With the implementation of the changes to the Pharmaceutical Benefits Scheme (PBS) Co-payment Closing the Gap (CTG) program that came into effect in July 2021, a period of grace for pharmacy claims is in place until the end of January 2022 to rectify some issues arising from the program changes.
From mid-2021, CTG annotation is recommended but no longer mandatory. Eligible CTG patients must be registered with Services Australia to be able to have CTG PBS prescriptions dispensed. People previously registered for CTG were automatically transferred to the Services Australia database ready for the change.
The PBS Online system has also been updated to provide alerts to any CTG claim issues. Should a pharmacy dispense a PBS prescription as CTG for a person who is not registered for CTG with Services Australia, the claim will be rejected and the pharmacy will receive reason code 810.
However, early after the change, it was recognised that pharmacies were having claims rejected for many eligible patients who were not correctly registered for CTG. To ensure patient access was not compromised, the Department of Health implemented a period of grace to allow time for eligible patients to be registered by their PBS prescriber or Aboriginal and Torres Strait Islander Health Practitioner. During this period, reason code 810 will accompany a PBS Online warning rather than a rejection.
The Pharmacy Guild of Australia has been working closely with the Department of Health along with Services Australia and other stakeholders to ensure eligible patients are registered before 31 January 2022.
If presented with a PBS Online 810 reason code when dispensing a CTG annotated prescription and the patient identifies as Aboriginal or Torres Strait Islander, the patients should be referred as soon as possible to their PBS prescriber or Aboriginal and Torres Strait Islander Health Practitioner for CTG assessment and registration. In the meantime, the period of grace allows the pharmacy to dispense and claim the prescription as CTG.
The Pharmacy Guild is distributing detailed advice to the Guild membership.
