What is the Pharmaceutical Benefits Scheme (PBS)?

The Pharmaceutical Benefits Scheme (PBS) helps people living in Australia get essential medicines at a reduced price. Instead of paying the full price yourself, the government covers part of the cost of your medicine.

The PBS is part of the Australian Government's National Medicines Policy. This policy aims to make sure people can get the medicines they need, while also considering the costs.

What is the RPBS?

RPBS stands for Repatriation Pharmaceutical Benefits Scheme. It is a separate scheme for veterans who have a White, Gold or Orange Card from the Department of Veterans' Affairs.

Who can use the PBS?

If you are an Australian resident and have a current Medicare card, you can use the PBS. When you get a PBS prescription and show your Medicare card, you don't pay the full cost of the medicine to the pharmacy.

Overseas visitors from countries that have a Reciprocal Health Care Agreement (RHCA) with Australia can also get medicines through the PBS. This covers visitors from:

• The United Kingdom
• Ireland
• New Zealand
• Malta
• Italy
• Sweden
• The Netherlands
• Finland
• Norway
• Belgium
• Slovenia

Who can prescribe PBS medicines?

Various healthcare professionals can prescribe PBS medicines. Such as your:

• doctor
• dentist
• optometrist
• midwife
• nurse practitioner
• specialist

The medicines that can be prescribed depend on their profession. A dentist can prescribe antibiotics for a tooth abscess but cannot prescribe medicines for high blood pressure.

Some nurses have authority to prescribe medicines that are on the list of Nurse Practitioner items. There is also a list of Midwife items.

PBS medicines that an optometrist can prescribe are listed on the Optometrical Schedule. These are mainly eye drops.

Some medicines can only be prescribed by a doctor with specialist training.

Am I eligible for all PBS medicines?

Over 900 different medicines are available through the PBS. Ask your doctor if the medicine they recommend is listed on the PBS.

You must meet specific criteria to qualify for some PBS scripts. You might need to have:

• a particular medical condition
• certain blood test results
• an imaging test such as an x-ray or MRI
• used another medicine previously
• seen a specialist

Your doctor must confirm you are eligible when they write your prescription.

Most PBS medicines are taken by people at home. Some chemotherapy medicines and other specialist treatments need to be given in a hospital.

What can I do if I need a medicine that is not covered by the PBS?

Doctors may prescribe medicines outside the PBS criteria.

You can still get a medicine that is not on the PBS by paying the full price. Ask your pharmacist what your medicine will cost.

If you have private health insurance, check your policy to see whether it covers medicines.

What is a PBS Authority prescription?

Your doctor may need additional approval to prescribe some medicines. These are usually medicines that cost the government more. They may need to get an Authority approval number from the PBS.

A Streamlined Authority prescription is similar, but your doctor can use a code to verify that you are eligible instead of contacting the PBS each time.

Where can I buy PBS medicines?

Almost all pharmacies in Australia have a licence to dispense PBS medicines. A few are non-PBS pharmacies. If you visit a non-PBS pharmacy, you will need to pay the full price for your medicine.

You can also order PBS medicines from an online pharmacy.

If you start a new medicine as a hospital inpatient, you may get a small supply to take home. You should see your usual doctor and pharmacist as soon as possible to get an ongoing supply.

How much will I pay for PBS medicines?

The amount you pay for your medicines will depend on your situation. If you have a Health Care Card or Pensioner Concession Card, your medicines will be cheaper. Services Australia issue these cards to people on low incomes.

Show your pharmacist your Medicare card and any concession cards so that they charge you the correct amount.

What is a PBS co-payment?

When you get a PBS medicine from the pharmacy, you will need to pay a set amount towards its cost. This payment is called a co-payment.

It's called a co-payment because you are only paying part of the cost. The rest is paid to the pharmacy by the government.

The general co-payment and concession co-payment amounts are reviewed by the government every year.

What is a brand price premium?

If you prefer the original brand of a medicine, you may need to pay a brand price premium.

To reduce how much you spend on brand price premiums, ask your pharmacist to suggest an alternative. The alternative will be a generic medicine with the same active ingredient. Generic medicines may look different and have different filler ingredients. Not all medicines have generic options available.

In some cases, your doctor may ask your pharmacist to dispense a specific brand of medicine.

What is the PBS Safety Net?

If you and your family take several regular PBS medicines, the PBS Safety Net may apply to you. Each year, Safety Net thresholds are set. If you buy enough PBS medicines to reach the threshold, you can get a Safety Net Card. A Safety Net Card means that you get reduced cost or free PBS medicines for the rest of the calendar year.

How can I keep track of what I've spent on medicines?

You or your pharmacist needs to keep a record of your spending on PBS prescriptions. The easiest way to do that is by having a regular pharmacy.

You can also use the Safety Net prescription record form to track medicines you and your family pay for during the year.

How does the 20-day and 50-day rule affect the Safety Net?

If you have your prescription dispensed more than 10 days early, the payment may not count towards the Safety Net threshold.

How do I save costs when taking a high dose of PBS medicine?

If you need to take more than the standard dose, your doctor can write an Authority Prescription for an increased quantity of your medicine. This will help to reduce the costs because you will pay for dispensing less often. Talk with your pharmacist if you think you are paying more than you should.

How does a 60-day prescription work?

PBS prescriptions generally give you enough medicine for a month at a time.

Since September 2023, patients with chronic, stable medical conditions can get a 60-day supply of medicine (rather than a 30‑day supply) for certain items. Ask your doctor if any of your medicines are available as a 60-day prescription.

How do I get enough of my medicine if I am away from my pharmacy for an extended period?

Talk with your doctor if you are travelling overseas or live remotely and cannot visit your pharmacy often. They can usually write you a special prescription that asks the pharmacy to dispense all your repeats at once.

How is it decided what medicines go on the PBS?

The process to list a new medicine on the PBS involves many stakeholders. These include:

• the pharmaceutical industry
• government
• consumers
• prescribers
• wholesalers

In Australia, medicines are approved for use by the Therapeutic Goods Administration (TGA). This government agency checks that medicines work and are safe. The TGA gets information from the medicine sponsor (usually a pharmaceutical company) to make their decision. This step happens before a medicine can be listed on the PBS.

The sponsor also needs to provide evidence that the new medicine gives a benefit over existing medicines on the PBS. Benefits might relate to the overall cost to the government or to patient quality of life. Consumers and prescribers can provide input.

A committee reviews all the evidence as part of a cost effectiveness assessment. If the committee decides to recommend the medicine for listing, the sponsor and the government must agree on a price before it can be listed.

There is a similar process for when a medicine has a new use, or when a new form of a medicine has been developed.

Resources and support

Visit the PBS website to view a video about the scheme.

Check the full PBS medicines A to Z list on the PBS website.

Got to Services Australia for more information on how the PBS can help you save money on your medicines.

Languages other than English

Queensland Health has information about the PBS in different languages.

Aboriginal and/or Torres Strait Islander peoples

Find out about Medicare services for Indigenous Australians and the Closing the Gap PBS Co-payment program.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.