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Processing new Authority requests in the Pharmaceutical Benefits Scheme (PBS) 012-25052901

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This document explains details for Service Officers about processing, generating assessment letters and replying to Pharmaceutical Benefits Scheme (PBS) Authority requests.

On this page:

Telephone Authority approval request in OPA

Written Authority approval request in OPA

PBS Authority request allocated in Work Optimiser

Responding to Authority requests in HPOS and posting an assessment letter for mailed Authority request

Troubleshooting HPOS form uploads and Authority request in Work Optimiser

Authority and patient comments in OPA

Telephone Authority approval request in OPA

Table 1

Expand table

Step

Action

1

Access Online PBS Authorities

In the Medicare - eBusiness Gateway:

  • Select the Source Office
  • Select PBS Authorities (OPA) from the eBusiness System dropdown menu > Submit > Request Authority

The Approved Prescriber Search screen will show.

2

Contact by an approved prescriber

When an approved prescriber contacts Services Australia with an authority approval request:

  • The prescriber must provide the name that matches the name shown on the OPA System screen
  • If the prescriber states they are known by another name, such as their middle name, Service Officers must explain they need to give the name they have registered with Australian Health Practitioner Regulation Agency (Ahpra)
  • OPA will show the first 15 characters of a prescriber's first name and the first 30 characters of a surname. If the prescriber has a long name, Service Officers can accept a closely matched name
  • Do not assume a prescriber's gender based on the sound of their voice

Approved Prescriber Search screen:

  • Key the approved prescriber number given by the prescriber
  • If the prescriber says the date of prescribing on the prescription is before today’s date, change it to the date stated
  • Select Search
  • Ask the approved prescriber to confirm their full name (if not previously given). Only proceed with the authority application if the prescriber gives both first and last name as part of the security check
  • Select Next

Did the Action required pop up show?

  • Yes, the Action required pop up shows and the prescriber:
    • gives a password without prompting:
      Confirm the password on the PBS Secure information SharePoint page
      Note: access to this SharePoint page is limited. If access is required, contact Health Service Delivery Division - Program areas > Pharmaceutical Benefit Scheme (PBS)
      If the password provided is correct select Yes, the Patient Search screen will show, go to Step 3
    • does not give a password or gives the incorrect password:
      Do not prompt the caller for password
      Do not tell the caller they need a password
      Do not give the caller the password
      Tell the caller that their identity cannot be confirmed and terminate the call. Service Officers must log a fraudulent incident report as soon as possible. Use the Report Suspected Fraud and Corruption form. Give as much detail as possible. For example, time of call, phone number and email details to Pharmaceutical Benefit Scheme (PBS)
      Procedure ends here
  • No, go to Step 3

3

Patient details

Ask the prescriber for the patient's Medicare card number. For patients who:

  • have a current Medicare card number, go to Step 5
  • do not have a current Medicare card number and the prescriber considers the patient to have an entitlement under PBS, and the prescriber:
    • can give the patient's name and date of birth, go to Step 4
    • cannot give the patient's name and date of birth, procedure ends here

4

Special Medicare card eligibility

Staff must add an Authority comment outlining the reason for eligibility. For:

  • patients who do not have a current Medicare card number
  • but the prescriber considers them entitled to PBS

For eligibility under the Special Medicare card, the patient may be:

  • a newborn (under the age of 52 weeks old)
  • a patient with an expired Medicare card
  • a visitor from a Reciprocal Health Care Agreement (RHCA) country
  • an Australian Defence Force (ADF) member without a Medicare card
  • an incarcerated customer (prisoner). See Eligibility for Pharmaceutical Benefits Scheme (PBS)

On the Patient Search screen:

  • Key the special Medicare card number 25437766611 in the Medicare number field
  • Select Search
  • The bottom of the screen shows the following fields to key. Ask the prescriber for the patient's:
    • First Name - If the Authority request is for an unnamed Newborn, Service Officers must key Newborn as the child's first name when keying the patient's details
    • If multiple newborn children, key Newborn 1, Newborn 2 as the child's first name
    • Last Name
    • Date of birth
    • Gender

Go to Step 7.

5

Patient Search screen

Key the Medicare card number in the Medicare number field.

  • Ask the prescriber to confirm the patient's name:
  • If there are patients with the same name on the Medicare card, ask the prescriber to confirm patients date of birth:
  • If no results show, increase the second last digit of the Medicare number by one, or

If staff are unable to search by Medicare card number, select Patient as the search type, and ask the prescriber for the following patient details and key the patient's:

  • First Name
  • Last Name
  • Date of Birth or Post Code
  • Select Search

Select the patient record.

Note: for privacy purposes, if the prescriber does not have the patient's current Medicare card number, do not give out the number to the prescriber.

Does the patient record show they have a Gold or White Department of Veterans' Affairs (DVA) card?

6

Department of Veterans' Affairs (DVA) card

If the patient is a:

  • Gold card holder, tell the prescriber that DVA processes the patient's authorities and offer to transfer the call to DVA. Procedure ends here
  • White card holder, ask the prescriber if the white card covers treatment with the requested medication. If the requested item is:
    • covered by the White card, DVA must process the request for authority approval. Offer to transfer the call to DVA. Procedure ends here
    • not covered by the White card, go to Step 7

Note: if the prescriber is uncertain whether the treatment is covered by the White card, they should contact Department of Veterans Affairs (DVA) to verify the eligible conditions.

7

Item search

In the Item search screen:

  • Keyword or item code field: start typing the drug name or brand if known. Refine the search by adding the form and strength
  • For extemporaneous items, add preparation name. For example, cream
  • Select the drug requested from the predictive search results
  • Add the Dose and select the Dose frequency from the dropdown menu requested by the prescriber
  • Do not key the non-daily dose as X, D or N. Select the appropriate Dose frequency
  • Dose and Dose frequency can be found in the Prescription details '?' help symbol on the Item Search screen

Quantity and repeats

The Prescribed Quantity and Prescribed Repeats defaults to the PBS listed quantity and repeats for the item. Change these if needed.

For Streamlined items where the prescriber is requesting the listed quantities and repeats, see Authority required (STREAMLINED) items in the Pharmaceutical Benefits Scheme (PBS).

For:

8

Efficient Funding of Chemotherapy (EFC)/RA Infusion items

Key:

  • Prescribed Quantity as the number of units (mcg, mg or iu) per infusion
  • the Dose as instructed by the prescriber including any decimals

9

Highly Specialised Drugs (HSDs) the Hospital Provider Number

For Highly Specialised Drugs (HSDs) the Hospital Provider Number field appears.

  • Key the hospital provider number:
    • The Hospital Provider Number is not required for Community Access (CA) S100 items or Trastuzumab S100 items
    • If the prescriber does not have the Hospital Provider Number but provides the Hospital Name See Hospitals approved to prescribe Pharmaceutical Benefits Scheme (PBS) Highly Specialised Drugs (HSD) for a list of Hospital approved to prescribe
    • Search for the Hospital provider number and key into the Hospital Provider number field in OPA
    • Do not release the Hospital Provider number to the prescriber
  • Key the correct:
    • Dose
    • Frequency
    • Quantity
    • Repeats
    • Hospital provider number (if applicable)
    • Select Next

10

Opioid Authority requests

There is a restriction for phone approvals to a one-month supply. Repeats are permitted as long as the total supply does not exceed one month. For example, quantity is for 2 weeks and one repeat.

Service Officers must:

  • check if the prescriber is requesting a General (S85) schedule opioid or a Palliative Care Schedule opioid. The item selected determines the restriction criteria that the prescriber needs to address through the Q&As
  • accept details provided by the prescriber. Service Officers do not need to check Patient history, for example, duration of treatment. Prescribers must state the length of opioid treatment
  • read out the question(s) exactly as they appear in the OPA System
  • select the relevant option based on the response given by the prescriber
  • pause before continuing when prescribers:
    • do not let Service Officers finish with the Q&As, or
    • give details inconsistent with the answers required

Restriction requirements General (s85) opioids for pain:

  • When an opioid request becomes Authority required the prescriber must confirm the patient has chronic severe disabling pain. Chronic severe pain is not acceptable
  • Daily, Continuous, Long term must be stated for the initial treatment restriction criteria. This applies to opioid patches. For example, Norspan and Fentanyl.
  • If the prescriber did not state this or answered 'No' to the questions, reject the request, go to Step 12
  • If the prescriber states 2 indications apply to their patient, ask the prescriber which of the 2 indications best suits their patient and include an Authority comment

11

Extemporaneous Ingredients Selection

Select the first ingredient from the dropdown menu given by the prescriber.

The approved prescriber may list ingredients by the commonly known name instead of the generic name appearing in the drug tariff.

If unable to find the requested ingredient in the list, see the Resources page for common alternative ingredient names.

  • Key the:
    • dose and dose frequency. For example, 500 per month
    • quantity and repeats. For example, 500g and 5 repeats
  • Select Next
  • Key and select the first ingredient from the dropdown menu
  • Key percentage requested
  • Select add ingredients
  • Repeat until 100% ingredients have been specified
  • Select Next

Go to Step 13.

12

Restriction screen

Note: the existing Question and Answer screen shows correct answers flagged by a tilde ~ symbol. Dynamic Question and Answer (DQ&A) correct answers are not flagged by a tilde symbol. See Resources > Dynamic Question and Answers (DQA) resources in Dosage calculators and charts for Pharmaceutical Benefits Scheme (PBS)

  • Select the appropriate restriction provided by the prescriber
  • Select Next if the authority is for the same prescriber, same patient, same restriction on the same date of prescribing as an already recorded authority:
    • Confirm with the prescriber that the request is for the same restriction and select Yes if copying the restriction answers from the previous authority. The previous answers show on the Answer Questions screen
    • Select No if not copying the restriction answers
  • Key or review the answers to the restriction questions and select Next
  • Read the questions to the prescriber if the details have not already been given
  • Key the answers provided by the prescriber, even if the answer is incorrect
  • If the prescriber cannot give sufficient details to select restriction or answers one or more questions, select Reject. Choose the appropriate reason from the Rejection reason dropdown menu
  • Key the reason for rejection into the Authority Comments and the P number/login number
  • Select Save

13

Authority Summary details

From the Authority Summary screen:

  • select Telephone for the applicable Internal Application Type
  • the Declaration Statement automatically ticks
  • key the Authority prescription number in the Authority prescription number field provided by the prescriber. Staff do not need leading zeroes
  • read the details on the Authority Summary screen back to the prescriber to confirm the authority details are added correctly
  • wait for the prescriber to confirm the details are correct
  • key the operator P number/Logon including any Authority comments
  • select Submit

Authority prescription number invalid

  • If the Authority prescription number is invalid, a pop up alerts the Service Officer
  • Select Amend number and ask the prescriber to confirm the Authority prescription number
  • If the number is still invalid, select continue and key an Authority comment indicating the prescriber confirmed the prescription number
  • OPA will reject the Authority request, if the only reason for the rejection is an invalid authority prescription number and an authority comment has been keyed
  • Override the rejection

Patient has a previous exemption to the PBS criteria

If the prescriber provides details via phone about the patient and includes they previously received an exemption to the PBS criteria for that medicine:

  • advise the prescriber you need to seek further advice on this authority application
  • escalate to a PA. Go to Table 2 in Escalate calls in Pharmaceutical Benefits Scheme (PBS)

14

Assessment result

See below for an assessment result that is:

  • Approved and an approval number generates
  • Rejected, or
  • Authority not required

Approved and an approval number generates

Check and action any Reason Codes as needed. Go to the PBS Reason Code Maintenance System for fix instructions under Automated PBS Authorities.

Read the approval number to the prescriber and ask them to endorse the number on the prescription.

Go to Step 15.

Rejected

If the assessment result is Rejected, action any Reason Codes as needed. Go to the PBS Reason Code Maintenance System:

  • Rejected as 'too soon', see Existing Authority request
  • If the Service Officer determines the Authority request meets the criteria and should be approved:
    • Select Approved from the Assessment Result Override dropdown menu > Override
    • Select the reason from the Override Reason dropdown menu, or
    • Select Other, to give the reason in the text box
    • Staff must key Authority comments in the Authority comments section in the Summary screen
  • Reason 075. Prescribed quantity and/or repeats is greater than the maximum allowed without Service Australia intervention, returns because of the limits set on the quantity and repeats by the Department of Health, Disability and Ageing
  • Service Officers can override these rejections only if the requested quantity and repeats are in line with the internal approval rules. Check the relevant dosage chart, PBS website and the National Drug Reference Database (NDRD) to decide if the request is within PBS guidelines

Authority not required STREAMLINED

See Process in Authority required (STREAMLINED) items in the Pharmaceutical Benefits Scheme (PBS) if the:

  • assessment result is Authority not required, and
  • item is Authority Required (STREAMLINED) for the listed quantity and repeat(s)

15

Prescriber request for another authority

Prescribers may request another authority for the same patient or a different patient.

From the Application Assessment Result screen if another authority is requested for:

  • a different patient:
  • the same patient, and the date of prescribing is today's date:

Written Authority approval request in OPA

Table 2

Expand table

Step

Action

1

Launch Work Optimiser desktop icon

To get a Written Authority request, select:

  • Worklist on Work Optimiser home page
  • Ready
  • Work Optimiser assigns a work item, which can be:
    • a HPOS form upload
    • a mailed application, or
    • an OPA delayed assessment

If Authority request details are not received with the application:

  • add a processing note on the work item, and
  • go to Table 2 in Digital Messaging Capability (DMC) - Health to create a rejection letter

Note: if the documents are hard to read, go to Table 5.

2

Locating mailed and HPOS form upload Authority requests using PaNDA when a prescriber contacts

Select PaNDA Search on the Work Optimiser home page.

For Written Authority requests, select:

Program:

  • Pharmaceutical Benefits Scheme (PBS), or
  • Complex Drugs

Work Type:

  • PBS, select based on the State that the prescription has been posted in from:
    • Authority Mailed (STATE), for mailed applications, or
    • Authority Proforma for HPOS uploads
  • Complex Drugs, select based on program:
    • Program - WRIT for mailed applications, or
    • Program - HPOS for HPOS upload applications
  • Search for work item, use Medicare card number to search for General:
    • PBS and Complex Drugs - work items. If the Medicare card number is not supplied, search on SURNAMEFIRSTNAME or authority number in the External Reference field
    • For HPOS form Upload Authority requests, key the HPOS reference number in the HPOS reference number field or Medicare card number in the External Reference field. Select Search > Select the document > Open file - confirm correct prescription

Delayed assessment Authority requests

To find work received in Work Optimiser through OPA for delayed assessments, see Table 1 in Processing Delayed Assessment requests in the Pharmaceutical Benefits Scheme (PBS).

Use status filter options to refine search:

  • Open for all open work items
  • Completed for all work items previously completed
  • Pended for work items currently pended
  • Non-Finalised for all pended and open work items

Has the authority application been located?

3

Access Online PBS Authorities

In the Medicare - eBusiness Gateway, select the Source Office > PBS Authorities (OPA) from the eBusiness System dropdown menu > Submit > Request Authority.

Prescriber Search screen will show.

4

Prescriber Search screen

When an approved prescriber sends Services Australia a written authority approval request, to help Service Officers find the correct prescriber details:

Prescriber Search screen:

  • Key the Prescriber number found on the Authority request
  • If Prescriber number is missing for Medical Practitioners only, go to Table 6 > Step 3 in Processing an existing Authority request in the Pharmaceutical Benefits Scheme (PBS)
  • Change the date of prescribing to the date on the prescription
  • Reject all post-dated Authority prescriptions:
    • Key the date of lodgement as the date of prescribing
    • Continue from Step 5 to Step 9
    • Add an Authority comment 'post-dated prescription dated DDMMYY'
    • Create a rejection letter. See Table 4 in Processing new Authority requests in the Pharmaceutical Benefits Scheme (PBS)
  • If the date of prescribing is missing:
    • key the date of lodgement as date of prescribing
    • continue from Step 5 to Step 9 and finalise the request in OPA
    • key an Authority comment; 'date of prescribing missing' and any other rejection reasons
    • create a rejection letter. See the Resources page for letters
  • Change the date of lodgement to the date the agency received the authority application
  • Select Search
  • Confirm Approved prescriber details match
  • Select Next

5

Patient details

Does the patient details include a Medicare card number or Name and date of birth, on the Authority request?

  • Yes:
    • Key the Medicare card number in the Medicare field.
      Check the patient details on the Authority request match the Patient Search screen
    • If the Patient name does not completely match the Authority request details (Example: last name is misspelt or different last name), continue processing the Authority request in OPA. When creating the rejection letter, the patient’s name should reflect what is included on the Authority request
      If no results show, increase the second last digit of the Medicare number by one
      OR
    • If unable to search by Medicare card number, select Patient as the search type, and key the patient's:
      First Name
      Last Name, and
      Date of Birth or Post Code
      Select Search
    • Locate the patient record. If it shows:
      they have a Gold or White Department of Veterans' Affairs (DVA) card, go to Step 7
      no DVA entitlement, go to Step 8
    • If unable to locate patient record, does the prescriber consider the patient eligible under PBS for the Special Medicare Card and listed the patient's name and date of birth?
      Yes, go to Step 6
      No, procedure ends here. See Digital Messaging Capability (DMC) - Health to create a rejection letter and use rejection reason Patient details or Medicare card number incorrect
  • No:

6

Special Medicare card eligibility

For patients that do not have a current Medicare card number, but the prescriber considers them entitled to PBS, an Authority comment must be included outlining the reason for eligibility.

If the Authority request is for:

  • a Newborn up to 52 weeks and not enrolled in Medicare:
    • Key Newborn as the child's first name when keying patient details. If the Authority request is for an 'unnamed newborn', Service Officers must key Newborn as the child's first name
    • If multiple newborn children, key Newborn 1, Newborn 2 as the child's first name
  • a child over the age of 52 weeks, create a rejection letter with rejection reason Patient details or Medicare card number incorrect. See Digital Messaging Capability (DMC) - Health to create a rejection letter through DMC
  • a Reciprocal Health Care Agreement (RHCA) - if the prescriber includes details to indicate they consider the patient eligible for PBS under RHCA, for example passport details or a note about the country the patient is from:
    • Continue to process with the Special Medicare card number, and
    • Add a PaNDA and Authority comment outlining eligibility
  • Australian Defence Force (ADF) patients - if a prescriber states ADF for their patient on the Authority request, process the request under the Special Medicare card
  • Incarcerated customer. See Eligibility for Pharmaceutical Benefits Scheme (PBS)

On the Patient Search screen:

  • Key the special Medicare card number 25437766611 in the Medicare number field
  • Select Search
  • The bottom of the screen shows the following fields to key:
    • First Name
    • Last Name
    • Date of birth
    • Gender

Go to Step 8.

7

Department of Veterans' Affairs (DVA) card

If the patient is a:

  • Gold card holder, see Table 3 > Step 2
  • White card holder, check Patient Comments in Mainframe to confirm PBS eligibility for the requested item. See:
    • Key the patient Medicare card number in RPQN > [Enter]
    • Select the corresponding number next to the patient’s name, press [F5]
    • Press [F12] to view patient comments
    • Scheme type will show D for all eligible indication and treatments

If the item is:

8

Item search

If the item requested is not available, select the closest available item and strength for the Complex Drugs Program as per the application.

In the Item search screen:

  • Keyword or item code field, start keying the drug name or brand if known. Refine the search by adding the form and strength
  • For extemporaneous items, add preparation name. For example, cream
  • Select the drug requested from the predictive search results
  • Add the Dose and select the Dose frequency from the dropdown menu requested by the prescriber
  • Do not key non-daily dose as X, D or N. Select the appropriate Dose frequency
  • Dose and Dose frequency can be found in the Prescription details '?' help symbol on the Item Search screen

Quantity and repeats

The Prescribed Quantity and Prescribed Repeats defaults to the PBS listed quantity and repeats for the item. Change these if needed.

For Streamlined listed quantities and repeats, see Authority required (STREAMLINED) items in the Pharmaceutical Benefits Scheme (PBS).

Cannot complete a mandatory field

If insufficient details to complete a mandatory field:

  • Select Reject from the Item Search screen
  • Select reason Insufficient details to complete mandatory field > Reject
  • From the Application Assessment Result page, select from the dropdown menu:
    • Revise Authority application, and
    • Authority Summary
  • Authority Comments, key the Service Officer P number/logon, an Authority comment for the reason to reject
  • Key the Authority prescription number
  • Select the correct Internal Application Type, Written - HPOS or Written- Post. Service Officers must make sure they select the correct option, as this flows through to the letter that is generated
  • Select Submit
  • Generate a Rejection letter, see Table 4

For:

9

Efficient Funding of Chemotherapy (EFC)/RA Infusion items

Key:

  • Prescribed Quantity as the number of units (mcg, mg or iu) per infusion
  • The Dose as instructed by the prescriber including any decimals

Go to Step 13.

10

Highly Specialised Drugs (HSDs) the Hospital Provider Number

For Highly Specialised Drugs (HSDs) the Hospital Provider Number field appears.

Key the hospital provider number:

Key the correct:

  • Dose
  • Frequency
  • Quantity
  • Repeats
  • Hospital provider number (if applicable)
  • Select Next

Go to Step 13.

11

Opioid Authority requests

HPOS and mailed requests can include up to a 3-month supply or via prescriber self-serve (OPA). A quantity sufficient for up to 1 month treatment with sufficient repeats is permitted.

Restriction requirements General (s85):

  • When an opioid request becomes Authority required the prescriber must confirm the patient has chronic severe disabling pain, chronic severe pain in not acceptable.
  • Daily, Continuous, Long term must be stated for the initial treatment restriction criteria. This applies to opioid patches. For example, Norspan and Fentanyl.
    If the prescriber did not state this or answered 'No' to the questions, reject the request. Go to Step 15
  • If the prescriber states 2 indications apply to their patient, for HPOS form upload or posted approval, select one option and include an Authority comment

Prescribers must give enough details to meet the restriction criteria in the Q&As in the OPA System to produce an authority approval

If the prescriber has not stated:

  • Initial or continuing on the submitted form or copy of the prescription, Service Officers may approve under initial if all other details are available
  • If the prescriber has not stated the patient has previously received PBS-subsidised treatment with this form of drug, for this condition after 1 June 2020, check the patient history to confirm

If the prescriber has not given enough details to meet the criteria on the submitted form or Authority request details, Service Officers must:

  • reject and return the relevant rejection letter to the prescriber
  • include Authority comment for the rejection reason
  • generate a Rejection letter. See Table 4

12

Extemporaneous Ingredients Selection

Select the first ingredient from the dropdown menu given by the prescriber.

The approved prescriber may list ingredients by the commonly known name instead of the generic name appearing in the drug tariff.

If unable to find the requested ingredient in the list, see the Resources page for common alternative ingredient names.

  • Key the:
    • dose and dose frequency. For example, 500 per month
    • quantity and repeats. For example, 500g and 5 repeats
  • Select Next
  • Key and select the first ingredient from the dropdown menu
  • Key percentage requested
  • Select add ingredients
  • Repeat until 100% ingredients have been specified
  • Select Next

13

Restriction screen

Select the Restriction screen.

Note: the existing Question and Answer screen shows correct answers flagged by a tilde ~ symbol. Dynamic Question and Answer (DQ&A) correct answers are not flagged by a tilde symbol. See Resources > Dynamic Question and Answers (DQA) resources in Dosage calculators and charts for Pharmaceutical Benefits Scheme (PBS).

Select the appropriate restriction provided on the Authority request:

  • Select Next if the authority is for the same prescriber, same patient, same restriction on the same date of prescribing as an already recorded authority, select:
    • Yes, if copying the restriction answers from the previous authority. The previous answers show on the Answer Questions screen
    • No, if not copying the restriction answers
  • Key or review the answers to the restriction questions and select Next
  • Key the answers given on the prescription and/or application form, even if the answers are incorrect

Insufficient details

If insufficient details to answer one or more questions:

  • Select Reject from the Q&A section
  • Reason Insufficient details to complete mandatory field > Reject
  • From the Application Assessment Result page, select Revise Authority application and Authority Summary from the dropdown menu
  • Authority Comments field, key the Service Officer P number/logon, an Authority comment with the reason for the rejection
  • Authority prescription field, key the Authority prescription number
  • Select the correct Internal Application Type, Written - HPOS or Written- Post. Service Officers must make sure they select the correct option, as this flows through to the letter that is generated
  • Select Submit
  • Generate a Rejection letter. See Table 4

14

Authority Summary details

Service Officers must make sure they select the correct Internal Application Type. Selecting the incorrect Internal Application Type may result in the Prescriber not receiving their assessment outcome.

From the Authority Summary screen:

  • Select Written - Post or Written - HPOS for the applicable Internal Application Type
  • The Declaration Statement automatically ticks
  • Key the Authority prescription number in the Authority prescription number field found on the authority prescription. Staff do not need leading zeroes.
    Note: the prescriber can use the same Authority ID number as long as they are not for the same item, strength, date, and other identical details
  • Confirm all the details from the Authority request match, including:
    • Date of Prescribing, and
    • Date of Lodgement

Authority prescription number invalid

  • If the Authority prescription number is invalid, a pop up alerts the Service Officer
  • Select Amend number to confirm the Authority prescription number on the Authority request provided
  • If the number is still invalid, select continue and key an Authority comment indicating the confirmed prescription number
  • OPA will reject the Authority request, if the only reason for the rejection is an invalid authority prescription number and an authority comment has been keyed
  • Override the rejection
  • If the Authority prescription number is missing:
    • key the prescriber number as the authority prescription number, and
    • add Authority comment 'No authority prescription number', and
    • reject the Authority request
  • Key the operator P number/Logon including any Authority comments
  • Generate a rejection letter. See Table 4

Patient has a previous exemption to the PBS criteria

If the details about the patient suggests they have a previous exemption to the PBS criteria for that medicine:

15

Assessment result

See below for an assessment result that is:

  • Approved and an approval number generates
  • Rejected, or
  • Authority not required

Approved and an approval number generates

Check and action any Reason Codes as needed. Go to the PBS Reason Code Maintenance System for fix instructions, under Automated PBS Authorities.

To generate correspondence, go to Table 4.

Rejected

If the assessment result is Rejected, action any Reason Codes as needed. Go to the PBS Reason Code Maintenance System, under Automated PBS Authorities:

  • Rejected as 'too soon', see Existing Authority request
  • If the Service Officer decides the Authority request meets the criteria and should be approved, they can select:
    • Approved from the Assessment Result Override dropdown menu
    • Override
    • the reason from the Override Reason dropdown menu, or
    • Other, to give the reason in the text box
  • Staff must key Authority comments in the Authority comments section in the Summary screen and P/Login number
  • Reason 075 Prescribed quantity and/or repeats is greater than the maximum allowed without Services Australia intervention, returns because of the limits set on the quantity and repeats by the Department of Health, Disability and Ageing
  • Service Officers can override these rejections only if the requested quantity and repeats are in line with the internal approval rules. Check the relevant dosage chart, PBS website and the National Drug Reference Database (NDRD) to decide if the request is within PBS guidelines
  • See Table 4

Authority not required Streamlined

See Process in Authority required (STREAMLINED) items in the Pharmaceutical Benefits Scheme (PBS), if the:

  • assessment result is Authority not required, and
  • item is Authority Required (STREAMLINED) for the listed quantity and repeat(s)

16

Prescriber request for another authority

Prescribers may request another authority for the same patient or a different patient.

From the Application Assessment Result screen if another authority is requested for Same Patient or a different patient, select New Authority Same Prescriber.

If needed, change the date of prescribing and date of lodgement from the Prescriber Search screen.


PBS Authority request allocated in Work Optimiser

Table 3

Expand table

Step

Action

1

Determine if the Authority request can be processed according to patient entitlement and skill tags

For patients with a DVA entitlement, go to Step 2.

If the application is for a Complex Drugs item, go to Step 3.

To escalate to Local Peer Support (LPS) or Pharmaceutical Adviser (PA), go to Step 4.

If the Requests is for a Streamlined Authority item for the listed quantity and repeats, see Authority required (STREAMLINED) items in the Pharmaceutical Benefits Scheme (PBS).

2

Is the prescription to be processed by DVA/RPBS?

When a Department of Veterans' Affairs (DVA) file number is recorded on the authority prescription or the Repatriation Pharmaceutical Benefits Scheme (RPBS) tick box has been highlighted, check the Patient Search screen in OPA to confirm PBS eligibility.

If the patient is DVA eligible, generate a rejection letter. Select the DVA patient reason.

For HPOS Form Upload requests, if the patient is DVA eligible:

Procedure ends here.

3

Is the prescription to be processed by the Complex Drugs team?

Service Officers skilled in the work type presented:

Service Officer not skilled in the work type presented and work type is uploaded to correct folder:

  • HPOS (Form Upload) or mailed applications
    • if not skilled in Complex Drugs Authority requests unassign to return the item to the national allocation pool and refer to a Team Leader to review skill tags

Service Officers not skilled in the work type presented and work type uploaded to the incorrect folder:

  • HPOS (Form Upload) and mailed application requests:
    • Add a Processing note on file, 'Re-categorised from PBS/Authority Proforma'
    • Unassign with reason Re-categorised
    • Select the relevant HPOS or WRIT folder - if not sure, escalate to a Complex drugs LPS
    • Select Submit
  • Delayed Assessment items: if not skilled in OPA Delayed Assessment items, unassign to return the item to the national allocation pool and refer to a Team Leader to review skill tags

4

Escalating to LPS

If the Written Authority requires help from LPS:

  • Request help from LPS and follow advice provided
  • Complete the Technical Support Tool (LPS and SSO) - Health online form
  • If LPS is unable to resolve the query, escalate the work item to a PA through the applicable escalation folder via Workload Management (WLM). Go to Step 5
  • Service Officers must add Processing notes to the work Item that outlines the action required before re-categorising

5

Escalating to PA

If the Written Authority requires help from a PA:

  • Service Officers must escalate the below using the applicable escalation folder via Workload Management (WLM):
    • For free text options on rejection letters where the rejection reason is not available
    • If an LPS is unable to resolve the query
    • Processing clinical enquiries that require PA assistance
    • Patient details suggests a historical exemption to PBS criteria
  • Service Officers must add Processing notes to the work Item that outlines the action required before re-categorising
  • Leave the Status as Open. Do not change it
  • For PA escalation, re-categorise the application for:

Responding to Authority requests in HPOS and posting an assessment letter for mailed Authority request

Table 4

Expand table

Step

Action

1

Written Post and HPOS assessment outcome

Service Officers must make sure they select the correct Internal Application Type. Selecting the incorrect Internal Application Type may result in the Prescriber not receiving their assessment outcome.

For an Authority request that is:

Service Officers generate the Z3035 PBS authority letter from OPA or DMC. See Digital Messaging Capability (DMC) - Health.

2

Authority request - Approved

Posted Written Authority correspondence is returned to the prescriber through post-central mail house.

HPOS form upload correspondence is returned to the prescriber via the original HPOS response. Letters must be downloaded and added to the HPOS response for all HPOS form upload Authority requests.

  • Select Create Letter on the Application Assessment Screen
  • If Multiple Authorities pop up shows, confirm which authorities are to be included in the letter
  • Letter Delivery method:
    • Written - Post, select post - central mail house
    • Written - HPOS, defaults to Local
  • Authority status, select Approved
  • Authority Information, select:
    • Complex Authority for Complex Drugs requests
    • General Authority for General Authority requests
  • Manually key the address located on the Authority request. For:
    • Written - HPOS letters, the prescriber's address is non-mandatory
    • Written - Post letters, if the prescriber's address is missing contact the prescriber or clinic to confirm
  • Select Next
  • Select Preview Letter to open the letter in a new tab. Confirm the details are correct, if details are:
    • correct, close the tab, and select Finalise
    • incorrect, close the tab and select Update letter details
  • Copy the Letter request ID and include this in the work item processing notes in PaNDA
  • For:

Returning Original Prescriptions scanning team

  • Scan the original prescription with date of prescribing on or after 1July 2024
  • Return the original prescription (and any supporting documents) to the prescriber
  • Generate an envelope
  • Confirm the prescribers name and address on the envelope match the original prescription
  • Place the envelope in the correct mailroom tray

3

Approved with changes

Posted Written Authority correspondence is returned to the prescriber through post-central mail house.

HPOS form upload correspondence is returned to the prescriber via the original HPOS response. Letters will need to be downloaded and added to the HPOS response for all HPOS form upload Authority requests.

  • Select Create Letter on the Application Assessment Screen
  • If Multiple Authorities pop up shows, confirm which authorities are to be included in the letter
  • Letter Delivery method:
    • Written - Post, select post - central mail house
    • Written - HPOS, defaults to Local
  • Authority status, select Approved with changes
  • Authority Information, select:
    • Complex Authority for Complex Drugs requests
    • General Authority for General Authority requests
  • Manually key the address located on the Authority request. For:
    • Written HPOS letters, the prescriber’s address is non-mandatory
    • Written Post letters, if the prescriber’s address is missing, contact the prescriber or clinic to confirm
  • Select the applicable Approved with changes reasons
  • Select Next
  • Select Preview Letter to open the letter in a new tab. Confirm if the details are correct. If details are:
    • correct, close the tab, and select Finalise
    • incorrect, close the tab and select Update letter details
  • Copy the Letter request ID and include this in the work item processing notes in PaNDA
  • For:

4

Rejected

Posted Written Authority correspondence is returned to the prescriber through post-central mail house.

HPOS form upload correspondence is returned to the prescriber via the original HPOS response. Letters must be downloaded and added to the HPOS response for all HPOS form upload Authority requests.

Note: if the patient’s name on the Authority request does not match OPA (Example: last name misspelt or different last name), update the patient’s name on the Letter details to match the Authority request received.

  • Select Create Letter on the Application Assessment Screen
  • If Multiple Authorities pop up shows, confirm which authorities are to be included in the letter
  • Letter Delivery method:
    • Written - Post, select post - central mail house
    • Written - HPOS, defaults to Local
  • Authority status, select Rejected
  • Authority Information, select:
    • Complex Authority for Complex Drugs requests
    • General Authority for General Authority requests
  • Manually key the address located on the Authority request. For:
    • Written - HPOS letters, the prescriber’s address is non-mandatory
    • Written - Post letters, if the prescriber’s address is missing, contact the prescriber or clinic to confirm
  • Select all applicable rejection reasons
  • If a rejection reason is not included on the letter, escalate to a PA for the free text option. See Table 3 > Step 5
  • Select Next
  • Select Preview Letter to open the letter in a new tab. Confirm if the details are correct, if details are:
    • correct, close the tab, and select Finalise
    • incorrect, close the tab and select Update letter details
  • Copy the Letter request ID and include this in the work item processing notes in PaNDA
  • For:

5

Download the letter and respond to an Authority request by HPOS Form upload
  • Select Download PDF from the Confirmation screen
  • Save a copy of the letter in the Customer information folder using the patient SurnameFirstname
  • Go to the work item, select Open in HPOS link located top right-hand corner
  • Reply to the Authority request using the suggested text for email and HPOS responses to a prescriber or delegate. See the Resources > Table 3 > Item 1
  • Select Choose File to find the letter > Open > Add file
  • Open the attached file from the prescriber to confirm the response is for the correct patient, if:
    • incorrect, escalate to Local Peer Support (LPS)
    • the link does not work, find the HPOS file by keying the 9 digit HPOS reference number in the Quick Search field on the top right hand corner of HPOS Support

Note: the HPOS reference number can be found in the HPOS Reference Number field in the work item, or the History tab in Workload Management (WLM).

Does an error message show when sending a HPOS reply?

6

Update work item

Update the work item:

  • With the correct primary reference number (Medicare card number) and if applicable, Program Reference Number
  • Add the Letter request ID to the work item processing note and include any rejection reasons
  • Change status to Complete
  • Select Save
  • Delete the saved letter from the Customer information folder
  • Procedure ends here

7

Error message when sending a HPOS response

Has a duplicate application been received (check HPOS/OPA)?

  • Yes, make a note in the work item as Duplicate application
  • No, if the authority has been approved, phone the prescriber and tell them the approval number. If:
    • rejected, give the rejection reason
    • the prescriber is not available, release the following details to the prescribers nursing or administrative staff. See Release of information in Pharmaceutical Benefits Scheme (PBS) for more details. Status of authority (approved or rejected), The date that Services Australia approved the prescription, Medicine description form and strength, PBS item code, Quantity and number of repeats, make a note in the work item, with the date and time of the call
    • the authority is not required, tell the prescriber 'Authority required (STREAMLINED) items for the listed quantity and/or repeats do not require approval from Services Australia. Streamlined authority codes are available in the Schedule of Pharmaceutical Benefits via the PBS website'

Troubleshooting HPOS form uploads and Authority request in Work Optimiser

Table 5

Expand table

Step

Action

1

Determine the problem

If the:

  • HPOS Upload is unclear or cannot be read, go to Step 2
  • file is a form other than a prescription request, go to Step 3
  • file is a prescription that has previously been actioned, go to Step 4
  • prescriber has sent multiple requests through HPOS, go to Step 5
  • Unable to locate Authority application in Work optimiser, go to Step 6
  • file is a Posted Authority request scan and it is of poor quality or is missing detail, go to Step 7
  • incorrect HPOS response is sent, go to Step 8

2

Unclear and cannot be read or unable to open the documents

Search for the HPOS Form Upload:

  • Select the Open in HPOS link located in top right hand corner
  • Open the attached file from the prescriber and check the response is for the correct patient
  • Select Reply
  • Unclear and cannot be read, copy and paste the details below into the Text field:
    The image uploaded was not clear. Please re-scan or take a new photo of the documentation and make sure the image is clear. Once completed please resubmit all documentation
  • Unable to open the documents, copy and paste the details below into the Text field:
    The documents provided are unable to be accessed. Please re-upload the documents for assessment
  • Select Send
  • Include a processing comment for requested re-submission
  • Change the status to complete, select Save
  • Procedure ends here

3

A form other than a prescription request

Escalate to Local Peer Support (LPS) for instruction on how to action if the form:

  • is not a prescription request. For example, stationery or a pathology form or
  • has been categorised incorrectly

4

HPOS Authority request has already been actioned

The prescription has been actioned and the prescriber has sent in multiple requests:

  • Select the Open in HPOS link located in top right hand corner
  • Open the attached file from the prescriber and check the response is for the correct patient
  • If incorrect patient, escalate to a Pharmaceutical Adviser (PA)
  • Select Reply
  • Copy and paste the details on the Resource Page Table 3 > item 4 into the Text field
  • Complete the work item and include a processing note
  • Procedure ends here

5

File has multiple patient prescriptions

If multiple patient prescriptions exist in one file:

  • Save the file:
    • Right click the file and select Save As
    • Save the file in the Customer Information folder
  • Extract the additional prescriptions from the PDF file and save the new files to the computer:
    • In Acrobat DC, select Tools > Organize Pages > Extract
    • Highlight the pages to be extracted
    • If the pages are to be extracted as separate documents, tick the Extract Pages As Separate Files box before selecting Extract
    • Save the item(s). These item(s) can be found in the saved folder which has the same name and numeric to differentiate, for example, 2 or as pages from <original title>
    • Locate the saved file (the file has the same title and a numeric, for example, 2)
  • In Work Optimiser create separate files for each person. To create new work items:
    • Select PaNDA Document Upload under the Health Services menu
    • Select Create New Work Item from Upload Type field
    • Select Browse and select a file from the pop up window
    • Change the Date of Lodgement (defaults to today's date)
    • Select Program from the dropdown menu
    • Select Work Type from the dropdown menu
    • Key Primary Reference Number (Medicare card number)
    • Key HPOS reference number, from original file. The work item must have a HPOS reference number for sending an email response to a prescriber or delegate
    • Add a processing note, if applicable
    • Select Upload to submit the new work item into the allocation pool
  • Repeat process as needed until all files are uploaded
  • Delete files from in the Customer Information folder
  • On the original file, include a processing note to indicate the other documents in the file have been extracted into new files.
    Also include suggested text for email and HPOS response to a prescriber or delegate. See Resources > Table 3 > Item 3

6

Unable to locate Authority application in Work Optimiser

Use alternative search criteria including:

  • Authority prescription number, Prescriber number or Surname First name
  • Search other work types, for example, different state or escalation folders

If still cannot locate, Service Officers must escalate to Local Peer Support (LPS).

7

Posted Authority request scan is of poor quality or is missing detail

If the poor quality or incomplete scan is an obvious Service Delivery error, escalate to Local Peer Support (LPS) to request a Re-Scan.

If the application or prescription details are missing and it is not a Service Delivery error:

  • Reject the application with the applicable letter
  • Print out a copy of the application form and supporting documents (if applicable), and
  • Post the application, associated documents and rejection letter to the prescriber

8

Incorrect HPOS Response sent

If an incorrect response to the Prescriber via HPOS is sent in error, for example: rejected instead of approved, staff must not include their own free text.

Complete a processing note on the work item including action taken.


Authority and patient comments in OPA

Table 6

Expand table

Step

Action

1

Recording details and comments

To record comments or details:

2

Authority comment

Service Officers must include these details when recording an Authority comment:

  • Staff member P/Logon
  • Specific details given by the prescriber or Pharmaceutical Adviser (PA)
  • Reasons for overriding a rejection or amending Quantity or Repeats
  • Lost, stolen, destroyed prescriptions or medication
  • Reason for cancelling an Authority request
  • Too soon rule applied where manual calculation is performed
  • Reciprocal Health Care Agreements (RHCA) details required, for example, passport number
  • Patient eligibility under the special Medicare Card

3

Recording an authority Comment - Authority Summary screen

On the Authority summary screen:

  • Key all relevant comments for the request in the Authority or Patient comment box when processing an authority, as per Step 2
  • Select Submit

4

Recording an authority comment via Amend

Select Search Authorities:

  • Search for the patient using the Medicare card number given
  • Find the authority record from the patient Search screen > Amend
  • Key comments in the Authority or Patient comments fields > Save

5

Recording an authority comment via View

Select Search authority:

  • Search for the patient using the Medicare card number given
  • Find the authority record to view
  • Select View

Key comments into the Authority or Patient comment fields

Select Save comments.