PBS Claiming for Closing the Gap Scripts

CTG scripts are indicated by with a c on claim reports. For claimable scripts, the claim amount is calcluated as the standard Government recovery amount, plus the CTG PBS co-payment relief amount.

Example: Pre-Preparation Report
Script number 1192 is priced as follows: Standard Govt Recovery + CTG PBS co-payment relief = 26.12 + (33.30-5.40) = 54.02
Note script numbers 1194 and 1197 for Toprol XL CR-Tab 47.5mg: 1194 is dispensed to a non-CTG patient, and 1197 is dispensed to a CTG General patient. The price difference between these scripts is the CTG amount of $27.90, which is the difference between what a non-CTG patient would pay ($33.30) and what a general CTG patient pays ($5.40). This is the CTG PBS co-payment relief amount which will be reimbursed to the pharmacy.

Claiming under co-payment CTG Scripts

Under the CTG scheme, scripts that would normally not be claimable because they are priced under the PBS co-payment amount are classified as ‘under co-payment’ CTG scripts,and are claimable. These under co-payment scripts are separated out from other claim categories on the relevant claim reports and are assigned the claim categories of UG (under co-payment general), UC (under co-payment concession) and UR (under co-payment repat).