Top of page. Residents of these countries must show their passports when lodging a prescription to prove their eligibility or they can contact Services Australia and get a Reciprocal Health Care Agreement Card to prove their eligibility.
Some overseas visitors may not be eligible for this card. Only those eligible for the PBS will receive subsidised medication and every time you present your script to the pharmacist, you will need to provide your Medicare card. Eligible veterans may need to present their DVA card in addition to their Medicare card. With your consent, the pharmacist may at their discretion keep a record of your Medicare number so that you do not have to show the actual card every time you lodge a script.
All medicines supplied under the RPBS are dispensed at the concessional rate or free if the patient has reached their Safety Net threshold. You can receive all other PBS medicines at the general rate. Dentists are not able to prescribe general PBS items, but have a separate Dental Schedule from which they can prescribe dental care medicines for their patients.
Optometrists are not able to prescribe general PBS items, but have a separate Optometrical Schedule from which they can prescribe eye care medicines for their patients. To be eligible for a concessional benefit, you will have one of the following concession cards:. These are not considered concession cards for the purposes of the PBS.
The co-payment is the amount you pay towards the cost of your PBS subsidised medicine. Many PBS medicines cost significantly more than the co-payment amount. The Australian Government pays the remaining cost.
The option to discount the co-payment does not apply for prescriptions which are an early supply of a specified medicine. The same general or concessional Safety Net threshold is applied to a family unit regardless of whether the unit consists of an individual, a couple or a family with dependent children. To be included in the same Safety Net family, the partners of a couple may be married or de facto, and of the same or opposite sex. A couple must be living together on a permanent basis, unless living separately due to illness.
After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. These are available from all pharmacies. The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals — this is called the joint Safety Net.
You will receive medicines under the PBS as either a general or concessional patient. This status will determine which co-payment level you are required to pay for PBS prescriptions. You are a general patient if you do not hold any of the mentioned cards, and will not receive PBS or RPBS medicines at the concessional rate. For more information on patient charges and patient co-payments please visit the Explanatory Notes section. The Therapeutic Goods Administration TGA classifies medicines in a scheduling system that determines where you can get your medicines:.
S8 medications listed on the PBS have some restrictions which are different in some States and Territories; please contact your local State or Territory health authority for more information.
The PBAC considers the medical effectiveness and cost-effectiveness of a proposed benefit compared to alternative therapies. The PBAC recommends maximum quantities and repeats, and may also recommend restrictions for medicines. The PBAC consists of medical experts who meet several times a year and is not a permanent unit in the Department of Health.
Because of its structure, the committee is best contacted by writing. Medicines are referred to as items under the PBS. These medicines are supplied as an Unrestricted, Restricted or Authority Required item:. Some items require authority in writing to be obtained from Services Australia. In some cases, your doctor will be required to provide further evidence in order for you to continue subsidised treatment.
Doctors can call to gain authority. If your doctor needs to increase the maximum quantity or give you more repeats of your prescription, they can apply for authorisation in the normal way by contacting Services Australia or the Department of Veterans' Affairs as appropriate, unless otherwise stated in the current PBS schedule.
For more information please see the Information for Prescribers section. This number can be obtained from Services Australia. The prescriptions must either be computer generated or handwritten.
Paper sized 18x12cm is also appropriate. Prescriptions should completely identify the medicine being prescribed. The following should be defined:. The prescription must be signed and dated by the prescriber forward or back-dating is not permitted. In urgent cases, your doctor can communicate with your pharmacist by telephone to get your prescription to you quickly. The prescription must be forwarded to your pharmacist within seven days. If you would like more information, please visit the Urgent Cases section.
Dentists are not able to prescribe you general PBS medicines; however they have a separate Dental formulary from which they can prescribe your medications. Optometrists can only prescribe certain medications. If you would like more information about the Optometrical Schedule please visit the Optometrical Items section.
These will be pharmacists, doctors in certain remote and rural areas, Friendly Society pharmacies, or hospital authorities. To claim their subsidy, pharmacists lodge claims with Services Australia detailing PBS prescriptions dispensed.
Your PBS prescription is valid for 12 months from the date it was written. If there is a change to the PBS before you have had the prescription, one or more of the following will apply:. If an item is in Supply Only on the schedule: PBS Prescriptions written prior to the Supply Only period are able to be dispensed using either the Supply Only product where available, or an equivalent product as specified on the PBS schedule. If you would like more information please go to the What to do if the Schedule changes section.
If the cost of a PBS medicine falls below the general co-payment amount under co-payment prescription , the method used to calculate the maximum general patient charge for the medicine includes an Additional Fee, an Additional Patient Charge, and any applicable price premiums. The maximum general patient charge for each under co-payment medicine is shown on the PBS website.
The Additional Fee is sometimes referred to as the Safety Net recording fee. The amounts are indexed annually on 1 July. A pharmacist may choose to charge all, part, or none of the Additional Fee component of the maximum charge for an under co-payment prescription. Only one Additional Fee is included in the maximum charge for a dispensed item, even if multiple quantities are required to make up the prescribed amount.
Where the cost of a medicine exceeds the general patient co-payment amount, the amount shown on the website is the general patient co-payment plus any applicable price premium. Where the cost of a medicine is less than or equal to the general patient co-payment, the amount shown on the website is the maximum general patient charge. These are known as under co-payment medicines. The amount shown on the website as the general patient charge for a brand of an under co-payment medicine is the maximum amount a pharmacist may charge when supplying the medicine under the PBS, including all fees, mark-ups and any applicable price premium.
A pharmacist may charge any amount up to the general patient charge for an under co-payment medicine supplied under the PBS. If a pharmacist charges more than the maximum general patient charge for a PBS prescription, that supply would be considered non-PBS that is, the supply would be as a private prescription and none of the amount paid would count towards your PBS Safety Net. Only one Additional Patient Charge is included in the maximum charge for a dispensed item, even if multiple quantities are required to make up the prescribed amount.
Pharmacists are free to discount these fees for PBS items where the cost is below the general patient co-payment. When there are two or more brands of the same medicine listed under the PBS, the Australian Government subsidises each brand up to the same amount. The Government and a pharmaceutical company can agree to list a brand at a higher price than other brands. This can only occur if at least one other brand of the same medicine is listed on the PBS at the base price and is available in sufficient quantities for patients to purchase if they do not wish to pay the premium.
If you choose the more expensive brand, the price difference is paid by you as a brand premium. A brand premium, which reflects the higher price that is paid to the pharmaceutical company, is paid in addition to the patient co-payment amount.
Where a brand premium applies for a PBS prescription, a community pharmacist is required to charge that additional amount. This is to ensure that the same pricing method applies for all subsidised PBS medicines across all approved PBS community pharmacies. However, it is not mandatory for hospitals to charge brand premiums for PBS prescriptions; for hospital pharmacies, adding a brand premium is optional.
PBS medicines are listed as substitutable if the manufacturer has proven that the brands are bioequivalent or therapeutically equivalent, or if the supporting evidence has already been provided and accepted by the Department of Health. It is the difference between what the manufacturer is charging and what the Government is willing to cover.
This cost is in addition to the patient co-payment and may take the cost above the patient co-payment threshold. This premium does not count towards the Safety Net threshold. For some SPCs, if you have medical or other reasons to prevent you from taking the lower priced medicine, your doctor may apply through the Authority Line for an exemption from paying the SPC.
If your medicine is not listed under the PBS Schedule, you will have to pay full price as a private prescription. It is not subsidised by the Australian Government. Pharmacies may charge differently for these non-PBS medicines, so you may want to shop around to find the best price. Please note that the cost of private prescriptions cannot count towards the Safety Net threshold.
This is not mandatory and is applied at the discretion of the pharmacist. Where the total cost of a PBS medicine is below the patient co-payment, a pharmacist may charge less than maximum patient charge at their discretion. If a pharmacist charges more than the maximum patient charge apart from after hours or delivery fees, if applicable , the supply would not be a PBS supply and would not count towards the PBS Safety Net.
The pharmaceutical allowance is a sum of money paid by Centrelink to help you afford the cost of your medicines. For more information please visit the Pharmaceutical Allowance section on the Centrelink website. The net medical expenses tax offset is being phased out. Please check and try again Please enter recipient's email Recipient's email is invalid.
Please check and try again Agree to Terms required. Thank you for sharing our content. A message has been sent to your recipient's email address with a link to the content webpage. Your name: is required Error: This is required. Your email: is required Error: This is required Error: Not a valid value. Send to: is required Error: This is required Error: Not a valid value. What is the PBS? You can browse the PBS online for: an A-Z of all subsidised medicines how you should use the medicines consumer information the cost to you, which will depend on whether you hold a concession card Who is eligible for the PBS?
The cost of medicines on the PBS Co-payments Everybody has to pay something towards the cost of medicines. Looking for more medicine information? Back To Top. General search results. The Australian Government funds and operates some aspects of the health system.
Opioids have an important role in the treatment of acute severe pain. Healthdirect 24hr 7 days a week hotline 24 hour health advice you can count on It also outlines agreements between the Australian Government and external stakeholders that are relevant to the PBS, and suggests some possible future developments.
The first attempt to legislate for a scheme to provide approved prescription medicines, such as antibiotics, free of charge to Australian residents was made by the Curtin Labor Government in but the legislation was struck down by the High Court. The PBS became a comprehensive scheme offering access to a wide range of medicines in By way of comparison, medical services including Medicare benefits accounted for 47 per cent of the administered funds, and private health insurance rebates for 13 per cent.
Expenditure on the PBS is uncapped , and can therefore increase as new drugs are added and demand grows. Total PBS expenditure grew at an average annual rate of 4. Parliamentary Budget Office analysis shows that although moderate growth in PBS spending to —19 was forecast in the —16 Budget, this was subsequently revised downwards to a relatively flat level of spending Figure 37, p. This downwards revision is due to the PBS Access and Sustainability Package of reforms, which is lowering the price the Government pays for many medicines.
It also reflects the ongoing impact of price disclosure policies, which are designed to move the PBS price paid by the Government closer to the market price of off patent medicines which may be heavily discounted.
Patients pay a co-payment towards the cost of each PBS medicine, with the Australian Government covering the remaining cost, which can vary from nil to thousands of dollars per prescription. This keeps otherwise expensive medicines affordable for consumers. The PBS Safety Net scheme is intended to protect patients needing a large number of medicines in one year from excessive out of pocket costs. This Bill has been before the Senate since July , but appears unlikely to pass. According to the —15 DoH Annual Report, as at June , the PBS included medicines in 2, forms and dosages, sold as more than 5, differently branded items p.
Most PBS medicines are dispensed by community pharmacies and used by patients at home. This includes medicines listed on the PBS, as well as additional items such as wound care products which are listed on the Repatriation Schedule of Pharmaceutical Benefits.
Under section of the NHA some PBS medicines are supplied through special arrangements where normal supply through community pharmacies is not suitable.
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