What's new?

May 2013

The Healthcare Identifiers Service Licensed Materials for the May 2013 release are now available.

January 2013

New eligibility requirements for the PIP eHealth Incentive start 1 February.

The Department of Human Services’ Compliance Program 2012—13 is now available.

The 2013 Medicare Teen Dental Plan voucher is valued up to $166.15

The Medicare Safety Net threshold figures for 2013 are now available.

PBS compensation

Information for pharmacists

Is a patient entitled to the PBS if they are claiming compensation?  
Yes. All Australian residents who hold a Medicare card are entitled to pharmaceutical benefits where a PBS prescription has been written. The patient is required to pay the contribution appropriate to their level of entitlement at the time of supply.
Can PBS medicine supplied for a compensation related injury count towards a patients PBS Safety Net threshold?
Yes. PBS medicines supplied for a compensation related injury can count towards a PBS Safety Net threshold for the patient and/or patient’s family, in the usual way.
If a pharmacist is billing a patient’s insurance company for PBS medicine, is the patient’s entitlement to PBS or the Safety Net affected?
No. Provided the prescription is written and supplied as a PBS prescription it can count towards an individual or family PBS Safety Net threshold.
Should a pharmacist change a PBS prescription to private if they know it’s for a compensation claim?
No.
Is a patient who is admitted to a private hospital as a compensation patient entitled to the PBS?

Yes. Patients who are admitted to a private hospital as a compensation patient are entitled to receive PBS medicine, regardless of whether the patient or the insurance company is billed or pays for the medicine.

Information for doctors

Do I have to write a private prescription for a compensation patient?
No. A PBS prescription can be written provided the patient is an eligible Australian resident and holds a valid and current Medicare card. You must also ensure that the patient meets any restrictions associated with the listed medicine. If they do not meet these requirements, you must write a private prescription.

Information for patients

Am I still entitled to the PBS if I am making a compensation claim?
Yes. All Australian residents are entitled to access PBS medicine and are required to pay the contribution appropriate to their level of entitlement at the time of supply.
Do I have to declare my compensation claim?
No. You do not need to declare a compensation claim at the time of being prescribed or supplied with a PBS medicine.
Can I be reimbursed the patient contribution once my compensation claim is finalised?
Any reimbursement of the patient contribution is between you and your insurance company. You will need to contact your insurance company to discuss this further.
If PBS medicine is supplied to me for a compensation related injury, can it count towards my PBS Safety Net threshold?
Yes. PBS medicine supplied can count towards a PBS Safety Net threshold for you and/or your family in the usual way. More information about registering your family for the safety net.

Last updated: 19 September, 2012