Closing the Gap (CTG) PBS Co-payment Program

Page last updated: 5 August 2024

The CTG PBS Co-payment Program improves access to affordable PBS medicines for First Nations people living with, or at risk of, chronic disease, and who in their doctor’s opinion would experience setbacks in the prevention or ongoing management of chronic disease if they did not take their prescribed medicine and would be unlikely to adhere to their medicines regimen without assistance through the program.

The cost of medicines remains a significant barrier to access for First Nations people. Under the CTG PBS Co-payment Program, eligible First Nations people who are registered on the CTG PBS Co-payment Register and who would normally pay the full general PBS co-payment amount, pay the concessional rate when obtaining PBS medicines from their local community pharmacy, approved medical practitioner, or a private hospital. Eligible patients who would normally pay the concessional rate receive their PBS medicines for free, without having to pay a co‑payment. 

Complementing this program and recognising that there may not be pharmacies available to dispense in some remote areas, the Remote Area Aboriginal Health Services (RAAHS) Program allows clients of approved RAAHS to receive PBS medicines directly from their RAAHS, without the need for a normal PBS script, and without charge.

For more information about the RAAHS Program, please visit the Services Australia or Department of Health and Aged Care website.

Prior to 1 July 2024 the CTG PBS Co-payment Program only applied to section 85 or ‘general schedule’ PBS medicines, when dispensed by a community pharmacy, approved medical practitioner or private hospital. From 1 July 2024, this program has been expanded to also apply to section 100 PBS medicines dispensed by community pharmacies, approved medical practitioners and private hospitals. This also includes all section 100 PBS medicines supplied under Continued Dispensing arrangements, where those medicines are eligible for supply under Continued Dispensing arrangements.

From 1 January 2025, the CTG PBS Co-payment Program will be further expanded to include all PBS medicines (including section 85 and section 100 medicines) dispensed by public hospitals.

Section 100 medicines now included under the CTG PBS Co-payment Program encompass all medicines included under the following Section 100 programs:

• Highly Specialised Drugs Program (which includes Opioid Dependence Treatment , hepatitis B, and HIV antiretroviral medicines)
• Efficient Funding of Chemotherapy Program
• Botulinum Toxin Program 
• PBS Growth Hormone Program
• In Vitro Fertilization (IVF) Program

Patient Eligibility

The CTG PBS Co-payment Program is available to First Nations people of any age who are registered with Medicare, and in the opinion of a prescriber or Aboriginal Health Practitioner (AHP):

• would experience setbacks in the prevention or ongoing management of a condition if the person did not take their prescribed medicine; and
• are unlikely to adhere to their medicines regimen without assistance through the program.

Registering for the CTG PBS Co-payment Program

Any PBS prescriber or eligible AHP can register eligible First Nations people for the CTG PBS Co-payment Program. Registration of eligible First Nations people is completed via the Services Australia Health Professional Online Services (HPOS) portal and is a one-off registration process.

Once a First Nations person has been assessed as being eligible for the program, their PBS prescriber or eligible AHP can authorise a HPOS delegate to act on their behalf to enter the registration details into HPOS. A delegate will need to register for their own PRODA (Provider Digital Access) account before being linked to a prescriber or health practitioner’s HPOS account.

If a patient is unsure whether they are registered for the program, their practitioner or the pharmacist will be able to check via HPOS for them.

In remote areas with limited internet access, a health service or clinic can phone Services Australia on 132 290 to register the patient for the program.

Patient Withdrawal / de-registration 

If a patient wishes to withdraw from the CTG program, they can do this by calling Services Australia on 132 290. A PBS prescriber or AHP cannot withdraw a patient from the CTG Program unless the registration was an administrative error. For assistance with amending a registration error call Services Australia on 132 290. 

Questions regarding registration as a Medicare Provider or use of the HPOS portal should be directed to Services Australia. Contact details can be found at Health professionals contact information – Services Australia.

Eligible PBS medicines and Approved Suppliers

As of 1 July 2024, the CTG PBS Co-payment Program now applies to scripts for all PBS medicines (including section 85 and section 100 medicines). Prior to this date the program had only applied to scripts for section 85 (or ‘general schedule’) PBS medicines.

Prior to 1 January 2025, CTG scripts can only be dispensed at by a community pharmacy, approved medical practitioner or private hospital. From 1 January 2025 onwards, CTG scripts will be able to be dispensed by public hospitals in addition to community pharmacies, approved medical practitioners and private hospitals.

If a patient is registered for the CTG PBS Co-payment Program at the time eligible PBS medicines are dispensed, the co-payment reduction will apply even if the script does not have a CTG annotation.

Where a brand premium applies to a PBS medicine covered under the CTG PBS Co-payment Program, eligible First Nations patients will need to pay the brand premium at the time of dispensing.

Further information?

Questions from pharmacists regarding changes to the dispensing software should be directed to the respective software vendor. Questions regarding PBS claiming can be directed to Services Australia on 132 290.

Answers to Frequently Asked Questions and further information for First Nations people, community pharmacies, hospital pharmacies, prescribers and Aboriginal and Torres Strait Islander Health Practitioners are provided at the links below:

• CTG PBS Co-payment Program – Frequently Asked Questions (PDF 796KB) - (Word 3.4MB)
• Information for First Nations People (PDF 711KB) - (Word 3.4MB)
• Information for Community Pharmacies (PDF 718KB) - (Word 3.4MB)
• Information for Hospital Pharmacies (PDF 782KB) - (Word 3.4MB)
• Information for Prescribers and Aboriginal and Torres Strait Islander Health Practitioners (PDF 786KB) - (Word 3.4MB)

Program Data and Expenditure Information

Total Expenditure for Medicines and Number of PBS Items Supplied 2010-11

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$2,500,029	$540,774	$117,740	$1,628,786	$447,923	$609,787	$108,311	$116,239	$6,069,589
PBS Items Supplied	343,817	80,911	13,979	212,513	63,600	80,691	14,768	13,304	823,583

Total Expenditure for Medicines and Number of PBS Items Supplied 2011-12

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$5,457,662	$1,236,246	$408,712	$3,667,974	$1,012,893	$1,579,836	$273,085	$252,889	$13,889,297
PBS Items Supplied	763,210	175,244	45,930	481,083	148,972	207,855	39,615	29,916	1,891,825

Total Expenditure for Medicines and Number of PBS Items Supplied 2012-13

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$7,438,131	$1,516,325	$646,572	$5,248,183	$1,371,726	$2,203,288	$425,045	$338,910	$19,188,179
PBS Items Supplied	1,051,636	216,394	73,149	698,536	200,102	290,006	62,003	41,025	2,632,851

Total Expenditure for Medicines and Number of PBS Items Supplied 2013-14

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$9,816,430	$1,683,014	$935,121	$6,827,129	$1,723,315	$3,123,573	$619,307	$428,452	$25,156,341
PBS Items Supplied	1,382,756	247,954	110,735	925,306	254,347	414,799	92,416	53,200	3,481,513

Total Expenditure for Medicines and Number of PBS Items Supplied 2014-15

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$11,741,443	$2,029,457	$859,690	$8,074,056	$2,202,649	$3,383,061	$774,318	$292,947	$29,357,621
PBS Items Supplied	1,702,570	304,988	108,442	1,138,348	328,891	471,576	120,340	37,333	4,212,488

Total Expenditure for Medicines and Number of PBS Items Supplied 2015-16

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$13,867,432	$2,540,274	$1,068,012	$9,720,552	$2,305,376	$4,006,622	$956,170	$368,797	$34,833,236
PBS Items Supplied	1,935,642	365,310	132,271	1,325,848	337,071	545,248	144,177	45,228	4,830,795

Total Expenditure for Medicines and Number of PBS Items Supplied 2016-17

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$15,495,206	$2,725,726	$1,134,860	$10,954,271	$2,667,655	$4,368,211	$1,143,950	$361,738	$38,851,621
PBS Items Supplied	2,157,753	388,032	140,129	1,512,323	386,749	596,169	170,156	42,264	5,393,575

Total Expenditure for Medicines and Number of PBS Items Supplied 2017-18

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$17,373,786	$3,088,747	$1,359,657	$12,591,789	$2,884,818	$4,845,041	$1,345,563	$416,730	$43,906,135
PBS Items Supplied	2,388,535	432,330	168,712	1,712,128	414,504	654,970	198,529	48,072	6,017,780

Total Expenditure for Medicines and Number of PBS Items Supplied 2018-19

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$19,167,646	$3,395,983	$1,522,072	$14,204,722	$3,146,362	$5,332,003	$1,559,079	$462,685	$48,783,635
PBS Items Supplied	2,591,849	460,730	184,148	1,890,189	444,072	711,832	227,353	51,597	6,561,770

Total Expenditure for Medicines and Number of PBS Items Supplied 2019-20

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$21,209,964	$3,893,438	$1,678,866	$16,014,274	$3,421,251	$5,928,628	$1,805,016	$514,785	$54,466,225
PBS Items Supplied	2,833,796	522,197	200,156	2,097,857	473,731	775,731	262,406	56,566	7,222,440

Total Expenditure for Medicines and Number of PBS Items Supplied 2020-21

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$21,643,080	$4,135,554	$1,739,773	$16,446,195	$3,434,498	$5,946,244	$1,912,271	$569,635	$55,827,252
PBS Items Supplied	2,955,651	565,002	207,671	2,207,179	489,797	784,224	285,266	63,554	7,558,344

Total Expenditure for Medicines and Number of PBS Items Supplied 2021-22

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$25,528,191	$5,061,511	$1,979,382	$20,614,868	$3,920,609	$7,127,291	$2,467,109	$693,890	$67,392,855
PBS Items Supplied	3,349,975	665,989	230,101	2,660,629	536,357	903,339	349,345	74,616	8,770,351

Total Expenditure for Medicines and Number of PBS Items Supplied 2022-23

	NSW	VIC	NT	QLD	SA	WA	TAS	ACT	TOTAL
TOTAL ($)	$24,405,025	$4,765,821	$1,997,771	$19,713,348	$3,652,695	$6,692,866	$2,351,202	$653,832	$64,232,564
PBS Items Supplied	3,356,993	666,169	238,766	2,652,385	530,868	833,852	352,128	75,666	8,756,827

Note: Total Expenditure reflects the total Closing the Gap benefit amount and scripts.

Expenditure of the Closing the Gap PBS Co-payment Program can vary depending on data being updated regularly, with no cut-off date for claim submission.

Requests for any additional data or further breakdowns should be directed to Services Australia.  Services Australia will evaluate your request in line with their data release policies, and respond accordingly.

Requests to Services Australia for statistical data must be made in writing and clearly state:

• how the information contributes to improving Australia's health;
• the type of information required;
• what the information will be used for; and
• to whom the information will be disclosed.

Written requests can be sent to:
Health MI Section
Health Support and Performance Branch
Services Australia
PO Box 7788
Canberra BC ACT 2610
or email:  statistics@servicesaustralia.gov.au