What Is The Pharmaceutical Benefits Scheme (PBS)?

What is the Pharmaceutical Benefits Scheme? 

The Pharmaceutical Benefits Scheme (PBS) is run by the Australian Government under their National Medicines Policy. With some medication costing thousands of dollars, the PBS subsidises the cost of these medicines to individuals who need them most.

The PBS Schedule lists all of the medicines available to be dispensed at a Government-subsidised price.

Subsidised prices on PBS medications are usually available to concessional patients who hold one of the following cards:

• Pensioner Concession Card
• Australian Seniors Health Card
• Health Care Card
• Department of Veterans’ Affairs (DVA) Card

When an individual has had a certain number of prescriptions dispensed on the PBS, they then become eligible for the Medicare Safety Net.

What is the Medicare Safety Net for PBS medicines?

If individuals pay a higher amount of out-of-hospital medical expenses such as frequently buying medications, the Medicare Safety Net provides them with higher benefits. These out-of-hospital medical expenses are added up and when the Medicare Safety Net threshold is reached, the cost of regular eligible medications and services are subsidised for the rest of the calendar year.

In order to use the Medicare Safety Net when you need it, you need to keep track of your dispensed medications. Ask your local pharmacist about a Prescription Record Form, which can help you to record each time you get medication dispensed. If you go to the same pharmacy for all your prescriptions, ask them to keep a virtual record on their computer for you.

What is the Repatriation Pharmaceutical Benefits Scheme?

The Repatriation Pharmaceutical Benefits Scheme (RPBS) is subsidised by the Department of Veterans’ Affairs (DVA) and can be used by veterans who have a DVA White, Gold, or Orange Card. If you have a DVA card, you are eligible for all PBS medicines and other medicines listed on the RPBS, which are dispensed at a concessional rate until the Medicare Safety Net is reached.

We’ve answered the question about whether you need health insurance if you have a DVA card; it depends on which card you hold.

Generic vs brand name medications on the PBS

A brand or price premium may apply to some medications, in which case the medication costs more because there is an additional payment to the supplier of the specified brand.

Manufacturers can develop generic (or cheaper) equivalents to premium brands and register them for the PBS. Generic products have been evaluated by the Therapeutic Goods Administration (TGA) and deemed to be equivalent, so there’s no need to worry about a difference in quality. Essentially the medication is exactly the same, just made by two different companies.

It’s important to note that the brand premium does not count towards your Medicare Safety Net limit. So it’s not worth paying more for brand name products – you will not reach your Medicare Safety Net any faster. The pharmacist is often able to substitute a less expensive brand at your request, so it’s worth asking about.

Find out more about how generic vs brand name medication compare on the Canstar Blue website.

Am I on the PBS?

If you hold a current Australia Medicare Card then you are registered on the PBS. The price you pay for medication will depend on whether you have a concessional card or not.

Do I need health insurance for medications cover?

Some private health insurers also offer pharmaceutical benefits to cover the gap between what Medicare pays for your medicines and what you have to pay, so it’s worth doing your research. Fortunately for you, CANSTAR compare over 800+ health insurance policies so you can search for an outstanding value policy for medications cover:

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