About the PBS
Frequently Asked Questions
Questions and answers about the Pharmaceutical Benefits Scheme.
Q. What is the Pharmaceutical Benefits Scheme (PBS)?
A. The PBS is an Australian Government initiative that provides affordable access for all Australian residents to effective and cost-effective medicines. Around 80 per cent of prescriptions dispensed in Australia are subsidised under the PBS.From 1 January 2013, you pay up to $36.10* for most PBS medicines, or $5.90* if you have a concession card. The Australian Government pays the remaining cost.
For more information go to About the PBS.
*Under current arrangements, these amounts are adjusted in line with inflation on 1 January each year.
Q. Why do Australians need the PBS?
A. For 60 years, the PBS has been integral to maintaining the health and wellbeing of Australians by ensuring that they have access to high quality, affordable medicines.Q. Why does the PBS cost so much?
A. Government expenditure on the PBS – currently around $9 billion annually – increases each year due to the high cost of subsidising new and expensive prescription medicines so that they are available at prices people can afford.In the year ending June 2012, around 194 million prescriptions were subsidised through the PBS. This represents around nine prescriptions per year for each person in Australia.
How the PBS works
Q. How does the PBS work?
A. The PBS covers all Australian residents when they fill a prescription for a medicine prescribed under the PBS. From 1 January 2013, if you are a general patient you pay up to $36.10* for a medicine listed on the PBS. People with concession cards pay $5.90*. These payments are called patient contributions or co-payments and are revised annually in line with the Consumer Price Index.*Under current arrangements these amounts are adjusted on 1 January each year.
Q. How do I get my PBS subsidy?
A. Please have your Medicare card or other proof of eligibility available when you present your prescription to the pharmacist. For an additional subsidy, you need your concession card.If you are a visitor from Italy, New Zealand, Republic of Ireland, Finland, Malta, the Netherlands, Sweden, Norway or the United Kingdom but don’t have a Medicare card or have not been issued with a Medicare number, you should show your passport to the pharmacist.
If you are eligible for PBS subsidies, but are unable to provide your Medicare number, talk to your pharmacist about what options are available to you. Should you require further information about this service, call the toll free PBS Information Line on 1800 020 613.
Q. Sometimes I have to pay more than the co-payment. Why?
A. Some brands of medicines cost more than others. You may need to pay extra if your doctor prescribes a brand that costs more than the least expensive brand of that medicine.If there are two or more brands of the same drug on the PBS, the Government subsidy is based on the price of the least expensive brand.
For more information, see Brand Price Premiums or Therapeutic Group Premiums.
Q. How can I avoid paying more than the co-payment?
A. To avoid paying extra, ask your doctor to prescribe a fully subsidised brand or ask the pharmacist to substitute another brand (unless your doctor has indicated that this is inappropriate).Q. Why is my medicine available on the Repatriation Pharmaceutical Benefits Scheme and not the Pharmaceutical Benefits Scheme?
A. Some medicines are available under a separate scheme called the Repatriation Pharmaceutical Benefits Scheme (RPBS). The RPBS is administered by the Department of Veterans’ Affairs and forms part of veterans’ health services arrangements. It provides access to certain additional pharmaceutical items and dressings for treatment of entitled veterans and war widows.Safety Net
Q. My family uses a lot of medicines. How does the PBS help people with high medicine costs?
A. From 1 January 2013, if you’re a general patient who needs a lot of medicines, once you’ve reached the Safety Net threshold of $1,390.60, you will pay the concessional rate ($5.90) for further PBS prescribed items for the remainder of the calendar year.From 1 January 2013, if you or your family receive PBS medicines at the concessional rate, your patient co-payment per prescription item will be removed once you’ve reached the Safety Net threshold of $354.00. Further PBS prescribed medicines are provided free for the remainder of the calendar year.
Q. Why is the PBS Safety Net threshold the same for single people as for families?
A. The same general or concessional Safety Net threshold is applied to a family unit whether the unit consists of an individual, couple or a family with dependent children.This approach results in a straightforward system for ease of understanding by users and ease of administrative interpretation and application.
The real cost of medicines Top of page
Q. How much is the real cost of my medicines?
A. Many PBS medicines cost a lot more than what you actually pay for them at the pharmacy.For example, medicines to treat asthma can cost up to $80, diabetes up to $200, and heart disease $115 per prescription. Under the PBS, from 1 January 2013, if you're a general patient you pay up to $36.10 for an item received under the PBS (concessional patients pay only $5.90). These payments, called patient contributions or co-payments, are revised annually in line with the Consumer Price Index.
When you fill a PBS prescription, you may see information on the label about the full cost of the medicine.
Q. Why do the subsidies vary in value?
A. Different medicines vary greatly in price. The Government subsidises medicines on the PBS so that the amount you pay is limited according to your co-payment rate. A listing of all medicines available on the PBS can be found in the Pharmaceutical Benefits Schedule. The schedule is updated monthly.Q. Why can’t the Government control the cost of medicines not listed on the PBS?
A. As pharmaceutical products are produced by private companies rather than by the Government, it is not possible to insist that manufacturers provide their products at a particular price.The Government negotiates agreed prices for medicines supplied under the PBS, but it is not involved in setting the prices of non-PBS medicines.
Q. What can I do to help keep the PBS medicines more affordable for all Australians?
A. Consumers can help reduce the cost of the PBS through simple actions. You can:- maintain a healthy lifestyle;
- be open to other treatment options that a doctor may recommend, including choosing a generic branded medicine;
- check whether the regular prescription medicine being taken is the best treatment; and
- fill prescriptions only as required for personal use and avoid stockpiling.
Listing medicines on the PBS
Q. How are medicines chosen to be subsidised by the PBS?
A. Before a medicine can be subsidised through the PBS, the Pharmaceutical Benefits Advisory Committee (PBAC) must assess it. The PBAC, an independent expert body whose membership includes doctors, other health professionals and a consumer representative, recommends new drugs to be listed.Q. Why is the medicine I want not subsidised?
A. Many medicines available on prescription are subsidised under the PBS. Some of the reasons a medicine may not be available on the PBS are:- the manufacturer has not registered the medicine to treat your particular condition with the Therapeutic Goods Administration (TGA);
- the manufacturer has not applied to the Government’s independent expert committee – the Pharmaceutical Benefits Advisory Committee (PBAC) – to evaluate the listing of your medicine on the PBS; or
- the manufacturer hasn’t yet supplied sufficient evidence, or the evidence supplied does not support a recommendation by the PBAC.
Q. Why can’t alternative/complementary medicines be subsidised?
A. Only pharmaceutical products registered on the Australian Register of Therapeutic Goods (maintained by the TGA) may be considered for listing on the PBS.Non-prescription medicines such as herbal, vitamin, mineral and other alternative or complementary medicines and preparations are available without prescription at community pharmacies, supermarkets and health product outlets. These products can be considered for PBS listing but would be subject to the same evidence-based requirements as other medicines.
Q. The maximum quantity/number of repeats is not suitable for my needs. Why?
A. The PBAC recommends the maximum quantity and number of repeats that apply to medicines listed on the PBS. This is because the PBAC wants to ensure that doctors regularly review your condition and your medicines.If you have an acute condition, the maximum quantity and number of repeats will usually provide sufficient medication for a normal single course of treatment. For chronic conditions, the maximum quantity and repeats usually provide up to six months’ therapy, based on the average dose of medicines and the need for your doctor to review your condition and medication.
If you need to receive a higher than average dose or increases in the listed maximum quantity and repeats of PBS medicines, you may be entitled to receive these through the Authority system administered by Medicare Australia. If this is the case, talk to your doctor during your next consultation.
Managing your medicines
Q. How should I store my medicines?
A. Always store your medicines safely. Keeping large amounts of medicines can be unsafe so only keep the medicines that you currently need. Some medicines lose their effectiveness or can even become toxic after their “use by” date. In addition, medicines stored in the house might be attractive to young children and could lead to poisoning.Q. How should I dispose of my medicines?
A. It is important that you dispose of your unwanted medicines safely. Take unwanted or expired medicines to your pharmacy for correct disposal.Q. Can I take my PBS prescription medicine overseas?
A. It is illegal to take or send PBS subsidised medicine out of Australia for reasons other than for your personal use or the use of someone travelling with you (eg. a child). A doctor's prescription or letter may be adequate to present to Customs to confirm that the drugs are required for the treatment of a medical condition and that possession is in accordance with Australian laws.There are specific arrangements which allow PBS medicines to be sent from Australia for use by Government officers working overseas.
To avoid breaking drug laws overseas you should contact the embassy/consulate of all of the countries you will be visiting and confirm any special requirements (eg. number of doses permitted). Should the overseas authorities require a letter from the Australian Government contact the Treaties and Export Section of the Therapeutic Goods Administration on (02) 6270 4321 at least 10 working days prior to departure.
Note: Some countries do not permit certain drugs to be imported regardless of the documentation held.
Q. How can I access drugs not available in Australia?
A. You may access drugs not available in Australia for personal use through the Special Access Scheme. Doctors must apply to the Therapeutic Goods Administration for approval to import such items by calling (02) 6232 8111. All costs associated with the importation of such items obtained through the scheme are borne by the patient.
Further Information
Q. Where can I get further information about medicines?
- Talk to your doctor or pharmacist.
- For more information about your entitlements under the PBS or the cost of your medicines contact the PBS Information line on 1800 020 613 (free call).
- For details on the cost of your medicine search the PBS Schedule.
The Therapeutic Goods Administration (TGA) is the Government agency that carries out a range of assessment and monitoring activities to ensure that medicines available in Australia are safe and effective. It ensures that the Australian community has access, within a reasonable time, to new treatments.
For further information call 1800 020 653 or visit the TGA website.
Consumer Medicine Information
The Australian Prescription Products Guide (APP Guide) provides detailed information about your medicines including possible side effects and adverse reactions. The APP Guide provides reference material such as Australian approved food additive numbers, medicines in pregnancy, patient support organisations, drug combinations and a pharmacological and therapeutic index.
Please note: If you wish to search the APP Guide, you need to register at the site. There is no charge for this. A long pick-list of categories for registration is available (including “general public”). Top of page
