Education guide - Closing the Gap - PBS Co-payment Measure - supporting Indigenous health
Information about patient registration, prescribing, dispensing and claiming pharmaceutical items under the CTG - PBS Co-payment Measure.
Overview of the CTG-PBS Co-payment Measure
This education guide has been created as part of the Indigenous health services education for health professionals’ package.
It includes a case study highlighting the benefits of the Closing the Gap Pharmaceutical Benefits Scheme (CTG-PBS) Co-payment Measure for Aboriginal and Torres Strait Islander patients with, or at risk of, a chronic disease.
A general practice or Indigenous Health Service must be registered under the measure to enable their prescribers to write CTG prescriptions for their patients.
When the practice is registered, they must obtain their patients’ consent to register the patient for the measure as a part of the patient registration process.
Assessment of a patient’s eligibility for CTG prescriptions only needs to be undertaken once by the prescriber. Patients are registered at either:
- general practices participating in the Indigenous Health Incentive under the Practice Incentives Programme, or
- Indigenous Health Services in urban and rural settings
CTG prescriptions can’t be written until the prescriber confirms the patient's eligibility and registration process is complete. This can be confirmed by either:
- using HPOS to access the practice’s list of registered patients, or
- contact us at Incentives programs
Prescriptions written under this measure are referred to as CTG prescriptions with the normal PBS prescription requirements applying.
By writing a CTG prescription, the patient receives the item at a lower patient contribution level or free of charge.
Further information about Indigenous health services is available at Indigenous health education for health professionals.
You work as a health practitioner in an Indigenous Health Service currently participating in the PBS Co-payment Measure as a ‘Non-Practice Incentive Program’ Health Service.
A 61 year old patient presents to your Indigenous Health Service with persistent ulcers of the foot.
Medical history includes:
- Diabetes mellitus type 2
Other health related information includes:
- has a poor diet
- seldom seeks medical attention
- usually attends every 6 months for script renewals
- isn't effectively managing chronic condition due to cost constraints
A detailed chronic disease management plan is completed during this consultation. You’ve determined that your patient is eligible for the CTG PBS Co-payment Measure as they’re unlikely to follow their medicine routine without cost relief benefits available under the measure.
During the consultation, you undertake the following actions needed to register your patient:
When the process of registering your patient is completed, you are able to start writing CTG prescriptions for your patient. The table below describes these actions:
CTG annotation code prescription - prescribing requirements
You can annotate CTG prescriptions in 2 ways. The table below describes these annotations:
|Computer generated||Prescribing software will annotate the prescription with a CTG alpha-numeric code.||CTG11K|
|Handwritten||Annotate the prescription with the letters ‘CTG’ and initials or signature of the prescriber.||
If prescriptions aren’t annotated or are annotated incorrectly, the pharmacist won’t be able to dispense the prescription as a CTG prescription.
You work as a pharmacist in the local community pharmacy. You need to indicate in the pharmacy dispensing software (PDS) that you’re dispensing a CTG prescription. The table below describes your actions:
|The local community pharmacist:|
CTG annotation code prescription - dispensing requirements
You can enter the code in the following 2 ways:
|Prescription type||PDS input|
|Computer generated||Enter the CTG alpha-numeric annotation code into the appropriate field. This will usually be located at the top right hand corner of the prescription.|
Depending on your PDS you’ll need to enter 1 of the following:
Common dispensing scenarios
The table below outlines some common dispensing scenarios and actions for pharmacists:
|Patient presents a CTG prescription||
||Pharmacists are required to check each prescription is correctly annotated at the time of dispensing.|
|Patient presents a CTG prescription to the pharmacy for the first time||
||Pharmacists are required to identify the patient as a CTG patient in the PDS.|
|An eligible patient presents a prescription that’s not annotated or is annotated incorrectly||
||The prescriber needs to correct or annotate the prescription as pharmacists can’t annotate the prescription even if they’ve contacted the prescriber.|
|CTG prescription with repeats||
||The annotation will carry over to all repeats. The code will usually be printed in the manual pricing box on the repeat authorisation form.|
Patient payments and PBS Safety Net recording
Under the CTG PBS Co-payment Measure patient contributions are less than non CTG prescriptions.
If the correct CTG annotation code is entered when dispensing, the PDS will automatically calculate the appropriate patient contribution and PBS Safety Net amount. The table below outlines a dispensing scenario for you:
While the patient pays a reduced amount for all 5 CTG prescriptions, the full co-payment amount (general patient) is printed on the prescription record form. This will ensure that the patient’s eligible PBS Safety Net family are able to reach the PBS Safety Net threshold at the normal rate.
CTG PBS Co-payment Measure patient contributions
The table below outlines the patient contribution for the measure:
|General patients||Concession cardholders|
Premiums for a small number of items are still payable by the patient in addition to the patient contribution.
The amount that can contribute to the PBS Safety Net for each CTG prescription is the same amount that would have been added in the absence of the CTG Measure.
|For claiming purposes:|
Prescriptions with 'U' serial numbers
The PDS prints some prescription serial numbers with 'U' as the first part of the serial number. This occurs when a prescription that would normally be under co-payment, priced below the general patient contribution rate, is now priced at the concession rate without changing the entitlement category.
Summary for prescribers:
- identify your patient’s eligibility
- discuss the Co-payment Measure with your patient
- complete the Co-payment Measure patient registration and consent form and submit to the Department of Human Services
- write PBS prescriptions as per normal requirements with CTG annotation
Summary for pharmacists:
- check prescriptions are correctly annotated - if not, contact the prescriber
- dispense PBS prescriptions as per normal requirements
- key the correct CTG annotation code into the PDS
- ensure the appropriate amount for eligible prescriptions is added towards the patient’s Safety Net Prescription Record Form
- Education services for health professionals to access other education resources
- read more on the Practice Incentives Program
- Closing the Gap - PBS Co-payment Measure for additional information
Contact us at PBS general enquiries.
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