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Changes to PBS Online Claiming for Residential Aged Care Claims

Page last updated: 1 July 2020

From 1 July 2020, all PBS claims for residents within a Residential Aged Care Facility (RACF) are to be clearly identified through PBS Online claiming.

Why are these changes occurring?

These changes will provide the Department with improved visibility and oversight of PBS medicines supplied within residential aged care sector, and assist the Department to develop PBS policy to better support this industry. 

What are the PBS Online Claiming Changes from 1 July 2020?

  • Pharmacists will be required to claim ALL PBS medicines supplied for residents within a RACF using either:
    • Patient Category ‘R’ for medicines prescribed and dispensed using a National Residential Medication Chart (NRMC); or
    • Patient Category ‘N’ for all non-NRMC prescriptions for residents in a residential aged care facility.
  • Pharmacists MUST include the RACF Identification number (RACF Id) on all claims for both patient categories. A RACF Id is a unique four-digit identification number allocated to all RACFs. Pharmacists should contact a RACF to obtain this number to enable PBS claiming.
  • From 1 July 2020, pharmacist should NOT claim PBS benefits for residents within a RACF using the general patient category, unless absolutely necessary, and where no other option is available.

Does this apply in all settings?

No, this only applies in the community setting. Pharmacists supplying PBS medicines for RACF residents while they are being treated in hospital (as in-patients or out-patients) or upon discharge are not required to meet these revised claiming arrangements. Hospital pharmacists should continue to use the appropriate public or private hospital patient categories when claiming subsidies through PBS Online, and are not required to include a RACF Id for patients treated at a hospital.  

What has the Department done to implement this change?

The Department has been working with dispensing software vendors to ensure this change is available in pharmacy software from 1 July 2020.  The Department has also been working with Services Australia to ensure the PBS Online claiming system accepts these revised claiming requirements. 

Who can I contact for more information?

For further information in regards to NRMCs please contact the Department of Health at PBSNRMC@health.gov.au. For information or queries relating to PBS claims, please use the existing communication channels