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Certain chemotherapy items administered by injection or infusion are available as PBS items under the Efficient Funding of Chemotherapy (EFC) initiative. These items are provided under section 100 of the National Health Act 1953. Read about section 100 arrangements on the PBS website.
They’re also listed in the Schedule of Pharmaceutical Benefits (the Schedule) under these arrangements. Check the Schedule on the PBS website.
|Chemotherapy items for private hospital use||Includes chemotherapy items administered through infusion or injection for use in a private hospital|
|Chemotherapy items for public hospital use||Includes chemotherapy items administered through infusion or injection for use in a public hospital|
|Related pharmaceutical benefits for public hospital use||Includes items such as antiemetics, antinauseants, immunostimulants and detoxifying agents for antineoplastic treatment for use in a public hospital|
To be eligible, a patient must meet the medical criteria for the item listed in the Schedule and be either:
- an Australian resident or other eligible person
- an eligible visitor from a country Australia has a Reciprocal Health Care Agreement with. Supply is limited to the original prescription only. Prescriptions for these patients can’t include repeats.
Steps for an approved prescriber
- The patient is referred to you.
- You decide chemotherapy protocol including if it’s administered by injection or infusion.
- You write a prescription for the patient’s first infusion.
- You write the Streamlined code or authority approval number on the prescription where appropriate.
You need to provide a prescription for each infusion with an appropriate number of repeats.
Steps for an approved supplier
- When you get the prescription and enter it into your pharmacy dispensing software, with the dose prescribed in the correct unit of measure as per the Schedule milligrams or micrograms:
- your pharmacy dispensing software will return the vial combination to be dispensed
- an algorithm in your pharmacy dispensing software calculates the combination of vial sizes that make up the prescribed quantity into an infusion at the lowest cost to government.
- The infusion is supplied and administered to the patient.
- You submit the claim for payment to us.
Prescription requirements for approved prescribers
You must write all prescriptions on PBS stationery. Public hospitals may write prescriptions on approved medication charts supplied in the public hospital.
All these requirements apply to all EFC prescriptions:
- You must write dose-specific prescriptions with the amount of active ingredients needed for a single infusion or injection using milligrams or other relevant units of measure.
- The prescription won’t refer to forms and strengths.
- You can prescribe by brand, but PBS claims will be calculated based on the most efficient combination of vial sizes offered across all brands.
- When loading and maintenance doses differ, you must prescribe them separately. If authority is required, you must request a separate approval for each prescription.
- Same day prescribing is allowed for EFC items administered through infusion or injection. Same day prescribing isn’t allowed for items listed as related pharmaceutical benefits.
- The following sections of the National Health (Pharmaceutical Benefits) Regulations do not apply to an infusion
- section 49 (previously Regulation 24), where multiple repeats are supplied at once
- section 51 (previously Regulation 25), the early supply rule
- section 53 (previously Regulation 26A), the deferred supply rule.
- normal requirements for number of items per PBS prescription apply.
EFC items are listed in the Schedule as:
- Unrestricted - These are medicines prescribed through the PBS or Repatriation Pharmaceutical Benefits Scheme (RPBS) with no restrictions on therapeutic use.
- Restricted - The are medicines prescribed through the PBS or RPBS when you’re satisfied the patient’s clinical condition matches the therapeutic uses listed in the Schedule.
- Authority Required - You must get approval from us before prescribing these items.
- Authority Required (STREAMLINED) - You don’t need prior approval from us when you’re satisfied the patient’s clinical condition matches the therapeutic uses listed in the Schedule, unless you need an increased amount or number of repeats. The prescription must include the 4-digit Streamlined authority code.
Each type of approved supplier gets a dispensing rule identifier that defines the fees and mark-ups payable.
Eligible suppliers include:
- section 90 community pharmacies
- section 92 dispensing doctors
- section 94 participating public hospitals
- section 94 private hospitals
- section 94 non-participating public hospitals but only for trastuzumab early-stage breast cancer.
Prescriptions are written with specific doses. Pharmacists can dispense any subsidised brand or combination of brands. The dispensing algorithm finds the most cost effective vial combination and calculates the amount to pay the approved supplier.
An approved prescriber prescribes 150 mg of a medicine listed in vial sizes of 80 mg and 200 mg. The pharmacy dispensing software will determine the most cost effective combination of vials. If this is 2 x 80 mg vials, then you’re paid for 2 x 80 mg vials. If you can’t dispense this combination, you can still use the 200 mg vial to prepare the item, but will only be paid for the cost of 2 x 80 mg vials.
Important information to remember about dose variations.
You don’t need a new prescription if the:
- approved prescriber directs the change in words or writing
- dose varies no more than 10% from the original amount prescribed.
This applies even if the new dose is greater than the listed amount in the Schedule and would normally require an approval.
You have a valid prescription for an EFC drug where the maximum quantity listed in the schedule is 100 mg:
- You have a prescription for 100 mg. The prescriber orders an increased dose to 110 mg, which is an increase of 10%. This takes the quantity over the maximum listed before authority is required. A new prescription is not necessary in this situation.
- You have an approved prescription for 200 mg. The prescriber orders a decreased dose to 170 mg, which is a decrease of 15%. A new authority prescription will need to be written and approved in this situation.
You need a new prescription when the dose varies more than 10% up or down from the original amount prescribed.
Doses on repeat prescriptions can’t vary more than 10% from the original amount prescribed.
For a dose variation, you must endorse the prescription or medication chart with:
- the name of the approved prescriber who gave the direction
- how you were notified of the dose change, for example, by phone or fax
- the date and time the you were notified
- the dose the EFC prescription was varied to
- your name as the pharmacist making the endorsement
- your signature as the pharmacist making the endorsement.
Important information to remember about patient costs:
- Standard PBS patient contributions are payable only on original prescriptions for each prescribed item. Patient contributions aren’t payable on repeat prescriptions.
- When loading and maintenance doses differ, you need separate prescriptions which attract 2 patient contributions. You can prescribe both doses on the same day.
- Special patient contributions, therapeutic group premiums, and brand price premiums apply to original and repeat prescriptions. Where an infusion has 3 vials and these all attract premiums, the patient will be charged 3 premiums.
Public hospital information
For public hospital patients to be eligible for EFC items they must be either:
- getting treatment from a participating public hospital and be a day admitted patient
- a non-admitted patient
- a patient on discharge.
EFC items can be dispensed from public hospital medication charts when supplied in the public hospital.
EFC public hospital medication charts must include the name and provider number of the hospital where the chart is prepared.
EFC public hospital prescriptions can be dispensed in a community pharmacy if:
- the item is prescribed on an approved PBS hospital prescription - not a medication chart
- it’s prepared using the private hospital item code
- the approved prescriber has the appropriate authority approval, if needed.
Private hospital prescriptions
Under the National Health Act 1953 a private hospital EFC prescription can’t be dispensed and claimed by a section 94 approved public hospital authority.
Claiming and remuneration
You can submit a claim for payment for EFC items to us through online claiming for PBS.
To be eligible for remuneration all claims for payment must include:
- a compounder ID and an infusion ID
- the drug item code - there are unique items codes for public hospital and private hospital items
- the Authority Required approval number or streamlined authority code as needed
- the prescribed dose of the item.
Remuneration for injectable and infusible EFC items recognises the specialist nature of chemotherapy preparation. There are different rates of remuneration based on the type of approved supplier. These are extra to the ready prepared dispensing fees paid per item claimed and include the:
- preparation fee
- distribution fee
- diluent fee.
Infusions with more than a single eligible item will attract multiple fees. If eligible this includes the:
- preparation fee
- dispensing fee
- diluent fee
- distribution fee.
Fees are indexed annually on 1 July. There are no wastage, container or dangerous drug fees payable.
Applicable fees per approved supplier type
|Fee||s. 90 Community Pharmacy (including s. 92 approved practitioners)||s. 94 Approved Public Hospital Authority||s. 94 Approved Private Hospital Authority|
|Distribution||Yes||No||Yes (not payable if the item is trastuzumab)|
|Ready prepared dispensing fee||Yes||No||Yes|
Read more about:
- the Pharmaceutical Benefits Schedule on the Department of Health and Aged Care website
- education services for health professionals
- our website disclaimer.
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