PBS Safety Net Changes 2025

The Australian Government has updated its PBS co-payment rules starting on January 1, 2025, with changes affecting threshold prescriptions that meet the PBS Safety Net threshold.

A threshold prescription is a prescription that either exactly meets or exceeds the PBS Safety Net threshold amount and will take the safety net reduced price.

Prior to this change, patients paid a reduced co-payment amount for any subsequent prescriptions after the threshold prescription that exactly met the PBS Safety Net threshold amount.

This means:

For a concessional patient, who has already had 35 prescriptions at $7.70 each, with the 36th prescription bringing the total to the threshold amount ($277.20), will now receive that prescription for free ($0.00).
For a general patient, they will be less likely impacted by the change as the Safety Net threshold amount ($1,694.00 in 2025) is not equivalent to a set number of prescriptions.

Prescription Record Forms (PRFs) should show the threshold script has been issued, and the actual amount of co-payment that the patient has made, which could be $0 or $7.70 depending on if they are concessional or entitlement patients.

Scenarios

Scenario

Recorded PRF Value

Script Dispensed

Outcome

Concession Patient

No PBS Copayment Discounts i.e. all scripts at $7.70

35 Scripts Dispensed x $7.70

Total: $269.50

1 Script Dispensed x $7.70

Total: $7.70

As the script dispensed meets the safety net of $277.20:

The patient is charged $0.00 for that script
The script is recorded on the PRF with a patient contribution of $0.00
Services Australia will accept the total value of $269.50 on the PRF as long as the 36th script is recorded

Concession Patient

PBS Copayment Discounts i.e. all scripts at $6.90

40 Scripts Dispensed x $6.90

Total: $276

1 Script Dispensed x $6.90

Total: $6.90

As the script dispensed exceeds the safety net of $277.20 (Total = $282.90)

The patient is charged $0.00 for that script
The script is recorded on the PRF with a patient contribution of $0.00
Services Australia will accept the total value of $276 on the PRF as long as the 36th script is recorded

Concession Patient

No PBS Copayment Discounts i.e. all scripts at $7.70

30 Scripts Dispensed x $7.70

Total: $231

Regulation 24/Section 49 Script Dispensed = $7.70 x 6

Total: $46.20

As the script dispensed meets the safety net of $277.20:

The patient is charged $0.00 for the entire Regulation 24/Section 49 script
The script is recorded on the PRF with a patient contribution of $0.00
Services Australia will accept the total value of $269.50 on the PRF as long as the 36th script is recorded

General Patient

Note: General Patients are less likely to be affected as their threshold is not tied to a specific number of prescriptions.

However we will highlight the change anyways

53 Scripts Dispensed x $31.60

Total: $1,674.80

1 Script Dispensed x $31.60

Total: $31.60

As the script dispensed meets the safety net of $1,694.00:

The patient is charged $7.70 for that script
The script is recorded on the PRF with a patient contribution of $7.70
Services Australia will accept the total value of $1,674.80 with the script that takes the patient at or over the threshold is recorded

Hi, how can we help?

Scenarios

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