5.4.3 PhA advance payment
Qualification for advance PhA
Pensioners who receive PhA separately may claim up to 7 times the fortnightly rate of PhA as an advance payment if they meet all of the following criteria:
- they qualify for PhA (that is, they are either recipients of PPS who are under age pension age or are disability support pensioners who are under 21 without dependent children), AND
- their ordinary income (1.1.O.30) does not exceed $20.50 per fortnight (Note: If the person is a member of a couple, the amount of the person's ordinary income is worked out by adding the couple's ordinary incomes on a fortnightly basis, and dividing by 2), AND
- their expenditure on prescription items must not be less than the amount of PhA received in that entitlement year. For a couple, their COMBINED expenditure, including that for dependent children (1.1.D.70), applies.
The amount paid to a person in a calendar year is not to exceed the total amount of PhA that would have been paid to the person during that year if the person had not received any advance PhA.
Exceptions: A pensioner who applies for an advance before the first payment delivery day (1.1.D.55) in an entitlement year will not have received any PhA payments in that entitlement year. The pensioner is eligible for an advance and does not need to have purchased any prescription items in that entitlement year.
A person who claims PPS or claims DSP and they are under 21 without dependent children may apply for an advance payment of PhA at the same time. If a social security pension is granted, the person is eligible for an advance from the date of grant. They do not need to have purchased any prescription items in that entitlement year.
Act reference: SSAct section 1061JC Amount of advance PhA, section 1061JD Annual limit, section 1061F Qualification for advance PhA, section 1061G Advance pharmaceutical allowance not payable …
Policy reference: SS Guide 3.8.2 PhA - qualification & payability
Pensioners can be paid further advances as soon as they have spent all the PhA they have received for the calendar year on prescription items, provided they still qualify for PhA.
An entitlement year for advance payments of PhA runs from 1 January to 31 December in the same calendar year.
Pensioners must apply in writing for an advance because of the need to verify their circumstances. They may also need to provide their prescription record form to verify that they have purchased sufficient prescription items.
Explanation: Prescription record forms are available from most pharmacists and are completed by the pharmacist when prescriptions are provided.
Payments to members of a couple
Although combined income is used to determine qualification for advances involving couples, the advance can be paid independently. This means that one pensioner may receive an advance while their partner receives PhA on a fortnightly basis. Once a pensioner receives an advance of PhA, the non-payment period remains the same, regardless of whether they become single or partnered.
Example: If a single pensioner receives an advance of $46.20, a non-payment period of 7 payment delivery days applies. If they later become a member of a couple, their non-payment period still expires after 7 payment delivery days. Once this expires, however, their fortnightly entitlement to PhA is $3.30 for each eligible member of a couple.