PBS Expenditure and Prescriptions Report 1 July 2019 to 30 June 2020
Page last updated: 17 December 2020
Summary of Pharmaceutical Benefits Scheme 2019-2020
Total Pharmaceutical Benefits Scheme (PBS) Government expense for the supply of medicines under Section 85 and Section 100 on an accrual accounting basis for the 2019-2020 financial year was $12,614 million (excluding revenue), compared with $11,818 million for the previous year. This is an increase of 6.7%.
The majority of the Expenditure and Prescriptions report refers to PBS Section 85 and Section 100 data reported by financial year (based on date of supply); however, a few tables refer to Section 85 only and some tables report pharmacy program expenditure.
Total 2019-20 PBS subsidised prescription volume increased by 1.6% to a total of 208.5 million, compared to 205.1 million for the 2018-19 financial year.
In 2019-20, PBS Government expenditure on a cash accounting basis for the supply of medicines under Section 85 and Section 100 was $12,507 million (excluding rebates) which is 89.2% of the total cost of PBS prescriptions. The remainder was patient contributions, which amounted to $1,520 million.
The majority of Government expenditure in 2019-20 on PBS Section 85 and Section 100 prescriptions was directed towards concessional cardholders ($8,253 million, 66.0% of the total), compared to concessional cardholders expenditure for 2018-19 ($7,777 million, 66.5% of the total).
The average dispensed price (Patient payment plus Government benefit) per prescription of PBS subsidised medicines increased to $67.34 in 2019-20, compared to $64.33 in 2018-19.
There were 902 different medicines in 5,371 brands listed on the PBS as at 30 June 2020.
Unless otherwise indicated this publication has been produced using data provided to the Department of Health by the Services Australia. The figures reported in this publication relate to the value (benefit) or volume of PBS prescriptions that have been processed by the Services Australia. They refer only to paid services processed for prescriptions submitted and claimed via the PBS Online claiming system by the approved suppliers. Claims of manually processed PBS programs are excluded.
PBS Expenditure includes the following patient categories:
- General - Non-Safety Net (Ordinary)
- General - Safety Net
- Concessional - Non-Safety Net (Ordinary)
- Concessional - Safety Net
- Doctor's Bag
The financial information in this publication is presented on a cash (expenditure) basis, except where indicated otherwise.
The patient category refers to the patient's eligibility status at the time of supply of the benefit. General patients hold a Medicare card, Concessional patients hold a Medicare card and one of the following cards from Centrelink:
- Pension Concession Card
- Commonwealth Seniors Health Card
- Health Care Card
There are two safety net thresholds – one for General patients and the other for Concessional patients.
From 1 January 2020, the general patient safety net threshold was $1,486.80. When patients and/or their families reached this amount, they could apply for a Safety Net Card and pay only $6.60 per prescription for the rest of the calendar year. The concessional safety net threshold was $316.80. Once patients and/or their families reached this amount, they could apply for a Safety Net Entitlement Card and receive items free of charge for the rest of the calendar year.
The Patient Contribution, Total Cost and Average Price amounts do not include brand or therapeutic premiums.
From 2016-17 this publication is based on the date that a prescription medicine was supplied to a patient. Previous publications were based on the date that a claim was processed (and the payment finalised) by the Services Australia. The historical data from 1948-49 to 2015-16 on pages 27 to 32 remains by date of processing.
Caution should be exercised in referring to the breakdown by patient category in Table 21(a) on pages 27 to 28 and Table 21(b) on pages 29 to 32, because of a past problem in data supplied by the Services Australia whereby a number of General Safety Net scripts were wrongly allocated to Concessional Non-Safety Net. This problem was fixed for 2008-09, but the 2006-07 and 2007-08 allocations of scripts and expenditure by patient category were inaccurate and not strictly comparable to the corresponding 2008-09 and later years’ numbers.
While Section 100 data has been included in the majority of tables in this report, this data does not include supplies to Aboriginal Health Services with the exception of Tables 1(a) and 1(b) on page 1.
Expenditure on nusinersen was adjusted to include manual payments that were not processed through the PBS Online system.
The Department of Health has taken every care to ensure the data supplied is accurate but does not warrant that the data is error free and does not accept any liability for errors or omissions in the data.