supply of:\n    (i) the benefit; or\n    (ii) another pharmaceutical benefit that is Schedule equivalent to the benefit; and\n    (c) both the ACSS eligible supply, and the immediately preceding supply referred to in paragraph (b) of this subsection, are of the increased maximum quantity of the relevant pharmaceutical benefit.","sortOrder":4}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This Determination specifies which community pharmacy supplies count as ACSS eligible and fixes the payment amounts, while excluding certain named special arrangements (s 5, s 6). By doing so it alters the operational scope of ACSS payments within the Act’s payment framework: it narrows eligibility for payments by excluding defined special arrangements and creates a conditional premium for supplies meeting the \"increased maximum quantity\" rules (s 5; s 6(1)–(3)). Implementation depends on external schedules that define the \"relevant purpose\" and increased maximum quantities (s 4(1)), which affects how broadly the payment will apply in practice."},"complexity_factors":["Cross-references to multiple provisions in the National Health Act (s 98B, s 89A, s 99AAA, s 98C, s 99AAAB) increase administrative and legal interdependence.","Dependence on external instrument schedules for the crucial definition of 'relevant purpose' and 'increased maximum quantity' (s 4(1)).","Two-tier payment logic with conditional eligibility (base payment vs. additional payment when increased maximum quantity conditions apply) (s 6(1)–(3)).","Listed exclusions of multiple named special arrangements that change eligibility in specific program contexts (s 5(a)–(f)).","Operational compliance tasks for pharmacists: verifying prescriptions, tracking immediately preceding supplies for s 6(3), and making claims under s 99AAA (s 6 Note)."],"plain_english_summary":"### What this instrument does\n\n- This Determination defines which community pharmacy supplies qualify for an \"Additional Community Supply Support\" (ACSS) payment and sets the dollar amount of that payment. It is made under paragraph 98B(1)(b) of the National Health Act 1953 (see s 3).\n\n- It declares that, except where specific special arrangements apply, a supply of a pharmaceutical benefit by an \"approved pharmacist\" is an ACSS eligible supply (see s 5). The Determination lists six named special arrangements whose supplies are excluded from ACSS eligibility (s 5(a)–(f)).\n\n- It sets a two-tiered payment for each eligible supply: a base payment of $1.21 per supply, and an additional $4.91 (making $6.12 total) for supplies that meet the instrument's \"increased maximum quantity\" conditions (s 6(1)–(3)).\n\n- The extra payment applies when the supply is made on an \"increased maximum quantity prescription\" (that is, a prescription directing the larger permitted quantity) (s 6(2)), or when a supply made without a prescription under section 89A follows an immediately preceding increased-maximum-quantity supply and both supplies are of the increased maximum quantity (s 6(3)).\n\n- The Determination relies on definitions and cross-references in the National Health Act and the National Health (Listing of Pharmaceutical Benefits) Instrument 2024 to identify what counts as an \"increased maximum quantity\" and a \"relevant purpose\" (s 4(1); see the Note and definition cross-reference in s 4(2)).\n\n\nWho is affected and who pays\n\n- Approved pharmacists who supply pharmaceutical benefits in the community are eligible to claim these payments for qualifying supplies (see s 4(2), s 6 Note). Pharmacies that operate under the listed special arrangements are excluded from ACSS eligibility for those supplies (s 5).\n\n- The payment is provided under the National Health Act framework; claims must be made under section 99AAA of the Act and are subject to any conditions made under section 98C and those set out in section 99AAAB of the Act (s 6 Note). That means the Commonwealth’s pharmaceutical benefits payment system funds the ACSS payments under the Act's procedures.\n\n\nWhy it matters (mechanics, incentives and trade-offs)\n\n- Payment signal: The Determination places a small base payment ($1.21) on each ACSS eligible supply and a specific premium ($4.91) for supplies made to the increased maximum quantity specified by prescription rules (s 6). This creates a direct monetary incentive for approved pharmacists to supply larger permitted quantities when the prescription and other legal conditions permit.\n\n- Who decides and compliance burden: Eligibility and entitlement depend on several legal conditions and administrative steps. Pharmacists must be \"approved\" (s 4(2)), must make claims under s 99AAA, and must meet any conditions imposed under ss 98C and 99AAAB of the Act (s 6 Note). Verifying eligibility requires checking the prescription wording (an \"increased maximum quantity prescription\") and whether the supply was for a \"relevant purpose\" as defined by other listing instruments (s 4(1)). These cross-references add administrative steps for pharmacists and for the agency processing claims.\n\n- Interaction with other arrangements: The Determination explicitly excludes supplies that occur under certain named special arrangements (s 5(a)–(f)). That exclusion changes which supplies attract ACSS payments and may shift which payment rules apply to particular programs.\n\n- Behavioural substitution and stock/contract effects: Because the extra amount attaches to supplying an increased maximum quantity, pharmacists and prescribers have an economic motive to use prescriptions and supply patterns that meet the increased-quantity criteria where clinically appropriate (s 6(2)–(3)). This could affect stock-holding, ordering and dispensing patterns at pharmacies.\n\n- Verification and implementation risk: The instrument depends on other statutory instruments and schedules to define the phrase \"relevant purpose\" and what counts as an \"increased maximum quantity\" (s 4(1)). That dependence requires administrative systems to match claims against those external schedule definitions, creating a risk of mismatch, delay, or disputes about entitlement if the external instruments are updated or interpreted differently.\n\n\nConcrete costs and benefits (mechanical)\n\n- Benefit to approved pharmacists: an additional $1.21 per eligible supply as a baseline, with an extra $4.91 where the supply meets the increased maximum quantity conditions (s 6(1)).\n\n- Cost bearer: the payments are made under the Act's payment framework (see s 3, s 6 Note). Paying these amounts uses the Act’s funding and administrative processes rather than creating a separate funding stream.\n\n\nKey cross-references to check when implementing or assessing claims\n\n- The definition of \"relevant purpose\" relies on Schedule 4 and Schedule 1 of the National Health (Listing of Pharmaceutical Benefits) Instrument 2024 (s 4(1)).\n- Claims and entitlement procedures are under ss 99AAA, 98C and 99AAAB of the Act (s 6 Note).\n- Supplies without a prescription are governed by s 89A of the Act, which is referenced for one eligibility path for the extra payment (s 6(3))."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument appears tightly scoped to its original purpose. It implements specific payment mechanics for the Additional Community Supply Support (ACSS) scheme introduced to support 60-day dispensing reforms. The instrument does not expand beyond its core function of determining eligible supplies and payment amounts."},"complexity_factors":["6 defined terms in section 4, plus incorporation by reference of multiple expressions from Part VII of the National Health Act 1953","Nested conditional logic in section 6: base rate ($1.21) vs enhanced rate ($6.12) determined by two alternative triggering conditions in subsections (2) and (3)","Cross-references to external instruments: National Health (Listing of Pharmaceutical Benefits) Instrument 2024 (Schedule 4 and Schedule 1), plus 6 separate special arrangement instruments listed in section 5","Technical concept of 'Schedule equivalent' pharmaceutical benefits requiring knowledge of PBS scheduling","Complex definition of 'relevant purpose' requiring parsing of purpose codes and conditional phrases from another legislative instrument","Section 6(3) creates a three-part test for emergency supplies without prescription, requiring look-back to immediately preceding supply"],"plain_english_summary":"This legislation sets up extra payments for pharmacies that dispense certain prescription medicines under Australia's Pharmaceutical Benefits Scheme (PBS).\n\n**What it does:**\n- Creates a bonus payment (called an \"ACSS payment\") for approved pharmacists when they supply PBS medicines to patients.\n- The standard payment is **$1.21** per supply.\n- However, if the pharmacist is dispensing a **larger-than-usual quantity** of medicine (specifically for patients with stable chronic conditions who qualify for extended supplies), the payment jumps to **$6.12** ($1.21 + $4.91).\n- This higher payment also applies when a pharmacist supplies medicine without a prescription in an emergency, provided the patient's last prescription was one of these larger-quantity ones.\n\n**Who it affects:**\n- **Community pharmacies** approved to supply PBS medicines.\n- **Patients** with stable chronic conditions who qualify for 60-day prescriptions (or other increased quantities) under recent PBS reforms.\n\n**Why it matters:**\nThe government is essentially paying pharmacies extra to handle these larger prescription quantities. This recognises that dispensing 60 days' worth of medicine at once involves different logistics, counselling, and record-keeping compared to standard 30-day supplies. It also covers the scenario where a patient needs an emergency supply between these larger prescriptions.\n\n**Key exclusions:**\nThe bonus payment doesn't apply to medicines supplied under special government programs like chemotherapy, IVF, growth hormone, botulinum toxin, highly specialised drugs, or take-home naloxone programs."}},"importantCases":[],"_links":{"self":"/api/acts/national-health-additional-community-supply-support-payment-determination-2024","history":"/api/acts/national-health-additional-community-supply-support-payment-determination-2024/history","analysis":"/api/acts/national-health-additional-community-supply-support-payment-determination-2024/analysis","conflicts":"/api/acts/national-health-additional-community-supply-support-payment-determination-2024/conflicts","importantCases":"/api/acts/national-health-additional-community-supply-support-payment-determination-2024/important-cases","documents":"/api/acts/national-health-additional-community-supply-support-payment-determination-2024/documents"}}