Efficient Funding of Chemotherapy (EFC) - Changes to Pharmaceutical Benefits Scheme (PBS) claiming requirements

Factsheet and Frequently Asked Questions

Page last updated: 5 September 2017

Under the PBS Access and Sustainability Package (Sixth Community Pharmacy Agreement), a revised payment structure for chemotherapy compounding fees was introduced in recognition of the additional costs incurred by Therapeutic Goods Administration (TGA)-licensed compounders in achieving TGA manufacturer licensing for a compounding site.  From 1 July 2015, a two-tiered fee structure provided for the payment of compound fees as per the following table:

Two-tiered fee structure for the payment of compound fees

Chemotherapy Compound Fees from 1 July 2015

Total Fee Paid

Components and Payment Route

Where an eligible PBS EFC item is compounded at a TGA-licensed compounding site

$60

  • a $40 compound fee paid to approved suppliers through the PBS; and
  • a $20 additional compound fee paid directly to TGA-licensed compounders through the Chemotherapy Compounding Payment Scheme (CCPS) Administration Agency

Where an eligible PBS EFC item is compounded at any other site

$40

  • a $40 compound fee paid to approved suppliers through the PBS

To support the introduction of these fees, a staged implementation of new fields within the PBS Online claiming system has been undertaken.

From 1 September 2016, approved pharmacists, approved medical practitioners and approved hospital authorities (approved suppliers) will need to provide new information when claiming eligible EFC items through the PBS.  New data fields within the PBS online claiming system for EFC claims will include:

  • a field to indicate the compounder of the item (compounder ID); and
  • a field for a serialised infusion identifier, which will be automatically generated by PBS dispensing software for each infusion (infusion ID).

From 1 December 2017, inclusion of the compounder ID field within an EFC claim will be mandatory.  Claims for eligible EFC items submitted through PBS Online without a valid compounder ID from this date will not be paid.

Chemotherapy compounders (both TGA-licensed and non-licensed) will need to apply to the CCPS Administration Agency, currently Australian Healthcare Associates (AHA), to obtain a compounder ID for each compounding site within their organisation.  Compounders will then need to provide approved suppliers with the compounder ID for the relevant compounding site(s), for approved suppliers to reference in claiming EFC items through the PBS.

The compounder and infusion ID data fields will provide the data on chemotherapy compounding which is necessary for making payments to compounders on the basis of PBS transaction data.  They will also enable a better understanding of the scope of chemotherapy compounding in Australia.

Frequently Asked Questions

Patient Frequently Asked Questions

What is changing for patients?

Nothing.  The way patients access chemotherapy medicines in Australia will remain unchanged.  Fees for chemotherapy compounders will continue to be provided to secure the provision of chemotherapy medicines at no increased cost to patients.

Prescriber & Clinic Frequently Asked Questions

What is changing for prescribers?

Nothing.  The inclusion of the compounder ID and infusion ID fields within a claim for EFC items relate only to processes undertaken by chemotherapy compounders and pharmacists (approved suppliers) in providing and claiming for the supply of chemotherapy medicines respectively.

Pharmacist & Compounder Frequently Asked Questions

What is changing for chemotherapy compounders?

You will need to request a compounder ID for each compounding site within your organisation from the CCPS Administration Agency, AHA, (TGA-licensed compounders will need to provide information about their TGA licence as part of this process).  You will need to provide the relevant compounder ID to approved suppliers in respect of each eligible PBS EFC item that you provide, or (if you are also an approved supplier) provide the compounder ID when claiming eligible EFC items through the PBS.

From 1 December 2017, TGA-licensed compounders will no longer need to provide manual claims to the CCPS Administration Agency to facilitate payment of supplies made for eligible PBS EFC items. Payments will be made by the CCPS Administration Agency based on PBS line-by-line data generated from PBS EFC claims. 

As part of the transition to the new payment system from 1 December 107, TGA-licensed compounders should continue to claim the compounding fee under current payment arrangements for any items supplied up to and including 30 November 2017.  AHA will accept claims data and generate payments via the manual payment system for these items up until 14 December 2017. 

Payment for items supplied on and after 1 December 2017 will be managed through the new payment arrangements.  To ensure payments for supplies your organisation has made are received, it is important that you provide your compounder ID to your approved suppliers.

The Department is aware that over the transition period there is likely to be some duplication of payments.  To limit this, TGA-licensed compounders should consider the shelf life of items being compounded in the lead up to 1 December 2017 and when they might be dispensed by an approved supplier.  If an item is likely to have an extended shelf life (ie beyond 30 November 2017), we ask that you not submit a manual claim for those medicines as the compounding fee will be paid when the medicines are dispensed and claimed by the approved supplier through PBS Online.

The Department will work with the CCPS Administration Agency to monitor payment volumes throughout December.  The Department reserves the right to audit and recover funds where it deems excessive double payments may have occurred. 

What is changing for pharmacists dispensing and claiming for chemotherapy medicines?

There will be no changes required to dispensing practices for PBS EFC medicines.  The introduction of the mandatory compounder ID field from 1 December 2017 relates only to claiming processes, where you will need to provide the compounder ID (as provided to you by the compounder) and infusion ID (as automatically generated by PBS dispensing software) when claiming eligible EFC items through the PBS.

During the interim period, 1 September 2016 to 30 November 2017, approved suppliers have had the option to use a generic ZZZ001 compounder ID code.  This code assisted approved suppliers to lodge a claim where the compounder ID was either unknown or not yet obtained. 

From 1 December 2017, the generic ZZZ001 code will no longer be available.  Approved suppliers are responsible for ensuring they have the compounder ID for any eligible PBS EFC items they claim.  Where they undertake their own compounding, they will need to have obtained their compounder ID from the CCPS Administration Agency.  The Department recommends that compounder IDs (if not already obtained) are acquired at least six (6) weeks prior to making a claim.

What is a compounder ID?

A compounder ID is a unique identification number that identifies the compounding site at which a chemotherapy infusion was prepared.  It is allocated for a single compounding site by the CCPS Administration Agency, AHA, upon the compounder’s provision of a completed Chemotherapy Compounder ID Allocation Form for that site.  The compounder who supplies a chemotherapy item will need to provide the approved supplier of that item with the compounder ID of the site at which it was prepared.

What is an infusion ID?

The infusion ID is a unique, serialised identification number that identifies a specific preparation of chemotherapy medicine(s) for infusion.  The infusion ID is automatically generated within PBS dispensing software at the point of creation of a PBS EFC claim.  Each infusion ID relates to a single chemotherapy infusion.  Where a chemotherapy infusion includes more than one PBS EFC item, PBS dispensing software will attach the same infusion ID to each item.  In this situation the compounder ID must be provided for each item associated with the same infusion ID, as the different items may have been sourced from the same or different compounders.

Why are these additional data fields required?

These changes support the move to a more streamlined payment system for the two-tiered fee structure.  The additional data fields will also enable a better understanding of the scope of chemotherapy compounding in Australia, and provide transparency of compounding activity funded through the PBS. Top of page

I am a chemotherapy compounder.  How do I get a compounder ID?

You will need to complete a Chemotherapy Compounder ID Allocation Form (available on the CCPS page of the Department’s website) for each site at which your organisation prepares chemotherapy infusions.  Completed forms must be returned to the CCPS Administration Agency, AHA, via email or post (details provided below).  AHA will confirm receipt of each form and advise you of the compounder ID that has been allocated to each compounding site for which a form has been received.

CCPS Administration Agency
Australian Healthcare Associates Locked Bag 32005
COLLINS STREET EAST  VIC  8003
Email: contact@ccpsagency.com.au

What information will I need to provide to AHA to be allocated a compounder ID?

The Chemotherapy Compounder ID Allocation Form collects information including organisation name and postal address; site name and street address; ABN; details of an authorised contact person; TGA licence status; and (for TGA-licensed compounders) TGA licence number and bank details.

I am a chemotherapy compounder and/or an approved supplier.  If each infusion ID relates to a single chemotherapy infusion, will I now be paid per infusion rather than per PBS EFC item?

No.  It is important to note that remuneration, including compounding fees, will continue to be made on the basis of each PBS EFC item included within a chemotherapy infusion, rather than on the basis of the infusion itself.  The infusion ID will not be used as the basis for payment.

I am an approved supplier.  My dispensing software does not allow me to provide a compounder and infusion ID as part of a PBS EFC claim.  What should I do?

You should contact your software vendor about upgrading your software or seek advice from within your organisation about when your software will be upgraded.

What will happen if I don’t provide the compounder and infusion IDs when lodging a PBS EFC claim?

To support the transition to the new claiming requirements, the compounder ID field will not immediately be mandatory for the acceptance of PBS EFC claims.  During the interim period, from 1 September 2016 to 30 November 2017, PBS EFC claims lodged without a compounder ID will result in a warning from the PBS online claiming system notifying users that once this field becomes mandatory, infusible chemotherapy drugs claims without a compounder ID will be rejected.

From 1 December 2017, the inclusion of a compounder ID within an EFC claim for an infusible chemotherapy will be mandatory.  Claims lodged without a compounder ID on and from 1 December 2017 will result in the claim being rejected and not paid. 

While the infusion ID is not a mandatory field, it will be automatically generated by PBS dispensing software for PBS EFC claims, so (where dispensing software has been updated) this data will always be included within a claim.

What about claiming for chemotherapy medicines prescribed and compounded prior to 1 December 2017?

The compounder and infusion ID data fields will be sought for any PBS EFC claim for which the date of supply is on or after 1 December 2017, irrespective of when the EFC medicines were prescribed and compounded.

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