National Health (Additional Community Supply Support Payment) Determination 2024

Who is affected and who pays

• 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).

• 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.

Why it matters (mechanics, incentives and trade-offs)

• 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.

• 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.

• 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.

• 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.

• 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.

Concrete costs and benefits (mechanical)

• 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)).

• 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.

Key cross-references to check when implementing or assessing claims

• 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)).
• Claims and entitlement procedures are under ss 99AAA, 98C and 99AAAB of the Act (s 6 Note).
• 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)).