The Closing the Gap - PBS Co-payment Measure

Page last updated: 15 February 2016

The Closing the Gap PBS Co-payment Programme, implemented on 1 July 2010, was one of 14 measures in the Indigenous Chronic Disease Package (ICDP), and was established to reduce the cost of PBS medicines for eligible Aboriginal and Torres Strait Islander people living with, or at risk of, chronic disease.  The ICDP was the Commonwealth’s contribution to the $1.6 billion National Partnership Agreement (NPA) on Closing the Gap in Indigenous Health Outcomes. 

The 2014-15 Budget consolidated Indigenous health programmes into the new Indigenous Australians’ Health Programme (IAHP).  The focus of the IAHP is the identification, treatment and management of chronic disease in Aboriginal and Torres Strait Islander patients.

When obtaining PBS medicines at their local pharmacy, eligible general patients who would normally pay the full PBS co-payment (currently $37.70 per item) pay the concessional rate (currently $6.10 per item).  Those who would normally pay the concessional price receive their PBS medicines without being required to pay a PBS co?payment. 

Eligibility

The Closing the Gap PBS Co-payment Programme is available to Aboriginal and/or Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease, and in the opinion of the prescriber:

  • would experience setbacks in the prevention or ongoing management of chronic disease if the person did not take the prescribed medicine; and
  • are unlikely to adhere to their medicines regimen without assistance through the programme.

Eligible patients can be registered at either:

  • general practices participating in the Indigenous Health Incentive under the Practice Incentives Programme (PIP); or
  • Indigenous Health Services (IHS) in urban and rural settings.

Eligible prescribers need to be a member, employee or contractor of a general practice participating in the Indigenous Health Incentive under the PIP or an Indigenous Health Service in a rural or urban setting.  To be eligible to participate in the PIP, practices must meet the Royal Australian College of General Practitioners (RACGP) definition of a 'general practice' and be accredited or registered for accreditation against the RACGP Standards for general practices.

To ensure continuity of a patient’s care, medical specialists are also eligible to annotate CTG prescriptions for eligible Aboriginal and Torres Strait Islander patients under the measure when they are:

  • providing services at a non-remote Indigenous Health Service; or
  • treating an eligible patient that has been referred by a GP from a PIP Indigenous Health Incentive practice or participating Indigenous Health Incentive.

The Measure is available in remote areas through general practices participating in PIP where there is a pharmacy available to dispense the prescription.  Complementing this, and recognising that there may not be pharmacies available to dispense in some remote areas, the Remote Area Aboriginal Health Services (RAAHS) Programme allows clients of approved remote area aboriginal health services (AHS) to receive medicines from the AHS, without the need for a normal PBS prescription form, and without charge.  Further information on the RAAHS Programme can be found on the Health website.

Applying for the Closing the Gap – PBS Co-payment Measure

The following links will take you to the Department of Human Services website which contains;

Pharmacy staff resource booklet

Questions and answers

Who can write CTG annotated prescriptions?

Prescribers in the following primary care settings may annotate PBS prescriptions for eligible patients under the Measure:

  • General practices that participate in the Indigenous Health Incentive under the Practice Incentives Programme; or
  • Approved Indigenous Health Services in urban and rural settings.

To ensure continuity of a patient’s care, medical specialists are also eligible to annotate CTG prescriptions for eligible Aboriginal and Torres Strait Islander patients under the measure when they are:

  • providing services at a non-remote Indigenous Health Service; or
  • treating an eligible patient that has been referred by a GP from a PIP Indigenous Health Incentive practice or participating Indigenous Health Incentive.

What PBS medicines are covered by the CTG PBS Co-payment Measure?

Prescriptions for an eligible patient’s PBS medicines are covered under the Measure.

Highly Specialised Drugs and other drugs provided under alternative arrangements under Section 100 are excluded from the Measure.

Note: Hospital prescriptions are excluded from the Measure.

How can I determine whether a patient is eligible?

A patient is eligible if they are an Aboriginal and Torres Strait Islander person of any age who presents with an existing chronic disease or are at risk of chronic disease and in the opinion of the prescriber:

  • would experience setbacks in the prevention or ongoing management of chronic disease if the person did not take the prescribed medicine; and
  • would be unlikely to adhere to their medicines regimen without assistance through the Measure.

Where can I obtain further information?

You can contact the PIP enquiry line on 1800 222 032 for further information on registration and renewal processes.

Note: for questions relating to administrative matters, such as how to sign up or annotate scripts, you should refer to the Department of Human Services website.

Data and Expenditure Information

Total Expenditure for Medicines and Number of PBS Items Supplied 2010-11
Total Expenditure for Medicines and Number of PBS Items Supplied to Participating Aboriginal Health Services 2011-12

NSW

VIC

NT

QLD

SA

WA

TAS

ACT

TOTAL

TOTAL ($)

$2,500,029

$540,774

$117,740

$1,628,786

$447,923

$609,787

$108,311

$116,239

$6,069,589

PBS Items Supplied

343,817

80,911

13,979

212,513

63,600

80,691

14,768

13,304

823,583

 

Total Expenditure for Medicines and Number of PBS Items Supplied 2011-12
Total Expenditure for Medicines and Number of PBS Items Supplied to Participating Aboriginal Health Services 2011-12

NSW

VIC

NT

QLD

SA

WA

TAS

ACT

TOTAL

TOTAL ($)

$5,457,662

$1,236,246

$408,712

$3,667,974

$1,012,893

$1,579,836

$273,085

$252,889

$13,889,297

PBS Items Supplied

763,210

175,244

45,930

481,083

148,972

207,855

39,615

29,916

1,891,825

 

Total Expenditure for Medicines and Number of PBS Items Supplied 2012-13
Total Expenditure for Medicines and Number of PBS Items Supplied to Participating Aboriginal Health Services 2011-12

NSW

VIC

NT

QLD

SA

WA

TAS

ACT

TOTAL

TOTAL ($)

$7,438,131

$1,516,325

$646,572

$5,248,183

$1,371,726

$2,203,288

$425,045

$338,910

$19,188,179

PBS Items Supplied

1,051,636

216,394

73,149

698,536

200,102

290,006

62,003

41,025

2,632,851

 

Total Expenditure for Medicines and Number of PBS Items Supplied 2013-14
Total Expenditure for Medicines and Number of PBS Items Supplied to Participating Aboriginal Health Services 2011-12

NSW

VIC

NT

QLD

SA

WA

TAS

ACT

TOTAL

TOTAL ($)

$9,816,430

$1,683,014

$935,121

$6,827,129

$1,723,315

$3,123,573

$619,307

$428,452

$25,156,341

PBS Items Supplied

1,382,756

247,954

110,735

925,306

254,347

414,799

92,416

53,200

3,481,513

Requests for any additional data or further breakdowns should be directed to the Department of Human Services (DHS).  DHS will evaluate your request in line with DHS data release policies, and respond accordingly.

Requests to DHS for statistical data must be made in writing and clearly state:

  • how the information contributes to improving Australia's health;
  • the type of information required;
  • what the information will be used for; and
  • to whom the information will be disclosed.

Written requests can be sent to:

Information Strategy
Information Management Branch
Department of Human Services
PO Box 1001
Tuggeranong DC ACT 2901

Phone: 1800 101 099
Fax: 02 6124 6935

or email: statistics@humanservices.gov.au