Pharmaceutical Benefits Report

Product

Context

The Medicare and Department of Veterans’ Affairs (DVA) benefits report records information about pharmaceutical items prescribed and dispensed to an individual that were partially or fully funded under the Pharmaceutical Benefit Schedule (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS).

Pharmaceutical benefits report in the Australian context

The PBS began as a limited scheme in 1948, with free medicines for pensioners and a list of 139 ‘life-saving and disease preventing’ medicines free of charge for other people in the community.

Today the PBS provides timely, reliable and affordable access to necessary medicines for Australians. Under the PBS, the government subsidises the cost of medicine for most medical conditions that are dispensed by pharmacists and used by patients at home.

The PBS is part of the Australian Government’s broader national medicines policy. The aim of the policy is to meet medication and related service needs so that both optimal health outcomes and economic objectives are achieved.

Context in digital health

When an individual registers for access to their Medicare information through their digital health record, the Department of Human Services (DHS) can register the individual’s Medicare CDA documents in their digital health record including their pharmaceutical benefits report entries.

The data items in the Medicare documents will be loaded into the My Health Record system to be used as a source of data for the individual’s Medicare overview. The Medicare CDA documents will be created by the DHS as the sole supplier of Medicare information within My Health Record.

The individual and healthcare providers with access to the individual’s Medicare information, will be able to retrieve the pharmaceutical benefits report CDA document through the individual’s My Health Record.

There are a number of key business flows that occur within digital health in Australia, as outlined in Figure 1 below.

Pharmaceutical Benefits Scheme

Figure 1: High-level overview of pharmaceutical benefits report

These flows are described below:

  1. Upon prescribing/dispensing of a PBS/RBS item, the details of the item are sent to the DHS system
  2. The DHS system uploads the pharmaceutical benefits report document to the consumer’s My Health Record.
  3. The pharmaceutical benefits report can be retrieved by the consumer or clinicians using appropriate mechanisms via the My Health Record system.

 

Specifications

The Australian Digital Health Agency has provided the following specifications that apply to the Pharmaceutical Benefits Report:

Current Specifications: 
Identifier: 
EP-1697:2014

When an individual registers for access to their Medicare information through their digital health record, the Department of Human Services can register the individual’s Medicare CDAdocuments in their digital health record, including their Pharmaceutical Benefits Report entries.

Supporting Specifications: 
Identifier: 
EP-1795:2014

Medicare Overview documents provide an overview of Medicare-sourced information stored in an individual’s My Health Record.

By operation of the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the Australian Digital Health Agency. In this website, on and from 1 July 2016, all references to "National E-Health Transition Authority" or "NEHTA" will be deemed to be references to the Australian Digital Health Agency. PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth).

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