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

From 1 July 2024, there was a change to the process to action mail received for PBS Authority requests. This is to make sure Services Australia is compliant with the legislation.

For Authorities with a date of prescribing on or after 1 July 2024, Services Australia does not:

• endorse the authority approval number and item code on the prescription
• forward approved prescriptions to the patient
• accept the original prescription
• check the complete validity of the proposed prescription. For example, signature, Active Ingredient Prescribing (AIP) compliant

Prescribers must submit a copy of:

• details for the PBS authority prescription. For example, a photocopy of the PBS authority prescription, and
• the application form and supporting documents, if applicable

Service Officers must:

• scan the original prescriptions with date of prescribing on or after 1 July 2024, and
• return the original prescription (and any supporting documents) to the prescriber telling them that the assessment result will follow

See the Resources page for Mandatory Requirements for Written Authority requests.

Approved prescribers can get a PBS authority item from the following options:

• calling Services Australia
• by mail
• uploading using HPOS secure form upload, or
• using the Authorities System (OPA System) for delayed /immediate assessment programs where available

Common reasons for mail and HPOS requests include, the:

• patient has sufficient medication, so the request is not urgent
• approved provider finds it more convenient to use post or the HPOS secure form upload facility
• request is for an item that's mandatory to apply in writing

Staff must process all requests for all PBS items in the Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System).

As part of finalising a Written Authority request, mail correspondence generates to notify a prescriber of the request outcome.

These letters allow correspondence addressed to the same prescriber to include multiple items. For example, on a hospital authority prescription.

For requests sent using HPOS Form upload, responses are sent as a reply to the prescribers' original upload in HPOS. See Table 4 on the Process page.

For mailed Authority request, correspondence is returned to the prescriber.

Some medicines used to treat chronic conditions need Written Authority approval from Services Australia before they can be PBS-subsidised. Due to the clinical use or other special features of these medicines, applications for authority approval must be made in writing.

The medicine will not be PBS-subsidised without authority approval. Retrospective approval (often known as owing a script) is not allowed.

For more details about which medicines must have Written Authority approval, see:

• Written Authority Required Drugs
• Highly Specialised Drugs (HSD) Program
• Section 100 in Pharmaceutical Benefits Scheme (PBS)
• the References page has links to legislation outlining the supply of pharmaceutical benefits and the specific Complex Authority Required (CAR) medications that must be in writing
• Dosage calculators and charts for Pharmaceutical Benefits Scheme (PBS) for greater than one month's supply. The Schedule of Pharmaceutical Benefits outlines the maximum quantity and repeats allowed for of these medicines

Handling of sensitive issues

Sensitive issues can arise when an approved prescriber needs to provide the medical condition/indication being treated over the phone in the presence of the patient. This may create embarrassment or may make the patient uneasy.

Examples of medication that can cause sensitivity for the approved prescriber or the patient may include medicines for the treatment of:

• cancer
• mental illness. For example, schizophrenia
• infectious conditions. For example, genital herpes

Sensitive issue guidelines

The following guidelines intend to minimise the sensitivity for approved prescribers stating medical conditions/indications in the presence of the patient.

If an approved prescriber suggests that they are unwilling to state the condition over the phone, Service Officers:

• can prompt the approved prescriber with the condition, and
• ask the approved prescriber to confirm with a simple 'Yes' or 'No' response

Service Officers must exercise judgement when processing these applications.

Some patients have an entitlement to get pharmaceutical benefits. However, for various reasons:

• they do not have a Medicare card, or
• the Medicare card number is not available at the time of consultation or supply

For example, the patient is:

• a newborn aged up to 52 weeks and not enrolled in Medicare
• a visitor from a Reciprocal Health Care Agreement (RHCA) country and they have an entitlement to access the PBS. See Reciprocal Health Care Agreements (RHCA) eligibility Pharmaceutical Benefits Scheme (PBS)
• Australian Defence Force (ADF) personnel without a Medicare card
• incarcerated customers (prisoner). See Eligibility for Pharmaceutical Benefits Scheme (PBS)

The acceptable situations for rejecting an Authority application are:

• the approved prescriber does not state the criteria that meets the restriction
• the patient does not meet the criteria
• answers given to questions do not qualify the patient for an Authority prescription
• the application is considered to be ‘too soon’
• someone other than the approved prescriber is requesting the Authority
• the item, form or strength of the Authority prescription is not subsidised under the PBS
• the approved prescriber is abusive or demonstrates inappropriate behaviour and the Service Officer terminates the call
• an incomplete written application