The following links provide information about the Pharmaceutical Benefit Scheme.
The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Schedule is part of the wider Pharmaceutical Benefits Scheme managed by the Department of Health and Ageing and administered by Medicare Australia.
This schedule is now on-line and updated on a monthly basis. This on-line searchable version contains:
The PBS has been in existence since 1948 and is governed by the National Health Act 1953 (Commonwealth).
The Scheme is available to all Australian residents who hold a current Medicare card.
Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the Scheme. Australia currently has RHCAs with: Italy, New Zealand, the Republic of Ireland, Finland, Malta, the Netherlands, Sweden, Norway, the United Kingdom and Belgium.
Residents of these countries must show their passports when lodging a prescription to prove their eligibility or they can contact Medicare and get a Reciprocal Health Care Agreement Card to prove their eligibility. Some overseas visitors may not be eligible for this card.
Only those eligible for the PBS will receive subsidised medication and every time you present your script to the pharmacist, you will need to provide your Medicare card.
Eligible veterans may need to present their DVA card in addition to their Medicare card.
With your consent, the pharmacist may (at their discretion) keep a record of your Medicare number so that you do not have to show the actual card every time you lodge a script.
The Repatriation Pharmaceutical Benefits Scheme (RPBS) is subsidised by the Department of Veterans’ Affairs, and can be used by veterans who have DVA White, Gold or Orange Card.
If you hold one of these cards then you are eligible for all PBS medicines, and other medicines listed on the RPBS, depending on your DVA entitlement. All medicines supplied under the RPBS are dispensed at the concessional rate (or free if the patient has reached their Safety Net threshold).
DVA white card entitles you to RPBS and PBS medicines at the concessional rate for a specific medical condition (which is at your doctor’s discretion). You can receive all other PBS medicines at the general rate.
DVA gold and orange cards entitle you to all RPBS and PBS medicines at the concessional rate.
Dentists are not able to prescribe general PBS items, but have a separate Dental Schedule from which they can prescribe dental care medicines for their patients.
Optometrists are not able to prescribe general PBS items, but have a separate Optometrical Schedule from which they can prescribe eye care medicines for their patients.
To be eligible for a concessional benefit, you will have one of the following concession cards:
Some State / Territory governments issue Seniors Cards. These are not considered concession cards for the purposes of the PBS.
Centrelink is responsible for the issue and administration of the Pensioner Concession Card, the Commonwealth Seniors Health Card and Health Care Cards.
DVA are responsible for White, Gold and Orange Cards.
There is also a DVA Pension Card which entitles holders to PBS medicines at the concessional rate (but not RPBS medicines).
General benefits apply if you do not have any of the above cards.
The co-payment is the amount you pay towards the cost of your PBS medicine. Many PBS medicines cost a lot more than you actually pay as a co-payment.
From 1 January 2010, you pay up to $33.30 for most PBS medicines or $5.40 if you have a concession card. The Australian Government pays the remaining cost.
The amount of co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI).
On 1 January 2010, the Safety Net thresholds changed from $318.00 to $324.00 (for concession card holders) and from $1,264.90 to $1,281.30 (for all other patients). These increases include the usual annual CPI indexation. A similar increase has occurred each year for four years (commencing in 2006). The 2009 thresholds include eight additional copayments compared with the 2005 thresholds.
The same general or concessional Safety Net threshold is applied to a family unit regardless of whether the unit consists of an individual, a couple or a family with dependent children. To be included in the same Safety Net family, the partners of a couple may be married or de facto, and of the same or opposite sex. A couple must be living together on a permanent basis, unless living separately due to illness.
After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. In order to access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form. These are available from all pharmacies.
A Safety Net Entitlement card or Safety Net Concession Card can be issued by the pharmacist once the threshold is reached.
For further information about drugs listed on the PBS and Safety Net arrangements, ask your pharmacist, contact the PBS Information Line on 1800 020 613 (free call) or collect a brochure at your nearest Medicare office.
The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals – this is called the joint Safety Net. From 1 January 2010, the contribution rate for general patients as outpatients at public hospitals in most states and territories in Australia is $26.60. In Queensland and in hospitals in states participating in the pharmaceutical reforms, patients pay the Safety Net value of an item when it is listed in the Pharmaceutical Benefits Scheme, and a maximum of $33.30 for items not listed in the schedule.
In public hospitals from 1 January 2010, concessional patients pay a maximum of $5.40 – except in South Australia where Department of Veterans’ Affairs (DVA) card holders are treated as general patients, and in New South Wales, where DVA White Card holders are treated as general patients.
These amounts are adjusted on 1 January each year.
For general patients, an allowable additional patient charge can apply. The allowable additional patient charge is a discretionary charge to general patients if a pharmaceutical item has a dispensed price for maximum quantity less than the general patient co-payment. The pharmacist may charge general patients the allowable additional fee but the fee cannot take the cost of the prescription above the general patient co-payment for the medicine.
The maximum fee is currently $3.83 and is adjusted on 1 January each year. This fee does not count towards your Safety Net threshold.
In addition, if a medicine has a ‘dispensed price for maximum quantity’ less than the general co-payment a safety net recording fee may be charged by your pharmacist. This fee may not take the cost of your script above the co-payment.
Concessional patients do not pay this fee.
This fee is currently $1.05 and is adjusted on 1 August each year. The amount of this fee does count towards your Safety Net threshold.
A price premium or brand premium, may apply to some medicines.
Where there are two or more brands of the same drug on the Schedule, the Government subsidises each brand to the same amount - up to the cost of the lowest priced brand.
If you are taking a more expensive brand the price difference is paid by you as a brand premium. This cost is in addition to your co-payment.
At your request, the pharmacist may be able to substitute a less expensive brand where your doctor has allowed this. If you have any concerns, you should talk to your doctor or pharmacist.
Pharmacists are legally required to charge brand premiums. The brand premium does not count towards the safety net threshold.
General information:
PBS information on health.gov.au site
PBS and Medicare Australia:
PBS information on medicareaustralia.gov.au site
The Safety Net:
Safety Net information on medicareaustralia.gov.au site