What's new?

August 2013

The Department of Human Services Compliance Program for 2013-15 has been released.

Pharmaceutical Benefits Scheme Safety Net

The Australian Government subsidises the cost of a wide range of prescription medicines through the Pharmaceutical Benefits Scheme (PBS). All Australian residents and eligible overseas visitorsExternal link can access affordable medicines through the PBS.

The Repatriation Pharmaceutical Benefits Scheme (RPBS) gives eligible veterans, war widows/widowers and their dependant's access to the PBS and additional medicines.

PBS Safety Net—eligibility

Anyone eligible for the PBS or RPBS is eligible for the PBS Safety Net. Your customers can also combine amounts for their family.

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 dependant 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 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)

If a family member dies, medicines supplied during the year for that person and recorded on the family Prescription Record Form (PRF) can still count towards the family PBS Safety Net threshold.

Regulation 24

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 will need to return to a prescriber for their next prescription.

PBS Safety Net thresholds

The thresholds are updated each year on 1 January. Following are rates for 2014.

Rates for 2014 General patients Concession card holders
Patient contribution Up to $36.90 $6.00
Safety Net threshold $1421.20 $360.00
Safety Net patient contribution $6.00 Free

If your customer chooses a more expensive brand of medicine, they may need to pay more. The extra amount they pay will not count towards their PBS Safety Net threshold.

Note: the relevant PBS Safety Net threshold amount for the customer needs to be recorded on their PRF (on the top right corner on the reverse page of the PRF).

PBS Safety Net cards

Issuing PBS Safety Net cards

You need to give your customer a PBS Safety Net card when they reach the PBS Safety Net threshold. There are two types, depending on the customer’s circumstances.

PBS Safety Net concession card

You need to issue a PBS Safety Net concession card when general patients have reached the PBS Safety Net threshold. With this card, their PBS medicines will be less expensive for the rest of the calendar year.

PBS Safety Net entitlement card

You need to issue a PBS Safety Net entitlement card when a concession card holder has reached the PBS Safety Net threshold. With this card, their PBS medicines will be free for the rest of the calendar year. They may have to pay if they choose a more expensive brand of medicine.

Supplementary or replacement cards

You can issue a supplementary PBS Safety Net card to a customer’s 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.

Your customers can request a replacement PBS Safety Net card if their card is lost or stolen.

To receive a new card, your customer will need to complete and submit the PBS Safety Net amendment, replacement or supplementary card application form available at humanservices.gov.au/pbssafetynetExternal link

They can also write to us at:

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

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

Charging medicine at the PBS Safety Net rate

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

For example:

A customer who is a general patient, not a concession patient, gives you a prescription to fill. Their PRF is $10 under the general threshold amount. If the cost of the medicine you supply puts them over the threshold amount, you should issue them with a PBS Safety Net concession card and charge them the PBS Safety Net rate.

There are two situations where crossover arrangements apply.

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

There are some families where a dependent child holds a concession card. This card carries a 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 PBS Safety Net entitlement card for the child, or
  • count their child’s expenses towards a PBS Safety Net concession card for the family. Note: the family’s expenses will not count towards a PBS Safety Net entitlement card for that child because they aren’t the child’s dependants.

Situation 2—a general patient gets a Human Services or Department of Veterans’ Affairs (DVA) 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.

When they reach the PBS Safety Net threshold for concession cardholders, you can issue them a PBS Safety Net entitlement card so they can get free PBS medicine for the rest of the calendar year. They may have to pay if they choose a more expensive brand of medicine.

If your customer has already reached the general PBS Safety Net threshold during the calendar year, and a PBS 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*.

PBS Safety Net claims

You can claim a payment for issuing PBS Safety Net cards by completing and submitting the PBS Safety Net claim for payment form. This needs to be sent to us within one month of a PBS Safety Net card being issued to a customer.

When submitting your claims, 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 PBS Safety Net application lists all family members.

PBS Safety Net claims that are not completed correctly will be rejected and will need to be re-submitted.

Human Services keeps a record of PBS Safety Net and concession cards issued to your pharmacy. To make sure you receive the correct payment for the cards issued to your pharmacy, let us know if:

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

Note: the Safety Net reply paid envelopes are for PBS Safety Net claims only. Don’t send prescription claims in these envelopes.

PBS prescription claims

To avoid delays, your PBS prescription claims should be submitted in ascending serial number order and be separated into four bundles as follows:

  • general patients
  • concession beneficiaries/PBS Safety Net concession cardholders
  • PBS Safety Net entitlement cardholders, and
  • RPBS patients.

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

  • you supplied the prescription within 20 days of a previous supply, and
  • it’s subject to the PBS 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/PBS Safety Net concession cardholders bundle.

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

Customer refunds

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

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

Not exceeding the PBS Safety Net threshold

Tell your customers early in the year that they can link their family members under the PBS Safety Net. This may assist with avoiding a situation where the customer exceeds the threshold and then needs to request a refund.

Proof of eligibility

Your customer can prove eligibility by showing you their:

  • Medicare card
  • PBS Safety Net card
  • Human Services concession card, or
  • DVA concession card.

If your customer can’t prove their eligibility at the time of purchasing their PBS medicine, and you charge them at a higher rate, you need to give them an official pharmacy receipt (S87A). This makes it possible for us to give them a refund if they are eligible.

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 prescription 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.

Submitting a claim for a refund

To claim a refund, your customer needs to:

  • complete and submit a PBS Patient claim for refund form available from humanservices.gov.au/pbssafetynetExternal link 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 PBS 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 9822 in their capital city, or
  • in person at 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.

Your customer won’t get a refund if:

  • their 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 PBS Safety Net 20 day rule, or
  • they haven’t signed the claim.

Customer refunds

We have developed a range of Pharmaceutical Benefits Scheme (PBS) Safety Net products to help you administer the PBS Safety Net. A PBS Safety Net kit will be distributed to all pharmacies at the end of each year.

Product Product number Product description/usage How to order

PBS Safety Net entitlement card

PB013 (formerly 4011)

This card is given to relevant customers when they reach the PBS Safety Net threshold. 

Note: the cards are numbered. You need to account for all cards issued to your pharmacy.

Call 132 290*

PBS Safety Net concession card

PB014 (formerly 4012)

This card is given to relevant customers when they reach the PBS Safety Net threshold. 

Note: the cards are numbered. You need to account for all cards issued to your pharmacy.

Call 132 290*

PBS Prescription Record Form (PRF)

PB015

(formerly 4013)

This form is given to customers to keep a record of their PBS medicines.

Log in to camerons.net/pbsExternal link to complete and submit the stationery order form

PBS Hospital Prescription Record Form (PRF)

PB016 (formerly 4014)

This form is given to customers to keep a record of their PBS medicines supplied through a public hospital out-patient department.

Log in to camerons.net/pbsExternal link to complete and submit the stationery order form

PBS Safety Net claim for payment form

PB017

(formerly 4015)

You use this form to claim a payment for issuing a PBS Safety Net card.

Log in to camerons.net/pbsExternal link to complete and submit the stationery order form

PBS Safety Net envelopes

EN348

(formerly 4017)

This envelope should be used to submit you claim for payment for the PBS Safety Net.

Note: only use this envelope for PBS Safety Net claims. Don’t send prescription claims in this envelope.

Call 132 290*

For more information

Online health.gov.au/pbsExternal link

Call      132 290* PBS enquiry line

* Call charges apply.

Last updated: 28 January, 2014