Increase in Pbs Prescription Co-Payments and Safety Net Thresholds From 01 January, 2017

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On 01 January 2017 the annual increase to the cost of Pharmaceutical Benefits Scheme (PBS) co-payments for medicines (treatments), and the PBS Safety Net Thresholds, came into effect, as follows:

2016 2017 PBS Co-payment Increase
General Patients $38.30 $38.80 $0.50 cents
Concessional Patients (Holders of a Centrelink Concession Card) $6.20 $6.30 $0.10 cents

 

The 2017 PBS amendments apply at both hospital pharmacies and community pharmacies. People living with HIV (PLHIV) are still able to receive two month’s supply of each prescription item of their HIV antiretroviral (ARV) treatment combination per co-payment amount. Below is a summary table of costs per item depending the individual number of ARVs in your regimen. The PBS co-payment also applies to all other prescribed medicines as well, but other medicines are generally not for 2 months’ supply.

 

Number of individual items (Medicines) per (combination regimen) script Cost for 2 months’ supply
General Patients Concessional Patients
1 $38.80 $6.30
2 $77.60 $12.60
3 $116.40 $18.90
4 $155.20 $25.20
5 $194.00 $31.50
6 $232.80 * $37.80 *

* This figure also represents your annual (12 monthly) cost for each ARV medicine item.

The announcement includes an increase to the PBS safety net thresholds for both general and concessional rates. The PBS Safety Net Scheme is designed to offer individuals and families requiring a large number of prescriptions reduced cost for prescriptions, once a certain amount has been spent toward eligible items/medicines (per calendar year – i.e. January to December). For the purposes of the safety net scheme, it includes:

  1. You – the person/individual,

2 Your married spouse or de-facto partner, and

  1. Any dependent children under the age of 16, or dependent full-time students under the age of 25.

 

Once a person or family reaches the safety net threshold they are entitled to reduced co-payments for the remainder of that calendar year. PBS general and concessional safety net thresholds increases (from 01 January 2017) are shown in the table below, comprising approximately 1.3% increase on 2016:

Safety Net Threshold General Patients Concessional Patients
2016 $1,475.70 $372.00
2017 $1494.90 $378.00
Cost per co-payment after reaching the threshold $6.30 FREE

 

Closing the Gap – PBS Co-payments for Aboriginal & Torres Strait Islander (ATSI) People

All ATSI people living with a chronic condition (such as HIV), have additional PBS co-payment support measures available to them. Although the same PBS co-payment costs and Safety Net thresholds (shown above) apply to ATSI people for the cost of HIV antiretroviral treatments (ART), all ATSI people can pay a lesser amount for any other general PBS medicines (i.e. other treatments for other conditions) from their local pharmacy (not hospital pharmacy). For these ‘other’ medicines, general patients (non-concession card holders) who would normally pay the full PBS co-payment of $38.80, instead need pay only pay $6.30 (the concessional rate), and concessional patients (with concession cards) who would normally pay $6.30, instead get those medicines for free. More Info: http://www.pbs.gov.au/info/publication/factsheets/closing-the-gap-pbs-co-payment-measure

Further to this, ATSI people living in any of the 162 designated remote areas within Australia, are able to get their ‘other’ general PBS medicines (not including HIV ART medicines) provided free (without cost or charge) from a remote Aboriginal Health Service (AHS) . More Info: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pbs-indigenous

 

Recording your PBS medicines

You need to keep a record of your (and family) PBS medicines on a Prescription Record Form. This form is available from your community or hospital pharmacist. This form helps you keep a record of all your PBS medicines (signed by you pharmacist) so you know when you have reached the PBS Safety Net threshold.

Your pharmacist’s dispensing system will keep a computer record of your co-payment contributions.  If you have a family, ask your pharmacist about combining the amounts for all eligible family members. Once you (including your family) have reached the Safety Net amount, you can apply for a Safety Net Card (and have eligible family members listed on the card). Your Safety Net Card can then be used at any pharmacy to obtain the lower fee or free supply (whichever applies), for the remainder of the calendar year.  If you use more than one pharmacy for your medicines, you will need to obtain your PBS co-payment record from each pharmacy and then present them in combination to a single pharmacy for issue of your Safety Net Card.

 

PBS Information Line:

For further information on fees, patient contributions, benefit items and safety net thresholds — Free call 1800 020 613

 

Further information:

  1. About the PBS changes (and additional fees): http://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee
  2. About the PBS Safety Net (including Safety Net Registration & Supplementary Cards): http://www.humanservices.gov.au/customer/services/medicare/pbs-safety-net

More detailed information about the PBS Safety Net: http://www.pbs.gov.au/pbs/healthpro/explanatory-notes/section1/Section_1_5_Explanatory_Notes