PBS Authorities
Medicare Australia has begun a series of changes to enhance the PBS authorities system. These changes were announced in the 2002-03 Federal Budget as part of the Pharmaceutical Benefits Scheme (PBS) budget package and are in keeping with the Government's Health Online agenda.
Enhancements to the PBS authorities process include a Pharmaceutical Benefits Advisory Committee review of the restriction wording for medicines listed in the Schedule of Pharmaceutical Benefits. Where necessary amendments to or clarification of the wording to more accurately reflect the intention of the listing will be made.
An internet website for PBS authorities was made available to prescribers on 1 August 2003 as an alternative method to request authority approvals. The website is available in addition to the current telephone and mail channels. Public Key Infrastructure (PKI) Healthcare Location Certificates are used to protect information transmitted through the new internet channel. Existing Healthcare Individual Certificate holders may use their current certificate, and do not need to apply for a Healthcare Location Certificate.
The PBS authorities website has been offered as an alternative way to make online requests for PBS authorities until an integrated solution can be made available.
For prescribers
Prescribers may be required to provide Medicare Australia with some additional information related to the restriction for a particular medicine. This will be based on existing patient information and will be required before an authority can be approved.
Prescribers will continue to have the choice to prescribe PBS medicines in the best interests of their patients' health and the Australian Government will continue to subsidise medicines meeting the enhanced PBS authority restrictions.
Streamlining authorities - information for pharmacists
Since 1 July Medicare Australia’s claims processing staff have noticed a rising number of prescriptions appearing that do not have the required authority approval from Medicare Australia or DVA.
When dispensing authority items, please remember that authority approval numbers, issued by either Medicare Australia (e.g. Z1234ab) or DVA (e.g. DVA4567cd), must always be present on prescriptions for items:
- marked Authority required in the Pharmaceutical Benefits Schedule, or
- when increased quantities and/or repeats are being prescribed.
Incorrect numbers on processed scripts, such as item codes or invalid streamlined authority codes, will lead to our staff rejecting the claim for your payment.
Helpful hint:
Whenever you're dispensing software returns reason code 150 or 151 the prescription must have a Medicare Australia or DVA issued authority approval number on it.
To highlight the importance of these reason codes new wording will be released for dispensing software in November this year. The risk of rejection will be emphasised and pharmacists will be directed to the fix instructions for further information.
Important changes to reason codes
Reason Code 150
REJECTION RISK! REFER TO FIX INSTRUCTIONS. Authority prescription number provided not found in authority records.
Fix instructions:
No authority for this prescription can be found as the authority prescription number provided does not match with any authority record in Medicare Australia’s system.
This prescription must have authority approval from Medicare Australia or DVA. It is either for an Authority Required item or increased quantities and/or repeats and is not eligible for the streamlined process.
Please note: Medicare Australia will only pay for this prescription if the prescriber has placed a validly formatted authority approval number on it (e.g. Z1234AB or DVA1234AB). Streamlined authority codes (e.g. 1234) or other incorrectly formatted authority approval numbers (.g. 4567A) will be rejected.
Actions:
- Check that the paper prescription details match the details provided in your claim.
- Check that authority approval number is in the required format (ie. either Z1234AB or DVA1234AB).
- If the details match and the paper prescription looks valid, including the authority approval number, no further action is required - send in paperwork to Medicare Australia.
- If the paper prescription details do not match your claim, please correct and re-submit.
- If the paper prescription does not look valid or does not appear to have approval, contact the doctor to clarify.
- For further information please call 13 22 90, quoting code 150 (call charges may apply)
Reason Code 151
REJECTION RISK! REFER TO FIX INSTRUCTIONS. Authority prescription details provided do not match authority records.
Fix Instructions:
No authority for this prescription can be found as the authority details provided do not match with any authority record in Medicare Australia’s system.
This prescription must have authority approval from Medicare Australia or DVA. It is either for an authority required item or increased quantities and/or repeats and is not eligible for the streamlined process.
Please note: Medicare Australia will only pay for this prescription if the prescriber has placed a validly formatted authority approval number on it (e.g. Z1234AB or DVA1234AB). Streamlined authority codes (e.g. 1234) or other incorrectly formatted authority approval numbers (e.g. 4567A) will be rejected.
Actions:
- Check that the paper prescription details match the details provided in your claim.
- Check that authority approval number is in the required format (i.e. either Z1234AB or DVA1234AB).
- If the details match and the paper prescription looks valid, including the authority approval number, no further action is required - send in paperwork to Medicare Australia.
- If the paper prescription details do not match your claim, please correct and re-submit.
- If the paper prescription does not look valid or does not appear to have approval, contact the doctor to clarify.
- For further information please call 13 22 90, quoting code 151 (call charges apply).
Streamlining the authority approval process
View more information about PBS reforms
Enhancing PBS authorities
In the 2002 - 03 Budget the Australian Government announced a number of measures aimed at securing the future of the Pharmaceutical Benefits Scheme (PBS). One of the measures focused on the process for requesting PBS authority items. The announcement stated that the:
- prescribers will be required to provide additional information when requesting a PBS authority item
- prescribers will be able to request PBS authority items electronically from Medicare Australia in August 2003.
PBS authorities website
This website is an Australian Government initiative designed to provide prescribers with an additional channel to request PBS authority items and a facility to make enquiries on restriction question and answer formats.
Before using this service prescribers will need to:
Obtain a Public Key Infrastructure (PKI) Healthcare Location (HCL) Certificate to request a PBS authority item using this service. Existing PKI Healthcare Individual Certificate holders may use their current Certificate, and do not need to apply for a Healthcare Location Certificate.
To begin using this service please select:
- Request a PBS authority - this service allows prescribers to request a PBS authority item.
- Enquire on restrictions - this service allows prescribers to enquire on restriction questions and answer formats.
How do I obtain access to the PBS authorities website?
To use the PBS authorities website you will need to:
| Steps | Timeframes | |
|---|---|---|
| 1 | Contract an Internet Service Provider | Anytime |
| 2 | Request and install a Public Key Infrastructure (PKI) Healthcare Location Certificate. Existing PKI Healthcare Individual Certificate holders may use their current certificate. You can apply for access to PKI by calling the eBusiness Service Centre 1800 700 199 | Anytime |
| 3 | Obtain the PBS authorities website installation CD and user support kit by calling Medicare Australia's eBusiness Service Centre on 1800 700 199, and | From August 01, 2003 |
| 4 | Install your PBS authorities website installation CD (Note: website CD installation must always follow the PKI Healthcare Location Certificate installation). | Anytime |
- Where can I get more information about using the authorities website?
-
Call Medicare Australia's eBusiness Service Centre on 1800 700 199.
The PBS authorities website user support kit contains the following printed material. Please note that you will still need to contact Medicare Australia's eBusiness Service Centre to obtain the PBS authorities website installation CD.
- What is Public Key Infrastructure (PKI)?
-
PKI secures online communication using digital certificates and provides high levels of confidentiality, privacy and authentication available for electronic communication. Medicare Australia uses PKI to encrypt and secure information electronically transmitted over the internet between you and Medicare Australia.
PKI secures online communication using digital certificates. Each practice that will transmit information using the PBS authorities secure online site requires a PKI Healthcare Location or Individual Certificate.
The Healthcare Location Certificate is used to identify the location from which a message has been received and allows a number of people at the same location to sign and encrypt messages. The Healthcare Individual Certificate is used to identify a person from whom a message has been received and allows the sender to attach a digital signature.
For more information about PKI and how to obtain a Location Certificate call 1800 700 199.
- If I have an Individual Certificate do I need to get a Healthcare Location Certificate?
- No. Existing PKI Healthcare Individual Certificate holders may use their current certificate.
Items excluded from online service
The following items are currently excluded from this service:
- Written Authority Only
- Imatinib Mesylate (Glivec)
- Phone Authority Only
- Highly Specialised Drugs (HSD) - unless otherwise specified in the Schedule of Pharmaceutical Benefits
- Written/Phone Authority
- Anticholinesterases
- Drotrecogin Alfa (Xigris)
- PBS Extemporaneous preparations
- Dexamphetamine Sulphate
- Clomiphene Citrate
- Acitretin
- Isotretinoin
- Acamprosate Calcium
- Naltrexone Hydrochloride
- Leflunomide
- Bupropion Hydrochloride
Department of Veterans’ Affairs Authorities (1800 552 580)
To request a Department of Veterans' Affairs Authority, please call 1800 552 580.
To request a PBS authority for PBS items excluded from this online service, please call 1800 888 333.
Information kit
Medicare Australia distributed information kits to prescribers in mid June 2003.
The kit included:
- PBS authority prescribing guide - a guide to assist you when requesting PBS authority items;
- Frequently asked questions;
- Patient information fliers - to allow you to discuss changes to PBS authorities with your patients;
- Contact information - an easy reference guide outlining who to call for assistance when requesting PBS authority items;
- PBS subsidy decision flow chart - to assist you in explaining to patients the eligibility criteria for receiving a PBS subsidised medicine; and
- A reorder form - a fax back form that you can send Medicare Australia to order more copies of the contents of this kit.
If you did not receive a kit you can order one by calling Medicare Australia's eBusiness Service Centre on 1800 700 199.
Frequently asked questions
How is my patient’s privacy protected?
Australian Government agencies such as Medicare Australia are covered by the Privacy Act 1988 and must comply with the Information Privacy Principles when handling personal information. Medicare Australia is also bound by secrecy and privacy provisions in the Health Insurance Act 1973 and National Health Act 1953 in relation to personal information. In addition to any legal obligation, Medicare Australia staff are committed to protecting the privacy and confidentiality of all personal information, and the Medicare Australia code of conduct reinforces the importance placed on confidentiality of the information Medicare Australia staff handle.
Private sector organisations, such as doctors and pharmacies, are also covered by the Privacy Act 1988, and must comply with the National Privacy Principles in their handling of personal information. Staff in private sector organisations also have an obligation to adequately protect access to the personal information that they hold on their computer systems. Data transmitted between the Doctor’s office and Medicare Australia is encrypted using Public Key Infrastructure (PKI). There are specific obligations about protection of private keys applying to PKI certificates.
Will I still be able to use the written and phone channels to request PBS authorities?
Yes. The current PBS authority written and phone channels will continue to be available to prescribers.
Why would I choose to use the PBS authorities website?
If you are interested in online solutions for business transactions, you may want to use this website for authority requests.
Contact Us
To register for a PKI Location Certificate or for PKI installation support, call 1800 700 199.
For more information on this service or for technical support, call 1800 700 199.
To request a PBS authority item over the phone, call 1800 888 333.
Feedback
To provide feedback on this service use the ‘Feedback’ link at the top of the page.
Some documents on this page may require the free Adobe PDF reader.
Last updated: 13 February, 2012