What does the Pharmaceutical Benefits Scheme (PBS) cover?

The Pharmaceutical Benefits Scheme (PBS) covers medicines for most medical conditions.

If you have a medical condition and need medicine, the PBS will subsidise the cost of that medicine.

The PBS does not cover the cost of over-the-counter medicines.

The decision on which medicines to include in the PBS is based on the principle that the Australian Government will subsidise medicines that are necessary and cost effective to maintain the health of the community.

The decision to list medicines on the PBS depends on:

• a thorough independent evaluation of evidence for clinical and cost effectiveness
• specifying maximum quantities and number of repeat prescriptions
• restricting medicines to specific therapeutic uses
• reviewing which medicines are listed on the PBS and their prices
• negotiating pharmacist fees and allowances
• monitoring medicine use.

A medicine can be recommended for listing on the PBS if:

• the community needs or will benefit from this drug

• it treats or prevents a significant medical condition that is not covered, or only partially covered by currently listed drug(s)
• it is more effective and/or less harmful than a currently listed drug
• it is as effective and safe as an existing listed drug.