7Additional procedures for giving information

7 Additional procedures for giving information

(1) For the purposes of paragraphs 98AC(4)(b) and 99AAA(8)(a) of the Act, this section defines additional procedures to be followed by an approved supplier in giving information to the Chief Executive Medicare, on behalf of the Secretary, in relation to the supply by the approved supplier of pharmaceutical benefits, whether the information is given: (a) under subsection 98AC(1) of the Act; or (b) in making a claim under section 99AAA of the Act. Claim made using manual system (2) Subsections (3) to (9) apply if the approved supplier’s claim is made using the manual system. (3) The information must be accompanied by the prescriptions on the presentation of which the pharmaceutical benefits that are the subject of the claim were supplied. (4) On each prescription (other than an authority prescription, a repeat authorisation, a deferred supply authorisation or a prescriber bag supply form), there must be marked a stamp format in the area on the extreme left of the prescription, horizontally aligned with the pharmaceutical benefit to which it relates in such a way as to avoid obliterating any other information on the prescription.

Note: For prescription and repeat authorisation, see subsection 5(1).

(5) On each prescription, there must be marked in the S section (or each S section) one or more serial numbers by the approved supplier, allotted in respect of each pharmaceutical benefit as follows: (a) in respect of general benefit prescriptions—commencing at “1” in each claim and continuing consecutively in respect of that claim; (b) in respect of concessional benefit prescriptions and concession card prescriptions—commencing at “C1” in each claim and continuing consecutively in respect of that claim; (c) in respect of entitlement card prescriptions—commencing at “E1” in each claim and continuing consecutively in respect of that claim; (d) in respect of prescriber bag supply forms—commencing at “1” in each claim and continuing consecutively in respect of that claim. (6) On each authority prescription, or repeat authorisation relating to an authority prescription, there must be marked as a prefix to the serial number allotted under subsection (5) the letter “A”. (7) On each deferred supply authorisation, there must be marked as a prefix to the serial number allotted under subsection (5) the letter “D”. (8) On each prescription (other than a prescription that was not in the possession of the approved supplier for reasons that are, in the opinion of the Chief Executive Medicare, outside the approved supplier’s reasonable control), there must be marked in the A section (or each A section): (a) if an election by the approved supplier is in force under subsection 31(3) of the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020, and the prescription is in respect of an extemporaneously‑prepared pharmaceutical benefit that is not a standard formula preparation—the price worked out by the approved supplier in accordance with section 18 of that determination; or (b) if no election by the approved supplier is in force under subsection 31(3) of the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020, and the prescription is an exceptional prescription—the price worked out by the approved supplier in accordance with section 18 of that determination; or (c) if the prescription is in respect of an extemporaneously‑prepared pharmaceutical benefit that is ear drops, eye drops or nasal instillations, and the supply of the benefit in a glass bottle container is specified by the PBS prescriber or considered necessary by the approved supplier—the words “glass bottle”.

Note: The RPBS provides that an RPBS claim is to be made in accordance with section 99AAA of the Act and this instrument except if the RPBS otherwise provides. If an RPBS claim is made using the manual system, RPBS prescriptions relating to the claim are given to the Chief Executive Medicare on behalf of the Secretary. The RPBS requires the provision of a serial number that uniquely identifies the RPBS benefit within the category “R”, being a serial number marked on the “S” section of the prescription by the approved supplier, commencing at “R1” in each claim and continuing consecutively in respect of that claim made in accordance with this section.

(9) The prescriptions referred to in subsections (3) to (8) must be grouped according to whether they are covered by paragraph (5)(a), (b), (c) or (d), with the prescriptions in each group sorted in accordance with the serial numbers allotted under the relevant paragraph, starting with the first number allotted.

Note: The RPBS also requires an approved supplier to create a group of RPBS prescriptions sorted in accordance with the “R” serial numbers allotted to the prescriptions, starting with the first number allotted.

Claim made using Claims Transmission System (10) If the approved supplier’s claim is made using the Claims Transmission System, the approved supplier must comply with the requirements of subsections (3) to (9) in relation to the prescriptions on the presentation of which the pharmaceutical benefits that are the subject of the claim were supplied, except that the prescriptions need not accompany the information given in accordance with this section. Exception for medication chart prescriptions (11) For the purposes of this section, a reference to a prescription does not include a reference to a medication chart prescription.

Note: If the information is given using the Claims Transmission System, Schedule 1 has the effect that a serial number is still allotted in relation to the supply of each pharmaceutical benefit on the basis of a medication chart prescription.