What is the Pharmaceutical Benefits Scheme (PBS)?

What is the Pharmaceutical Benefits Scheme (PBS)?

The Pharmaceutical Benefits Scheme (PBS) is an Australian Government program (which is part of the Australian Government's broader National Medicines Policy). It provides subsidised prescription medicines aimed at ensuring Australian residents (who hold a current Medicare card) 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 $31.60*.
  • 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 on Value, Essential, Advanced and Top Extras or 60% of the cost (above the PBS amount) up to annual limit on Simple Extras.  
  • Benefits cannot be paid on 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. 

*PBS amounts

  • $31.60 is the co-payment for 2024.
  • $30.00 is the co-payment for 2023.

Please note: The Australian Government requires members to match the current PBS co-payment before HIF can pay a benefit.

For more detailed information on the PBS or to see if you're eligible for a concession, please visit: pbs.gov.au