9. Accessing the PBS Co-payment Measure1
- Information for General Practitioners on the Indigenous Chronic Disease Package
- Patient identification
- Practice Incentives Program (PIP) Indigenous Health Incentive
- Aboriginal and Torres Strait Islander health assessment items
- MBS items overview
- Chronic disease follow-up services
- Allied health follow-up services
- Practice nurses/Registered Aboriginal Health Worker follow-up services
- Pharmaceuticals Benefit Scheme (PBS) Co-payment measure
- Care Coordination and Supplementary Services Program (CCSS)
Who is this document for?
- General practices
- Aboriginal Community Controlled Health Services and other Indigenous Health Services
As part of the Indigenous Chronic Disease Package, eligible practices/services can prescribe more affordable PBS medicines for Aboriginal and Torres Strait Islander patients with, or at risk of, chronic disease.
The benefit is available to Aboriginal and/or Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease (see GP Booklet for explanation), and in the opinion of the prescriber:
- Would experience setbacks in the prevention or ongoing management of chronic disease if the person did not take the prescribed medicine; and
- Are unlikely to adhere to their medicines regimen without assistance through the measure.
In assessing whether patients meet the above needs-based criteria, prescribers may use the following guidance:
- the patient is currently holding a concessional entitlement card for PBS benefits, or is eligible to receive such benefits; or
- the patient is currently not holding a concessional
entitlement card for PBS benefits, and is not
eligible to receive such benefits, but shows one of
- a history of evidence of foregoing medicines;
- evidence that health is failing because of noncompliance with medicines;
- social and/or legal obligations for a large family including guardianship of children; or
- existence of co-morbidities and need for three or more prescribed medicines.
Patients can choose to register for the PBS Co-payment measure only, or in addition to the PIP Indigenous Health Incentive.
- General practices and non-remote Indigenous Health Services registered for the PIP Indigenous Health Incentive.
- Indigenous Health Services not eligible to participate in the PIP Indigenous Health Incentive can sign up for the PBS measure under the Department of Health and Ageing’s special arrangements.
- Medical specialists to whom a registered patient has been referred by one of the above health services.
- Determine eligibility for the PIP Indigenous Health Incentive and/or the PBS Co-payment measure.
- Provide the patient (or parent/guardian) with a Patient Information Sheet. After the patient has read the information and/or you have explained it to them, and you are satisfied that they have understood what you have said, ask the patient (or parent/guardian) to complete the Patient Consent Form.
- On the Patient Consent Form there is a tick-box option for each incentive – the PIP Indigenous Health Incentive and the PBS Co-payment measure. Your patient should tick the box next to the program(s) they wish to be part of.
- Once the patient has signed the Patient Consent Form, you should complete a Patient Registration Form. Upon completion of the Patient Registration Form you can begin annotating the patient’s scripts. Both the Patient Consent and Patient Registration Forms should be kept on file at the practice/service (either in hard copy or electronically).
- A copy of the Patient Registration Form should be sent to Medicare Australia. Practices/services may be eligible to receive a patient registration payment if the patient is also participating in the PIP Indigenous Health Incentive.
Annotation of prescriptions under the measure
You will need to annotate the prescriptions of registered patients to indicate that they are to be dispensed with co-payment relief. Upon presenting a correctly annotated prescription to a pharmacy for dispensing, your patient will be supplied the medicine at the reduced rate.
The Australian Government is supporting changes to prescription writing software to automate the annotation process for eligible patients. If your software has not been upgraded, you can manually annotate prescriptions by writing the letters ‘CTG’ (Closing the Gap) and your initials or signature next to the annotation. You will need to print the annotation prominently at the top of the prescription or on the right hand side of the prescription to the right of the ‘Patient’s name and address’ area.
(Refer to sample diagram shown at right).
Referring registered patients to a specialist
Medical specialists to whom a registered patient has been referred are also able to annotate ‘CTG’ prescriptions under this measure.
To help inform the specialist of the benefits of the measure for your referred patient, you may wish to include the following words or similar in your referral:
“John Citizen is eligible for extra assistance with the cost of medicines. To ensure he is able to access this, please annotate the top of any prescriptions with the letters ‘CTG’ and initial.”
PBS co-payments under the measure
Eligible patients who would normally pay the full PBS co-payment will pay the concessional rate. Those who normally pay the concessional price will not be required to pay a PBS co-payment, with the exception of a small number of medicines which have premiums that will still need to be paid by the patient.
All PBS medicines are covered under the measure whether or not the medicines are being used to treat chronic or acute medical conditions.
The cost of filling dose administration aids such as webster packs is a service fee that is negotiated between the individual patient and pharmacist and is not covered under the PBS measure. The measure only relates to the cost of the PBS medicines that the patient receives’.
For detailed information about the eligibility requirements for the PIP Indigenous Health Incentive and the PBS Co-payment, please refer to the guidelines available from
www.medicareaustralia.gov.au > For Health Professionals > Incentives and Allowances > Practice Incentives Program (PIP) > Forms and Guidelines.
1. Department of Health and Ageing. MBS Online. Canberra: DOHA; 2010. Available at: www.health.gov.au/mbsonlineBack to Top
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