PBS Safety Net

2012 PBS Safety Net kit

The 2012 PBS Safety Net kit sent to all community pharmacies in December contains the items you need to administer the PBS Safety Net in your pharmacy during 2012, including:

• PBS Safety Net—A pharmacist’s guide 2012 [PDF, 1.1Mb]
• PBS entitlement cards 2012 [PDF, 2.3Mb]
• Pharmaceutical Benefits Scheme 2012 [PDF, 859Kb]—brochures for the general public explaining how the PBS and the Safety Net work
• PBS Safety Net concession cards and entitlement cards
• PBS Prescription Record Forms (PRF).

A standard number of items have been included in the 2012 kit. If your pharmacy needs extra items call 132 290*.

2012 PBS patient contributions

^† If a patient 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. All Australian residents and people from countries with a Reciprocal Health Care Agreement (RHCA) with Australia are eligible. The PBS Safety Net is available to both 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
• a single person with dependent children.

Note: a dependent child is someone under the age of 16 years or a full-time student under 25 years attending school, college or university, who you wholly or substantially support.

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

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

Reaching the PBS Safety Net

The medicine that takes the patient over the Safety Net threshold amount is the first medicine to be charged at the PBS Safety Net rate.

For example, a general patient presents a prescription to the pharmacist for supply. Their current PRF is $10 short of the general threshold amount. The patient should be issued with a Safety Net card and charged at the concession rate as this medicine will take them over the threshold.

Where the patient has a Regulation 24 prescription supplied, which takes them over the Safety Net threshold, they must be reminded of the following options:

• pay the usual cost for all supplies and seek a patient refund
• have less repeats supplied which makes the remaining repeats void
  or
• return to the prescriber for their next prescription.

PBS Safety Net cards

All Safety Net concession cards and entitlement cards need to be accounted for. They are numbered documents and are recorded as being issued to your pharmacy by the Department of Human Services (Human Services).

To make sure the correct pharmacy receives payment for the issue of the cards, let Human Services know if:

• entitlement cards issued came from another pharmacy
• your pharmacy is sold and a new approval number is issued.

A claim for payment for the issue of a Safety Net card must be submitted to Human Services within one month of the card being issued.

Misplaced PBS Safety Net cards

Patients can request a replacement Safety Net card by writing to Human Services. They will need to provide their Safety Net card number and list all the family members covered by the card.

Supplementary cards

A supplementary Safety Net entitlement card or concession card may be issued by a pharmacy to a spouse/de facto partner or dependent child at the same time the original card is issued. Requests for a supplementary card at a later date should be referred to Human Services. Supplementary cards and application forms must include the original card holder’s details. 

Crossover arrangements

There are two situations in which crossover arrangements apply.

Situation 1—child on a Centrelink card

There are some families where a dependent child (under 16 years) holds a Centrelink concession card. This card carries concession entitlement to the PBS for that child. The child is therefore only required 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 may either:

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

The parents and other family members’ expenditure cannot be converted to the concession amount and counted towards a Safety Net entitlement card, as they are not the child’s dependents.

Situation 2—when a general patient receives a Centrelink or Department of Veterans’ Affairs (DVA) card part-way through the year

Where a patient’s status changes to a concession patient, all medicines recorded on the patient’s PRF or pharmacy computer at the general rate should be converted to the concession rate. A Safety Net entitlement card can then be issued for free^† PBS medicine for the rest of the calendar year when the patient has been supplied with 60 prescriptions.

If the patient has already reached the general Safety Net threshold during the calendar year and a Safety Net concession card has been issued, the PRF will have been forwarded to Human Services. If your pharmacy dispensing software shows the number of previous supplies, this number can be transferred to the new PRF and endorsed with your signature. If you cannot establish the number of previous supplies, call 132 290*.

^† If an individual 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. 

Refunds

There are two types of patient refunds:

• the patient exceeded their PBS Safety Net threshold before being issued with a card, and
• the patient was unable to prove eligibility at the time the medicine was supplied.

You cannot make a claim for a refund on behalf of an individual/a patient, but you can help the patient by collating the information required.

Exceeding the PBS Safety Net threshold

PBS Safety Net threshold refunds may be the result of a patient exceeding the threshold limit before a Safety Net entitlement or concession card was issued. Many of the threshold refunds processed by Human Services are a result of family members not being linked together. It is important to link all family members early in the year to help determine when a family is approaching the relevant threshold.

A patient can make a claim for a refund by submitting the following by mail (GPO Box 9822 in their capital city) or to a Medicare Service Centre:

• a completed PBS Patient claim for refund [PDF, 129Kb] form (also available from Medicare Service Centres) and a copy of all PRFs to support the claim
  or
• a signed letter from the patient requesting a refund which includes their name, address, Medicare card details and Safety Net concession or entitlement card number and a copy of all PRFs to support the claim.

Unable to prove eligibility

When a patient can’t prove their eligibility level at the pharmacy (with a Medicare, PBS Safety Net, Centrelink or DVA card) and they are charged at a higher rate, they should be issued with an official pharmacy receipt (S878A). This lets Human Services make a PBS patient refund.

In order for the patient to submit a patient refund, the pharmacy receipt should include the following information:

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

Human Services can’t process the claim if any of these details are missing. The patient will be advised to contact the pharmacy to get the missing information.

Refund refused

A patient will not receive a refund if:

• the entitlement number has expired
• the medicine claimed is not a PBS listed medicine
• the PBS Safety Net threshold has not been exceeded
• Human Services has no record of the patient’s entitlement number
• an unpaid pharmacy account is presented instead of a pharmacy receipt
• details are missing from the pharmacy receipt
• the prescription is issued under the Safety Net 20 day rule, or
• the claim has not been signed by the patient.

PBS Safety Net claiming

PBS Safety Net claims not bundled correctly will be returned to your pharmacy for sorting. Before sending in your PBS Safety Net claims in the reply paid envelope provided, you must check:

• correct values have been recorded and the total calculated
• PRFs have been filled in correctly and are signed by the patient/agent
• the claim form has been completed and does not contain more than 12 applications per form
• all PRFs are attached to the claim form in the order that they appear on the claim form
• the PRFs (both computer generated and non-computer generated) are signed by the pharmacist—this is a legal requirement
• ensure the PRF and Safety Net application lists all family members.

You do not need to attach a blank PRF when sending in a computer generated PRF.

Important: reply paid envelopes marked ‘Safety Net’ are supplied in the PBS Safety Net kits for Safety Net claims only. Do not 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 according to benefits supplied:

• general patients
• concession beneficiaries/Safety Net concession card holders
• Safety Net entitlement card holders
• RPBS patients.

Prescriptions supplied within 20 days after a previous supply and subject to the Safety Net 20 day rule should be bundled in accordance with the amount paid by the patient. For example, you would normally submit the prescription of a general patient who has reached the PBS Safety Net in the ‘concession beneficiaries/Safety Net’ bundle.

Under the Safety Net 20 day rule, where a medicine has been supplied within 20 days, the patient will pay their usual PBS contribution instead of the reduced Safety Net amount, and that prescription should be submitted in the ‘general patients’ bundle.

Frequently asked questions

Q: One parent holds a Centrelink 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 Centrelink 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 Centrelink Heath Care card.

For more information

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—1800 020 613** PBS information line (for general public)
Visit—Department of Health and Ageing PBS website

* Call charges apply.
** Call charges apply from mobile or pay phones.

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Last updated: 30 March, 2012

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