6CPA- Pharmacy and Wholesaler Remuneration

    Dispensing fee increase

    From 1 July 2017 the dispensing fee will increase to $7.15 for ready-prepared prescriptions. This fee is indexed annually on 1 July by CPI.

    AHI fee replaces pharmacy mark-up

    From 1 July 2015, the pharmacy mark-up component of remuneration was replaced by a new Administration, Handling & Infrastructure (AHI) Fee.

    The AHI substantially delinks pharmacy remuneration from the price of medicines and is in recognition of the non-professional costs of delivering the PBS to patients on behalf of the Government. Compared to the existing mark-up structure, which would have continued to trend down over the 6CPA period due to falling PBS prices, the AHI provides an immediate overall increase compared with current mark-up and will increase each year during the 6CPA as a result of indexation.

    Importantly, the AHI Fee has been tiered such that the fee applicable to the most expensive drugs on the PBS will remain in line with the current mark-up (a $72.43 maximum).

    The value of this fee from 1 July 2017 will be:

    • Where the Approved Price to Pharmacist (wholesaler PBS list price) is up to $180.00: $3.94 per prescription
    • Where the Approved Price to Pharmacist is between $180.00 and $2,089.71: $3.94 plus 3.5% of the amount by which the price exceeds $180
    • Where the Approved Price to Pharmacist is $2,089.71 or above: $72.43

    The AHI Fee is indexed annually on 1 July by CPI.

    Premium-Free Dispensing Incentive change

    The Premium-Free Dispensing Incentive (PFDI) will increase to $1.78 from 1 July 2017.

    The PFDI is indexed annually on 1 July by CPI.

    Dangerous Drug Fee increase

    The Dangerous Drug Fee will increase to $3.01 from 1 July 2017.

    The Dangerous Drug Fee is indexed annually on 1 July by CPI.

    Under co-payment prescriptions

    Allowable fees for the pricing of under co-payment prescriptions will continue to apply, in addition to all other fee arrangements described above. From 1 July 2017 the allowable fees for ready-prepared items will be:

    • Safety Net Recording Fee: $1.21 (RP) $1.57 (EP)
    • Additional allowable fee: $4.38

    As with the 5CPA, the Premium-free Dispensing Incentive will not apply to under co-payment prescriptions. The AHI Fee applies to the pricing of all prescriptions, including under co-payment prescriptions.

    There is no obligation to comply with the allowable fees and they are not Commonwealth Government initiated. It is up to each pharmacy to determine their own charges for under co-payment prescriptions.

    Once systems are established, pharmacies will be required to transmit through PBS Online the price charged for under co-payment prescriptions.

    Extemporaneously prepared prescriptions

    In addition to all fees that apply to ready-prepared items (including the new AHI Fee), an additional fee of $2.04 will apply for extemporaneously prepared dispensing. This is unchanged compared with the 5CPA.

    Remuneration review

    A remuneration review will be conducted to inform possible pharmacy remuneration arrangements for the 7CPA (July 2020 onwards). The review will not be able to be used to change pharmacy remuneration during the 6CPA.

    National Diabetes Services Scheme (NDSS)

    From 1 July 2016, it is intended that product supply and delivery under the NDSS will be redirected through the established CSO distribution network to community pharmacies with pharmacies that supply NDSS products receiving a payment of $1 for each product supplied (not indexed).

    Chemotherapy

    The Government intends to make some changes to the structure of remuneration for chemotherapy infusions. This is intended to include some payments being made direct to compounders (including third party compounders), with a different fee applying depending on whether the compounder holds a TGA licence. The implementation of any new arrangements will be a matter for consultation with chemotherapy compounders and pharmacists.

    Wholesalers and the Community Service Obligation (CSO)

    The current wholesaler mark-up arrangements will continue to apply under the 6CPA. No indexation will apply to the CSO funding pool. Wholesalers will still be required to supply section 85 medicines under CSO arrangements at or below the official PBS price to pharmacists, and will not be permitted to impose new or additional fees where the supply is covered by the CSO requirements. CSO requirements are being examined and may be subject to change.

    The remuneration review will be used to examine wholesaler remuneration during the 6CPA.

    Under the NDSS supply arrangements intended to apply from 1 July 2016, CSO wholesalers will also be entitled to receive $1 for each unit they distribute.

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    Page last updated 25 August 2017