Falling foul of regulations

business owners holding up red cards for reprimand

Pharmacists have been caught out in recent PBS compliance activities that focus on “unintentional administrative anomalies”, alleges Pharmacy Guild

Pharmacists are being penalised for administrative errors that were often due to prescribers unfamiliar with their PBS obligations, claims Pharmacy Guild of Australia Executive Director Suzanne Greenwood.

“Intentional fraud should rightly be frowned upon and the Department of Health is justified in taking the necessary actions needed to address such fraud and reclaim monies. However, recent PBS compliance activities by the Department have focused on unintentional administrative anomalies which is traumatic to the pharmacist and staff involved and can affect patient care,” wrote Ms Greenwood in her latest column.

“When we combine changes within the PBS with the myriad external factors brought about by the pandemic, we see an often confusing and rapidly evolving situation for both prescribers and pharmacists which occasionally can result in unintended non-compliance.”

Ms Greenwood alleges that the “focus for PBS compliance appears to only target pharmacies”.

“It is the pharmacists who are being penalised for administrative errors that were often due to prescribers unfamiliar with their PBS obligations. In many cases, the issue may be minor but the potential impact on the patient can be huge,” she said.

If an error is made that falls foul of Commonwealth compliance regulations, the options for the patient are to contact the prescriber for a PBS compliant prescription, if that is possible, or pay the non-PBS costs “which may be prohibitive” she added.

“Delays in having a compliant PBS prescription supplied can interrupt a patient’s treatment with potential detrimental health consequences.

“And if the pharmacy dispenses according to the intent of the prescriber, then they may get caught up in one of the Department of Health’s compliance activities.

“This can be a costly error for a pharmacy if the medicine costs thousands of dollars. We know this is happening and it is affecting the businesses of some pharmacies, and also the ability of patients to access medicines. And adding to the frustration is that an inadvertent prescriber error can affect a patient who has otherwise been having prescriptions dispensed successfully for some time.”

Ms Greenwood called on the department to prioritise an education and awareness campaign for both prescribers and pharmacists, and to urgently review and update the PBS Online alerts alongside Services Australia.

“Pharmacists have told us how easy it is to overlook a warning, whereas claim rejections prompt urgent attention by dispensary staff,” she said.

“Pharmacists are not infallible. They too may overlook some requirement and make an unsubstantiated PBS claim. Pharmacists need to continually review their dispensing and claiming processes and make sure staff are aware of their obligations and actioning any alerts provided through PBS Online. However, the bigger issue is making sure that compliant PBS prescriptions are issued in the first place.”

The Department of Health has been contacted for comment but was unable to respond by the time of publication.

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