What is the Pharmaceutical Benefits Scheme (PBS)?
The Pharmaceutical Benefits Scheme (PBS) is an Australian Government program that provides subsidised prescription medicines to residents of Australia. It's aim is to ensure Australian residents have affordable and reliable access to a wide range of necessary medicines at an affordable price.
Can I claim a pharmacy benefit from HIF?
- A benefit can only be paid on non-Government Pharmaceutical Benefits Scheme (PBS) prescription items; if the item exceeds the PBS amount of $41.00*.
- If the cost of the item is less than the PBS amount a benefit cannot be paid.
- A maximum benefit of $80.00 per script item can be claimed, up to a members annual pharmacy limit.
- Benefits cannot be paid on contraceptives or PBS prescriptions or over the counter items purchased with or without a prescription.
- When submitting a claim, an official pharmacy receipt must be included which identifies the patient, the item supplied and the prescribing doctor's name.
Non PBS item rebate example
Nikki is covered under Super Options and she visits her pharmacy to purchase a Boostrix vaccination prior to her holiday. As Boostrix is a non-Government Pharmaceutical item and the pharmacy fee exceeds the PBS, Nikki is eligible to receive a rebate from HIF. The following table is an example of the fee and the rebates Nikki will attract.
| Non PBS Item | Pharmacy Fee | Nikki Pays the PBS amount | Rebate to Nikki | Maximum Payable | Annual Pharmacy Limit |
|---|
| Boostrix | $100.00 | $41.00 | $59.00 | $80.00 | Up to 3 years: $200; Over 3 years: $400 |
Samantha is covered under Special Options and she visits her pharmacy to purchase Duromine. As Duromine is a non-Government Pharmaceutical item and the pharmacy fee exceeds the PBS, Samantha is eligible to receive a rebate from HIF. The following table is an example of the fee and the rebates Samantha will attract.
| Non PBS Item | Pharmacy Fee | Samantha Pays the PBS amount | Rebate to Samantha | Maximum Payable | Annual Pharmacy Limit |
|---|
| Duromine | $140.00 | $41.00 | $80 | $80.00 | $200 |
*PBS amounts
- $41.00 is the co-payment for 2020.
- $40.30 was the co-payment for 2019.
- $39.50 was the co-payment for 2018.