The Clinical Interventions Program is a formalisation of the clinical role undertaken by Pharmacists practising in a community setting. The Program seeks to improve patient health outcomes and improve Quality Use of Medicines.

A Clinical Intervention is a clinical activity undertaken by a Registered Pharmacist that contributes to improved medicines utilisation, improved health outcomes, improved Quality Use of Medicines, or reduces adverse outcomes. These clinical activities constitute recommendations or education provided to Patients that affect their medication taking behaviour.

Clinical Interventions do not include routine activities such as dispensing medicines or recommending treatment options. Clinical Interventions do not include the substitution of generic medicines, routine medicine counselling, provision of Consumer Medicine Information, recommending another funded service, or providing medication under state or territory emergency supply arrangements.

To be eligible to receive incentive payments for the Clinical Intervention Program, a Community 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. the Quality Care Pharmacy Program) or in the process of completing their accreditation
  • Abide by the Pharmacy Programs Administrator General Terms and Conditions
  • Agree to publicly display and comply with the Community Pharmacy Service Charter and Customer Service Statement
  • Deliver Clinical Interventions in accordance with the Clinical Interventions Program Rules and the Pharmaceutical Society of Australia Professional Practice Standards (PSA Standards)
  • Register for the Program via the Pharmacy Programs Administrator Portal
  • Deliver Clinical Interventions in accordance with the Clinical Interventions Program Rules.

It is the responsibility of the owner/manager of each Approved CI Service Provider to ensure all Pharmacists performing and recording CIs abide by the definition detailed in the PSA Standards.

To be eligible for payment under the Program, a Clinical Intervention must relate to a medicine and must be recorded using the D.O.C.U.M.E.N.T. classification system. Clinical Interventions that are characterised under the M.E.N. components cannot be claimed and should not be included in the claim.

Claiming

Service Providers approved under the Clinical Interventions Program are entitled to claim incentive payments for Clinical Interventions that have been recorded using the D.O.C.U.M.E.N.T. classification system in accordance with the PSA Standards. Incentive payments will not be made for interventions that are classified under the M.E.N. components of the classification system, or those that do not meet the PSA Standards.

Claims for incentive payments are submitted four times per year as set out in the table below. Claims made after the due date for the relevant period will not be paid and are not eligible for resubmission.

Eligible Claiming Periods Claim Due Date
1 January – 31 March 1-14 April
1 April – 30 June 1-14 July
1 July – 30 September 1-14 October
1 October – 31 December 1-14 January

Payment

The Australian Government Department of Health and the Pharmacy Programs Administrator will assess the payment amounts that each Approved CI Service Provider is entitled to receive. The calculation is based on the number of Clinical Interventions provided in each claiming period, and the size of the Approved CI Service Provider (based on prescription volume). Prescription volume data is sourced from the Australian Government Department of Human Services.

Clinical Intervention services are subject to a cap of 3.5% of prescription volume for Approved CI Service Provider.

Clinical Interventions FAQ

  1. Refer to the Clinical Interventions Portal User Guide.

  2. Claims are submitted four times a year. Claims are due between the 1st and 14th of January, April, July and October. Claims for each period are for Clinical Interventions conducted during the preceding three-month period

  3. Unfortunately, no. However, if you feel there were exceptional circumstances beyond your control that prevented you from submitting the claim then you can contact the Support Centre, who can advise if you may be eligible to submit an Exceptional Circumstances claim, which will be assessed by the Department of Health.

  4. Payments are calculated based on a number of factors, including the total number of PBS prescriptions that the pharmacy has dispensed; the total number of CIs performed and scripts dispensed by all service providers in the program; and the allocated funds for the Program. The total number of CIs that can be paid to a Pharmacy is capped at 3.5% of their total PBS prescription volume for the period.

  5. Payments are calculated based on a number of factors and vary from period to period. See ‘How is my payment calculated?’ for more information.

  6. The CI Program is not a fee-for-service Program. Payments are calculated based on a number of factors and vary from period to period. See ‘How is my payment calculated?’ for more information.

  7. Please refer to the Program Rules for eligibility information.

  8. Only if your Pharmacy is in the process of attaining accreditation. To be eligible to claim, your Pharmacy must gain accreditation within six months of lodging your CI registration.

  9. No, only the s90 number that is active at the time that the claim is lodged is eligible to be paid for the claiming period. Splitting any payment for the period should be decided between the two parties at the time of sale.