PRESCRIPTIONS INFORMATION & PRICING
- Different Types of Prescription Pricing
- Generic Brands & Government Surcharges
- PBS Safety Net
- 20 Day Rule
Different Types of Prescription Pricing
Depending on your eligibility for entitlement, you may receive different subsidy levels from the Australian Government for your prescription medications. There are 4 different types of prescription pricing:
- Concession, and
1. PBS (General Patients)
PBS pricing is for general patients. General patients have a Medicare card but do not have a Concession card.
2. Private (Non-PBS Prescription)
These are medications which do not qualify for any subsidy from the Government; hence you will need to pay the full price for the medicine.
Concessional pricing is heavily subsidised by the Australian Government. To be eligible for concession pricing you will need to have one of the following concession cards:
- Pensioner Concession Card,
- Commonwealth Seniors Health Card,
- Health Care Card,
- DVA White, Gold, or Orange Card – also known as ‘Repat’ card
- Blue Safety Net Concession Card (Learn more about the Safety Net)
The cost of prescription items on a concession card is usually $5.80. However, if you choose a more expensive brand of medicine, or if your doctor prescribes one, you may need to pay more. You may avoid paying any extra costs by selecting the generic brand. Learn more
4. Entitlement (Green Safety Net Card)
Concession card holders whose yearly spend on PBS medication has reached the Safety Net threshold* are entitled to a Green Safety Net (SN) card. This qualifies you to obtain your PBS prescriptions for free for the rest of the calendar year - unless you choose a more expensive brand of medicine, in that case you may need to pay more. You may avoid paying any extra costs by selecting the generic brand. Learn more
*$348 (60 PBS Scripts) for 2012
*Brand price premiums do not count towards the threshold.
*Private (non PBS) prescriptions do not count towards your Safety Net threshold amount.
Learn more about the PBS Safety Net
Generic Brands & Government Surcharges
Generic medicines are different brands containing the same active ingredient as the original patented brand. As well as being as safe and effective as original brand medicines, in most cases, they are less expensive; providing better value for money.
When a pharmaceutical company first develops a new medicine, it takes out a patent. This makes sure no other company can make or sell that particular medicine. Patents last a certain period – usually 10 to 20 years – after that period is over, other companies can make the same medicines. These medicines are called generics, or generic medicines.
Why do I have to pay extra for some brands?
The Australian Governments PBS subsidises all brands of the same drug to the same amount; that is, up to the cost of the lowest priced brand. A manufacturer may be unwilling to market their brand at the lowest price and as a result will ask that patients pay extra for their brand. In most cases this is the reason for the extra surcharges on medications. Importantly, there will always be at least one brand without a brand premium – that is the generic brand.
Are generic medicines the same as the brand name medicines?
They have the same active ingredients — the substances that make the medicine work. They have the same potential effect on the body. They have the same potential side effects as the original medicines. They are different in some ways. They may have different inactive ingredients, such as fillers. They are likely to have different packaging and may be a different colour. They may be a different shape or may be capsules instead of tablets.
Are they safe?
All medicines have some risks. Generic medicines are as safe as the original medicines. The manufacturer must prove to the Australian Government that they contain the same active ingredient as the original medicine. If they contain the same active ingredient they will have the same effect. Generic medicines may use different inactive substances such as fillers. They may not be safe for people who are allergic to an inactive substance, such as gluten, lactose or preservatives.
Can I switch to the generic brand?
Yes, a pharmacist can dispense another brand of the same medicine at your request. Speak to one of our friendly pharmacists to see if a generic brand is available for your medications.
PBS Safety Net
The PBS Safety Net is a scheme that entitles people to free or cheaper medicines if they spend more than a certain amount on PBS prescription medicines in a calendar year.
Before you can become eligible for free or cheaper medicines under the PBS Safety Net scheme, you must have a record of how much you have spent on PBS medicines that year.
If you always use the same pharmacy, ask your pharmacy to record your spending on their computer.
If you use different pharmacies, record your spending on a 'Prescription Record Form', which can be obtained from any pharmacy. The Safety Net applies to a calendar year, so ask for a form the first time you buy a PBS medicine in the beginning of every year. Thereafter, each time you lodge a prescription, hand your Prescription Record Form to the pharmacist. The pharmacist will then record the medicine and its cost on the form.
If you have a family, ask your pharmacy to combine the amounts spent on each person's medicines into one Safety Net total or use one Prescription Record Form for the entire family. An eligible family can comprise you, your spouse (including de facto spouse), dependent children under 16 years of age and dependent students under 25 years of age.
Safety Net Card
When your record shows that you have spent the required amount on PBS medicines, your pharmacist will give you a 'Safety Net Card' that you can use to obtain free or cheaper medicines for the rest of the calendar year.
If you asked your pharmacist to record you’re spending, they will issue you with a Safety Net Card when you become eligible. If you use a Prescription Record Form, you will need to keep track of your tally, so you can tell the pharmacist when you have spent the required amount.
Concession card holders
If you hold a Government concession card, you will be eligible for a Safety Net Card once you have spent $348 (in 2012). (This amount is the equivalent of 60 PBS prescriptions at the concession rate.) You can then use the card to obtain free PBS medicines for the rest of the year.
If you do not have a Government concession card, you will be eligible for a Safety Net Card when you have spent $1363.30 (in 2012) on PBS medicines. You can then use the card to obtain PBS medicines at the concession rate of $5.80 (in 2012) for the rest of the year.
If you buy certain medicines within 20 days of having bought them previously, a special rule called the 'Safety Net 20-day rule' may apply. In such cases, the cost of the medicine will not count towards your Safety Net tally, or you will have to pay the usual amount for it if you are already using a Safety Net Card.
The rule applies only to selected PBS medicines used long-term for chronic conditions where a prescription is intended to last one month. The rule does not apply to medicines intended for short-term use (eg antibiotics).
The rule is designed to prevent people on a Safety Net Card using their card to hoard additional supplies of their medicines at the end of a calendar year.