Electronic prescription fee

Approved suppliers are paid a fee for each eligible electronic prescription supplied.

The electronic prescription fee has been extended through the 6th Community Pharmacy Agreement. Approved suppliers are paid $0.15 for each eligible electronic prescription supplied. Online claiming allows pharmacies to be paid the electronic prescription fee at the same time prescription claims are assessed and paid.

Eligibility

The electronic prescription fee can be claimed:

  • where a Pharmaceutical Benefits Scheme (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS) electronic prescription is:
    • uploaded by a prescriber to a prescription exchange service and downloaded by an approved supplier from the prescription exchange service with an electronic prescription flag (also known as a script qualifying flag)
    • supplied by the approved supplier, with the dispensing records uploaded to the prescription exchange service for each item supplied, and the supply is claimed via online claiming for PBS
  • for repeat authorisations or deferred supply authorisations in relation to an original electronic prescription that meets the criteria above

Private prescriptions are not eligible for the electronic prescription fee through either the electronic or manual claiming solutions.

Electronic claiming process

For prescriptions to be paid the electronic prescription fee via online claiming for PBS, prescription records submitted to us must contain an electronic prescription flag and valid prescription exchange service ID. This information must be included for each prescription when downloaded from an approved prescription exchange service and claimed online.

Under co-payment prescriptions and the electronic prescription fee

Under co‑payment prescriptions that attract an eligible electronic prescription fee will be automatically paid for eligible electronic prescription data. For audit and verification purposes, you will need to retain records for a period of 2 years that show how these prescriptions meet the requirements for claiming the electronic prescription fee.

Online claiming for PBS functions

Your detailed PBS claims report and the PBS reconciliation statement only reflect information about fee payments if the approved supplier has received a payment. Identifiers relating to various fees and incentive payments are included with information for each prescription.

Rejection or warning reason codes that relate specifically to the online claiming of the electronic prescription fee are:

  • 615 Reject - the electronic prescription flag is not valid
    meaning the electronic prescription flag sent in the transmission is not valid and that we will only accept Y, N, U
  • 616 Warning - the PES ID is not provided
    meaning an electronic prescription flag of Y has been received but no prescription exchange service ID has been sent in the transmission - we will pay the prescription but not the electronic prescription fee
  • 618 Reject - the PES ID provided is not valid
    meaning an electronic prescription flag of Y has been received but the prescription exchange service ID sent to us is not correctly formatted with 3 alphabetic characters

You should contact your software vendor if you receive any of these reason codes or require further assistance.

Read more about the Pharmaceutical Benefits Scheme on the Department of Health website.

Page last updated: 11 July 2016

This information was printed Thursday 8 December 2016 from humanservices.gov.au/health-professionals/enablers/electronic-prescription-fee 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.