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.
How are medications covered by the public and private health systems?
Public health system. In Australia this is known as Medicare, and it is responsible for administering the Pharmaceutical Benefits Scheme (PBS) which contains a list of all medicines offered to Australians at a subsidised price. However, this list does not include all drugs, which is why you may want to consider taking out health insurance to cover non-PBS items.
Private health system. If you want cover for the cost of non-PBS pharmaceuticals, you will need to take out a private health insurance extras policy that includes cover for pharmacy costs. Even with such a policy in place, you will need to cover a portion of the cost of the medication – currently $38.30 – before your private health insurance will kick in and cover the remaining purchase price up to a set limit per script.
What costs will my health fund cover?
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:
Costs more than $38.30.
Is dispensed by a registered pharmacist in a private practice.
Is only available when prescribed and is listed on the Australian Register of Therapeutic Goods.
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.
How Australian health funds cover non-PBS items
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.
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.
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
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.
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.
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.
CBHS health fund restricts its membership to current and former staff (including their families) of Commonwealth Bank Group and their subsidiaries which include Aussie, Bankwest, Colonial First State and more.
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.
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.
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.
Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
Email me my results (optional)
To get a copy of your results for later, add your email below
You'll pay the same price as going direct - we don't
charge fees
We don't ask for your phone number to see prices
Hang tight - we're fetching policies just for you!
Comparing quotes from 30+ funds...
How do I claim non-PBS pharmaceuticals on my health insurance?
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:
On the spot by swiping your health fund membership card
Online through your health fund's member services centre
Via your fund's mobile claims app
Over the phone with your health fund
Via email, post or fax
By visiting a health fund branch
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.
What is prescription medication?
Prescription medications are active medicinal products that perform a therapeutic, preventative or functional role. These medications can divided into two categories:
Internal. Medications taken in tablet, pills or liquid form
External. Items such as salves and lotions
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.
What can I expect from my pharmacist?
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.
Why you can trust Finder's health insurance experts
You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
Gary Ross's expertise
Gary Ross has written 725 Finder guides across topics including:
Remedial massage can help ease pain from general wear and tear as well as specific injuries. This treatment isn’t covered by Medicare but is included in private health insurance extras cover. Find out how private health insurance can cover you for remedial massage therapy.
Physiotherapy services can be beneficial at any life stage, so it could be worth considering and comparing extras health insurance that can cover the cost of this type of treatment.
This guide takes a look at private health insurance in relation to gym membership and other health-related services.
Feedback
How likely would you be to recommend Finder to a friend or colleague?
0
1
2
3
4
5
6
7
8
9
10
Very UnlikelyExtremely Likely
Required
Thank you for your feedback.
Our goal is to create the best possible product, and your thoughts, ideas and suggestions play a major role in helping us identify opportunities to improve.
Important information about this website
finder.com.au is one of Australia's leading comparison websites. We are committed to our readers and stands by our editorial principles
We try to take an open and transparent approach and provide a broad-based comparison service. However, you should be aware that while we are an independently owned service, our comparison service does not include all providers or all products available in the market.
Some product issuers may provide products or offer services through multiple brands, associated companies or different labeling arrangements. This can make it difficult for consumers to compare alternatives or identify the companies behind the products. However, we aim to provide information to enable consumers to understand these issues.
We make money by featuring products on our site. Compensation received from the providers featured on our site can influence which products we write about as well as where and how products appear on our page, but the order or placement of these products does not influence our assessment or opinions of them, nor is it an endorsement or recommendation for them.
Products marked as 'Top Pick', 'Promoted' or 'Advertisement' are prominently displayed either as a result of a commercial advertising arrangement or to highlight a particular product, provider or feature. Finder may receive remuneration from the Provider if you click on the related link, purchase or enquire about the product. Finder's decision to show a 'promoted' product is neither a recommendation that the product is appropriate for you nor an indication that the product is the best in its category. We encourage you to use the tools and information we provide to compare your options.
Where our site links to particular products or displays 'Go to site' buttons, we may receive a commission, referral fee or payment when you click on those buttons or apply for a product. You can learn more about how we make money.
When products are grouped in a table or list, the order in which they are initially sorted may be influenced by a range of factors including price, fees and discounts; commercial partnerships; product features; and brand popularity. We provide tools so you can sort and filter these lists to highlight features that matter to you.
Please read our website terms of use and privacy policy for more information about our services and our approach to privacy.
We update our data regularly, but information can change between updates. Confirm details with the provider you're interested in before making a decision.