Efficient Funding of Chemotherapy (EFC) – Section 100 Arrangements

Page last updated: 5 September 2017

Explanatory Notes

In addition to the drugs and medicinal preparations listed in the Schedule of Pharmaceutical Benefits, a number of drugs are also available as pharmaceutical benefits but are distributed under alternative arrangements. These alternative arrangements are provided for under section 100 of the National Health Act 1953.

Section 100 Chemotherapy Cancer Drugs

Revised prescribing and dispensing arrangements for certain chemotherapy drugs subsidised by the Pharmaceutical Benefits Scheme (PBS) came into effect on 1 December 2011 under the Revised Arrangements for the Efficient Funding of Chemotherapy Drugs initiative (2011 Revised Arrangements).

Chemotherapy drugs used for the treatment of cancer and administered through infusion or injection are covered by the 2011 Revised Arrangements. The 2011 Revised Arrangements operate under a section 100 program which includes certain intravenous chemotherapy drugs, as listed in this Schedule, which were previously supplied through:

  • the General Pharmaceutical Benefits Schedule (section 2);
  • the Special Authority Program (trastuzumab - Herceptin®); and
  • the Chemotherapy Pharmaceutical Access Program (CPAP).

This Schedule is split into three parts:

1) Chemotherapy items for private hospital use

This includes items subject to the Revised Arrangements, i.e. chemotherapy drugs administered through infusion or injection.

2) Chemotherapy items for public hospital use

This includes items subject to the Revised Arrangements, i.e. chemotherapy drugs administered through infusion or injection.

PBS products available for private and public hospital use may be dispensed in accordance with the relevant section 100 special arrangements through community pharmacy. 

3) Related pharmaceutical benefits for public hospital use

This includes items such as antiemetics, antinauseants, immunostimulants and detoxifying agents for antineoplastic treatment.

Where public hospital prescribers write prescriptions for chemotherapy infusibles that are to be dispensed outside public hospitals, they will need to prescribe from the list of chemotherapy items for private hospital/private clinic use. In these circumstances any related pharmaceutical benefits will need to be prescribed using the General Schedule listings of these drugs. Any associated authority approvals would also need to be obtained.

Prescribing and Supplying - Information for PBS Prescribers and Pharmacists

Chemotherapy Compounding Payment Scheme

From 1 July 2015, the Chemotherapy Compounding Payment Scheme (CCPS) initiative under the Sixth Community Pharmacy Agreement provided for the payment of chemotherapy compounding fees based on a two-tiered fee structure. The new fee structure recognises the additional costs associated with TGA licensing and the greater focus on the quality use of medicines that it provides.

Approved suppliers will need to provide details of the compounder for eligible EFC items through the PBS. For details regarding these changes please see the CCPS page.

Revised Prescribing and Supplying Arrangements from 1 December 2011

NOTE: The following information relates only to chemotherapy items subject to the 2011 Revised Arrangements. The related pharmaceutical benefits listed in this Schedule primarily follow the same rules as those listed in the General Pharmaceutical Benefits Schedule.

Chemotherapy drugs are listed based on the relevant unit of measure. Prescribers of these drugs must write dose-specific prescriptions, which specify the amount of active ingredient/s required for a single infusion or injection using milligrams or other relevant units of measure.

  • Prescribing will exclude reference to forms and strengths;
  • Loading and maintenance doses will need to be prescribed separately;
  • Prescriptions will no longer take the form of an order for a certain number of items, but will instead order an amount of a drug or drugs at the generic (drug) level for a specific infusion/injection; and
  • Prescribers retain the right to prescribe by brand.

This Schedule has been updated to include:

  • one item code per drug (in most circumstances), under which brands, forms and strengths are listed; and
  • maximum amount, which replaces maximum quantity and refers to the upper limit in milligrams or other relevant unit of measure.

Dispensing software has been upgraded to include an algorithm which will calculate the most cost-efficient combination of vial sizes that make up the required patient dose (one prescription) and calculate the level of remuneration paid.

The algorithm does not determine how the infusion is prepared, however remuneration will be made based on the most cost-efficient combination of vial sizes. Pharmacists will still be able to dispense any subsidised brand or combination of brands.

A dose variation of up to 10 per cent from the original amount prescribed will be allowed on the recommendation of the prescriber without requirement for a new prescription.

Same-day prescribing will be allowed. Regulations 24 (immediate supply necessary) and 25 (hardship provisions) will not apply for items under this initiative.

To recognise the specialist nature of dispensing chemotherapy drugs the Government has determined new remuneration arrangements. The fee structure for community pharmacies, public hospitals and private hospitals is provided below. 

For more information on prescribing and supplying chemotherapy medicines subject to the 2011 Revised Arrangements, refer to the Factsheet for Revised Arrangements for the Efficient Funding of Chemotherapy Drugs from 1 December 2011.

Authorisation Requirements

Authorisation requirements have not been varied by the 2011 Revised Arrangements.  Items that require an Authority continue to require an Authority from the Department of Human Services.

Prior approval is not needed for Authority Required (STREAMLINED) items (except where increased quantities and/or repeats are required). Instead the authority prescription form must include a four digit streamlined authority code. Under the 2011 Revised Arrangements more items are available as Authority Required (STREAMLINED).

For more information on authorisation requirements, refer to the Explanatory Notes of the Schedule of Pharmaceutical Benefits or the Department of Human Services website.

Remuneration Arrangements

Fees payable per eligible PBS EFC item claimed:

Section 90 Community Pharmacy (incl. Section 92 Approved Medical Practitioners)

  • Ready-prepared dispensing fee ($7.15)
  • Preparation fee ($83.83)*
  • Distribution fee ($26.28)
  • Diluent fee ($5.21)

Section 94 Approved Public Hospital Authority

  • Preparation fee ($83.83)*

Section 94 Approved Private Hospital Authority

  • Ready-prepared dispensing fee ($7.15)
  • Preparation fee ($83.83)*
  • Distribution fee ($26.28) (not payable where the drug is trastuzumab)
  • Diluent fee ($5.21)

*Includes a $40 compound fee paid to approved suppliers through the PBS.

TGA-Licensed Chemotherapy Compounders

  • Additional compound fee where compounding was undertaken at a TGA-licensed compounding site ($20)