Customer refunds under the PBS safety net

Circumstances where we might provide a refund to your customer.

There are 2 circumstances where we might provide a refund to your customer:

  • if they exceed their PBS safety net threshold before being issued with a PBS safety net card, or
  • if they cannot prove eligibility when you supply their medicine

Not exceeding the PBS safety net threshold

Tell your customers early in the year that they can link their family members under the PBS safety net. This may assist with avoiding a situation where the customer exceeds the threshold and then needs to request a refund.

Proof of eligibility

Your customer can prove eligibility by showing you their:

  • Medicare card
  • PBS safety net card
  • Human Services concession card, or
  • Department of Veterans' Affairs concession card

If your customer cannot prove their eligibility at the time of purchasing their PBS medicine, and you charge them at a higher rate, you need to give them an official pharmacy receipt (S87A). This makes it possible for us to give them a refund if they are eligible.

An official pharmacy receipt needs to include:

  • the patient's name and address
  • the patient's payment level (for example, private, general, concession or free)
  • the prescriber's name
  • the prescriber's address or prescriber number
  • the date the medicine was supplied
  • an item code
  • the quantity
  • clarification of whether regulation 24 applies
  • an authority prescription number (if applicable)
  • the price paid, and
  • the pharmacy approval number

We cannot process the claim if any of these details are missing. If something is missing, we will tell your customer to contact you to get the missing information.

Submitting a claim for a refund

To claim a refund, your customer needs to:

  • complete and submit a Patient claim for refund Pharmaceutical Benefits Scheme (PBS) form with a copy of all their prescription record forms to support their claim, or
  • send us a letter requesting a refund. This needs to include their name, address, Medicare card details and PBS safety net card number. They also need to include a copy of all prescription record forms to support their claim

Your customer can return these to us by mail, or in person at a Medicare shop front.

You cannot make a claim for a refund for your customer. You can only help them by providing the information they need.

Your customer will not get a refund if:

  • their entitlement number has expired
  • the item claimed is not a PBS-listed medicine
  • the PBS safety net threshold has not been exceeded
  • we have no record of their entitlement number
  • an unpaid pharmacy account is presented instead of an official pharmacy receipt
  • details are missing from the official pharmacy receipt
  • the prescription is issued under the PBS safety net 20-day rule, or
  • they have not signed the claim

Page last updated: 12 October 2016

This information was printed Friday 9 December 2016 from humanservices.gov.au/health-professionals/enablers/customer-refunds-under-pbs-safety-net It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.