Department of Human Services can grant pharmacists approval to supply Pharmaceutical Benefits Scheme (PBS) subsidised items in accordance with section 90 of the National Health Act 1953.
Discounting patient co-payment
Since 1 January 2016, community pharmacies and dispensing medical practitioners have had the option to discount up to a maximum of $1.00:
- the general PBS patient co-payment, and
- the concessional PBS patient co-payment
Patients will still need to make a co-payment for each original and repeat prescription. This applies to medicines with a Commonwealth price equal to or above the co-payment as per current PBS Safety Net provisions.
You can discount the co-payment for:
- prescriptions endorsed with ‘section 49 (previously regulation 24) or ‘Hardship conditions apply’, and
- Closing the Gap (CTG) prescriptions
You must record the co-payment amounts for these prescriptions on the Prescription Record Form.
You can supply a pharmaceutical benefit under section 51 (previously regulation 25) if the patient meets the requirements for an immediate supply. In this situation, as part of the PBS Safety Net 20 day rule, you can only discount the co-payment by up to $1.00 if the supply is for a medicine not specified in the early supply instrument.
For more information go to Department of Health’s website.
Becoming an approved PBS supplier - for pharmacists
Information for pharmacists on becoming an approved supplier of PBS subsidised items.
Annotating prescriptions to clarify a prescriber's intention
Pharmacists can annotate a prescription to clarify a prescriber's intention. Major changes must be made by the prescriber.
When something isn't clear on a PBS prescription and getting a new prescription will delay the customer's treatment, you can call the prescriber to clarify their intentions. You may then annotate the prescription with the prescriber's intentions.
To clarify a prescription, you must:
- first call the prescriber
- clearly annotate and endorse the prescription with:
- the date the prescriber was contacted
- the prescriber's advice
- your name and signature
- keep a record of your discussion with the prescriber in your customer's dispensing history
Major changes to a prescription
If the prescription needs major or multiple changes, the patient will need to get a new prescription or an annotated prescription signed by the prescriber before you can supply and claim the item.
Changing an authority prescription
To change an authority prescription, you must contact the prescriber and they must annotate the prescription and initial the annotations. The prescriber must also contact the PBS authority line or go online to update the PBS authority approval record.
If the prescriber doesn’t contact the PBS authority line, we’ll reject the claim.
Read more about PBS authorities.
Changes that are unacceptable
You must not claim a completely different item to what you supplied - for example, atenolol to metoprolol, or an additional item, or, for example, a prescription for atenolol only changed to atenolol and fluoxetine. Also the following changes are unacceptable:
- alterations to prescriptions for Schedule 8, Controlled Drugs items
- increasing the quantity and, or repeats
- the date of prescribing
- a different patient
- prescriber details
- repeat forms
You can only change the repeat form to correct a previous pharmacist's dispensing error to make it consistent with the prescriber's original prescription.
Continued dispensing of PBS medicines
Continued Dispensing lets pharmacists supply eligible PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS) medicines to a patient when there is an immediate need, but it isn’t practicable to get a prescription.
A patient can only receive 1 supply of eligible medicine every 12 months.
‘Continued dispensing’ is regulated by the National Health Act 1953. It’s the responsibility of pharmacists in each state or territory to make sure the necessary legislation is enacted in their place of practice before undertaking a continued dispensing supply.
Schedule 1 of the National Health (Continued Dispensing) Determination 2012 (Commonwealth) lists medicines eligible for continued dispensing.
For more information on the continued dispensing initiative requirements read the Education guide – Continued Dispensing Initiative – PBS requirements.
Online claiming for PBS
Information for pharmacists about electronic claiming of PBS or Repatriation Pharmaceutical Benefits Scheme (RPBS) medicines with Medicare.
Checking the PBS service or system status
Our PBS Services status tool provides health professionals with real time information on the operational status of PBS Services and systems, including phone lines.
Use the PBS Services status tool to check if there are system problems before sending online claims to us.
Ensuring timely payments when claiming PBS or RPBS
To ensure timely payment, pharmacists should provide complete and accurate information in their PBS claims.
When making a claim for payment, make sure each pharmaceutical benefit item claimed is supported by the relevant prescription documentation. The prescription documentation must be kept in electronic or paper form for a period of 2 years. Complete and accurate information in the PBS or RPBS claim ensures timely payments.
When entering data, make sure:
- the patient's PBS or RPBS eligibility is recorded correctly using the Medicare or repatriation card number and if applicable, concession or safety net card number
- the correct prescriber number and date of prescribing are entered when dispensing, and
- for owing prescriptions, the date the approved supplier telephoned the prescriber is the actual date of dispensing, rather than the date on the prescription form or the date the prescription was received
When closing a claim through your Prescription Dispensing Software, make sure you:
- reconcile prescriptions in the actual prescription claim against the 'missing script' report
- delete prescription serial numbers from the computer claim for to uncollected or missing prescriptions
- re-serialise prescriptions that are present but listed as missing
- check that both the approval number and claim period number are valid
- ensure the certification of supply statement is completed by an authorised person, and
- use the 'Close a Claim' transaction to send the claim to the department for processing
Missing prescriptions or claim related paperwork for PBS claims
If your pharmacy has lost or damaged prescriptions or paperwork for claims due to circumstances outside of your reasonable control you can complete a statutory declaration that includes a statement about the lost or missing paperwork.
Your declaration should include information about the nature of the loss, such as natural disaster, emergency or misplaced prescriptions. The pharmacy needs to keep this for a period of 2 years for audit and verification purposes.
If you’re lodging a manual PBS claim, complete the statutory declaration form and send it to us along with your other prescriptions and claim paperwork.
Example wording for your statutory declaration can be:
- I can’t provide the paper prescriptions to support this claim because of the effects of the disaster, for example, a fire
- I haven’t and won’t make a claim against my insurance company for the lost claim. If I find the prescriptions or claim paperwork I’ll send it to the Department of Human Services with a note stating I won’t resubmit these prescriptions or claim paperwork for payment
A completed Statutory Declaration may be sent to:Teams Manager
Department of Human Services
GPO Box 9826 in your state
Read more about statutory declarations from the Attorney General's website.
Medicare Cards - Improved Monitoring of Entitlements
Improved Monitoring of Entitlements (IME) is a measure to ensure pharmaceutical benefits are provided only to people eligible to receive them.
The PBS concessional rate has not been applied
Information you can provide to your customers if they aren't entitled to medicines at a concessional rate.
Deactivation of PBS pharmacist approvals
Information for pharmacists who want to temporarily 'deactivate' an approval to supply pharmaceutical benefits.
PBS Authority approvals phone line - emergency provision arrangements
You must follow any emergency provision messaging on the PBS Authority approvals enquiry line 1800 888 333 to prescribe an Authority required item.
PBS reason codes for online claiming for PBS Pharmacies
Pharmaceutical Benefits Scheme (PBS) processing reason codes for online claiming by PBS pharmacies.
Collection of under co-payment prescription data
The National Health Act 1953 requires approved suppliers to supply prescription data for items priced below the patient co-payment to us. This data gives us information about medicine use in the community and is a valuable tool for:
- health policy planning
- monitoring risk management protocols
- collecting information on the adverse effects of medicines, and
- monitoring the quality use of medicines in the community
Under co-payment prescription data is collected through the online claiming for PBS channel through Pharmacy Dispensing Software.
PBS systems assess under co-payment data and only a limited set of reject reason codes will be returned for approved suppliers for follow up.
Pricing of Pharmaceutical Benefits Scheme medicine
Detailed information on how prescription medicines are priced under the PBS and RPBS.
Revised arrangements for the efficient funding of chemotherapy medicines
Revised arrangements for prescribers and pharmacists limit waste and reduce expenditure on intravenous chemotherapy medicines.
This initiative was introduced to reduce waste and PBS expenditure on chemotherapy medicines used in the treatment of cancer and administered through intravenous infusion or injection.
Revised arrangements for prescribers
For health professionals who prescribe chemotherapy medicines:
- prescriptions will need to be dose-specific and written in milligrams or other unit of measure as appropriate
- patients will generally pay no more than 1 co-payment per cycle of treatment - for example, a co-payment will be paid on each original prescription, but not on each repeat
- 1 prescription is required, either an original or repeat if needed per infusion or injection
The number of repeats on the prescription must be clinically appropriate for the treatment protocol that the patient is undergoing and within the parameters set by the Pharmaceutical Benefits Advisory Committee (PBAC). If more repeats are required, an authority will need to be sought.
Revised arrangements for pharmacies
For approved pharmacies that dispense chemotherapy medicines:
- pharmacies will only be paid for the most cost-efficient combination of vials that make up a patient's dose, and
- the specialist nature of preparing chemotherapy medicines will be acknowledged with a series of new dispensing fees depending on where the medicines are claimed
These fees include 1 or more of the following:
- distribution fee
- diluent fee
- preparation fee, or
- dispensing fee
All medicine that meets the criteria for inclusion in the measure, including trastuzumab (Herceptin®), is subject to the new prescribing, dispensing and claiming arrangements.
Average rates payable for extemporaneous items
The average 10 g/mL rates apply to extemporaneously prepared benefits not in the Standard Formulae List, where the approved supplier didn’t price such prescriptions.
National Residential Medication Chart
You can use the National Residential Medication Chart (NRMC) to prescribe most PBS medicines for your patients in residential aged care facilities.