You or someone you care about may use lots of medicines each year. The cost can really eat into your budget. In Australian there are government programs that can help keep your costs down. The Pharmaceutical Benefits Scheme (PBS) and the Safety Net are two examples.
Keep track of medicines and access important health info any time and anywhere, especially in emergencies.
You or someone you care about may use lots of medicines each year. The cost can really eat into your budget. In Australian there are government programs that can help keep your costs down. The Pharmaceutical Benefits Scheme (PBS) and the Safety Net are two examples.
In Australia, the Therapeutic Goods Administration (TGA) approves all medicines that are for sale.
The TGA is a division of the Australian Government Department of Health. The TGA approves all prescription and non-prescription medicines.
After TGA approval, the company that makes the medicine can ask for it to become part of the PBS. The PBS (Pharmaceutical Benefits Scheme) is operated by the Australian Government. The PBS helps keep the cost of some prescription medicines low for Australians. Basically, the government shares the expense, so people who need the medicine do not have to pay the full cost.
A group of experts give the government advice about putting a medicine on the PBS. The group is called the Pharmaceutical Benefits Advisory Committee.
They look at information about the medicine to find out:
The cost of your medicine is lower when the PBS covers it for your condition. The most someone will pay in 2022 is $42.50 per script. Some people will pay much less because they have a concession or health care card. The amount you pay for a PBS medicine is called a co-payment.
Sometimes the PBS may not cover the medicine you have been prescribed for your condition. This means you pay the full price for it. Most of the time, it can be between $10 and $100 for each script. In some cases, it can be a lot more. Some private health funds may cover part of the cost for full-priced medicines.
You should also know that the price may vary between pharmacies. So it may be worth shopping around.
If costs are a problem for you, talk with your prescriber or pharmacist. They may have options to help lower costs.
Active ingredients are what make a medicine work. There are lots of medicines with the same active ingredient, but with different brand names. This is true for prescription and non-prescription medicines.
The PBS may cover more than one brand of a prescription medicine. If there are many brands, the PBS will pay no more than the lowest-priced brand. If you choose to buy a brand that costs more, you will need to pay an extra amount. This is called the 'brand price premium'.
Most of the time, there will be a brand on the PBS with the same active ingredient that will not have any extra costs. Using a different brand may help you save money.
Not everyone should change brands. If this is the case for you, your doctor will mark the 'Brand substitution not permitted' box on your script.
Read more about active ingredients in medicines, and active ingredient prescribing.
PBS medicines are available to:
Make sure you show your Medicare card when having a script filled. This will allow you to get medicine at the covered price. The pharmacy can keep a record of your Medicare number so you only have to show your card once.
The PBS also covers some over-the-counter medicines. Ask your doctor. They will tell you if you can get a prescription for any of the over-the counter medicines you take.
If your medicine or brand is not on the PBS you can still get it on private script. You will need to pay the full cost. In some cases, private health funds may pay part of the cost of medicines bought on private scripts.
The costs of some medicines may be further reduced for some people if they have one of the following cards:
Some state and territory governments issue Seniors’ Cards. These do not get the concession rate on PBS medicines.
Centrelink is in charge of Pensioner Concession Cards, Commonwealth Seniors Health Cards and Health Care Cards.
The Department of Veterans' Affairs is in charge of Gold, White and Orange Cards as well as DVA Pensioner Concession Cards.
Some veterans and their dependents can access the RPBS. There are more medicines under this scheme than those on the PBS. If you would like to know more click here.
The Closing the Gap PBS Co-payment Program further reduces the cost of PBS medicines for Aboriginal and Torres Strait Islander people with a chronic disease (or at risk of a chronic disease).
The PBS Safety Net is another way to help get the cost of medicines down for some people. It is for patients and their families who use a lot of PBS or RPBS medicines.
If your PBS/RPBS co-payments get to a certain amount in a single year (January to December) then you have reached what is called the Safety Net threshold.. Once you reach the Safety Net threshold, PBS medicines cost even less or are free for the rest of that year.
The Safety Net threshold changes each year. Find out what the current thresholds are on the PBS website.
You must keep a record of how much you have spent on PBS medicines that year.
Your pharmacist will give you a Safety Net Card when you reach the threshold. This allows you to get free or cheaper medicines for the rest of the calendar year.
You can add co-payments made for your family’s medicines together into one Safety Net total. You can also use one prescription record form for the whole family. A safety net family includes:
There is one thing to keep in mind. Any amount you pay on a brand price premium does not count towards your Safety Net threshold.
If you fill your repeat scripts before a certain amount of time has passed, the Safety Net early supply rule might apply. This means your Safety Net Card will not count and you will have to pay your normal PBS co-payment. If you haven't reached the Safety Net threshold, the cost of the medicine will not count towards your total.
There is a reason for this rule. It stops people from using their Safety Net Card to get more supplies of medicines they don't need. This often happens at the end of a calendar year.
This rule applies only to certain PBS medicines. It depends on the type of medicine and the amount you can get on a script.
If you've been taking a lot of medicines for some time, a review may help. It may show that:
It helps to make sure you are only taking the medicines, and the doses, you need. It helps lower the risk of medicine problems and can help save money as well.
If you are concerned about costs, talk with your health professional. They may be able to suggest ways to streamline your medicines that don't put your health at risk.
Your doctor can go over your medicines or arrange for a trained pharmacist to do a Home Medicines Review. Talk to your doctor or pharmacist about getting one.
You should never decide to stop taking something just to save money. You should never stop taking a medicine unless:
If you would like to learn more about home medicine reviews click here for a factsheet you can download, print or save.
Some medicines are only covered by the PBS for:
This means the prescriber will need to get an 'authority' script, by:
Authority scripts are sometimes used if you need a higher than normal dose. This will allow you to pay the same amount as someone on the standard dose.
Ask your prescriber to see if this might be an option for you.
If you have an authority script, you take it to your pharmacist as you would any other script.
There may be groups of medicines that are similar when it comes to treating certain conditions. They are all as safe and work as well as each other. The government will only pay the cost of the one that costs the least.
If you are not buying the one that costs the least, you will need to pay the extra amount. This extra amount is the 'therapeutic group premium'. There may be a health reason to explain why you need to take a medicine that costs extra. Your prescriber can ask for an exemption so you don't need to pay it.
Only a small number of medicines have this extra amount. You can check the PBS website to see if your medicine falls into this group
