Non-PBS Pharmaceuticals

What are PBS Pharmaceuticals?

The Pharmaceutical Benefits Scheme (PBS) is an Australian Government program that subsidises the cost of medicines so all Australians have prompt, reliable and affordable access to medicines.

The PBS covers many common drugs.

You pay no more than $31.60 (or $7.70 concession rate) for medicines listed on the PBS.

What are Non-PBS Pharmaceuticals?

The PBS does not cover a number of drugs, including some:

• asthma medications
• antibiotics
• contraceptive pills.

If a drug is not covered under the PBS, you have to pay the full cost of these medications. Without a PBS subsidy, Non-PBS Pharmaceuticals can be expensive. 

Does private health insurance cover PBS Pharmaceuticals?

No. The Australian Government does not allow private health insurers to cover the cost of medicines you can receive through the PBS. 

Does private health insurance cover Non-PBS Pharmaceuticals?

If your private health insurance covers Non-PBS Pharmaceuticals, it falls under Extras Cover.

Ask your insurer:

• whether you are covered for Non-PBS Pharmaceuticals
• what medicines are covered under your policy (insurers can choose not to pay for certain items such as experimental drugs)
• how your Non-PBS cover works.

In most cases, you have to make a co-payment and your insurer pays a percentage of the remaining cost. 

If your insurer offers cover for Non-PBS Pharmaceuticals, check whether it is subject to:

• a waiting period before you can make a claim
• per claim limits
• annual limits.

Does Medicare cover Non-PBS Pharmaceuticals?

No. Medicare does not cover the cost of Non-PBS Pharmaceuticals. 

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