Updates to PBS subsidies, prescribing, and digital health services will go into effect July 1.
In addition to changes to the MBS from July 1, updates to other areas related to general medicine will be implemented from the new exercise.
Closing the Gap PBS Co-Pay Program
The new fiscal year marks the end of the grace period for reforming the PBS script’s Closing the Gap (CTG) metrics. The co-pay program was extended in July 2021, before further grace periods were extended through January and July 2022.
The CTG registration system for Aboriginal and Torres Strait Islander patients is operated by Services Australia and operates online through the Health Professional Online Services (HPOS) portal.
To date, the main benefits of the program include:
- single registration
- check-in should only be done via HPOS
- any PBS prescriber (such as physicians, dentists, optometrists, midwives, nurse practitioners) or AHPRA-registered Aboriginal and Torres Strait Islander health practitioners registered with Medicare as provider can register eligible Aboriginal and Torres Strait Islander
- people can be enrolled in the program regardless of where they live and their chronic disease status
- prescriptions no longer need to be annotated with ‘CTG’.
However, the RACGP is concerned about some of the July 1 changes that mean patients who are not properly registered will pay more for PBS drugs.
Dr. Mary Belfrage has previously stated newsGP that it is not entirely the responsibility of general practitioners to register patients.
“While the changes to the program are positive … it is up to the individual prescriber to verify eligibility,” she said.
‘[But] it is also the responsibility of pharmacies to know this, because it is actually at the time of dispensing that this becomes a problem, and not at the time of prescription.
While many patients have been successfully transferred from the old CTG registration system, there are currently potentially thousands of eligible clients who are not properly registered on CTG, and GP clinical software systems may not provide a clear indication of a client’s CTG registration status.
Also, writing or printing “CTG” on a script or filling out PIP forms does not guarantee that a patient will receive CTG scripts – this can only be done through HPOS
To help maintain access to medicines for Aboriginal and Torres Strait Islander patients, the college recommends that GPs and practice teams consider:
- ensure workflow and systems support both verification of Aboriginal and Torres Strait Islander patient registration status and registration of all eligible CTG clients
- ask patients if they have had any problems accessing CTG drugs when they come to a pharmacy
- Bulk SMS to Aboriginal and Torres Strait Islander patients with key information, if practice software allows.
As only ‘warnings’, not ‘rejections’, are issued at the pharmacy for customers who are not registered (before July 2022), GPs may also wish to contact their local pharmacies to check if they received numerous PBS “warnings” for their respective clients.
Health professional training resources are available on the Services Australia website, and NACCHO has developed a CTG Information and FAQs document for Indigenous community-controlled health organizations to better address issues linked to the new CTG reforms.
Provider Digital Access Account Requirements
From July 1, it will be mandatory for all physicians and medical practices to have and use a Provider Digital Access Account (PRODA).
When independent contract doctors work in a practice, each doctor must have their own PRODA account and issue invoices with their own ABN (and not that of the practice). If the doctor uses the firm’s PRODA account, this doctor cannot be considered an independent contractor.
When physicians are employed by the practice, they can use the practice’s PRODA account and ABN when invoicing. At this stage, electronic invoicing via PRODA will not be mandatory.
If GPs have specific questions about PRODA and e-billing, they can contact Services Australia or a finance/tax professional.
PBS Safety Net Thresholds
Beginning July 1, Pharmaceutical Benefit Scheme Safety Net thresholds will be reduced by the equivalent of 12 full-price scripts for concession card holders and the equivalent of approximately two full-price scripts for unpaid patients. concessionaires.
For concessional patients, the safety net threshold will be lowered from $326.40 to $244.80 – a reduction of $81.60 for concessional patients. This means that when a concession cardholder reaches the safety net threshold, after 36 full-price concession scripts, they will receive PBS drugs free for the remainder of the year.
For other patients, the general safety net threshold will be reduced from $1,542.10 to $1,457.10 – a maximum reduction of $85 for non-concessional patients, meaning that after the equivalent of approximately 34 general full-rate co-payments, general patients only pay the preferential rate. co-payment of $6.80 per PBS scenario (plus any applicable bonus) for the remainder of the year.
Further information can be found on the PBS website or in the Department of Health and Aged Care FAQ document.
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