Opioid Dependence Treatment (ODT) Community Pharmacy Program

Registration and claiming for the ODT Community Pharmacy Program is now available on the PPA Portal.

The ODT Community Pharmacy Program is designed to improve access to and affordability of ODT within the community pharmacy sector, by supporting the delivery of pharmacy services for people in treatment programs for opioid dependence.

The ODT Community Pharmacy Program will complement, but is not part of, PBS arrangements for the supply of ODT medicines.

The ODT Community Pharmacy Program aims to improve access to and affordability of opioid dependence treatment within the community pharmacy sector by supporting the delivery of pharmacy services including the staged supply of these medicines and, subject to state and territory legislation and guidelines, pharmacist administration of buprenorphine injections.

The ODT Community Pharmacy Program will allow participating Section 90 pharmacies to submit claims for eligible oral/sublingual and long acting injectable ODT medications.

Service Provider Eligibility Criteria

To be eligible to become an Approved Service Provider and participate in the ODT Community Pharmacy Program, a Pharmacy must:

  • Be approved to dispense pharmaceutical benefits as part of the Pharmaceutical Benefits Scheme (PBS) defined in Section 90 of the National Health Act 1953 (Section 90 Pharmacy)
  • Be approved by their relevant State/Territory to supply/administer the relevant ODT medications to patients
  • Provide/administer ODT Community Pharmacy Services in accordance with relevant State/Territory requirements
  • Consent to share their contact information and supply data with their relevant State/Territory
  • Undertake ODT Community Pharmacy Services in accordance with the PPA General Terms and Conditions (available here) and the ODT Community Pharmacy Program Rules (available here), including those related to patient eligibility
  • Provide/administer ODT Community Pharmacy Services in accordance with relevant Professional Standards and Guidelines
  • Obtain appropriate written consent for provision/administration of the service and provision of patient data to the PPA/Department of Health and Aged Care (the Department). Please note that State/Territory consent forms are not sufficient as they do not include consent for data to be provided to the PPA/Department. A consent form is available here and at Appendix A of this document
  • Ensure that the preparation and supply of the instalment occurs in an area which accords with legislative requirements for dispensing medications
  • Comply with legislative requirements in relation to storage of and staff access to medicines that are held in the pharmacy, including ensuring that the area where the medicines are stored is not accessible to the public
  • Provide all aspects of the ODT Community Pharmacy Service at no cost to participating patients (other than a patient PBS medication co-payment, if applicable).

 

Patient Eligibility Criteria

To be eligible for an ODT Community Pharmacy Service funded under the Program, the patient must:

  • Be a Medicare and/or Department of Veterans’ Affairs (DVA) cardholder
  • Have been prescribed one or more medicines for opioid dependence listed on the Section 100 Highly Specialised Drugs Program (Community Access)
  • Be enrolled in a state or territory ODT program and receiving ODT medicines from a s90 approved community pharmacy.

Where a patient does not meet the eligibility criteria, the Service Provider may offer the service at the patient’s own cost providing that by doing so they are still meeting their relevant State or Territory requirements. A lack of eligibility for funding under this Program does not invalidate a prescriber’s request to provide ODT medicines to patients.

 

Two types of claims can be lodged by Service Providers:

  1. An ODT Staged Supply Claim, for the staged supply of oral/sublingual medicines
  2. An ODT Injection Claim, for the administration of long-acting injectable medicines.

ODT Staged Supply Claiming and Payments

Claiming

Approved Service Providers (i.e. pharmacies that at all times meet the Eligibility Criteria set out in these ODT Community Pharmacy Program Rules) will be able to claim a daily fee per patient for activities associated with the staged supply of eligible ODT medicines (i.e., for in-pharmacy and take-away dosing preparation including consumables). Eligible ODT medicines are:

  • methadone oral liquid
  • buprenorphine sublingual tablets
  • buprenorphine + naloxone sublingual films.

Long-acting injectable buprenorphine products are excluded from ODT Staged Supply Community Pharmacy claims and, where administered to the patient by the Service Provider, should instead be submitted as an ODT Injection Community Pharmacy Service claim (below).

Service Providers can claim for all eligible patients for which they are providing ODT Staged Supply services i.e. there are no caps on the number of eligible patients for which a Service Provider can claim each month. Whilst no Service Provider caps apply under the ODT Community Pharmacy Program, Service Providers must continue to comply with any State/Territory limits placed upon the number of patients they can service.

Details on how to submit an ODT Staged Supply claim can be found on pages 3-5 of the ODT Community Pharmacy Program User Guide.

Claiming Timeframes

Service Providers must submit eligible ODT Staged Supply Service claims via the PPA Portal:

  • On a monthly basis in arrears
  • By the end of the next calendar month (e.g. services provided in November must be claimed by 31 December)
  • As one monthly claim per eligible patient.

Claims that are outside this timeframe or are incomplete cannot be submitted and will not be paid. 

Payment

Approved Service Providers can claim the following ODT Staged Supply Service payments under the Program. These payments are GST Exempt.

Description   Fee 
Provision of ODT Staged Supply Service (per dosing day, per patient):  
Dose management fee (staged supply fee)     $4.69
Consumable allowance fee     $0.97
Total fee (per dosing day)     $5.66

ODT Staged Supply Services include ODT doses administered to patients in-pharmacy and as take-home doses.

Please note split doses, double/triple doses or additional doses provided to a patient on a given day should only be recorded as one dosing day for claiming purposes. Where a dose has been prepared but has not been collected by a patient, this dose can still be recorded and claimed as an in-store or take-away dosing day, depending on the dose type prepared.

No additional patient charges may be levied for participating patients who are funded through the ODT Community Pharmacy Program, however patients will still be required to pay the PBS co-payment for the medicine (if applicable).

 

ODT Injection Claiming and Payments

Claiming

Subject to state and territory guidelines and regulations, approved Service Providers can submit payment claims for in-pharmacy administration of buprenorphine injections (weekly and monthly), where these injections are provided by an appropriately qualified pharmacist.

Service Providers may claim a fee for each eligible long-acting buprenorphine (weekly or monthly) injection provided under the ODT Community Pharmacy Program.

Service Providers can claim for all eligible patients they have administered long-acting injectable buprenorphine to, i.e. there are no caps on the number of eligible patients for which a Service Provider can claim each month. Whilst no Service Provider caps apply under the ODT Community Pharmacy Program, Service Providers must continue to comply with any State/Territory limits placed upon the number of patients they can service.

Details on how to submit an ODT Injection claim can be found on pages 5-8 of the ODT Community Pharmacy Program User Guide.

 

Claiming Timeframes

Service Providers must submit eligible ODT Injection claims via the PPA Portal:

  • By the end of the next calendar month (e.g. services provided in November must be claimed by 31 December)
  • Each injection must be submitted as a separate claim.

ODT injections can be claimed as soon as the injection has been administered – you do not need to wait to submit these on a monthly basis. 

Claims that are outside this timeframe or are incomplete cannot be submitted and will not be paid.

Payment

Approved Service Providers can claim the following Injectable ODT Services payments under the Program. These payments are GST Exempt.

Description Fee (per injection)
In-pharmacy administration of ODT Injection Service $22.15

No additional patient charges may be levied for participating patients who are funded through the ODT Community Pharmacy Program, however patients will still be required to pay the PBS co-payment for the medicine (if applicable).

 

Record Keeping and Auditing

Service Providers participating in the ODT Community Pharmacy Program must keep all relevant records for seven years after the provision of the funded services. These records may be electronic or hard copy and must include all claim forms, program evaluations, notes and records of Patient interviews, and any other records generated in the provision of the services. Staged Supply Service Providers may be subject to audits by the Australian Government Department of Health and Aged Care to ensure the services are provided in accordance with the Pharmacy Programs Administrator General Terms and Conditions and the ODT Community Pharmacy Program Rules.

The PPA have offered software vendors the option to integrate their software with the PPA portal for this program. Interested software vendors were able to connect to the Program in order to send claims directly from their software to the PPA Portal from 30 August 2023.

Please note the PPA has no control over when or if vendors choose to integrate their software with the PPA portal.

The following software vendors have integrated their software with the PPA portal for this program:

  1. Autodose
  2. Modeus
  3. StrongRoom.

The following software vendor has advised that they are interested in integrating their software with the PPA portal for this program:

1.   idose.

Service Providers not utilising any professional services software will need to claim directly via the PPA Portal.

Payment timeframes for this program will be in line with PPA Payments for other large programs, that is, the payment turnaround will be less than a week – it can often be as quickly as the next business day.

This section provides an overview of recent correspondence from the PPA.

ODT Community Pharmacy Program FAQs

  1. Service Providers that meet the eligibility criteria were able to start providing funded services under the program to eligible patients from 1 July 2023.

    Registration and claiming became available on the PPA Portal from 1 August 2023, with interested software vendors able to connect to the Program in order to send claims directly from their software to the PPA Portal from 30 August 2023.

    Please refer to the ODT Community Pharmacy Program User Guide for a step-by-step process for registering and claiming for the ODT Community Pharmacy Program.

  2. Eligible PBS community pharmacies (i.e. those approved under section 90 of the National Health Act 1953) are the only type of Service Provider that can claim under this program for in-pharmacy and take-away staged supply dosing provision/injection administration. Individual States/Territories may have other programs that support ODT medicine provision in other settings.

    For queries relating to reforms to ODT access or PBS listings please contact the Department via email on ODT@health.gov.au.

  3. There are no caps on the number of eligible patients for which a Service Provider can claim each month under the ODT Community Pharmacy Program.

    Service Providers must however continue to comply with any State/Territory limits placed upon the number of patients they can service.

  4. The following ODT medicines listed on the Section 100 Highly Specialised Drugs Program (Community Access) of the Schedule of Pharmaceutical Benefits (the PBS Schedule) from 1 July 2023 are eligible for staged supply provision/administration payments under this program:

    -methadone oral liquid

    -buprenorphine sublingual tablets

    -buprenorphine + naloxone sublingual films

    -long-acting injectable buprenorphine products.

  5. No. Only ODT medications supplied/administered to patients on or after 1 July 2023 can be claimed through the program.

  6. No. No additional patient charges may be levied for participating patients who have received their ODT medications through the PBS or are funded through the ODT Community Pharmacy Program.

    Patients may however be required to pay a PBS co-payment for the medicine (if applicable).

  7. No. The ODT Community Pharmacy Program payment is designed to remunerate services managed within the pharmacy.

  8. No. The PPA is only contracted to administer the payments relating to the provision of the service to patients (i.e the oral/sublingual staged supply component and/or administration of injectable ODT). The PPA are not involved in the PBS payments for the ODT medications to pharmacies and is therefore unable to provide advice on the dispensing of ODT prescriptions via the PBS or answer questions regarding medicine access issues.

    Further information for prescribers, pharmacies and patients on the PBS listing changes for ODT medicines is available at www.pbs.gov.au/browse/section100-md.

    For queries relating to reforms to ODT access or PBS listings please contact the Department via email on ODT@health.gov.au.

  9. It is the a decision of the pharmacy if they continue to supply doses to the patient privately if they have already paid dosing fees in advance (i.e. they could continue to use stock that has been provided at no cost in this scenario) however a patient cannot be charged both the PBS co-payment and private fees. If a patient is being charged private fees the pharmacy cannot claim the Staged Supply service under the ODT Community Pharmacy Program.

  10. Approved Hospital Authorities may be able to dispense ODT medicines via the PBS if they are approved by their State/Territory to do so. Please note however that the Commonwealth’s ODT Community Pharmacy program only allows eligible Section 90 community pharmacies to claim for the oral/sublingual staged supply provision and long acting injectable ODT medication administration.

    Non-section 90 pharmacies are not eligible for participation within the new program and are therefore unable to submit claims to the PPA Portal for any ODT services provided.

    For queries relating to reforms to ODT access please contact the Department via email on ODT@health.gov.au.

  11. Section 90 community pharmacies must ensure they are allowed by their State/Territory to dispense ODT medicines to patients before registering to participate in the ODT Community Pharmacy program.  Registration for the program can be undertaken via the PPA Portal, please refer to the ODT Community Pharmacy Program User Guide for a step-by-step process for registering.

    Please note registering for the ODT Community Pharmacy Program (once available) on the PPA Portal is not the same as being allowed to dispense and provide ODT medicines under your State/Territory legalisation.

    You will need to ensure you are allowed by your State/Territory to dispense and provide ODT medicines prior to being able to participate and receive funding under the Commonwealth’s ODT Community Pharmacy program for ODT staged supply provision /administering injections. 

  12. No. The PPA is only contracted to administer the payments relating to the provision of the service to patients (i.e the oral/sublingual staged supply component and/or administration of injectable ODT). The PPA are not involved in any of the legislative requirements for dispensing ODT medicines.

    Section 90 community pharmacies should confirm with their relevant State/Territory whether there is anything they need to do prior to dispensing ODT medicines to patients such as submitting an application to participate in the State/Territories’ ODT Program.

  13. The ODT Community Pharmacy Program does not prevent your pharmacy from receiving payments/fees from your State/Territory.

  14. Pharmacies are not required to participate in the ODT Community Pharmacy Program (this program complements but is not part of, PBS arrangements for the supply of ODT medicines). It should be noted that pharmacies that are currently providing ODT medicines to patients and choose not to participate in the ODT Community Pharmacy Program are still not able to charge additional out-of-pocket (private) dispensing or dosing fees to patients if their medicine/s are dispensed under the PBS, as per the PBS Opioid Dependence Treatment Program.

    Please note the PPA cannot provide advice on the dispensing of ODT prescriptions via the PBS or answer questions regarding medicine access issues.

    Further information for prescribers, pharmacies and patients on the PBS listing changes for ODT medicines is available at www.pbs.gov.au/browse/section100-md.

    For queries relating to reforms to ODT access or PBS listings please contact the Department via email on ODT@health.gov.au.

  15. No. There are no exemptions for private clinics and non-PBS dosing sites to participate in the ODT Community Pharmacy Program. If however, you believe you may be eligible to apply for approval to become a Section 90 PBS approved supplier, the Department of Health and Aged Care has provided the following link. Please note that the PPA are unable to assist with queries regarding this process.

  16. Yes. Where a dose has been prepared but has not been collected by a patient, this dose can still be recorded and claimed as an in-store or take-away dosing day, depending on the dose type prepared.

  17. No. These types of doses can only be recorded as one dosing day for claiming purposes.

  18. A dosing day means any day that the Service Provider prepares in-pharmacy take-away dose/s for supply to a patient.

    For example, if a patient comes into the pharmacy for an in-pharmacy dose on a Monday, but also collects six take-away doses, this counts as seven dosing days (one in-pharmacy dosing day and six take-away dosing days).

    If a patient receives split dosing (i.e. two doses on the same day) this counts as one dosing day.

    If a patient receives alternate day dosing, e.g. receives a dose in the pharmacy on a Monday, does not receive either an in-pharmacy or takeaway dose on a Tuesday and then receives a dose in the pharmacy on a Wednesday, this counts as two dosing days.

    If you prepare a dose for a patient (either for delivery in-pharmacy or to take-away) and the patient does not collect that dose, this still constitutes a dosing day, as the dose was prepared for supply.

  19. Service Providers may claim monthly in arrears and be paid for each in-pharmacy dosing day and each take-away dosing day they’ve prepared during that month as part of their ODT service. This means for example if a patient presents for one in-pharmacy dose and then collects 29 days of take-away doses that same day, the Service Provider in their monthly claim can enter and be paid for one in-pharmacy dosing day and 29 take-away dosing days (30 total dosing days in this example).

  20. Yes. You may submit an ODT Staged Supply claim for the ODT medicines you provide as in-pharmacy or take-away doses. You may also submit a Staged Supply claim for the other eligible non-ODT medicines the patient receives under the Staged Supply program. You must only count the days the patient picks up the non-ODT medicines for the Staged Supply claim. e.g. if each month the patient gets their ODT medicine every day but only picks up their other Staged Supply eligible medicines weekly– only count the weekly pick-ups in the Staged Supply claim. The ODT medicine daily pick up can then be claimed for in the ODT Staged Supply claim.

  21. Yes however, each pharmacy should only count the dosing days (in-pharmacy or take-away) that that pharmacy has prepared for the patient during the month. They should not include any dosing days done by another site in their claim.

    Please note that this advice is specific to ODT Community Pharmacy Program claims and that relevant State/Territory requirements should be taken into consideration as location changes may affect ongoing script eligibility in some jurisdictions.

  22. No. Providing you meet all State/Territory and PBS requirements you can be paid for dispensing the medicine/s under the PBS Opioid Dependence Treatment Program however, the ODT Community Pharmacy Program is a separate program.  Under this particular program, Community Pharmacies are only eligible for payment for in-pharmacy injection administration/staged supply provision of oral/sublingual medicines where it has been directly supplied to patients by the pharmacy.

  23. No. Patients must complete a consent form in order for services with their information to be claimed under the ODT Community Pharmacy Program.

    If the patient is unwilling to sign a consent form Service Providers will not be able to charge additional out-of-pocket (private) dispensing or dosing fees to patients for PBS supplies of ODT medicines (even if they can’t claim through the ODT Community Pharmacy Program). This is a government decision as part of the Commonwealth’s PBS Opioid Dependence Treatment Program (please note this is separate from the ODT Community Pharmacy Program and is not administered by the PPA).

  24. The consent form relates to patient access to this new ODT Community Pharmacy program and associated reporting and claiming, not the dispensing of the medication itself. Informed patient consent is required that covers both the provision of:

    -The service (e.g. staged supply instalments of oral/sublingual ODT medicines or administration of a buprenorphine injection)

    -Identifying patient information to the PPA, Department and State/Territory governments to allow for the claim to be processed and paid.

    A consent form, which includes information that explains this to patients is available at Appendix A of the Program Rules and under the Program Rules and Other Downloads section of the website. A Consent Conversation Card is also available to help you explain this to the patient.

    The consent form allowing their details to come to the PPA/Dept must have been signed by the patient/carer before patient details can be provided in any claim forms for payment.

  25. One consent form can be signed per patient per pharmacy – this will cover any ODT staged supply services for oral/sublingual medicines and/or administration of long acting injectable buprenorphine the pharmacy does for the patient going forward.

  26. Registration and claiming became available in the PPA Portal on 1 August 2023. The ODT Community Pharmacy Program includes two different claim types:

    -ODT Staged Supply Claims

    -In-pharmacy administration of ODT Injection Claims

    The ODT Program Rules include an overview of the data fields community pharmacies will need to collect in order to claim, but for detailed information, please refer to the ODT Community Pharmacy Program User Guide for a step-by-step process for registering and claiming for the ODT Community Pharmacy Program.

  27. Service Providers must submit eligible ODT claims by the end of the next calendar month (e.g. services provided in November must be claimed by 31 December).

    Claims that are outside this timeframe or are incomplete cannot be submitted and will not be paid.

    Please see the ODT Program Rules for further information on claiming requirements.

  28. The PPA is pleased to advise that integration is now available for any interested software vendors to connect to the Program in order to send claims directly from their software to the PPA Portal. The following vendors have integrated software which allows claims to be submitted to the PPA Portal:

    –Autodose 

    –idose 

    –Modeus (MethDA) 

    –StrongRoom AI 

ODT Community Pharmacy Program

This section will include additional resources provided by the Department of Health and Aged Care to support community pharmacies.

Information for prescribers, pharmacies and patients regarding the PBS listing changes including prescribing, dispensing and transitional arrangements for ODT medicines is available at www.pbs.gov.au/browse/section100-md. Community Pharmacies should ensure that they are familiar with the information and arrangements outlined on this page.

Factsheets 

  • PBS Opioid Dependence Treatment Program Reforms Consumer Fact Sheet
    This factsheet is targeted to consumers to assist them in understanding the 1 July 2023 PBS changes and what it may mean for their current medications/scripts. Community Pharmacies can utilise the factsheet as an additional source of patient information. 
  • The Department’s ODT Medicines FAQs include advice on how patients can elect to restrict access to their records and/or specific documents within the My Health Record (MHR) system as ODT medicines will now appear in MHR. Please note that the PPA is not linked to MHR and claims made directly through the PPA Portal do not appear in MHR. The PPA Support Centre is unable to assist with MHR queries.

Webinars

The following pre-recorded webinars have also been made available to provide additional information for pharmacists and primary care practitioners regarding the PBS Section 100 HSD Program (Community Access):

Please note that you may be required to enrol or log in to the webinar provider sites to access some of the content provided above and the PPA are unable to assist with access issues. 

 


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