PBS Safety Net

2013 PBS Safety Net kit

The Pharmaceutical Benefits Scheme (PBS) Safety Net kit helps you administer the PBS Safety Net. It includes:

• PBS Prescription Record Forms (PRF) (4013)
• PBS Safety Net concession cards (4012)
• PBS Safety Net entitlement cards (4011), and
• PBS Safety Net claim for payment pad (4015) and envelopes.

We posted a kit to you in December. If you need extra items, call us on 132 290*.

2013 PBS patient contributions

^† If your customer chooses a more expensive brand of medicine, or their doctor prescribes one, they may need to pay more and the extra amount they pay will not count towards their PBS Safety Net threshold.

PBS Safety Net—who is eligible?

Anyone eligible for the Pharmaceutical Benefits Scheme (PBS) and/or the Repatriation Pharmaceutical Benefits Scheme (RPBS) is also eligible for the PBS Safety Net. The PBS Safety Net is available to individuals and families.

Who makes up a PBS Safety Net family?

A PBS Safety Net family is:

• a couple legally married and not separated or a couple in a de facto relationship with or without dependent children, or
• a single person with dependent children.

Note: a dependent child is someone under 16 years or a full-time student under 25 years attending school, college or university, who is wholly or substantially supported financially.

Examples of groups who are not considered a family for PBS Safety Net purposes are:

• full-time students 25 years and over and their parent(s)
• separated couples (unless living separately due to illness or infirmity)
• two or more adult siblings, or
• an adult and their parent(s).

Note: if a family member dies, medicines supplied during the year for that person and recorded on the family PRF can still count towards the family Safety Net threshold.

Charging medicine at the PBS Safety Net rate

The first medicine that you need to charge at the reduced PBS Safety Net rate is the one that puts your customer over the Safety Net threshold.

For example, a customer who is considered a general patient (i.e. not a concession patient), gives you a prescription to supply. Their current PRF is $10 under the general threshold amount. You should issue a Safety Net card and charge them the PBS Safety Net rate because the cost of this medicine will put them over the threshold.

If you supply a Regulation 24 prescription which puts a customer over the Safety Net threshold, let them know they can:

• pay the usual cost for all supplies and ask for a refund from Medicare, or
• have less repeats supplied, making the remaining repeats void. Note: they’ll need to return to a prescriber for their next prescription.

PBS Safety Net cards

All Safety Net concession and entitlement cards are numbered. You need to account for all cards issued to your pharmacy. You need to give a card to your customer when they reach the Safety Net threshold.

To make sure you receive the correct payment for the cards issued to your pharmacy, let us know if:

• the card issued to you came from another pharmacy, or
• your pharmacy is sold and a new approval number is issued.

You can claim a payment for issuing Safety Net cards. Use the PBS Safety Net claim for payment pad (form 4015) to send us your claim. This needs to be sent to us within one month of the card being issued to make sure your claim isn’t rejected.

Lost cards

Your customer can request a replacement Safety Net card by downloading the PBS Safety Net amendment, replacement or supplementary card application form, or writing to us at:

Department of Human Service
Pharmaceutical Benefits Section
GPO Box 9826
In your capital city.

They need to give us their Safety Net card number and list all family members that are on the card.

Supplementary cards

You can issue a supplementary Safety Net card to a spouse/de facto partner or dependent child at the same time an original card is issued. If your customer wants a supplementary card at any other time, they need to contact us. Supplementary cards and application forms must include the original cardholder’s details.  

Crossover arrangements

There are two situations where crossover arrangements apply.

Situation 1—child on a Department of Human Services concession card

There are some families where a dependent child (under 16 years) holds a concession card. This card carries concession entitlement to the PBS for that child. The child only needs to pay the concession amount for their PBS medicine, while other family members pay the general rate. In relation to the PBS Safety Net, the family can:

• count their child’s expenses towards an individual Safety Net card for the child, or
• count their child’s expenses of the concession amount towards a Safety Net concession card with the rest of the family.

The expense of the parents and other family members can’t be changed to the concession amount and counted towards a Safety Net entitlement card. This is because they aren’t the child’s dependents.

Situation 2—a general patient gets a Department of Human Services or Department of Veterans’ Affairs concession card part-way through the calendar year

If your customer’s status changes from general to concession, all their PBS medicines need to be changed from the general rate to the concession rate on their PRF, or their record on your computer.

Once your customer has been supplied with 60 PBS medicines, you can issue a Safety Net card so they can get free^†  PBS medicine for the rest of the calendar year.

If your customer has already reached the general Safety Net threshold during the calendar year, and a Safety Net concession card has been issued, you’ll need to send their PRF to us. If your pharmacy dispensing software shows the number of previous supplies, you can transfer this number to the new PRF and endorse it with your signature. If you can’t find out the number of previous supplies, call 132 290*.

^† If your customer chooses a more expensive brand of medicine, or their doctor prescribes one, they may need to pay more. This extra amount doesn’t count towards their PBS Safety Net threshold.

Customer refunds

There are two circumstances where we might provide a refund to your customer:

• if they go over their PBS Safety Net threshold before being issued with a Safety Net card, or
• if they can’t prove eligibility when you supply their medicine.

To claim a refund, your customer needs to:

• complete a PBS Patient claim for refund form and send it to us with a copy of all their PRFs to support their claim, or
• send us a letter requesting a refund. This needs to include their name, address, Medicare card details and Safety Net card number. They also need to include a copy of all PRFs to support their claim.

Your customer can return these to us:

• by mailing them to GPO Box 9826 in their capital city, or
• in person by visiting a Medicare Service Centre.

You can’t make a claim for a refund for your customer. You can only help them by providing the information they need.

Exceeding the PBS Safety Net threshold

Tell your customers early in the year that they can link their family members under the family Safety Net. This may stop them from exceeding the threshold and needing a refund.

Unable to prove eligibility

If your customer can’t prove their eligibility and you charge them a higher rate, you need to give them an official pharmacy receipt (S87A). This makes it possible for us to give them a refund.

Your customer can prove their eligibility by showing you their:

• Medicare card
• PBS Safety Net card
• Department of Human Services concession card, or
• Department of Veterans’ Affairs concession card.

An official pharmacy receipt needs to include:

• the patient’s name and address
• the patient’s payment level (for example, private, general, concession or free)
• the prescriber’s name
• the prescriber’s address or prescriber number
• the date the medicine was supplied
• an item code
• the quantity
• clarification of whether Regulation 24 applies
• an authority number (if applicable)
• the price paid, and
• the pharmacy approval number.

We can’t process the claim if any of these details are missing. If something is missing, we will tell your customer to contact you to get the missing information.

Refund refused

Your customer won’t get a refund if:

• the entitlement number has expired
• the item claimed is not a PBS listed medicine
• the PBS Safety Net threshold hasn’t been exceeded
• We have no record of their entitlement number
• an unpaid pharmacy account is presented instead of an official pharmacy receipt
• details are missing from the official pharmacy receipt
• the prescription is issued under the Safety Net 20 day rule, or
• they haven’t signed the claim.

Claiming

We’ll send any Safety Net claims that aren’t t bundled correctly back to you to sort and re-submit. Before you send in any claims in the reply paid envelope, make sure:

• the correct values are recorded and the total is calculated
• the PRFs have been filled in correctly and are signed by your customer or their agent
• the claim form has been completed and doesn’t have more than 12 applications per form
• all PRFs are attached in the order they appear on the claim form
• you have signed the PRFs (both computer generated and non-computer generated)—this is a legal requirement, and
• the PRF and Safety Net application lists all family members.

You don’t need to attach a blank PRF when you send in a computer generated PRF.

Note: only use reply paid envelopes marked ‘Safety Net’ for Safety Net claims. Don’t send prescriptions in these envelopes.

Bundling prescription claims and Safety Net 20 day rule

To avoid delays, your PBS claim prescriptions should be in ascending serial number order and be separated into the following four bundles:

• general patients
• concession beneficiaries/Safety Net concession cardholders
• Safety Net entitlement cardholders, and
• Repatriation Pharmaceutical Benefits Scheme (RPBS) patients.

You need to bundle a prescription in line with the amount paid by your patient if:

• you supplied the prescription within 20 days after a previous supply, and
• it’s subject to the Safety Net 20 day rule.

For example, you would submit the prescription of a general patient who has reached the PBS Safety Net in the concession beneficiaries/Safety Net concession cardholders bundle.

Under the Safety Net 20 day rule, where a medicine has been supplied within 20 days, the patient won’t be entitled to the reduced Safety Net amount and the prescription should be submitted in the general patients bundle.

Frequently asked questions

Q: One parent holds a concession card and the other family members are general patients. Are they a Safety Net family?

A: Yes, family may choose to count their PBS prescriptions towards either a:

Safety Net concession card

• this allows general prescriptions to be recorded on the PRF at the general rate, and for concession prescriptions to be recorded at the concession rate
• once the general Safety Net threshold is reached, all family members are entitled to receive prescriptions at the concession rate for the remainder of the calendar year. However, they are still required to pay any additional charges for more expensive brands of medicine.

or

Safety Net entitlement card

• general and concession prescriptions must be counted at the concession rate, until the concession threshold is reached
• all family members are entitled to receive medicine at no charge for the remainder of the calendar year. However, they are still required to pay any additional charges for more expensive brands of medicine.

Q: If a person or family changes their eligibility status during the year which card do they apply for?

A: The person or family should apply for the Safety Net card that is relevant to them at the time of application. If the person or family has recently obtained concession status, an application can be made for a Safety Net entitlement card. Any supplies previously made at the general rate will need to be converted and counted as concession entries toward the concession threshold.

If the person or family is no longer entitled to their Centrelink concession and now has general patient status, an application can be made for a Safety Net concession card. Any previous supplies made at the concession rate will be counted towards the general threshold.

Q: An 18 year old living at home and not a student has a Health Care card. Can their prescriptions be counted with the rest of the family?

A: No, children 16 years of age and over who are not dependent students cannot be included with the rest of the family for the PBS Safety Net, whether or not they hold a Heath Care card.

For more information

Online             Department of Health and Ageing PBSwebsite

Call—              132 290* PBS enquiry line
Option 1          Concession and Medicare entitlement enquiries
Option 2          All claim payment, Safety Net, stationery and general enquiries
Option 3          Technical support for online claiming or information about online claiming

* Call charges apply.

** Call charges apply from mobile or pay phones.

Last updated: 23 January, 2013

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