🇦🇺Australia

PBS Reimbursement Delays

2 verified sources

Definition

Pharmacies experience extended Days Sales Outstanding on PBS claims due to sequential TGA approval (255 working days) followed by PBAC HTA process before subsidised reimbursement.

Key Findings

  • Financial Impact: AUD 2,000-5,000/month in tied-up capital per pharmacy (high AR days from delayed PBS approvals)
  • Frequency: Ongoing for Category B SAS and new PBS listings
  • Root Cause: Sequential TGA ARTG listing (~1 year) then PBAC PBS inclusion

Why This Matters

The Pitch: Retail pharmacies in Australia 🇦🇺 face 1-year delays from TGA dossier to PBS listing. Automation of authorisation cuts time-to-cash drag.

Affected Stakeholders

Accounts Receivable Staff, Pharmacy Owners, PBS Claims Processors

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Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Prior Authorisation Delays

AUD 5,000-10,000/month per pharmacy in lost sales from queues (based on 20-40 working days delay per authorisation cycle)

Patient Access Friction

AUD 10,000-20,000/year per pharmacy in lost repeat sales (2-5% churn from delays)

TGA Enforcement Action & License Revocation Risk

Business closure/license revocation = 100% revenue loss (unquantified in sources; typical community pharmacy revenue AUD 500k-2M+ annually at risk); estimated enforcement investigation cost: AUD 5,000-15,000 in compliance remediation and legal fees

Manual Documentation Bottleneck & Service Capacity Loss

Estimated 15-30 hours/month of pharmacist time at AUD 50-80/hour (fully-loaded cost) = AUD 750-2,400/month per FTE = AUD 9,000-28,800/year per pharmacist; 2-5% revenue leakage due to lost/delayed scripts during manual documentation bottlenecks = AUD 10,000-50,000/year for typical community pharmacy (estimated AUD 1-2M annual turnover)

Medication Safety Incidents & Liability Risk from Documentation Gaps

Estimated per-incident: AUD 10,000-100,000+ in liability claim, legal defense, settlement, and refunds; reputational damage = 5-15% patient churn = AUD 25,000-150,000+ annual revenue loss; pharmacy closure in severe cases; insurance excess typically AUD 2,500-5,000 per claim; annual insurance premium increases 10-20% post-incident

Excessive Compliance Labor & Rework Due to October 2024 Guideline Expansion

Training cost: 5-10 hours per staff member × AUD 30-50/hour × average 3-5 staff members = AUD 450-2,500 per pharmacy; SOP redesign and audit labor: 20-40 hours × AUD 60-80/hour = AUD 1,200-3,200; total estimated one-time remediation cost: AUD 2,000-6,000 per pharmacy; ongoing monthly compliance overhead increase: AUD 300-800/month (additional record-keeping, verification, supervisor review)

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