Education guide - Closing the Gap - PBS Co-payment Measure - supporting Indigenous health

Overview of the CTG-PBS Co-payment Measure

This education guide has been created as part of the Indigenous health services education for health professionals’ package.

It includes a case study highlighting the benefits of the Closing the Gap Pharmaceutical Benefits Scheme (CTG-PBS) Co-payment Measure for Aboriginal and Torres Strait Islander patients with, or at risk of, a chronic disease.

A general practice or Indigenous Health Service must be registered under the measure to enable their prescribers to write CTG prescriptions for their patients.

When the practice is registered, they must obtain their patients’ consent to register the patient for the measure as a part of the patient registration process.

Assessment of a patient’s eligibility for CTG prescriptions only needs to be undertaken once by the prescriber. Patients are registered at either:

• general practices participating in the Indigenous Health Incentive under the Practice Incentives Programme, or
• Indigenous Health Services in urban and rural settings

CTG prescriptions can’t be written until the prescriber confirms the patient's eligibility and registration process is complete. This can be confirmed by either:

• using HPOS to access the practice’s list of registered patients, or
• contact us at Incentives programs

Prescriptions written under this measure are referred to as CTG prescriptions with the normal PBS prescription requirements applying.

By writing a CTG prescription, the patient receives the item at a lower patient contribution level or free of charge.

Further information about Indigenous health services is available at Indigenous health education for health professionals.

We recommend that you also read the Closing the Gap – PBS Co-payment Measure and Practice Incentives Program web services pages for further information about the CTG-PBS Co-payment Measure.

Case study

You work as a health practitioner in an Indigenous Health Service currently participating in the PBS Co-payment Measure as a ‘Non-Practice Incentive Program’ Health Service.

A 61 year old patient presents to your Indigenous Health Service with persistent ulcers of the foot.

Medical history includes:

• Diabetes mellitus type 2

Other health related information includes:

• smokes
• has a poor diet
• seldom seeks medical attention
• usually attends every 6 months for script renewals
• isn't effectively managing chronic condition due to cost constraints

A detailed chronic disease management plan is completed during this consultation. You’ve determined that your patient is eligible for the CTG PBS Co-payment Measure as they’re unlikely to follow their medicine routine without cost relief benefits available under the measure.

Patient registration

During the consultation, you undertake the following actions needed to register your patient:

Practitioner	Patient	Practitioner
discusses the patient’s current condition confirms the patient’s ongoing health care needs explains the cost relief benefits of the measure outlines the registration requirements seeks patient’s registration consent	agrees to registration	assists the patient with registration form lodges form with the Department of Human Services on behalf of the patient

Prescribing

When the process of registering your patient is completed, you are able to start writing CTG prescriptions for your patient. The table below describes these actions:

Practitioner	Patient
writes 5 computer generated PBS prescriptions with the correct CTG code annotation against each prescription	presents the 5 CTG prescriptions to the local community pharmacy

CTG annotation code prescription - prescribing requirements

You can annotate CTG prescriptions in 2 ways. The table below describes these annotations:

Prescription type	Annotation	Example
Computer generated	Prescribing software will annotate the prescription with a CTG alpha-numeric code.	CTG11K
Handwritten	Annotate the prescription with the letters ‘CTG’ and initials or signature of the prescriber.	CTG JB CTG J. Bloggs

If prescriptions aren’t annotated or are annotated incorrectly, the pharmacist won’t be able to dispense the prescription as a CTG prescription.

Dispensing

You work as a pharmacist in the local community pharmacy. You need to indicate in the pharmacy dispensing software (PDS) that you’re dispensing a CTG prescription. The table below describes your actions:

The local community pharmacist:
checks all 5 prescriptions are correctly annotated by the prescriber dispenses the prescriptions in their PDS ensuring the CTG annotation code is keyed for each prescription being dispensed

CTG annotation code prescription - dispensing requirements

You can enter the code in the following 2 ways:

Prescription type	PDS input
Computer generated	Enter the CTG alpha-numeric annotation code into the appropriate field. This will usually be located at the top right hand corner of the prescription.
Handwritten	Depending on your PDS you’ll need to enter 1 of the following: H 00B CTG00B

Common dispensing scenarios

The table below outlines some common dispensing scenarios and actions for pharmacists:

Scenario	Pharmacist action	Comment
Patient presents a CTG prescription	check the prescription is correctly annotated and enter the CTG annotation code into the PDS when dispensing	Pharmacists are required to check each prescription is correctly annotated at the time of dispensing.
Patient presents a CTG prescription to the pharmacy for the first time	flag the patient profile in the PDS as a CTG patient	Pharmacists are required to identify the patient as a CTG patient in the PDS.
An eligible patient presents a prescription that’s not annotated or is annotated incorrectly	refer the patient back to the prescriber	The prescriber needs to correct or annotate the prescription as pharmacists can’t annotate the prescription even if they’ve contacted the prescriber.
CTG prescription with repeats	enter the CTG code into the PDS	The annotation will carry over to all repeats. The code will usually be printed in the manual pricing box on the repeat authorisation form.

Patient payments and PBS Safety Net recording

Under the CTG PBS Co-payment Measure patient contributions are less than non CTG prescriptions.

If the correct CTG annotation code is entered when dispensing, the PDS will automatically calculate the appropriate patient contribution and PBS Safety Net amount. The table below outlines a dispensing scenario for you:

Pharmacist	Patient
enters CTG annotated prescription details into the PDS ensuring the CTG annotation code is keyed for each prescription dispensed	pays a reduced amount for all 5 CTG prescriptions

While the patient pays a reduced amount for all 5 CTG prescriptions, the full co-payment amount (general patient) is printed on the prescription record form. This will ensure that the patient’s eligible PBS Safety Net family are able to reach the PBS Safety Net threshold at the normal rate.

CTG PBS Co-payment Measure patient contributions

The table below outlines the patient contribution for the measure:

General patients	Concession cardholders
pay the current concessional rate for each item	free of charge

Premiums for a small number of items are still payable by the patient in addition to the patient contribution.

The amount that can contribute to the PBS Safety Net for each CTG prescription is the same amount that would have been added in the absence of the CTG Measure.

Claiming

For claiming purposes:
normal PBS claiming procedures apply
CTG prescriptions for general patients and concession cardholders are bundled in the appropriate claim category and retained in paper or electronic form by the approved supplier, for a period of 2 years

Prescriptions with 'U' serial numbers

Summary

Summary for prescribers:

• identify your patient’s eligibility
• discuss the Co-payment Measure with your patient
• complete the Co-payment Measure patient registration and consent form and submit to the Department of Human Services
• write PBS prescriptions as per normal requirements with CTG annotation

Summary for pharmacists:

• check prescriptions are correctly annotated - if not, contact the prescriber
• dispense PBS prescriptions as per normal requirements
• key the correct CTG annotation code into the PDS
• ensure the appropriate amount for eligible prescriptions is added towards the patient’s Safety Net Prescription Record Form

More information

Online:

• Education services for health professionals to access other education resources
• read more on the Practice Incentives Program
• Closing the Gap - PBS Co-payment Measure for additional information

Contact us at PBS general enquiries.

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