Improved Monitoring of Entitlements to pharmaceutical benefits

Improved Monitoring of Entitlements (IME) is a measure that ensures we only provide pharmaceutical benefits to eligible people.

Background

Improved Monitoring of Entitlements (IME) ensures we only provide pharmaceutical benefits to eligible people.

The IME is supported by the National Health Amendment (Improved Monitoring of Entitlement of Pharmaceutical Benefits) Act 2000.

Before we reimburse you for dispensing prescriptions we identify the patient and check they’re eligible.

We use:

  • the patient's Medicare card number or Veterans' Affairs file number you provide in your claim
  • the patient’s concession card number if provided in your claim.

This is how we identify the patient and check their eligibility.

Benefits

This measure helps ensure taxpayers' dollars go to those who are entitled to them. The IME checks the patient’s entitlement arrangements. This reduces the number of subsidies paid to ineligible people. A person may be ineligible if they’re a visitor from a country without a Reciprocal Health Care Agreement or an illegal immigrant.

The IME doesn’t change patient entitlements for medications listed on the PBS.

Proof of eligibility

Most patients only need to provide their Medicare card number when they get prescriptions filled for PBS subsidised medicines.

To receive an additional subsidy, concession card holders also have to provide their concession card number.

Veterans covered by the Repatriation Pharmaceutical Benefits Scheme (RPBS) need to provide their Veteran's Affairs file number. This is on their Gold, White or Orange card.

White card holders have to provide their Medicare card number for prescriptions not covered under the RPBS.

People collecting prescribed medicines for someone else must provide proof of that person's eligibility to receive PBS subsidised medicines.

Visitors to Australia

People visiting from countries with a Reciprocal Health Care Agreement who haven’t been issued with a Medicare card, should show their passport to the pharmacist when having prescriptions filled.

Patients without a Medicare card number

Sometimes patients who are entitled to receive pharmaceutical benefits can’t provide a Medicare card number. Patients who don’t know their Medicare number can either:

If an eligible patient doesn’t know their number, they can pay the full price for the medication and get a refund later. They can get a refund from a Medicare office or DVA state office. They’ll need a PBS patient refund receipt from you.

You can contact us on the PBS general enquiries line to get a patient’s:

  • Medicare, Veteran's or Centrelink card number to use in PBS claims
  • Card expiry date to ensure they are still eligible.

You need the patient’s consent to access this information.
We can release a maximum of 5 card numbers and expiry dates per call.

Medicare special numbers

There are some situations where you can use a Medicare special number for an eligible patient who isn’t able to provide one. This could be, for example, in an emergency or if the patient is an eligible overseas visitor.

National Health (Entitlement to Pharmaceutical Benefits – Special Evidentiary Categories) Determination 2017 supports the use of Medicare special numbers.

You can use one of the Medicare special numbers if the circumstances fit. There are 6 Medicare special numbers available, outlined in the following table.

Medicare special number When to use
25437754111 Emergency situation
25437759611 Visitors covered by a Reciprocal Health Care Agreement
25437766611 People who a doctor considers are entitled to PBS subsidy
25437768411 People who a pharmacist considers are entitled to PBS subsidy
25437529911 Urgent clinical need
25437783311 Seemingly valid Medicare card form

Compliance

We encourage people to voluntarily comply with the programs we administer.

We monitor how Medicare special numbers are used and we’ll conduct audits to check pharmacists are using them appropriately. It’s the pharmacist’s responsibility to make sure they use Medicare special numbers appropriately.

Page last updated: 3 December 2019