Program Updates from 1 July 2024

The ACOP Measure commenced on 1 July 2024, providing funding for Section 90 community pharmacies and residential aged care homes (RACHs) to engage credentialed pharmacists to work on-site in residential aged care homes.

The Measure involves two tiers, as follows:

• Tier 1 relates to arrangements where a community pharmacy claims and receives payments to engage an ACOP to work at a RACH
• Tier 2 relates to arrangements where a RACH claims and receives payments to engage an ACOP to work at the RACH. Note that RACHs can only participate in Tier 2 of the Measure where they have been unsuccessful in sourcing an ACOP from at least one community pharmacy, under Tier 1 of the Measure.

Click here to view the Tier 1 webpage, which includes ACOP Measure Tier 1 Rules, FAQs and information for pharmacies on how to register in the PPA Portal.

Click here to view the Tier 2 webpage including ACOP Measure Tier 2 Rules, which includes ACOP Measure Tier 2 Rules, FAQs and information on interim application arrangements for RACHs.

Changes have been made by the Department of Health and Aged Care (the Department) and the PPA to consent forms for the following programs:

• Dose Administration Aids
• Indigenous Dose Administration Aids
• Home Medicines Review
• MedsChecks and Diabetes MedsCheck
• Residential Medication Management Review
• Staged Supply

These changes have been made to remove the references to 7CPA (where relevant), to provide clearer information to patients regarding what each service entails and to align the information captured in the consent forms across programs. Service Providers should ensure they are using the most up to date consent forms when they obtain patient consent. Patient consent is mandatory and services cannot be claimed where informed consent was not obtained.

Both regular (as linked above) and low ink versions of the consent forms are available for download in the ‘Program Rules and other Downloads’ section of each program’s webpage.

As agreed in the 8CPA, the weekly DAA base cap has increased from 60 to 90 DAA services per week. These changes take effect from 1 July 2024.

This means pharmacies that previously had weekly DAA caps of 60 – 89, have had their weekly cap automatically increased to 90 DAA services per week.

There are no changes for pharmacies with grandfathered weekly DAA caps of 90 or more.

Please note: the weekly DAA cap is based on the date the DAA service was provided (the start date on the pack) and not the date the claim was submitted to the PPA Portal. Any claims submitted in July with a service date in June will therefore be assessed against the weekly cap that was in effect at the time of the service (i.e. before the base cap increase).

The PPA is not permitted to consider requests for cap increases above 90.

The Department has indexed fees payable to Service Providers from 1 July 2024 for three programs administered by the PPA. These three programs are listed below. Programs administered by PPA which are not listed below have not had any indexation applied from 1 July 2024.

Please note payment rates are based on the date of service/supply. Claims relating to service/supply prior to 1 July 2024 will therefore be paid at the rate in place at the time of service/supply.

COVID-19 Vaccination in Community Pharmacy (CVCP) Program

CVCP payment rates have been increased as set out in the following table from 1 July 2024.

*Modified Monash Model (MMM)

National Immunisation Program Vaccinations in Pharmacy (NIPVIP) Program

The NIPVIP payment rate has been increased as set out in the following table from 1 July 2024.

Take Home Naloxone (THN) Program

Any individual supply claims submitted with a date of supply on or after 1 July 2024 will be paid under the new indexed amounts, which can be found on THN webpage and in the THN Program Rules. For section 90 pharmacies, these amounts are set out in the following table.

Claims submitted with a date of supply on or before 30 June 2024 will be paid in accordance with the previous fees that were in effect at the time of the supply (i.e. before the price changes). Previous pricing arrangements can be found in the THN Program Rules.

As per existing Program Rules, Authorised Alternative Suppliers do not receive payment for supply of naloxone products under the THN Program.

The NIPVIP Program was recently expanded to allow pharmacies to claim administration of NIP vaccinations off-site in residential aged care and disability homes.

Starting from 15 July 2024, additional questions will be added to the NIPVIP claim form to capture details of off-site vaccinations, such as the location that vaccines were administered.

If you use a software that is integrated with the PPA portal to submit your NIPVIP claims (Fluger, MedAdvisor or VaxApp), these new questions will be ready and available on your software interface from 15 July 2024.

The General Terms have been updated following the signing of 8CPA and to reflect additional programs the PPA now administer. From 1 July 2024, by continuing to participate in any programs administered by the PPA you agree to be bound by the updated General Terms, so please ensure you have read this updated document.

The updated General Terms includes a clearer definition of an ‘Exceptional Circumstance’. The Exceptional Circumstance definition now reads as:

“Exceptional Circumstances means circumstances that are out of the ordinary, unavoidable or unexpected, and may have affected your ability to make a claim for payment that meets the requirements of this Agreement and the relevant Program Rules.”

For example, exceptional circumstances could include but are not limited to:

• Property damage due to flood, fire or theft that resulted in a disruption to normal operation
• Power outages that last the remainder of the claiming period
• Software or IT concerns that last the remainder of the claiming period.

Circumstances that would not be considered ‘exceptional’ for example could include but are not limited to:

• Staffing difficulties including leave, resignations, handovers, locums etc.
• Forgotten submissions.

Ultimately, it is the Service Providers responsibility to ensure appropriate processes and procedures are in place, to ensure claims are submitted correctly and within appropriate timeframes.

Please note that services performed during the Seventh Community Pharmacy Agreement will no longer be able to be submitted as Exceptional Circumstance requests from 30 September 2024. Following this date, requests will only be sent to the Department for services completed on or after 1 July 2024.

As part of the 8CPA, the Department announced the RPTA will end on 30 June 2024, with final payment for the month of June made in July.

The new Additional Community Supply Support (ACSS) payment is designed to give pharmacists more confidence to continue delivering services for their patients, particularly cheaper medicines through 60-day prescriptions, without increasing patient fees. It is intended that first ACSS payments will be made by November 2024, with this process being managed by Services Australia as part of regular PBS payments. Questions regarding this payment are to be directed to the Department of Health and Aged Care.