What medicines can I claim on health insurance? 

If you’ve visited a pharmacy lately you’ll know that medicines can be expensive, even when they’re subsidised by the government. The good news is that if you’re prescribed medication that isn’t subsidised by the government, you might be able claim back some of those costs on private health insurance, depending on your cover. Here’s what you need to know. 

Claiming medications on health insurance

For claiming medications on health insurance you’ll need to have Extras Cover that includes Non-PBS Pharmaceuticals. Usually this is only offered on mid to top level Extras Cover policies. 

To claim the cost of medications, you’ll need to pay a co-payment. There are limits per claim and per year, and your medication must cost more than the co-payment amount (which most insurers adjust regularly).  

So if your policy covers Non-PBS Pharmaceuticals, what can you claim? Firstly, they need to be not covered by the Pharmaceuticals Benefits Scheme (PBS), the Australian government program that subsidises certain common medicines. You can find out what medicines are covered by the PBS here. They also need to be medicines that are: 

• approved by the Therapeutic Goods Administration (TGA), which regulates medications 

• prescribed by a registered healthcare professional (i.e. they can’t be over-the-counter medications) 

• supplied by a registered pharmacist 

• not experimental medicines 

• not prescribed during a hospital stay (you may be able to claim this on your Hospital Cover instead; check with your insurer). 

What is the PBS?

Can I claim contraception on health insurance? 

Many insurers exclude contraception but some will allow you to claim oral contraceptives on your Extras Cover if it’s prescribed for something other than contraception, such as a skin or hormonal condition.  

Can I claim weight loss drugs on health insurance? 

Weight loss drugs such as Ozempic, Wegovy and Saxenda are listed on the PBS for diabetes, which means they can’t be claimed on your health insurance if they’re prescribed for diabetes. However if you’re prescribed these drugs for weight loss, you’ll be able to claim them on your Extras Cover – provided your policy covers them. Make sure you check the limits as some insurers have lowered their claim limits for weight loss drugs in recent years.  

Does health insurance cover weight loss surgery?

Can I claim mental health medication on health insurance? 

If your mental health medication is listed on the PBS, you will not be able to claim it on your policy. If, however, you’ve been prescribed medication for a mental health condition and it’s not listed on the PBS, you may be able to claim it on your Extras Cover – unless your insurer specifically excludes it. It’s best to contact your insurer and find out.   

Can I claim HRT on health insurance? 

Since early 2025, some types of HRT (now called menopausal hormone therapy, or MHT) have been listed on the PBS, which means they’re no longer eligible for Extras Cover claims. These include Estrogel, Promentrium and Estrogel Pro. If you’ve been prescribed a different type of hormone-replacement medication, check with your insurer whether it’s covered.    

Can I claim travel medications on health insurance? 

Yes, if you have Extras Cover most insurers allow you to claim for travel medications and vaccinations, such as malaria medication and typhoid vaccines.  

How do I claim for medications on my Extras Cover policy? 

You’ll need a receipt from your pharmacy that clearly shows certain information, including the name of the medication and quantity, the pharmacy name and contact number, and your  name and address. Check with your insurer about their exact requirements for pharmaceutical claims. Some insurers have an app that allows you to scan your receipt for payment or you can claim online, at your insurer’s branch or by post – find your insurer’s contact details here.  

How do I find health insurance that covers medications? 

If your Extras Cover doesn’t include Non-PBS Medications, or it doesn’t provide the level of cover you want, we recommend you look for a better deal with the healthslips.com.au Calculator. Our Calculator searches every policy available in Australia, without commercial bias, so you can make an informed choice. It’s free to use, and provides open access – meaning you don’t need to enter any contact details to get the information you need. Try the Calculator to find a new policy, or compare your existing Extras Cover with other policies to find the best deal for you and your family.  

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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