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Prescription co-payments

From 1 July 2024 prescriptions from approved providers may attract a maximum $5 prescription co-payment per item.

Approved providers are:

  • Public hospitals
  • Midwives (with a Section 94 Notice)
  • Family Planning Clinics
  • General Practices (as long as they are part of a PHO)
  • After Hours Accident and Medical Services (as long as they have a Health New Zealand or a PHO contract)
  • During normal business hours (ie, not after hours) general practitioners where the person is not enrolled (ie, ‘casual’ visits) are approved if the person is an eligible person and the general practice is part of a PHO.
  • Youth Health Clinics (as long as they have a Health New Zealand or a PHO contract)
  • Hospices (as long as they have a Health New Zealand contract)
  • After-hours providers with an access or service agreement with an approved service provider. Health New Zealand can provide pharmacists with a list of approved after-hours providers.
  • Dentists, if the prescription relates to a service being provided under a Health New Zealand contract
  • Private specialists (eg, ophthalmology, orthopaedics), if the prescription relates to a patient receiving a publicly funded service contracted by Health New Zealand
  • ACC-related claim.

Prescriptions from approved providers for the following groups are exempt from the $5 prescription co-payment:

  • Children under 14 years
  • Community Services Card holders and their dependents
  • Seniors aged 65 years and over

Any provider/prescriber not specifically listed by Health New Zealand as an approved provider/prescriber should be treated as not approved.

Prescriptions from unapproved prescribers attract high prescription co-payments:

Senior (ages 65 and over) $15
Adults (ages 18 years to 64 years) $15
Junior (ages 14 to 17 years) $10

These charges reduce to $5 if a person has a High Use Health Card, or the prescription is for an oral contraceptive, and $0 (no charge) if a person has a Community Services Card.

Prescription subsidy card

Once patients and their families have collected 20 prescription items in a year, they can get a Prescription Subsidy card, which means they won’t have to pay any more prescription charges until 1 February the following year.

For a Prescription Subsidy Card, a family (a family unit) is the patient and his or her partner and dependent children aged from 14 up to 18.

How to find a co-payment provider

Hospitals have a list of eligible providers in their respective regions. Any provider/prescriber not specifically listed as an approved provider/prescriber should be regarded as not approved.

How to tell if someone is eligible for publicly funded pharmaceuticals

Patients are eligible for publicly funded pharmaceuticals if they are a New Zealand citizen or have the correct permits in their passport (see Guide to eligibility for public health services).

The pharmacist can determine a patient’s eligibility by asking the patient to provide evidence or checking with the provider.

The pharmacist is entitled to rely on the prescriber’s information about the patient’s eligibility.

Australian and UK tourists

Although tourists cannot join a PHO, if the prescriber is an approved provider the prescription attracts a prescription co-payment. The same prescription co-payment rules that apply to New Zealanders also apply to Australian and UK citizens visiting New Zealand. In most cases the standard $5 prescription co-payment will apply. 

An Australian citizen or Australian permanent resident on a temporary visit to New Zealand, who requires medical treatment that is immediately and clinically necessary for the diagnosis, alleviation, or care of that condition, will be entitled to subsidised pharmaceuticals in relation to that condition only.

A UK citizen, temporarily in New Zealand, who requires prompt medical treatment for a condition arising after they arrived in New Zealand (or became acutely exacerbated after arrival), will be entitled to subsidised pharmaceuticals in relation to that condition only.

ACC prescriptions

ACC prescriptions are funded by ACC. ACC advise that all ACC-related prescriptions should be coded A4 for a standard $5 prescription co-payment.

Incorrectly coded or un-coded prescriptions

If the pharmacist has information that indicates a prescription is coded incorrectly, the pharmacist may alter the code.

If the prescription is not coded the pharmacist needs to confirm that the:

  • patient is eligible for publicly funded pharmaceuticals
  • prescriber is an approved prescriber.

Once confirmed, the pharmacist can decide the correct code for prescription co-payment purposes.

However, the pharmacist must have information which they can point to and which they believe is factual. Examples include:

  • a list of approved providers
  • that the prescription is on a public hospital prescription
  • advice from Health New Zealand that the prescriber is approved (such as midwives and family planning)
  • advice from Health New Zealand that a prescriber from a private hospital is providing health services under a Health New Zealand contract.

 

The alteration to the coding on the prescription should be done in a manner that is identifiable and auditable, as required in the Pharmacy Procedures Manual under clause 7.13 for annotations.