Bulletin Board
On this page
- Reforms inject health into the PBS
- 1 August changes to payments
- PBS access for government officers working outside of Australia
- Medicare Australia’s compliance program strikes a balance
- National Compliance Program 2007–08 Snapshot of achievements
- Pharmacist jailed for PBS fraud
- Education for health professionals
- Correct use of Medicare numbers by pharmacy
- Reminder
- Online claiming hints and tips
- Useful contact details
In this section
Bulletin Board is a quarterly newsletter covering the PBS and related issues for pharmacists and pharmacy assistants.
Current Issue: Spring edition 2008 [PDF, 2.8Mb]
Key story: Reforms inject health into the PBS
Reforms inject health into the PBS
PBS reforms have recently brought about the biggest change to the Scheme in the 60 years it has been in existence, according to the Pharmacy Guild of Australia’s National President, Kos Sclavos.
Addressing the National Press Club on 23 July 2008, Mr Sclavos said the 1 August 2008 changes—including changes to government pharmacy payments—will make sure the PBS remains effective, efficient and sustainable in the long term.
‘For patients, the Guild estimates 1045 medicines priced between $4.65 and $20.00, will see an average price drop of $2.00’, Mr Sclavos said.
‘The reforms will see a 25 per cent drop in the price the government pays for 99 medicines, across hundreds of brands’, he said.
Mr Sclavos also highlighted the introduction of a high-level of transparency for the pharmacy industry, including rigorous price disclosure which will generate savings in the billions over the next decade.
Singing the praises of Online Claiming for PBS—of which 98 per cent of prescriptions are now claimed, compared to only three per cent three years ago—Mr Sclavos projected that the system was already responsible for PBS savings in the tens of millions of dollars each year.
For more information about the 1 August 2008 changes to payments, see 1 August changes to payments.
1 August changes to payments
As well as the introduction of the new $1.50 premium free dispensing incentive and improvements to the existing 40 cent online incentive payment, on 1 August 2008 there were also changes to pharmacy remuneration dispensing fees and pharmacy mark-up.
Dispensing fees
As part of the PBS reforms, some payments to pharmacies for dispensing Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) medicine were changed. These adjustments, which were implemented 1 August 2008, are automatically included in the payments you receive from Medicare Australia.
Pharmacy mark-up
1 August 2008 also saw changes to the pharmacy mark-up price of PBS listed medicine. These changes include additional cost of medicine categories.
The pharmacy mark-up is included in the payment the Australian Government makes to you, which covers:
• the cost of the medicine
• a retail mark-up for storing and handling medicine
• a fee for your professional advice and services in dispensing the medicine.
Dispensing fees
| Type of payment | Basis of payment | July 2008 | 1 August 2008 |
|---|---|---|---|
| Dispensing fee (ready-prepared) | PBS or RPBS medicine | $5.81 | $5.99 |
| Dispensing fee(extemporaneously prepared) | PBS or RPBS medicine | $7.85 | $8.03(including special handling fee) |
| Special handling fees (no change) | Dangerous drug | $2.71 | $2.71 |
| Extemporaneously prepared | $2.04 | $2.04 |
Pharmacy mark-up
| Pre August 2008 | 1 August 2008 | ||
|---|---|---|---|
| Cost of medicine | Value | Cost of medicine | Value |
| Up to and including $180.00 | 10% | Up to and including $30.00 | 15% |
| Between $30.01 and $45.00 | $4.50 | ||
| Between $45.01 and $180.00 | 10% | ||
| Between $180.01 and $450.00 | $18.00 | Between $180.01 and $450.00 | $18.00 |
| Between $450.01 and $1000 | 4% | Between $450.01 and $1750 | 4% |
| Over $1000 | $40.00 | Over $1750 | $70.00 |
PBS access for government officers working outside of Australia
PBS legislation―now allows access to the PBS for Australian government officers working outside of Australia.
Up until recently, it has been illegal for you to supply PBS medicine for a person who is not in Australia at the time of supply, and for PBS medicine to be sent overseas for another person.
Changes to the legislation mean you can now dispense PBS medicine for eligible Commonwealth, state or territory government officers working overseas, and for their accompanying spouses and dependants.The medicine can be sent out of Australia for use by these officers.
PBS access under this provision is limited only to government officers who would otherwise be eligible for the PBS when residing in Australia. Other PBS supply rules still apply.
Now:
• you can dispense PBS medicine for eligible Australian government officers working overseas and their accompanying spouses and dependants
• PBS medicine can be sent out of Australia for use by these officers.
For more information call the Department of Health and Ageing PBS enquiries line 1800 020 613** or email
.
Medicare Australia’s compliance program strikes a balance
To encourage voluntary compliance among health care professionals, in 2008–09 Medicare Australia’s deterrence and enforcement measures will be balanced by increased education and support activities.
This month Medicare Australia released the National Compliance Program 2008–09.
Key focus for 2008–09:
- incorrect supply of PBS drugs
- identifying pharmacists at high risk of dispensing outside the intent of the PBS
- the supply of medicine for prescriptions where the patient is deceased — pharmacies that dispense a high proportion or volume of Regulation 25 supplies.
To help new and existing pharmacists get it right, Medicare Australia is committed to enhancing our education and information services and products, and increasing convenience and accessibility.
In 2007–08 we provided face to face education to almost 3700 pharmacy students, and more than 2200 new medical practitioners and 2700 other health care professionals.
Medicare Australia understands that the complexity of the PBS and the dispensing environment can create potential for innocent mistakes and opportunities for abuse.
When honest errors occur, pharmacists will be given a fair opportunity to explain or rectify their mistake; however, those who deliberately misuse the system will face the full force of the law.
In 2007–08 we identified $6.82 million in recovery of incorrect payments and referred 74 individuals to the Commonwealth Director of Public Prosecutions (CDPP) for criminal prosecution. The CDPP successfully prosecuted 51 of these individuals, including four pharmacists.
National Compliance Program 2007–08 Snapshot of achievements
Face to face and online education
- We provided face to face education to almost 3700 pharmacy students, and more than 2200 new medical practitioners and 2700 other health care professionals
- 180 participants have completed 1063 online PrimeEd PBS education units and 18 participants have completed online MBS education through the Australian College of Rural and Remote Medicine (ACRRM) website.
Fraud Tip-off line
- We received more than 2230 contacts of which more than 950 have led to further assessment.
Audits
- The fourth Multiple Payment Review covering claims has been finalised. 324 pharmacies were audited and 26 480 incorrect claims with a total value of $1.1 million were identified.
Investigations
- We finalised almost 600 investigation cases, including cases relating to 223 medical practitioners, 42 pharmacists and 330 members of the public.
- We are currently investigating suspected fraud by 209 individuals and have referred 74 individuals to the Commonwealth Director of Public Prosecutions for criminal prosecution.
Prosecutions
- The Commonwealth Director of Public Prosecutions has successfully finalised prosecution of 51 individuals, including one medical practitioner, four pharmacists, and 46 members of the public.
Recoveries
- We identified $6.82 million in incorrect payments for recovery from 513 individuals or organisations.
Pharmacist jailed for PBS fraud
The recent jail sentencing of a pharmacist who defrauded the PBS sends a timely reminder that Medicare Australia will not tolerate fraud.
A Medicare Australia investigation found that over a four year period a Queensland pharmacist fraudulently claimed PBS benefits they were not entitled to.
The pharmacist received two sentences of four and half years imprisonment, to be served concurrently, with a non parole period of 12 months.
They also had to repay the sum of $400 000, as well as an additional cost of $92 000 associated with property seized.
Our investigations identified a number of methods used to commit the offences, such as non supply, creating original supplied deferred scripts and substitution of pharmaceuticals.
The pharmacist’s fraudulent activities included submitting false scripts, using their parent’s names and directing pharmacy assistants to falsify signatures on prescriptions not supplied. They also admitted to using recently deceased peoples’ identities to submit false PBS claims.
This case came to our attention when routine audit activity showed the pharmacist’s PBS dispensing profile had shifted dramatically and that they were now one of Queensland’s highest dispensers of PBS subsidised medicine.
Evidence of the fraud was seized when our investigators executed a search warrant on the pharmacy premises and home residence of the pharmacist.
This sentencing shows our commitment to rigorously monitoring and investigating any instance of possible fraud, to protect the sustainability and integrity of the PBS.
If you suspect PBS fraud is being committed, call the Australian Government Services Fraud Tip-off line on 131 524*.
Education for health professionals
For information and resources designed to help you get it right, visit medicareaustralia.gov.au/education Our content is updated regularly so save our webpage as a favourite bookmark and check it out for yourself!
Correct use of Medicare numbers by pharmacy
Medicare (or Veterans’) card numbers are only provided by Medicare Australia or your customer for the purpose of dispensing medicine at your pharmacy.
Medicare numbers should only be used for this purpose and you should not supply them to another pharmacist (outside of the pharmacy) or any other third party.
Providing information to a third party places you at risk of breaching:
- Section 14 of the Privacy Act 1988
, in particular Information Privacy Principles 9, 10 and 11. - Section 135AAA of the National Health Act 1953, which outlines how prescribers and approved suppliers must observe secrecy in relation to Medicare numbers and expiry dates provided for PBS purposes.
To obtain Medicare numbers from Medicare Australia
Generally your customer will be able to provide you with their Medicare card number. However there may be times when you will need to call the PBS service on 132 290* and select option 1 to obtain a Medicare (or Veterans’) card number.
When calling the PBS service:
- only a pharmacist, hospital pharmacist or dispensing doctor and their staff can call
- a Medicare card number can only be relayed to the pharmacist or staff member who has obtained the consent of the patient
- the customer must be fully informed as to why their Medicare number is being collected
- the Medicare number can be stored for the purpose of dispensing prescriptions at the pharmacy.
Reminder
Don’t hold on to your Safety Net claims
Just a reminder that a claim for payment for the issue of a Safety Net card must be submitted to Medicare Australia within one month of the card being issued.
Early receipt of these claims will ensure prompt payment and reduce warnings or potential rejections that are returned to your pharmacy via the Online Claiming for PBS and your PBS Entitlement Errors Report.
Online claiming hints and tips
Remove your rejected prescriptions
Remember to remove paper prescriptions from your claim if they have been rejected through Online Claiming for PBS.
Before you send in your claim to Medicare Australia you need to:
- correct the error and re-transmit the prescription—you can then include the paper prescription in your claim
or
- remove any prescriptions that have been rejected at the point of transmission.
To help us in processing your claims more efficiently, please make sure that any outstanding rejected prescriptions are not included in your paperwork.
Keep your payment advice
Similar to keeping your bank statements, it is important to keep each payment advice from Medicare Australia.
Keeping your payment advice allows you to reconcile your monthly statements. Included in the payment advice are GST details, which are important for tax time. Your payment advice is posted to you after your payment has been made.
Remember to update your banking details
To make sure payments from Medicare Australia are paid to you on time we need to have your correct bank account details.
These details include your BSB, account number and account name. Let us know of any changes which may affect these details including:
- a change of financial institution
- introduction of new account number
- changes to your pharmacy approval number.
Please call 132 290* and select option 2, and ask to speak to an approval clerk in your state who can provide you with a direct deposit form for you to complete.
Useful contact details
PBS
132 290*
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
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**
Rural Program
1800 010 550**
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
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Last updated: 10 September, 2008