About the PBS

How much should I pay?

This section of the website contains information on PBS patient co-payment amounts and product (brand and therapeutic) premiums.

If you are a general patient, from 1 January 2008 you pay up to $31.30 for most prescription medicines supplied through the PBS (concessional patients pay only $5.00). These payments, called patient co-payments, are revised annually in line with the Consumer Price Index.

Brand premium policy

The PBS subsidises all brands of the same drug to the same amount; that is up to the cost of the lowest priced brand. A manufacturer may be unwilling to market their brand at the lowest price and will ask that patients pay extra for their brand. The extra amount is called the ‘brand premium’ and it does not count towards the safety net threshold. Importantly there will always be at least one brand without a brand premium. Unless your doctor has specifically indicated otherwise on the prescription, a pharmacist can dispense another brand of the same medicine at your request. In this way, you can avoid paying a brand premium.

Therapeutic group premium policy

Within the PBS there are specifically defined groups of drugs which have similar safety and health outcomes. Within these groups the drugs can be interchanged at the patient level. The Government subsidises all drugs within a group to the level of the lowest priced drug. The difference in price between the lowest priced drug and higher priced drugs within the group is called a therapeutic group premium, this is paid by the patient and does not count towards the safety net threshold.

There is always at least one drug within each group of drugs available without a premium. In addition, if you, for a medical reason, are only able to take a drug which has a premium, your doctor can request an exemption from Medicare Australia.

Special Patient Contributions (other than Brand Premiums or Therapeutic Group Premiums)

Special patient contributions are applied when the Manufacturer and the Government cannot agree on the dispensed price. In most cases your doctor can seek an authority from Medicare Australia to waive this patient contribution where there is not clinically suitable alternative listed on the PBS at the lower price. Doctors are encouraged to seek a waiver whenever appropriate so that patients are not financially disadvantaged.