Pharmaceutical Benefits Scheme Collection of Under Copayment Data

Page last updated: 21 July 2011

Amendments to the Commonwealth of Australia National Health Act 1953 have been enacted that will require approved suppliers of Pharmaceutical Benefits Scheme (PBS) medicines to provide the Australian Government, from 1 April 2012, with data on PBS prescriptions that are priced below the general copayment level (under copayment). Details of the legislation enacted on 23 November 2010 can be found at National Health Amendment (Pharmaceutical Benefits Scheme ) Act 2010.

PBS prescription data is currently only collected for prescriptions that attract a Government subsidy. The collection of under copayment information will enhance the Department of Health and Ageing PBS data set and will provide a valuable additional tool for health policy planning, monitoring risk management protocols, pharmacovigilance and monitoring the quality use of medicines in the community.

The information to be collected is exactly the same as that already being collected for subsidised prescriptions, with the exception of the PBS medicine pricing information.

The collection will apply only to claims submitted online or through the Claims Transmission System. Therefore, paper claims will not be collected and paper prescriptions do not need to be forwarded to the Department of Human Services (formerly Medicare Australia). The dispensing computer software will be updated by the respective software vendors to automatically send the under copayment information through to the Department of Human Services in its normal claiming process, and the Department of Human Services will then include the data in the regular information files they forward to the Department of Health and Ageing.

There will be no change to the existing dispensing or claiming processes and approved suppliers will not have any additional workload apart from validation of essential information such as prescription dates, pharmacy identification, patient eligibility and medication details.

For more information, you can contact the Department of Health and Ageing at PBS Under Copayment Data/Health@Health_gov_au and the Department of Human Services, Medicare on 13 22 90 (call charges may apply), or at www.medicareaustralia.gov.au/provider.

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