Government responds to compliance confusion

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Department of Health commits to working with pharmacists following complaints about its crackdown on PBS compliance

The Federal Department of Health has reassured pharmacists it is committed to working with the profession and prescribers to provide education and support when it comes to PBS compliance activities.

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

“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,” said Ms Greenwood.

“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.”

The Guild has explained to the AJP the types issues being reported. For example, compliance issues have been noted when there were multiple PBS claims for the one prescription.

This has occurred with digital image prescriptions – when the prescriber transmits a digital image script but also issues an original script, since COVID-related PBS arrangements require prescribers to retain original script for two years.

It has also occurred when a prescriber has issued duplicate prescriptions.

“The problem is multiplied if repeats are also involved,” a Guild spokesperson said.

Other reported issues include phone authority details not being consistent with dispense details, and claims for prescriptions that have been written after a person’s death.

“This may be because prescriber has authorised urgent supply which pharmacist dispenses as ‘owing’, but the script is written after death,” said the spokesperson.

Ms Greenwood told AJP: “Our concern is at all times to ensure members are compliant. But things like claims being refused because a patient has passed away is frustrating.”

The Department of Health acknowledged that pharmacists are confused.

“COVID-19 has impacted the healthcare community and the Department greatly values the commitment and efforts by pharmacists in their continued support of the community,” the Department told the AJP.

“We understand there has been a number of complexities as well as confusion experienced by pharmacists during this time.

“However, the Department has an obligation to undertake compliance activities to ensure that legislative requirements are met, duplicate payments are recovered and, of course, all fraud is appropriately treated. 

“During this compliance activity, the Department has learnt from pharmacies that they know their claims were non-compliant and we are committed to using these learnings to improve compliant claiming behaviours.”

The Department emphasised its “strong” compliance program protects Australia’s health payments system from incorrect claiming and fraud.

“These compliance activities remain important to reduce the risk on more serious non-compliant behaviours,” they said.

However they responded to the call from Ms Greenwood to prioritise an education and awareness campaign for both prescribers and pharmacists.

The Department said: “We remain committed and are actively working with the Guild and other representative bodies to provide further education and support to prescribers and pharmacists to create greater awareness of their obligations and responsibilities under the legislation that governs the PBS.”

Ms Greenwood also asked the Department and Services Australia to urgently review and update the PBS Online alerts, with pharmacists reporting that it was too easy to overlook warnings in the system.

“If the sector would like ‘warnings’ in the claiming system amended so that these cannot be overridden for potentially non-compliant claims, the Government is happy to work with consumers, pharmacists and prescribers on such changes,” said the Department.

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