The MedsCheck and Diabetes MedsCheck services involve the provision of an in-Pharmacy one-on-one discussion between a Pharmacist and a Patient to improve the Quality Use of Medicines. These services represent a Patient-centred approach to addressing concerns or questions a Patient has about their medicines.

A MedsCheck service is provided within a Community Pharmacy and consists of a review of a Patient’s medicines to improve the Patient’s understanding of their medicines and ultimately, Patient outcomes. The service aims to support self-management by evaluating a Patient’s knowledge about their medicines, addressing any problems the Patient has identified with their medicines, and advising the Patient about the best way to utilise and store their medicines. A Diabetes MedsCheck builds on the format of a MedsCheck service while focusing specifically on the Patient’s experience with type 2 diabetes. A Diabetes MedsCheck likewise includes a discussion between the Pharmacist and Patient. It seeks to assist the Patient in understanding their diabetes medicines, improve their utilisation of self-monitoring devices and improve blood glucose parameters, thereby reducing the risk of developing complications associated with diabetes. Pharmacies participating in the MedsCheck and Diabetes MedsCheck Program are requested to also collect health outcomes data and submit this data to the Pharmacy Programs Administrator. This comprises initial Patient Registration data and six-month Follow Up data. This data allows the Australian Government Department of Health to evaluate the delivery and impact of the MedsCheck and Diabetes MedsCheck Programs. Service Providers must gain consent from Patients to perform a MedsCheck or Diabetes MedsCheck service, and for the collection of health outcomes data that will be provided to the Pharmacy Programs Administrator.

Pharmacy

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

  • Be approved as a Section 90 Pharmacy under the National Health Act 1953 (Cwlth)
  • Agree to deliver MedsCheck Services in accordance with the Pharmacy Programs Administrator General Terms and Conditions and MedsCheck Program Rules, including those related to Patient eligibility
  • Provide MedsCheck services in accordance with the Pharmaceutical Society of Australia Professional Practice Standards and the Pharmacy Board of Australia Guidelines for Dispensing of Medicines
  • Undertake to obtain appropriate written consent for the provision of a MedsCheck service prior to providing the service. A consent form is available at the Downloads section of this page
  • Ensure that services delivered under the Program are carried out by a Registered Pharmacist face-to-face with the Patient in an area of the Community Pharmacy approved premises that is physically separated from the retail trading floor so that the privacy and confidentiality of the Patient is protected. The area must meet the following requirements:
    • Be appropriately furnished with facilities to allow the Patient and the Pharmacist to sit down together
    • Be of sufficient size and appropriate layout to accommodate efficient workflow, including adequate room for the Patient, their carer and the Pharmacist as well as all the consumables, equipment and documentation required for the service
    • Allow the Patient and the Pharmacist to talk at normal speaking volumes without being overheard by any other person (including Pharmacy staff)
    • Be clearly sign-posted as a private consultation area.
  • Ensure the Registered Pharmacist conducting the services under the Program is not responsible for dispensing or undertaking other professional duties at the time of consultation
  • Understand that services under the Program can be carried out in a public area of the Pharmacy when a Community Pharmacy is closed to members of the public, as long as the conversation between the Registered Pharmacist and the Patient cannot be overheard by any other person (including pharmacy staff)
  • Understand that no more than 20 MedsCheck and Diabetes MedsCheck Services in total per Service Provider per calendar month will be remunerated. The threshold applies regardless of the number of Registered Pharmacists that may provide MedsCheck and Diabetes MedsCheck services on the Service Provider’s behalf
  • Agree to accept the payment received under this Program as full payment and provide any services under the Program at no cost to Patients
  • Agree to continue to meet the above Eligibility Criteria while participating in the MedsCheck Program and advise the PharmacyPrograms Administrator if the Pharmacy ceases to be eligible for the MedsCheck Program.

Patients

A Patient who is eligible to receive a MedsCheckservice will meet the following criteria:

  • Current Medicare cardholder or Department of Veterans’ Affairs (DVA) cardholder
  • Has not received a MedsCheck, Diabetes MedsCheck, Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) in the previous 12 months
  • Lives at home in a community setting and
    • Takes five or more prescription medicines or
    • Has recently experienced a significant medical event. Significant medical events are those events that have the potential to affect current medication adherence, understanding, or increase the risk of medication misadventure. This may include a new diagnosis, changes in health status, or medical interventions or
    • Takes a medication associated with a high risk of adverse events.

A Patient who is eligible to receive a Diabetes MedsCheck service will meet the following criteria:

  • Current Medicare cardholder or Department of Veterans’ Affairs (DVA) cardholder
  • Has not received a MedsCheck, Diabetes MedsCheck, HMR or RMMR in the previous 12 months
  • Lives at home in a community setting and
  • Is unable to gain access in a timely manner to existing diabetes education/health services in their community and
  • Has recently been diagnosed with type 2 diabetes (in the last 12 months) or
  • Has less than ideally controlled type 2 diabetes.

Barriers to ‘timely access’ to existing diabetes education/health services should be determined by the Registered Pharmacist based on the Patient’s specific needs and may include:

  • Appointment availability is not suitable to address the Patient’s immediate needs
  • Distance to be travelled to the nearest diabetes education/health service is impractical for the Patient

or

  • A lack of accessibility to transport.

Diabetes MedsCheck Services are not available to in-Patients of public or private hospitals, day hospital facilities, transitional care facilities, to residents of an Aged Care Facility or Patients in a correctional facility. The Pharmacist should take reasonable steps to determine if the Patient is eligible for a MedsCheck or Diabetes MedsCheck service.

Claiming

Service Providers are subject to a service cap of 20 MedsCheck and/or Diabetes MedsCheck services per calendar month. The service cap applies to the Service Provider regardless of the number of Pharmacists who provide the service. This cap applies to any combination of MedsCheck or Diabetes MedsCheck services provided.

Claim Submission

MedsCheck, Diabetes MedsCheck, Patient Registration and Follow Up services must be claimed online via the Pharmacy Programs Administrator Portal by the end of the calendar month following the services (e.g. services undertaken in May must be claimed by 30 June). Claims submitted outside this timeframe will not be paid and cannot be resubmitted. In the instance where a Follow Up service has been provided, this service can only be claimed if the corresponding MedsCheck or Diabetes MedsCheck has been claimed successfully.

Claim Amendments

In the instance where a claim is incorrectly submitted due to incomplete or incorrect information, the claimant will be notified that an amendment is required. Amended claims must be submitted within 30 days of the notification to be eligible for payment. Claims that exceed the service cap or that are submitted late are not eligible for resubmission.

Payments

Service Providers will receive payments for MedsCheck, Diabetes MedsCheck, Patient Registration and Follow Up services provided and claimed within the claiming period as set out in the following table:

Fee (per Patient) Description
$66.53 Initial MedsCheck service
$99.79 Initial Diabetes MedsCheck service
$31.90 Collection of data at Patient Registration
$31.90 Collection of data at Follow Up service

Note that for a service provided as part of the MedsCheck and Diabetes MedsCheck Program, Patients cannot be charged any additional or gap fees for the service.

Record Keeping and Auditing

Service Providers participating in Community Pharmacy Programs must keep all relevant records for seven years after the provision of funded services. These records may be electronic or hard copy and include all claim forms, notes and records of the consultation, or other records generated in the provision of the service. The Australian Government Department of Health is responsible for auditing the delivery of the Community Pharmacy Programs. Anomalies observed by the Pharmacy Program Administrator will be reported to the Department. If an audit is conducted, the Service Provider will be required to produce supporting documentation within a specified timeframe. Service Providers found to be in breach of the Program Rules may be subject to penalties.

MedsCheck and Diabetes Medscheck FAQ

  1. Please refer to the Portal User Guide – MedsCheck and Diabetes MedsCheck that is available from the Downloads section of this page.

  2. Please see the Program Rules available from the Downloads section of this page.

  3. A total of 20 services per Pharmacy per calendar month. This can comprise any combination of MedsCheck and Diabetes MedsCheck Services so long as the total number of these services does not exceed 20.

  4. There are no restrictions placed on the make-up of those 20 services.

  5. Where consent has been obtained, health outcome data should be collected and submitted at the initial service and for the six month follow up.

  6. No sooner than six months since the initial service when consent has been obtained. The Pharmacy Programs Administrator Portal will not accept a follow-up service date less than six months after the initial service. This service must be performed face-to-face.

  7. Pharmacists are allowed to offer the service to Patients who are ineligible for a funded MedsCheck Service, or where the cap has been reached, and they may charge the Patient for this service.

  8. Claims are due at the end of the calendar month after the service was completed, e.g. a claim for a service completed on 15 February 2019 should be submitted by 31 March 2019.

  9. So long as the claim is submitted within the timeframe (the end of the calendar month after the service was completed), you can submit as many claims as you like.

  10. No; however, the consent form should be retained for seven years to support any claim for payment. 

  11. No. An Action Plan should be developed with the Patient and should list specific goals agreed to during the MedsCheck. See the PSA MedsCheck Guidelines in the Downloads section for more information on what should be in an Action Plan. An electronic or paper copy of the Action Plan should be retained for seven years for auditing purposes.

  12. Pharmacists are advised to use their professional knowledge and discretion when determining if a Patient is eligible under this criterion. Appropriate documentation should be recorded and stored for audit purposes, which includes justification for Patient eligibility.

  13. Yes. Examples include paracetamol, calcium and vitamin D. While the Patient may not need a prescription for re-supply of non-prescription medicines, the original order should be from a prescriber with a record in the Pharmacy’s dispense history for the Patient.

  14. The component medicines of a combination product may be counted as individual medicines, except for medicines that are almost invariably used together in fixed-dose combinations for clinical reasons e.g. oral contraceptives, hormone replacement therapies and Helicobacter pylori eradication regimens.

MedsCheck and Diabetes MedsCheck Program Resources