Changes to pharmacy remuneration arrangements

New arrangements for s90 community pharmacies and s92 dispensing doctors came into effect on 1 July 2015.

As part of the 6th Community Pharmacy Agreement, the remuneration arrangements have changed.

This is for:

  • community pharmacies approved under section 90
  • dispensing doctors approved under section 92 of the National Health Act 1953

Under these changes, the new Administration, Handling and Infrastructure (AHI) Fee replaces the former 6 tier pharmacy mark-up component of remuneration. This means there is now a set fee to cover the costs of storing and handling PBS medicines. It is included in our payment to pharmacists.

The value of this fee from 1 July 2015 is calculated as follows:

  • Tier 1 – where the approved price to pharmacist is less than $180.00 for a maximum quantity supplied – $3.49 per prescription
  • Tier 2 – where the approved price to pharmacist is between $180.00 and $2,089.71 for a maximum quantity supplied – $3.49 per prescription plus 3.5% of the amount by which the price exceeds $180.00
  • Tier 3 – where the approved price to pharmacist is greater than $2,089.71 for a maximum quantity supplied – $70.00 per prescription

 As of 1 July 2015:

  • we automatically calculate and pay the fixed fee components of tiers 1, 2 and 3
  • for tier 2 variable fees (the 3.5% component), we manually pay pharmacists each month a bulk adjustment per claim into the nominated bank account. The PBS Payment Advice pharmacies receive in the post itemises bulk adjustment payments by payment category with a 9 series PBS Payment ID, for example, 90000012345

Processing of the first manual bulk adjustment payments started in mid-August 2015 for claims submitted in July 2015.

As of 1 September 2015:

  • we automatically calculate and pay the full tier 2 fees (fixed and 3.5% variable component) for all prescriptions dispensed where the quantity supplied is equal to the items maximum quantity, except for Efficient Funding of Chemotherapy (EFC) items and Aboriginal Health Services Claims
  • each month, for tier 2 variable fees (the 3.5% component), we manually pay pharmacists a bulk adjustment per claim for all prescriptions where the quantity supplied is not equal to the items maximum quantity

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Page last updated: 23 January 2016

This information was printed Monday 26 September 2016 from humanservices.gov.au/health-professionals/news/changes-pharmacy-remuneration-arrangements 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.