What is the PBS? And how does it work?

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The Pharmaceutical Benefits Scheme (PBS) provides timely, reliable and affordable access to essential medicines for all Australians. 

The PBS began in 1948, providing 139 ‘life-saving and disease preventing’ medicines free of charge for the whole community.

Today, the PBS subsidises the cost of medicine for most medical conditions. Most of the listed medicines are dispensed by pharmacists and used by patients at home.

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

Who is eligible for the PBS?
The PBS is available to all Australian residents who hold a current Medicare card.

Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the PBS. Australia currently has RHCAs with the United Kingdom, Ireland, New Zealand, Malta, Italy, Sweden, the Netherlands, Finland, Norway, Belgium and Slovenia.

Residents of these countries must show their passports when lodging a prescription to prove their eligibility or they can contact Department of Human Services (DHS) and get a Reciprocal Health Care Agreement Card to prove their eligibility. Some overseas visitors may not be eligible for this card.

Only those eligible for the PBS receive subsidised medication and every time you present your script to the pharmacist, you need to provide your Medicare card.

Eligible veterans may need to present their DVA card in addition to their Medicare card.

With your consent, the pharmacist may (at their discretion) keep a record of your Medicare number so that you don’t have to show the actual card every time you lodge a script.

What is the RPBS?
The Repatriation Pharmaceutical Benefits Scheme (RPBS) is subsidised by the Department of Veterans’ Affairs (DVA), and can be used by veterans who have DVA White, Gold or Orange Card.

If you hold one of these cards then you are eligible for all PBS medicines, and other medicines listed on the RPBS, depending on your DVA entitlement. All medicines supplied under the RPBS are dispensed at the concessional rate (or free if the patient has reached their Safety Net threshold).

The DVA white card entitles you to RPBS and PBS medicines at the concessional rate for a specific medical condition (which is at your doctor’s discretion). You can receive all other PBS medicines at the general rate.

DVA gold and orange cards entitle you to all RPBS and PBS medicines at the concessional rate.

Who is eligible for a concession?
To be eligible for a concessional benefit, you will have one of the following concession cards:

  • Pensioner Concession Card;
  • Commonwealth Seniors Health Card;
  • Health Care Card;
  • DVA White, Gold, or Orange Card.

Some state/territory governments issue seniors cards. These are not considered concession cards for the purposes of the PBS.

Centrelink is responsible for the issue and administration of the Pensioner Concession Card, the Commonwealth Seniors Health Card and Health Care Cards.

The Department of Veterans’ Affairs are responsible for White, Gold and Orange Cards.

There is also a DVA Pension Card which entitles holders to PBS medicines at the concessional rate (but not RPBS medicines).

General benefits apply if you do not have any of the above cards.

Do you take any medication that isn’t subsidised by the PBS? What medicines would you like to see added to the list?

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Written by Ben

5 Comments

Total Comments: 5
  1. 0
    0

    Just to add to that there are many “Big Brand” medications that will attract a higher cost than the concessional $6.60. This is to get you go with the generics where possible which are at the normal concessional rate.

    Interesting how a medicine my wife takes is one of the dearer ones, $9.60 instead of $6.60 but if you get the $6.60 generic it’s made by the same people, printed on he box with a similar name.

  2. 0
    0

    Regarding generic medications. Whilst the content may be similar to the brand name the coatings are very often considerably different. These differences may cause issue with some people.
    Stick to your guns and ask for the brand name if your prefer it. it may need to be ordered in and it may cost a bit more. You cannot be denied the prescribed brand.

  3. 0
    0

    Is far too restrictive. I have a condition that requires monthly medication – not available on the PBS. I wrote to the Health Minister about this, and the reason? – my condition is not ‘popular enough’.
    Net time, I’ll try and get something more popular.


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