The Pharmaceutical Benefits Scheme (PBS) and how to maximise its benefits.
, by Gima R., 5 min reading time
What is the Pharmaceuticals Benefits Scheme (PBS)?
The Pharmaceutical Benefits Scheme (PBS) is an Australian Government program that subsidises the cost of medications for all Australians. It helps reduce the cost of essential medicines, making them more affordable for individuals and families. For Example, concession card holders will pay $7.70, and the government will cover the rest of the cost of the medication even if the cost may be over $1000, as in the case of COVID-19 antiviral medications. Further medication subsidising is also available for families who reach the safety net.
What is the Safety Net and how do I reach it?
The safety net is a scheme introduced to protect families and individuals who require
many medications and to fork out a large sum of money.
You or your family will reach the PBS Safety Net threshold once you or your family spend a certain amount on PBS medicine.
The PBS threshold changes each year. In 2025, for General Patients who don't hold
a concession card, once they spend $1694.00 in a calendar year, they reach their safety net, and the cost of medications drops from $31.60 to $7.70 However, concession card holders reach their safety net once they spend $277.20 in a calendar year, and the cost of medications drops from $7.70 to Free of charge.
How do Generic and Branded medications count towards my safety Net?
Generic Medications and Branded medications count equally towards the safety net.
However, the surcharge on a branded medicine does not count towards the safety
net threshold. For Example, if a patient is on Esomeprazole 20mg Tablets and chooses the brand Nexium, the cost will be $14.90, but only $7.70 will count towards the Safety Net tally. However, if the patient chooses a generic alternative such as Esopreze 20mg Tablets, the cost will be $7.70 and $7.70 will count towards the safety tally. For the Nexium brand in this Example, the patient pays a brand premium of $7.20 out of pocket, and that premium of $7.20 does not count towards the safety threshold tally.
What about 60-day Prescriptions? Will they save me money?
Since September 1, 2023, the government has introduced 60-day prescriptions. This
means instead of the patient receiving a month's worth of medications per prescription, they can receive 2 months' worth of their medicines for the same price.
However, although this was introduced to alleviate the pressure of living by bringing
down the cost of drugs, this delays the patients reaching their safety net and receiving the medications for free! So, patients who reach their safety net might be worse off getting a 60-day prescription instead of a 30-day prescription, as it may
cost them more in a given calendar year!
Will getting a $1 Discount on PBS prescriptions delay my PBS Safety Net reach?
Some pharmacies offer a $1 discount on PBS medications, so, for Example, instead of paying $7.70 on a prescription, they pay $6.70. However, this will delay patients from reaching their safety net. In effect, individuals or families who take many medications will be worse off paying $1 less for their prescriptions! For Example, a family that pays $7.70 per prescription will reach its safety net after 36 prescriptions.
Still, a family who pays $6.70 for 42 prescriptions in a calendar year will reach their safety net. The family who gets their scripts at a discount of $6.70 per prescription will pay for six prescriptions to achieve their safety net, costing them $40.20 per year.
Track your PBS Spending
It is important to track your own PBS spending on medications. Each dollar spent on
PBS prescriptions counts towards your safety net threshold, and the sooner you reach your safety, the sooner you will receive your medications for free if you are a concession card holder.
If you always visit the same pharmacy, your PBS spent will be tracked automatically, and the pharmacist will let you know when you reach your safety net. However, if you visit multiple pharmacies, you must track your spending. You can ask each pharmacy you visit for a printout of all your PBS spending and tally the total yourself, and once you reach the safety net threshold, which is $277.20 for concession card holders in 2025 or $1694.00 for general patients, let your pharmacist know they will issue you a Safety Net Card to use till the end of the calendar year.
Exceeding the Safety Net and claiming a refund If you have exceeded the Safety Net threshold and require a refund, you can claim the overspent amount by applying in writing to Services Australia. If you have one, you must include your PRF, Medicare card, and Concession Card photocopies.
Can you claim a refund from previous Years?
Yes, you can! If you were unaware of the safety net, have been going to different pharmacies over the years, and are sure you exceeded the PBS safety net threshold, you can claim a refund. You will need a printout (PRF) from each pharmacy to show how much you spent and submit it to Medicare. Ask one of our pharmacists at Sea Lake Pharmacy to help you with your paperwork to claim a refund.
What are other ways to maximise my PBS benefits and health outcomes?
Services such as Medscheck or a Home Medicine Review can be a great way to ensure that you are maximising your savings on medications and getting optimal health outcomes.
A medscheck, which is an in-store medication review, provides you with a list of your
medications and a plan. The meds check will list each medication you are taking, when to take it, how long to take it, and any potential side effects to be aware of.
This ensures none of your medications are doubled up, and you are not taking any medications you are not meant to be taking. This can save you a lot of money and save your health, too!
A Home Medicine Review is a more thorough review that will also ensure your medications are reconciled, stored correctly, not interacting with other medicines, not prescribed unnecessarily, not used for a prolonged period, and if some medications can be combined into one to save you more money. Overall, a Home Medicine Review can also be a cost-saving exercise and health-beneficial.