Fees, Patient Contributions and Safety Net Thresholds

The following fees, patient contributions and safety net thresholds apply as at 1 January 2014 and are included, where applicable, in prices published in the Schedule —

Dispensing Fees: Ready-prepared $6.76
Dangerous drug fee $2.71
Extemporaneously-prepared $8.80
Allowable additional patient charge* $4.19
Additional Fees (for safety net prices): Ready-prepared $1.15
Extemporaneously-prepared $1.50
Patient Co-payments: General $36.90
Concessional $6.00
Safety Net Thresholds: General $1421.20
Concessional $360.00
Safety Net Card Issue Fee: $9.26

*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.

 

The Real Cost of Medicines

Information on how much medicines really cost and gives examples of the amount the Government subsidises some 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
High cholesterol Atorvastatin Calcium 80mg $40.79 $36.90 $3.89 $6.00 $34.79 Nil $40.79
Alzheimer’s disease Donepezil Hydrochloride $81.74 $36.90 $44.84 $6.00 $75.74 Nil $81.74
Asthma + COPD** Fluticasone + Salmeterol 250mcg/25mcg $78.65 $36.90 $41.75 $6.00 $72.65 Nil $78.65
Prostate cancer Goserelin Acetate
10.8 mg
$1,108.97 $36.90 $1,072.07 $6.00 $1102.97 Nil $1,108.97
Multiple sclerosis Fingolimod 500 mcg $2,313.19 $36.90 $2,276.29 $6.00 $2,307.19 Nil $2,313.19
Chronic Myeloid Leukaemia
Imatinib Mesylate 400 mg
$3,779.58 $36.90 $3,742.68 $6.00 $3,773.58 Nil $3,779.58
  *Please note that some medicines on the PBS are only subsidised for certain conditions. Amounts current as of 1 January 2014.

 

Who Pays What?

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

Patient Copayment before Safety Net Patient Copayment post Safety Net Safety Net Threshold
General patient pays from 1 January 2014 $36.90 $6.00 $1,421.20
for PBS drugs up to $36.90, the PBS dispensed price, plus an additional $1.13 fee (from 1 August 2013) for recording safety net expenditure on the Patient Record Form, plus an optional pharmacy charge of $4.19 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 2014 $6.00 Nil $360.00
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 Copayments 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
Copayment Copayment Safety Net Threshold $ Copayment $ 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 Copayment 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. previously paid general copayment
2. a compensating Pharmaceutical Allowance was introduced equal to copayment 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  

Page last updated 1 July 2014