Bulletin Board

Bulletin Board is a quarterly newsletter covering the PBS and related issues for pharmacists and pharmacy assistants.

Current Issue: Winter edition 2009 [PDF, 1.0Mb]

The 2009–10 Budget at a glance

On Tuesday 12 May 2009, Treasurer, the Hon Wayne Swan MP, delivered the Federal Budget for 2009–10. The Budget provides funding for Medicare Australia, as part of the Department of Human Services, to continue our strong service delivery, and provide improved access to Medicare services.

Of the Budget measures announced, a number affect Medicare Australia through new initiatives and changes to existing policies. Please note all measures are subject to legislative approval.

Listing of Sutent® (sunitinib)

It is proposed that Sutent®—a medicine for the treatment of advanced metastatic renal cell carcinoma—be listed as a Section 85 Authority required listing on the Schedule.

When
Expected implementation: retrospective from 1 May 2009.

Listing of Avastin® (bevacizumab)

It is proposed that Avastin®—a medicine for use in combination with first line chemotherapy for the treatment of metastatic colorectal cancer—be listed on the Schedule.

When
Expected implementation: 1 July 2009.

Extending the PBS reference pricing policy to all non-exempt pharmaceutical items

This measure will extend the current Weighted Average Monthly Treatment Cost reference pricing methodology, by requiring all items in a therapeutic group to be included in this pricing methodology, unless deemed to be an exempt item consistent with current legislation.

When
Expected implementation: 1 December 2009.

Extending the therapeutic group premium policy

The current therapeutic group premium arrangements will be extended by creating a new therapeutic group consisting of two lipid lowering medicines, atorvastatin and rosuvastatin.
For therapeutic groups, the lowest priced medicine is used as the basis for pricing other medicines in the group.

When
Expected implementation: 1 December 2009.

Minor new listings

There are four proposed minor listings, which relate to the following drugs:

• Ribavirin and Peginterferon Alfa-2b—listing extended for chronic hepatitis C to include retreatment of treatment failures
• Risedronate sodium/Risedronate sodium and calcium carbonate—listing extended for the treatment of corticosteroid induced osteoporosis in a patient on long-term, high dose corticosteroid therapy
• Zoledronic Acid—listed for the treatment of osteoporosis in women aged 70 years or older with a Bone Mineral Density T-score of -3.0 or less and for established osteoporosis with fracture due to minimal trauma
• Zoledronic Acid—used in the treatment of established osteoporosis in men with hip fracture due to minimal trauma.

When
Expected implementation: retrospective from December 2008–April 2009.

Checking visitors’ eligibility for PBS medicine and the PBS Safety Net

All Australian residents and overseas visitors from countries with Reciprocal Health Care Agreements (RHCA) with Australia are eligible for PBS medicine and the PBS Safety Net. The PBS Safety Net is available to both individuals and families.

Australia has an RHCA with the following countries:

• Finland
• Italy
• Malta
• New Zealand
• Norway
• the Republic of Ireland
• Sweden
• the Netherlands
• the United Kingdom
• Belgium (effective 1 September 2009).

Before supplying subsidised medicine you must first be satisfied your customer is eligible for the PBS. Generally, to prove eligibility, your customer must show you their current Medicare card each time they have PBS medicine supplied. People from an RHCA country will have an RHCA Medicare card, with the exception of New Zealand and the Republic of Ireland. People from these two countries will need to show their current passport.

Where do I go for more information?
132 290*

If your customers have questions about their eligibility for Medicare and the PBS direct them to www.medicareaustralia.gov.au > For individuals and families > Migrants and travellers > New residents

Intravenous Chemotherapy Supply Program delay

In the Autumn edition of Bulletin Board we introduced information about the Intravenous Chemotherapy Supply Program (ICSP) which was due to be implemented on 1 July 2009. The initiative has now been delayed until 1 September 2009. We will provide you with more information in the Spring edition of Bulletin Board.

Where do I go for more information?

More information will soon be available Intravenous Chemotherapy Supply Program
132 290*

PBS statistics making it easier for you

To help you stay informed with the latest information on how medicines are being used in the community, PBS statistics are available from our website.

These pages are interactive and you can customise the reports to your requirements—you can generate reports on either individual PBS medicine, therapeutic groups of PBS medicines or by Divisions of General Practice.

PBS statistics are also useful for other groups including:

• researchers to evaluate treatments or therapies
• policy makers when assessing initiatives to improve Australia’s health
• health professionals to stay informed with medicine trends.

Where do I go for more information?
PBS statistics

Government tackles harms of alcohol misuse

The Australian Government campaign Don’t turn a night out into a nightmare, tackles the consequences of alcohol misuse by younger Australians.

The campaign along with a range of initiatives aims to contribute to a reduction in the harm associated with drinking to intoxication by young Australians.

As a result your customers may come to you with concerns of their own, or someone else’s, such as their child’s drinking habits. If unsure of how to help your customer, you may like to refer them to a service that specialises in alcohol problems.

Where do I go for more information?

You can refer your customers to the Drinkingnightmare website which has information for young Australians and parents as well as links to organisations that can help.

Are patients entitled to the PBS if they are claiming compensation?

A patient’s entitlement to pharmaceutical benefits is not affected by whether or not they make a compensation claim.

• A compensation claim does not need to be declared at the time of prescribing or supply.
• A patient is required to pay the patient contribution appropriate to their level of entitlement at the time of supply.
• PBS medicine supplied for a compensation related injury can count towards a PBS Safety Net threshold for the patient and/or patient’s family, in the usual way.
• The pharmacist submits a claim for pharmaceutical benefits as usual.
• Any attempt by the patient for recovery of the patient contribution is outside the PBS and is between the patient and their insurance company.
• Once the compensation claim is finalised, there are no legal provisions available to Medicare Australia to recover any benefits paid to a pharmacy.

Where do I go for more information?

PBS compensation

Compliance update

We are finalising key activities outlined in our National Compliance Program 2008–09, and we wanted to let you know how we are progressing.

Supporting you with information and tools through a targeted education program continues to be a focus of our work. So far 1700 pharmacy students have received face-to-face education. Our ongoing work with the Pharmacy Guild of Australia to develop education for pharmacy assistants is progressing well.

It is great to see our ‘Travelling with PBS medicines’ line and website so widely used—we have received over 3000 calls to the enquiry line and more than 17 300 hits to the website. This program increases the Australian public’s understanding of the PBS restrictions when travelling overseas, so that we reduce any confusion about the laws associated with travelling overseas with PBS medicine.
We’ve received feedback during audits of pharmacies that it takes a long time for us to approach pharmacies with the scripts extracted from claims—so we are working to streamline this process. Where pharmacy claims information indicate noncompliance values at under $5000, Medicare Australia will make contact with the pharmacy and seek an explanation on the basis of the electronic data alone. If a pharmacy requests a document review we will retrieve and review the paper documents. This means that where there is possible noncompliance you will know about it much sooner.

We are currently working on the National Compliance Program 2009–10. If you have any suggestions for the next National Compliance Program, please send them to compliance.feedback@medicareaustralia.gov.au

More information will be available in the Spring edition of Bulletin Board.

Where do I go for more information?

National Compliance Program

Online claiming warning reason codes

You may receive a warning reason code if there is a possible error in the prescription you have transmitted through your prescription dispensing software.

If you ignore the warning displayed, you risk payment not being made when you send your paper prescription to Medicare Australia. Your software will provide you with ‘fix instructions’—information to help resolve prescription issues. It is important you try to resolve the issue while your customer is still in the pharmacy and before you send your claim for payment.

Where do I go for more information?

PBS Reason Codes

Meet our pharmacists

our third instalment of the ‘Meet our pharmacists’ feature we introduce Jonathan Feather from our newly formed Health Advisory Branch.

Meet Jonathan Feather

I once heard a pharmacist jokingly say “at this pharmacy we ‘dispense’ with accuracy”. Here is an example of a double entendre—providing two meanings and creating ambiguity.

Jokes aside, accuracy is paramount to all pharmacists when supplying medicine and related information to patients. Similarly, Medicare Australia is committed to providing clear, accurate, consistent and timely information to help you ‘get it right’.

I first started working as a compliance pharmacist for Medicare Australia (then the Health Insurance Commission) in 1992. In 2001, I was promoted to the position of Manager, PBS Compliance in New South Wales, managing a team of up to 10 compliance pharmacists. I continued in this role until 2008, when I started working for the newly created Health Advisory Branch (HAB) as a senior pharmaceutical adviser.

Our compliance focus at Medicare Australia is on voluntary compliance. It is important to emphasise that the majority of people do the right thing—our focus is strongly towards education and support.
My current role with the HAB focuses on providing Medicare Australia with expert pharmaceutical advice as it relates to the PBS. As part of this, I attend regular stakeholder meetings, review key compliance initiatives and respond to requests for advice.

Where do I go for more information?

Our compliance model

In the workplace

At a recent stakeholder meeting, I was asked about compensation and how it relates to the PBS. To help you better understand how compensation relates to the PBS, see the article in this edition of Bulletin Board.

Reorder your materials for the PBS Safety Net

A standard number of items were included in your 2009 PBS Safety Net kit. If your pharmacy requires additional items place your order as soon as possible.

PBS enquiry line 132 290*

Bulletin Board—tell us what you think

Do you have questions about the PBS or Medicare Australia? Perhaps there is an article you would like to see included in Bulletin Board. We would like to make Bulletin Board better for you. Send us your comments, questions or suggestions.

editor.bulletinboard@medicareaustralia.gov.au

Useful contact details

PBS

General PBS and stationery enquiries 132 290*

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

PBS information line (for general public)
1800 020 613**

Authority prescription approval
1800 888 333**

DVA authority prescription approvals
1800 552 580**

Travelling with or sending PBS medicine enquiry line
1800 500 147**

Specialised drugs
1800 700 270**
pbs@medicareaustralia.gov.au

Australian Government Services Fraud Tip-off line   

131 524*—option 2

Medicare

Practitioners and staff (schedule interpretation, Medicare numbers, claim enquiries, Medicare advisers) 132 150*

Indigenous access line
1800 556 955**

General public
132 011*
medicare.prov@medicareaustralia.gov.au

Medicare Australia National Feedback Register

1800 465 717**
customer.feedback@medicareaustralia.gov.au

For business information

 www.business.gov.au

TTY or hearing impaired 1800 552 152**
TIS translating interpreting service 131 450*

• * Call charges apply.
• **Call charges apply from mobile and pay phones only.

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Last updated: 26 June, 2009