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PBS Safety Net for pharmacists

Information to help pharmacists manage their customers' access to the Pharmaceutical Benefits Scheme (PBS).

The Australian Government subsidises the cost of many prescription medicines through the PBS so that all Australian residents and eligible overseas visitors can access affordable medicines.

The PBS Safety Net reduces the cost of prescription medicines for individuals and families who reach the threshold.

About

Eligibility

Anyone eligible for the PBS is eligible for the PBS Safety Net.

Your customers can also combine amounts for eligible family members.

A PBS Safety Net family is:

  • a couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children
  • a single person with dependent children, or
  • a couple separated by illness for example, where one member resides in a nursing home

A dependent child is someone:

  • younger than 16 or a full time student younger than 25
  • attending school, college or university, and
  • who you substantially support financially

Groups not considered a family for the PBS Safety Net include:

  • full time students 25 years or older and their parent(s)
  • separated couples, unless living separately due to illness or infirmity
  • 2 or more adult siblings, or
  • an adult and their parent(s)

If a family member who dies was receiving PBS medicines recorded on the family prescription record form during the year, these can still count towards the family PBS Safety Net threshold.

Thresholds

The PBS Safety Net thresholds are updated each year on 1 January.

Rates for 2017 General patients Concession card holders
Patient contribution Up to $38.80 $6.30
Safety net threshold $1,494.90 $378
Safety net patient contribution $6.30 Free

If your customer chooses a more expensive brand of medicine, they may need to pay more, and the extra amount will not count towards their PBS Safety Net threshold.

Record your customer's PBS Safety Net threshold amount on a Prescription Record Form.

Charging medicine at the PBS Safety Net rate

The first medicine that puts your customer over the PBS Safety Net threshold needs to be charged at the reduced PBS Safety Net rate.

Example
A customer who is a general patient, gives you a prescription to fill and their prescription record form is $10 under the general threshold amount. If the cost of the medicine you supply puts them over the threshold, issue them with a PBS Safety Net concession card and charge them the PBS Safety Net concession rate.

PBS Safety Net cross-over arrangements

In a calendar year, a patient or their family member’s entitlement status may change between general patient to concessional patient or vice versa.

A patient should apply for the PBS Safety Net card appropriate to their status at the time they apply.

Examples of cross-over arrangements

Concession patients who were previously general patients

These patients can apply for a PBS Safety Net entitlement card when they reach the concessional PBS Safety Net threshold. In this case, the PBS medicines previously supplied at the general patient contribution rate in that calendar year should be counted at the concession patient contribution rate.

General patients who were previously concessional patients

These patients can apply for a PBS Safety Net concession card when they reach the general PBS Safety Net threshold. In this case, any PBS medicines previously supplied at the concession patient contribution rate in that calendar year will be counted at the concession patient contribution rate.

Families with different entitlement statuses

In the case of a family where one parent holds a concession card and the other family members do not, the family can choose to apply for either a PBS Safety Net entitlement card or a PBS Safety Net concession card:

  • If the family chooses to apply for a PBS Safety Net entitlement card, all PBS medicines in that calendar year (including those paid at the general patient contribution rate) are counted at the concessional patient contribution rate
  • If the family chooses to apply for a PBS Safety Net concession card, the PBS medicines paid at the general patient contribution rate will be counted at the general patient contribution rate and the PBS medicines paid at the concession patient contribution rate will be counted at the concession rate in that calendar year

In the case of a family where one dependent child holds a concession card and other family members do not, the family can choose to either:

  • count their child’s PBS medicine expenditure towards an individual PBS Safety Net entitlement card for the child - the other family members including the parents cannot use this card as they are not dependents of the child, or
  • count their child’s PBS medicine expenditure towards a PBS Safety Net concession card with the rest of the family - the child’s PBS medicines will be counted at the concession patient contribution rate

The PBS Safety Net early supply rule

 The PBS Safety Net early supply rule means that for some PBS or RPBS medicines, a repeat supply of the same medicine within a set time will fall outside the PBS Safety Net.

If the early supply rule applies for a prescription, this means:

  • your customer’s payment for that prescription won’t count towards their PBS Safety Net threshold
  • if you have reached the PBS Safety Net threshold, the charge will be your usual contribution amount, not the reduced PBS Safety Net amount

Read more about the early supply rule and a list of the PBS medicines this rule applies to on the Department of Health website.

Claiming

PBS Safety Net claims

To claim a payment for issuing PBS Safety Net cards, complete and submit the PBS Safety Net claim for payment form.

This form needs to be sent to us within 1 month of issuing the customer a PBS Safety Net card.

When you submit your claim, make sure you:

  • record the correct values and calculate the total
  • fill in the prescription record forms correctly and have them signed by your customer or their agent
  • complete the claim form - there's a limit of 12 applications per form
  • attach all prescription record forms in the order they appear on the claim form
  • have signed the prescription record forms, both computer and non-computer versions, as this is a legal requirement, and
  • list all family members on the prescription record form and PBS Safety Net applications

Any incorrectly completed PBS Safety Net claim forms will be rejected and need to be re-submitted.

We keep a record of the PBS Safety Net entitlement and concession card numbers issued to your pharmacy. To make sure you receive the correct payment for these cards, let us know if:

  • the cards issued to you came from another pharmacy, or
  • your pharmacy approval number changes

The Safety Net reply paid envelopes are for PBS Safety Net claims only.

Customer refunds under the PBS Safety Net

Circumstances where we may provide a refund to your customer.

Read more about customer refunds

Resources

PBS Safety Net cards

Information about issuing, supplementary or replacement PBS Safety Net cards.

Issuing PBS Safety Net cards

Give your customer a PBS Safety Net card when they reach the PBS Safety Net threshold. There are 2 types, depending on the customer's circumstances.

PBS Safety Net concession card

Issue a PBS Safety Net concession card when general patients have reached the PBS Safety Net threshold. Their PBS medicines will be less expensive for the rest of the calendar year.

PBS Safety Net entitlement card

Issue a PBS Safety Net entitlement card when a concession card holder has reached the PBS Safety Net threshold. Their PBS medicines will be free for the rest of the calendar year. They may pay more if they choose an expensive brand of medicine.

Supplementary or replacement cards

Issue a supplementary PBS Safety Net card to a customer’s spouse or de facto partner or dependent child, at the same time an original card is issued.

Your customers can request a supplementary or a replacement PBS Safety Net card if their card is lost or stolen.

They need to complete and submit the PBS Safety Net amendment, replacement or supplementary card application form.

Safety Net products

We've developed a range of PBS Safety Net products to help you administer the PBS Safety Net.

A PBS Safety Net Kit is distributed to all pharmacies at the end of each year.

Product Product number Product description or use How to order
PBS Safety Net entitlement card PB013 (formerly 4011) A card is for relevant customers when they reach the PBS Safety Net threshold.
The cards are numbered. You need to account for all cards issued to your pharmacy.
Complete the PBS Safety Net stationery order for pharmacies form (PB185)

Call us
PBS Safety Net concession card PB014 (formerly 4012) A card for relevant customers when they reach the PBS Safety Net threshold.
The cards are numbered. You need to account for all cards issued to your pharmacy.
Complete the PBS Safety Net stationery order for pharmacies form (PB185)

Call us
PBS Prescription Record Form (PRF) and Application for a Safety Net card PB015 (formerly 4013) A form for customers to keep a record of their PBS medicines. Log in to camerons.net/pbs to complete and submit the stationery order form
PBS Safety Net public hospital Prescription Record Form (PRF) and Application for a Safety Net card PB016 (formerly 4014) A form for customers to keep a record of their PBS medicines supplied through a public hospital outpatient department. Log in to camerons.net/pbs to complete and submit the stationery order form
PBS Safety Net claim for payment form PB017 (formerly 4015) Use this form to claim a payment for issuing a PBS Safety Net card. Log in to camerons.net/pbs to complete and submit the stationery order form
PBS Safety Net envelopes EN348 (formerly 4017) Use this envelope to submit your claim for payment for the issue of PBS Safety Net cards.
Only use this envelope for PBS Safety Net claims. Do not send prescription claims in this envelope.
Complete the PBS Safety Net stationery order for pharmacies form (PB185)

Call us

Contact details

For more information about PBS Safety Net for pharmacists or to submit a claim for refund, call us.

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Page last updated: 9 October 2017