5. The Safety Net Scheme
Page last updated: 1 January 2017
The PBS safety net protects patients and their families requiring a large number of PBS or RPBS items. For the purposes of the scheme, the family includes the person:
- the partner or de facto partner;
- children under the age of 16 who are in the care and control of the person; or
- dependent full-time students under the age of 25.
The scheme requires pharmacists, on request by patients, to record the supply of PBS and RPBS items on prescription record forms. When a patient reaches the Safety Net threshold within a calendar year, they qualify to receive PBS or RPBS items at a cheaper price or free of charge for the rest of that year. Any applicable special patient contributions, brand premiums or therapeutic group premiums must still be met by the patient.
The safety net threshold is reached by accumulating eligible patient contributions for PBS prescriptions supplied through community pharmacies and private hospitals and for out-patient medication supplied by public hospitals.
Pharmaceutical benefits (including authority items) can only be counted towards the safety net threshold when prescribed and supplied according to PBS conditions. A medicine supplied by a pharmacist not approved to supply pharmaceutical benefits cannot count towards the safety net.
Prescriptions for some pharmaceutical items are not eligible for safety net benefits if re‑supplied as an ‘early supply’ (i.e. within a specified period after a previous supply of the same or an equivalent item for the same person. The patient contribution for an early supply does not count towards the safety net threshold (see also details under '4. Patient Charges' and '7. How Pharmacists Claim Reimbursement'). Early supply arrangements do not apply to out-patient medications in public hospitals or to any prescriptions originating from a hospital.
There are separate arrangements for PBS prescriptions in certain public hospitals. To obtain pharmaceutical benefits under these arrangements a patient must attend a participating public hospital and be a discharge patient or non-admitted patient. Only a medical practitioner providing medical treatment or a midwife providing midwifery treatment or a nurse practitioner providing nurse practitioner treatment in a participating public hospital may prescribe PBS subsidised medication. Victoria, Queensland, South Australia, Western Australia, Tasmania and the Northern Territory have these arrangements.
Safety net thresholds
There are two safety net thresholds. The general patient safety net threshold is currently $1,494.90. When a person and/or their family's total applicable co-payments reach this amount, they may apply for a safety net concession card and pay the concessional co-payment amount of $6.30 plus any applicable premium for pharmaceutical benefits for the rest of that calendar year.
The concessional safety net threshold is $378.00 (this also applies to gold, white or orange card holders under the RPBS). When a patient and/or their family's total applicable co-payments reach this amount, they may apply for a safety net entitlement card and may receive pharmaceutical benefits free of charge (except for any applicable premium) for the rest of that calendar year.
Brand premiums, therapeutic group premiums and special patient contributions do not count towards the safety net thresholds.
The safety net thresholds are adjusted on 1 January each year in line with inflation.
Safety net cross-over arrangements
Some patients and/or members of their families will change between general patient and concessional patient status during a calendar year. Patients should apply for the safety net card appropriate to their status at the time they apply.
Concessional patients who were previously general patients can apply for a safety net entitlement card when they reach the concessional safety net threshold. In this case, any pharmaceutical benefits previously supplied at the general co-payment rate in that calendar year will be counted at the concessional rate per item.
General patients who were previously concessional patients can apply for a safety net concession card when they reach the general safety net threshold. In this case, any pharmaceutical benefits previously supplied at the concessional rate in that calendar year will be counted at the concessional rate per item.
In the case of families where one parent holds a concession card and other family members are general patients, the family can choose to apply for either a safety net entitlement card or a safety net concession card.
To receive a safety net entitlement card, all pharmaceutical benefits (including general pharmaceutical benefits) are counted at the concessional rate per item until the concessional threshold is reached. To receive a safety net concession card, general pharmaceutical benefits are counted at the general co-payment rate per item and concessional pharmaceutical benefits at the concessional rate per item, until the general safety net threshold is reached.
White DVA card holders may either be general or concessional patients (depending on their Centrelink entitlements). If they are receiving treatment for a specific disability accepted by the DVA, they are also supplied with specified items under the RPBS at the concessional rate per item. Therefore, these patients are encouraged to maintain a concessional prescription record form, plus a general prescription record form for items not covered under the RPBS.
White card holders may choose at any time to count contributions made at the general level towards the concessional safety net threshold and receive credits equal to the concessional co-payment amount for each pharmaceutical benefit purchased. Alternatively, white card holders can count contributions at the concessional level towards the general safety net, and receive credits equal to the concessional co-payment amount for each pharmaceutical benefit purchased.
Gold or orange DVA card holders may receive all of their prescription items under the RPBS, and only pay the concessional co-payment amount for each item.
Dependants of white, gold or orange card holders are treated separately and may be either general patients or concessional patients. Their prescriptions may be included in the cross-over arrangements.
There are two types of prescription record forms to record PBS prescription items. A blue form, used for items obtained at community pharmacies and available from community pharmacies, Medicare Service Centres and the Department of Human Services; and a grey form, used by out-patients who pay for items at public hospital pharmacies and available from hospital out-patient departments or the Department of Human Services.
Patients should record their general or concessional status on the prescription record form, enter their Centrelink, DVA and/or Safety Net Concession/Entitlement Card number, and list family members covered. General patients must also record their Medicare number when applying for a safety net concession card.
Details to be entered on the form by the pharmacist are:
- date of supply;
- PBS/RPBS code number of the item (for community pharmacies only);
- the safety net value of the item (for community pharmacies only);
- pharmacist's approval number (for community pharmacies only);
- item identification — medicine code, name of medicine or abbreviation (for public hospitals only);
- hospital charge (for public hospitals only);
- hospital safety net number (for public hospitals only); and
- signature of the authorised person making the entry.
Community pharmacists should record in the 'safety net value' column:
- the patient contribution when it is less than the PBS dispensed price; or
- the safety net value shown in the Schedule, or any lesser amount charged, if the PBS dispensed price is less than or equal to the patient contribution. The pharmacist may discount the price for these items.
Some computer software suppliers provide a special label to record this information on the prescription record forms. Some suppliers also provide a computer printout as a prescription record form.
The patient is responsible for maintenance and storage of their prescription record form. However, it may be kept in the pharmacy. A person (or family) may have more than one prescription record form.
Items to be recorded on hospital prescription record forms must be approved by the hospital's pharmaceutical advisory committee and may be listed on a hospital's formulary (a list of pharmaceutical items approved by the committee for the treatment of particular illnesses), or authorised on a patient-by-patient basis.
Multi-item prescription forms
If a patient submits a multi-item PBS prescription form, which would take the total co-payments past the safety net threshold, any items in excess are treated as entitled items once a safety net entitlement/concession card is issued.
Excess items should be treated as 'deferred supply' items.
For example, if a family has a new PBS prescription for three items and the first takes the family up to the threshold, then this item should be supplied at the general rate. If the second item takes the family over the threshold, the pharmacist should then issue a safety net concession card and supply both this and the third item at the concessional rate. This involves the deferral of two items, recording the safety net concession card number, and the subsequent supply of these items.
A PBS prescription should be supplied at the concessional rate or free of charge plus any applicable premium, when the safety net value or hospital charge for that PBS prescription takes the total co-payments over the qualifying amount for a safety net entitlement/concession card.
Lost prescription record forms
If a prescription record form has been lost, stolen or destroyed, a pharmacist may prepare a duplicate copy, but is under no obligation to do so.
Responsibility for claiming entitlements rests with the patient. If items recorded on a prescription record form have exceeded the safety net threshold, the cost of those items in excess of the limit cannot be refunded by a pharmacist.
However, if the patient failed to apply for a safety net entitlement/concession card on reaching the safety net threshold they should write to the Department of Human Services and provide copies of pharmacy accounts or a signed statement from the pharmacist giving the date of supply, description and cost of items supplied and paid for. A copy of the relevant prescription record form should also be provided. If these are not available, the patient should give the name of the pharmacy where the card was issued and the number on the card so that the Department of Human Services can locate the prescription record form in its records. Cash refunds are not available. The Department of Human Services contact details are provided in the 'Addresses — Department of Human Services' part of the Schedule.
If the patient cannot satisfy a pharmacist that they have a current entitlement and is charged the general patient price, the pharmacist should issue the patient with a receipt and a claim form (provided by the Department of Human Services). The patient can then obtain a refund via Medicare Service Centres or PBS processing centres. RPBS prescription refunds are paid at DVA State offices.
The Department of Human Services can only pay refunds for PBS items supplied through approved pharmacies. Refunds for hospital supplied items should be referred to the relevant hospital or health department. Refunds cannot be made where the patient was charged the general or concessional amount instead of the safety net concessional or safety net entitlement amount as a result of the safety net early supply rule. Receipts for prescriptions where the safety net early supply rule has applied must include ‘SNESR’ to indicate the reason for the amount charged.
There are separate arrangements for PBS prescriptions in some public hospitals. To obtain pharmaceutical benefits under these arrangements a patient must attend a participating public hospital and be a discharge patient or non-admitted patient. Only a medical practitioner providing medical treatment or a midwife providing midwifery treatment or a nurse practitioner providing nurse practitioner treatment in a participating public hospital may prescribe PBS subsidised medication. Victoria, Queensland, South Australia, Western Australia, Tasmania and the Northern Territory have these arrangements.
Applying for a Safety Net Entitlement/Concession Card
Once the safety net threshold has been reached, the person covered by a prescription record form may complete the application and declaration to get a safety net entitlement/concession card. Please note that software packages that produce computer generated applications must be approved by the Department of Human Services.
If the card is issued to a dependent child or student, it should be in the name of a parent.
When issuing entitlement/concession cards, pharmacists do not have to check all prescription record form details. However, they should ensure each entry has been signed and that the prescription record form total qualifies the patient for the relevant safety net card.
When appropriate the pharmacist should check that the patient's Medicare card number is on the prescription record form.
Issuing a Safety Net Entitlement/Concession Card
When satisfied that the individual or family is entitled, the pharmacist should issue the next blank safety net entitlement/concession card with the following details:
- the names of family members covered. If there are more than eight family members, a second card should be issued listing the card holder and family members not listed on the first card. The prescription record form has space to record that two cards have been issued, and
- the two-character code to indicate the relationship to the card holder. Applicable codes are:
- SP - partner;
- DC - child under 16 years; and
- DS - dependent full-time student under 25 years.
The pharmacist should be satisfied that only family members are listed on the card. The unused space on the card should be ruled through to prevent extra names being added. The sticky label from the safety net entitlement/concession card, pre-printed with the card number, should be attached to the prescription record form. The pharmacist should sign and stamp each prescription record form with the pharmacy stamp and enter the card issue details on a safety net — claim for payment form.
A pharmacist may give a card holder a supplementary card for a partner or dependant only at the time the original card is issued. The duplicate card should be recorded in the additional box on the prescription record form.
Later requests for supplementary cards and requests to add a new family member to the original card are to be referred to the Department of Human Services.
Notification to the Department of Human Services and claim for payment
Payment for issuing a safety net entitlement/concession card is made after the safety net — claim for payment form is sent to the Department of Human Services, no later than one month after a card is issued.
Each form must be accompanied by all supporting documentation (prescription record form and cancelled or void safety net entitlement/concession cards).
Payment will not be made for void cards.
When a card has been lost, damaged, stolen or destroyed, a pharmacist cannot re-issue a person with a replacement card. The original card holder (or partner) must apply to the Department of Human Services.
Pharmacy record of issued cards
A record of all cards issued must be kept at the pharmacy from which the pharmacist is approved to supply pharmaceutical benefits. The duplicate ('bookfast') copy in the safety net — claim for payment book is provided for this purpose.