Closing the Gap - PBS Co-payment Measure
The CTG PBS Co-payment Measure improves access to PBS medicines for eligible Aboriginal and Torres Strait Islander Australians living with, or at risk of, chronic disease.
Eligible Aboriginal and Torres Strait Islander Australians living with or at risk of chronic disease have access to low cost or free Pharmaceutical Benefits Scheme (PBS) medicines. They can access these through the Closing the Gap (CTG) Pharmaceutical Benefits Scheme Co-payment Measure (the measure).
A patient is eligible if they:
- would experience setbacks in preventing or managing chronic disease if they didn’t take the prescribed PBS medicine
- are unlikely to keep up their treatment without assistance through the measure.
Eligible patients can register at:
- general practices participating in the Indigenous Health Incentive Practice Incentives Program (PIP), or
- Indigenous Health Services (located in urban and regional areas).
PBS prescribers can provide patients with a CTG annotated script if they work in one of the following settings:
- a practice that’s participating in the Indigenous Health Incentive under the PIP
- an Indigenous Health Service in rural or urban settings.
A medical specialist can also annotate a PBS prescription for GTG, if the patient is both:
- eligible for the measure
- referred by a medical practitioner working in a practice participating in the Indigenous Health Incentive under the PIP.
We can’t accept hospital generated prescriptions. Prescribers within public hospitals must use their personal PBS prescriptions.
Prescribers need to:
- assess the patient’s eligibility for the measure once
- make sure the patient gives their consent to register for the measure
- confirm a patient’s eligibility before writing each CTG PBS prescription.
Prescribers can check patient eligibility:
- in Health Professional Online Services (HPOS) through the registered patients on their practice list
- by contacting us.
Closing the Gap PBS prescriptions
To grant the benefits of the measure to a registered patient, prescribers must annotate the patient’s prescription. The annotation should indicate that the pharmacist should dispense the medication with co-payment relief. Closing the Gap prescriptions will have either an automated annotation or a manual annotation.
Closing the Gap and PBS Safety Net
Eligible patients are also eligible for the PBS Safety Net.
The measure doesn’t change the amount that can be added to a family’s Safety Net threshold.
Processing and dispensing Closing the Gap PBS prescriptions
Prescribers must enter the correct CTG indicator or code into dispensing software. The code they use will depend on their dispensing software.
The patient will be charged the wrong amount for their prescription if the code isn’t right.
These groups can dispense CTG PBS prescriptions:
- all approved community pharmacies
- suppliers approved under section 92 of the National Health Act 1953, and
private hospital authorities approved under section 94 of the National Health Act 1953.
Pharmacists should charge general patients with a CTG PBS prescription, the current concessional rate for each PBS item.
Concessional patients with a CTG PBS prescription don’t need to pay a patient co-payment for each PBS medicine.
The patient or their agent must still pay mandatory charges such as brand premiums.
Prescribers can’t charge patients the Under Co-payment Additional Surcharge under this measure.
If an eligible patient doesn’t have a CTG PBS prescription, pharmacists should refer the patient back to their prescriber. Pharmacists can’t annotate CTG PBS prescriptions.
Pharmacists should process prescriptions that don’t have ‘CTG’ on them as standard PBS prescriptions.
Claiming Closing the Gap PBS prescriptions
Pharmacies must record the CTG annotation on the prescription in the Pharmacy Dispensing System prescription record.
If the annotation is valid, we’ll repay the cost of the medicine supplied, including the co-payment relief amount. If the prescription is a CTG under co-payment prescription, we’ll repay the PBS item price less the patient co-payment.
Helping you reconcile Closing the Gap PBS prescriptions
We’ll clearly show CTG PBS prescriptions in your PBS reconciliation statement.
Read the pharmacy staff resource booklet on the PBS website.
Learn about Indigenous health services.
Page last updated: 3 November 2020
This information was printed 1 December 2020 from https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/closing-gap-pbs-co-payment-measure. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.