On 1 January 2023, the Australian Government will introduce changes to the Pharmaceutical Benefits Scheme (PBS) that will:
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Reduce the PBS general patient co-payment from its current amount of $42.50 to $30.00.
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Allow pharmacists to be able to provide an increased discount to general patients on prescriptions with a Commonwealth price between $30.00 and $45.60. This range is called the increased discount range (IDR). Discounted prescriptions will be considered under co-payment.
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Have no changes to concessional patients.
PBS Changes Summary Table
2022 |
2023 |
|
General Patients |
||
| PBS Co-Payment Price | $42.50 | $30.00 |
| PBS Discount | Maximum of $1.00 | Maximum of $1.00 for items with a full cost above $45.60 For full cost items within the Increased Discount Range (IDR) - $30 - $45.60: you can discount these further than $1.00 (under co-payment) |
| Safety Net |
$1,457.10 |
$1,563.50 |
Concessional Patients |
||
| PBS Co-Payment Price | $6.80 | $7.30 |
| PBS Discount | Maximum of $1.00 | Maximum of $1.00 |
| Safety Net | $244.80 | $262.80 |
Closing the Gap (General Patients) |
||
| PBS Co-Payment Price | $6.80 | $7.30 |
| PBS Discount | Maximum of $1.00 | Maximum of $1.00 |
| Safety Net (Single Contribution) | $42.50 or less (under co-payment scripts) | $42.50 or less (under co-payment scripts) Normally with CTG, the pricing would take the current general PBS Co-Payment (e.g. $30) but to ensure that CTG Patients aren't "worse off", they retain last year's general co-payment of $42.50 |
Closing the Gap (Concessional Patients) |
||
| PBS Co-Payment Price | $0 | $0 |
| PBS Discount | n/a | n/a |
| Safety Net | $6.80 |
$7.30 |
Frequently Asked Questions
What are the changes to the general patient co-payment?
From 1 January 2023, the co-payment will reduce from $42.50 to $30.00.
For general medications that have a commonwealth price between $30.00 and $45.60, pharmacies will be able to discount these further. Once the pharmacy discounts the items, they will be considered under co-payment.
What is the Commonwealth price?
The Commonwealth price is the full cost of the medication, per PBS pack.
This becomes particularly important for Regulation 24 as a medication might not be within the IDR with 1 pack, but can be within the IDR once it’s a regulation 24.
How will I know if a medication will be in the IDR to be able to discount further? Is there a list?
Unfortunately, PBS do not have a list available.
In Z Dispense, you will be able to see if a medication can be discounted further in the middle panel. Medications within the IDR will come up as Claimable (IDR):
You can also hover over for more information:
What are the changes for Closing the Gap (CTG) General Patients?
Closing the Gap (CTG) general scripts priced at or above $30.00 will continue to count toward the PBS Safety Net at the current general patient co-payment amount of $42.50, rather than at a reduced amount after the co‑payment is lowered to $30.00.
Do these changes affect concessional patients?
No, there are no reduced co-payment changes to concessional patients.
More Information
- Changes to PBS general patient co-payment from 1 January 2023
- Changes to the PBS to make medicines more affordable
- PBS General Co-Payment Reduction Fact Sheet
- PBS Changes Explainer Table
Have Questions?
For more information, call 132 290 or visit the Services Australia website.
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