Payments

Offline solution payments overview

Payments are made monthly in arrears from August 2009.

Payments will be made directly to the state or territory health department’s nominated bank account as supplied to Medicare Australia on the Highly Specialised Drugs program – State or Territory Health Department bank account details form [PDF, 131Kb].

Payments depend on state and territory health departments accepting the following conditions:

• supply is to eligible patients
• prescribing is in accordance with PBS criteria
• prescribing is consistent with the therapeutic uses approved by the Therapeutic Goods Administration (TGA) for the supply of the medicine.

National medicine price

Medicare Australia will meet the agreed price above the patient contribution, for each item supplied in accordance with this program.

Standard national medicine prices will be established through direct negotiations with suppliers through the Pharmaceutical Benefits Pricing Authority. The price is referred to as the agreed price.

Where generically equivalent brands of a medicine are included in these arrangements, then the subsidy will equal the price of the lowest priced brand.

Payments

Payments under the offline solution will be made within 30 days of receipt of correctly submitted claims, provided these claims are received by Medicare Australia within 14 days of the end of the relevant month.

Payments will be made to the state or territory health department’s nominated bank account as identified to Medicare Australia.

The following table identifies payment for the 2011 calendar year.

The above table outlines the date that Medicare Australia will release payments to financial institutions.

Medicare Australia cannot be held accountable for when the payment will be released from the financial institution to the nominated bank account. 

Medicare Australia will not be responsible for delays or errors in payment due to factors outside the reasonable control of Medicare Australia, such as delays or errors in the banking system or errors in the account details provided by the state and territory health departments.

If the electronic funds transfer payment is returned to Medicare Australia, Medicare Australia will reprocess the payment within five working days (subject to Medicare Australia receiving correct bank and account details).

After receiving a notice of overpayment from Medicare Australia, the state or territory health department will repay Medicare Australia any payment credited in error to that state or territory health department.

Claim payments will be for the cost of medicines claimed less patient contributions. Claims received under the offline solution will have a contributions percentage applied at the time of payment (0.8 per cent as of May 2009).

Where a quantity of a medicine claimed is not equal to the quantity contained in the manufacturer’s pack, claim payments will be for the cost of medicines multiplied by the percentage that the quantity supplied bears to the quantity contained in the manufacturer’s pack, less patient contributions.

HSD and PBS trastuzumab (Herceptin®) items dispensed under this initiative will have no mark-ups applied. All medicines under this arrangement will be reimbursed for the medicine cost only less patient contribution and no other fees, such as dangerous drug or broken pack fees will apply.

Change of bank account details

The Medicare Australia Highly Specialised Drugs program – State or Territory Health department bank account details form [PDF, 131Kb] can also be used to advise Medicare Australia of any subsequent changes to those bank account details.

Medicare Australia must be notified in writing, on the approved Medicare Australia bank details form, of changes to bank account details at least five working days before the change is to take effect.

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Last updated: 4 January, 2011

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