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Understanding the Pharmaceutical Benefits Scheme

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Luke Arundel
National Professional Services Manager

 

Updated 30 October 2015

 

Key points

• This information is for early career optometrists who are about to register as a PBS prescriber and outlines what you need to know about prescribing scheduled medicines, understanding the Pharmaceutical Benefits Scheme (PBS) and how to get a PBS prescriber number and pad.

• All optometry students who graduated in Australia from 2012 are authorised to prescribe scheduled medicines. About 40 per cent of the optometry profession can prescribe scheduled medicines and this proportion will increase.

• The list of scheduled medicines that optometrists are authorised to prescribe can be found within the Optometry Board of Australia (OBA) scheduled medicines registration standard.

• Some but not all of the medicines optometrists are authorised to prescribe provide eligible patients with a subsidy through the PBS.

• Guides and information on writing PBS prescriptions and how to order PBS prescription stationery is found below.

Which drugs can I prescribe?

Authorised optometrists can prescribe Schedule 2, 3 or 4 medicines from a list maintained by the Optometry Board of Australia. The list includes anti-infective, anti-inflammatory, anti-glaucoma and other drugs used in the detection and treatment of eye conditions.

The OBA-approved list is known as the ‘common list’ and can be found in the OBA registration standard. An optometrist who is authorised can obtain, possess, administer and prescribe any drug from this list for topical use.

Nearly all of the drugs on this list are available in Australia; however, there are some drugs such as cyclosporine that are not yet available in Australia and require special approval to prescribe through the Therapeutics Goods Administration, the body responsible for the importation of drugs.

You might want to keep an eye on the OBA-approved list from time to time as it will change when new drugs are developed and become available for use by optometrists. Members of Optometry Australia will be updated whenever this happens.

Pharmaceutical Benefits Scheme

Under the PBS, the government subsidises the cost of medicine for many medical conditions and the benefits are available to all Australian residents who hold a Medicare card. The PBS schedule lists all the medicines that are available to patients at the government subsidised price and is available online and updated monthly. It has a specific section on the drugs that optometrists can prescribe that are eligible for subsidy.

The PBS works under a co-payment scheme. Under this scheme, patients will pay no more than $37.70 for each PBS-listed drug prescription, or no more than $6.10 if they have an eligible concession card, Commonwealth Seniors card, Health Care card or Veterans card.

The government subsidises the cost of the drug above these co-payment amounts. This means that when you prescribe a drug for topical use that costs $15.00 at the pharmacy, a non-concessional patient will pay $15.00 but if you prescribe a drug for topical use that costs $37.70 or more, the non-concessional patient will pay only $37.70

Which drugs are eligible for a PBS subsidy?

The list of drugs that optometrists prescribe with eligibility for PBS subsidy can be found on the PBS website. If a drug that an optometrist is authorised to prescribe (as per the OBA-approved list) is not listed for PBS subsidy, you can still prescribe it as a private or non-PBS prescription. Some PBS-listed drugs have special criteria that must be met in order for you to write a PBS prescription. In general, all PBS-listed drugs fall into one of three groups.

Unrestricted benefit

There is no restriction on these drugs and you can just write the prescription for eligible patients. Most of the drugs that optometrists prescribe are unrestricted.

Restricted benefit

These drugs are eligible for PBS subsidy only when a specific condition is present or special criteria apply. An example of this is prednisolone, which is eligible for PBS subsidy only when the clinical condition being treated is uveitis. Restricted drugs that optometrists are authorised to prescribe can be written as a private non-PBS prescription when the restriction is not met.

Authority required benefit

These drugs require prior approval from the Department of Human Services before being prescribed. Examples include Systane unit dose eye-drops, which can be prescribed only under the PBS for severe dry eye syndrome in patients who are sensitive to preservatives in multi-dose eye-drops, and fluoroquinolones such as ofloxacin and ciprofloxacin, which are eligible for PBS subsidy only when prescribed for bacterial keratitis and the patient is being treated in conjunction with an ophthalmologist.

It is an offence to prescribe these under the PBS without seeking prior approval. You can call the department on 1800 888 333 for an approval code to enter or write on your prescription.

How do I become a PBS prescriber?

1. Get a PBS prescriber number

Optometrists authorised to prescribe scheduled medicines need to apply to Medicare for approval as a PBS prescriber. You will need to download the application form and once completed, submit it to Medicare. You must include information that you are authorised to prescribe by the OBA before you submit this application. It is best to wait until you receive written confirmation from the OBA that you are registered and your name is on the practitioner register. Once your submitted PBS prescriber application is approved, you will be given a PBS prescriber number by Medicare which is to be included on all the prescriptions you write.

2. Prescription stationery

Hard copy PBS prescription pads and computerised prescription forms are available free of charge from Medicare. You can download the prescription stationery forms PB028 and PB030 and it is important to include your practice address, qualifications and so on as this will be printed on the pads or computerised forms. You can do this only once you have been approved as a PBS prescriber and have a PBS prescriber number. Prescription stationery is location-specific so if you work at two practices, you will need to order prescription stationery for each location.

More questions?

Medicare has produced useful guides that are relevant for early career optometrists new to prescribing. If you have any specific question you can always contact Optometry Australia for help.

PBS for new health professionals. An introductory module for all health practitioners about prescribing drugs under PBS.

PBS for Optometrists on The Department of Human Services website.



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