84CEligibility for concession and entitlement cards

84C Eligibility for concession and entitlement cards

(1AA) A person who has been, at any time during a relevant entitlement period, a general patient is eligible to be issued with a concession card in respect of that period if the total value for safety net purposes of supplies of pharmaceutical benefits, repatriation pharmaceutical benefits and out‑patient medication made: (a) to the person during the period; or (b) to the person and the person’s family during the period; is not less than the amount of the general patient safety net (within the meaning of section 99F).

Note: Supplies of pharmaceutical benefits may include supplies referred to in subsections 99(2A), (2AB) and (2B).

(1B) A person is eligible to be issued with a concession card at the time of the supply of a pharmaceutical benefit, repatriation pharmaceutical benefit or out‑patient medication to the person or a member of the person’s family, if including the value for safety net purposes of the supply in the total mentioned in subsection (1AA) would fulfil that subsection. (1C) A person who has been, at any time during a relevant entitlement period, a concessional beneficiary is eligible to be issued with an entitlement card in respect of that period if either of the following paragraphs applies: (a) the total of: (i) the value for safety net purposes of supplies of pharmaceutical benefits, repatriation pharmaceutical benefits and out‑patient medication made to the person during the relevant entitlement period when the person was a concessional beneficiary; and (ii) where the person has, during the relevant entitlement period, been a general patient—the transferred value of supplies of pharmaceutical benefits, repatriation pharmaceutical benefits and out‑patient medication made to the person during the period when the person was a general patient; is not less than the amount of the concessional beneficiary safety net (within the meaning of section 99F); (b) the total of: (i) the value for safety net purposes of supplies of pharmaceutical benefits, repatriation pharmaceutical benefits and out‑patient medication made to the person and the person’s family during the relevant entitlement period when the person was a concessional beneficiary; and (ii) where the person has, during the relevant entitlement period, been a general patient—the transferred value of supplies of pharmaceutical benefits, repatriation pharmaceutical benefits and out‑patient medication made to the person and the person’s family during the period when the person was a general patient; is not less than the amount of the concessional beneficiary safety net (within the meaning of section 99F).

Note: Supplies of pharmaceutical benefits may include supplies referred to in subsections 99(2A), (2AB) and (2B).

(1D) A person is eligible to be issued with an entitlement card at the time of the supply of a pharmaceutical benefit, repatriation pharmaceutical benefit or out‑patient medication to the person or a member of the person’s family if: (a) where the person is a concessional beneficiary at the time of the supply—including the value for safety net purposes of the supply; or (b) where the person is a general patient at the time of the supply—including the transferred value of the supply; in the total mentioned in paragraph (1C)(a) or (b) would fulfil that paragraph. (1E) The regulations may prescribe the value for safety net purposes of a supply of a pharmaceutical benefit. (1F) Regulations made for the purposes of subsection (1E) must take into account the amount charged for the supply, but may make adjustments to the value for safety net purposes such as: (a) excluding certain components of the amount charged; or (b) setting a maximum limit on the value. (2) For the purposes of this section, a pharmaceutical benefit supply or a supply of out‑patient medication is taken to have been made, during a relevant entitlement period, to a person’s family if and only if the supply was made, during that period, to: (a) a person who was, at the time when the person applied for the issue of a concessional card or an entitlement card in respect of that period, a member of the person’s family; or (b) a person who was, at the time of supply, a member of the person’s family. (3) Where: (a) a prescription is for the supply of a pharmaceutical benefit or a repatriation pharmaceutical benefit to a person (in this subsection referred to as the patient); and (b) upon the prescription, a pharmaceutical benefit or repatriation pharmaceutical benefit (the benefit) is given to another person, as agent for the patient, for supply to the patient; the benefit shall, for the purposes of this section, be taken to have been supplied to the patient upon the prescription. (4) The supply or repeated supply of a pharmaceutical benefit to a person shall not be taken into account for the purposes of this section unless: (a) the pharmaceutical benefit is supplied: (i) by an approved pharmacist, at or from premises in respect of which the pharmacist is for the time being approved, on presentation of a prescription written by a PBS prescriber in accordance with this Act and the regulations, or, in such circumstances as are prescribed for the purposes of paragraph 89(a), on communication to the pharmacist, in the manner prescribed for the purposes of that paragraph, of a prescription of a PBS prescriber; or (ii) in accordance with section 92 or 94; and (b) at the time of supply, the person is not a holder of an entitlement card; and (c) in a case where the supply is made upon a general benefit prescription and the Commonwealth price for the pharmaceutical benefit exceeds the general patient charge amount—the amount received in respect of the supply is equal to the sum of the following: (i) if the supply is not eligible for increased discounting—the general patient charge amount (less any allowable discount); (ia) if the supply is eligible for increased discounting—the amount charged for the supply under paragraph 87(2)(e); (ii) if an amount may be charged for the supply under subsection 87(2A)—that amount; (iii) any charge for supply at a time outside normal trading hours; (iv) any charge for delivery in accordance with regulations made for the purposes of paragraph 87(4)(b); and (d) in a case where the supply is made upon a concessional benefit prescription and the Commonwealth price for the pharmaceutical benefit exceeds $4.60—the amount received in respect of the supply is equal to the sum of the following: (i) $4.60 (less any allowable discount); (ii) if an amount may be charged for the supply under subsection 87(2A)—that amount; (iii) any charge for supply at a time outside normal trading hours; (iv) any charge for delivery in accordance with regulations made for the purposes of paragraph 87(4)(b); and (e) in a case where the supply is one to which subsection 99(2A), (2AB) or (2B) applies—the amount charged or received in respect of the supply does not exceed the sum of the following: (i) the price worked out in accordance with a determination in force under subsection (7) for the pharmaceutical benefit; (ii) any amount charged or received by reason only that the supply was made at a time outside normal trading hours; (iii) any amount charged or received in accordance with regulations made for the purposes of paragraph 87(4)(b). (4AA) The supply or repeated supply of a pharmaceutical benefit or repatriation pharmaceutical benefit to a person must not be taken into account for the purposes of this section if it is an early supply of a specified pharmaceutical benefit. (4A) The supply or repeated supply of a repatriation pharmaceutical benefit to a person is not to be taken into account for the purposes of this section unless: (a) the repatriation pharmaceutical benefit is supplied: (i) under the scheme established under section 91 of the Veterans’ Entitlements Act 1986; or (ii) in accordance with a determination under paragraph 286(1)(c) of the Military Rehabilitation and Compensation Act 2004; or (iii) under a scheme that applies under section 18 of the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006; or (iv) under a scheme that applies under section 20 of the Treatment Benefits (Special Access) Act 2019; and (b) at the time of supply the person was not a holder of an entitlement card. (4B) A supply of out‑patient medication to a person is not to be taken into account for the purposes of this section if, at the time of the supply, the person is the holder of an entitlement card. (7) The Minister may determine, by legislative instrument, the manner in which the price for particular quantities or numbers of units of all or any pharmaceutical benefits is to be ascertained for the purpose of subparagraph (4)(e)(i). (8) A manner determined under subsection (7) shall: (a) in the case of a pharmaceutical benefit that is a listed brand of a pharmaceutical item—take as a basis the approved ex‑manufacturer price or a proportional ex‑manufacturer price of the brand of the pharmaceutical item that was in force on the first day of the month of the year in which the supply occurs; and (b) in the case of other pharmaceutical benefits—take as a basis the basic wholesale price of each ingredient that is applicable on the day on which the supply occurs; and (c) provide for the addition of such fees and other amounts as are determined by the Tribunal for the purposes of paragraph 98B(2)(c); and (d) provide for the addition of such other fees and other amounts as are determined by the Minister. (9) The Minister shall not determine an amount for the purpose of paragraph (8)(d) unless the Pharmacy Guild of Australia has agreed in writing to the making of that determination. (11) In this section, unless the contrary intention appears: