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Pharmaceutical Benefits Scheme (PBS) prescription—PBS patient contribution, total Australian currency N[NNNNN].NN

Identifying and definitional attributes

Metadata item type:Help on this termData Element
Short name:Help on this termPBS patient contribution
Synonymous names:Help on this termPatient co-payment
METeOR identifier:Help on this term603362
Registration status:Help on this termCommonwealth Department of Health, Standard 17/12/2015
Definition:Help on this term

For a given Pharmaceutical Benefits Scheme (PBS) prescription, the total amount paid by the patient or PBS consumer to the approved pharmacy for a prescription, exclusive of any special patient contributions, e.g. brand price premiums or therapeutic group premiums, expressed in Australian dollars.

This amount also excludes any optional fees imposed at the discretion of the pharmacy and payable by the patient, e.g. fees associated with the maintenance of Safety Net records on behalf of the patient by the pharmacy.

Data Element Concept:Pharmaceutical Benefits Scheme (PBS) prescription—PBS patient contribution

Value domain attributes

Representational attributes

Representation class:Help on this termTotal
Data type:Help on this termCurrency
Format:Help on this termN[NNNNN].NN
Maximum character length:Help on this term8
Unit of measure:Help on this termAustralian currency (AU$)
Unit of measure precision:Help on this term2

Collection and usage attributes

Guide for use:Help on this term

This value domain must be expressed to two decimal places. Where there is a dollar value and no cent value, the cents must be expressed as .00 (e.g. 100.00).

Data element attributes

Collection and usage attributes

Guide for use:Help on this term

The amount of patient co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI). The patient co-payment amount varies according to whether the PBS benefit is being claimed on behalf of a general patient or a concessional patient, and also whether the patient (including their family members) reaches the Safety Net threshold applicable to their circumstances in the relevant calendar year.

For example, under the general PBS, in 2014 a general (non-concessional) 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

Source and reference attributes

Submitting organisation:Help on this term

Department of Health

Relational attributes

Related metadata references:Help on this term

See also Pharmaceutical Benefits Scheme (PBS) prescription—PBS benefit amount, total Australian currency N[NNNNN].NN Commonwealth Department of Health, Standard 17/12/2015

Implementation in Data Set Specifications:Help on this term

Pharmaceutical Benefits Scheme (PBS) state/territory data extract 2013-14 Commonwealth Department of Health, Standard 17/12/2015

DSS specific attributes +
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