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Pharmaceutical Benefits Scheme (PBS) state/territory data extract 2013-14

Identifying and definitional attributes

Metadata item type:Help on this termData Set Specification
METeOR identifier:Help on this term602524
Registration status:Help on this termCommonwealth Department of Health, Standard 17/12/2015
DSS type:Help on this termData Set Specification (DSS)
Scope:Help on this term

This data set specification describes the output data set made available to each Australian state and territory via the Commonwealth Department of Health's Enterprise Data Warehouse (EDW) in relation to the ongoing operations of the Pharmaceutical Benefits Scheme (PBS). It describes the PBS data items supplied in respect of the 2013-14 reference year, i.e. those data records where the date of completed validation is between 1 July 2013 and 30 June 2014 inclusive.

The data set contains data as presented for analysis by users of the EDW, i.e. the data has generally undergone some degree of validation or reformatting in comparison with the raw input data sets provided to the Department of Health by the Commonwealth Department of Human Services.

The PBS is a programme under which the cost of prescription medications provided to consumers is subsidised by the Australian Government. Under the PBS, the government subsidises the cost of medicine for most medical conditions.

Benefits provided under the PBS, in the form of subsidised over-the-counter prices for prescription medications, are available to all Australian residents who hold a Medicare card, as well as to visitors to Australia from countries with which Australia has a Reciprocal Health Care Agreement (RHCA). As at 1 July 2015, the countries with which Australia has an RHCA include the United Kingdom, Ireland, New Zealand, Malta, Italy, Sweden, the Netherlands, Finland, Norway, Belgium and Slovenia.

Under the PBS, some types of medical professionals can only prescribe a subset of the medications listed in the general PBS schedule, e.g. dental practitioners can only prescribe the dental care medicines listed in the separate Dental schedule. Similarly, optometrists can only prescribe the eye care medicines listed in the separate Optometrical schedule.

Most of the medicines listed in the various PBS schedules are dispensed by pharmacists and used by patients at home. Some medicines, e.g. chemotherapy drugs, are dangerous to administer without medical supervision and are only accessible at specialised medical services, usually hospitals.

The PBS is managed by the Department of Health and administered by the Department of Human Services. The PBS is governed by the National Health Act 1953 (Cwth) and the National Health (Pharmaceutical Benefits) Regulations 1960 (Cwth).

The data set also contains data sourced from a number of assistance programmes that are related to but not strictly part of the PBS, e.g. the Repatriation Pharmaceutical Benefits Scheme (RPBS) and the Stoma Assistance Scheme (SAS).

The RPBS is a scheme administered by the Department of Veterans' Affairs under which the cost of prescription medications provided to veterans of Australia's defence force, their widows/widowers and dependants is subsidised by the Australian Government. The RPBS offers a wider range of medications at concessional rates than the PBS.

The Stoma Appliance Scheme (SAS) provides support to people with a stoma by improving access to the most suitable and clinically appropriate stoma-related products. A stoma is a temporary or permanent body opening, either natural or surgically created, which connects a portion of the body cavity to the outside environment to allow bodily waste to leave the body.

In some use cases, data produced in accordance with the structures described in this data set specification may need to be suppressed, de-identified or perturbed by the Department of Health in order to protect the privacy and/or confidentiality of individual patients, prescribers or pharmacies.

Collection and usage attributes

Statistical unit:Help on this term

The data described in this data set specification is administrative by-product data generated by the ongoing daily operations of the PBS and allied schemes including the RPBS and SAS.

In broad terms, a new PBS data record is generated each time a prescription written by an authorised PBS prescriber for a medicinal product included in the Schedule of the PBS is dispensed by an approved supplier.

Guide for use:Help on this term

The applicable co-payment amounts, i.e. the contribution paid by patients towards Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Scheme medicinal products, for the 2013-14 financial year are as follows:

 

Table 1: Co-payment amounts for 2013-14

Date General co-payment Concessional co-payment
1 January 2013 – 31 December 2013 $36.10 $5.90
1 January 2014 – 31 December 2014 $36.90 $6.00

The applicable Safety Net thresholds for the 2013-14 financial year are as follows:

Table 2: Safety Net thresholds for 2013-14

Date General patients Concessional patients
1 January 2013 – 31 December 2013 $1,390.60 $354.00
1 January 2014 – 31 December 2014 $1,421.20 $360.00

 

Under the general PBS, in 2014 a general patient would have paid a maximum over-the-counter price of $36.90 for each prescribed PBS medicinal product, plus any applicable special patient contribution, brand premium or therapeutic group premium. If the total amount spent by the patient during the year reached the general Safety Net threshold of $1,421.20, the maximum over-the-counter price paid for any additional item during the remainder of the year would be $6.00, plus any applicable special patient contribution, brand premium or therapeutic group premium.

Similarly, in 2014 a concessional patient would have paid a maximum over-the-counter price of $6.00 for each prescribed PBS medicinal product, plus any applicable special patient contribution, brand premium or therapeutic group premium. If the total amount spent by the patient during the year reached the concessional Safety Net threshold of $360.00, any additional items during the remainder of the year would be supplied free of charge, plus any applicable special patient contribution, brand premium or therapeutic group premium.

Implementation start date:Help on this term01/07/2013
Implementation end date:Help on this term30/06/2014

Source and reference attributes

Steward:Help on this termDepartment of Health
Origin:Help on this term

Department of Health 2015. Pharmaceutical Benefits Scheme website. Department of Health, Canberra. Viewed 25 June 2015,
http://www.pbs.gov.au

Department of Health 2015. Repatriation Pharmaceutical Benefits Scheme website. Department of Health, Canberra. Viewed 30 October 2015,
http://www.pbs.gov.au/browse/rpbs

Department of Health 2015. Stoma Assistance Scheme website. Department of Health, Canberra. Viewed 30 October 2015,
http://www.health.gov.au/internet/main/publishing.nsf/
Content/Stoma+Appliance+Scheme-3

Reference documents:Help on this term

Office of Parliamentary Counsel, ComLaw website 2014. National Health Act 1953 (Cwth). Office of Parliamentary Counsel, Canberra. Viewed 22 September 2015,
https://www.comlaw.gov.au/Details/C2015C00081

Office of Parliamentary Counsel, ComLaw website 2014. National Health (Pharmaceutical Benefits) Regulations 1960 (Cwth). Office of Parliamentary Counsel, Canberra. Viewed 22 September 2015,
https://www.comlaw.gov.au/Details/F2015C00314 

Office of Parliamentary Counsel, ComLaw website 2015. Repatriation Pharmaceutical Benefits Scheme, Instrument 2013, No. R43. Office of Parliamentary Counsel, Canberra. Viewed 30 October 2015,
https://www.comlaw.gov.au/Details/F2015C00298

Metadata items in this Data Set SpecificationHelp on this term

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Seq No.Help on this termMetadata itemHelp on this term ObligationHelp on this term Max occursHelp on this term
1Pharmaceutical Benefits Scheme (PBS) prescription—PBS item prescribed, code NN[NNN]AMandatory1
2Pharmaceutical Benefits Scheme (PBS) prescription—patient category, entitlement code AAMandatory1
3Pharmaceutical Benefits Scheme (PBS) prescription—PBS form type, code AAMandatory1
4Pharmaceutical Benefits Scheme (PBS) prescription—quantity of PBS item supplied, total number N[NNN]Mandatory1
5Pharmaceutical Benefits Scheme (PBS) prescription—PBS benefit amount, total Australian currency N[NNNNN].NNMandatory1
6Pharmaceutical Benefits Scheme (PBS) prescription—PBS patient contribution, total Australian currency N[NNNNN].NNMandatory1
7Prescription—repeat prescription indicator, code XMandatory1
8Pharmaceutical Benefits Scheme (PBS) prescription—Regulation 24 applicable indicator, yes/no code AMandatory1
9Pharmaceutical Benefits Scheme (PBS) prescription—patient payment category, code XMandatory1
10Pharmaceutical Benefits Scheme (PBS) prescription—type of drug prescribed, broad category code XXMandatory1
11Hospital—hospital identifier, identifier N[NNNNNN]AMandatory1
12Pharmaceutical Benefits Scheme (PBS) prescription—specialty of prescriber, group code NNMandatory1
13Pharmaceutical Benefits Scheme (PBS) prescription—pharmacy approval type, code XMandatory1
14Patient—Closing the Gap co-payment eligibility indicator, code AAA[NNA]Mandatory1
15Pharmaceutical Benefits Scheme (PBS) prescription—PBS claim type, code AMandatory1
16Pharmaceutical Benefits Scheme (PBS) prescription—prescriber type, code AMandatory1
17Pharmaceutical Benefits Scheme (PBS) prescription—number of times previously supplied, total number N[N]Mandatory1
18Pharmaceutical Benefits Scheme (PBS) prescription—number of authorised prescription repeats, total number N[N]Mandatory1
19Pharmaceutical Benefits Scheme (PBS) prescription—record extract date, DDMMYYYYMandatory1
20Pharmaceutical Benefits Scheme (PBS) prescription—number of authorised medication supplies, total number N[N]Mandatory1
21Pharmaceutical Benefits Scheme (PBS) prescription—patient entitlement status (derived), Commonwealth government assistance scheme code AXMandatory1
22Pharmaceutical Benefits Scheme (PBS) prescription—pharmaceutical benefit entitlement source, code AMandatory1
23Pharmaceutical Benefits Scheme (PBS) prescription—eligibility card type, code AAMandatory1
24Pharmaceutical Benefits Scheme (PBS) prescription—therapeutic group, code NMandatory1
25Pharmaceutical Benefits Scheme (PBS) prescription—bioequivalent allowed indicator, code AMandatory1
26Pharmaceutical Benefits Scheme (PBS) prescription—patient identifier, identifier N[N(8)]Mandatory1
27Pharmaceutical Benefits Scheme (PBS) prescription—prescriber identifier, identifier N[N(19)]Mandatory1
28Pharmacy—pharmacy identifier, identifier XXNNNAMandatory1
29Pharmacy—Australian state/territory identifier, ACT-prioritised code AA[A]Mandatory1
30Person—Australian state/territory identifier, ACT-prioritised code AA[A]Mandatory1
31Prescriber—Australian state/territory identifier, ACT-prioritised code AA[A]Mandatory1
32Pharmacy—geographic remoteness, PBS classification (ASGS-RA) XMandatory1
33Person—geographic remoteness, PBS classification (ASGS-RA) XMandatory1
34Prescriber—geographic remoteness, PBS classification (ASGS-RA) XMandatory1
35Pharmaceutical Benefits Scheme (PBS) prescription—date of supply, DDMMYYYYMandatory1
36Pharmaceutical Benefits Scheme (PBS) prescription—date of prescribing, DDMMYYYYMandatory1
80Pharmaceutical Benefits Scheme (PBS) prescription—specialty of prescriber, major specialty code NNNNMandatory1
81Pharmaceutical Benefits Scheme (PBS) prescription—specialty of prescriber, subspecialty code NNNNNNMandatory1
98Person—date of birth, DDMMYYYYMandatory1
99Person—sex, code AMandatory1
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