PBS: why have I been asked to pay more for my medicine?

What extra charges are applied to PBS medicines?

Senior woman with medicine and reading drug prescription

Bill is confused by the extra charge he has been required to pay on his regular prescription medicine. Debbie explains why the surcharge has been applied.

Q. Bill
Today I presented my script to the chemist and was told that one particular item would have a $5 surcharge, making my script $10.30 instead of the usual $5.30. I am a pensioner and confused by the surcharge, as I have been prescribed this item for many years without having to pay any extra charges.

I hope you are able to explain this extra charge.

A. When asked to pay extra by your pharmacist, it’s always useful to ask at the time why this is.

From what you have told me, I would suggest that you have been asked to pay a Special Patient Contribution Premium (SPCP), a Brand Premium (BP) or a Therapeutic Group Premium (TGP).

An SPC is a surcharge to cover the difference between what a manufacturer charges for a particular medicine and what the Government is willing to cover under the Pharmaceutical Benefits Scheme (PBS).

A BP is where that particular brand of medicine costs more than the lowest price of an available substitute.

A TGP is when drugs in a particular group may have similar safety and health outcomes and the PBS covers the cost of the lowest-priced medicine.

If asked to pay any of these premiums, you should ask your pharmacist if there is a lower priced, usually generic medicine you can take instead. If you are required to only have the brand medicine, you can ask your GP to apply on your behalf for an exemption on paying the SPC and TGP.

The medicines that are available on the PBS are reviewed periodically, so it could be that a surcharge has been implemented since the last time you had your prescription filled.

To find out more, visit PBS.gov.au

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    COMMENTS

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    Slimmer Cat
    28th Feb 2017
    11:42am
    Everybody who has the Health Care Card and gets medicine on the PBS should have to take the Generic Medicine or pay the difference in cost and in some cases it is a lot more than $5.00. There is no difference in Generic medicine to Brand Name medicine only the cost to the Tax Payers of Australia. In the example above it is $5.00 and the $5.00 per script add up to about $500,000,000 a year.
    Joy Anne
    28th Feb 2017
    12:06pm
    Certainly don't agree with your comments. I have tried Generic and they have no result at all and make me violently ill. It is the compound makeup as it is cheaper.
    Since I cannot take Generic why as a pensioner should I have to pay PB on scripts.
    Maybe you can take them well then you are lucky. Generic medication does not work on many people and they cannot take them.
    Teddy
    28th Feb 2017
    1:57pm
    Funnily enough I have noticed that I frequently encounter those who have violent reactions to generic medicines when they are ahead of me in the Pharmacy Dispensary trawling the shopping centre to save money on aspirin and paracetamol in dollar saver shops. Presumably those tablets manufactured in SE Asia are mysteriously better than the ones in the pharmacy. The savings achieved by us all using generic medicines would allow the system to fund medications for people with life threatening illnesses which include infants, children, young people and parents.
    tia-maria
    28th Feb 2017
    4:08pm
    Joy Anne 100% agree with your comment.........I have chronic health issues and the generic are different and don't always work for many patients..........Unfortunately our bloody government don't care about the pensioners and this is why we given the cheaper brand and they dam know the difference other wise we be all on the same medication brands.........and anyone who does not agree with my comment like Slimmer Cat may its because he most likely not on heaps medications to keep him going
    Joy Anne
    28th Feb 2017
    12:10pm
    This is so wrong when pensioners especially cannot take Generic medication. I am one as it makes me violently ill. I have no choice and I know many people who can't take Generic medications. They are made up by a cheap compound and this reacts with people. I have also heard from people that they don't work in some cases. The Turnbull Government have caused this and I am disgusted with the government. Its alright for them to abuse perks.
    Slimmer Cat
    28th Feb 2017
    12:59pm
    Generic Medication is identical to the brand name, it becomes generic when the copyright expires. In some cases it may be a different colour and if you are allergic to the colouring in the tablet your doctor should have to get an exemption so you can get the Brand name.
    TOTALLY rubbish that generic brands are made of cheaper compounds and do not work.
    The only people who seem to buy Generic Brands are people who have to pay for them the rest rip the PBS off with complaints of not working.
    Slimmer Cat
    28th Feb 2017
    1:10pm
    People who pay for their own medication and take Generic Brands pay a lot more than the PBS cost of $5.30
    Teddy
    28th Feb 2017
    1:32pm
    They seem to be all alive and well in the NZ health system and of course the system itself is very cost effective in NZ.
    tia-maria
    28th Feb 2017
    4:09pm
    Slimmer Cat your full of it mate
    Blondie
    28th Feb 2017
    1:16pm
    $5.50!!!!!! Wow! I pay $6.20 here in WA for my prescriptions! Generic is the EXACT formulation, without the brand name!
    Slimmer Cat
    28th Feb 2017
    1:50pm
    In NSW most of the large pharmacies give an extra dollar or 90c. off the price of the script
    Hillbillypete
    28th Feb 2017
    3:08pm
    Boy us in Queensland miss out as well, we pay $6.30
    Kiri
    28th Feb 2017
    2:16pm
    Thanks for this explanation. I had noticed I'd been charged more for a particular medication I've been taking for years. Now I know why I'm paying more for insisting on the brand-name product.
    PlanB
    28th Feb 2017
    3:41pm
    And they say there is NO change to Medicare -- what a load of utter BS!

    The genetic Meds have different fillers most times and some can not take them -- you will also find that last years PBS Meds went up in price AND also you had to have bought more B$ you were able to get the FREE ones this year they have also raised the amount you have to uy b4 the free ones

    28th Feb 2017
    6:59pm
    My view is that those on PBS should always always be given Generic medicine
    If they want the expensive brand names, then they should pay the difference or provide proof that the generics are incompatible die to severe allergic reaction and exactly what chemical is it in the generic that causes such a reaction.
    This will get rid of the rorters
    There is absolutely no difference between generic and brand
    Clee
    28th Feb 2017
    10:14pm
    To clarify a couple of facts, I have discovered the following:-

    1. Even though the compounds in the generic are the same, sometimes they are manufactured in a different way. For example, some products do not have an enteric coating to protect the users intestines until it can be absorbed.

    2. Sometimes, if a person has been taking a particular medication for a long time, and then switches to a generic, the body doesn't react in the same way. I have been told this by a pharmacist, and my husband has proved it by switching back to the original prescription and getting relief that he could not get with the generic.

    Hope this answers a few questions for people.
    Anonymous
    1st Mar 2017
    6:58am
    Many hypochondriacs around

    That's why they should be vetted.

    Generics for everyone under PBS unless proven otherwise
    Teddy
    1st Mar 2017
    9:19am
    It would be interesting to see how many doctors would recommend brand name medications if they were required to submit a case to a health department panel composed of pharmacists and medical practitioners. I suspect the panel wouldn't need to meet very often.
    BundyGil
    1st Mar 2017
    3:45am
    Generic medicines are EXACTLY the same as the brand name medicines. They wouldn't be allowed to be sold to you if they weren't. Unfortunately, the difference is in the mind of the user. If you're being ripped off my your imagination, you'll just have to suck it up and pay the extra.
    Teddy
    1st Mar 2017
    9:15am
    As my father often said 'Many people are allergic to saving money, particularly when someone else is paying the bill'.