“Common sense change” to payment of PBS concessional entitlements on date of death welcomed by pharmacy
The move is one of three changes to the National Health Amendment (Pharmaceutical Benefits) Bill 2016.
This bill contains amendments to the National Health Act 1953 aimed at updating and supporting “the efficient operation” of the PBS.
The change is a technical correction relating to concessional entitlements, aimed at ensuring these entitlements work correctly until the last day of a person’s life.
“Health policy has always been that concessional entitlements apply for PBS medicines obtained on the day of a person’s death,” according to the second reading speech for the Bill in Parliament.
“Under social security legislation, where eligibility is decided, concessional entitlements cease on the day prior to death. This timing is to allow the payment of other social services benefits to apply from the date of death”.
To account for this difference, claims for PBS prescriptions supplied for a concessional beneficiary on the day they die need to be adjusted, the reading explained.
Since streamlined processing of claims was introduced in April 2015, this adjustment no longer occurs.
“The proposed amendments modify the definitions of concessional beneficiary and dependant for PBS purposes to ensure that PBS entitlements apply until midnight on the day a concessional beneficiary or a dependant dies”.
Commenting on the change, a spokesperson for the Pharmacy Guild of Australia said: “The ‘day of death’ amendment addresses a longstanding and delicate anomaly. It is a common sense solution to the problem, mainly encountered by community pharmacies who deliver services and medication to nursing homes”.
Over 146 million PBS prescriptions were supplied for concessional beneficiaries last year. Of these, less than a thousand were supplied on the date of death, according to data presented during the second reading.
“For these prescriptions, there is a shortfall in the payment to the pharmacist equal to the difference between the general patient co-payment and the concessional co-payment. This is currently a difference of $32.10 per prescription. The amount that would be owing across all PBS pharmacies is estimated to be accruing at around $2,000 per month.
The two other changes including in the bill are to allow computer decision-making for administrative processes to “make the prescribing of ‘authority required’ scripts more efficient for doctors”, and “reducing red tape for pharmacies in the aftermath of disasters such as fire or flood”.