Prescription Shopping Programme
About the programme
The Prescription Shopping Programme (PSP) protects the integrity of the Pharmaceutical Benefits Scheme (PBS).
Prescription shopping is when a patient unknowingly or deliberately gets more medicine than they need. They will visit many doctors without telling them about their other consultations.
The PSP helps prescribers identify and reduce the number of patients who get more PBS subsidised medicines than they medically need.
The PSP has a 24 hour Prescription Shopping Information Service (PSIS) and a Prescription Shopping Alert Service. Prescribers and approved suppliers can access these services. An approved supplier can be an approved pharmacist, approved medical practitioner or approved hospital authority.
Prescription Shopping Information Service
Prescription Shopping Information Service (PSIS) is a 24 hour, 7 days a week telephone service. It gives prescribers information on whether patients meet the criteria of the PSP and is accurate up to the last 24 hours.
Prescribers and approved suppliers can access the PSIS. Multiple prescribers can contact the PSIS about the same patient if they are consulting with that patient.
Prescription Shopping Alert Service
The alert service assesses patients monthly who meet the PSP criteria. We will write to patients and their prescribers if there are concerns the patient may be getting more PBS medicines than medically needed.
Criteria for PSP
If you suspect your patient is getting more medicine than they medically need, call the PSIS.
To meet the criteria for the PSP your patient must have been supplied at least one of the following:
- pharmaceutical benefits prescribed by 6 or more different prescribers
- a total of 25 or more target pharmaceutical benefits
- a total of 50 or more pharmaceutical benefits
Target pharmaceutical benefits are pharmaceutical benefits in certain categories of the Anatomical Therapeutic Chemical classification system. You can read more information about which categories are included under the PSP in the Anatomical Therapeutic Chemical classification system on the Commonwealth Consolidated Regulations website.
Reasons why your patients may get more medicines than they need include:
- stockpiling for later use
- drug dependency
- intention to sell, exchange or give medicines to relatives, or
- send it illegally overseas
Patients who meet the PSP criteria
If your patient meets the PSP criteria, we can tell you:
- the number of PBS medicines supplied in the past 3 months—this includes repeat prescriptions and prescriptions issued within 12 months
- the number of individual prescribers of PBS medicines supplied by pharmacies during the identified period. We cannot provide the details of other prescribers for your patient
If your patient meets the PSP criteria it does not mean you cannot prescribe to them. If they meet the criteria you can request a patient summary report.
Patients who do not meet the PSP criteria
If your patient does not meet the PSP criteria and you still have concerns, you can:
- learn more about the conditions and limitations of the information provided by the PSIS
- contact your state or territory health department for more information on any statutory reporting requirements or programs available
- report the patient to our fraud tip off line
- get PBS information about your patient by getting them to complete the Authority to release personal Medicare and Pharmaceutical Benefit Scheme claims information to a third party (2690) form and return it to us
Registering for the programme
Prescribers and approved suppliers can register using the Prescription Shopping Information Service registration form (PB131) or by calling the PSIS.
Once registered, you can use PSIS to find out if your patient meets the PSP criteria.
Using the PSIS
At the start of your phone call we will ask for:
- your prescriber number
- your full name
- a question to confirm your identity
- the patient's Medicare number, date of birth and full name
Once we have confirmed who you are, we will tell you if your patient has met the PSP criteria.
If your patient has not met the PSP criteria, we won’t be able to access or tell you more information about them.
Medical practice staff cannot contact the PSIS on behalf of a prescriber.
Patient summary report
A patient summary report lists PBS medicines supplied to the patient over a 3 month period. You can only request one if your patient meets the PSP criteria.
The report includes:
- the number of individual prescribers for PBS medicines supplied by pharmacies. This is for prescriptions supplied during the period the patient met the criteria, and may include repeat prescriptions
- PBS medicines supplied to the patient, including the total number prescribed and the pack size
Accessing a patient summary report
You can access a patient summary report online through HPOS. Reports are available for 14 days from the time you call PSIS.
You can also receive the report by fax.
Conditions and limitations of the programme
We administer the PSIS within strict privacy and legal constraints. We can tell you:
- about PBS medicines your patient has received if they meet the PSP criteria
- information to help you make decisions about the medication needs of your patient. This information should not be used for any other purpose
We cannot tell you if the information we have is a complete picture of your patient’s medicine supply record. We also cannot tell you about the PBS medicines supplied to a person who isn’t your patient.
We won’t be able to tell you if:
- samples of medication have been provided to your patient by a prescriber
- private prescriptions have been supplied
- over the counter medicine has been used by your patient
- any emergency treatment has been provided to your patient by a prescriber
- emergency PBS medicine has been supplied by a pharmacist
- medicine is prescribed under the RPBS, or
- it is the supply of section 100 medicines. Read more about PBS section 100 items on the PBS website
Report a patient
Patients accessing information
You can advise your patient that they can also access their own PBS information. They will need to write to us. You can read more about how we manage personal information releases.