If you need medicines not listed on the pharmaceutical benefits list (PBS), you don't need to pay full price. Some extras insurance policies will cover you for non-PBS pharmaceuticals — we've listed them for you below.
Cover for non-PBS medications is included on some high-level extras cover policies from Australian health funds. However, cover is only included if the non-PBS medication:
The exact level of cover provided depends on the health fund and the policy you choose. Your health fund will most likely impose a limit on the amount you can claim per item, for example $50.
It might also limit the maximum amount of pharmaceutical benefits you can claim each year. This annual limit may increase the longer you are a member of the fund.
| Health fund | What level of cover do these funds offer for non-PBS medication? | Find out more |
|---|---|---|
 | Policies offered by AAMI all include cover for non-PBS medication, although with varying overall limits, which are $400 for Premium Active, $300 for Everyday Active, $150 for Starter Boost and $100 for Starter Extras. | More info |
 | Pharmacy cover as part of the AHM Lifestyle Extras policy includes cover for general items (excluding PBS scripts, over-the-counter medicines, vitamins and herbal medicines), hormonal implants, contraceptives for medical reasons and preventive/travel vaccines. Up to $50 above the general patient PBS amount is covered for each item, up to a maximum annual limit of $350. | Get quote |
 | HCF Vital Extras Cover provides cover for up to $50 per script after you've made the PBS equivalent co-payment, up to a maximum annual limit of $180 per policy combined with vaccines and immunizations | Get quote |
 | Medibank's Top Extras policy covers up to $600 of non-PBS pharmaceuticals each year depending on claim back percentage. | Get quote |
 | Top Extras policy from nib covers up to $500 of non-PBS pharmaceuticals each year. | More info |
 | All of Qantas extras policy cover non-PBS pharmaceuticals from Basic extras covering $100 annually to Top extras with $500 annual limit. | Get quote |
 | Top, Mid, Everyday and Starter Extras policies offered by Suncorp all include cover for non-PBS medication, although with varying overall limits, which are $450 for Top Extras, $300 for Mid Extras, $150 for Everyday Extras and $100 for Starter Extras. | More info |
 | Cover for non-PBS pharmaceuticals varies depending on the extras policy you select. For example, the Total Extras policy will give you an annual limit if $570, the 75% Extras policy allows you to claim up to $500 annually, while the Classic Extras covers up to $300 each year. | More info |
 | Cover for non-PBS pharmaceuticals varies depending on the Australian Unity extras policy you select. For example, the Classic Extras policy allows you to claim up to $40 per script up to a maximum annual limit of $400 per person, while Basic Extras covers up to 100% of the cost per script up to $100 per person per year combined with travel vaccinations. | More info |
 Restricted fund |
Top, Intermediate and Essential Extras policies offered by CBHS all include cover for non-PBS medication, although with varying overall limits, which are $1,000 for Top Extras, $300 for Intermediate Extras and $200 for Essential Extras. | More info |
 | Top, Intermediate and Basic Extras policies offered by GMHBA all include cover for non-PBS medication, although with varying overall limits, which are $350 for Top Extras, $250 for Mid Extras and $150 for Basic Extras. | Get quote |
 | HIF's Premium Options Extras allows members to claim a maximum benefit of $80 per script above the PBS co-payment, up to a maximum annual limit of $200 in the first three years of cover, or $400 after three years. | Get quote |
 | Transport Health Top Extras covers pharmacy costs up to a maximum annual limit of $400 per person, or $800 per policy. | More info |
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If you wish to claim a benefit for pharmaceuticals, you can usually do so using one of the normal extras claim options offered by your health fund. You will first have to pay a portion of the cost of the medication before claiming the remaining purchase price back using one of the following methods:
You'll also need to include an official pharmacy receipt with your claim. This receipt must show your name, the script number and the name of the drug you've purchased. Most pharmacies will include the designation (Private or "Priv") on the receipt, which indicates that the script is for a non-PBS pharmaceutical and is covered by private health insurance.
Prescription medications are active medicinal products that perform a therapeutic, preventative or functional role. These medications can divided into two categories:
In order to be able to purchase one of these medications, they must usually be prescribed to you by a doctor. However, in some cases you can also receive a written prescription from a dentist, optometrist or a midwife.
Doctors and specialists prescribe these medications for you in order to help your body fight off illness or disease, or to better manage a pre-existing condition. Your doctor will give you a written prescription that contains a range of information about the medicine you need including its name, the form in which you will take it, the quantity to be dispensed and the dose you will need to take.
Once you are given a script by your doctor or specialist, you'll need to head to your nearest chemist or pharmacy to pick up your medication. Head to the counter with the big "Prescriptions" sign and hand your script to the pharmacist.
The pharmacist will dispense the medication you need – this is also referred to as filling your prescription – and provide you with instructions on the correct dosage and how to safely administer the medication.
You can also visit your local pharmacist for advice on minor health concerns and ailments, to help you access important health services such as immunisations and to provide health screenings to help you assess your overall well-being.
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| Response | Male | Female |
|---|---|---|
| Non-PBS pharmaceuticals | 3.13% | 3.07% |
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