Pharmaceutical charges

MSD must check if the client qualifies for Disability Allowance for pharmaceutical charges.

If the client qualifies for Disability Allowance, this must be granted before MSD assess if the client qualifies for Temporary Additional Support.

The client may have allowable health and disability costs for Temporary Additional Support when they do not qualify for Disability Allowance because:

• they do not meet the Disability Allowance income limit or
• their disability will last less than 6 months or
• they are certain refugees, protected persons or residence applicants

A registered medical practitioner or nurse practitioner must complete a Disability Allowance medical certificate confirming the client’s disability, the need for treatment and that pharmaceuticals are necessary. The certificate must also confirm the treatment is beneficial and of therapeutic value and that the costs are:

• additional and
• ongoing and
• directly related to the client's disability

Allowable costs for Temporary Additional Support can include the regular, ongoing pharmaceutical charges a client has because of their disability.

These costs can only be included for the portion of the costs that are not covered by the Community Services Card, High Use Health Card, Pharmaceutical Subsidy Card, medical insurance, ACC or other accident insurer.

Allowable costs for pharmaceutical products are generally only for the cost of pharmaceutical products that are fully or partially subsidised under the Healthy Futures (Pae Ora) Act 2022.

When a client has non-subsidised pharmaceutical costs, additional factors must be considered before the cost can be included in Disability Allowance. For example, if there is a fully subsidised or partially subsidised alternative that could be used.

The part-charge and pharmacy fees for non-subsidised services such as packaging, mailing out medications and faxing are allowable costs for Temporary Additional Support.

In addition to the charges for medication, clients may have additional charges which can be included as allowable costs for Temporary Additional Support. These can include:

• printed reports that list what pharmaceutical charges were paid over a period of time
• blister packs (this refers to the way a client's medication may be packaged)
• assistance to pick up medication from the pharmacy that incurs a cost (e.g. courier or mailing costs)
• the cost to print, fax or electronically send prescriptions

Allowable costs for Temporary Additional Support do not include:

• non-pharmaceutical drugs, even if the items are recommended by a registered medical practitioner or nurse practitioner , as these costs are not additional costs directly related to a disability
• pharmaceutical items not related to the client's disability (e.g. a cough suppressant for the flu, as the flu is not an ongoing disability)
• illegal drugs used for medical purposes (e.g. recreational cannabis that has not been prescribed by a doctor that may be used for pain relief)

The client must provide:

• a Disability Allowance medical certificate completed and signed by a registered medical practitioner or nurse practitioner and
• receipts as proof of their ongoing pharmaceutical costs

Note if a fee has been charged by a registered health practitioner or pharmacist for the cost of a report or print out to verify medical fees or pharmaceutical charges; this fee or other administration related cost can be included as a cost for Temporary Additional Support.