National Health (Supply of Pharmaceutical Benefits—Under Co-payment Data and Claims for Payment) Rules 2022
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actual contribution means the actual amount a patient pays for each prescription, including a special patient contribution.
Note: This amount does not include any charge for delivery, or for supply of a pharmaceutical benefit outside normal trading hours.
allowable discount has the meaning given by subsection 87(2AAAA) of the Act.
Note: The allowable discount may be greater than $1.00 in the limited cases where subsection 92A(2) of the Act applies to the supply of the pharmaceutical benefit by a friendly society, or by a friendly society body, to an eligible member.
approved private hospital means a private hospital that has an approved hospital authority.
approved public hospital means a public hospital that has an approved hospital authority.
A section means:
(a) in respect of a prescription that is an authority prescription, a repeat authorisation, a deferred supply authorisation or a prescriber bag supply form—the section of the form on which the prescription is written that is provided for the purpose of recording the information required by the provision of this instrument in which the expression occurs; or
(b) in respect of any other prescription—the section of the stamp format marked “A” on the prescription.
authority prescription has the meaning given by subsection 5(1) of the Regulations.
claim means information given, and procedures followed by, an approved supplier to make a claim for payment under section 99AAA of the Act for the supply of a pharmaceutical benefit.
Claims Transmission System has the meaning given by subsection 99AAA(1) of the Act.
Note: See the procedures in section 8 of this instrument.
continued dispensing means a supply of a pharmaceutical benefit by an approved pharmacist without a prescription in accordance with subsection 89A(1) of the Act and the Regulations.
Section 5 - National Health (Supply of Pharmaceutical Benefits—Under Co-payment Data and Claims for Payment) Rules 2022 - Definitions | Zoe
Note: See also the legislative instruments in force under subsection 89A(3) of the Act and Part 5 of the Regulations.
contribution discount for a supply of a pharmaceutical benefit (other than an early supply of a specified pharmaceutical benefit) means:
(a) if the supply is not eligible for increased discounting—the amount of the allowable discount for the supply of the pharmaceutical benefit; or
(b) if the supply is eligible for increased discounting—the amount worked out by reducing the general patient charge amount by the amount charged for the supply under paragraph 87(2)(e) of the Act.
deferred supply authorisation means a deferred supply authorisation prepared under section 53 of the Regulations on the basis of which a pharmaceutical benefit was supplied.
early supply of a specified pharmaceutical benefit has the meaning given by subsection 84AAA(1) of the Act.
electronic communication has the meaning given by the Electronic Transactions Act 1999.
electronic prescription has the meaning given by subsection 5(1) of the Regulations.
eligible for increased discounting has the meaning given by section 87AA of the Act.
exceptional prescription means a prescription for an extemporaneously‑prepared pharmaceutical benefit:
(a) that is not a standard formula preparation; and
(b) for which the price of the ingredients worked out in accordance with sections 19 to 21 of the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020 is not less than twice the amount worked out in accordance with section 30 of that determination, excluding the container price and dispensing fee.
extemporaneously‑prepared pharmaceutical benefit means a pharmaceutical item in respect of which no determination under subsection 85(6) of the Act is in force.
healthcare identifier has the meaning given by the Healthcare Identifiers Act 2010.
healthcare provider organisation has the meaning given by the Healthcare Identifiers Act 2010.
information technology requirements has the same meaning as in the Electronic Transactions Act 1999.
manual system has the meaning given by subsection 99AAA(1) of the Act.
Note: See the procedures in section 10 of this instrument.
Medicare Australia/DVA copy, for a paper‑based prescription, means the duplicate of the prescription that includes the words “Medicare Australia/DVA copy”.
medication chart prescription has the meaning given by the Regulations.
non‑ACSS payment means a payment to an approved supplier from the Commonwealth under Part VII of the Act in relation to the supply of a pharmaceutical benefit, other than an ACSS payment.
Note: Commonwealth payments to approved suppliers under Part VII of the Act that are not ACSS payments include payments under sections 93, 93AB and 99 of the Act.
paper‑based prescription has the meaning given by the Regulations.
PBS prescriber, in relation to a prescription, means the PBS prescriber who wrote or prepared the prescription.
prescriber bag supply form means:
(a) an order form approved by the Secretary, as referred to in section 33 of the Regulations; or
(b) a form approved by the Secretary, as referred to in paragraph 36(5)(a) of the Regulations, for the purpose of an approved medical practitioner giving notice of having obtained a pharmaceutical benefit when making a claim using the manual system, as required by paragraph 36(4)(c) of the Regulations; or
(c) a form approved by the Secretary, as referred to in paragraph 36(8)(a) of the Regulations, for the purpose of an approved medical practitioner creating a written record of having obtained a pharmaceutical benefit if the practitioner makes a CTS claim in relation to obtaining the benefit, as required by paragraph 36(7)(c) of the Regulations.
prescription includes the following:
(a) the Medicare Australia/DVA copy of a paper‑based prescription;
(b) a copy of a medication chart prescription that is not an electronic prescription;
(c) an electronic prescription.
Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.
repeat authorisation means:
(a) a repeat authorisation prepared under subparagraph 52(3)(a)(i) of the Regulations using a repeat authorisation form; or
(b) continued dispensing using a repeat authorisation form prepared by an approved pharmacist;
on the basis of which a pharmaceutical benefit has been supplied.
repeat authorisation form has the meaning given by the Regulations.
RPBS means:
(a) the Repatriation Pharmaceutical Benefits Scheme determined under subsection 91(1) of the Veterans’ Entitlements Act 1986; or
(b) the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) (Modifications of the Repatriation Pharmaceutical Benefits Scheme) Instrument 2017 made under section 18 of the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006; or
(c) the MRCA Pharmaceutical Benefits Scheme (No. MRCC 44/2013) made under section 286 of the Military Rehabilitation and Compensation Act 2004.
S section means:
(a) in respect of a prescription that is an authority prescription, a repeat authorisation, a deferred supply authorisation or a prescriber bag supply form—the section of the form on which the prescription is written that is provided for the purpose of recording the information required by the provision of this instrument in which the expression occurs; or
(b) in respect of any other prescription—the section of the stamp format marked “S” on the prescription.
stamp format means the following format, whether made by stamp or otherwise and whether the lines are included or not:
S
A
standard formula preparation means an extemporaneously‑prepared pharmaceutical benefit described in an item of the table in clause 1 of Schedule 5 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019.
under co‑payment data means information in relation to the supply of a pharmaceutical benefit:
(a) by an approved supplier if subsection 99(2A), (2AB) or (2B) of the Act applies in relation to the supply; or
(b) by an approved hospital authority if the amount payable by the Commonwealth in accordance with a determination made under subsection 99(4) of the Act is nil due to the dispensed price not exceeding the applicable patient co‑payment, as defined in the determination.
Note: If subsection 99(2A), (2AB) or (2B) of the Act applies in relation to the supply, no claim is payable under section 99AAA of the Act.
(2) Where an expression that is used in this instrument is defined for the purposes of Part VII of the Act, it has the same meaning in this instrument as it has in that Part. Expressions used in this instrument that are defined in Part VII include the following:
(a) ACSS eligible supply;
(b) ACSS payment;
(c) approved hospital authority;
(d) approved supplier;
(e) general patient charge amount;
(f) pharmaceutical benefit;
(g) special patient contribution.
(3) A reference in this instrument to the supply of a pharmaceutical benefit includes a reference to the obtaining of a pharmaceutical benefit by an approved medical practitioner for the purpose of the supply of the benefit under section 93 of the Act.