{"id":"F2026L00219","name":"National Health (Closing the Gap—PBS Co-payment Program) Special Arrangement 2026","slug":"national-health-closing-the-gap-pbs-co-payment-program-special-arrangement-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443173,"registerId":"F2026L00219-fast-fetch-1775958083432","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"National Health (Closing the Gap—PBS Co-payment Program) Special Arrangement 2026","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n![Commonwealth Coat of Arms of Australia](image.001.jpeg)\n\n \n\nNational Health (Closing the Gap—PBS Co‑payment Program) Special Arrangement 2026\n\nI, Sarah Norris, as delegate of the Minister for Health and Ageing, make the following special arrangement.\n\nDated   25 February 2026\n\nSarah Norris\n\nAssistant Secretary  Community Access Programs Branch  Technology Assessment and Access Division  Department of Health, Disability and Ageing\n\n \n\n \n\n \n\n \n\nContents\n\nPart 1—Preliminary\n\nDivision 1—General\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Simplified outline\n\n5 Definitions\n\n6 Meaning of special arrangement supply\n\n7 Pharmaceutical benefits covered by this instrument\n\nDivision 2—CTG registered patients\n\n8 Registration of eligible patients\n\nPart 2—Supply of pharmaceutical benefits under this instrument\n\n9 General modifications\n\n10 Co‑payment reduction etc.\n\n11 Value for safety net purposes\n\nPart 3—Payment for supply of pharmaceutical benefits under this instrument\n\n12 Payment by Commonwealth\n\n13 Claim for payment\n\nPart 4—Transitional arrangements\n\nDivision 1—Transitional provisions in relation to the commencement of this instrument\n\n14 Things done under the National Health (Closing the Gap — PBS Co‑payment Program) Special Arrangement 2016\n\n15 Existing registered patients\n\n \n\nPart 1—Preliminary\n\nDivision 1—General\n\n \n\n1  Name\n\n (1) This instrument is the National Health (Closing the Gap—PBS Co‑payment Program) Special Arrangement 2026.\n\n (2) This instrument may also be cited as PB 25 of 2026.\n\n2  Commencement\n\n (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provisions Commencement Date/Details\n- 1. The whole of this instrument 1 April 2026. 1 April 2026\n\n\nNote: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.\n\n3  Authority\n\n  This instrument is made under section 100 of the National Health Act 1953.\n\n4  Simplified outline\n\nThis instrument makes a special arrangement for, or in relation to, providing that an adequate supply of pharmaceutical benefits will be available to Aboriginal or Torres Strait Islander patients who are registered under this instrument.\n\nUnder this instrument, CTG registered patients have their co‑payments eliminated or reduced on certain pharmaceutical benefits. CTG registered patients also have their co‑payments eliminated or reduced on certain pharmaceutical benefits covered by other special arrangements.\n\nThis instrument also deals with payments for supplies of pharmaceutical benefits covered by this instrument.\n\nNote: Part VII of the Act, and regulations or other instruments made for the purposes of that Part, have effect subject to this instrument (see subsection 100(3) of the Act).\n\n5  Definitions\n\nNote A number of expressions used in this instrument are defined in the Act, including the Chief Executive Medicare.\n\n  In this instrument:\n\nAct means the National Health Act 1953.\n\nallowable discount has the same meaning as in Part VII of the Act.\n\napproved hospital authority has the same meaning as in Part VII of the Act.\n\napproved medical practitioner has the same meaning as in Part VII of the Act.\n\napproved pharmacist has the same meaning as in Part VII of the Act.\n\nconcessional beneficiary charge has the same meaning as in Division 4A of Part VII of the Act.\n\nCTG registered patient means a person registered under subsection 8(1).\n\nCTG supplier means an approved supplier (within the meaning of Part VII of the Act).\n\nNote: Each of the following is an approved supplier:\n\n(a) an approved pharmacist;\n\n(b) an approved medical practitioner;\n\n(c) an approved hospital authority.\n\ngeneral patient charge has the same meaning as in Division 4A of Part VII of the Act.\n\ngeneral patient reduced charge has the same meaning as in Division 4A of Part VII of the Act.\n\nlisted brand has the same meaning as in Part VII of the Act.\n\npharmaceutical benefit has the same meaning as in Part VII of the Act.\n\npharmaceutical item has the same meaning as in Part VII of the Act.\n\nspecial arrangement supply: see section 6.\n\nspecial patient contribution has the same meaning as in Part VII of the Act.\n\nvalue for safety net purposes has the same meaning as in Part VII of the Act.\n\n6  Meaning of special arrangement supply\n\n  A supply of a pharmaceutical benefit to a person is a special arrangement supply of the benefit if:\n\n (a) the person is a CTG registered patient; and\n\n (b) the benefit is supplied by a CTG supplier; and\n\n (c) if the prescription for supply of the benefit to the person is a medication chart prescription (within the meaning of the National Health (Pharmaceutical Benefits) Regulations 2017)—the person is receiving treatment in or at an approved residential care home (within the meaning of the Aged Care Act 2024) in which the person is accessing funded aged care services through the service group residential care (within the meaning of that Act).\n\n7  Pharmaceutical benefits covered by this instrument\n\n (1) This instrument applies to a pharmaceutical benefit that is available for supply in accordance with Part VII of the Act (including in accordance with special arrangements under section 100 of the Act).\n\n (2) However, this instrument does not apply to a pharmaceutical benefit that can only be supplied under the prescriber bag provisions (within the meaning of Part VII of the Act).\n\nNote 1: See section 85AAA of the Act in relation to pharmaceutical benefits that can only be supplied under the prescriber bag provisions of the Act.\n\nNote 2: The modifications of the Act under this instrument relating to:\n\n(a) charges for the supply of a pharmaceutical benefit (see section 10); and\n\n(b) payments to a CTG supplier by the Commonwealth for the supply of a pharmaceutical benefit (see section 12);\n\nmay apply in relation to the supply of a pharmaceutical benefit under other special arrangements made under section 100 of the Act to a CTG registered patient.\n\nNote 3: In 2026, the other special arrangements referred to in Note 2 are the following:\n\n(a) the National Health (Botulinum Toxin Program) Special Arrangement 2025;\n\n(b) the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2024;\n\n(c) the National Health (Growth Hormone Program) Special Arrangement 2025;\n\n(d) the National Health (Highly Specialised Drugs Program) Special Arrangement 2021;\n\n(e) the National Health (IVF Program) Special Arrangement 2025.\n\nDivision 2—CTG registered patients\n\n \n\n8  Registration of eligible patients\n\nEligible patients may be registered by registering practitioners\n\n (1) A registering practitioner may register a patient for the supply of pharmaceutical benefits in accordance with this instrument if:\n\n (a) the patient:\n\n (i) is entitled to receive pharmaceutical benefits as mentioned in section 86 of the Act; and\n\n (ii) identifies themself to the practitioner as being of Aboriginal or Torres Strait Islander descent; and\n\n (iii) provides consent to the practitioner to receive supplies in accordance with this instrument; and\n\n (b) in the opinion of the registering practitioner, the patient:\n\n (i) would experience setbacks in the prevention or ongoing management of a medical condition if the patient did not adhere to a course of treatment (involving a pharmaceutical benefit) for that medical condition; and\n\n (ii) is unlikely to adhere to the course of treatment without assistance under this instrument.\n\n (2) A registering practitioner is:\n\n (a) a PBS prescriber (within the meaning of Part VII of the Act); or\n\n (b) an individual who:\n\n (i) is registered in the Aboriginal and Torres Strait Islander health practice profession under the Health Practitioner Regulation National Law (within the meaning of Part VIIIA of the Act); and\n\n (ii) has been allocated an identification number by the Chief Executive Medicare, for the purposes of the Health Insurance Act 1973, in relation to a place of practice.\n\nNote:  For the allocation of identification numbers mentioned in subparagraph (b)(ii), see section 35 of the Human Services (Medicare) Regulations 2017.\n\nHow registration is to be made\n\n (3) The registration must be made by use of the HPOS (short for Health Professional Online Services).\n\nNote: In 2026, the HPOS could be accessed on the Services Australia website (https://www.servicesaustralia.gov.au/).\n\n (4) However, the registration may be made by telephone to Services Australia if, for reasons outside the registering practitioner’s control, the practitioner:\n\n (a) does not have access to functioning IT systems, including the internet; or\n\n (b) is unable to access the HPOS.\n\nPart 2—Supply of pharmaceutical benefits under this instrument\n\n \n\n9  General modifications\n\nSpecial arrangement supplies not eligible for increased discounting\n\n (1) Despite section 87AA of the Act, a special arrangement supply of a pharmaceutical benefit is not eligible for increased discounting.\n\nUnder co‑payment supplies\n\n (2) Despite subsections 99(2A), (2AB) and (2B) of the Act, a supply and receipt of a pharmaceutical benefit described in any of those subsections is taken, for the purposes of this instrument, to be a supply and receipt for the purposes of Part VII of the Act.\n\n10  Co‑payment reduction etc.\n\n (1) Section 87 of the Act applies to a special arrangement supply of a pharmaceutical benefit subject to the modifications set out in this section.\n\nCo‑payment of nil for concessional beneficiaries\n\n (2) The amount that a CTG supplier acting in accordance with the supplier’s approval may charge for a special arrangement supply of a pharmaceutical benefit is nil if the CTG registered patient receiving the supply:\n\n (a) would otherwise have been charged the concessional beneficiary charge or the general patient reduced charge for the supply; or\n\n (b) is receiving a supply that is described in subsection 99(2AB) or (2B) of the Act.\n\nNote: Under the Act, a supply described in subsection 99(2AB) or (2B) of the Act is deemed to be a supply and receipt otherwise than under Part VII of the Act, other than for the purposes of Division 1A of that Part and normally an approved supplier does not make a claim for payment for supply of a pharmaceutical benefit. When a special arrangement supply is made in accordance with this instrument, a CTG supplier may make a claim in accordance with section 13 of this instrument.\n\nCo‑payment reduction for general patients\n\n (3) The amount that a CTG supplier acting in accordance with the supplier’s approval may charge for a special arrangement supply of a pharmaceutical benefit is:\n\n (a) in the case that the CTG registered patient receiving the supply would otherwise have been charged the general patient charge for the supply—an amount that is equal to the concessional beneficiary charge (less any allowable discount); or\n\n (b) in the case that the CTG registered patient is receiving a supply that is described in subsection 99(2A) of the Act—an amount that does not exceed the lower of:\n\n (i) the concessional beneficiary charge; and\n\n (ii) the Commonwealth price (within the meaning of Part VII of the Act) in relation to the pharmaceutical benefit.\n\nNote: Under the Act, a supply described in subsection 99(2A) of the Act is deemed to be a supply and receipt otherwise than under Part VII of the Act, other than for the purposes of Division 1A of that Part and normally an approved supplier does not make a claim for payment for supply of a pharmaceutical benefit. When a special arrangement supply is made in accordance with this instrument, a CTG supplier may make a claim in accordance with section 13 of this instrument.\n\nSpecial patient contributions—approved pharmacists and approved medical practitioners\n\n (4) Subsection (5) applies if:\n\n (a) a CTG supplier that is an approved pharmacist or approved medical practitioner makes a special arrangement supply of a pharmaceutical benefit that is a listed brand of a pharmaceutical item in relation to which a determination under subsection 85B(3) of the Act is in force; and\n\n (b) the supplier is not entitled to be paid by the Commonwealth an amount equal to the special patient contribution for the brand of the pharmaceutical item that is the pharmaceutical benefit under subsection 99(2AA) of the Act.\n\n (5) In addition to any amount that may be charged for the special arrangement supply in accordance with subsection (2) or (3) of this section (which may be an amount of nil), the CTG supplier acting in accordance with the supplier’s approval may charge the CTG registered patient to whom the benefit is supplied an amount equal to the special patient contribution mentioned in paragraph (4)(b).\n\n (6) Subsection (5) applies despite subsection 87(2A) of the Act.\n\nSpecial patient contributions—approved hospital authorities\n\n (7) Subsection (8) applies if:\n\n (a) a CTG supplier that is an approved hospital authority makes a special arrangement supply of a pharmaceutical benefit that is a listed brand of a pharmaceutical item in relation to which a determination under subsection 85B(3) of the Act is in force; and\n\n (b) the supply is not an early supply of a specified pharmaceutical benefit (within the meaning of Part VII of the Act) prescribed for a patient who is the holder of an entitlement card.\n\n (8) In addition to any amount that may be charged for the special arrangement supply in accordance with subsection (2) or (3) of this section (which may be an amount of nil), the CTG supplier acting in accordance with the supplier’s approval may charge the CTG registered patient to whom the benefit is supplied an amount equal to the special patient contribution for the brand of the pharmaceutical item that is the pharmaceutical benefit as if the supply had been made by an approved pharmacist.\n\n (9) Subsection (8) has effect in addition to section 87 of the Act.\n\nCharge for delivery of pharmaceutical benefits\n\n (10) To avoid doubt, nothing in this section prevents a CTG supplier that is an approved pharmacist or approved medical practitioner from charging an amount in accordance with regulations made for the purposes of subsection 87(4) of the Act.\n\nNote: For the charge for delivery of pharmaceutical benefits, see section 56 of the National Health (Pharmaceutical Benefits) Regulations 2017.\n\nMeaning of approval\n\n (11) For the purposes of subsections (2), (3), (5) and (8), an approval of a CTG supplier is an approval or deemed approval mentioned in:\n\n (a) for an approved pharmacist—the definition of approved pharmacist in subsection 84(1) of the Act; and\n\n (b) for an approved medical practitioner—the definition of approved medical practitioner in subsection 84(1) of the Act; and\n\n (c) for an approved hospital authority—the definition of approved hospital authority in subsection 84(1) of the Act.\n\n11  Value for safety net purposes\n\n (1) Regulations made for the purposes of subsection 84C(1E) of the Act apply to a special arrangement supply of a pharmaceutical benefit subject to the modifications set out in this section.\n\n (2) Despite subsection 17A(2) of the National Health (Pharmaceutical Benefits) Regulations 2017, the value for safety net purposes of the amount charged for a special arrangement supply of a pharmaceutical benefit to which paragraph 10(2)(b) or (3)(b) of this instrument applies is the price of the pharmaceutical benefit worked out in accordance with a determination in force at the time of the supply under subsection 84C(7) of the Act.\n\nNote: In 2026, the determination is the National Health (Pharmaceutical Benefits) (Subsection 84C(7) Price) Determination 2019.\n\n (3) Despite subsection 17A(3) of the National Health (Pharmaceutical Benefits) Regulations 2017, the value for safety net purposes of the amount charged for a special arrangement supply of a pharmaceutical benefit to which paragraph 10(2)(a) or (3)(a) of this instrument applies is:\n\n (a) if the concessional beneficiary charge or the general patient reduced charge would have applied to the supply but for paragraph 10(2)(a)—the concessional beneficiary charge or the general patient reduced charge respectively (less any allowable discount); and\n\n (b) if the general patient charge would have applied to the supply but for paragraph 10(3)(a)—$42.50 (less any allowable discount).\n\nPart 3—Payment for supply of pharmaceutical benefits under this instrument\n\n \n\n12  Payment by Commonwealth\n\n (1) Section 99 of the Act applies to a special arrangement supply of a pharmaceutical benefit subject to the modifications set out in this section.\n\nIf the co‑payment is nil under paragraph 10(2)(a)\n\n (2) If the amount that a CTG supplier is entitled to charge for a special arrangement supply of a pharmaceutical benefit is nil under paragraph 10(2)(a), the supplier is entitled to be paid by the Commonwealth an amount equivalent to the concessional beneficiary charge or the general patient reduced charge in addition to what the supplier is entitled to be paid for the supply under subsection 99(2) of the Act and, if relevant, subsection 99(2AA) of the Act or subsection 99(4) of the Act.\n\nIf the co‑payment is nil under paragraph 10(2)(b)\n\n (3) If the amount that a CTG supplier is entitled to charge for a special arrangement supply of a pharmaceutical benefit is nil under paragraph 10(2)(b), the supplier is entitled to be paid by the Commonwealth the price worked out in accordance with a determination in force under subsection 84C(7) of the Act for the pharmaceutical benefit.\n\nIf the co‑payment is for a general patient under paragraph 10(3)(a)\n\n (4) If the amount that a CTG supplier is entitled to charge for a special arrangement supply of a pharmaceutical benefit is equal to the concessional beneficiary charge (less any allowable discount) under paragraph 10(3)(a), the supplier is entitled to be paid the difference between the concessional beneficiary charge and the general patient charge (ignoring any discount given) in addition to what the supplier is entitled to be paid for the supply under subsection 99(2) and, if relevant subsection 99(2AA) of the Act or subsection 99(4) of the Act.\n\nIf the co‑payment is for a general patient under paragraph 10(3)(b)\n\n (5) If the amount that a CTG supplier is entitled to charge for a special arrangement supply of a pharmaceutical benefit is equal to the concessional beneficiary charge under paragraph 10(3)(b), the supplier is entitled to be paid by the Commonwealth the amount (if any) by which the price worked out in accordance with a determination in force under subsection 84C(7) of the Act for the pharmaceutical benefit exceeded the amount charged.\n\nNote: Approved pharmacists who make ACSS eligible supplies (within the meaning of Part VII of the Act) may also be entitled to ACSS payments (within the meaning of Part VII of the Act) under section 99AAAA of the Act.\n\n13  Claim for payment\n\n (1) Section 99AAA of the Act applies to a special arrangement supply of a pharmaceutical benefit subject to the modifications set out in this section.\n\n (2) A CTG supplier who wants to receive payment from the Commonwealth in relation to a special arrangement supply of a pharmaceutical benefit must make a claim for payment to the Chief Executive Medicare on behalf of the Secretary.\n\n (3) If the claim is in relation to a special arrangement supply mentioned in paragraph 10(2)(b) or 10(3)(b), the claim must be made in accordance with rules made for the purposes of subsection 99AAA(8) of the Act as if the supply were a supply to which Part VII of the Act applies.\n\n (4) If the claim is made using a manual system (within the meaning of section 99AAA of the Act), the claim must include an indicator that the claim is being made for a special arrangement supply of a pharmaceutical benefit.\n\nPart 4—Transitional arrangements\n\nDivision 1—Transitional provisions in relation to the commencement of this instrument\n\n \n\n14  Things done under the National Health (Closing the Gap — PBS Co‑payment Program) Special Arrangement 2016\n\n (1) If:\n\n (a) a thing was done for a particular purpose under the National Health (Closing the Gap—PBS Co‑payment Program) Special Arrangement 2016 as in force immediately before that instrument was repealed; and\n\n (b) the thing could be done for that purpose under this instrument;\n\nthe thing has effect for the purposes of this instrument as if it had been done for that purpose under this instrument.\n\n (2) Without limiting subsection (1), a reference in that subsection to a thing being done includes a reference to the following:\n\n (a) the registration of a patient;\n\n (b) writing a prescription for a special arrangement supply of a pharmaceutical benefit;\n\n (c) charging a person for a special arrangement supply of a pharmaceutical benefit;\n\n (d) making a claim for a payment from the Commonwealth for a special arrangement supply of a pharmaceutical benefit.\n\n15  Existing registered patients\n\n  At the commencement of this instrument, a person is taken to be a patient registered under subsection 8(1) of this instrument if, immediately before the repeal of the National Health (Closing the Gap — PBS Co‑payment Program) Special Arrangement 2016, the person was a patient registered under subsection 10(2) of that instrument.\n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The instrument maintains the original scope of the 2016 Closing the Gap PBS Co-payment Program. While it updates the legislative framework and extends the program's operation, it does not expand beyond the original purpose of reducing pharmaceutical co-payments for Aboriginal and Torres Strait Islander patients to improve medication adherence. The inclusion of other special arrangements (chemotherapy, IVF, etc.) was already a feature of the 2016 instrument and represents implementation detail rather than scope creep."},"complexity_factors":["Extensive cross-referencing to the National Health Act 1953 (Part VII) and associated regulations, requiring readers to understand definitions and provisions in external instruments","Multiple conditional payment calculations in sections 10 and 12 with nested scenarios (concessional vs general patients, subsection 99(2A) vs 99(2AB) vs 99(2B) supplies, allowable discounts)","Dual registration pathways for practitioners (PBS prescribers vs Aboriginal and Torres Strait Islander health practitioners) with different qualification requirements","Complex transitional provisions ensuring continuity from the 2016 instrument, including deemed registrations and preserved actions","Interaction with five other special arrangements (Botulinum Toxin, Chemotherapy, Growth Hormone, Highly Specialised Drugs, and IVF programs) noted in section 7","Technical distinctions between 'special arrangement supplies' under this instrument versus standard PBS supplies, affecting payment mechanisms and safety net calculations","Specific exclusion for prescriber bag supplies and conditional inclusion for medication chart prescriptions in residential aged care"],"plain_english_summary":"**What this legislation does:**\n\nThis instrument creates a special arrangement under the National Health Act 1953 to make prescription medicines more affordable for Aboriginal and Torres Strait Islander people who face barriers to taking their medication as prescribed.\n\n**Who it affects:**\n\n- **Patients:** Aboriginal or Torres Strait Islander people who are registered under the program (called \"CTG registered patients\"). To qualify, a health practitioner must determine that the patient would struggle to stick to their treatment without financial help, and that not taking their medication would worsen their health.\n- **Health practitioners:** Doctors, nurse practitioners, and Aboriginal and Torres Strait Islander health practitioners who can register eligible patients using an online system (HPOS) or by phone.\n- **Pharmacies and hospitals:** Approved suppliers (pharmacists, doctors, and hospital authorities) who dispense medicines under this program.\n\n**How it works:**\n\n- **Registration:** Eligible patients are registered by authorised health practitioners through Services Australia's online portal.\n- **Reduced costs:** Once registered, patients pay less for their PBS medicines:\n  - **Concessional patients** (those with concession cards) pay **nothing** (instead of the usual concessional co-payment).\n  - **General patients** (those without concession cards) pay the **concessional rate** instead of the higher general patient rate—saving roughly $30 per prescription in 2026.\n- **Safety net:** The value of these subsidised medicines still counts toward the PBS Safety Net, which provides further free or cheaper medicines once a spending threshold is reached.\n- **Payments:** The Commonwealth reimburses pharmacies and hospitals for the difference between what the patient pays and the full cost of the medicine.\n\n**Why it matters:**\n\nThis program addresses a significant health equity gap. Aboriginal and Torres Strait Islander people experience higher rates of chronic disease and earlier death than other Australians. Cost is a major barrier to taking prescribed medicines. By eliminating or reducing co-payments, this instrument aims to improve medication adherence, prevent disease complications, and close the gap in health outcomes.\n\n**Key features:**\n- The program applies to most PBS medicines, including those supplied under other special programs (like chemotherapy or IVF drugs).\n- It replaces and continues the 2016 Closing the Gap PBS Co-payment Program, with existing registrations automatically transferring to the new system.\n- Patients in residential aged care can also benefit when their medicines are prescribed via medication charts."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"The instrument continues a special arrangement providing reduced or nil PBS co‑payments for registered Aboriginal and Torres Strait Islander patients and carries forward registrations and actions from the earlier 2016 arrangement (sections 14–15). It operates by modifying how Part VII of the Act applies to those supplies (sections 9, 10, 11, 12, 13) rather than introducing a new, broader class of beneficiaries or an expansion beyond the pre‑existing framework described in the instrument."},"complexity_factors":["Extensive cross‑references to Part VII of the National Health Act and to subordinate determinations and regulations (sections 9, 11, 12, 13).","Multiple patient charge categories (concessional beneficiary, general reduced, general patient, special patient contributions) with different rules for each (section 10).","Different treatment for supplies that are deemed under subsections 99(2A), (2AB), (2B) and for prescriber bag exclusions (sections 7, 9(2), 10 notes).","Registration requires practitioner subjective judgment about adherence risk and uses specific electronic systems (HPOS) with limited telephone fallback (section 8).","Supplier payment entitlements depend on several alternative calculation formulas linked to existing determinations (section 12).","Safety net valuation rules are modified only for special arrangement supplies and depend on determinations under subsection 84C(7) (section 11).","Claims and manual claim indicators must follow adapted rules, adding operational steps for suppliers (section 13).","Transitional carry‑over of prior registrations and acts requires mapping prior instrument actions to this instrument (sections 14–15)."],"plain_english_summary":"What this instrument does, in plain terms\n\n- Establishes a special arrangement called the National Health (Closing the Gap—PBS Co‑payment Program) Special Arrangement 2026 (the instrument) to change how certain Pharmaceutical Benefits Scheme (PBS) medicines are supplied to registered Aboriginal and Torres Strait Islander patients (called CTG registered patients). The instrument takes effect 1 April 2026 (see section 2).\n\nWhat it covers and who is affected\n\n- Which medicines: It applies to PBS pharmaceutical benefits supplied under Part VII of the National Health Act 1953, except medicines that can only be supplied under the prescriber bag provisions (section 7(1)–(2)).\n- Who can get the changed treatment: A person can become a CTG registered patient when a registering practitioner registers them on HPOS or, in limited cases, by telephone (section 8(1), (3)–(4)). The practitioner must form an opinion the person would suffer setbacks without adherence help and is unlikely to adhere without assistance (section 8(1)(b)). The patient must identify as Aboriginal or Torres Strait Islander and consent to participate (section 8(1)(a)(ii)–(iii)).\n- Who supplies medicines under the arrangement: Supplies must be made by an approved supplier (an approved pharmacist, approved medical practitioner, or approved hospital authority) — defined in section 5 and applied in section 6.\n\nKey mechanical changes to charges and payments\n\n- Co‑payments for CTG registered patients are either eliminated or reduced depending on the patient’s usual charge category:\n  - If the patient would otherwise pay the concessional beneficiary charge or the general patient reduced charge (or is receiving a supply treated under subsections 99(2AB) or (2B) of the Act), the supplier may charge nil for that supply (section 10(2)).\n  - If the patient would otherwise pay the general patient charge, the supplier may charge an amount equal to the concessional beneficiary charge (less any allowable discount) (section 10(3)(a)).\n  - For supplies deemed under subsection 99(2A), the supplier may charge no more than the lower of the concessional beneficiary charge and the Commonwealth price for the medicine (section 10(3)(b)).\n- Where suppliers charge nil or a reduced amount, the Commonwealth pays suppliers specified compensating amounts so suppliers receive payment for the supply (section 12(2)–(5)). The payment formulas vary depending on which co‑payment rule applied (section 12).\n- Special patient contributions (co‑payments that apply to particular listed brands) may still be charged in certain situations by approved pharmacists, medical practitioners or hospital authorities (sections 10(4)–(9)).\n- A special arrangement supply is not eligible for increased discounting (section 9(1)), and the instrument modifies the value counted towards PBS safety net thresholds for these supplies (section 11).\n- Suppliers claim the Commonwealth payments through Chief Executive Medicare under modified claim rules; manual claims must include an indicator that the claim is for a special arrangement supply (section 13(2)–(4)).\n\nWhy the instrument matters (stated purpose and how it operates financially and administratively)\n\n- The instrument is presented as making an adequate supply of PBS medicines available to registered Aboriginal and Torres Strait Islander patients by removing or reducing out‑of‑pocket costs and by ensuring suppliers are paid by the Commonwealth for those supplies (see simplified outline and sections 4, 10, 12).\n\nCosts, incentives, trade‑offs and implementation mechanics (source‑grounded)\n\n- Who pays and who receives money: Patients face lower out‑of‑pocket costs (section 10). The Commonwealth reimburses suppliers under the payment formulas in section 12. Suppliers therefore have a direct financial incentive to participate because the instrument provides statutory payment entitlements where suppliers charge nil or reduced co‑payments.\n- Who decides access: Registration requires an approving judgment by a registering practitioner that the patient needs adherence support and is unlikely to adhere without it; that practitioner effectually decides which patients receive the treatment of this program (section 8(1)(b)). The instrument limits registration to practitioners with specified approvals or identification numbers (section 8(2)).\n- Compliance and administrative burden: Registering practitioners must use HPOS for registration except where IT access is unavailable (section 8(3)–(4)). Suppliers must make claims to Chief Executive Medicare using rules adapted for special arrangement supplies, and manual claims must include a special indicator (section 13(2)–(4)). These steps create administrative tasks for practitioners and suppliers.\n- Bureaucratic discretion and operational control: The Chief Executive Medicare and the Secretary are the payment/claim processing authorities for suppliers (section 13(2)). Determinations under subsection 84C(7) of the Act set pricing references used by this instrument (section 11(2), section 12(3), (5)). Those existing administrative instruments and officials therefore determine key numeric values applied under this arrangement.\n- Interaction with broader PBS settings: The instrument explicitly modifies aspects of Part VII (discounting eligibility, safety‑net valuation, and payment claim rules) rather than replacing them, so it operates by layering adjustments onto the existing PBS framework (sections 9, 11, 12, 13). Supplies treated under certain Part VII deeming provisions are handled differently for charging and claiming (sections 9(2), 10 notes, 13(3)).\n\nPotential behavioural and market effects (mechanical, source‑grounded observations)\n\n- For patients: Lower co‑payments reduce immediate price barriers to obtaining listed PBS medicines for registered patients (section 10).\n- For suppliers: The instrument creates statutory payment entitlements to replace lost co‑payments (section 12). Suppliers must follow claim procedures to receive those payments (section 13). Approved suppliers (pharmacists, medical practitioners, hospital authorities) are the actors authorised to make special arrangement supplies (sections 5–6), so the instrument channels supply through existing approved supplier categories.\n\nTransitional arrangements\n\n- Actions taken under the previous 2016 special arrangement that could be done under this instrument are treated as having been done under this instrument (section 14). People registered under the earlier arrangement are taken to be registered under this instrument at commencement (section 15).\n\nImplementation risks and practical constraints (source‑grounded)\n\n- Reliance on practitioner judgement for registration creates a gatekeeping step that depends on practitioner availability and recordkeeping (section 8(1)(b)).\n- HPOS is the primary registration mechanism, with a telephone fallback only where IT access is not functioning (section 8(3)–(4)), which may affect timeliness or scale of registrations in settings with connectivity issues.\n- The instrument depends on cross‑referenced determinations and Part VII constructs (discounts, safety net, Commonwealth prices, special patient contributions). Changes in those underlying instruments or in payment/determination settings will change the numeric outcomes of this arrangement without further change to this instrument (sections 9, 11, 12)."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/national-health-closing-the-gap-pbs-co-payment-program-special-arrangement-2026","history":"/api/acts/national-health-closing-the-gap-pbs-co-payment-program-special-arrangement-2026/history","analysis":"/api/acts/national-health-closing-the-gap-pbs-co-payment-program-special-arrangement-2026/analysis","conflicts":"/api/acts/national-health-closing-the-gap-pbs-co-payment-program-special-arrangement-2026/conflicts","importantCases":"/api/acts/national-health-closing-the-gap-pbs-co-payment-program-special-arrangement-2026/important-cases","documents":"/api/acts/national-health-closing-the-gap-pbs-co-payment-program-special-arrangement-2026/documents"}}