PBS co-payment reduction – What pharmacists need to know

The maximum cost of a PBS prescription for general patients will reduce from $42.50 to $30 from 1 January 2023. This is a 29% reduction.

This is the first time in 75 years the general co-payment under the PBS has fallen. This change will help ease cost-of-living pressures for Australians.

Facts for pharmacists

Costs and discounts

• The maximum cost of the general co-payment for PBS prescriptions will reduce by $12.50, from $42.50 to $30.
• Pharmacists will be able to provide an increased discount to general patients on prescriptions with a Commonwealth price between $30 and $45.60.

Safety Net, Closing the Gap and concessional patients

• When the new discretionary discount is applied, the amount paid by the patient will still count towards their PBS Safety Net. This ensures no-one will be worse off by the changed co-payment. Pharmacists will not be eligible to claim PBS benefits if the discretionary discount is applied.
• These changes won’t affect the amount concession card holders pay. This includes concession card holders in the Closing the Gap (CTG) PBS co‑payment program. However, from 1 January 2023 the concessional co‑payment amount will change in line with the CPI.
• Concessional patients are already receiving benefits from reductions to the PBS Safety Net. On 1 July 2022 the Safety Net reduced by $81.60 to $244.80.
• Patients who are part of the CTG program won’t be disadvantaged by a reduced co-payment when reaching the general PBS Safety Net threshold.
• CTG prescriptions priced at or above the general co-payment ($30 in 2023, then indexed annually) will continue to count toward the PBS Safety Net at the current amount of $42.50.

Software updates

• The Australian Government has worked with software providers to make relevant updates.
• Pharmacists won’t have to do anything to implement the changes. Software systems will automatically update.

Services Australia

• Services Australia administers the PBS.
• This includes processing pharmaceutical benefits and Safety Net claims, authority applications and supply of PBS stationery used by health professionals.
• For more information call 132 290 or visit the Services Australia website.

For more information and downloadable patient resources, see the PBS website.