The Pharmaceutical Benefits Scheme (PBS)
What is the PBS and what does it cover? Find out in this handy guide.
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Many of the medicines you buy are actually much more expensive than the price you pay. The price is kept down thanks to the PBS. The PBS is an Australian government scheme that subsidises the cost of a wide range of medicines for all Australians.
But what medications are included in the PBS and what benefits does the PBS provide? Read on to find out.
What is the PBS?
The PBS is a key pillar of the Australian government’s National Medicines Policy. It provides affordable and reliable access to a range of important medicines for Australians.
Under the PBS, the Australian government subsidises the cost of prescription medicines for an extensive range of medical conditions. This means that Australians can access a large number of prescription medications without having to pay full price.
All of the medicines available at a government-subsidised price are listed in the PBS schedule, which is available as a searchable resource online.
Who is eligible for the PBS?
The PBS provides subsidised medicines to all Australian residents who hold a current Medicare card. You will need to present your card to the pharmacist when you lodge your prescription.
The PBS is also available to visitors from the following countries that have a Reciprocal Health Care Agreement (RHCA) with Australia:
- The United Kingdom
- The Republic of Ireland
- New Zealand
- The Netherlands
If you’re a resident of one of the countries listed above, you’ll need to show your passport when getting a prescription filled. Alternatively, you can contact the Department of Human Services (DHS) to obtain an RHCA Card.
What you pay for PBS medicines
Even though the cost of many prescription medications is subsidised by the government, you will still have to pay a certain amount. This difference between the full price of the medicine and the amount the government pays is the co-payment.
The maximum co-payment for general patients is $38.30, but eligible concession card holders have a maximum co-payment of $6.30. The following are the eligible concession cards:
- Pensioner Concession Card
- Australian Seniors Health Card
- Health Care Card
- Department of Veterans' Affairs (DVA) Gold, Orange, or White Card
What medications are subsidised by the government?
According to the Department of Health, the PBS subsidises medicines that “are necessary to maintain the health of the community in a way that is cost effective”. Medications for most medical conditions are subsidised, which are typically dispensed by pharmacists and used by patients at home.
However, some medicines (such as chemotherapy drugs) can only be administered under medical supervision and are only available at hospitals or other specialised medical services.
For a full, searchable list of all the drugs listed on the PBS and what you can expect to pay for those medicines, visit the Department of Health’s PBS website.
What is the Medicare Safety Net for PBS medicines?
The Medicare Safety Net offers extra financial support for people who have high medical costs, for example for people who require ongoing doctor visits and medication.
The out-of-pocket expenses each patient incurs for prescription medications is tallied up each year and once they have reached the Medicare Safety Net threshold, they can access cheaper PBS medications for the rest of the year. Your pharmacist can provide you with a Prescription Record Form to help you keep track of the total cost of prescription medication. If you always visit the same pharmacy, they may be able to keep a digital record for you.
The table below outlines the Medicare Safety Net thresholds for 2017 for general patients and concession card holders:
|General patients||Concession card holders|
|Patient contribution (co-payment)||Up to $38.30||$6.30|
|PBS safety net threshold||$1,494.90||$378 or 60 prescriptions|
|Contribution once PBS safety net threshold has been reached||$6.30||Free|
What is the Dental Schedule?
Dentists are unable to prescribe general items listed on the PBS. However, they have a separate Dental Schedule which lists a wide range of dental care medicines they can prescribe for their patients. The Dental Schedule is available on the Department of Health’s PBS website.
What is the Optometrical Schedule?
Optometrists are not able to prescribe general PBS items, but they do have their own Optometrical Schedule. This features a range of subsidised eye care medicines that optometrists can prescribe for their patients.
Generic or brand medications
If your doctor or specialist prescribes a brand-name medicine rather than a generic medicine, you may need to pay extra for the brand-name medication. This is the brand premium or price premium.
Pharmaceutical companies are able to develop generic alternatives to premium brands and get them registered on the PBS. These generic medications must first be deemed to be equivalent before being included in the PBS. Equivalent medications means there’s no difference in quality between premium and generic brands, so there’s no need to pay more for a brand name.
In addition, the brand premium is not counted towards your PBS safety net threshold, so paying extra for a brand-name medicine will not help you reach the safety net threshold any quicker.
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