Commonwealth Consolidated Acts Commonwealth Consolidated Acts(1AA) A person who is both a general patient and an eligible person at any time during a relevant entitlement period is eligible to be issued with a concession card if:
(a) the total of the amounts charged (otherwise than under subsection 87(2A)) to the person for supplies of pharmaceutical benefits (including supplies taken, because of subsection 99(2A) to be supplies otherwise than under this Part) and repatriation pharmaceutical benefits made to the person during the period and of the applicable amounts in relation to the supplies of out-patient medication made to the person during the period; or
(b) the total of the amounts charged (otherwise than under subsection 87(2A)) to the person and to the person's family for supplies for pharmaceutical benefits (including supplies taken, because of subsection 99(2A) to be supplies otherwise than under this Part) and repatriation pharmaceutical benefits made to the person and the person's family during the period and of the applicable amounts in relation to the supplies of out-patient medication made to the person and to the person's family during the period;
is the amount of the general patient safety net (within the meaning of section 99F) or an amount that, together with the amount that the person may be charged under paragraph 87(2)(b), (c) or (e) (whichever is applicable) for the supply of a pharmaceutical benefit, would not be less than the amount of the general patient safety net.
Note: The figures expressed in this subsection in dollars are periodically adjusted under section 99G.
(1C) A person who is a concessional beneficiary during a relevant entitlement period commencing on or after 1 January 1992 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 amounts charged (otherwise than under subsection 87(2A)) for supplies of pharmaceutical benefits and repatriation pharmaceutical benefits made to the person during that period when the person was a concessional beneficiary; and
(ia) the applicable amounts in relation to the supplies of out-patient medication made to the person during that period when the person was a concessional beneficiary; and
(ii) where the person has, during that period, been a general patient--the transferred value of amounts (if any) charged for supplies of pharmaceutical benefits and repatriation pharmaceutical benefits made to the person, and of applicable amounts in relation to the supplies (if any) of out-patient medication made to the person, during that period when the person was a general patient;
is the amount of the concessional beneficiary safety net (within the meaning of section 99F) or an amount that, together with the amount chargeable under paragraph 87(2)(a) for the supply of a pharmaceutical benefit would be not less than the amount of the concessional beneficiary safety net;
(b) the total of:
(i) the aggregate of amounts charged (otherwise than under subsection 87(2A)) for supplies of pharmaceutical benefits and repatriation pharmaceutical benefits made to the person and the person's family during that period when the person was a concessional beneficiary; and
(ia) the applicable amounts in relation to the supplies of out-patient medication made to the person and the person's family during that period when the person was a concessional beneficiary; and
(ii) where the person has, during that period, been a general patient--the transferred value of amounts (if any) charged for supplies of pharmaceutical benefits and repatriation pharmaceutical benefits made to the person and the person's family, and of applicable amounts in relation to the supplies (if any) of out-patient medication made to the person and the person's family, during that period when the person was a general patient;
is the amount of the concessional beneficiary safety net (within the meaning of section 99F) or an amount that, together with the amount chargeable under paragraph 87(2)(a) for the supply of a pharmaceutical benefit would be not less than the amount of the concessional beneficiary safety net.
(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;
Note: Sometimes a supply can still be taken into account if the pharmacist is approved later. See subsection 99(3B).
(b) at the time of supply, the person:
(iii) was not a holder of an entitlement card;
(c) in a case where the supply is made upon a general benefit prescription, the Commonwealth price for the pharmaceutical benefit exceeds $28.60 and an approved pharmacist or approved medical practitioner is not entitled to be paid by the Commonwealth under subsection 99(2AA) an amount that is equal to the special patient contribution for a brand of a pharmaceutical item that is the pharmaceutical benefit--the amount received in respect of the supply is equal to or exceeds the aggregate of $28.60 and the special patient contribution (if any) for the brand of the pharmaceutical item;
(d) in a case where the supply is made upon a concessional benefit prescription, the Commonwealth price for the pharmaceutical benefit exceeds $4.60 and an approved pharmacist or approved medical practitioner is not entitled to be paid by the Commonwealth under subsection 99(2AA) an amount that is equal to the special patient contribution for a brand of a pharmaceutical item that is the pharmaceutical benefit--the amount received in respect of the supply is equal to or exceeds the aggregate of $4.60 and the special patient contribution (if any) for the brand of the pharmaceutical item; and
(e) in a case where the supply is deemed, by virtue of subsection 99(2A), (2AB) or (2B), to be a supply otherwise than under this Part:
(i) the amount demanded or received in respect of the supply does not exceed the aggregate of:
(A) the price worked out in accordance with a determination in force under subsection (7) for the pharmaceutical benefit;
(B) any charge demanded or received by reason only that the supply was made at a time outside normal trading hours; and
(C) any charge demanded or received in accordance with regulations made for the purposes of paragraph 87(4)(b).
Note: The figures expressed in this subsection in dollars are periodically adjusted under section 99G.
(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:
(a) it is an early supply of a specified pharmaceutical benefit; and
(b) it is not a supply of out-patient medication.
(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 (Treatment) Act 2006 ; 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 the manner in which the price for all or any pharmaceutical benefits and repatriation pharmaceutical benefits is to be ascertained for the purpose of this section.
(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 price to pharmacists 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 and repatriation 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.
(10) A determination under subsection (7) shall:
(a) be made by notice in writing published in the Gazette ; and
(b) come into operation on such date as is specified in the determination.
(11) In this section, unless the contrary intention appears:
"basic wholesale price" has the same meaning as in section 98B.
"pharmaceutical benefit supply" means a supply or a repeated supply of a pharmaceutical benefit or repatriation pharmaceutical benefit.