Helping when you can’t charge the PBS concessional rate

There may be times when you can’t charge the patient the PBS concessional rate. This may be because the patient’s:

• concessional entitlement is not current
• entitlement card has expired.

A patient must have a valid concessional entitlement to get the lower PBS concessional rate.

Before you provide PBS or RPBS medicine at a subsidised rate, you must check the patient’s entitlement status. You have to make sure it’s valid. This ensures only people who are eligible get subsidised PBS or RPBS medicine. This helps the PBS to be sustainable for all Australians.

Invalid cards

There could be several reasons why a patient’s card is invalid, including:

• their card has expired
• they have recently changed their name
• their Centrelink payments have stopped
• they’ve returned from overseas and haven’t  informed Centrelink
• there’re changes to caring arrangements of their children
• their income has changed
• their living arrangements or their partner’s living arrangements have changed.

Please advise the patient to contact the government agency who issued the concession card. The table below shows which agencies issue which cards.

A patient can claim a refund from us or DVA if they pay a higher price for prescription medicine when they are entitled to pay a concession rate.

The patient will need their receipt and their valid entitlement card.