Pricing of a PBS Prescription

Range of medications in pharmacy

How PBS medicines are priced and how much they cost can be confusing. Below is information and resources for use by community pharmacies and consumers to understand more the pricing and costs of a PBS prescription.

Effective 1 January 2022

Patient Co-Payments

  • Concessional patient $6.80
  • General patient $42.50

Professional Fees Made Up Of

  • Dispensing fees $7.78 (RP)
    $9.82 (EP)
  • AHI fee $4.30
    +5% of the amount by which the price to pharmacists exceeds $100, to a total cap of $99.28
  • Dangerous drug fee $4.82
  • Safety Net recording fees for items priced below the general co-payment $1.30 (RP)
    $1.67 (EP)
  • Allowable fee for items price below the general co-payment $4.54
  • Fee for Entitlement Card issue $10.65

Frequently Asked Questions

The Australian Government’s Pharmaceutical Benefits Scheme (PBS) aims to provide affordable medicines to all Australians. A wide range of prescription medicines are available at subsidised prices on the PBS.

Most Australians pay a price up to a cap for their PBS medicines and the Australian Government pays any remaining amount owed to the pharmacy.

There is a standard cap of $42.50 for the general population.

There is a cap of $6.80 for people with a Pension, Concession or Veteran’s card.

If you have a Veteran’s White Card, the lower price only applies for prescriptions for specific conditions. Your doctor can advise if your medicine will be covered by your white card. If it is not covered, the standard cap of $42.50 will apply.

For Aboriginal and Torres Strait Islander people who are registered for the Closing The Gap program, PBS prescriptions are usually free for those with a Pension, Concession or Veteran’s card or $6.80 otherwise.

Further information about the Closing The Gap program is available online.

Aboriginal or Torres Strait Islander people must be registered for the Closing The Gap program by your doctor or Indigenous Health Services provider. Patients only need to register once, anywhere in Australia.

If your concession card has expired but you are still entitled to one, you will need to contact Centrelink to arrange for a new card. Until then, PBS medicines must be charged at the higher rate. Your pharmacist can provide a receipt for you to claim the difference from Medicare.

The Australian Government has a Safety Net scheme for PBS prescriptions.

This means if you and your immediate family fill a lot of PBS prescriptions during the year, you may reach the PBS Safety Net threshold.

When you reach the PBS Safety Net threshold, you can get PBS prescriptions for you and your immediate family at a lower price for the remainder of the year. The standard PBS Safety Net price is $6.80 and free for those with a Pension, Concession or Veteran’s card.

In 2022, the standard PBS Safety Net threshold is $1,542.10 and $326.40 for those with a Pension, Concession or Veteran’s card.

The PBS Safety Net scheme covers a calendar year (i.e. January to December) and restarts every January.

Further information about the Safety Net Scheme is available online.

For some medicines there are multiple brands available and there may be a price difference between different brands.

This price difference is an extra cost which is agreed between the Australian Government and the medicine company and is called a Brand Premium.

This extra cost is ultimately paid to the medicine company, as the pharmacist pays this extra cost when they buy the medicine.

Your pharmacist must charge the extra cost when dispensing a prescription for a medicine with a Brand Premium.

The Brand Premium can make the price of the medicine higher than the PBS price cap.

If there is a Brand Premium on your prescribed medicine, you may be able to request another brand (often referred to as a generic medicine) which does not have the extra cost.

Your pharmacist can advise you further about Brand Premiums and generic medicines.

While the standard PBS price cap for people is $42.50, there are some PBS medicines which cost less. This is because the cost for the pharmacy to buy and dispense the medicine is less than $42.50.

Pharmacies can decide how much they charge when dispensing these PBS medicines and they may include some extra fees to cover their costs. The extra fees include a fee of $1.30 (for ready prepared medicines) for keeping Safety Net records and an Allowable Fee of up to $4.54. This recognises that individual pharmacies can have different business and operational costs such as rent, wages, utilities, or insurance.

Importantly, while the pharmacy can decide the price it charges for these medicines, it cannot exceed the standard price cap of $42.50. For the script to remain a PBS script that counts towards the PBS safety net threshold, the additional charges are capped at $5.84 for ready prepared medicines.

You may ask your pharmacist about the price of your medicines prior to dispensing.

Further information for fees and charges for pharmaceutical benefit prescriptions is available online.

The Australian Government has a website with more information about the medicines it subsidises through the Pharmaceutical Benefits Scheme and a list of the prices for all PBS medicines –

Ask your pharmacist if you have any questions about the price of your medicine.

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