CLOSING THE GAP (CTG)

Tackling Indigenous Chronic Disease

PBS Co-payment MeasureLONG DANG

Director (Acting)

pbs-indigenous@health.gov.au

Contents

• Background

• Key features

• How the PBS Co-payment Measure works

• Sample ‘CTG’ scripts

• PBS Co-payment Measure / PIP IHI Interface

Background

• One of 14 measures in the ICDP

• Aims to better treat / prevent chronic disease by increasing access to PBS medicines

• Commenced 1 July 2010 (‘CTG’ prescriptions)

• Patient access to Measure through registered general practices or Indigenous Health Services

Key features

Service eligibility:

– General practices participating in PIP IHI (registration process through Medicare Australia)

– Indigenous Health Services* (may also register for PIP IHI, otherwise registration process through Department)

*Indigenous Health Service: servicing predominantly Aboriginal & Torres Strait Islander population, eligible to provide Medicare services, and in urban or rural location.

Key features

Patient eligibility:

The Measure is intended to benefit Aboriginal and Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease, and in the opinion of the prescriber:

a) would experience setbacks in the prevention or ongoing management of chronic disease if the person did not take the prescribed medicine; and

b) are unlikely to adhere to their medicines regimen without assistance through the Measure.

Key features

‘chronic disease’

Measure uses MBS definition:

Disease that has been, or is likely to be present for at least six months, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke.

Key features

‘at risk of chronic disease’• Recognition that the risk of developing chronic

disease over a person’s lifetime is influenced by complex biological, environmental and socially determined factors

• Prescribers encouraged to use clinical judgment to determine if patient at risk

*Guidance provided in the GP Resource document

Key features

Needs based criteria – in the opinion of prescriber

a) patient is currently holding a concessional entitlement card for PBS benefits, or is eligible to receive such benefits or

b) patient is not currently holding a concessional entitlement card for PBS benefits, and is not eligible to receive such benefits, but shows the following:

- a history of evidence of foregoing medicines;

- evidence that health is failing because of non-compliance with medicines;

- social and/or legal obligations for a large family including guardianship of children; or

- existence of co-morbidities and need for three or more prescribed medicines.

How will the Measure work?Prescribing

– Patient meets eligibility criteria & provides consent

– Usual general practice / IHS registers patient (registers once)

– Eligible PBS prescribers can annotate ‘CTG’ prescriptions including medical specialists treating a patient referred to them.

– Annotation of PBS prescriptions• Prescription Writing Software

• Hand annotation

How will the Measure work?Dispensing– No ‘new’ adjudication by pharmacists

– PBS OnLine functionality

– Dispenser enters CTG annotation in dispensing software

– Sometimes ask for a code for hand written prescriptions and this guidance is in their dispensing software upgrade notes.

– No change to usual dispensing and counselling activities

– Lower co-payment charged at till

– Pharmacies are paid by Medicare Australia for every correctly annotated prescription processed

Key features

What does it mean for patients?

Lower costs for PBS medicines* available for eligible patients via annotated PBS prescriptions– General patients: $5.40**

– Concessional patients: nil PBS co-payment**

*whether for acute or chronic conditions**Brand premiums will be paid by the patient

Scripts

PIP IHI – PBS Co-payment Measure

Contact

Call: (02) 6289 2409 between 9am to 5pm (EST)

go to: www.health.gov.au/tackling-chronic-disease

email: pbs-indigenous@health.gov.au

write: PBS Co-payment Measure

Australian Government Department of Health and Ageing

Mail Drop Point 901

GPO Box 9848

Canberra ACT 2601