Complications with our PBS system

Australia's Pharmaceutical Benefits Scheme (PBS) is a wonderful system where the government pays for the cost of medicines for the its people. All Australians who own a medicare card are entitled to the PBS scheme, and essentially patients do not need to pay more than $36.10 for medications no matter if the medicine's actual price costs hundreds or thousands of dollars. Concession patients pay up to a maximum of $5.90 per item, and the rest is paid by our government. 

Although there are people who complain they pay a lot for their medicines, I suspect they do not know the actual savings they are making with this generous subsidy from PBS scheme. 

An additional feature of the PBS system is called the Safety Net. The safety net ensures further subsidy to patients who spend more than a certain amount on medicines in a calendar year. For general patients, the safety net amount is $1,390.xx. Once they have spent more than that amount, the pharmacy will issue them a Concession safety net card which entitles them to have scripts that cost no more than $5.90 for the rest of the year. For concession patients whom pay $5.90 for scripts, once they reach 60 scripts in a year, the pharmacy issues an Entitlement safety net card. This allows them to receive any additional medications for FREE* for the rest of the year.

*Additional out-of-pocket charges may apply to certain medications, but anywhoo.

It is part of a pharmacist's daily job to dispense medications and issue out safety net cards to those who have reached the requirements. For customers who stick with one particular store, life for the pharmacist would be quite easy. The dispensing software would prompt the pharmacist to issue a card, and then it would print out a list of all the medicines that the patient paid for within the calendar year. We would then get the patient to sign the print out, take out a safety net card with a specific code, register it with the associated paper work (by writing the card number onto the print out) and then issuing the card to the patient. 

Once the pharmacist has collected 12 or more of these paper works, he/she then sends of the paperwork to medicare to officially activate the issued safety net cards.

To make life more complicated for a pharmacist, patients are not legally bound to go to only one pharmacy. As pharmacies do not share dispensing information with each other, it makes it difficult for the system to keep track of when the patient reaches safety net. To over come this problem, medicare has safety net record forms available for patients. This record form is a sticker collector that allows pharmacists to stick specific stickers onto the form as physical evidence of the purchase of medication. This allows patients to go from pharmacy to pharmacy and still reach safety net without missing out on their entitlement. 

Curse you Record Form! As fun as a sticker board sounds, after 6 - 7 months of collecting stickers, it becomes a messy, dirty, floppy board of peeling stickers that we need to sort through to ensure the patient checks out. The night mare begins when the pharmacist has to add up 74 slimy stickers worth of medicines to make sure the total adds up to $1390!!  

I am positive that in our current day and age, we are way past using hard copies to operate the safety net system. We lack a overlaying system that would unify all pharmacy dispensing data. With current cloud technology, I believe this is certainly possible to achieve, however impossible to implement. If the government is having trouble implementing a unified system for doctors, I doubt the safey net would see any differences in the near future.

Sigh... back to counting stickers

45, 46, 47 .... what number was I up to again? Darn it!