Registration for Close the Gap PBS Co-payment program extended

UPDATED
 
Criteria for the Close the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment program was expanded in July, allowing registered Aboriginal and Torres Strait Islander patients more streamlined access to subsidised medications.
 
A grace period to ensure all eligible patients are registered for the program has now been extended to January 2022, with the Department of Health attributing the need for an extension to the ‘significant number’ of eligible patients who are not yet ‘correctly registered’.
 
This period will prevent CTG PBS Co-payment prescriptions being rejected at the time of dispensing if the Aboriginal or Torres Strait Islander person is not formally registered for the program through Services Australia.
 
PBS prescribers can ensure their Aboriginal and Torres Strait Islander patients are registered for the program via Services Australia’s Health Professional Online Services (HPOS). If the patient is not registered, their status will be indicated as ‘inactive’ in HPOS.
 
But GP and RACGP Aboriginal and Torres Strait Islander Health Clinical Lead Dr Mary Belfrage has some concerns that GPs have been left with an administrative burden caused by poor interoperability between health information systems.
 
‘Although the changes to the program are positive, it was implemented very badly, because it seems they went live before they tested it and realised the database wasn’t complete,’ Dr Belfrage told newsGP.
 
‘GPs have reported to us that not everyone who had historically been registered for the CTG PBS Co-payment program was transferred via HPOS [to the Services Australia register] to be available to pharmacists at the point of dispensing, and that was promised.
 
‘So there has been a big glitch and that’s a problem.
 
‘This grace period is talked about as if it’s GPs’ and patients’ responsibility, but it’s actually about Services Australia [needing] to get their house in order.
 
‘I think they’re now relying on GPs to mop up their poor process, which was the failure to transfer all the patients. So that needs to be corrected, as that seems to be falling on GPs.’
 
Dr Belfrage believes the onus should not be on GPs and other prescribers to ensure all their eligible patients are registered.
 
‘Health services and practices should just register new people, because everyone who’s ever been registered is already on that database, but that didn’t happen,’ she said. ‘So they’ve created a crisis because that whole database wasn’t properly imported.’
 
However, a spokesperson from Services Australia disputed Dr Belfrage’s characterisation of the issue and said more than 520,000 records previously registered were successfully transferred prior to 1 July.
 
‘There have been no technical issues with transferring previously registered individuals to the new centralised database,’ the spokesperson said.
 
‘In the past, some people who were not registered may have received medicine under the scheme. Pharmacists are receiving warnings for these patients when they present with a script, directing them back to their prescriber to register.
 
‘This does not affect their access to medicine at the CTG price now.’
 
In addition to ensuring patients have access to medications, Dr Belfrage said the program should work to minimise inconvenience and embarrassment for patients, as well as disruption to healthcare providers and services.
 
‘We received reports that people who have been registered [to receive the co-payment] for years … were fronting up to a pharmacy and then being charged the non-subsidised rate,’ she said.
 
‘Potentially they go to get their monthly or six-monthly medications and they are told, “Okay that’ll be $500” instead of paying more like $40.
 
‘And there’s all sorts of problems with that. There’s the social problem that it can be humiliating to have conversations like that where you might have to argue that you’re Aboriginal [for example].’
 
Dr Belfrage said while GPs should not have the burden of having to check whether their patients are still registered, they cannot assume it is going to be apparent to the pharmacist that a patient is eligible to receive the co-payment.
 
‘Then that uncomfortable conversation about payment happens,’ she said.
 
‘It’s on the individual prescriber to check the eligibility … [but] the onus is also on the pharmacies to know because it’s actually at the point of dispensing that it becomes an issue, not at the point of prescribing.’
 
There are, however, positive steps forward, according to Dr Belfrage.
 
‘The program is not different to how it has been before [where GPs and other prescribers ensure all their patients are registered to receive medication],’ she said.
 
‘It’s just that all the mechanisms have changed and now any PBS prescriber, like optometrists and hospital-based clinicians who are PBS prescribers, as well as GPs can register patients or check registration on HPOS.

‘That’s a really good thing − the increased access to it. Because we used to get patients discharged from hospital and they would bring their outpatient prescriptions to us to write the script.
 
‘Now … it’s been extended to PBS prescribing in hospitals, so outpatients can be discharged with PBS medications.’
 
Eligibility criteria for Aboriginal and Torres Strait Islander people has also been expanded to include all ages, having previously covered 15 years and over.
 
Self-identification to support adherence and Medicare enrolment is another significant step forward, Dr Belfrage said.
 
‘This is a really important point, that the prescriber doesn’t need to have any proof of Indigenous status, just that Aboriginal and Torres Strait Islander people self-identify,’ she said.
 
‘Because that is one of our real cultural safety issues, [when someone says] “But you don’t look Aboriginal”.
 
‘So now with self-identification, having access to the co-payment measure will support adherence, and that the person is registered with Medicare.’
 
This feature builds on the Services Australia database now allowing for one-off patient registration linked to the individual rather than the practice or healthcare provider − another ‘administrative debacle’ Dr Belfrage said has been rectified.
 
‘That’s a good thing that it travels with the patient,’ she said. ‘It should be visible when it’s set up and working well, and at the point of dispensing it will be clear to pharmacists that they are Aboriginal and/or Torres Strait Islander people and that some are eligible for the CTG PBS Co-payment.

‘When the system works, the principles are good – it’s patient-centric, and it’s apparent at the point of dispensing for anyone who’s on that database.
 
‘It doesn’t rely on anyone notating a script or doing anything else. That’s a very good thing, it’s just that it hasn’t been set up yet to work in that way.’
 
More information on how to register patients for the CTG PBS Co-payment is available on the Services Australia website.

This article was updated at 1.00 pm on 5 October to include a response from Services Australia.
 
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Aboriginal and Torres Strait Islander health PBS Co-payment program prescribers