The PBS concessional rate has not been applied

Information you can provide to your customers if they are not entitled to medicines at a concessional rate.

You are unable to charge the patient at the PBS concessional rate.

This is because:

  • Medicare's PBS online claiming system, which accesses data directly from Centrelink, indicates the concessional entitlement is not current, and/or
  • the patient’s entitlement card has expired

You cannot charge the lower PBS concessional rate if the patient does not have a valid concessional entitlement.

Before pharmacies can provide PBS or RPBS medicine at a subsidised rate, they are required by law to check the patient’s entitlement status to ensure it is valid. This is an Australian Government requirement that ensures only eligible people receive subsidised PBS or RPBS medicine, helping to ensure that the PBS remains sustainable for all Australians.

Invalid cards

There could be several reasons why a patient’s card is invalid, including:

  • their card has expired
  • they have recently changed their name
  • their Centrelink payments have stopped
  • they have returned from overseas and have not informed Centrelink
  • there have been changes in the caring arrangements of their children
  • there have been changes in their income
  • there have been changes in the living arrangements of either the patient or their partner

If the patient is unsure as to why they are not entitled and you would like to query this matter, you should contact the government agency that issued the card.

Government agency Type of Card Contact us
Medicare
  • Medicare Card
  • PBS Safety Net Entitlement Card
Centrelink
  • Pensioner Concession Card
  • Commonwealth Seniors Health Card
  • Health Care Card
Department of Veterans' Affairs (DVA)

Repatriation Health Cards:

  • Gold, White or Orange card
  • Pensioner Concession Card
  • Commonwealth Seniors Health Card

The customer service officer will be able to provide you with further information.

If the patient pays a higher price for their prescription and it is found that they were actually entitled to the concession rate when they were supplied the medicine, they will be able to claim a refund through Medicare or the Department of Veterans' Affairs (DVA), once they have shown:

  • the receipt for the medicine
  • their valid entitlement card(s)

Pharmacies check entitlement cards

Under the PBS, our taxes subsidise the cost of prescription medicine making it more affordable for all Australians. The cost of some medicine is much more than the price the patient pays – in some cases hundreds of dollars more – but our taxes provide eligible people a subsidy so they pay less. It is therefore important that pharmacies check entitlement cards.

Page last updated: 13 October 2016

This information was printed Monday 5 December 2016 from humanservices.gov.au/health-professionals/enablers/pbs-concessional-rate-has-not-been-applied 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.