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
- Learn more about changes to remuneration arrangements from 1 July 2015
- Find out more about the Pricing of Pharmaceutical Benefits Scheme medicine and the AHI fee values
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