Pharmaceutical subsidies

MSD must check if the client qualifies for Disability Allowance.

If the client is entitled to Disability Allowance, this must be granted before MSD assesses whether the client qualifies for Temporary Additional Support.

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

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

Allowable costs for Temporary Additional Support can include:

• the co-payment on fully subsidised prescription items from publicly and privately funded health providers
• the cost of partially subsidised prescription items from publicly and privately funded health providers
• in certain circumstances non-subsidised prescription items may be considered for Temporary Additional Support allowable costs

Allowable costs can also cover the "part-charge" if the cost to manufacture the item is more than the government subsidy.

The amount pharmaceuticals are subsidised by will depend on what prescription item is needed, whether it was prescribed by a publicly funded health provider or a privately funded health provider, and if the person holds a Community Services Card, Pharmaceutical Subsidy Card and/or High Use Health Card.

From 1 February 2026, prescribers can issue prescriptions for up to 12 months in some cases. Any co-payment charged is per prescription, rather than each time it is dispensed. This means clients may only have to pay for one $5.00 co-payment within a 12-month period.

Anyone getting a prescription may have to pay other pharmacy fees that are not subsidised (e.g. packaging, printing and faxing). This includes clients with a Community Services Card or a Pharmaceutical Subsidy Card, and families with children under 14 years.

Allowable costs for Temporary Additional Support cannot include the portion of pharmaceutical costs covered by the Community Services Card, High Use Health Card, Pharmaceutical Subsidy Card, ACC or other accident insurer, or medical insurance.

Allowable costs for Temporary Additional Support can include the co-payment on prescription items that are subsidised by the Government. It can also be used to pay for the 'part-charge' if the cost to manufacture the item is more than the government subsidy.

Fully subsidised prescription items from publicly funded health providers (including public specialists) are free for people:

• under 14 or
• holding a Community Services Card (and their dependents aged 14-17 years old) or
• 65 years or older (from 1 July 2024)

If someone in one of the above groups is prescribed items from a publicly funded health provider, they may still have to pay a fee.

For example, if they are prescribed partially subsidised and non-subsidised prescription items.

This includes clients who hold a Community Services Card, Pharmaceutical Subsidy Card and/or High Use Health Card.

Example 1 - client is not in a subsidised group

George has asthma that has been stable for 10 years. He visits a publicly funded specialist for his inhaler.

He requests to change from one of the partially subsidised inhalers to a fully subsidised inhaler. His doctor notes that both inhalers do the same thing.

At the pharmacy George pays a $5.00 co-payment for his initial inhaler as he does not fall into one of the subsidised groups, and any extra inhalers needed in that 12-month period will not have another co-payment.

Example 2 - client is in a subsidised group

Tina visits her general practitioner (GP). They prescribe her medication she needs for her on-going disability. The medication prescribed is fully subsidised.

At the pharmacy Tina does not have to pay anything for her medication as she has a Community Services Card.

When prescriptions are prescribed by privately funded health providers (including private specialists) there is a cost.

This includes fully subsidised, partially subsidised and non-subsidised prescription items.

Prescriptions from privately funded health providers have a:

• $10.00 co-payment for people aged 14-17 years old or
• $15.00 co-payment for people aged 18 years and older

Example

Sarah has an ongoing skin condition and visits her private specialist. She prescribed a fully subsidised prescription cream.

As Sarah is over 18 years old, she is charged a $15.00 co-payment for her medicine at the pharmacy.

An individual or family unit pays the co-payment for the first 20 prescription items prescribed in any "pharmaceutical year" (defined as 1 February to 31 January).

Note this applies to every new prescription and does not apply to repeat supplies on the same prescription.

After 20 pharmaceutical items have been purchased by an individual or family from the same pharmacy, the pharmacist issues a Pharmaceutical Subsidy Card.

Once a Pharmaceutical Subsidy Card is issued that individual or family unit will not have to pay the co-payment for the rest of the pharmaceutical year.

When a client has non-subsidised pharmaceutical costs, additional factors must be considered before the cost can be included in Temporary Additional Support.

For example, if there is a subsidised or partially subsidised alternative that could be used.

Note the part-charge and pharmacy fees for non-subsided services such as packaging and faxing are additional charges that are considered allowable costs for Temporary Additional Support.