Payments
Payments overview
Payments will be made monthly in arrears, with the first payment to be made in August 2009.
Payments will be made directly to the state and territory health department’s nominated bank account as supplied to Medicare Australia on the Highly Specialised Drugs program – State or Territory Health Department bank account details form [PDF, 131Kb]
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Payments depend on state and territory health departments accepting the following conditions:
- supply is to eligible patients
- prescribing is in accordance with PBS criteria which reflect the recommendations of the Pharmaceutical Benefits Advisory Committee (PBAC)
- prescribing is consistent with the therapeutic uses approved by the Therapeutic Goods Administration (TGA) for the supply of the drug.
National drug price
Medicare Australia will meet the agreed price above the patient contribution, for each item supplied in accordance with this program.
Standard national drug prices will be established through direct negotiations with suppliers through the Pharmaceutical Benefits Pricing Authority. The price is referred to as the “agreed price”.
Where generically equivalent brands of a drug are included in these arrangements, then the subsidy will equal the price of the lowest priced brand.
Items dispensed prior to 1 July 2009
The Department of Health and Ageing (DoHA) will continue to administer payments to state and territory health departments until 30 June 2009.
DoHA will administer any residual payments required to be made in financial year 2009-2010 for HSD and PBS trastuzumab items dispensed prior to 1 July 2009.
Payments
Payments under the offline solution will be made within 30 days of receipt of correctly submitted claims, provided these claims are received by Medicare Australia within 14 days of the end of the relevant month.
Payments will be made to the state or territory health department’s nominated bank account [PDF, 131Kb] as identified to Medicare Australia.
To assist state and territory health departments in transitioning to the new arrangements, there will be two (2) payment runs during the months of August 2009 and September 2009.
The following table identifies payments runs for the first six (6) months (July – December 2009). Payments will be made monthly on the last working day of the month after December 2009.
| Month | Payment date* |
|---|---|
| July 2009 | |
| August 2009 | 17 August 2009 31 August 2009 |
| September 2009 | 14 September 2009 30 September 2009 |
| October 2009 | 30 October 2009 |
| November 2009 | 30 November 2009 |
| December 2009 | 30 December 2009 |
* The above table outlines the date that Medicare Australia will release payments to the financial institutions. Medicare Australia cannot be held accountable for when the payment will be released from the financial institution to the nominated bank account.
Medicare Australia will not be responsible for delays or errors in payment due to factors outside the reasonable control of Medicare Australia, such as delays or errors in the banking system or errors in the account details provided by the state and territory health departments.
If the electronic funds transfer payment is returned to Medicare Australia, Medicare Australia will reprocess the payment within five working days (subject to Medicare Australia receiving correct bank and account details).
On receipt of notice of an overpayment from Medicare Australia, the state or territory health department agrees to repay Medicare Australia any payments credited in error to that state or territory health department.
Where a HSD public hospital utilises an outreach service to prison or similar, or a community pharmacy supplies HSDs or PBS trastuzumab as an agent of the hospital, the claim must be lodged by the HSD public hospital overseeing the dispensing.
Claim payments will be for the cost of drugs claimed less patient co-payments. Claims received under the offline solution will have a co-payment percentage applied at the time of payment (0.8 per cent as of May 2009).
Where a quantity of a drug claimed is not equal to the quantity contained in the manufacturer's pack, claim payments will be for the cost of drugs multiplied by the percentage that the quantity supplied bears to the quantity contained in the manufacturer's pack, less patient co-payments.
HSD and PBS trastuzumab items dispensed under this initiative will have no mark-ups applied. All drugs under this arrangement will be reimbursed for the drug cost only less patient co-payment and no other fees, such as dangerous drug or broken pack fees will apply.
Change of bank account details
The Medicare Australia Highly Specialised Drugs program – State or Territory Health department bank account details form [PDF, 131Kb] can also be used to advise Medicare Australia of any subsequent changes to those bank account details.
Medicare Australia must be notified in writing, on the approved Medicare Australia bank details form, of changes to bank account details at least five working days before the change is to take effect.
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Last updated: 30 June, 2009