Pharmaceutical Benefits

Fees, Patient Contributions and Safety Net Thresholds

Page last updated: 1 January 2021

The following fees, patient contributions and Safety Net thresholds apply as at 1 January 2021 and are included, where applicable, in prices published in the Schedule:

Fees, Patient Contributions and Safety Net Thresholds
Dispensing Fees: Ready-prepared $7.74
Dangerous drug fee $4.80
Extemporaneously-prepared $9.78
Allowable additional patient charge* $4.42
Wholesale Mark-Up (for Ready Prepared Pharmaceutical
Benefits)***
Where the Ex-Manufacturer Price is up to and including $5.50 $0.41 per dispense
Where the Ex-Manufacturer Price is over $5.50 and up to and including $720 7.52 per cent of the Ex-Manufacturer Price per dispense
Where the Ex-Manufacturer Price is over $720 $54.14 per dispense
Administration, Handling and Infrastructure Fee (AHI Fee):

Tier One AHI Fee

For a Listed Brand with a Price to Pharmacists for Maximum Quantity less than $100

 

$4.28 per dispense of Maximum Quantity

 

Tier Two AHI Fee

For a Listed Brand with a Price to Pharmacists for Maximum Quantity from $100 and up to and including $2,000

Tier One AHI Fee plus 5% of the amount by which the Price to Pharmacists for Maximum Quantity exceeds $100, per dispense of Maximum Quantity

 

Tier Three AHI Fee

For a Listed Brand with a Price to Pharmacists for Maximum Quantity over $2,000

 

Tier One AHI Fee and $95 per dispense of Maximum Quantity

Additional Fees (for Safety Net prices): Ready-prepared $1.29
Extemporaneously-prepared $1.66
Efficient Funding of Chemotherapy (EFC)** Preparation fee $85.78
Distribution fee $27.45
Diluent fee $5.44
Patient Co-payments: General $41.30
Concessional $6.60
Safety Net Thresholds: General $1,497.20
Concessional $316.80
Safety Net Card Issue Fee: $10.34

*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.

** Public hospital pharmacies which are authorised to supply PBS-subsidised chemotherapy medicines are only eligible for the preparation fee (ie, not the distribution or diluent fees).

*** The wholesale mark-up for a Pack Quantity of a Listed Brand is calculated using the Relevant Quantity.

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 propionate with salmeterol 250mcg/25mcg

$62.32

 

$41.30

$21.02

$6.60

$55.72

Nil

$62.32

Atrial fibrillation Dabigatran etexilate 150mg

$81.57

$41.30

 

$40.27

$6.60

$74.97

Nil

$81.57

Prostate cancer Goserelin and bicalutamide 3.6mg

$421.68

$41.30

$380.38

$6.60

$415.08

Nil

$421.68

Multiple sclerosis Fingolimod 500mcg

$2,219.45

$41.30

$2,178.15

$6.60

$2,212.85

Nil

$2,219.45

Chronic Myeloid Leukaemia Imatinib 400mg

$937.83

$41.30

$896.53

$6.60

$931.23

Nil

$937.83

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

$41.30

$6.60

$1,497.20

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

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

1/1/2021

6.60

6.60

316.80

41.30

1,497.20

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.