PBS reforms
In November 2006 a package of reforms to the Pharmaceutical Benefits Scheme (PBS) was announced by the former Australian Government. A complete overview of the PBS reforms can be found on the Department of Health and Ageing website
.
Online claiming for PBS - incentives
40 cents per script claimed online
Since 1 July 2007, every script submitted to Medicare Australia via online claiming for PBS has entitled pharmacies to receive a 40 cent incentive payment.
Prescriptions dispensed from 1 August 2008
From 1 August 2008, the 40 cent online incentive payment that you were previously paid monthly in arrears will now be paid at the same time your online claim is assessed and paid.
The 40 cent online incentive payment will be seperately identifed on the Medicare Australia reconciliation statements. The statements will display the total number of prescriptions paid, the amount paid and will also identify individual prescriptions that were paid the online incentive.
Prescriptions dispensed from 1 July 2007−31 July 2008
Payments are made monthly in arrears for prescriptions dispensed between 1 July 2007 and 31 July 2008, once the pharmacy's online prescription has been finalised.
Important: a pharmacy claim is finalised when all paper prescriptions have been received and processed by Medicare Australia.
The following table outlines the payment schedule for online incentive payments for precriptions that are dispensed between 1 July 2007 and 31 July 2008.
| Month in which claim is finalised | Payment made |
|---|---|
| July, August, September 2007 | 6 December 2007 |
| October, November 2007 | 19 December 2007 |
| December 2007 | 4 February 2008 |
| January 2008 | 4 March 2008 |
| February 2008 | 4 April 2008 |
| March 2008 | 4 May 2008 |
| April 2008 | 4 June 2008 |
| May 2008 | 4 July 2008 |
| June 2008 | 4 August 2008 |
| July 2008 | 4 September 2008 |
| August, September, October 2008 | 4 November 2008 |
What pharmacies need to do
To receive the 40 cent incentive, pharmacies must submit their script online. The first step toward claiming online is to register with us.
To register, submit an Online claiming for PBS participation agreement [PDF, 151Kb]
. When Medicare Australia receives the agreement and all of the necessary information, the registration process will be completed and a Public Key Infrastructure (PKI) certificate will be issued.
Letter about incentives — sent to pharmacists in March 2007 [PDF, 18Kb]
Incentive for dispensing premium-free substitutable medicine
From 1 August 2008, a payment of $1.50 will be paid to all Friendly Societies and community pharmacies (Section 90), dispensing doctors (Section 92) and hospitals (Section 94, not public hospitals participating in the pharmaceutical reforms in public hospitals) that dispense a subsidised PBS prescription, which costs the patient no more than the standard co-payment.
The $1.50 premium free dispensing incentive supports pharmacy in the dispensing of premium free PBS listed products in cases where there are multiple substitutable versions of an item on the PBS. It will also ensure that pharmacy customers are aware of their right to pay no more than the co-payment for their medicine and will encourage greater use of generic medicine.
For a pharmacy to receive the $1.50 premium free dispensing incentive, they must identify the brand that was dispensed in their claim to us.
Payment of the $1.50 premium free dispensing incentive will be made at the same time that a pharmacy claim is assessed and paid by us.
The $1.50 premium free dispensing incentive will be separately identified on the Medicare Australia reconciliation statements. The statements will display the total number of prescriptions paid, the amount paid and will also identify individual prescriptions that were paid the online incentive.
Streamlined authority process
The Pharmaceutical Benefits Schedule (the Schedule) now identifies certain items as Authority required (STREAMLINED). Prescriptions for listed quantities and/or repeats for these items no longer require telephone approval from Medicare Australia or DVA to obtain an authority approval number.
Prescribers can find the streamlined authority code in the Schedule next to the text that describes the indications for which the item may be prescribed.
- Placement of authority approval number on prescriptions
- Department of Veterans' Affairs approval process
- Increased quantities and repeats
- Helpful hints for pharmacists
- Important changes to reason codes
- Information sheet for pharmacists [PDF, 153Kb]
Placement of authority approval number on prescriptions
Prescribers will still need to place the authority approval number on the prescriptions to show that the prescription meets agreed prescribing requirements. No changes have been made to requirements about the placement of this number or any other information on the script. The streamlined authority code will be published next to the appropriate indication in the Schedule.
Department of Veterans’ Affairs approval process
Some authority required items are listed in both the PBS and RPBS sections of the Schedule of Pharmaceutical Benefits, e.g. clopidogrel. There are no authority required (STREAMLINED) items listed in the RPBS Schedule.
RPBS prescriptions can be written with a streamlined authority code. This is because veterans can be prescribed any item in the general section of the Schedule—including authority required (STREAMLINED) items—as long as they meet the relevant requirements.
RPBS prescriptions that have been endorsed with a streamlined authority code can be dispensed with the relevant PBS streamlined authority item code as specified on the prescription.
Increased quantities and repeats
When a prescriber wants to increase quantities and/or repeats, prior authority must be sought from either Medicare Australia or DVA. The streamlined authority process will not apply in these circumstances.
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Last updated: 25 July, 2008