Electronic prescription fee
Background
The Fifth Community Pharmacy Agreement provides for approved suppliers to be paid $0.15 for each eligible electronic prescription supplied from 1 July 2010. From 1 July 2010, a manual claiming process for pharmacies to claim the electronic prescription fee was established.
From 1 July 2011, the Department of Human Services established an online claiming solution that allowed pharmacies to be paid the electronic prescription fee at the same time prescription claims were assessed and paid.
During the period 1 July 2011 to 31 March 2012 a transitional arrangement was put in place to continue with the manual claiming process so that pharmacies would have time to implement changes and to coincide with the introduction of the collection of under co‑payment prescription data from 1 April 2012.
Eligibility for the electronic prescription fee
The electronic prescription fee can be claimed:
- where a PBS or RPBS electronic prescription is:
- uploaded by a prescriber to a Prescription Exchange Service (PES) and downloaded by an approved supplier from the PES with an Electronic Prescription Flag (also known as Script Qualifying Flag [SQF])
- supplied by the approved supplier, with the dispensing records being uploaded to the PES for each item supplied, and
- the supply is claimed via Online Claiming for PBS.
- for repeat authorisations and/or deferred supply authorisations in relation to an original electronic prescription which meet the criteria above.
- where a PBS or RPBS electronic prescription that satisfies the criteria above, relates to an item priced below the maximum general patient contribution (under co-payment) and the following details are validated and, if necessary, corrected by the approved supplier:
- patient's name and Medicare number
- information contained in, and relating to, the prescription
- prescriber approval number and approved supplier number.
Note: private prescriptions are not eligible for the electronic prescription fee through either the electronic or manual claiming solutions.
Electronic claiming process
For prescriptions to be eligible to be paid the electronic prescription fee via Online Claiming for PBS, prescription records submitted to the Department of Human Services must contain an Electronic Prescription Flag and valid PES ID. This information must be included for each prescription when downloaded from an approved PES and claimed online.
Under co payment prescriptions and the electronic prescription fee
Under co‑payment prescriptions that attract an eligible electronic prescription fee will begin to be automatically paid for eligible electronic prescription data with a supply date from 1 April 2012.
Approved suppliers are not required to submit copies of prescriptions to claim the electronic prescription fee for under co‑payment prescriptions. Adequate records should be kept to demonstrate prescriptions meet the requirements for claiming the electronic prescription fee. Your pharmacy should contact your software vendor if you receive any of these reason codes.
Changes to claiming the electronic prescription fee
The electronic prescription fee for items supplied up to 31 March 2012 can be claimed via the manual claiming process until 30 June 2012 if not claimed via the online claiming solution.
The electronic prescription fee manual claiming claim for payment form will not be accepted by the Department of Human Services from 1 July 2012. During the period of 1 April 2012 to 30 June 2012, only prescriptions supplied prior to 1 April 2012 will be accepted and processed.
All eligible prescriptions supplied from 1 April 2012 will be assessed and paid via the online claiming solution only.
Individual pharmacies should contact their software vendors to ensure the changes required in their pharmacy dispensing software are in place by 1 April 2012.
Related changes to Online Claiming for PBS functions
Your detailed PBS claims report and the PBS reconciliation statement have been changed to reflect information about fee payments, only if the approved supplier has received a payment. Identifiers relating to various fees and incentive payments are included with information for each prescription.
Three rejection/warning reason codes were introduced on 1 July 2011 that relate specifically to the online claiming of the electronic prescription fee. These are:
- 615 Reject—the electronic prescription flag is not valid
Reason code 615 is a rejection code advising the electronic prescription flag sent in the transmission is not valid and that Medicare Australia will only accept Y, N, U or Blank in this field. - 616 Warning—the PES ID is not provided
Reason code 616 is a warning code advising:- an electronic prescription flag of 'Y' has been received but no PES ID has been sent in the transmission
- Medicare Australia will pay the prescription but not the electronic prescription fee.
- 618 Reject—the PES ID provided is not valid
Reason code 618 is a rejection code advising an electronic prescription flag of 'Y' has been received but the PES ID sent to Medicare Australia is not correctly formatted with three alphabetic characters.
Your pharmacy should contact your software vendor if you require further assistance.
Manual claiming process
The manual claiming process for the Electronic Prescription Fee $0.15 ceased effective from 1 July 2012.
For more information
Fifth Community Pharmacy Agreement
Last updated: 4 September, 2012