Highly Specialised Drugs Program (Community Access)

The Highly Specialised Drugs (HSD) Community Access arrangements align existing Section 100 HSD Program arrangements with current clinical practice and models of care, through improvements to the way some medicines are prescribed, dispensed and accessed under the s100 HSD Program. Medicines under HSD Community Access arrangements include:

• clozapine for the treatment of schizophrenia (maintenance therapy only)
• HIV antiretroviral medicines
• hepatitis B medicines
• opioid dependence medicines (see Opioid Dependence Treatment (ODT) Program)
• lanreotide
• octreotide.

These arrangements remove the requirement for patients and prescribers to be affiliated with a hospital setting.  Patients also have greater choice about where they access their medicines, through either a community pharmacy, or a private or public hospital pharmacy. Community pharmacists can dispense these medicines regardless of where the medicine is prescribed.

The remuneration rates for HSDs dispensed through community pharmacies are aligned to those paid to private hospitals which comprise the normal PBS ready-prepared dispensing fee plus a mark-up ascertained as follows:

• 10% for drugs with an ex-manufacturer price of less than $40
• $4 for drugs with an ex-manufacturer price of between $40 and $100
• 4% for drugs with an ex-manufacturer price of between $100.01 and $1000
• $40 for drugs with an ex-manufacturer price of greater than $1000.

Patient eligibility criteria are unchanged. Patients will continue to pay a patient co-payment which will contribute to the PBS Safety Net Record.