PBS Safety Net: How it Benefits Patients and Hospitals

The Australian Government provides affordable access to medicines by subsidising the cost of a wide range of prescription medicines through the Pharmaceutical Benefits Scheme (PBS). The price an individual pays for PBS medicines will depend on their eligibility. In 2013, the general patient contribution is up to $36.10 and the concession card holder patient contribution is $5.90 for each PBS medicine. The PBS benefits all Australian citizens and residents as well as people from countries that have a Reciprocal Health Care Agreement with Australia. Australia currently has agreements with New Zealand, the United Kingdom, the Republic of Ireland, the Netherlands, Finland, Sweden, Norway, Malta, and Italy. The Repatriation Pharmaceutical Benefits Scheme (RPBS) gives eligible veterans, war widows/widowers, and their dependants, access to pharmaceutical benefits additional to the PBS.

Anyone eligible for the PBS and RPBS is also eligible for the PBS Safety Net scheme. The PBS Safety Net scheme is a system designed to protect individuals and families from the high total cost of needing large numbers of PBS medicines. The Safety Net threshold is reached by accumulating eligible patient contributions for PBS prescriptions supplied through community pharmacies, private hospitals and out-patient supplies from public hospitals. The patient is responsible for keeping a record of the amount spent on PBS medicines, which includes keeping track of their dependents’ spending by using a Prescription Record Form (PRF) available at any pharmacy. Each time a PBS medicine is supplied, the form can be handed to the pharmacist to record the supply.

The dispensing system used at pharmacies helps patients by also keeping a record of the number of prescriptions dispensed and will prompt pharmacists to issue a Safety Net card once the patient reaches the Safety Net threshold. In 2013, the general patient Safety Net threshold is $1,390.60 and the concessional threshold is $354.00, which can be as few as 60 prescriptions shared between all family members in a calendar year. After achieving the Safety Net threshold, PBS medicines for general patients will be charged at the concessional rate of $5.90 and PBS medicines will be free for concessional patients for the remainder of the calendar year. Therefore, the overall cost of medicines is reduced.

If a patient doesn’t have their card on admission to hospital, the pharmacist can obtain the patient’s Safety Net card number or PRF records from their local pharmacy (if they are approaching the Safety Net threshold). This is to ensure that medicines dispensed to the patient are charged at the correct rate. Furthermore, PBS medicines dispensed whilst the patient is in hospital contribute to their Safety Net threshold, enabling patients to reach their eligibility quicker. Therefore, if the patient reaches their Safety Net whilst in hospital, the pharmacist will issue a Safety Net card. As a result, this reduces the patient’s (and hospital’s) financial burden.

A large number of oral and injectable medicines that are kept on the imprest at hospitals are covered under the PBS. Hence, medicines prescribed during a patient’s hospital admission that are dispensed by the pharmacy will be covered by the hospital at minimal cost when the patient has reached their PBS Safety Net threshold for that calendar year. This provides significant cost savings to the hospital as the cost of each medicine provided is only $5.90 or free. The Australian Government will reimburse the pharmacy for the balance of costs of medicines.

Through the PBS Safety Net scheme, the Australian Government subsidises medicines that are necessary to maintain the health of the community in a cost effective way. As a result, patients and hospitals are able to have access to PBS medicines in a timely and affordable manner.