Report on Under Co-payment Prescriptions 2022–23 (by date of supply)

Page last updated: 15 December 2023

PBS / RPBS Under Co-payment Prescription Data 2022–23 (XLSX 103 KB)

Definitions

Approved supplier: an approved pharmacist, an approved medical practitioner, or an approved hospital authority as prescribed in section 84 of the National Health Act 1953

Community pharmacy: a pharmacy business carried on, at or from, the particular premises in respect of which a pharmacist is approved under section 90 of the National Health Act 1953

Co-payment: the amount of contribution paid by patients towards PBS/RPBS medicines

Table 1: Co-payments for 2022-23
Date	General co-payment	Concessional co-payment
1 Jan 2022 – 31 Dec 2022	$42.50	$6.80
1 Jan 2023 – 31 Dec 2023	$30.00	$7.30

Pharmacy software vendors: companies responsible for maintaining desktop software on behalf of approved suppliers

Subsidised: over co-payment

Under co-payment: a prescription priced at or below the co-payment as defined in the National Health Act 1953.

Executive Summary

The collection of under co-payment prescription data for the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) commenced on 1 April 2012.

From 1 July 2022 to 30 June 2023, approximately 105.6 million under co-payment prescriptions were supplied under the PBS and RPBS. From 1 January 2023 the PBS general patient co-payment amount was lowered from $42.50 to $30.00 per prescription.

The data continues to be successfully collected from both community pharmacies and public and private hospitals.

The data is of a high quality, and it is now being made available on the Department of Health and Aged Care website and in regular PBS publications and reports.

The availability of this additional data is providing the Department of Health and Aged Care and other researchers with enhanced coverage of medicines that are approved and dispensed under the PBS/RPBS.

It is improving the accuracy of information available to the Pharmaceutical Benefits Advisory Committee and others to support evidence-based decision making and policy formulation.

Background

Legislation

The collection of PBS/RPBS under co-payment prescription data is provided for under the National Health Act 1953, and was first given effect following the National Health Amendment (Pharmaceutical Benefits Scheme) Act 2010 (the Amendment Act).

On 22 November 2010 as part of the second reading motion of the Amendment Bill in the Senate, a second reading amendment stated that:

'...the Senate calls on the Government:

(a) to ensure that there is an annual report to Parliament on all available data on under co-payment products, including the drug name and form, the quantities dispensed;...'.

Hansard from the Senate indicates that this second reading amendment was agreed to (page 1799).

Data collection

Data collected by Services Australia includes:

the patient’s name*;
the patient’s Medicare Number*;
information about the prescription (including the date of prescribing and supply, the PBS or RPBS code number, the listed brand, the quantity dispensed and the number of repeats);
the PBS prescriber number;
the approved supplier number; and
the price charged by the approved supplier.

* Patient name and Medicare number are not provided in the data supplied to Health by Services Australia

From 1 January 2016 pricing information is being collected.

Approved suppliers go through similar steps when processing both subsidised and under co-payment prescriptions, using pharmaceutical dispensing software programmes. In providing under co-payment data pharmacists are not performing any additional work, apart from validation of essential information such as prescription dates, pharmacy identification, patient eligibility and medication details.

Funding of $2.9 million was provided in the 2010–11 Budget to assist pharmacy software vendors to make a number of changes to pharmacy IT systems relating to 5CPA programs, including changes to allow under co-payment data collection.

Under co-payment data is being collected and disclosed in accordance with the Privacy Act 1988 and the secrecy provisions of the National Health Act 1953. The Office of the Australian Information Commissioner has been advised of this data collection.

No significant issues have been reported with the implementation of the data collection since July 2012.