By Dr Jeannie Knapp.
Overview
The Closing the Gap Pharmaceutical Benefits Scheme (PBS) co-payment measure was established to reduce the cost of PBS medicines for eligible Aboriginal and Torres Strait Islander people living with, or at risk of, chronic disease.
When obtaining PBS medicines at their local pharmacy, eligible patients who would normally pay the full PBS co-payment ($40.30 per item, as of 1 January 2019) pay the concessional rate ($6.50 per item, as of 1 January 2019). Those who would normally pay the concessional price receive their PBS medicines without being required to pay any PBS co‑payment.
Which patients are eligible?
The Closing the Gap co-payment is available to Aboriginal and/or Torres Strait Islander people of any age who:
- Present with an existing chronic disease or are at risk of chronic disease;
- In the opinion of the prescriber, would experience setbacks in the prevention or ongoing management of chronic disease if the person did not take the prescribed medicine; and
- Are unlikely to adhere to their medication regimen without assistance through the program.
Eligible patients can be registered at either:
- A general practice participating in the Indigenous Health Incentive under the Practice Incentives Program (PIP); or
- An Aboriginal Medical Service (AMS).
Which prescribers are eligible?
Medical practitioners working in a practice that is participating in the Indigenous Health Incentive under the PIP, or any medical practitioner working in an AMS, are eligible to prescribe under this scheme.
Prescribers need to:
- Assess the patient’s eligibility for the measure once.
- Make sure the patient gives their consent to register for the measure.
- Confirm a patient’s eligibility before writing each Indigenous Health PBS prescription.
How do practices participate in the Indigenous Health Incentive PIP?
The PIP Indigenous Health Incentive aims to support general practices and Indigenous health services to provide better health care for Aboriginal and Torres Strait Islander patients, including best practice management of chronic disease.
At least two staff members from the practice (one must be a GP) must complete appropriate cultural awareness training (see below) within 12 months of the practice signing on to the incentive (unless the practice is an AMS).
Practices must be registered for the Indigenous Health Incentive PIP before prescribers can annotate prescriptions for Closing the Gap co-payment relief.
For practices to register patients for the PIP Indigenous Health Incentive and the PBS Co-payment Measure, patients must self-identify to the GP or practice staff as being of Aboriginal and/or Torres Strait Islander origin. Patients do not need to provide evidence to support this.
What payments does the practice receive for participating in the Indigenous Health Incentive PIP?
- Sign-on payment: $1,000 per practice.
- Patient registration payment: $250 per eligible patient per calendar year.
- Outcomes payment:
- Tier 1: $100 per eligible patient per calendar year.
A payment to practices for each registered patient where a target level of care is provided by the practice in a calendar year.
- Tier 2: $150 per eligible patient per calendar year.
A payment to practices for providing the majority of care for a registered patient in a calendar year.
More information on the PIP Indigenous Health Incentive guidelines and payments can be found on the Department of Human Services website.
Where can I find more information?
Cultural awareness training
For the purpose of the PIP Indigenous Health Incentive, at least two staff members from the practice (one must be a GP) must complete appropriate cultural awareness training within 12 months of the practice signing on to the PIP Indigenous Health Incentive.
There are no specific time, length or method criteria (such as face-to-face vs online vs distance education) associated with the cultural awareness training requirement, as long as it fulfils the components outlined above. This includes training endorsed by a professional medical college offering Continuing Professional Development (CPD) points; or training endorsed by the National Aboriginal Community Controlled Health Organisation (NACCHO) or one of its state or territory affiliates.
Training available in NWMPHN catchment
- RACGP Cultural awareness and safety training online ALM
- ACRRM online Cultural Awareness training
- VACCHO (Victorian Aboriginal Community Controlled Health Organisation Inc) Cultural Safety Training
Key resource
- HealthPathways Melbourne has an overview page on the PIP Indigenous Health Incentive and a page on the CTG PBS co-payment.
If you do not have access to HealthPathways please contact info@healthpathwaysmelbourne.org.au
Other resources for general practice
- Pen CS has a CAT4 recipe to identify patients eligible for the PIP Indigenous Health Incentive.
Disclaimer: This article was provided by Dr Jeannie Knapp. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.
