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PBS reforms

In November 2006, a package of reforms to the Pharmaceutical Benefits Scheme (PBS) was announced by the former Australian Government. A complete overview of the PBS reforms can be found on the Department of HealthExternal link website.

Premium free dispensing incentive

Since 1 August 2008, an incentive payment (which was indexed to $1.56 as of 1 August 2010) has been paid to all Friendly Societies and community pharmacies (Section 90), dispensing doctors (Section 92) and hospitals (Section 94, not public hospitals participating in the pharmaceutical reforms in public hospitals) that dispense a subsidised PBS medicine, which costs the patient no more than the standard patient contribution.

The incentive supports pharmacy in the dispensing of premium free PBS listed products in cases where there are multiple substitutable versions of an item on the PBS. It also ensures your customers are aware of their right to pay no more than the patient contribution for their medicine and encourages greater use of generic medicine.

For a pharmacy to receive the premium free dispensing incentive, they must identify the brand dispensed in their claim to us.

Payment of the incentive is made at the same time that a pharmacy claim is assessed and paid by us.

The premium free dispensing incentive is separately identified on the Medicare reconciliation statements. The statements display the total number of prescriptions paid, the amount paid and also identify individual prescriptions that were paid the online claiming incentive.

Streamlined authority process

The Pharmaceutical Benefits Schedule (the Schedule) now identifies certain items as Authority required (STREAMLINED). Prescriptions for listed quantities and/or repeats for these items no longer require telephone approval from Medicare or DVA to obtain an authority approval number.

Prescribers can find the streamlined authority code in the Schedule next to the text that describes the indications for which the item may be prescribed.

Placement of authority approval number on prescriptions

Prescribers will still need to place the authority approval number on the prescriptions to show that the prescription meets agreed prescribing requirements. No changes have been made to requirements about the placement of this number or any other information on the script. The streamlined authority code will be published next to the appropriate indication in the Schedule.

Department of Veterans’ Affairs approval process

Some authority required items are listed in both the PBS and RPBS sections of the Schedule of Pharmaceutical Benefits, e.g. clopidogrel. There are no authority required (STREAMLINED) items listed in the RPBS Schedule.

RPBS prescriptions can be written with a streamlined authority code. This is because veterans can be prescribed any item in the general section of the Schedule—including authority required (STREAMLINED) items—as long as they meet the relevant requirements.

RPBS prescriptions that have been endorsed with a streamlined authority code can be dispensed with the relevant PBS streamlined authority item code as specified on the prescription.

Increased quantities and repeats

When a prescriber wants to increase quantities and/or repeats, prior authority must be sought from either Medicare or DVA. The streamlined authority process will not apply in these circumstances.

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Last updated: 3 October, 2013