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

Information about patient registration, prescribing, dispensing and claiming pharmaceutical items under the Closing The Gap - PBS Co-payment Measure.

About the Closing The Gap-PBS Co-payment Measure

This guide explains the Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment Measure (the measure).

The measure provides free or low cost medicines to Aboriginal and Torres Strait Islanders who have, or at risk of, chronic disease.

Under the measure, a general practice or Indigenous Health Service must register with us to prescribe CTG prescriptions.

The registered practice must also get their patients’ consent to register for the measure.

The prescriber only needs to assess a patient’s eligibility for CTG prescriptions once.

The prescriber can register a patient at:

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

The prescriber must confirm the patient’s eligibility for CTG prescriptions before they register a patient. They can do this:

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

Prescriptions written under this measure are CTG prescriptions. You must have CTG written or printed on the prescription. The normal PBS prescription requirements also apply.

This Guide is part of the Indigenous health services education for health professionals' package.

Case study

You work as a health practitioner in an Indigenous Health Service 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

The patient also:

  • 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

You complete a detailed chronic disease management plan during this consultation. You’ve determined that your patient is eligible for the CTG PBS Co-payment Measure. This is because the patient is unlikely to follow their medicine routine without cost relief benefits.

Patient registration

During the consultation, you take these actions to register your patient:

Practitioner Patient Practitioner
  • discuss the patient’s current condition
  • confirms the patient’s ongoing health care needs
  • explain the cost relief benefits of the measure
  • outline the registration requirements
  • seek patient’s registration consent
  • agree to registration
  • assists the patient with registration form
  • lodge form with us on behalf of the patient

Prescribing

When you've registered your patient, you can write CTG prescriptions for them. For example:

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 correctly, the pharmacist can't 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. For example:

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 2 ways:

Prescription type PDS input
Computer generated Enter the CTG alpha-numeric annotation code into the appropriate field. This is usually on 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

There are 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 must 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 must 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.

Recording patient payments and PBS Safety Net

Under the measure patient contributions are less than non CTG prescriptions.

If the pharmacist enters the correct CTG annotation code when dispensing, the PDS will automatically calculate the appropriate contribution and PBS Safety Net amount. For example:

Pharmacist Patient

enters CTG annotated prescription details into the PDS. They must key the CTG annotation code for each prescription dispensed

pays a reduced amount for all 5 CTG prescriptions

While the patient pays less for all 5 CTG prescriptions, the full co-payment (general patient) is printed on the prescription record form. This will make sure that the patient’s eligible PBS Safety Net family can reach the PBS Safety Net threshold at the normal rate.

CTG PBS Co-payment Measure patient contributions

This shows the patient contribution for the measure:

General patients Concession cardholders

pay the current concessional rate for each item

free of charge

The patient may need to pay premiums for a small number of items in addition to the patient contribution.

The amount that contributes to the PBS Safety Net for each CTG prescription is the same amount that would have been added without the CTG Measure.

Claiming

For claiming purposes

normal PBS claiming procedures apply

CTG prescriptions for general patients and concession cardholders are bundled in the relevant claim category and kept by the approved supplier for a period of 2 years

Prescriptions with 'U' serial numbers

The PDS prints some prescription serial numbers with 'U' as the first part of the serial number. This occurs when a prescription that would normally be under co-payment, priced below the general patient contribution rate, is now priced at the concession rate without changing the entitlement category.

Summary

Summary for prescribers:

Summary for pharmacists:

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

More information

Read more about:

Contact us about the PBS, the Incentives program, or give us your feedback on these education resources.

Page last updated: 20 November 2018