Education guide - Closing the Gap - PBS Co-payment Measure - supporting Indigenous health
Information about patient registration, prescribing, dispensing and claiming pharmaceutical items under the Closing The Gap - PBS Co-payment Measure.
About the Closing The Gap-PBS Co-payment Measure
This guide explains the Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment Measure (the measure).
The measure provides free or low cost medicines to Aboriginal and Torres Strait Islanders who have, or at risk of, chronic disease.
Under the measure, a general practice or Indigenous Health Service must register with us to prescribe CTG prescriptions.
The registered practice must also get their patients’ consent to register for the measure.
The prescriber only needs to assess a patient’s eligibility for CTG prescriptions once.
The prescriber can register a patient at:
- general practices participating in the Indigenous Health Incentive under the Practice Incentives Program, or
- Indigenous Health Services in urban and rural areas
The prescriber must confirm the patient’s eligibility for CTG prescriptions before they register a patient. They can do this:
- using HPOS to access the practice’s list of registered patients, or
- contacting us at Incentives programs
Prescriptions written under this measure are CTG prescriptions. You must have CTG written or printed on the prescription. The normal PBS prescription requirements also apply.
This Guide is part of the Indigenous health services education for health professionals' package.
You work as a health practitioner in an Indigenous Health Service participating in the PBS Co-payment Measure as a ‘Non-Practice Incentive Program’ Health Service.
A 61 year old patient presents to your Indigenous Health Service with persistent ulcers of the foot.
Medical history includes:
- Diabetes mellitus type 2
The patient also:
- has a poor diet
- seldom seeks medical attention
- usually attends every 6 months for script renewals
- isn't effectively managing chronic condition due to cost constraints
You complete a detailed chronic disease management plan during this consultation. You’ve determined that your patient is eligible for the CTG PBS Co-payment Measure. This is because the patient is unlikely to follow their medicine routine without cost relief benefits.
During the consultation, you take these actions to register your patient:
When you've registered your patient, you can write CTG prescriptions for them. For example:
writes 5 computer generated PBS prescriptions with the correct CTG code annotation against each prescription
presents the 5 CTG prescriptions to the local community pharmacy
CTG annotation code prescription - prescribing requirements
You can annotate CTG prescriptions in 2 ways. The table below describes these annotations:
|Computer generated||Prescribing software will annotate the prescription with a CTG alpha-numeric code.||CTG11K|
|Handwritten||Annotate the prescription with the letters ‘CTG’ and initials or signature of the prescriber.||
If prescriptions aren’t annotated correctly, the pharmacist can't dispense the prescription as a CTG prescription.
You work as a pharmacist in the local community pharmacy. You need to indicate in the pharmacy dispensing software (PDS) that you’re dispensing a CTG prescription. For example:
|The local community pharmacist|
checks all 5 prescriptions are correctly annotated by the prescriber
dispenses the prescriptions in their PDS ensuring the CTG annotation code is keyed for each prescription being dispensed
CTG annotation code prescription - dispensing requirements
You can enter the code in 2 ways:
|Prescription type||PDS input|
|Computer generated||Enter the CTG alpha-numeric annotation code into the appropriate field. This is usually on the top right hand corner of the prescription.|
Depending on your PDS you’ll need to enter 1 of the following:
Common dispensing scenarios
There are some common dispensing scenarios and actions for pharmacists:
|Patient presents a CTG prescription||
check the prescription is correctly annotated and enter the CTG annotation code into the PDS when dispensing
|Pharmacists must check each prescription is correctly annotated at the time of dispensing.|
|Patient presents a CTG prescription to the pharmacy for the first time||
flag the patient profile in the PDS as a CTG patient
|Pharmacists must identify the patient as a CTG patient in the PDS.|
|An eligible patient presents a prescription that’s not annotated or is annotated incorrectly||
refer the patient back to the prescriber
|The prescriber needs to correct or annotate the prescription as pharmacists can’t annotate the prescription even if they’ve contacted the prescriber.|
|CTG prescription with repeats||
enter the CTG code into the PDS
|The annotation will carry over to all repeats. The code will usually be printed in the manual pricing box on the repeat authorisation form.|
Recording patient payments and PBS Safety Net
Under the measure patient contributions are less than non CTG prescriptions.
If the pharmacist enters the correct CTG annotation code when dispensing, the PDS will automatically calculate the appropriate contribution and PBS Safety Net amount. For example:
enters CTG annotated prescription details into the PDS. They must key the CTG annotation code for each prescription dispensed
pays a reduced amount for all 5 CTG prescriptions
While the patient pays less for all 5 CTG prescriptions, the full co-payment (general patient) is printed on the prescription record form. This will make sure that the patient’s eligible PBS Safety Net family can reach the PBS Safety Net threshold at the normal rate.
CTG PBS Co-payment Measure patient contributions
This shows the patient contribution for the measure:
|General patients||Concession cardholders|
pay the current concessional rate for each item
free of charge
The patient may need to pay premiums for a small number of items in addition to the patient contribution.
The amount that contributes to the PBS Safety Net for each CTG prescription is the same amount that would have been added without the CTG Measure.
|For claiming purposes|
normal PBS claiming procedures apply
CTG prescriptions for general patients and concession cardholders are bundled in the relevant claim category and kept by the approved supplier for a period of 2 years
Prescriptions with 'U' serial numbers
The PDS prints some prescription serial numbers with 'U' as the first part of the serial number. This occurs when a prescription that would normally be under co-payment, priced below the general patient contribution rate, is now priced at the concession rate without changing the entitlement category.
Summary for prescribers:
- check your patient’s eligibility
- discuss the Co-payment Measure with your patient
- complete the Co-payment Measure patient registration and consent form and submit to Services Australia
- write PBS prescriptions with CTG annotation
Summary for pharmacists:
- check prescriptions are correctly annotated - if not, contact the prescriber
- dispense PBS prescription
- key the correct CTG annotation code into the PDS
- make sure the appropriate amount for eligible prescriptions is added towards the patient’s Safety Net Prescription Record Form
Read more about:
- Education services for health professionals
- the Practice Incentives Program
- Closing the Gap - PBS Co-payment Measure
- Indigenous health education for health professionals
- our website disclaimer
Page last updated: 12 February 2020
This information was printed 24 November 2020 from https://www.servicesaustralia.gov.au/organisations/health-professionals/topics/education-guide-closing-gap-pbs-co-payment-measure-supporting-indigenous-health/31811. 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.