Pharmaceutical
What is the Repatriation Pharmaceutical Benefits Scheme?
The Repatriation Pharmaceutical Benefits Scheme (RPBS) provides a wide range of pharmaceuticals and dressings at a concession rate for the treatment of eligible veterans, war widows/widowers, and their dependants.
Eligible veterans may access:
- Items listed in the Schedule of Pharmaceutical Benefits (SPB) available to the general community under the Pharmaceutical Benefits Scheme(PBS).
- An additional list of items contained in the Repatriation Schedule of Pharmaceutical Benefits (RSPB) which is available only to veterans.
- Items not listed on the SPB or RSPB on a case-by-case basis.
To view the full Schedule of Items listed under the RPBS, see www.pbs.gov.au.
What am I eligible for?
If you have a Repatriation Health Card – For All Conditions (Gold Card) you can obtain pharmaceuticals under the RPBS for all your medical conditions.
If you have a Repatriation Health Card – For Specific Conditions (White Card) you can obtain pharmaceuticals under the RPBS for your accepted disabilities.
If you are an Australian veteran you are also covered for malignant cancer, pulmonary tuberculosis and post traumatic stress disorder (PTSD) if these conditions are accepted by DVA. Medicines for the treatment of your other conditions are available under the PBS, either at the general rate, or concession rate (if holder of Pensioner Concession Card/Commonwealth Seniors Health Card/Health Care Card).
If you have a Repatriation Pharmaceutical Benefits Card (Orange Card)you can obtain pharmaceuticals under the RPBS for all medical conditions. The Orange Card does not entitle you to any medical or other health care treatment. If you also have a White Card you should continue to use it to obtain treatment and pharmaceuticals related to your accepted disabilities and use your Orange Card to obtain pharmaceuticals for all other conditions.
For more information refer to DVA Factsheets HSV92 Repatriation Pharmaceutical Benefits Scheme (RPBS) and IS30 Pension Rates, Limits and Allowances Summary.
Do I need to show the pharmacist my DVA treatment entitlement card or Repatriation Pharmaceutical Benefits card?
Yes. You need to show the pharmacist your Gold, White, or Orange Card to receive medicines on the RPBS and your Pensioner Concession Card to receive medicines at the concessional patient contribution rate.
You may be charged more if you do not present a valid card.
Does my doctor need DVA authorisation to prescribe pharmaceuticals under the RPBS?
Your doctor does not need prior authorisation from DVA to prescribe a large range of scheduled pharmaceuticals available under the RPBS. However, your doctor will need prior authorisation from DVA to prescribe:
- medicines listed as requiring prior authorisation;
- greater quantities and/or repeats than that listed; and
- medicines not listed in the schedules.
I used to get a medicine under RPBS, but am no longer able to. Why is that?
Sometimes a medicine is no longer available under the RPBS because:
- the medicine is no longer marketed in Australia
- there are better and safer medicines available
- the medicine has been found to have serious side effects and its use is discouraged.
How long is an RPBS prescription valid?
An RPBS prescription is valid for 12 months.
Do I have to pay anything for my prescriptions?
Yes. You have to pay a patient contribution charge (co-payment) for each prescription, until your combined family total reaches the Safety Net Limit/Threshold under the Safety Net Scheme.
This is adjusted at the beginning of each year in line with inflation. The co-payment for 2008 is in rates table 7, Talk to your pharmacist who will assist you with safety net entitlements.
What is the safety net limit / threshold?
The Safety Net Scheme is designed to protect you (and your family) if you require a large number of RPBS items. It ensures that you do not pay concessional co-payments for more than a maximum number of prescriptions in a calendar year, after which the prescriptions are free. The scheme is available to all Australians including DVA card holders and their families.
The Safety Net Limit/Threshold is the maximum number of prescriptions (or the total amount of money) you and dependent family members pay for RPBS prescriptions and hospital medicines in a calendar year. After you reach this limit, your medicines are free for the rest of the calendar year. This cost is offset by the Pharmaceutical Allowance.
For the concessional safety net limit for the current calendar year see rates table 7.
What is a prescription record form?
You use a Prescription Record Form (PRF) to keep track of how much you and your dependent family have spent on medicines for safety net entitlement purposes.
It is your responsibility to keep track of how much has been spent and to know when the safety net limit has been reached. Every time a RPBS item or hospital medicine is dispensed ask the pharmacist to record the safety net value on the form.
Where can I get a PRF?
A PRF is available free from any community or public hospital pharmacy. There are two forms, each clearly identified by name:
- one for RPBS/PBS prescriptions dispensed by community pharmacists; and
- the other for medicines obtained at public hospital pharmacies.
Who is included as my family member?
A family member is a:
- spouse
- de facto spouse
- child under 16 years in your care and control
- dependent full-time student under 25 years of age.
What is a Safety Net Card and how do I get one?
The Safety Net Card (with a unique number for you and your family) officially entitles you and your dependant family to free prescriptions for the rest of the calendar year.
When you reach the Safety Net Limit you need to ask your pharmacy to issue you with a Safety Net Card. Your pharmacist will require you to present your PRF and exchange it for a Safety Net Card. That is why it is important to always keep track of your medications using the PRF.
Must I show my Safety Net Card to a pharmacist?
Yes. After you receive the Safety Net Card, you should present it together with your DVA Gold, White or Orange Card to the pharmacist to obtain prescription items at no charge.
If you do not present the cards, the pharmacist may still charge you for each prescription item.
Are there any other charges besides the Pharmaceutical Co-payment?
Yes. Some medications can have a Brand Premium and/or Therapeutic Group Premium (they are not the same). They are in addition to your co-payment, so they will increase the price you pay per prescription. They also need to be paid even if you have received the Safety Net Card.
What is the Brand Price Premium & can it be avoided?
Generic medicines contain the same active ingredients as other more expensive brand medicines. The Government will only pay for the lowest priced brand where more than one brand is available. The Brand Price Premium is the gap between the cheapest/generic brand price and the others.
You can ask your doctor if it is possible to prescribe the cheapest/generic brand, so you do not have to pay a gap fee to cover the extra cost. Provided your doctor has not indicated otherwise on the prescription, a pharmacist may dispense a cheaper generic medicine than the one listed on the prescription. No prior financial authorisation process is required to gain exemption from Brand Premiums.
The Brand Premium gap fee paid cannot be counted towards the Safety Net Limit.
What is the Therapeutic Group Premium & can it be avoided?
Therapeutic Group Premiums were introduced on 1 February 1998 to encourage everyone to be aware of the significant difference in prices between similar medicines which, although not identical chemically, are commonly used to effectively treat the same condition.
Therapeutic Group Premiums cover medicines that are clinically similar, but not chemically identical. A pharmacist is not able to vary the doctor’s prescription or to substitute one medicine for another under the same therapeutic group (unlike the generic brands).
However, your doctor may decide that none of the alternative drugs in the same therapeutic group are appropriate for the management of your condition. If your current medication is affected, your doctor can seek financial authorisation from DVA so that you do not have to pay its Therapeutic Group Premium.
The Therapeutic Group Premium gap fee paid cannot be counted towards the Safety Net Limit.
Do I have to pay a patient contribution charge (co-payment)?
Yes. For RPBS prescriptions, a co-payment is required until the safety net limit is reached. Prescriptions are then free for the rest of the calendar year.
For PBS prescriptions, co-payment is at the concessional rate, or up to the general rate. The current patient contribution charge (co-payment) is in rates table 7.
Why do I have to pay a gap fee for a dearer priced brand of drug?
The Government will only pay for the lowest priced drug where more than one brand is available. Ask your doctor if it is possible to prescribe the lowest priced brand so you do not have to pay a gap fee to cover the extra cost.
The gap fee paid cannot be counted towards the safety net limit.
What medicines will change because of Therapeutic Group Premiums?
Therapeutic Group Premiums were introduced on 1 February 1998 to encourage everyone to be aware of the significant difference in prices between similar medicines which, although not identical chemically, are commonly used to effectively treat the same condition.
If your current medication is affected, and your doctor believes none of the base price medicines are appropriate to the management of your condition, your doctor can seek financial authorisation from DVA so that your medicine can continue to be supplied at the same concessional co-payment as before.
Are Therapeutic Group Premiums the same as generic (brand) price premiums?
No. Generic medicines contain the same active ingredients as other more expensive brand medicines. Provided your doctor has not indicated otherwise on the prescription, a pharmacist may dispense a cheaper generic medicine than the one listed on the prescription. No prior financial authorisation process is required to gain exemption from generic (or brand price) premiums.
Therapeutic Group Premiums cover medicines that are clinically similar but not chemically identical. A pharmacist is not able to vary the doctor’s prescription or to substitute one medicine for another under Therapeutic Group Premiums, as can be done with generic medicines.
What is the DVA pharmaceutical allowance?
A pharmaceutical allowance is paid to eligible veterans to compensate them for the payment for each RPBS prescription item. A pharmaceutical allowance is paid fortnightly see rates table 2.
Are there advance payment provisions?
Advance payments of pharmaceutical allowance can be made in certain circumstances, subject to strict eligibility criteria. For more information, contact your nearest DVA office.
The maximum amount of advance payable is 7 times the fortnightly rate of pharmaceutical allowance.
See: Repatriation Pharmaceutical Benefits Scheme