However, the report also noted that there are areas where improvement can be made. For example, it’s estimated that in 2017-18, almost half of us had one or more chronic conditions.
Many of these chronic conditions, as well as other medical conditions, can require us to take medicine on an ongoing basis—this medicine could be quite costly for us if there were no external assistance provided.
The Pharmaceutical Benefits Scheme (PBS)
The Government’s Pharmaceutical Benefits Scheme (PBS) subsidises the cost of medicine for most medical conditions—providing you with timely, reliable and affordable access to a wide range of necessary medicines.
As an example of the many benefits, and widespread scope, of the PBS, below is a summary of several key facts from the most recently available PBS Expenditure and Prescriptions Report^:
PBS medicines are available to all Australian residents who hold a current Medicare card. Also, overseas visitors may be eligible to access PSB medicines where there is a Reciprocal Health Care Agreement (RHCA) in place*.
*For example, Australia currently has RHCAs with Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, the Republic of Ireland, Slovenia, Sweden, and the United Kingdom.
In addition, PBS medicines are available to veterans, war widows and widowers, and dependants who are eligible under the Repatriation Pharmaceutical Benefits Scheme (RPBS).
The PBS Schedule lists all of the medicines available at a Government-subsidised price.
PBS medicines, that don’t encompass over-the-counter medicines, can be collected from a community pharmacy, or an out-patient pharmacy at a public hospital pharmacy—your Medicare card, concession/health care card*, and PBS Safety Net Card (see below) need to be shown when filling a prescription.
*For example, Pensioner Concession Card, Commonwealth Seniors Health Card, Health Care Card, or Department of Veterans’ Affairs (DVA) Gold, Orange, or White Card.
When paying for PBS medicines, you pay a co-payment of up to $6.60 (concession/health care card holder) or up to $41.00 (general patient) towards the cost of the PBS medicine, and the Government pays any remaining cost—many PBS medicines cost significantly more than the co-payment amount.
For example, on 1 October 2019#, the medicines, Tecentriq® and Avastin®, were extended on the PBS Schedule to include first-line treatment of patients with stage IV metastatic non-squamous non-small cell lung cancer.
Importantly, without the PBS subsidy, these medicines would cost patients more than $11,400 per script; or a total of more than $189,100 per course of treatment (around 16 scripts per course of treatment).
If you (and your family) need a large number of PBS medicines in one year, the PBS Safety Net also serves to protect you from excessive out-of-pocket costs.
For example, if you spend an amount equal to your PBS Safety Net threshold amount on co-payments in a calendar year, and are issued with a PBS Safety Net Card, you can receive further prescriptions for that year:
As at 1 January 2020, the PBS Safety Net threshold amount is:
The Pharmaceutical Allowance
In conjunction with the PBS, it’s important to note that the Government’s Pharmaceutical Allowance can provide further assistance with the cost of medicine to eligible Australians.
The Pharmaceutical Allowance is a regular extra payment paid on top of some income support payments, where certain conditions are met. These income support payments can include:
The Pharmaceutical Allowance payment rate is:
However, if you are a member of an illness-separated couple or a respite care couple or where a partner is in prison, the Pharmaceutical Allowance payment rate is $6.20 per fortnight.
Please note: For most age pensioners and other relevant income support recipients (e.g. Carer Payment), the value of the Pharmaceutical Allowance has been incorporated into the Pension Supplement—the maximum Pension Supplement is currently $69.60 a fortnight (singles) and $105 a fortnight (couples, combined).
If you have any questions regarding this article, please contact us.
*Australian Government, Australian Institute of Health and Welfare (2020). Australia’s health snapshots 2020.
^Australian Government, Department of Health. (2019). PBS Expenditure and Prescriptions Report 1 July 2018 to 30 June 2019.
#Australian Government, Minsters (Department of Health. (2019). Cheaper medicine for over 500,000 patients.