Improved Monitoring of Entitlements - Medicare Cards
Improved Monitoring of Entitlements (IME) is a measure to ensure pharmaceutical benefits are provided only to those people eligible to receive them.
There are no changes to patient entitlements.
From 1 May 2002 Medicare numbers or Veterans' Affairs file numbers, and concession card numbers if applicable, have to be included on pharmaceutical benefit prescription information provided to Medicare Australia. This ensures that when a PBS claim is made, the claimant can be reliably identified and their eligibility checked by Medicare Australia.
This measure will help ensure taxpayers' dollars go to those people who are entitled to them. The IME checks entitlement arrangements and reduces the number of subsidies paid to ineligible people, for example, visitors from countries without a Reciprocal Health Care Agreement and illegal immigrants.
Legislation supporting IME is known as the National Health Amendment (Improved Monitoring of Entitlement of Pharmaceutical Benefits) Act 2000. It came into full effect on 1 May 2002.
After this date, payments by Medicare Australia to pharmacists in relation to the dispensing of prescriptions for pharmaceutical benefits is dependent on:
- the pharmacist providing the patient's Medicare card number or Veterans' Affairs file number with their claim; and
- the Medicare card number (where used) matching the one held by Medicare Australia in relation to that particular person.
Most people need only provide their Medicare card number to the pharmacist when having prescriptions filled for medicines listed under the PBS.
In order to receive an additional subsidy, concession card holders are also required to provide their concession card number.
Veterans covered by the Repatriation Pharmaceutical Benefits Scheme (RPBS) need to provide their Veteran's Affairs file number (Gold, White or Orange card).
White card holders are required to provide their Medicare card number for prescriptions not covered under the RPBS.
People from countries with Reciprocal Health Care Agreement with Australia i.e. Finland, Italy, Malta, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and the Republic of Ireland, who have not been issued with a Medicare card, should show their passport to the pharmacist when having prescriptions filled.
People collecting prescribed medicines for someone else must provide proof of that person's eligibility to the pharmacist.
With each individual's consent, the pharmacist may store a consumer's Medicare number for use on future prescriptions. Please note that the Medicare card number changes with each Medicare card renewal or re-issue. A veteran's file number does not change with renewal or re-issue.
- The customer can call and obtain the number from the person who holds the card;
- The customer can call the Medicare enquiries line (132 011 local call cost) to obtain their Medicare card number;
- The pharmacist can contact the pharmacists' hotline (132 290 local call cost), with the patient's consent to obtain the Medicare number for the patient;
- The pharmacist may use one of the special numbers* if the circumstances fit;
- The customer may pay full price for their medication. If they are eligible, they may be able to obtain a refund from a Medicare office (or DVA state office for Veterans phone 133 254). The customer will require a patient refund receipt from the pharmacy.
*In some circumstances, people who are entitled to receive pharmaceutical benefits may not be able to provide a Medicare number. Special numbers have been established to cover emergencies and other situations where consumers are eligible but cannot produce a Medicare card number.
Some people who are entitled to receive PBS medicines may not be able to provide a Medicare card or number. There are six Medicare special numbers available for pharmacists to use in these circumstances.
Medicare special numbers are designed to be used when eligible people are unable to produce a Medicare card, for example some Indigenous Australians and eligible overseas visitors.
The Medicare special numbers available for pharmacists to use in their PBS claim are listed below.
Pharmacists also have the option (with their patient’s consent) to call PBS Enquiries and Support on 132 290 (option 1) to get the patient's Medicare card number.
Medicare Australia encourages a culture of voluntary compliance with the programs we administer. We will monitor the use of Medicare special numbers and, where appropriate, conduct audits to verify appropriate use.
It is the responsibility of pharmacists to make sure Medicare special numbers are used appropriately.
Where do I go for more information?
- 132 290 (option 1).
|Medicare special number||Explanation and use|
|25437759611||Visitors covered by a Reciprocal Health Care Agreement (RHCA)|
|25437766611||People a doctor considers are entitled to PBS|
|25437768411||People a pharmacist considers are entitled to PBS|
|25437529911||Urgent clinical need|
|25437783311||Seemingly valid Medicare card|
Medicare Australia provides a Medicare number enquiry line to assist pharmacists in obtaining Medicare (or Veteran's) card numbers for use in Pharmaceutical Benefits Scheme (PBS) claims. This phone service allows pharmacists to call Medicare Australia and with the consent of their patient, obtain the patient's Medicare (or Veteran's) card number and card expiry date. The enquiry line number is 132 290.
The enquiry line can release a maximum of five numbers and expiry dates per call. For more than five numbers, Medicare Australia has established a fax back service to pharmacists. The Medicare number release form [PDF, 64Kb] may be used to obtain patients' Medicare (or Veteran's) card numbers and expiry dates.
More information can be found at the following websites:
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Last updated: 25 October, 2012