Clinical Interventions

Clinical Interventions has been designed to identify, resolve and document drug-related issues that are identified with community pharmacy. The Program seeks to improve patient health outcomes and improve quality use of medicines.

A Clinical Intervention is a professional activity undertaken by a registered pharmacist directed towards improving quality use of medicines and resulting in a recommendation for a change in the patient’s medication therapy, means of administration or medication-taking behaviour.

It does not include generic medicine substitution, routine prescription-related counselling, provision of emergency supply medicine under State or Territory law, CMI provision or professional activities directed towards improving QUM undertaken during HMR, RMMR, MedsCheck or Diabetes MedsCheck services.

Participation

To be eligible to receive incentive payments for the Clinical Intervention Program, a community pharmacy must:

  • be a Section 90 Pharmacy;
  • be accredited by an approved Pharmacy Accreditation Program such as the Quality Care Pharmacy Program (QCPP);
  • agree to publicly display and comply with the Community Pharmacy Service Charter and Customer Service Statement;
  • register for the program via the 6CPA Registration and Claiming Portal;
  • continue to meet the above eligibility criteria while participating in the Clinical Intervention Program; and
  • 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 on behalf of an Approved CI Service Provider, abide by the definition of a CI as detailed in the PSA Standards.

A CI must relate to a medicine and must be recorded using the D.O.C.U.M.E.N.T. classification system. Please note:  CIs under the M.E.N. components cannot be claimed and should not be included on the Claim.

Claiming and Payments

Claiming

An Approved CI Service Provider is entitled to claim incentive payments four times per year for performing and recording Clinical Interventions 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 delivered under the M.E.N. components of the classification system.

Approved CI Service Providers must submit claims via the 6CPA Registration and Claiming Portal. Claims must be submitted in accordance with the following time frames:

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

Note: As stated in the Clinical Interventions Program Rules claims will be rejected if received after the claim due date.

Payment

The 6CPA Administrator and the Australian Government will jointly assess the payment amount the  approved CI Service Provider is entitled to receive based on the number of CI services and pharmacy size (e.g. prescription volume). The Approved CI Service Provider claimable prescription volume will be sourced from the Department of Human Services.

CI claims will be capped at the rate of 3.5% of prescription volume.

The claimable PBS prescriptions dispensed during the eligible Claiming Period will be counted jointly by the 6CPA Administrator and the Australian Government across multiple Section 90 approval numbers associated with the claiming Approved CI Service Provider for the corresponding eligible Claiming Period.