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June 2008
Forum and Bulletin Board

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Bulletin Board

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

Current issue: Winter edition 2008

Key story: Compliance operations update 

Budget at a glance

The 2008-09 BudgetExternal link provides $236 million over the next four years for the following Human Services portfolio measures to:

  • improve service delivery
  • address fraud and non-compliance.

New to the PBS
From 1 July 2008

  • listing of Sensipar on the PBS

From 1 January 2009

  • you will be able to register same sex couples for PBS Safety Net—subject to legislation change

From 1 July 2009

  • introduction of more efficient funding arrangements for chemotherapy medicine.

Removal of discrimination against same-sex couples and their children

From 1 January 2009, subject to the change in legislation, you will be able to register same sex couples for the PBS Safety Net.

Medicare and Pharmaceutical Benefits Safety Net thresholds do not currently recognise same-sex couples for the purpose of establishing a family threshold.

Amendments to the definitions surrounding couples and families in Commonwealth laws† will mean people in same-sex relationships, and their families, will have access to the same financial entitlements as couples who are either married or in de-facto, opposite-sex relationships.

You will receive more information in the 2009 Safety Net kit, sent to pharmacies in December each year.

† For purpose of Medicare, the Health Insurance Act 1973External link and the National Health Act 1953External link.

Listing of Sensipar on the PBS

From July 2008, cinacalcet hydrochloride (Sensipar) will be listed on the PBS as an authority required item for patients with end stage renal disease receiving dialysis with uncontrolled secondary hyperparathyroidism.

More efficient arrangements for chemotherapy medicine

More efficient funding arrangements for chemotherapy infusions will reduce wastage, with providers reimbursed for the amount of the active ingredient used. Currently, funding is based on the number of vials used. The new arrangements will be introduced from 1 July 2009, along with the introduction of a fee for preparing chemotherapy infusions. For more information visit www.pbs.gov.auExternal link)

new program will be developed under Section 100 in the Schedule of Pharmaceutical Benefits (the Schedule)External link for chemotherapy items, which will replace the listing of these chemotherapy items in the general Schedule (Section 85).

Pharmacists first to be asked—how do we rate?

Pharmacists were the first group of health professionals to be surveyed in this year’s research and results show that your satisfaction with us has risen from 87 per cent in 2007 to 91 per cent this year.

We would like to thank everyone who participated in this year’s survey. Your input is invaluable and helps us identify where we are performing well and where we can continue to improve to meet our goal of making things easier for you. We will keep you informed about improvements we make as a result of this year’s findings.
Each year we conduct independent research to gauge how satisfied pharmacists, the public and other health care providers are with our service. As an organisation that strives to deliver great service, we value your feedback on our performance and aim to incorporate suggestions into our planning for continuous improvement.

What you are telling us

  • 91 per cent of you believe Medicare Australia is performing well and is continuing to improve.
  • 74 per cent of you are satisfied with the support you have received for Online Claiming for PBS and believe online claiming has made your day-to-day business easier.
  • 68 per cent of you now use our website to get information and you are increasingly interested in communicating through online channels.
  • We need to improve our consistency and clarity of advice about claim rejections.
  • Some of our programs need improvement so your cash flow is not affected and your time is not wasted.

Pharmacy feedback forms stacking up

Thank you for your overwhelming response to our 2008 PBS Safety Net kit pharmacy feedback form. We have received more than 600 completed forms from a range of pharmacies across the nation. We will assess your input and, where possible, incorporate your suggestions into the 2009 PBS Safety Net kit.

Overall, your feedback is very positive, with most of you telling us you are satisfied or very satisfied with the kit and you find the information useful.

One common suggestion has focused on the quantity of each item you receive, for example, the PBS Safety Net entitlement cards.

To order more 2008 Safety Net stationery please call
13 22 90* and select option 2.
You can find electronic copies  of the information provided in the 2008 PBS Safety Net kit

PBS reforms—two beneficial changes

The last in the series of PBS reforms will be introduced from 1 August 2008 with a new $1.50 generic dispensing incentive and improvements to the existing 40 cent online incentive payment.

From 1 August, there will be a new payment of $1.50 for all Friendly Societies and community pharmacies (Section 90), dispensing doctors (Section 92) and hospitals† (Section 94) when you dispense a subsidised PBS prescription that costs the patient no more than the standard co-payment.

Payment of the $1.50 dispensing incentive will be made at the same time your pharmacy claim is assessed and paid by us.

The $1.50 generic dispensing incentive aims to support you in the dispensing of premium free PBS listed products in cases where there are multiple substitutable versions of an item on the PBS.

It will also ensure that your customers are aware of their right to pay no more than the co-payment for their medicine and will encourage greater use of generic medicine.

Also, the 40 cent incentive payment that you are normally paid monthly in arrears will be paid at the same time your online claim is assessed and paid.

If your pharmacy is not already submitting claims via Online Claiming for PBS, now is a great time to consider the benefits. To find out more about how you can register visit Online Claiming for PBS

† This does not include public hospitals participating in the pharmaceutical reforms.

Calling community pharmacists—help us to get it right

The Department of Health and Ageing (DoHA) is inviting community pharmacists to take part in two important reviews:

  • Aged Care residential facilities and private hospitals review
  • Section 100 of the National Health Act 1953External link review (S100).

These reviews are part of a commitment made by the Pharmacy Guild of Australia and DoHA under the Fourth Community Pharmacy Agreement to address issues impacting on community pharmacies.

An external consultant will facilitate each of the reviews and report back to the Agreement Consultative Committee (ACC). The ACC was set up under the Fourth Agreement, and comprises members from both DoHA and the Guild.

Aged Care residential facilities and private hospitals review

This review will consider the existing PBS supply arrangements in the context of Aged Care residential facilities and private hospitals.

Start date‡ May 2008
End date‡ November 2008

S100 review

This review will consider the:

  • claiming arrangements for pharmaceutical services to a private hospital, which provides medicine under the Highly Specialised Drug program to eligible outpatients
  • existing arrangements for drugs supplied under certain S100 programs.

Start date‡ June 2008
End date‡ January 2009

The review process:

  1. Consultant conducts the reviews
  2. Stakeholder consultation
  3. Discussion paper distributed to interested parties
  4. Workshops facilitated
  5. Report produced and presented to ACC

If you would like to take part in either review, please email your name and contact details to 4CPAReviews@health.gov.auEmail

In addition to these reviews, a study of the collection and recording of PBS under co-payment prescription data has begun. The study is expected to be completed by the end of June 2008.

For further information you can visit Department of Health and AgeingExternal link

‡Approximate dates only

Going green

With about 96 per cent of pharmacies now claiming online, it is time to phase out Online Claiming for PBS orange stickers. Instead we have introduced new green stickers so that Medicare Australia’s service officers can easily identify Claim Transmission System claims.

  • If you claim via Online Claiming for PBS you can send in your paper prescriptions without an orange sticker.
  • If you claim via the Claim Transmission System, please stick green stickers on your claim packets and Claim for payment form before sending them into us.

 Those of you requiring green stickers should receive them in the mail. If not, please phone 13 22 90* and select option 2.

Dispensing Regulation 24 prescriptions

Regulation 24 supply
If your customer presents a Regulation 24 prescription and does not require all repeats at one time, you are able to supply less repeats. However, if you do so you must cancel the remaining repeats.

Regulation 24 and multiple items
If there is more than one item prescribed on a single prescription, the prescriber should make a Regulation 24 endorsement at item level (see image). If your customer does not want the non-endorsed item supplied, normal defer arrangements apply.

Regulation 24 and the PBS Safety Net
Where your customer has a Regulation 24 prescription supplied, which takes them over the Safety Net threshold, please remind them that they have two options:

  • pay the usual cost for all supplies and seek a patient refund

or

  • have less repeats supplied which makes the remaining repeats void.  
    Important: your customer will need to return to the prescriber for their next prescription.

Regulation 24 enables a prescriber to write a prescription where the original and repeat supplies of a medicine can be supplied at one time. This is common if a patient is going overseas.

  • Regulation 24 prescription can be abbreviated to ‘Reg 24’.
  • Only a prescriber is able to endorse a Regulation 24 prescription.

Pharmacy claim declaration

Medicare Australia processing centres undertake random quality assurance interventions to ensure that pharmacists have submitted the correct paper documentation relating to their Online Claiming for PBS, Claims Transmission System (CTS) or manual claims.

Make sure that when you sign your Claim for payment form, it accurately reflects the documentation that is included in your claim packet.

Medicare Australia will reject a prescription if it is missing from your claim packet.

Important: The Claim for payment form must be properly completed and attach all required documentation to enable payments to be made under legislation. If you do not comply this may lead to the rejection of prescriptions and potentially lead to more serious legal ramifications

Online claiming hints and tips

Avoid delays when downloading statements

To ensure you can download your PBS reconciliation statements without delay, your claim should be closed off once you have between 3000–3500 prescriptions.

If your claim has more than 3500 prescriptions you may experience problems when you download your statement.

Important: if you regularly submit large claims please write to the Manager of PBS processing in your state/territory requesting approval to close off your claims more frequently.

Archive your data

To ensure you can retrieve your data and duplicate electronic PBS reconciliation statements, it is important to archive your data and store it away safely.

In keeping with electronic data storage processes, we are reducing the amount of electronic data we store. As a result, from 1 July 2008 we will only be able to provide you with duplicate electronic PBS reconciliation statements for up to two years.

Did you know?

Your customer’s right to decide
Repeat authorisations should not be kept without the expressed permission of your customer. They must be able to decide if they want to keep the repeat themselves or to have it retained by you.

Receipt of supply
Your customer’s signature of receipt of medication must be obtained at the time of supply, not when they drop their prescription off for dispensing.

Useful contact details

Enquiries Contact details
PBS
General PBS and stationery enquiries
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		 13 22 90*
PBS information line (for general public) 1800 020 613**
Authority prescription approval 1800 888 333**
DVA authority prescription approvals 1800 552 580**
Travelling with PBS medicine enquiry line 1800 500 147**
Specialised drugs 1800 700 270**
Email: pbs@medicareaustralia.gov.auEmail
Rural Retention Program 1800 010 550**
Australian Government Services Fraud Tip-off line 13 15 24*—option 2
Medicare
Practitioners and staff (schedule interpretation, Medicare number, claim enquiries, Medicare advisers) 13 21 50*
Indigenous access line 1800 556 955**
General Public 13 20 11*
Email: medicare.prov@medicareaustralia.gov.auEmail
For business information
business.gov.au www.business.gov.auExternal link

Feedback

We are happy to receive your feedback on Bulletin Board.

Address: The Editor Bulletin Board
Medicare Australia
PO Box 1001
Tuggeranong DC ACT 2901

Email: editor.bulletinboard@medicareaustralia.gov.auEmail

TTY or hearing impaired: 1800 552 152**

TIS translating interpreting service: 131 450*

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Last updated: 4 July, 2008

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