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

We can pay the reasonable costs of the provision of medication to a customer, without prior approval, when it is required as a result of a transport accident injury.

We will review our client’s 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.

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.

Gap in treatment

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

Other things to note

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

How much we can pay

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

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.

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.

What we need from you

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

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