Closing the Gap (CTG) PBS Co-payment Program

The CTG PBS Co-payment Program improves access to affordable prescribed PBS medicines for First Nations people who, in their doctor’s opinion, would experience setbacks in the prevention or ongoing management of chronic disease if they did not take their prescribed PBS medicine and would be unlikely to adhere to their medicines regimen without assistance through the program.

The cost of medicines remains a significant barrier to access for First Nations people. Under the CTG PBS Co-payment Program, if a patient is registered for the CTG PBS Co-payment Program at the time eligible PBS medicines are dispensed, the co-payment reduction will apply. Therefore, eligible First Nations people who are registered on the CTG PBS Co-payment Register and who would normally pay:

• the full general PBS co-payment amount, pay the concessional rate when obtaining their PBS medicines from an CTG PBS Co-payment Program approved supplier,
• the concessional rate receives their prescribed PBS medicines for free, without having to pay a co‑payment, from an approved CTG PBS Co-payment Program supplier.

For the CTG PBS Co-payment to apply, the PBS prescription must be dispensed by an CTG PBS Co-payment Program supplier. CTG PBS Program suppliers are:

• An approved community pharmacist (approved under section 90 of the National Health Act 1953)
• An approved medical practitioner (approved under section 92 of the National Health Act 1953)
• An approved private or public hospital authority (approved under section 94 of the National Health Act 1953)

Complementing this program and recognising that there may not be pharmacies available to dispense in some remote areas, the Remote Area Aboriginal Health Services (RAAHS) Program allows clients of approved RAAHS to receive PBS medicines directly from their RAAHS, without the need for a normal PBS prescription, and without charge.

For more information about the RAAHS Program, please visit the Services Australia or Department of Health, Disability and Ageing website.

CTG PBS Co-payment Program Patient Eligibility

The CTG PBS Co-payment Program is available to First Nations people of any age, no matter of their location, who are registered with Medicare, and in the opinion of a prescriber or Aboriginal Health Practitioner (AHP):

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

Registering for the CTG PBS Co-payment Program

Any PBS prescriber or eligible AHP can register eligible First Nations people for the CTG PBS Co-payment Program and is referred to as a CTG PBS Co-payment Program registering practitioner. Registration of eligible First Nations people is completed via the Services Australia Health Professional Online Services (HPOS) portal and is a one-off registration process.

Once a First Nations person has been assessed by an CTG PBS Co-payment Program registering practitioner as being eligible for the program, the CTG PBS Co-payment Program registering practitioner can register the patient to the CTG PBS Co-payment Program within HPOS. Alternatively, the CTG PBS Co-payment Program registering practitioner can authorise a HPOS delegate to act on their behalf. A delegate will need to register for their own PRODA (Provider Digital Access) account before being linked to a CTG PBS Co-payment Program registering practitioners HPOS account.

Refer to Services Australia training module for a step-by-step guide on how to register an eligible assessed patient: Pharmaceutical Benefits Scheme (PBS) - Closing the Gap PBS Co-payment - Health Professional Education Resources

If a patient is unsure whether they are registered for the program, their health professional, who has access to HPOS will be able to check via HPOS for them. Alternatively, a pharmacist can check the patient’s registration status within their dispensing software.

In remote areas with limited internet access, a health service or clinic can phone Services Australia on 132 290 to register the patient for the program.

Questions regarding the use of the HPOS portal should be directed to Services Australia. Contact details can be found at Health professionals contact information – Services Australia.

CTG PBS co-payment Program - Patient Withdrawal / de-registration

A CTG PBS co-payment Program registering practitioner or their delegate cannot withdraw a patient from the CTG PBS Co-payment Program unless the registration was an administrative error. For assistance with amending a registration error call Services Australia on 132 290.

If a patient wishes to withdraw from the CTG PBS Co-payment Program, they can do this by calling Services Australia on 132 290.

CTG PBS Co-payment Program - Eligible PBS medicines

The CTG PBS Co-payment Program applies to PBS prescriptions for ALL medicines listed on the PBS. Eligible medicines included are:

• All Section 85 PBS medicines (General Schedule)
• All Section 100 PBS medicines (Section 100), including the Section 100 programs:
• Highly Specialised Drugs Program (which includes Opioid Dependence Treatment , hepatitis B, and HIV antiretroviral medicines)
• Efficient Funding of Chemotherapy Program
• Botulinum Toxin Program
• PBS Growth Hormone Program
• In Vitro Fertilization (IVF) Program
• Approved 60-day PBS medicines
• Medicines supplied under Continued Dispensing arrangements

NOTE:

• Over-the-counter and non-PBS medicines are not eligible under the CTG PBS Co-payment Program.
• Where a brand premium applies to a PBS medicine covered under the CTG PBS Co-payment Program, eligible First Nations patients will need to pay the brand premium at the time of dispensing.

Further information for the CTG PBS Co-payment Program

Questions from pharmacists regarding changes to the dispensing software should be directed to the respective software vendor. Questions regarding PBS claiming can be directed to Services Australia on 132 290.

Answers to Frequently Asked Questions and further information for First Nations people, community pharmacies, hospital pharmacies, prescribers and Aboriginal and Torres Strait Islander Health Practitioners are provided at the links below:

• CTG PBS Co-payment Program – Frequently Asked Questions (PDF 796KB) - (Word 3.4MB)
• Information for First Nations People (PDF 711KB) - (Word 3.4MB)
• Information for Community Pharmacies (PDF 718KB) - (Word 3.4MB)
• Information for Hospital Pharmacies (PDF 782KB) - (Word 3.4MB)
• Information for Prescribers and Aboriginal and Torres Strait Islander Health Practitioners (PDF 786KB) - (Word 3.4MB)

Questions regarding PBS claiming can be directed to Services Australia on 132 290.

Program Data and Expenditure Information

We report the following for the CTG PBS Co-payment Program:

• Annual number of PBS items supplied under the CTG PBS Co-payment Program
• Annual expenditure of the CTG benefit amount

Note:

• Expenditure figures are rounded to the nearest dollar and are reported for each state and territory.
• Expenditure figures refer to payments made through Services Australia and directly from the Department of Health, Disability and Ageing financial journaling system.
• Accuracy on the Expenditure of the CTG PBS Co-payment Program can vary depending on when the data has been updated.

Note: Total Expenditure reflects the total Closing the Gap benefit amount and prescriptions.

Expenditure of the Closing the Gap PBS Co-payment Program can vary depending on data being updated regularly, with no cut-off date for claim submission.

Requests for any additional data or further breakdowns should be directed to Services Australia.  Services Australia will evaluate your request in line with their data release policies, and respond accordingly.

Requests to Services Australia 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:
Health MI Section
Health Support and Performance Branch
Services Australia
PO Box 7788
Canberra BC ACT 2610
or email: statistics@servicesaustralia.gov.au