The Pharmaceutical Benefits Scheme explained

How the Pharmaceutical Benefits Scheme and Safety Net work

The Pharmaceutical Benefits Scheme (PHARMACEUTICAL BENEFITS SCHEME) is designed to minimise the cost of medicines for Australian residents.  This is particularly helpful if you are on regular, repeat medications and/or medicines that cost a lot of money.  

If you spend a lot of money on Pharmaceutical Benefits Scheme medicines, you may be eligible for further subsidies via the Pharmaceutical Benefits Scheme Safety Net. The Safety Net subsidies become available once you reach the total spend thresholds outlined below for General Medicare patients or Concession cardholders. 

This article explains how the Pharmaceutical Benefits Scheme and Safety Net work. 

Who is eligible for Pharmaceutical Benefits Scheme subsidies and discounts?

1. Australians and concession card holders who have a current Medicare card 
2. Overseas visitors from the 11 countries with which Australia has a Reciprocal Health Care Agreement (Belgium, Finland, Italy, Malta, Netherlands, New Zealand, Norway, Republic of Ireland, Slovenia, Sweden and the United Kingdom). 
3. Veterans, war widows and widowers, and dependents who are eligible under the Repatriation Pharmaceutical Benefi Scheme 

Where and how to get your Pharmaceutical Benefits Scheme medicines

You can only get Pharmaceutical Benefits Scheme medicines from a pharmacy (like those that fill prescriptions when you order from Chemist2U). You will need a prescription, your Medicare card number and (if applicable) your concession or other healthcare card. 

Health Care cards include:  

• • • a Health Care Card 
    • a Commonwealth Seniors Health Card 
    • an Ex-Carer Allowance (Child) Health Care Card 
    • a Foster Child Health Care Card 
    • a Low Income Health Care Card
    • a Pensioner Concession Card 
    • a Department of Veterans’ Affairs Card 
    • a Pharmaceutical Benefits Scheme Safety Net Card.

Note when collecting your Pharmaceutical Benefits Scheme medicines from a pharmacy

• • Your pharmacist will confirm whether your medicine is cheaper under the Pharmaceutical Benefits Scheme 

• • The Pharmaceutical Benefits Scheme does not include over the counter medicines 
  • You may get a further discount on Pharmaceutical Benefits Scheme medicines if you have a concession or health care card. 

Can I collect Pharmaceutical Benefits Scheme medicine for someone else?

Yes, if you have their prescription, Medicare card details and (if applicable) details of their concession, health care and Pharmaceutical Benefits Scheme Safety Net cards. 

Note also that you will need to sign their prescription to prove that you collected the medicine. 

What if I can’t get a prescription?

If you cannot get to the doctor, you can get up to one month’s supply of your Pharmaceutical Benefits Scheme medicines at the discretion of a pharmacist without a prescription.  

If you have been prescribed the medicine before and have an ongoing need for it, your pharmacist will charge the normal Pharmaceutical Benefits Scheme price.  But note, you can only access medicines without a prescription once in 12 months, after which you will need to get a prescription for any further supply. 

Pharmaceutical Benefits Scheme Safety Net thresholds

When you or your family spend a certain amount on Pharmaceutical Benefits Scheme medicines you will reach the Pharmaceutical Benefits Scheme Safety Net threshold. 

Calculated over a calendar year and typically reset at the beginning of the year, the Pharmaceutical Benefits Scheme Safety Net thresholds were updated 1st January 2023 to: 

• • $262.80 for concession card holders 
  • $1,563.50 for general patients. 

Up to the threshold, the Pharmaceutical Benefits Scheme caps what you pay for each medicine: 

• • Up to $7.30 for concession card holders 
  • Up to $30.00 for general patients 

Over the threshold, you can apply for a Pharmaceutical Benefits Scheme Safety Net card and what you pay for Pharmaceutical Benefits Scheme medicines becomes: 

• • FREE for concession card holders 
  • Up to $7.30 for general patients 

Note: if there are 2 or more brands of the same medicine and you choose a more expensive one, you may pay over these caps.

Useful links 

References