Staged Supply

Staged Supply has been designed to support the provision of PBS medicines in instalments when requested by the prescriber (excluding the section 100 opioid dependency treatment program). These instalments may be daily, weekly, or as otherwise agreed with the prescriber. The service is particularly targeted to patients with a mental illness, drug dependency or who are otherwise unable to manage their medicines safely.

For the purpose of this program Staged Supply is the provision of PBS medicines in instalments when requested by the prescriber. The frequency of Staged Supply dosing instalments should be determined by the prescriber in consultation with the pharmacy and patient/carer. Staged Supply services specifically exclude medicines supplied under the Section 100 Opioid Dependence Treatment Program.

Participation

Pharmacy:

To be eligible to receive payments under the Staged Supply Program, a Service Provider must:

  • be approved under Section 90 of the National Health Act;
  • 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;
  • abide by the 6CPA General Terms and Conditions;
  • register for the program via the 6CPA Registration and Claiming Portal;
  • continue to meet the eligibility criteria outlined in clause 3.1 of the Program Rules while participating in the Staged Supply Program.

Patients:

For a patient to be eligible for a service under the staged supply program they must:

  • have a valid Medicare or Department of Veterans’ Affairs (DVA) Card; and
  • have a valid Government issued Concession Card; and
  • live at home in a community setting; and
  • have been referred for a Staged Supply service by their prescriber; and
  • be prescribed one or more of the following types of medications:
    • opioid analgesics
    • antipsychotics
    • anxiolytics
    • hypnotics and sedatives
    • antidepressants
    • psycho-stimulants

Staged Supply services funded under this Program are not available to in-patients of public or private hospitals, day hospital facilities, transitional care facilities, residents of an Aged Care Facility or patients in a correctional facility.

Staged Supply services funded under this Program are not available to patients receiving Staged Supply services funded under other Federal or State and Territory Government Programs.

Where a patient does not meet the eligibility criteria the Staged Supply Service Provider may offer the service at a patient’s own cost.

Claiming and Payments

Claiming

Pharmacy Practice Incentive (PPI) payments for Staged Supply end on 30 June 2017.

Staged Supply Service Providers may claim a payment under the 6CPA Program for the provision of Staged Supply services for up to four (4) patients that meet the eligibility criteria outlined in clause 3.2 of the Program Rules while participating in the Staged Supply Program. Funds are available for each pharmacy to allow for a maximum for of four (4) eligible Staged Supply Services to be provided at any one time.

From 1 July 2017, community pharmacies participating in the Staged Supply Program will be required to collect and provide patient data for all patients receiving a 6CPA subsidised Staged Supply service to monitor the Program’s delivery of health outcomes for patients.  This information will be collected and submitted in accordance with Attachment A of the Program Rules. This information will be required at the initial patient registration and at six monthly intervals. This information must be recorded on the appropriate Staged Supply claiming templates. Service Providers will need to attach this to the claim as well as indicating the number of eligible subsidised Staged Supply services provided during the claiming period.

Please note that there will be a template for the collection of patient data at the registration stage and a separate template for the collection of patient data at the six month follow up.

Claim Submission

Service Providers must submit claims for eligible Staged Supply services via the 6CPA Registration and Claiming Portal.  Staged Supply services and associated Follow Up services must be claimed by the end of the next calendar month (e.g. Staged Supply services undertaken in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

A Follow Up service claim can only be made where a Staged Supply service has been successfully claimed continuously over at least four consecutive months.

More information on how to submit your claim on the 6CPA Registration and Claiming Portal will be available in the coming weeks.

Claim Amendments

Staged Supply or Follow Up service claims that are submitted with incomplete or incorrect data will be required to be amended within thirty (30) days of the amendment notification.

Claims that are not amended within thirty (30) days of the amendment notification will not be paid.

Payments

The table below summaries the payments for which participating Service Providers are eligible to receive as part of the 6CPA Staged Supply Program from 1 July 2017.

Fee
(per patient)
Description
$7.90 Provision of initial Staged Supply service per week (day 1 visit )
$4 Each additional provision of a Staged Supply service per week (days 2-7)
$31.90 Collection of data at patient registration
$31.90 Collection of data at Follow Up service

No additional patient charges may be applied for participating patients.

Record Keeping and Auditing

Service Providers participating in 6CPA Programs must keep all relevant records for seven (7) years, inclusive of service records, claim records and patient information for Program evaluation. The records may be electronic or hard copy.

The Department of Health is responsible for auditing 6CPA Programs. Anomalies observed by the 6CPA 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 harsh penalties.