Pharmaceutical Benefits Scheme Collection of Under Co-payment Data

Page last updated: 5 April 2017

From 1 April 2012, approved suppliers of Pharmaceutical Benefits Scheme (PBS) medicines are required to provide the Australian Government, with data on PBS prescriptions that are priced below the general co-payment level (under co-payment). Details of the supporting legislation enacted on 23 November 2010 can be found at National Health Amendment (Pharmaceutical Benefits Scheme ) Act 2010.

Prior to April 2012, PBS prescription data was only collected for prescriptions that attracted a Government subsidy. The collection of under co-payment prescription information enhances the Department of Health PBS data set and provides a valuable additional tool for health policy planning, monitoring risk management protocols, pharmacovigilance and monitoring the quality use of medicines in the community.

The information being collected is exactly the same as that previously collected for subsidised prescriptions and from 1 January 2016 PBS medicine pricing information is being collected.

The collection applies only to claims submitted online or through the Claims Transmission System. Therefore, paper claims are not collected and paper prescriptions do not need to be forwarded to the Department of Human Services (formerly Medicare Australia). Dispensing computer software was updated by software vendors to automatically send the under co-payment information through to the Department of Human Services in its normal claiming process, and the Department of Human Services includes the data in the regular information files they forward to the Department of Health.

There has been no change to previous dispensing or claiming processes and approved suppliers do not have any additional workload apart from validation of essential information such as prescription dates, pharmacy identification, patient eligibility and medication details.

For more information, you can email PBS Stats at the Department of Health, call the Department of Human Services (Medicare) on 13 22 90 (call charges may apply), or visit the Medicare website.

 Report on the Collection of PBS / RPBS Under Co-payment Prescription Data