Closing the Gap—PBS Co-payment Measure
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What is the Closing the Gap—PBS Copayment Measure?
In November 2008, the Council of Australian Governments (COAG) agreed to a $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes to address the first of the COAG Closing the Gap (CTG) targets – to close the life expectancy gap between Indigenous and non-Indigenous Australians within a generation.
The CTG PBS Co-payment Measure will contribute to achieving this aim by improving access to Pharmaceutical Benefits Scheme (PBS) medicines for eligible Aboriginal and Torres Strait Islanders living with, or at risk of, chronic disease. The assistance is available from 1 July 2010 and will be in the form of lower or nil patient co-payment for PBS medicines.
Who is eligible?
The measure is intended to benefit Aboriginal and Torres Strait Islander people of any age
who present with an existing chronic disease or are at risk of chronic disease and in the opinion of the prescriber:
- would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine and
- are unlikely to adhere to their medicines regimen without assistance through the Measure.
Eligible patients can be registered at either:
- general practices participating in the Indigenous Health Incentive under the Practice Incentives Program (PIP) or
- Indigenous Health Services (IHS) in urban and rural settings.
Which prescribers are eligible to provide a CTG annotated prescription?
The following prescribers are eligible to provide their patients with a CTG annotated script:
- Any medical practitioner working in a practice that is participating in the Indigenous Health Incentive under PIP
- Any medical practitioner working in IHS in rural or urban settings
- Any medical specialist in any practice location provided the patient is eligible under the CTG – PBS Co-payment Measure, and has been referred by a medical practitioner working in a practice that is participating in the Indigenous Health Incentive/PBS Co-Payment Measure under the PIP.
Annotation of prescriptions
When a patient is registered for the measure and the prescriber wants to grant the benefits of the measure to the patient, the prescriber will annotate the patient’s prescription to indicate that it is to be dispensed with co-payment relief. CTG prescriptions will either have an automated annotation or a manual annotation.
Under the measure, general (non-concessional) patients presenting a CTG prescription should be charged the current concessional rate for each PBS item on that prescription. Concessional patients presenting a CTG prescription do not need to pay a patient co-payment for each PBS item on that prescription. However, mandatory charges—such as any applicable brand premiums—must still be paid by the patient or their agent.
If a patient presents as an eligible PBS co-payment patient but does not have an annotated prescription confirming their eligibility, the pharmacy will need to refer the patient back to their prescriber.
Processing annotated prescriptions
Prescribers who issue handwritten prescriptions to their patients must annotate the prescription with the letters ‘CTG’, their initials and signature.
When you receive a manually annotated prescription and are processing that prescription through your dispensing software you must ensure that the CTG code is entered correctly into your processing software (either manually or automatically). The correct code to use will depend on your dispensing software.
For example, using a correct CTG code of H, 00B or CTG00B will make sure the manual annotation is valid. Using an invalid code will result in an incorrect calculation of the payment due from the patient for their prescription.
Will this change the way I claim?
Yes, you must include the CTG annotation on the prescription in the Pharmacy Dispensing System (PDS) prescription record sent to Medicare Australia.
You will be reimbursed the cost of the medicine supplied, inclusive of the co-payment relief amount applicable, if the annotation is valid. If the prescription is a CTG under co-payment prescription, you will be reimbursed the price of the PBS item minus the applicable patient co-payment.
Helping you reconcile CTG prescriptions
Medicare Australia will provide additional information in your PBS reconciliation statement. CTG prescriptions will be clearly identified by the CTG annotation which will be included in the reconciliation statement information.
CTG prescriptions should be included in your claim as per current requirements. CTG under co-payment prescriptions (those prescriptions where a PBS subsidy is not applicable) are not required to be sent to Medicare Australia.
For more information
Email: PBS-Indigenous@health.gov.au
Call: 02 6289 2409* (CTG PBS Co-payment Measure)
132 290* (Claiming information)
*Call charges apply.
Further information can be found in the Pharmacy Staff Resource Booklet available for download from the Department of Health and Ageing
website.
For information about the COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes visit the Department of Health and Ageing website.
Last updated: 25 October, 2012