Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Ten numbers, one sub numerate, and one hell of a lot of trouble.
Medicare Card details must be checked because, apparently, there are a significant number of people claiming medication entitlements and subsidies to which they are not entitled.
We have all heard stories of patients being stopped at airports carrying thousands of dollars of subsidized insulins and antihypertensives.
But is it such a problem that many hours need to be spent by pharmacists and pharmacy staff?

There are a number of key issues that need to be addressed.

1. Is the problem of such proportions that it requires constant monitoring?

In 1995, United Airlines paid a committee of six an estimated $40,000 for a one month investigation into the catering of first class passengers.
Their principal recommendation was to reduce every salad that comes with the in flight meal by one olive to make a saving of sixteen thousand dollars per year.
Are the PBS “olives” worth the incredulous task of asking every individual for their medicare card details?

Maybe it’s just the lovely mid north coast region of New South Wales, but I have only encountered one customer who was not entitled to a Medicare Card, and hence had to pay full private price for prescription medications.

2. Is it genuinely the job of the pharmacist to collect medicare details?

If I receive a prescription marked “PBS” by the doctor, should that not be enough to acknowledge that the prescribing doctor has verified that the patient is most definitely in fact entitled to a PBS prescription?
If the doctor has marked the prescription with “PBS” to someone who is not entitled to that subsidy, is that not some form of fraud?

The Health Insurance Commission (HIC) has bundled the problem into the “too hard basket”, and effectively handed it directly back to pharmacists, waving the big stick of non-payment for medications. And the reason for this?
The HIC has no power (or grapes) to feed the problems back to the prescribing doctors.

What’s more, why do Medicare details need to be recorded for those who have an authority prescription? Surely those who approve the authority will not do so without the medicare card details?
If they do, should they?

3. Are the HIC truly invoking the full wrath of their responsibility?

It may shock some of you for me to suggest that the HIC needs to be more fastidious with their processing of claims.
If they come across a prescription that is not marked as being a PBS entitlement, then should they not reject it?
I’m sure we have all at some stage placed an item through as a PBS entitlement despite medical director placing a line of crosses through the PBS and RPBS boxes.
And why do pharmacists do that?
Because if we were to explain to the patient that the doctor hasn’t allowed it to be dispensed as a subsidised item, they would pick up their prescription(s) and take it to the pharmacy down the road who would profit immensely from the customers pharmacy change.

4. Are we truly receiving the support of the system?

Medicare have been kind enough to send us a letter mentioning which Medicare details that we have recorded are in fact incorrect.
Unfortunately, there is no mention of what claim the details are incorrect in (handy to see if we have rectified the problem), nor is there a mention of what the new numbers should be.
I find it to be fair in the case of Health Care Card and Pension Numbers when they are returned as “invalid”.
But in a system where almost all of the nations constituents own a card, why are corrective details not being attached?

The system must be improved.

All the best for Christmas and the coming New Year. From Simon Rudderham