Pharmaceutical Benefits

Fees, Patient Contributions and Safety Net Thresholds

Page last updated: 1 January 2020

The following fees, patient contributions and Safety Net thresholds apply as at 1 July 2019 and are included, where applicable, in prices published in the Schedule:

Fees, Patient Contributions and Safety Net Thresholds
Dispensing Fees: Ready-prepared $7.39
Dangerous drug fee $3.11
Extemporaneously-prepared $9.43
Allowable additional patient charge* $4.60
Administration, Handling and Infrastructure Fee (AHI Fee): For a pack quantity of a listed brand with a price to pharmacists less than $180 $4.09
For a pack quantity of a listed brand with a price to pharmacists from $180 to $2,089.71 $4.09, plus 3.5% of the amount by which the price to pharmacists exceeds $180
For a pack quantity of a listed brand with a price to pharmacists more than $2,089.71 $74.79 
Additional Fees (for Safety Net prices): Ready-prepared $1.25
Extemporaneously-prepared $1.61
Patient Co-payments: General $41.00
Concessional $6.60
Safety Net Thresholds: General $1,486.80
Concessional $316.80
Safety Net Card Issue Fee: $10.27

*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. This fee does not count towards the Safety Net threshold.

Includes the Additional AHI Fee of $0.35.

The Real Cost of Medicines

Information on how much medicines really cost and gives examples of the amount the Government subsidises some medicines.

The Real Cost of Medicines

Condition/Medicine (chemical name)

Actual Cost of Medicine* (dispensed price for maximum qty)

General Patients*
(Non-Concession)

General Patients*
(Non-Concession)

General Patients after reaching PBS Safety Net/Concessional Patients* (Concession Card)

General Patients after reaching PBS Safety Net/Concessional Patients* (Concession Card)

Concessional Patients after reaching Safety Net

Concessional Patients after reaching Safety Net

Cost to patient

Gov’t Subsidy

Cost to patient

Gov’t Subsidy

Cost to patient

Gov’t Subsidy

Asthma & Chronic Obstructive Pulmonary Disease
Fluticasone + Salmeterol 250mcg/25mcg

$61.78

$41.00

$20.78

$6.60

$55.18

Nil

$61.78

Atral fibrillation
Dabigatran etexilate Capsule 150 mg

$88.77

$41.00

$47.77

$6.60

$82.17

Nil

$88.77

Prostate cancer
Goserelin and bicalutamide Acetate 10.8 mg

$1,048.71

$41.00

$1,007.71

$6.60

$1,042.11

Nil

$1,048.71

Multiple sclerosis
Fingolimod 500 mcg

$2,210.41

$41.00

$2,169.41

$6.60

$2,203.81

Nil

$2,210.41

Chronic Myeloid Leukaemia
Imatinib 400 mg

$1,457.11

$41.00

$1,416.11

$6.60

$1,450.51

Nil

$1,457.11

*Please note that some medicines on the PBS are only subsidised for certain conditions. Amounts current as of 1 January 2020.

Who Pays What?

Information on Government subsidies, patient co-payments and how manufacturers, pharmacies and wholesalers are paid.

Who Pays What
Patient Co-payment before Safety Net Patient Co-payment post Safety Net Safety Net Threshold

General patient pays from 1 January 2020

$41.00

$6.60

$1,486.80

for PBS drugs patients can be charged up to $41.00. Pharmacists or dispensers can charge, the PBS dispensed price, plus an additional fee up to $1.25 (from 1 July 2019) for recording Safety Net expenditure on the Patient Record Form, plus an optional pharmacy charge of $4.60 or less, such that the total charge does not exceed the patient co-payment. Plus any delivery or after hours fee, brand or therapeutic group premium, or special patient contribution that may be applicable.

Concessional patient pays from 1 January 2020

$6.60

Nil

$316.80

plus any delivery or after hours fee, brand or therapeutic group premium, or special patient contribution that may be applicable.

Government pays

any additional cost of drugs exceeding patient co-payments up to the dispensed price, excluding any delivery or after hours fee, brand or therapeutic group premium, or special patient contribution that may be applicable.

 

History of PBS Co-payments and Safety Net Thresholds

Table outlining past Co-payments and Safety Net Thresholds

Table outlining past Copayments and Safety Net Thresholds
Date of Change Concessional Beneficiaries Concessional Beneficiaries Concessional Beneficiaries General Beneficiaries General Beneficiaries
Co-payment Co-payment Safety Net Threshold $ Co-payment $ Safety Net Threshold $
Pensioners $ Others $
1/3/1960 0.50
1/11/1971 1.00
1/9/1975 1.50
1/3/1976 2.00
1/7/1978 2.50
1/9/1979 2.75
1/11/1981 3.20
1/1/1983 1 2.00 4.00
1/7/1985 5.00
1/11/1986 2.50 25 scripts 10.00 25 scripts
1/7/1988 11.00
1/11/1990 22.50 2.50 130.00 15.00
1/1/1991 Introduction of 1st tier ..............
2nd tier .............
300.00
50.00
1/8/1991 15.70
1/10/1991 2.60 2.60
1/1/1992 RPBS Co-payment Introduced 2.60 135.20 1st tier ..............
2nd tier .............
309.90
51.60
1/8/1992 15.90
1/1/1993 1st tier ..............
2nd tier .............
312.30
52.00
1/8/1993 16.00
1/1/1994 Discontinuance of 1st tier ..............
2nd tier .............
400.00
nil
1/8/1994 16.20
1/1/1995 407.60
1/8/1995 16.80
1/1/1996 2.70 2.70 140.40 600.000
1/8/1996 17.40
1/1/1997 33.20 3.20 166.40 20.00 612.60
1/1/1999 20.30 620.30
1/1/2000 3.30 3.30 171.60 20.60 631.20
1/7/2000 43.30 3.30 171.60 20.60 631.20
1/1/2001 53.50 3.50 182.00 21.90 669.70
1/1/2002 3.60 3.60 187.20 22.40 686.40
1/1/2003 3.70 3.70 192.40 23.10 708.40
1/1/2004 3.80 3.80 197.60 23.70 726.80
1/1/2005 4.60 4.60 239.20 28.60 874.90
1/1/2006 4.70 4.70 253.80 29.50 960.10
1/1/2007 4.90 4.90 274.40 30.70 1,059.00
1/1/2008 5.00 5.00 290.00 31.30 1,141.80
1/1/2009 5.30 5.30 318.00 32.90 1,264.90
1/1/2010 65.40 5.40 324.00 33.30 1,281.30
1/1/2011 75.60 5.60 336.00 34.20 1,317.20
1/1/2012 85.80 5.80 348.00 35.40 1,363.30
1/1/2013 5.90 5.90 354.00 36.10 1,390.60
1/1/2014 6.00 6.00 360.00 36.90 1,421.20
1/1/2015 6.10 6.10 366.00 37.70 1,453.90
1/1/2016 6.20 6.20 372.00 38.30 1,475.70
1/1/2017 6.30 6.30 378.00 38.80 1,494.90
1/1/2018 6.40 6.40 384.00 39.50 1,521.80
1/1/2019 6.50 6.50 390.00 40.30 1,550.70
1/1/2020 6.60 6.60 9$316.80 41.00

10$1,486.80

1. Previously paid general co-payment
2. a compensating Pharmaceutical Allowance was introduced equal to co-payment x 52
3. Pharmaceutical Allowance maintained at $2.70 per week paid fortnightly
4. Pharmaceutical Allowance increased to $2.80 per week paid fortnightly
5. Pharmaceutical Allowance increased to $2.90 per week paid fortnightly
6. Pharmaceutical Allowance increased to $3.00 per week paid fortnightly
7. Pharmaceutical Allowance is $3.00 per week paid fortnightly
8. Pharmaceutical Allowance increased to $3.10 per week paid fortnightly
9. The number of scripts for concessional beneficiaries to reach the Safety Net threshold was reduced from 60 to 48 scripts on 1 January 2020.
10. Amendments to the National Health Act 1953 lowered the general patient Safety Net threshold to $1,486.80 on 1 January 2020.