Depending on their health fund and cover, patients may have benefits that cover medication not eligible for a government subsidy.
As a medical practitioner, you would be familiar with Australian Government programs like the Pharmaceutical Benefits Scheme (PBS), Repatriation Pharmaceutical Benefits Scheme (RPBS) and Life Saving Drugs Program that help to keep the cost of medicines down for Medicare-eligible Australians.
The PBS
The PBS lists all medicines that can be prescribed to patients at a lower price. When you prescribe items on the PBS, your patients will pay no more than $30 for most medicines, or no more than $7.30 if they have a concession card, with the remining cost subsidised by the Australian Government.
This patient co-payment was reduced on 1 January 2023 from $42.50 to $30.00 per pharmaceutical benefit and is indexed on 1 January every year.
But while the PBS list includes medicine for most conditions, not all medication prescribed is subsidised by the government. If a medicine is not covered by the PBS, patients pay full price – a price that is typically higher compared to subsidised medication.
Rebates for non-PBS medication are available
The good news is that even if the prescribed medication is not eligible for a government subsidy, your patients may still receive a rebate on non-PBS medicine through their private health insurance. Reminding patients of this benefit could see them save on their otherwise expensive, completely patient-funded medication.
Benefits for non-PBS items are usually included under extras cover, otherwise known as general treatment cover.
The eligibility criteria and conditions around what kinds of non-PBS medication can be claimed, waiting periods, annual limits and individual item benefits varies across each health fund. For example, whether the policy benefits include coverage for immunisations, such as allergy medication, or any thresholds that need to be met before benefits can be paid.
It is important that your patient checks with their health fund as to what is available to them as well as any requirements to process a claim.
It can also be helpful to prompt your patients to ask for an Official Pharmacy Receipt from their pharmacy when their medication is dispensed, which includes information about the supply of their medication such as patient name and script number. Having this information ready will guarantee a smooth experience when claiming benefits, as it may be a requirement of their health fund to submit this official receipt as part of their claim.
By reminding patients about their potential health fund benefits and helping them to understand the rebates available to them with prescription medication, doctors can help lower the cost of healthcare.
Established by the AMA in 1977, Doctors’ Health Fund provides health cover to members of the medical community and their families. To view cover options or get in touch with our expert team, visit doctorshealthfund.com.au.
If you join on combined hospital and extras cover by 7 December, you’ll receive 8 weeks free.* Plus, your two-month waiting periods will be waived on extras, meaning you can claim on things like general dental, optical and physio straightaway. To find out more visit https://www.doctorshealthfund.com.au/8weeksfree.
Additional resources:
* Offer and policy T&Cs apply. New members only.
