Commonwealth Consolidated Acts

NATIONAL HEALTH ACT 1953 - SECT 86C

Approved supplier must request provision of medicare numbers in certain circumstances

  (1)   If:

  (a)   an approved supplier is presented, on or after 1   January 2001, with a prescription for the supply of a pharmaceutical benefit to a person; and

  (b)   the pharmaceutical benefit is one in respect of the supply of which the approved supplier would, but for the operation of subsection   99(7), be entitled to receive a payment under subsection   99(2) or (4); and

  (c)   the person presenting the prescription claims to be, or to be the agent of, the person to whom the prescription relates; and

  (d)   the person presenting the prescription does not request that the drug or medicinal preparation to which the prescription relates not be supplied as a pharmaceutical benefit;

the approved supplier must, if:

  (e)   the prescription does not contain a medicare number as a number applicable to the person to whom the prescription relates; and

  (f)   the approved supplier's records do not already contain a medicare number as such a number (whether with or without the expiry date in relation to that number) recorded and retained in accordance with section   86D;

request the person presenting the prescription to provide to the approved supplier a medicare number applicable to the person to whom the prescription relates and the expiry date in relation to that number.

Inclusion of medicare number in a prescription does not prevent later request

  (2)   Even if:

  (a)   the prescription presented to the approved supplier already contains a medicare number as a number applicable to the person to whom the prescription relates; or

  (b)   the approved supplier's records already contain a medicare number as such a number (whether with or without the expiry date in relation to that number) recorded and retained in accordance with section   86D;

the approved supplier may request the person presenting the prescription to provide to the approved supplier a medicare number applicable to the person to whom the prescription relates and the expiry date in relation to that number.

Approved supplier's obligations in relation to medicare number provided

  (3)   If:

  (a)   a medicare number is provided to the approved supplier as a number applicable to the person to whom the prescription relates following a request under subsection   (1) or is included as such a number in the approved supplier's records in accordance with section   86D; and

  (b)   the prescription has not already been endorsed with a medicare number as a number applicable to the person to whom the prescription relates;

the approved supplier must:

  (c)   endorse the prescription with the medicare number so provided or included; or

  (d)   insert the number so provided or included in the CTS claim relating to the prescription.

If medicare number is provided, approved supplier may check prescription endorsed by practitioner

  (4)   If:

  (a)   a medicare number applicable to the person to whom the prescription relates is provided to the approved supplier following a request under subsection   (2) or is included in the approved supplier's records in accordance with section   86D; and

  (b)   the prescription has already been endorsed with a medicare number as a number applicable to the person to whom the prescription relates;

the approved supplier may check the number so provided or included against the endorsed number and:

  (c)   confirm that they are the same; or

  (d)   if they are not the same and the approved supplier considers the number so provided or included more reliable than the endorsed number:

  (i)   alter the endorsed number to the number so provided or included; or

  (ii)   insert the number so provided or included in the CTS claim relating to the prescription, noting the discrepancy; or

  (e)   if they are not the same and the approved supplier considers the endorsed number more reliable than the number so provided or included--disregard the number so provided or included and, if making a CTS claim, insert the endorsed number in the CTS claim relating to that prescription.

Approved supplier may check to ensure that supply not being sought after relevant expiry date

  (5)   If the approved supplier has also been provided with, or has in the approved supplier's records, the expiry date in relation to the medicare number ultimately supplied to the Chief Executive Medicare, the approved supplier may confirm that the supply of the pharmaceutical benefit authorised by the prescription is not being sought after the expiry date.

Requirement in respect of prescription (other than communicated prescription) covering person included in class determined under subsection   86E(1)

  (6)   If:

  (a)   the prescription for the supply of a pharmaceutical benefit that is presented to the approved supplier does not contain a medicare number as a number applicable to the person to whom the prescription relates; and

  (b)   despite a request under subsection   (1), a medicare number is not provided to the approved supplier as such a number; and

  (c)   a medicare number is not retained in the approved supplier's records in accordance with section   86D as such a number; and

  (d)   the approved supplier is satisfied that the person to whom the prescription relates is included within a class of persons identified by the Minister in a determination under subsection   86E(1);

the approved supplier must:

  (e)   endorse on the prescription the special number applicable to the person as a member of that class; or

  (f)   insert that special number in the CTS claim relating to the prescription.

Requirement in respect of written version of communicated prescription not containing medicare number

  (7)   If:

  (a)   a prescription for the supply of a pharmaceutical benefit is not presented to an approved supplier as described in subsection   (1) but is communicated to the approved supplier in circumstances set out in regulations made for the purposes of paragraph   89(a); and

  (b)   the pharmaceutical benefit is one in respect of the supply of which the approved supplier would, but for the operation of subsection   99(7), be entitled to receive a payment under subsection   99(2) or (4); and

  (c)   the approved supplier later receives a written version of the prescription that does not contain a medicare number as a number applicable to the person to whom the prescription relates;

the approved supplier must, after the written version of the prescription is received, endorse on the written version, or insert in the CTS claim relating to the prescription:

  (d)   if a medicare number is already retained in the approved supplier's records in accordance with section   86D as a number applicable to the person to whom the prescription relates--that medicare number; or

  (e)   if a medicare number is not so retained as a number applicable to the person to whom the prescription relates--the special number applicable to the person under subsection   86E(1) as a person in respect of whom a prescription has been so communicated.

Note 1:   Subsection   99(7) sets out the consequences of a failure ultimately to supply a medicare number or special number to the Chief Executive Medicare or, in the case of a medicare number that is so supplied, of a discrepancy with a medicare number held in the records of the Chief Executive Medicare.

Note 2:   If, because a medicare number is not provided and a special number is not applicable, a person pays the full amount to an approved supplier for the supply of a pharmaceutical benefit, the person may be entitled to an appropriate refund from the Commonwealth (see subsection   87A(2)).