Closing the Gap - PBS Co-payment Measure

The CTG PBS Co-payment Measure improves access to PBS medicines for eligible Aboriginal and Torres Strait Islanders living with, or at risk of, chronic disease.

Eligibility

Eligible Aboriginal and Torres Strait Islanders living with or at risk of chronic disease have  access to low cost or free Pharmaceutical Benefits Scheme (PBS) medicines. They can access these through the Closing the Gap (CTG) Pharmaceutical Benefits Scheme Co-payment Measure (the measure).

Patients

A patient is eligible if they:

  • would experience setbacks in preventing or managing chronic disease if they didn’t take the prescribed PBS medicine
  • are unlikely to keep up their treatment without assistance through the measure.

Eligible patients can register at:

  • general practices participating in the Indigenous Health Incentive Practice Incentives Program (PIP), or
  • Indigenous Health Services (located in urban and regional areas).

Prescribers

The following prescribers are eligible to provide their patients with a CTG annotated script:

  • medical practitioners working in a practice that’s participating in the Indigenous Health Incentive under the PIP
  • any medical practitioner working in an Indigenous Health Service in rural or urban settings
  • any medical specialist as long as the patient is
    • eligible for the measure
    • referred by a medical practitioner working in a practice participating in the Indigenous Health Incentive under the PIP.

Note: We can’t accept hospital generated prescriptions. Medical specialists within public hospitals must use their personal PBS prescriptions.

Prescribers need to:

  • assess the patient’s eligibility for the measure once
  • make sure the patient gives their consent to register for the measure
  • confirm a patient’s eligibility before writing each CTG PBS prescription.

Prescribers can check patient eligibility:

Closing the Gap PBS prescriptions

To grant the benefits of the measure to a registered patient, prescribers must annotate the patient’s prescription. The annotation should indicate that the pharmacist should dispense the medication with co-payment relief. Closing the Gap prescriptions will have either an automated annotation or a manual annotation.

Pharmacists should charge general patients with a CTG PBS prescription, the current concessional rate for each PBS item.

Concessional patients with a CTG PBS prescription don’t need to pay a patient co-payment for each PBS medicine.

The patient or their agent must still pay mandatory charges such as brand premiums.

Prescribers can’t charge patients the Under Co-payment Additional Surcharge under this measure.

If an eligible patient doesn’t have a CTG PBS prescription, pharmacists should refer the patient back to their prescriber. Pharmacists can’t annotate CTG PBS prescriptions.

Pharmacists should process prescriptions that don’t have ‘CTG’ on them as standard PBS prescriptions.

Closing the Gap and PBS Safety Net

Eligible patients are also eligible for the PBS Safety Net.

The measure doesn’t change the amount that can be added to a family’s Safety Net threshold.

Processing and dispensing Closing the Gap PBS prescriptions

Prescribers must enter the correct CTG indicator or code into dispensing software. The code they use will depend on their dispensing software.

The patient will be charged the wrong amount for their prescription if the code isn’t right.

These groups can dispense CTG PBS prescriptions:

Claiming Closing the Gap PBS prescriptions

Pharmacies must record the CTG annotation on the prescription in the Pharmacy Dispensing System prescription record.

If the annotation is valid, we’ll repay the cost of the medicine supplied, including the co-payment relief amount. If the prescription is a CTG under co-payment prescription, we’ll repay the PBS item price less the patient co-payment.

Helping you reconcile Closing the Gap PBS prescriptions

We’ll clearly show CTG PBS prescriptions in your PBS reconciliation statement.

More information

Read the CTG PBS education guide, start our PBS for Pharmacy eLearning program or contact us.

Read the pharmacy staff resource booklet on the PBS website.

Learn about Indigenous health services.

Page last updated: 6 November 2018