IN A notice from the Pharmaceutical Benefits Scheme (PBS), pharmacists are being reminded about biosimilar substitution requirements in relation to reason codes 162/163.
Pharmacies have been receiving a warning reason code 162/163 when substituting a biosimilar for the reference brand, where 162 indicates the item provided does not match to the authority approval and 163 that the repeat item provided does not match the authority approval.
"Pharmacists (and approved PBS suppliers) are reminded that they can substitute biosimilar brands that are 'a'-flagged in consultation with the patient, and provided that the prescriber has not marked 'brand substitution not permitted' on the prescription," the PBS stated.
"When dispensing however, attention must be paid to selection of the correct PBS item code to ensure the correct product is claimed," the PBS cautioned.
"Claiming incorrect item codes may result in a warning or rejection message from Services Australia."
The PBS explained that warning codes may be triggered when a biological medicine has been approved for PBS subsidy under an Authority Required listing and the PBS item code for the biosimilar is different to the PBS item code for the reference brand.
Substituting biosimilar brands of adalimumab for the reference brand Humira appears to be a particular issue.
The PBS assured pharmacists they can still substitute biosimilar brands for the reference brand when they get a warning code, but they should first "review and action these as appropriate".
"Upon review when substituting, if the selected item code can be supplied in line with substitution arrangements, then the pharmacist can disregard the warning."
If pharmacists are still unsure about it, they can contact Services Australia to confirm if they can continue to supply the item.
Services Australia can then advise whether the item can be supplied as a PBS benefit or if a different PBS item code will need to be used.
There is more information about reason and rejection codes for online claiming on the Services Australia website HERE. KB
The above article was sent to subscribers in Pharmacy Daily's issue from 24 Jan 25
To see the full newsletter, see the embedded issue below or CLICK HERE to download Pharmacy Daily from 24 Jan 25