Bulletin Board

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

Current Issue: 

• Spring edition 2010 [RTF, 245Kb]

Online Claiming for PBS incentive payment has change

Under the Fifth Community Pharmacy Agreement, approved suppliers being paid a 40 cent incentive payment for Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) eligible prescriptions supplied and claimed via Online Claiming for PBS, has ceased for section 90 and 92 approved suppliers from 30 June 2010.

The 40 cent incentive payment will continue for eligible prescriptions claimed via Online Claiming for PBS for:

• All PBS and RPBS, including Highly Specialised Drugs (HSD), prescriptions claimed through HSD approved public hospitals which are participating in the Pharmaceutical Reforms, and
• HSD prescriptions (PBS and RPBS) supplied through HSD approved public hospitals which are not participating in the Pharmaceutical reforms.

Where do I go for more information?

Call PBS enquiry line (option 2)
132 290*

Changes to claiming section 85 PBS medicines in section 94 hospitals

As part of the initiatives announced in the 2010-11 Budget, the remuneration arrangements for private hospitals approved under section 94 of the National Health Act 1953 (NHA) to supply PBS medicines will change from 1 October 2010.

Under the new arrangement, the current wholesale mark-up will be replaced with a flat storage and handling mark-up of 11.1 per cent and the pharmacy retail mark-up will be replaced with a flat 1.4 per cent private hospital mark-up. These mark-up changes will only apply to PBS medicines supplied as 'pharmaceutical benefits' under section 85 of the NHA by private hospitals approved under section 94 of the NHA.

All fees will remain unchanged and will be paid as per current arrangements. This includes the dispensing fee and when applicable, dangerous drug fee and container fee.

Medicare Australia will change its systems to reflect the new remuneration arrangements.  This will ensure any section 85 PBS item supplied by a section 94 private hospital pharmacy from 1 October 2010, is paid at the new remuneration rate. 

Medicare Australia has also provided the software vendors with information to assist them in understanding the changes in remuneration.

Where do I go for more information?

Visit Section 94 private hospitals

Call PBS enquiry line (option 2)
132 290* 

PBS information line
1800 020 613**

Nurse practitioners and midwives accessing the PBS

On 16 March 2010, the Australian Government passed The Health Legislation Amendment (Midwives and Nurse Practitioners) Act 2010.

The passage of legislation means that eligible nurse practitioners and midwives will be able to have access to the Pharmaceutical Benefits Scheme (PBS) for the first time from 1 November 2010.

Medicare Australia will start issuing provider and prescriber numbers from 1 September 2010. This will enable authorised nurse practitioners and midwives to order their prescription pads in preparation for prescribing.

The personalised and unpersonalised prescription pads for nurse practitioners and midwives will have the same look and feel as prescription pads for other prescribers but the colour will be different. On the personalised prescription pads the indicator "NP" for nurse practitioner or "MW" for midwife will be printed after the prescriber number to assist the pharmacy to identify the prescriber type. On the unpersonalised prescription pads, nurse practitioners and midwives will indicate their prescriber type by ticking the appropriate box on the prescription form.

From 1 November you will be able to supply PBS prescriptions written by authorised nurse practitioners and midwives. Prescriptions written by authorised nurse practitioners and midwives should be claimed as per the current process for prescriptions.

New reason codes

As part of these initiatives, two new reason codes are being introduced on 1 November 2010.

606 – 'Prescriber is not authorised to prescribe this item'.

You will receive this reason code when the prescriber is not authorised to prescribe this item.

607 – 'Prescriber is not authorised to prescribe this item at date of prescribing'.

You will receive this reason code when the prescriber is not authorised to prescribe the item at the date of prescribing.

Where do I go for more information?

Call For more information about Reason Codes call the PBS general enquiries line on 132 290* (option 2)

Closing the Gap–new PBS Co-payment measure

In the winter edition of Bulletin Board we introduced you to the new Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment measure which started on 1 July 2010. The CTG PBS Co-payment measure aims to reduce the cost of PBS medicines for eligible Indigenous Australians. Many of your Aboriginal and Torres Strait Islander patients living with, or at risk of, chronic disease will be eligible under the new arrangements. They will be presenting 'CTG' annotated prescriptions to your pharmacy which will qualify them for a lower or nil patient co-payment.

In this edition we look at processing manually annotated prescriptions in pharmacies. We also take a look at requirements for claiming CTG prescriptions.

Manually annotated CTG prescriptions

Under instruction by Medicare Australia and the Department of Health and Ageing, prescribers who issue handwritten prescriptions must annotate the prescription with the letters ‘CTG’ and their initials or signature.

When processing a manually annotated prescription through your dispensing software you must ensure the CTG code is entered correctly into your software (either manually or automatically). The correct CTG code to use will depend on your dispensing software. For example, using a correct CTG code of "H", "00B" or "CTG00B" will ensure the manual annotation is valid. Using an invalid code will result in an incorrect calculation of the payment due from the patient for their prescription.

CTG under co-payment claims

When claiming a CTG under co-payment item (online or CTS channel), you are not required to submit the paper prescription to Medicare Australia. Paper prescriptions for CTG under co-payment claims received (online or CTS) will not be collected by Medicare Australia.

When claiming a CTG under co-payment item via the manual claiming channel, you are required to submit a paper prescription for manual data processing purposes. Medicare Australia will collect and store paper prescriptions received for CTG under co-payment prescriptions that are received for manual processing.

Where do I go for more information?

Call For claiming information 132 290*

Email   PBS-Indigenous@health.gov.au

Web For copies of the Pharmacy Staff Resource Booklet

Claiming Highly Specialised Drugs for public hospitals (through CTS) and community pharmacy

On 1 July 2010, Medicare Australia began providing an online paperless electronic claiming and payment process for all approved public hospitals supplying Highly Specialised Drugs (HSD). This online process provides a simple, secure, electronic claiming option for public hospitals when claiming for Pharmaceutical Benefit Scheme (PBS) HSD medicines.

This change to allow online claiming and processing has resulted in Claims Transmission System (CTS) claims for Complex Authority Required (CAR) HSD medicines and PBS trastuzumab (Herceptin®) being rejected for public hospitals participating in the Pharmaceutical Reform Arrangements (participating public hospitals). This was not the intention of the new online claiming and payment measure. Changes have been made to the Medicare Australia system to enable these medicines to be claimed through the CTS channel until 31 December 2012 (which is the deadline for participating public hospitals to start using the online channel to claim).

Since 1 July 2010, unanticipated difficulty has also been experienced in relation to the payment of claims submitted by approved pharmacists for the supply of CAR medicines, through the HSD Program, for prescriptions written in a public hospital.  

The Department of Health and Ageing is taking action to enable appropriate payments to be made as soon as possible. The Department of Health and Ageing asks that approved pharmacists continue to supply these medicines to patients, as the arrangements are being made to ensure payments can be made with minimal delay. 

Where do I go for more information?

Visit Highly Specialised Drugs

Call 13 22 90* (option 2)

National Compliance Program 2010-11

Medicare Australia’s National Compliance Program is developed each year to inform health professionals, industry stakeholders and the wider community about our compliance approach for the coming financial year.

The Program focuses on delivering high quality compliance services, information and support to make it easier for health professionals to understand their compliance obligations. This is complemented by an appropriate system of professional audits, reviews and, where necessary, criminal investigations.

The National Compliance Program for 2010–11 will be released soon and the focus for the year is to:

• improve education by developing resources that support health professionals to meet their compliance obligations
• engage with stakeholders regarding the co-design of compliance initiatives
• complete the program of work set out in the National Compliance Program 2009–10
• work closely with other Human Services agencies to improve compliance and fraud management.

Where do I go for more information? 

Visit National Compliance Program

National Compliance Program 2009–10 achievements

The following is a snapshot of actions that have been achieved as part of the 2009–10 National Compliance Program.

For the complete list of achievements, go to Compliance 

Face-to-face and online education

• We delivered face-to-face education to almost 3000 medical practitioners (including GPs, medical interns and specialists), around 3300 pharmacy students and pharmacy interns, 100 medical students and almost 1000 others in the health care industry.
• We presented at nine national health conferences on topics including our online education model for new health professionals, compliance audits and billing Medicare items including anaesthesia, chronic disease management, mental health, skin and diabetes management items.
• We launched five new PBS and You advanced eLearning modules for health professionals, including pharmacists.

Audits

• We audited 414 Practice Incentive Payments (PIP) recipients.
• We audited 1943 medical practitioners, pharmacists and members of the public in relation to claiming for MBS or PBS benefits.
• We completed 159 investigations of medical practitioners, pharmacists or members of the public for suspected fraudulent behaviour.
• We completed reviews of 151 medical practitioners through our Practitioner Review Program.

Prosecutions

• We referred eight individuals to the Commonwealth Director of Public Prosecutions (CDPP) for criminal prosecution, including a medical practitioner.
• We assisted the CDPP to successfully prosecute 12 individuals—all members of the public.

Professional Services review

• We requested the Director of Professional Services Review (DPSR) to review 36 medical practitioners for inappropriate practice.

Incorrect payments identified for recovery action

• We identified more than $10.29 million in incorrect payments to medical practitioners, pharmacists and members of the public.
• We received repayments of more than $7.94 million.

Where do I go for more information?

Visit National Compliance Program

Stay informed—try Medicare Australia’s new eLearning program for pharmacists

Medicare Australia is improving online education services for health professionals by providing a new eLearning program.

The PBS and You—dispensing and claiming for pharmacists eLearning program is the first to be developed specifically for you and your staff.

The eLearning program is an easy to use and interactive way for you and your staff to update your understanding and knowledge of the Pharmaceutical Benefits Scheme (PBS). The three modules in the program are:

• Finding your feet—dispensing basics
• Following the rules—regulations and emergency drug supplies
• Claiming and PBS Safety Net.

Available 24 hours a day, seven days a week, Medicare Australia’s online education services offer greater flexibility for you and your staff to stay informed at a time convenient for you.

Where do I go for more information?

Visit Online education services

Email education@medicareaustralia.gov.au

PBS Authority prescription line—emergency message

When writing an authority required prescription, it is necessary for prescribers to call Medicare Australia’s Pharmaceutical Benefits Scheme (PBS) Authority prescription line on 1800 888 333. Where phone problems occur and Medicare Australia is not contactable, prescribers will hear the following emergency message: 

You have called the PBS Authority prescription line. We are currently experiencing difficulties and are unable to take your call.

By adhering to the following emergency instructions you are authorised to prescribe up to the scheduled maximum quantity and/or repeats for this prescription only. For an 'authority required item' mark the prescription with today's date and time and the words 'emergency authorised by Medicare Australia'. For a 'HSD authority required item' the prescription must also be marked with the hospital provider number, number of days treated and the letters ‘HSD’.

When this emergency message is used, prescribers should only be writing the prescription for the listed quantity and repeats.

How are patients and pharmacies affected?

Failure to adhere to the PBS Authority prescription line emergency message may create a delay in patients receiving their medicine. Pharmacies may experience a delay in payment or be put at risk of non-payment for supplying these prescriptions.

What should I do if the prescriber has not followed the instructions in the emergency message?

If an emergency prescription has been written for a quantity and/or repeat higher than the listed quantity and/or repeat you may:

• contact the prescriber to advise them your pharmacy can only dispense the listed quantity and/or repeat and endorse the prescription to this effect
• contact the prescriber and ask them to call Medicare Australia when the PBS Authority prescription line (1800 888 333) is available to receive an approval before the medicine/s is supplied.

Where do I go for more information?

Call PBS General enquiries line

132 290** (option 2)

PBS Authority prescription line

1800 888 333** (available 24 hours a day, 7 days a week)

Email pbs@medicareaustralia.gov.au

Australian Organ Donor Register

Australia has one of the highest transplant success rates in the world, and research* shows the majority of Australians support organ and tissue donation. Around 1700 people are on Australian organ transplant waiting lists at any one time.

Sadly, many Australians die each week waiting for the gift of a heart, liver, kidney, lung or pancreas transplant. Organ and/or tissue donation is a life-saving and life transforming medical process.

The Australian Organ Donor Register (the Donor Register) enables people to register their decision about becoming an organ and/or tissue donor.

The Donor Register is the only national register that ensures your donation decision can be verified 24 hours a day by authorised medical personnel, anywhere in Australia. In the event of your death, information about your donation decision may be accessed from the Donor Register and provided to your family.

It is important you discuss your donation decision with your family as they will be asked to give consent. They will be asked about your donation decision to confirm you had not changed your mind since you recorded your consent (or objection). Families that know each other’s donation decisions are more likely to uphold them. 

*Woolcott Research, National Community Awareness Survey, Australian Organ and Tissue Authority, Canberra, 2010. 

How to register or find out more

To register your donation decision:

Visit Australian Organ Donor Register

Call 1800 777 203**

Visit your local Medicare office

Reminder—Bulletin Board online

Bulletin Board is only available to subscribers in an online format.

If someone you know is missing out on the information they need, remind them to subscribe to Bulletin Board today!

Subscribing to Bulletin Board online is easy—simply need to go to Bulletin Board online via Medicare Australia's website.

Tell us what you think

Your feedback is important to us. 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 continue to make Bulletin Board better for you. Send your comments, questions or suggestions to lisa.pelayo@centrelink.gov.au

Where do I go for more information?

Visit Bulletin Board online

Email lisa.pelayo@centrelink.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 overseas enquiry line
1800 500 147**

Highly 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.

Last updated: 31 August, 2010