What is a CAR Item

Page last updated: 9 May 2019

Complex Authority Required (CAR) items have special business rules for prescribing, authorisation and dispensing. The ‘CAR’ status of an item is a modifier for the treatment of the item. ‘CAR’ is not a restriction level as such.

CAR items have special rules for applying for an authority to prescribe and how DHS process the authority application.

In the Public Hospital HSD program, CAR items may be dispensed by a Community Pharmacy, as well as a Public Hospital Pharmacy.

NB. A Streamlined Authority Required item may also be an Administrative CAR item.

CAR Items are identified in the v3.x PBS XML. The documentation on how to identify CAR Items is included below.

The text extracts do not include information on CAR Items.

Complex Authority Required

Certain PBS Items (prescribing rules) are classified as "Complex Authority Required" (CAR). These are known as 'CAR Items'. There are two different meanings to the phrase "CAR":

  • The legal definition of a CAR drug, or
  • The administration by Services Australia (previously called the Department of Human Services) to:
    • Authorise prescribing of the medicine
    • Dispense the medicine

PBS Items in the Public Hospital HSD program (HB) that are marked as 'Administrative CAR' may be dispensed by a Community Pharmacy.

Legal CAR Items

A "Complex Authority Required drug" is defined in the legislative instrument National Health (Highly specialised drugs program) Special Arrangement 2010 (PB 116 of 2010), see Part 1, Division 1, Section 4 Definitions.

Every prescribing rule is a member of one of the http://pbs.gov.au/complex-authority-required groups. There are two groups of this type: http://pbs.gov.au/complex-authority-required/is-complex and http://pbs.gov.au/complex-authority-required/not-complex. A prescribing rule must be a member of exactly one of these groups; it cannot be a member of both.

A Legal CAR Item is identified in the PBS XML by being a member of the group http://pbs.gov.au/complex-authority-required/is-complex. For example,

Example 1. Legal CAR Item

<prescribing-rule>

  ...

  <member-of-list>

    ...

    <member-of rdf:resource='http://pbs.gov.au/complex-authority-required/is-complex'>

      <code rdf:resource="http://pbs.gov.au/code/group">is-complex</code>

      <effective>

        <date>2019-02-01</date>

      </effective>

    </member-of>

  </member-of-list>

</prescribing-rule>

A prescribing rule that is not a Legal CAR Item is identified in the PBS XML by being a member of the group http://pbs.gov.au/complex-authority-required/not-complex. For example,

Example 2. Prescribing Rule that is not legal CAR

<prescribing-rule>

  ...

  <member-of-list>

    ...

    <member-of rdf:resource='http://pbs.gov.au/complex-authority-required/not-complex'>

      <code rdf:resource="http://pbs.gov.au/code/group">not-complex</code>

      <effective>

        <date>2017-08-01</date>

      </effective>

    </member-of>

  </member-of-list>

</prescribing-rule>

Administrative CAR Items

Some PBS Items have more complex administrative requirements for Services Australia. Such items are indicated by the presence of an administrative-advice element that is associated with the PBS Ontology concept http://pbs.gov.au/DHS/authority/complex. Such an element is known as a 'CAR Note'.

Example 3. CAR Note

<administrative-advice xml:id="a25639" rdf:resource="http://pbs.gov.au/DHS/authority/complex">

  <code rdf:resource="http://pbs.gov.au/code/prescribing-text">11165</code>

  <dbk:note>

    <dbk:para>For details on the appropriate minimum exercise program that will be accepted for the purposes of administering this restriction, please refer to the Department of Human Services website at www.humanservices.gov.au</dbk:para>

  </dbk:note>

  <effective>

    <date>2017-09-01</date>

   </effective>

</administrative-advice>

References to a CAR Note may be made directly from a prescribing rule, or from a restriction that is attached to a prescribing rule. As long as there is at least one CAR Note attached to the prescribing rule, then the entire prescribing rule is considered to be an Administrative CAR Item.

CAR Note on a Prescribing Rule

A CAR Note may be directly referenced from a prescribing rule. In this case, there is an administrative-advice-reference element that links to a CAR Note in the prescribing rule's prescribing-text-references-list element.

Example 4. CAR Note Reference, Prescribing Rule

<prescribing-rule>

  <prescribing-text-references-list>

    <administrative-advice-reference xlink:href="#a25639">

      <code rdf:resource="http://pbs.gov.au/code/prescribing-text">11165</code>

      <effective>

        <date>2017-09-01</date>

      </effective>

    </administrative-advice-reference>

  </prescribing-text-references-list>

  ...

</prescribing-rule>

CAR Note on a Restriction

Alternatively, a CAR Note may be referenced from a restriction that is attached to a prescribing rule. In this case, there is an administrative-advice-reference element that links to a CAR Note in the content of the restriction. The restriction, in turn, is referenced from a restriction-references-list element in the prescribing rule.

Example 5. CAR Note Reference, Restriction

<prescribing-rule>

  <benefit-types-list>

    <benefit-type rdf:resource="http://pbs.gov.au/benefit-type/authority-required">

      <restriction-references-list>

        <restriction-reference xlink:href="#a13912">

          <code rdf:resource="http://pbs.gov.au/code/restriction">5965</code>

          <effective>

            <date>2017-09-01</date>

          </effective>

        </restriction-reference>

      </restriction-references-list>

      <effective>

        <date>2017-09-01</date>

      </effective>

    </benefit-type>

  </benefit-types-list>

  ...

</prescribing-rule>

 

<restriction xml:id="a13912">

  <code rdf:resource="http://pbs.gov.au/code/restriction">5965</code>

  <code rdf:resource="http://pbs.gov.au/code/treatment-of">6189</code>

  <assessment rdf:resource="http://pbs.gov.au/assessment/full">

    <code rdf:resource="http://pbs.gov.au/assessment">full</code>

    <effective>

      <date>2017-09-01</date>

    </effective>

  </assessment>

  <indication-reference xlink:href="#a35361">

    <code rdf:resource="http://pbs.gov.au/code/prescribing-text">10646</code>

    <effective>

      <date>2017-09-01</date>

    </effective>

  </indication-reference>

  <administrative-advice-reference xlink:href="#a25639">

    <code rdf:resource="http://pbs.gov.au/code/prescribing-text">11165</code>

    <effective>

      <date>2017-09-01</date>

    </effective>

  </administrative-advice-reference>

  <effective>

    <date>2017-09-01</date>

  </effective>

</restriction>