Non PBS prescriptions
The Pharmaceutical Benefits Scheme (PBS) is a listing of prescribed medicines that are subsidised by the Government. The Scheme is managed by the Department of Health and administered by Medicare Australia.
Medicare has set the 2020 PBS co-payment amount to $41.00 for most PBS medications, which is the maximum amount that they'll bill you for medicines on the PBS. This price is reviewed by the Government, and updated on 1 January each year.
You can browse all medications listed under the PBS here.
Some of our extras policies provide benefits for non-PBS prescriptions medications, which includes travel vaccines. You're required to pay an initial co-payment of $41.00, and then we pay a benefit back on the balance.
This means that for your medication to be eligible for claiming, it must cost more than $41.00.
If it's less than this amount, then there's a fair chance that your medication is already subsidised by the government through the Pharmaceutical Benefits Scheme (PBS). If this is the case, it is not eligible to be claimed through Private Health Insurance.
There are some specific requirements in order to claim non PBS scripts. They need to be:
- Approved by the Therapeutic Goods Administration for sale in Australia
- A prescription only medication (category S4 or S8)
- Not a compound medication (no unique blends)
Since we need to ensure the above requirements are satisfied, we'll need to sight your original pharmacist receipt that shows:
- Full medication name and dosage
- Full name of the person the prescription is made out to
- Dispense date
- Price you paid
The receipt issued for your payment at the front counter is not sufficient. Make sure that you ask your pharmacist for the full invoice to claim back through your private health insurance, and that it includes the above requirements.
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Learn more about how this may affect your Extras cover here.
