PBS Online claiming system changes for highly specialised drugs

31 October 2017

There are new PBS Online rejection codes where the prescribing and supply combination doesn’t meet dispensing rules.

The Highly Specialised Drugs (HSD) Program gives access to Pharmaceutical Benefits Scheme (PBS) medicines for treating chronic conditions.

Due to their clinical use and other special features, there are restrictions on where these drugs can be prescribed and supplied.

From 5 November 2017, PBS Online will reject claims made by pharmacies when they’re not authorised to supply a prescription under the HSD restrictions. The reason code message will tell you the prescription can’t be claimed by your type of pharmacy.

These changes will reduce the risk for pharmacies which may accidently supply HSD items when they’re not entitled to a PBS payment.

Patients will need to visit a pharmacy that meets prescribing rules or return to the prescriber for an amended prescription.

Next steps

Page last updated: 31 October 2017