PBS for pharmacists

Medicare can grant pharmacists approval to supply Pharmaceutical Benefits Scheme (PBS) subsidised items in accordance with section 90 of the National Health Act 1953.

About

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 ‘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 Regulation 25 if the prescriber has indicated an immediate supply is necessary. 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.

Read more about becoming an approved PBS supplier

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 requires significant alterations 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 annotate the prescription as above. The prescriber must also contact the PBS authority line or go online to update the PBS authority approval record.

If the prescriber does not contact the PBS authority line, we will reject the claim.

Read more about PBS authorities.

Changes that will not be accepted

We will not pay the claim if:

  • changes were made to prescriptions for Schedule 8, Controlled Drugs items
  • a completely different item was supplied - for example, atenolol to metoprolol, or additional item; or, for example, a prescription for atenolol only changed to atenolol and fluoxetine
  • changes were made to increase the quantity and/or repeats
  • changes were made to the date of prescribing
  • the item was supplied to a different patient
  • changes were made to the prescriber details
  • changes were made to 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 is not practicable to get a prescription.

A patient can only receive one supply of eligible medicine every 12 months.

‘Continued dispensing’ is regulated by the National Health Act 1953. It is 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 that are eligible for continued dispensing.

For more information on the continued dispensing initiative requirements read the Education guide – Continued Dispensing Initiative – PBS requirements.

Claiming

Online claiming for PBS

Information for pharmacists about electronic claiming of PBS or Repatriation Pharmaceutical Benefits Scheme (RPBS) medicines with Medicare.

Read more about online claiming for PBS

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 transmitting 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, you must make sure that each pharmaceutical benefit item claimed is supported by the relevant prescription documentation. The prescription documentation must be retained in electronic or paper form for a period of 2 years. Complete and accurate information in the PBS or RPBS claim will ensure that timely payments are made.

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
  • you delete prescription serial numbers from the computer claim corresponding to uncollected or missing prescriptions
  • you re-serialise prescriptions that are present but listed as missing
  • you check that both the approval number and claim period number are valid
  • you ensure the certification of supply statement is completed by an authorised person, and
  • you 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 claim related paperwork 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 will need to retain this for a period of two years for audit and verification purposes.

If you are 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 as follows:

  • I cannot provide the paper prescriptions to support this claim because of the effects of the disaster, for example, a fire
  • I have not, and will not make a claim against my insurance company for the lost claim. If the prescriptions or claim paperwork is located I will forward it to the Department of Human Services with a note of explanation stating that I will not resubmit these prescriptions or claim paperwork for payment

A completed Statutory Declaration may be sent to:

Teams Manager
Pharmaceutical Benefits
Department of Human Services
GPO Box 9826 in your state

Read more about statutory declarations from the Attorney General's website.

Managing

Medicare Cards - Improved Monitoring of Entitlements

Improved Monitoring of Entitlements (IME) is a measure to ensure pharmaceutical benefits are provided only to those people eligible to receive them.

Read more about medicare cards - IME

The PBS concessional rate has not been applied

Information you can provide to your customers if they are not entitled to medicines at a concessional rate.

Read more about he PBS concessional rate not being applied

Deactivation of PBS pharmacist approvals

Information for pharmacists who want to temporarily 'deactivate' an approval to supply pharmaceutical benefits.

Read more about deactivation of PBS pharmacist approvals

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.

Read more about the emergency provision arrangements

Resources

PBS reason codes for online claiming for PBS Pharmacies

Pharmaceutical Benefits Scheme (PBS) processing reason codes for online claiming by PBS pharmacies.

Read more about PBS reason codes

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 provides us with 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.

Read more about the pricing of PBS medicine

Revised arrangements for the efficient funding of chemotherapy medicines

Revised arrangements for prescribers and pharmacists aim to minimise waste and reduce expenditure on intravenous chemotherapy medicines.

This initiative was introduced to minimise waste and reduce 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 additional 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 one 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 table below lists the average 10 g/mL rates payable for extemporaneous items supplied during October 2017 in all states.

Read more about the average rates payable

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.

Read more about the National Residential Medication Chart

Page last updated: 27 August 2017