..Information to Pharmacists
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    Your Monthly E-Magazine
    June, 2002

    Published by Computachem Services

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    ROLLO MANNING

    From a Rural/Remote/Isolated and Indigenous
    Pharmacy Perspective
    Is There a Better System?

    Retail pharmacy has locked itself in to a complexity of regulation to ensure there is accountability for the medicines supplied under the Pharmaceutical Benefits Scheme to the Australian population at large.
    A comparison of the "claims process" between the system for "mainstream" Australia, and the remote Aboriginal community population shows that there is a simpler way of managing the supply of PBS medicines.
    Maybe a compromise exists which would simplify the process and maintain the accountability element.
    Has retail pharmacy locked itself into a computer system which leaves it vulnerable for acting as the agent for the Government in data collection and fraud management?
    Developing a data base for a dispense program at a remote Aboriginal community gives an insight into the complexity of the current pharmacy dispense programs used in "mainstream" pharmacy.
    Why is it so?
    Simple.
    It revolves around the method of payment for the medicines supplied under the Pharmaceutical Benefits Scheme (PBS).
    There are two different sections of the National Health Act involved in the process.
    The first and original is the Section 85 (NH Act 1953) arrangement that apply to the PBS as it is practiced in "mainstream" Australia.
    That is a doctor writes a prescription for a drug listed in the Schedule of Benefits; the patient presents at a pharmacy where it is dispensed; and the dispensing pharmacist gets paid by the Health Insurance Commission when a claim is made accompanied by proof that the patient received the medicine (the signature on the script).
    The second method of payment is through the Section 100 arrangements that apply to health clinics operating in a remote Aboriginal community.
    Here the health clinic orders the supply of PBS medicines from an Approved Pharmacy, and the pharmacy makes a claim on the HIC for the "bulk supply" made to the clinic.
    The big difference - the Section 100 arrangement for remote Aboriginal health clinics does not need the identification of the patient.
    So the dispense program at the remote clinic simply needs to monitor the total PBS drug usage to be able to place an order for replacement stock to be supplied.
    For proper quality control, and to meet State/Territory Poisons Act requirements, the recording of the patient name, clinician supplying, and the instructions given to the patient should be recorded. The HIC does not need this information.

    The differences may be tabulated as follows:
    The difference between s100 and s85 PBS when supplied to remote Aboriginal Health Clinics

    Supply Feature s100   s85
    Identify date prescribed No   Yes
    Identify patient No   Yes
    Patient Medicare Number needed No   Yes
    Identify prescriber No   Yes
    Identify quantity dispensed No   Yes
    Identify number of repeats No   Yes
    Authority authorisation required No   Yes
    Prescribed only by a doctor with a Prescriber Number No   Yes
    HIC payment on prescription No   Yes
    Collect Copayment from patient No   Yes
    HIC payment on item into store Yes   No

    One wonders if the Commonwealth Government realised what a brilliantly simple system was being set up when it accepted the recommendations of the Pharmacy Guild and the NACCHO (through the Australian Pharmaceutical Advisory Council). The two peak bodies had been asked to develop a plan whereby the problem of the payment of a copayment and access to PBS for remote living Aboriginal and Torres Strait Islander people was resolved.

    The development of an IT system to manage a remote health clinic brings home the simplicity of the method of "supply and claim" that has been developed.

    The only problem from the viewpoint of the pharmacy is that there is no formal method of updating the "dispensing fee", or "handling fee", as it is called.

    This was originally linked to being the difference between the value of the Health Care Card copayment, and the PBRT determined "dispensing fee". When first introduced this was a value of $1.14.
    (The difference between the copayment in 1999 of $3.20 and dispensing fee of $4.34).
    How this happened is another story for another day, but the author is willing to discuss with interested persons.

    It was quickly realised that in time (and a very short time as it turns out) this would have been a negative value. It was agreed that the fee would be not less than $1.14.
    In 2002 beyond August as proposed, this would have been MINUS 2 cents!

    Lessons to learn?
    Well maybe.
    Does a claim process need to be as stringent and complex as it is?
    Or would pharmacists prefer the higher remuneration and effective database to handle the needs of Commonwealth accountability.

    This columnist is not advocating a Section 100 arrangement for the Australian population, but believes there should always be reviews to establish the cost benefit of processes as they develop.

    Think about it?
    There maybe an alternative to the ongoing problems that are articulated over the requirements to supply Medicare numbers on all claim prescriptions, and whatever might be thought of next that can plug into the IT system now available to the Commonwealth in every community pharmacy.

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