1National Health (Closing the Gap—PBS Co-payment Program) Special Arrangement 2026

--- meta-content-style-type: text/css meta-content-type: application/xhtml+xml; charset=utf-8 ---    National Health (Closing the Gap—PBS Co‑payment Program) Special Arrangement 2026 I, Sarah Norris, as delegate of the Minister for Health and Ageing, make the following special arrangement. Dated   25 February 2026 Sarah Norris Assistant Secretary Community Access Programs Branch Technology Assessment and Access Division Department of Health, Disability and Ageing         Contents Part 1—Preliminary Division 1—General 1 Name 2 Commencement 3 Authority 4 Simplified outline 5 Definitions 6 Meaning of special arrangement supply 7 Pharmaceutical benefits covered by this instrument Division 2—CTG registered patients 8 Registration of eligible patients Part 2—Supply of pharmaceutical benefits under this instrument 9 General modifications 10 Co‑payment reduction etc. 11 Value for safety net purposes Part 3—Payment for supply of pharmaceutical benefits under this instrument 12 Payment by Commonwealth 13 Claim for payment Part 4—Transitional arrangements Division 1—Transitional provisions in relation to the commencement of this instrument 14 Things done under the National Health (Closing the Gap — PBS Co‑payment Program) Special Arrangement 2016 15 Existing registered patients   Part 1—Preliminary Division 1—General   1  Name  (1) This instrument is the National Health (Closing the Gap—PBS Co‑payment Program) Special Arrangement 2026.  (2) This instrument may also be cited as PB 25 of 2026. 2  Commencement  (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.   - Commencement information - Column 1 Column 2 Column 3 - Provisions Commencement Date/Details - 1. The whole of this instrument 1 April 2026. 1 April 2026 Note: This table relates only to the provisions of this instrument as originally made.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.  (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. 3  Authority   This instrument is made under section 100 of the National Health Act 1953. 4  Simplified outline This 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. Under 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. This instrument also deals with payments for supplies of pharmaceutical benefits covered by this instrument. Note: 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). 5  Definitions Note A number of expressions used in this instrument are defined in the Act, including the Chief Executive Medicare.   In this instrument: Act means the National Health Act 1953. allowable discount has the same meaning as in Part VII of the Act. approved hospital authority has the same meaning as in Part VII of the Act. approved medical practitioner has the same meaning as in Part VII of the Act. approved pharmacist has the same meaning as in Part VII of the Act. concessional beneficiary charge has the same meaning as in Division 4A of Part VII of the Act. CTG registered patient means a person registered under subsection 8(1). CTG supplier means an approved supplier (within the meaning of Part VII of the Act). Note: Each of the following is an approved supplier: (a) an approved pharmacist; (b) an approved medical practitioner; (c) an approved hospital authority. general patient charge has the same meaning as in Division 4A of Part VII of the Act. general patient reduced charge has the same meaning as in Division 4A of Part VII of the Act. listed brand has the same meaning as in Part VII of the Act. pharmaceutical benefit has the same meaning as in Part VII of the Act. pharmaceutical item has the same meaning as in Part VII of the Act. special arrangement supply: see section 6. special patient contribution has the same meaning as in Part VII of the Act. value for safety net purposes has the same meaning as in Part VII of the Act. 6  Meaning of special arrangement supply   A supply of a pharmaceutical benefit to a person is a special arrangement supply of the benefit if:  (a) the person is a CTG registered patient; and  (b) the benefit is supplied by a CTG supplier; and  (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). 7  Pharmaceutical benefits covered by this instrument  (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).  (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). Note 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. Note 2: The modifications of the Act under this instrument relating to: (a) charges for the supply of a pharmaceutical benefit (see section 10); and (b) payments to a CTG supplier by the Commonwealth for the supply of a pharmaceutical benefit (see section 12); may 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. Note 3: In 2026, the other special arrangements referred to in Note 2 are the following: (a) the National Health (Botulinum Toxin Program) Special Arrangement 2025; (b) the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2024; (c) the National Health (Growth Hormone Program) Special Arrangement 2025; (d) the National Health (Highly Specialised Drugs Program) Special Arrangement 2021; (e) the National Health (IVF Program) Special Arrangement 2025. Division 2—CTG registered patients   8  Registration of eligible patients Eligible patients may be registered by registering practitioners  (1) A registering practitioner may register a patient for the supply of pharmaceutical benefits in accordance with this instrument if:  (a) the patient:  (i) is entitled to receive pharmaceutical benefits as mentioned in section 86 of the Act; and  (ii) identifies themself to the practitioner as being of Aboriginal or Torres Strait Islander descent; and  (iii) provides consent to the practitioner to receive supplies in accordance with this instrument; and  (b) in the opinion of the registering practitioner, the patient:  (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  (ii) is unlikely to adhere to the course of treatment without assistance under this instrument.  (2) A registering practitioner is:  (a) a PBS prescriber (within the meaning of Part VII of the Act); or  (b) an individual who:  (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  (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. Note:  For the allocation of identification numbers mentioned in subparagraph (b)(ii), see section 35 of the Human Services (Medicare) Regulations 2017. How registration is to be made  (3) The registration must be made by use of the HPOS (short for Health Professional Online Services). Note: In 2026, the HPOS could be accessed on the Services Australia website (https://www.servicesaustralia.gov.au/).  (4) However, the registration may be made by telephone to Services Australia if, for reasons outside the registering practitioner’s control, the practitioner:  (a) does not have access to functioning IT systems, including the internet; or  (b) is unable to access the HPOS. Part 2—Supply of pharmaceutical benefits under this instrument   9  General modifications Special arrangement supplies not eligible for increased discounting  (1) Despite section 87AA of the Act, a special arrangement supply of a pharmaceutical benefit is not eligible for increased discounting. Under co‑payment supplies  (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. 10  Co‑payment reduction etc.  (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. Co‑payment of nil for concessional beneficiaries  (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:  (a) would otherwise have been charged the concessional beneficiary charge or the general patient reduced charge for the supply; or  (b) is receiving a supply that is described in subsection 99(2AB) or (2B) of the Act. Note: 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. Co‑payment reduction for general patients  (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:  (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  (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:  (i) the concessional beneficiary charge; and  (ii) the Commonwealth price (within the meaning of Part VII of the Act) in relation to the pharmaceutical benefit. Note: 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. Special patient contributions—approved pharmacists and approved medical practitioners  (4) Subsection (5) applies if:  (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  (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.  (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).  (6) Subsection (5) applies despite subsection 87(2A) of the Act. Special patient contributions—approved hospital authorities  (7) Subsection (8) applies if:  (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  (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.  (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.  (9) Subsection (8) has effect in addition to section 87 of the Act. Charge for delivery of pharmaceutical benefits  (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. Note: For the charge for delivery of pharmaceutical benefits, see section 56 of the National Health (Pharmaceutical Benefits) Regulations 2017. Meaning of approval  (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:  (a) for an approved pharmacist—the definition of approved pharmacist in subsection 84(1) of the Act; and  (b) for an approved medical practitioner—the definition of approved medical practitioner in subsection 84(1) of the Act; and  (c) for an approved hospital authority—the definition of approved hospital authority in subsection 84(1) of the Act. 11  Value for safety net purposes  (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.  (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. Note: In 2026, the determination is the National Health (Pharmaceutical Benefits) (Subsection 84C(7) Price) Determination 2019.  (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:  (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  (b) if the general patient charge would have applied to the supply but for paragraph 10(3)(a)—$42.50 (less any allowable discount). Part 3—Payment for supply of pharmaceutical benefits under this instrument   12  Payment by Commonwealth  (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. If the co‑payment is nil under paragraph 10(2)(a)  (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. If the co‑payment is nil under paragraph 10(2)(b)  (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. If the co‑payment is for a general patient under paragraph 10(3)(a)  (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. If the co‑payment is for a general patient under paragraph 10(3)(b)  (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. Note: 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. 13  Claim for payment  (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.  (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.  (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.  (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. Part 4—Transitional arrangements Division 1—Transitional provisions in relation to the commencement of this instrument   14  Things done under the National Health (Closing the Gap — PBS Co‑payment Program) Special Arrangement 2016  (1) If:  (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  (b) the thing could be done for that purpose under this instrument; the thing has effect for the purposes of this instrument as if it had been done for that purpose under this instrument.  (2) Without limiting subsection (1), a reference in that subsection to a thing being done includes a reference to the following:  (a) the registration of a patient;  (b) writing a prescription for a special arrangement supply of a pharmaceutical benefit;  (c) charging a person for a special arrangement supply of a pharmaceutical benefit;  (d) making a claim for a payment from the Commonwealth for a special arrangement supply of a pharmaceutical benefit. 15  Existing registered patients   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.