Last Updated on 28 August 2020

Pharmaceutical Benefits Scheme: How does the PBS Work?

When it comes to health care costs and medical insurance comparison, there is more to think about than just doctor and hospital bills. For many people, especially those dealing with chronic conditions, prescription medication costs can quickly amount up and be very difficult to deal with. That’s where the Pharmaceutical Benefits Scheme (PBS) comes in.

Designed to help Australians pay for their prescription medicines, the PBS is a huge help to many, whether they need a prescription only occasionally or on a regular basis.

How the Pharmaceutical Benefits Scheme Works

The program works by allowing participants to purchase medicines on the PBS Schedule at a government-subsidised price which is much lower than the actual cost of the medicine. The Schedule is a list of hundreds of drugs. All Australians who hold a current Medicare card are eligible for this benefit.

In order to receive the subsidized price, participants simply show their Medicare cards and prescriptions at the pharmacy and the discount is automatically applied. The patient pays the co-payment instead of the actual cost of the medicine, which can be much more than the co-pay. In 2011, general patients can pay up to $34.20 for medicines on the PBS Schedule. The Pharmaceutical Benefits Scheme Schedule can be found on-line and is updated each month.

How Some Get a Bigger Discount

Certain individuals can receive a concessional benefit which provides an even lower co-pay on medicines. To be eligible for the concessional rate, you must have one of the following cards: Pensioner Concession Card, Commonwealth Seniors Health Card, Health Care Card or DVA White, Gold or Orange Card. Those who receive the concessional rate pay only $5.60 for covered medicines in 2011.

How the Pharmaceutical Benefits Scheme Helps Patients

The cost of medicine continues to rise each year and many fairly common medicines are quite expensive. For example in 2011, if you have diabetes, the medicine you need can cost up to $200. Drugs to treat asthma can cost up to $80. However, under the PBS, most Australians will only pay $34.20 for either of these drugs. Concession card holders would pay only $5.60. Obviously, these co-payments may save some patients hundreds of dollars over time.

How the Safety Net Helps Even More

Even though these co-pays are relatively small, they can add up if you or a family member has a serious illness or chronic medical condition. The Safety Net is designed to further help those dealing with extreme medical expenses.

If you reach the Safety Net threshold during a year, you will be eligible for an even greater discount on your medicines. In 2011, the threshold was $1,317.20 for general patients and $336 for concession card holders.

If you are nearing your Safety Net threshold, talk to your pharmacist about applying for a Safety Net card. Once you have one, you will pay $5.60 for your PBS medicines if you are a general patient. Medicines are normally free for concession card holders with a Safety Net card.

How Much the PBS Costs and How You Can Help

Providing such a benefit to citizens isn’t cheap, and the cost of the PBS has risen dramatically in recent years. Government expenditure on the PBS is currently around $8.3 billion each year. Obviously, this is a huge expense for the government and leaders are always looking for ways to cut back on costs. Consumers can help reduce the cost of the Pharmaceutical Benefits Scheme through some simple steps such as:

  • Filling prescriptions only as required
  • Maintaining a healthy lifestyle by eating right and exercising
  • Being open to various treatment options
  • Choosing a generic branded medicine
  • Making sure the regular prescription medicine being taken is a suitable treatment

The Pharmaceutical Benefits Scheme is an important part of Australia’s overall health care program, and it is a great help to Australians when it comes to paying for prescription drugs. Take time to understand the PBS and you are well on your way to saving money and taking care of your health.


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