Circumstances where we may provide a refund to your customer.
There are 2 situations where we may give a refund to your customer:
- if they exceed their PBS Safety Net threshold before receiving a PBS Safety Net card, or
- if they can’t prove eligibility when you supply their medicine
Not exceeding the PBS Safety Net threshold
Tell your customers early in the year they can link their family members under the PBS Safety Net. This helps the customer to avoid exceeding the threshold and needing to get a refund.
Proof of eligibility
Your customer can prove eligibility by showing you their:
- Medicare card
- PBS Safety Net card
- Human Services concession card, or
- Department of Veterans' Affairs concession card
If your customer can’t prove their eligibility at the time of purchasing their PBS medicine, and you charge them at a higher rate, you need to give them an official pharmacy receipt (S87A). This lets us give them a refund if they’re eligible.
An official pharmacy receipt needs to include:
- the patient's name and address
- the patient's payment level, this may be private, general, concession or free
- the prescriber's name
- the prescriber's address or prescriber number
- the date the medicine was supplied
- an item code
- the quantity
- a note stating whether section 49 (previously regulation 24) applies
- an authority prescription number, if applicable
- the price paid, and
- the pharmacy approval number
We can’t process the claim if any of these details are missing. If something is missing, we’ll tell your customer to contact you to get the missing information.
Submitting a claim for a refund
To claim a refund, your customer needs to:
- complete and submit a Patient claim for refund Pharmaceutical Benefits Scheme (PBS) form with a copy of all their prescription record forms to support their claim, or
- send us a letter to request a refund. This needs to include their name, address, Medicare card details, PBS Safety Net card number, and a copy of all prescription record forms to support their claim
You can’t make a claim for a refund for your customer. You can only help them by giving them the information they need.
Your customer won’t get a refund if:
- their entitlement number expired
- the item claimed is not a PBS-listed medicine
- they didn’t exceed the PBS safety net threshold
- we have no record of their entitlement number
- an unpaid pharmacy account is presented instead of an official pharmacy receipt
- details are missing from the official pharmacy receipt
- the prescription is issued under the PBS safety net 20-day rule, or
- they haven’t signed the claim