Report on Under Co-payment Prescriptions 2018-19 (by date of supply)

Page last updated: 17 December 2019

PBS / RPBS Under Co-payment Prescription Data 2018-19 (XLSX 109 KB)

Definitions

Approved supplier  :  an approved pharmacist, an approved medical practitioner, or an approved hospital authority as prescribed in Section 84 of the National Health Act 1953

Community pharmacy  : a pharmacy business carried on, at or from, the particular premises in respect of which a pharmacist is approved under Section 90 of the National Health Act 1953

Co-payment  :  the amount of contribution paid by patients towards PBS/RPBS medicines

Table 1: Co-payments for 2018-19
Date General
co-payment
Concessional
co-payment
1 Jan 2018 – 31 Dec 2018 $39.50 $6.40
1 Jan 2019 – 31 Dec 2019 $40.30 $6.50

 

Pharmacy software vendors  : companies responsible for maintaining desktop software on behalf of approved suppliers

Subsidised : over co-payment

Under co-payment  : a prescription priced below the co-payment as defined in the National Health Act 1953.

Executive Summary

The collection of under co-payment prescription data for the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) commenced on 1 April 2012.

From 1 July 2018 to 30 June 2019, approximately 94 million under co-payment prescriptions were supplied under the PBS and RPBS.

The data continues to be successfully collected from both community pharmacies and public and private hospitals.

The data is of a high quality, and it is now being made available on the Department of Health website and in regular PBS publications and reports. 

The availability of this additional data is providing the Department of Health and other researchers with enhanced coverage of medicines that are approved and dispensed under the PBS/RPBS.


It is improving the accuracy of information available to the Pharmaceutical Benefits Advisory Committee (PBAC) and others to support decision making and policy formulation.

Background

Legislation

The collection of PBS/RPBS under co-payment prescription data was agreed to under the Fifth Community Pharmacy Agreement (5CPA), and announced in the 2010-11 Budget. Legislation enabling the data to be collected is provided for in the National Health Amendment (Pharmaceutical Benefits Scheme) Act 2010 (the Amendment Bill). Supporting legislative instruments, made by the then Department of Health and Ageing and the Department of Veterans’ Affairs, were registered on the Federal Register of Legislative Instruments prior to 1 April 2012.

On 22 November 2010 as part of the second reading motion of the Amendment Bill in the Senate, Senator Siewert moved a second reading amendment in relation to the second reading motion for the National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2010 which stated that:

             '...the Senate calls on the Government:

(a)   to ensure that there is an annual report to Parliament on all available data on under co-payment products, including the drug name and form, the quantities dispensed;...'.

Hansard from the Senate indicates that this second reading amendment was agreed to (page 1799).

Data collection

As agreed under the 5CPA, the data being collected by the Services Australia includes:

  • the patient’s name*;
  • the patient’s Medicare Number*;
  • information about the prescription (including the date of prescribing and supply, the PBS code number, the drug name and form, the quantity dispensed and the number of repeats);
  • the prescriber approval number; and
  • the approved supplier name.

* Patient name and Medicare number are not provided in the data supplied to Health by the DHS

From 1 January 2016 pricing information is being collected.

Approved suppliers go through similar steps when processing both subsidised and under co-payment prescriptions, using pharmaceutical dispensing software programmes.  In providing under co-payment data pharmacists are not performing any additional work, apart from validation of essential information such as prescription dates, pharmacy identification, patient eligibility and medication details.

Funding of $2.9 million was provided in the 2010-11 Budget to assist pharmacy software vendors to make a number of changes to pharmacy IT systems relating to 5CPA programs, including changes to allow under co-payment data collection.

Under co-payment data is being collected and disclosed in accordance with the Privacy Act 1988 and the secrecy provisions of the National Health Act 1953.  The Office of the Information Commissioner has been advised of this.

Both the Pharmacy Guild of Australia and Services Australia have confirmed that no significant issues have been reported since the collection commenced. There were some initial difficulties with dispensing software at a small number of pharmacies and hospitals but these issues were resolved prior to 1 July 2012.

Historical Data

PBS / RPBS Under Co-payment Prescription Data 2017-18 (XLSX 83 KB)

PBS / RPBS Under Co-payment Prescription Data 2016-17 (XLSX 81 KB)

PBS / RPBS Under Co-payment Prescription Data 2015-16 (XLSX 86 KB)

PBS / RPBS Under Co-payment Prescription Data 2014-15 (XLSX 87 KB)

PBS / RPBS Under Co-payment Prescription Data 2013-14 (XLSX 83 KB)

PBS / RPBS Under Co-payment Prescription Data 2012-13 (XLSX 2 MB)