Special Patient Contributions

The amount the patient is required to pay to cover the difference between the amount the Australian Government is willing to reimburse and the full price set by the Responsible Person (manufacturer) for a given product. This amount may be made up of Brand Premium, Therapeutic Group Premium or Other Special Patient Contributions.

Section 1 of the Schedule—Explanatory notes, 4. Patient charges

Section 2 of the Schedule—Special pharmaceutical benefits, and RPBS section of the Schedule—RPBS explanatory notes

The special patient contribution is a compulsory charge.

For certain expensive medicines, where the Australian Government and the manufacturer cannot negotiate a mutually acceptable price, the Australian Government makes a part contribution towards the manufacturer’s price. For these situations, the patient pays their normal contribution plus the difference between the contribution and the actual cost of the supplied medicine. This difference is the “special patient contribution”.

Medical practitioners may apply for an authority prescription from Medicare Australia that grants exemption from the special patient contribution on clinical grounds. The phone approval number issued by Medicare Australia starts with “SPX” or a stamp with “SPX approved” will be on the authority prescription.

The special patient contribution amount does not count towards the patient’s PBS Safety Net threshold and cannot be entered on the PBS Safety Net PRF.

The calculation for pricing medicines that attract a special patient contribution and those granted exemption from the special patient contribution, are the same as therapeutic group premium medicines and exemptions.

The exception is RPBS patients. The special patient contribution does not apply to RPBS prescriptions, so these patients only pay their normal contribution (for example, $5.60) and DVA pays the rest.

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