1AName of Scheme
This instrument is the MRCA Pharmaceutical Benefits Scheme.
This instrument is the MRCA Pharmaceutical Benefits Scheme.
Any process under the revoked scheme that had not been finalised before the commencement of this Scheme is to be completed under this Scheme as if it had commenced under this Scheme.
For the purpose of working out a pharmaceutical reimbursement, a co‑payment by an Eligible Person for a Pharmaceutical benefit under the revoked scheme, that could have been counted for a pharmaceutical reimbursement under the revoked Scheme but in respect of which a pharmaceutical reimbursement had not been made immediately before the commencement of this Scheme, is taken to be a co‑payment for a Pharmaceutical benefit under this Scheme.
The MCRA Pharmaceutical Benefits Scheme is authorised by, and subject to, section 286 of the Military Rehabilitation and Compensation Act 2004.
The MRCA Pharmaceutical Benefits Scheme enables Community Pharmacists to supply Pharmaceutical benefits to Eligible Persons.
For the purposes of this Scheme, unless a contrary intention appears:
accepted disability means a service injury, a service disease or a DRCA disability.
service injury and service disease are defined in the Act.
Act means the Military Rehabilitation and Compensation Act 2004.
approval number means a number allotted by the Secretary or the Minister for Health under section 16 of the National Health (Pharmaceutical Benefits) Regulations 2017 to an approval under the National Health Act 1953 of a person described in the section who, under the Scheme, is a Community Pharmacist.
approved hospital means a hospital in respect of which the hospital authority is approved under section 94 of the National Health Act 1953.
Approved Hospital Authority has the meaning given by subsection 84(1) of the National Health Act 1953.
approved information technology requirements means information technology requirements of a kind approved in writing by the Secretary under section 12 of the National Health (Pharmaceutical Benefits) Regulations 2017 for the purposes of the provision in those regulations in which the expression is used.
Approved Medical Practitioner means a medical practitioner approved under section 92 of the National Health Act 1953 for the purposes of supplying Pharmaceutical benefits.
approved supplier has the meaning given in Part VII of the National Health Act 1953.
Authorised Midwife has the meaning given by subsection 84 (1) of the National Health Act 1953.
Authorised Nurse Practitioner has the meaning given by subsection 84 (1) of the National Health Act 1953.
authorised nurse prescriber has the meaning given by subsection 84(1) of the National Health Act 1953.
authorised optometrist has the meaning given by subsection 84(1) of the National Health Act 1953.
authority prescription means:
a prescription of a Pharmaceutical benefit for which Prior Approval under section 6 is required;
an authority prescription as defined in the National Health (Pharmaceutical Benefits) Regulations 2017.
Authority Prescription Form means a prescription in the form, if any, for an authority prescription under the National Health (Pharmaceutical Benefits) Regulations 2017 in force from time to time.
Chief Executive Medicare has the meaning given by the Human Services (Medicare) Act 1973.
claims rules mean the rules, in force from time to time, made under subsections 98AC(4) and 99AAA(8) of the National Health Act 1953.
Commission means the body corporate continued in existence by section 360B of the Act.
Community Pharmacist means:
a registered pharmacist approved for the purposes of section 90 of the National Health Act 1953 in charge of a community pharmacy; or
a registered pharmacist approved for the purposes of section 90 of the National Health Act 1953, being the manager of a registered Friendly Society Dispensary; or
an Approved Hospital Authority; or
an Approved Medical Practitioner.
concessional beneficiary has the same meaning it has in section 84 of the National Health Act 1953, in force from time to time.
concessional beneficiary safety net has the same meaning it has in section 99F of the National Health Act 1953, in force from time to time.
concession card has the meaning given by subsection 84 (1) of the National Health Act 1953.
continued dispensing supply means the supply of Pharmaceutical benefits in the circumstances in paragraph 16A.
co‑payment, in respect of a pharmaceutical benefit, means that part of the price of a pharmaceutical benefit that is borne by the Eligible Person in relation to a Pharmaceutical benefit made available under the Scheme.
deferred supply authorisation means the situation described in section 53 of the National Health (Pharmaceutical Benefits) Regulations 2017.
generally a deferred supply authorisation occurs where a prescription contains a direction to supply more than 1 Pharmaceutical benefit and the Community Pharmacist to whom the prescription is presented, at the request of the person for whom the prescription is written, defers the supply of one or more of the Pharmaceutical benefits.
Department means the Department of Veterans’ Affairs.
dependant, in relation to a concessional beneficiary, has the meaning given by Part VII of the National Health Act 1953.
dispensed price has the meaning it has in the RPBS.
DRCA disability means an injury (within the meaning of the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988):
for which the Military Rehabilitation and Compensation Commission has accepted liability to pay compensation under that Act; and
for which the person with the injury is entitled to be provided with treatment under Part 3 of Chapter 6 of the Act.
In the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988 the definition of injury includes a disease (see section 5A of that Act).
Section 280A of the Act provides eligibility for treatment of a person with an injury under the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988.
Drugs or Medicines means goods for therapeutic use as defined for human use by the Therapeutic Goods Act 1989.
electronic medication chart has the meaning given by subsection 11B(8).
electronic prescription means a prescription that is prepared and submitted:
in accordance with approved information technology requirements (if any), by means of an eligible electronic communication; and
in accordance with the appropriate form approved by the Secretary under:
subparagraph 40(2)(c)(ii) (prescriptions other than medication chart prescriptions) of the National Health (Pharmaceutical Benefits) Regulations 2017; or
subsection 41(5) (medication chart prescriptions) of the National Health (Pharmaceutical Benefits) Regulations 2017.
eligible electronic communication means:
an electronic communication of a kind approved by the Secretary under section 11 of the National Health (Pharmaceutical Benefits) Regulations 2017 for the purposes of the provision in which the expression is used; or
if no such approval is in force for the purposes of the provision in which the expression is used—any electronic communication.
Eligible Person means:
a person who holds a Repatriation Health Card ‑ For All Conditions; or
a person who holds a Repatriation Health Card ‑ For Specific Conditions.
entitlement card has the meaning given by subsection 84 (1) of the National Health Act 1953.
Explanatory Notes means:
the document forming part of the Pharmaceutical Benefits Scheme that is SECTION 1‑ EXPLANATORY NOTES; and
the document forming part of the Pharmaceutical Benefits Scheme that is the RPBS Explanatory Notes;
being the version of the documents in the form in which they exist from time to time.
general patient safety net has the same meaning it has in section 99F of the National Health Act 1953, in force from time to time.
healthcare identifier has the same meaning as in the Healthcare Identifiers Act 2010.
healthcare provider organisation has the same meaning as in the Healthcare Identifiers Act 2010.
income support payment is a service pension (defined in subsection 5Q(1) of the Veterans’ Entitlements Act 1986) or an income support supplement (referred to in Part IIIA of the Veterans’ Entitlements Act 1986).
income support payment under the Social Security Act 1991 means a payment referred to in the definition of income support payment in subsection 23(1) of the Social Security Act 1991.
Medical Practitioner has the same meaning as medical practitioner has in the Health Insurance Act 1973.
medicare number has the meaning given by subsection 84 (1) of the National Health Act 1953.
medication chart has the meaning given by subsection 11B(6).
medication chart prescription has the meaning given by section 11B.
member has the meaning it has in the Act and includes a former member.
member of a couple has the meaning it has in subsection 5E(2) of the Veterans’ Entitlements Act 1986.
Minister for Health means the Minister administering the National Health Act 1953.
MPBS means the MRCA Pharmaceutical Benefits Scheme.
MPBS prescriber means a Medical Practitioner, an Authorised Midwife, an Authorised Nurse Practitioner, an authorised nurse prescriber, a participating dental practitioner or an authorised optometrist.
a MPBS prescriber who is not a Medical Practitioner may only prescribe Pharmaceutical benefits listed on the PBS. A prescription issued by an MPBS prescriber who is not a Medical Practitioner for Pharmaceutical benefits that are not available on the PBS is not recognised under the Scheme.
MRCA supplement means the compensation payable under section 300 of the Act, in force from time to time.
MRCA Treatment Principles means the determination called the MRCA Treatment Principles, made by the Commission under section 286 of the Act and in force from time to time.
paper‑based prescription means a prescription that is prepared in duplicate in accordance with subsection 40(2) of the National Health (Pharmaceutical Benefits) Regulations 2017 in force from time to time.
participating dental practitioner has the meaning given by subsection 84(1) of the National Health Act 1953.
PBS or Pharmaceutical Benefits Scheme means the document entitled “SCHEDULE OF PHARMACEUTICAL BENEFITS” with International Standard Serial Number 1037‑3667, being the version of the document in the form in which it exists from time to time.
PBS prescriber has the meaning given by subsection 84(1) of the National Health Act 1953.
PBS prescriber number means the number given by the Chief Executive Medicare to a person who may prescribe a pharmaceutical benefit under the National Health Act 1953.
PBS Schedule means the collection of instruments made under Part VII of the National Health Act 1953 (the Act) by the Minister who administers that Act, as those instruments are in force from time to time.
pension supplement has the same meaning it has in subsection 5Q(1) of the Veterans’ Entitlements Act 1986, in force from time to time.
pharmaceutical allowance means the component of the MRCA supplement, veterans supplement or pension supplement or war widow/war widower pension that is to assist with the purchase of Pharmaceutical benefits, the calculated value of which is referred to in paragraph 37 (pharmaceutical allowance component) of Part 5A.
pharmaceutical benefit has a drug has the same meaning as in Part VII of the National Health Act 1953.
Pharmaceutical benefits has the same meaning as pharmaceutical benefits in subsection 91(9) of the Veterans’ Entitlements Act 1986.
pharmaceutical item has the meaning given in Part VII of the National Health Act 1953.
pharmaceutical reimbursement means the financial amount described in paragraphs 33‑35 of Part 5A.
Prior Approval means the prior approval of the Commission.
relevant streamlined authority code, for a pharmaceutical benefit that is prescribed, means the streamlined authority code that is part of:
the circumstances determined under paragraph 85(7)(b) of the National Health Act 1953 for the Pharmaceutical benefit; or
the conditions determined under subsection 85A(2A) of the National Health Act 1953 for the Pharmaceutical benefit.
Repatriation Health Card ‑ For All Conditions means an identification card, or written authorisation, provided to a person eligible under Part 3 of Chapter 6 of the Act for treatment, subject to the MRCA Treatment Principles, for all injuries or diseases.
Repatriation Health Card ‑ For Specific Conditions means an identification card, or written authorisation, provided to a person eligible under Part 3 of Chapter 6 of the Act for treatment, subject to the MRCA Treatment Principles, for a service injury or a service disease.
Repatriation Pharmaceutical Benefits Scheme has the same meaning as in the Veterans’ Entitlements Act 1986.
Repatriation Schedule of Pharmaceutical Benefits means all of the content in the Pharmaceutical Benefits Scheme for the part with the heading “Repatriation Pharmaceutical Benefits Scheme”.
repeat authorisation form means the form mentioned in subparagraph 52(3)(a)(i) of the National Health (Pharmaceutical Benefits) Regulations 2017 in force from time to time.
residential care service means a residential care home as defined in subsection 10(2) of the Aged Care Act 2024.
Subsections 10(3), (4) and (5) of the Aged Care Act 2024 are applicable when applying subsection 10(2) of that Act.
revoked scheme means the MRCA Pharmaceutical Benefits Scheme (Instrument 2004 No. M22).
RPBS means the Repatriation Pharmaceutical Benefits Scheme.
RPBS Explanatory Notes means the document forming part of the Pharmaceutical Benefits Scheme that is the RPBS Explanatory Notes being the version of the document in the form in which it exists from time to time.
RPBS Schedule means the document forming part of the Pharmaceutical Benefits Scheme that is the Repatriation Schedule of Pharmaceutical Benefits, being the version of the document in the form in which it exists from time to time.
safety net, in respect of its application to a person under this Scheme, means the concessional beneficiary safety net or general patient safety net, whichever amount first applies to the person for the purposes of section 84C of the National Health Act 1953, in force from time to time.
under section 84C of the National Health Act 1953 a concession card or entitlement card is issued when a person reaches their Safety Net. The card is issued for the “relevant entitlement period”. The relevant entitlement period is the remainder of the calendar year after the card is issued.
Scheduled item means an item in the PBS Schedule or the RPBS Schedule.
Scheme means the MRCA Pharmaceutical Benefits Scheme.
Secretary has the meaning given in Part 1 of the National Health Act 1953.
service injury and service disease have the same meanings given by section 5 of the Act and for a person with a DRCA disability means the person’s injury (within the meaning of the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988) that was caused by, or arose out of, the person’s employment in the Defence Force that is covered by the Safety, Rehabilitation and Compensation (Defence‑related Claims) Act 1988.
social security pension supplement means a rate or amount worked out under section 20A of the Social Security Act 1991.
special arrangement means the National Health (COVID‑19 Supply of Pharmaceutical Benefits) Special Arrangement 2020 (the instrument) made by the Minister for Health under section 100 of the National Health Act 1953 to modify the arrangements for the supply of pharmaceutical benefits under Part VII of that Act.
Standard Prescription Form means a prescription prepared in accordance with subsection 40(2) of the National Health (Pharmaceutical Benefits) Regulations 2017.
a Standard Prescription Form does not include a medication chart prescription.
supply certification form means the form of that name in the claims rules.
veterans supplement means the payment under section 118A of the Veterans’ Entitlements Act 1986.
war widow/war widower pension means a payment received by a war widow/war widower—pensioner comprised of:
a pension under Part II or IV of the Act at a rate determined under or by reference to subsection 30(1) of the Act; or
a lump sum mentioned in paragraph 234(1)(b) of the MRCA or a weekly amount mentioned in that paragraph.
MRCA is defined in subsection 5Q(1) of the Act as the Military Rehabilitation and Compensation Act 2004.
references in the Scheme to paragraphs, subparagraphs, sections and subsections are interchangeable. For example a reference to “paragraph 10” of the Scheme is the same as a reference to “section 10” of the Scheme and vice versa.
Where it is provided for the Department or the Commission to notify of certain matters under the Scheme, the inclusion of the matter in the RPBS Explanatory Notes and publication of the RPBS Explanatory Notes (as part of the publication of the Pharmaceutical Benefits Scheme which includes the RPBS Explanatory Notes) shall be taken to constitute such notification.
Where it is provided that the Department may notify of certain matters, the Department may only do so for and on behalf of the Commission, as its agent.
The Commission may approve any matters requiring Prior Approval; and
Prior Approval must be sought, in advance, in accordance with an Authority Prescription Form.
Restrictions apply to the prescribing of certain items. These include:
items—quantities and repeats: those listed in the RPBS Schedule or PBS Schedule;
surgical appliances and other treatment aids: surgical appliances and other treatment aids provided under the MRCA Treatment Principles or under the Act may not be prescribed unless specifically listed in the RPBS Schedule;
admixtures: the following restrictions apply to admixtures:
admixture of two or more ready‑prepared items into a single combined form, or the addition of one or more supplementary ingredients to a ready‑prepared item, is not recognised as a Pharmaceutical benefit;
the extemporaneous prescribing of two or more official formulary preparations in a single combined form, or the addition of one or more supplementary ingredients to an official formulary preparation, is a recognised Pharmaceutical benefit; and
where one or more of the components of a preparation specified in subparagraph (ii) are non‑RPBS Schedule or non‑PBS Schedule items, Prior Approval is required for their prescribing;
conformity with standards: no drug or therapeutic substance shall be prescribed unless it conforms with the specific or general standards as determined by the relevant Minister under the Therapeutic Goods Act 1989.
basis for prescribing: the prescribing of therapeutic substances other than for a clinical diagnosis provided by a Medical Practitioner, Authorised Nurse Practitioner, Authorised Midwife, authorised nurse prescriber, participating dental practitioner or authorised optometrist shall be invalid.
a MPBS prescriber who is not a Medical Practitioner may only prescribe Pharmaceutical benefits listed on the PBS. A prescription issued by a MPBS prescriber who is not a Medical Practitioner for Pharmaceutical benefits that are not available on the PBS is not recognised under the Scheme.
approval for therapeutic use: it is invalid to prescribe:
an item that is not approved for therapeutic use in the treatment of human illness by the relevant Commonwealth, State or Territory Government agencies, or
an item for use if it is not in accordance with the terms and conditions specified by the relevant Government agencies in approving the item as a therapeutic substance;
Prior Approval for non‑conforming items: any drug or medicine intended for use other than in conformity with the requirements in subparagraph (d) requires Prior Approval;
PBS Schedule restricted items: the prescribing of PBS Schedule restricted items is to comply with the restrictions relating to the prescribing of such items as indicated in the PBS Schedule unless Prior Approval is obtained to prescribe otherwise;
RPBS Schedule restricted items: the prescribing of RPBS Schedule restricted items under this Part is to comply with the restrictions relating to the prescribing of such items as indicated in the RPBS Schedule unless Prior Approval is obtained to prescribe otherwise;
Prior Approval for non‑Schedule items: the prescribing of an item not included in the RPBS Schedule or PBS Schedule requires Prior Approval.
The PBS Schedule and RPBS Schedule are the primary references for the prescribing of Pharmaceutical benefits.
Restrictions specified in the PBS Schedule and RPBS Schedule which limit supply of items to a particular class of person, or are reserved for specified purposes or require an authority to prescribe, apply unless Prior Approval is obtained to prescribe otherwise.
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