Document ID: chunk:federal_register_of_legislation:F2025C00083:reg:32a:p4
Version: federal_register_of_legislation:F2025C00083
Segment Type: reg
Provision Reference: reg 32A (pt 4/5)
Character Range: 86655–89384

is payable in the first quarter in each calendar year in respect of co‑payments the person made for a Pharmaceutical benefit under this Scheme in the previous calendar year ‑ not being a calendar year before 1 January 2012.
Note 1: calendar year is defined in section 2B of the Acts Interpretation Act 1901.
               (3) The pharmaceutical reimbursement is not payable for a person in the first quarter in a calendar year as mentioned in (2) if the data necessary to calculate the payment for the person is not available to the Department in which case the  pharmaceutical reimbursement is payable to the person as soon as practicable after the data is available.

       38A  Five Year Limit on Payment of Pharmaceutical Reimbursement
 (1) Unless the Commission is of the opinion that there are special circumstances, a pharmaceutical reimbursement shall not be paid in respect of co‑payments incurred by a person more than 5 calendar years before the Commission decision to accept financial responsibility for the pharmaceutical reimbursement for the person.
 (2) If the Commission decides there are special circumstances in relation to a person, then it is to determine a date on and from which co‑payments are to be counted for the pharmaceutical reimbursement for the person.

       39  Pharmaceutical Reimbursement Calculator
 (1) The pharmaceutical reimbursement for an Eligible Person is worked out as follows:
  Step 1 add the co‑payments for the Pharmaceutical benefits incurred by the person in the previous calendar year (sum of co‑payments) up to the threshold of payments according to the safety net and disregarding any uncounted co‑payment.
  Step 2 compare the sum of co‑payments with the sum of the pharmaceutical allowance component of the MRCA supplement, pension supplement, veterans supplement and war widow/war widower pension payable to the person in respect of the previous calendar year.
  Step 3 if the sum of co‑payments (amount 1) exceeds the sum of the pharmaceutical allowance component of the MRCA supplement, pension supplement, veterans supplement and war widow/war widower pension payable (amount 2), the amount by which amount 1 exceeds amount 2 is the pharmaceutical reimbursement for the person.
Note: the amount of any of these supplements may be zero.

       40
  For the Pharmaceutical Reimbursement Calculator an uncounted co‑payment is a co‑payment for a Pharmaceutical benefit where the co‑payment is not counted for the purposes of the safety net applying to the person.
Note: included here are co‑payments for Pharmaceutical benefits dispensed under the "Safety Net 20 Day Rule" (subsection 84C(4AA)) of the National Health Act 1953.

Part 5B—Under Co‑payment Data Collection