Saving on prescription costs
Taking advantage of the PBS Safety Net Scheme can make a big difference to your yearly expenditure on medication. If you are in a relationship (de facto couple), you can reach the PBS Safety Net threshold much sooner. Applying for a Safety Net Card is easy.
Lance Feeney unpacks the PBS Safety Net.
Unpacking the PBS Safety Net
If you or your partner need a lot of medicines in a year, the PBS Safety Net helps you with the cost of medicines. If you reach the Safety Net threshold, you can apply for a Safety Net card – then your PBS medicine will be less expensive or free for the rest of the calendar year.
Who is eligible?
- All Australian residents
- People from other countries with a reciprocal Health Care Agreement with Australia.
What does it cover?
All prescribed medicine which is PBS listed (both HIV and other)
Who makes up the Safety Net?
A Medicare care holder and their:
- Spouse/de facto partner. People in same sex relationships now qualify
- Dependent children
- Dependent students
PBS patient contributions and thresholds
| General patients (waged) | Concessional card holders | |
| Patient contribution | Up to $33.30 (per item) | $5.40 (per item) |
| Safety Net threshold per annum (Single or couple) | $1281.30 | $324.00 |
| Amount paid per script after Safety Net threshold has been reached or exceeded | $5.40 (per item) | Free (per item) |
Note: If you choose a more expensive brand of medicine (non-generic) or your doctor prescribes one, you may need to pay more and the extra amount you pay won’t count towards your PBS Safety Net threshold.
Reaching the PBS Safety Net
After reaching the Safety Net threshold, you can apply for a Safety Net card. Talk with your HIV dispensing pharmacist about getting a card. After the card has been issued, medicines will be charged at the PBS Safety Net rate. For the rest of that calendar year, you and your partner will be charged $5.40 for each prescription or get you medication free if you are a concession care holder. Remember that prescriptions include both HIV and other medications.
How do I know when I have reached the threshold?
If you want to take advantage of the PBS Safety Net you will need to keep a track of your PBS expenditure each year. From 1 January, keep a track of the number of prescriptions that you, or you and your partner get dispensed. Ask your HIV pharmacists and your community pharmacist to provide you with a print-out of the cost of all the prescriptions you have had dispensed during the year. You will also be able to estimate the time when you reach the PBS Safety Net threshold by multiplying the total number of prescriptions by the number of months by the cost of each prescription ($33.30 if you are waged or $5.40 if you are a concession card holder).
For example:
Waged
- 3 HIV meds @ 33.30 per month + 4 other medications @ $33.30 = $233.10 per month. If you add together the total monthly cost, some time in May the threshold of $1281.30 would be reached. For the rest of the year you would be charged the PBS Safety Net rate of $5.40 per script and the cost of your 7 medications would be $37.80 per month for the rest of the year
Health Care Card holders
- 3 HIV meds @ 5.40 per month + 4 other medications @ $5.40 = $37.80 per month. Some time in August the threshold ($324) would be reached. For the rest of the calendar year, all your medication would be free of charge.
Making a claim for a refund
You can make a claim for a refund if you have exceeded the Safety Net threshold. Ask your pharmacist for information about how to make a claim or go to the Medicare Australia website (link at end of article) for instructions.
The Table below provides a cost comparisons for singles and couples (both waged and for Health Care Card holders) who require multiple HIV and other medications. The Safety Net threshold is the same for singles and couples, so a couple will reach the threshold sooner.
| With Health Care Card | Without Health Care Card (waged) | ||
| Individual | Cost per month | Individual | Cost per month |
| 3 HIV anti-retroviral drugs @ $5.40 per prescription | $16.20 | 3 HIV anti-retroviral drugs @ $33.30 per prescription | $99.90 |
| 3 non-HIV medications @ $5.40 | $16.20 | 3 non-HIV medications @ $33.30 | $99.90 |
| Couple with similar medication regimes | Couple with similar medication regimes | ||
| 6 HIV anti-retroviral drugs @ $5.40 per prescription | $32.40 | 6 HIV anti-retroviral drugs @ $33.30 per prescription | $199.80 |
| 6 non-HIV medications @ $5.40 | $32.40 | 6 non-HIV medications @ $33.30 | $199.80 |
For more information
Call—132 290* PBS enquiry line
Option 1— Concession and Medicare entitlement enquiries
Option 2— All claim payment, Safety Net, stationery and general enquiries
Option 3— Technical support for online claiming or information about online claiming Call—1800 020 613** PBS information line (for general public)
Visit—Department of Health and Ageing PBS website: http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/safety-net.jsp
Comments
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Martin | 5 December 2010
Thanks for the practical article, Lance.
Not having a HCC, but spending close to $1400 pa on medication, the figures presented made me realise that this year - given changes to the Hospital Pharmacy (S100) Prescription Rate - I'd probably exceeded the Safety Net already and may be entitled to a Refund. So thanks for the tip & web link.
In the past I've been irritated by the clumsy way in which clients have to maintain their own record of prescriptions (especially difficult if you travel or don't always use the same 1 or 2 pharmacies). And after all that paper record keeping, finding that you only just scrape 'over the line' (as it were) to be eligible for the Concessional rate in Dec!
Surely it's about time the PBS Safety Net and Medicare move into the electronic era?
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