Pharmacist guidelines

These guidelines should be read in conjunction with our General provider guidelines and our Medication guidelines.

Who can provide pharmacy services?

You can provide services if you are a pharmacist who is registered under the Health Practitioner Regulation National Law (e.g. AHPRA) to practice in the pharmacy profession (other than as a student).

What we can pay for

Within the first 90 days of a client’s accident, we can help pay for medication without the need for you or the client to contact us for approval first. The medication must be recommended by a health professional, related to the client’s accident injuries and delivered in line with the Clinical Framework.

If the client receives treatment beyond 90 days after their transport accident, we will review their medication to ensure it’s reasonable, clinically justified, outcome focused and in line with the Clinical Framework. We'll ask our client and their health practitioners for information during these reviews and may temporarily stop funding medication if we don’t receive it.

Reviews help us understand our client’s injuries, treatment needs, their goals and how to best support them get their lives back on track. After a review we’ll let you and our client know the decision regarding further medication.

If our client has not received treatment in 6 months they will need to seek approval from us before we will pay for further treatment. Ask our client for a copy of their approval if you haven’t seen them in 6 months.

For details see What we can pay for and How to seek TAC approval.

We can pay for:

  • medication prescribed by a medical practitioner or dentist in accordance with the Pharmaceutical Benefits Scheme (PBS) and registered (not listed) on the Australian Register of Therapeutic Goods (ARTG)
  • privately prescribed medications that are clinically appropriate for the accident-related injury or illness, where there is no readily available alternative on the PBS
  • medication prescribed for “off label” use that is supported by National Health and Medical Research Council level 1 or 2 evidence
  • over the counter items that are recommended by a medical practitioner or dentist
  • basic medical and rehabilitation equipment recommended by a registered health practitioner
  • sunscreen, where required, to counteract the effects of sun-sensitive medications or for customers with skin grafting and burn injuries

See our Medication guidelines for further details.

Other things to note

We may contact you to seek further information and/or discuss the client’s treatment plan.

How much we can pay

We can pay for services in line with the Pharmaceutical Benefits Scheme (PBS).

If your fee is higher than our fee, you may choose to charge the client the difference in the form of a gap payment.

All TAC clients with a Medicare card are entitled to medications prescribed under the PBS. The TAC can pay the reasonable costs of medications that are provided in accordance with the PBS. The TAC will fund the patient contribution set out in the PBS including any additional brand premium (i.e. the maximum General Patient Charge to the consumer). Where the patient holds a PBS Concession Entitlement, the TAC will fund the patient Concession contribution plus any additional brand premium.

Privately prescribed medication

The following fee structure applies:

Wholesale price*

Mark-up

Dispensing fee

Less than $100

Up to 60%

$7.50

Between $100 and $400

Up to 25%

$7.50

Greater than $400

Up to 10%

$7.50

The dispensing fee for Schedule 8 medications is $11.70.

In some circumstances, the TAC may consider funding Staged Supply Services for the following groups of medications:

  • opioid analgesics
  • antipsychotics
  • anxiolytics
  • hypnotics and sedatives
  • antidepressants
  • psycho-stimulants

These can only be considered upon request of the prescribing doctor and any such requests will be reviewed by the TAC's Clinical Panel for determination. The same principles apply to Opioid Replacement Therapy if attributable to and payable under the relevant claim. Staged Supply Services cannot be considered for funding by the TAC where the client is receiving Staged Supply Services funded under other federal, state or territory government programs.

Over the counter items

The following fee structure applies:

National Drugs and Poisons Scheduling Committee classification

Mark-up (excludes GST)

Dispensing fee

No classification or schedule 2

Up to 50% above the wholesale price*

none

Schedule 3

Up to 75% above the wholesale price*

none

*Wholesale price is based on the Fred Dispense wholesale price. Sigma price 1 (wholesale cost excluding GST) or manufacturer’s wholesale list price (excluding GST) will be used for items not listed on the Fred Dispense System.

The TAC does not consider a dispensing fee for an OTC item to be a reasonable cost, even when the TAC client has a prescription. However, if an OTC item is prescribed on the PBS, the pharmacist is entitled to dispense the item through the PBS and invoice the TAC for the patient contribution.

Upon request from the TAC, pharmacists may be asked from time to time to produce documentation (request from medical practitioner or registered dentist) supporting the invoicing of OTC items for TAC clients.

Invoicing the TAC

For invoices not submitted through LanternPay, we require the following details before we can pay your invoice:

  • date dispensed
  • PBS item number, where available
  • item description, for non-PBS items
  • quantity of medication dispensed
  • medication strength, where applicable
  • amount charged per item
  • dispensary computer generated tax invoice/tax receipt
  • for hospital patients, whether the medication is for outpatient or discharge

Before submitting an account

Before you submit an account, please ensure that:

  • your patient has an accepted TAC claim
  • only one patient appears on each account
  • you do not issue the TAC with receipts or patient history reports

Accounts should be in the form of a dispensary computer-generated tax invoice (not a statement) and must be addressed to the TAC. The status of an item, for example OTC, may be handwritten onto the tax invoice.

Your patient can also choose to pay for their pharmacy items themselves and then seek reimbursement from the TAC. The patient may therefore ask you for a dispensary computer-generated tax receipt to ensure all necessary information is provided to the TAC.

For more information, see How to invoice the TAC.

Reconciliation of accounts

Remittance advice, with detailed information about the status of each item you have invoiced, will be provided to you following the processing of your invoices. Please ensure that you reconcile your accounts each month using the remittance advice.

The TAC will not process or accept invoices that state ‘outstanding balance’. If there is a difference between the billed amount and the amount paid by the TAC, please refer to the explanations on the remittance advice as indicated.

To assist in the timely reconciling of your accounts, please register for access to the Westpac PaymentsPlus Portal, which enables you receive remittances electronically on the day after payment is made, rather than waiting for remittances in the post.

What we cannot pay for

We cannot pay for:

  • services that are included in a hospital inpatient bed fee
  • herbal remedies
  • sunscreen, unless detailed above
  • Schedule 3, Schedule 4 and Schedule 8 drugs that have not been prescribed and used in the manner required by the Drugs and Poisons Regulation Group in Victoria or the corresponding body in another State or Territory in Australia

Where to get more information

If you have a query about a specific item for payment on your pharmacy invoice, please contact the TAC.

You can access our policy for Pharmacy and medication expenses. Further information about TAC policies can be found on our website or by contacting the TAC on free call 1300 654 329.