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Expenditure and Prescriptions twelve months to 30 June 2016

Page last updated: 16 December 2016

Tables of prescription volumes and government costs (expenditures) under the Pharmaceutical Benefits Scheme.

The same document broken into smaller sections:

Supplement 2

Supplement 3

Supplement 4

Summary of Pharmaceutical Benefits Scheme 2015-2016

Total Pharmaceutical Benefits Scheme (PBS) government expenditure (both Section 85 and Section 100) on an accrual accounting basis for the 2015-2016 financial year was $10,838.0 million, compared with $9,072.1 million for the previous year. This is an increase of 19.5%.

The majority of the Expenditure and Prescriptions Report and the remainder of this summary refer to PBS Section 85 data reported on a cash accounting basis by date of processing.

Total PBS prescription volumes decreased by 1.9% to a total of 208.0 million for 2015-16, compared to 212.1 million for the previous year.

Government expenditure amounted to $7,964.9 million which was 85.1% of the total cost of PBS prescriptions. The remainder was patient contributions that amounted to $1,394.2 million, down from $1,465.9 million in the previous twelve-month period.

The majority of government expenditure on PBS prescriptions was directed towards concessional cardholders ($6,044.8 million, 75.9% of the total). This is compared to concessional expenditure of $5,503.9 million in the previous period (77.4% of the total).

The average dispensed price per prescription of PBS medicines increased to $45.00 for 2015-16 ($40.45 for the previous financial year). The average government cost of these scripts was $38.29 for the same period ($33.54 for 2014-15).

The three drugs with the highest cost to government were Ledipasvir + Sofosbuvir ($357.9 million), Adalimumab ($334.7 million) and Ranibizumab ($217.8 million). The PBS drugs most frequently dispensed were Atorvastatin, followed by Esomeprazole and then Rosuvastatin. See Table 10(b) for details.

Note that there may be minor differences in data reported in this publication compared to previous editions of Expenditure and Prescriptions. This is because of a different treatment of Closing the Gap prescriptions, and the receipt of some late adjustments to claims from pharmacies due to the new streamlined claiming process.

Important Information

Please direct enquiries about this publication or requests for complimentary copies via:

Director,
PBS Information Management Section.
Pharmaceutical Policy Branch, MDP 900
Department of Health
GPO Box 9848 Canberra ACT 2601

E-mail: pbsstats@health.gov.au

Report production: Gareth Thomas, Peter Marlton.

Thanks to the following people for their help in the access and provision of data and information used in this report: Sonja Davis, Matthew Fairhall, Robert Nichols, Nikolai Tsyganov, Dan Troselj, Erin Thorncraft, Karen Prstec, Christopher Parker, Simon Wells, Andrew Kopras.

Unless otherwise indicated this publication has been produced using data provided to the Department of Health by the Department of Human Services. The figures reported in this publication relate to the value (benefit) or volume of PBS prescriptions that have been processed by the Department of Human Services. They refer only to paid services processed from claims presented by approved suppliers. They do not include any adjustments made against claims, any manually paid claims or any benefits paid as a result of retrospective entitlement or refund of patient contributions.

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 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 2016, the general patient safety net threshold was $1,475.70. When patients and/or their families reached this amount, they could apply for a Safety Net Concession Card and pay only $6.20 per prescription for the rest of the calendar year. The concessional safety net threshold was $372.00. 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.

Caution should be exercised in referring to the breakdown by patient category in Table 20(a) on page 27 and Table 20(b) on page 30, because of a past problem in data supplied by the Department of Human Services whereby a number of General Safety Net scripts were wrongly allocated to Concessional Non-Safety Net. This problem has been 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.

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.