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 Department of Human Services (Human Services) on the Highly Specialised Drugs program bank account details form. This form will be made available to Health Department representatives by contacting PBS Services, Complex Programs.

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

Human Services 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 Human Services 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 Human Services.

The following table identifies payment for the 2013 calendar year.

The above table outlines the date that Human Services will release payments to financial institutions.

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

Human Services will not be responsible for delays or errors in payment due to factors outside the reasonable control of Human Services, 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 Human Services, Human Services will reprocess the payment within five working days (subject to Human Services receiving correct bank and account details).

After receiving a notice of overpayment from Human Services, the state or territory health department will repay Human Services 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

Highly Specialised Drugs program – State or Territory bank account form can also be used to advise Human Services of any subsequent changes to those bank account details. This form will be made available to Health Department representatives by contacting PBS Services, Complex Programs on 1800 700 270, option 5 or Public.Hospital.HSD@humanservices.gov.au

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

Last updated: 6 February, 2013

Explore Medicare