Commonwealth Consolidated Acts

NATIONAL HEALTH ACT 1953 - SECT 87A

  (1)   If:

  (a)   an approved supplier did not supply a pharmaceutical benefit to a person on terms that are appropriate for the supply of a benefit to:

  (i)   the holder of a concession card or entitlement card; or

  (ii)   a concessional beneficiary; or

  (iii)   a person who is a dependant of a concessional beneficiary within the meaning of subsection   84(4) or (7);

    because the supplier was not satisfied that the person was entitled to receive the benefit on those terms; and

  (b)   the Secretary is satisfied that the person was entitled at the time to receive the benefit on those terms;

the person is entitled to be paid by the Commonwealth an amount equal to the difference between:

  (c)   the amount payable for the supply of the benefit on those terms; and

  (d)   an amount equal to:

  (i)   if, because of subsection   99(2A), (2AB) or (2B), the supply of the benefit is taken to be a supply otherwise than under this Part--the Commonwealth price for the supply of the benefit; or

  (ii)   in any other case--the amount that the person was charged under section   87.

  (2)   A person is entitled to be paid by the Commonwealth an amount equal to the difference between the amount payable for the supply of a pharmaceutical benefit on terms that are appropriate for the supply of the benefit to a general patient and an amount equal to the Commonwealth price for the supply of the benefit if:

  (a)   an approved supplier did not supply the benefit to the person on those terms because the supplier was not satisfied that the person was entitled to receive the benefit on those terms; and

  (b)   the Secretary is satisfied that the person was entitled at the time to receive the benefit on those terms.

  (3)   Subsection   (4) applies if:

  (a)   under this Act an approved supplier charged a person an amount in respect of a supply of a pharmaceutical benefit; and

  (b)   at the time of the supply, the person was eligible to be issued with a concession card or an entitlement card but was not the holder of such a card.

Note:   For when a person is eligible to be issued with a concession or entitlement card, see section   84C.

  (4)   If the Secretary is satisfied:

  (a)   that the failure to issue a concession card or entitlement card was not caused by some wilful action of the person; and

  (b)   that in the circumstances the person should be treated as if:

  (i)   the person had been at the time when the pharmaceutical benefit was supplied the holder of a concession card or entitlement card; and

  (ii)   the prescription upon which the pharmaceutical benefit had been supplied were a concession card prescription or entitlement card prescription (as the case may be);

the person is entitled to be paid by the Commonwealth an amount equal to any amount paid by the person that would not have been payable if the pharmaceutical benefit had been supplied on a concession card prescription or an entitlement card prescription (as the case may be).