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Factsheet HSV92 - Repatriation Pharmaceutical Benefits Scheme

Purpose

This Factsheet describes how you can get access to concessional pharmaceuticals under the Department of Veterans' Affairs (DVA) Repatriation Pharmaceutical Benefits Scheme (RPBS).

What is the Repatriation Pharmaceutical Benefits Scheme?

The RPBS provides a wide range of pharmaceuticals and wound dressings at a concessional rate for the treatment of eligible veterans, war widows/widowers, and their dependants.

The RPBS allows you access to all pharmaceutical items available to the general community under the Pharmaceutical Benefits Scheme (PBS), and also an additional list contained in the Repatriation Schedule of Pharmaceutical Benefits (RSPB) which is available only to veterans.

What am I eligible for?

If you have a DVA Health Card – All Conditions within Australia (Gold) or Totally & Permanently Incapacitated (Gold) you can obtain pharmaceuticals under the RPBS for all your medical conditions. Please see Factsheet HSV60 Using the DVA Health Card - All Conditions (Gold Card) or DVA Health Card Totally & Permanently Incapacitated (Gold Card) for more information.

If you have a DVA Health Card –Specific Conditions (White) you can obtain pharmaceuticals under the RPBS for your accepted conditions. If you are an Australian veteran you may be eligible for non-liability health care treatment, whether war caused or not. Please see Factsheet HSV61 DVA Health Card – Specific Conditions (White Card) for more information.

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 DVA Health Card –Pharmaceuticals Only (Orange) 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. Please see Factsheet HSV69 DVA Health Card – Pharmaceuticals Only (Orange Card) for more information.

If you also have a White Card you should continue to use it to obtain treatment and pharmaceuticals related to your accepted conditions and use your Orange Card to obtain pharmaceuticals for all other conditions.

Do I need to show the pharmacist my treatment entitlement card or Repatriation Pharmaceutical Benefits card?

Yes. You do need to show your pharmacist your DVA Health Card - All Conditions (Gold), Totally & Permanently Incapacitated (Gold), Specific Conditions (White) or Pharmaceuticals Only (Orange) to receive medicines on the RPBS, and your Pensioner Concession Card to receive medicines at the concessional patient contribution rate.

If you do not present a valid DVA Health Card, you may be charged more and your purchase will not contribute to your Safety Net Threshold under the RPBS.

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:

  • a limited number of medicines listed on the schedule
  • greater quantities and/or repeats than those listed; and
  • Medicines not listed on the schedule.

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; and/or
  • there are better and safer medicines available; and/or
  • the medicine has been found to have serious side effects and its use is discouraged.

How long is an RPBS prescription valid?

A 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. This is adjusted at the beginning of each year in line with inflation.

The maximum co-payment for 2019 is $6.50 per prescription, until your combined family total reaches the Safety Net Threshold under the Safety Net Scheme. From 1 January 2016, pharmacists have been able to discount co-payment amounts by up to $1.00 for each dispensed medicine. Pharmacists can choose whether to offer a discount, and the amount to the $1.00 maximum. A discounted co-payment supply will count for safety net purposes and the amount accruing to the Safety Net Threshold is the amount charged. Talk to your pharmacist who will assist you with safety net entitlements.

What is the Safety Net Scheme and the Safety Net Threshold?

The Safety Net Scheme is designed to protect you (and your family) if you require a large number of PBS/RPBS items. It ensures that you do not pay concessional co-payments for more than the Safety Net Threshold in a calendar year, after which the prescriptions exempt from the co-payment. The scheme is available to all Australians including DVA card holders and their families.

The Safety Net Threshold is the total amount of money you and dependent family members pay for RPBS prescriptions and hospital medicines in a calendar year. The concessional Safety Net Threshold for 2019 is $390.00. After you reach this threshold you medicines are exempt from the co-payment for the rest of the calendar year. For eligible DVA clients, the cost of the co-payment is offset by the Pharmaceutical Allowance and the Veterans' Pharmaceutical Reimbursement Scheme. For more information on the Pharmaceutical Allowance please see Factsheet IS16 – Pension Supplement.

What is a Prescription Record Form?

You use a Prescription Record Form (PRF) to keep track of how much you and your dependents 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 can I include as my family member?

A family member is a:

  • spouse
  • de facto spouse
  • child under 16 years in your care and control; or
  • dependant 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. This 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 Health Card - All Conditions (Gold), Totally & Permanently Incapacitated (Gold), Specific Conditions (White) or Pharmaceuticals Only (Orange) to the pharmacist to obtain prescription items at no charge. If you do not present the card, the pharmacist still may charge you for each prescription item.

Are there any other charges besides the $6.50 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 $6.50 co-payment, so they will increase the price you pay above the $6.50 per prescription. They also need to be paid even if you have received the Safety Net Card.

What is the Brand Price Premium and 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.

The Brand Premium gap fee paid cannot be counted towards the Safety Net Limit.

What is the Therapeutic Group Premium and 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.

More Information

DVA General Enquiries

Phone: 1800 555 254 *

Email: GeneralEnquiries@dva.gov.au

DVA Website: www.dva.gov.au

Factsheet Website: www.dva.gov.au/factsheets

* Calls from mobile phones and pay phones may incur additional charges.

Related Factsheets

Disclaimer

The information contained in this Factsheet is general in nature and does not take into account individual circumstances. You should not make important decisions, such as those that affect your financial or lifestyle position on the basis of information contained in this Factsheet. Where you are required to lodge a written claim for a benefit, you must take full responsibility for your decisions prior to the written claim being determined. You should seek confirmation in writing of any oral advice you receive from DVA.

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1 February 2019