Staged Supply

Staged Supply services provide PBS medicines in instalments when requested by the prescriber. The Staged Supply Program aims to assist people who are at risk of drug dependency or who are otherwise unable to manage their medicines safely.

Staged Supply services can be requested when the prescriber determines that a Patient may be at risk if they were to obtain a full PBS supply of the nominated medicine. The service is of particular value to Patients with a mental illness, drug dependency, or who are unable to manage their medicines safely (e.g. people living in accommodation where there is the possibility of theft or a lack of refrigeration for the medication). The frequency of Staged Supply dosing instalments should be determined by the prescriber in consultation with the Pharmacy and the Patient and/or their carer. The Staged Supply Program specifically excludes medicines supplied under the Section 100 Opioid Dependence Treatment Program.

Pharmacy Eligibility Criteria

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

  • Be approved as a Section 90 Pharmacy under the National Health Act 1953
  • Be accredited by an approved Pharmacy Accreditation Program (e.g. Quality Care Pharmacy Program), or be in the process of attaining accreditation within six months of applying to participate in the Program
  • Publicly display and comply with the Community Pharmacy Service Charter and Customer Service Statement, available from the Resources page
  • Abide by the Pharmacy Programs Administrator General Terms and Conditions
  • Abide by the most recent version of the Staged Supply Program Rules, relevant Professional Standards, and Pharmacy Board Guidelines
  • Remain eligible to participate in the Staged Supply Program while delivering these services, as outlined in the Staged Supply Program Rules.

Patient Eligibility Criteria

To be eligible for a Staged Supply Service, a Patient must:

  • Be a Medicare or Department of Veterans’ Affairs (DVA) cardholder
  • Hold a current, valid, government-issued concession card
  • Live at home or in a community setting
  • Have been referred for a Staged Supply Service by their prescriber
  • Have been prescribed one or more Pharmaceutical Benefits Scheme (PBS) listed medicines which fall within the following medicine classes/body system classification codes:
Medicine Class PBS Body System Classification Code
Opioid analgesics N02A
Antipsychotics N05A
Anxiolytics N05B
Hypnotics and Sedatives N05C
Antidepressants N06A
Psycho-stimulants N06B

 

Pharmacies are encouraged to utilise the ‘Body System Classification’ found on the PBS website to identify whether certain medications are eligible under the Staged Supply Program. We remind you that the Staged Supply Program specifically excludes medicines provided under the Opioid Dependence Treatment (ODT) Community Pharmacy Program.

A Patient is not eligible for a Staged Supply Service if they are currently an in-patient at a public hospital, private hospital, day hospital facility or transition care facility, or a resident of an Aged Care Facility or a correctional facility. Staged Supply Services funded under this Program are not available to Patients receiving Staged Supply Services funded under other federal, state or territory government programs. Patients who are not eligible for funded services under the Staged Supply Program may receive medicines in staged supply at their own cost. A lack of eligibility for funding under this Program does not invalidate a request by the patient or their carer to provide medicines in a manner equivalent to staged supply.

Claiming

To become an Approved Staged Supply Service Provider and participate in the Staged Supply Program, eligible Pharmacies must first register via the Pharmacy Programs Administrator Portal. Once approved, Service Providers may claim payments for the provision of Staged Supply Services for up to 15 eligible Patients. Service Providers must submit claims for eligible Staged Supply services via the Pharmacy Programs Administrator Portal. Claims must be submitted by the end of the next calendar month (e.g. services provided in May must be claimed by 30 June). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

Payments

Approved Service Providers can claim the following payments under the Program:

Description Fee (per patient)
Provision of first Staged Supply Service each week (first day) $8.12
Each additional provision of a Staged Supply Service during the week (subsequent days) $4.12

No additional patient charges may be levied for participating patients who are funded through the Staged Supply Program.

Record Keeping and Auditing

Service Providers participating in the Staged Supply 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 to ensure the services are provided in accordance with the Pharmacy Programs Administrator General Terms and Conditions and the Staged Supply Program Rules.

Staged Supply FAQ

  1. Please see the Staged Supply Program Rules for a detailed outline of participation requirements for the program. The Program Rules are also available from the Downloads section of this page. Service Providers should ensure they are familiar with the Staged Supply Program Rules prior to registering for the program and commencing claims.

  2. Please refer to the Portal User Guide – Staged Supply. The Portal User Guide is also available from the Downloads section of this page.

  3. No, eligible Patients must hold a current, government-issued concession card. Holders of the following eligible concession cards are eligible under the Staged Supply Program:

    – Pensioner Concession Card;
    – Commonwealth Senior Health Care Card;
    – Health Care Card (including Low Income Health Care Card); or
    – Department of Veterans’ Affairs Gold, White or Orange Cards.

    Please note the PBS Safety Net Card is not classified as an eligible concession card under the Program.

  4. Pharmaceutical Benefits Scheme (PBS) listed medicines which fall within the following medicine classes/body system classification code are eligible under the Staged Supply Program:

    Medicine Class PBS Body System Classification Code
    Opioid analgesics N02A
    Antipsychotics N05A
    Anxiolytics N05B
    Hypnotics and Sedatives N05C
    Antidepressants N06A
    Psycho-stimulants N06B

    Pharmacies are encouraged to utilise the ‘Body System Classification’ found on the PBS website to identify whether certain medications are eligible under the Staged Supply Program. We remind you that the Staged Supply Program specifically excludes medicines provided under the Opioid Dependence Treatment (ODT) Community Pharmacy Program.

    Service Providers should ensure they are only entering the PBS details for medicines listed in the above classifications during the claiming process.

  5. No, you only need to list one eligible medication per patient in the Portal claim form.

    If your patient is currently taking multiple medications eligible under the Staged Supply Program, additional collections days can be included under the initial medication claim indicated above, noting that if you see a patient more than once in a day it will only count as once.

  6. You can claim up to 15 patients per month.

  7. The Staged Supply payment is based on the number of Staged Supply Services each Patient receives each week. For the first service each week, the Pharmacy is paid $8.12 per Patient. For any subsequent services that week, the Pharmacy is paid $4.12 per service.

  8. No, claims cannot be submitted until the start of the following calendar month.

  9. Claims are due by the end of the calendar month after the Staged Supply Services were performed, e.g. Staged Supply Services performed in March would need to be submitted by the end of April.

  10. Yes, this information must be provided in the Portal during Program registration.

  11. Yes, patients who are not eligible for the program can be charged by the Pharmacy for provision of a staged supply service. Patients eligible for the staged supply program should not be charged for the service.

  12. The number of doses dispatched column is intended to count the number of days you have seen the patient. If you see a patient more than once in a day count all of those times as just once.

  13. Yes, if a patient’s data has already been entered during a previous month, the Portal will auto populate all relevant fields after the patient’s Medicare/DVA number has been entered into a new claim.

Staged Supply Program Resources


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