Protecting patients needing many medicines
Higher safety net thresholds will keep the Pharmaceutical Benefits Scheme sustainable, enabling the Government to continue to protect patients who require numerous PBS medicines
The PBS Safety Net
The PBS Safety Net protects patients who require a lot of medicines by reducing PBS co-payments for the patient and their family once certain safety net thresholds have been reached each calendar year.
After thresholds are reached, general patients and their families receive medicines at the concessional rate ($6.90* in 2015 rather than $42.70*), and concessional patients receive free medicines (rather than $6.90*).
Patients must keep a record of their own and their family's PBS costs on a form available from pharmacies.
Current arrangements
Under current arrangements the PBS Safety Net threshold for general patients will be $1,452.50* in 2015.
Once this is reached patients pay the concessional co-payment of $6.10* for the rest of the calendar year.
The concessional safety net threshold would be 60 PBS prescriptions in 2015 ($366*). Once this is reached patients receive free PBS medicines for the rest of the calendar year.
Thresholds are adjusted every January in line with inflation. Estimates provided are based on current forecasts and may change with inflation.
Increasing safety net thresholds
The Government is increasing the PBS Safety Net thresholds for all patients to keep the PBS sustainable, and to enable the Government to continue to protect those patients that are most in need.
From 1 January 2015 the general safety net threshold will rise to $1,597.80* per calendar year. The general safety net will continue to increase by 10 per cent above inflation for a further three years.
The concessional safety net will increase to 62 prescriptions in 2015 ($427.80 at $6.90 per prescription*). It will then increase by two prescriptions each year for a further three years — from 62 in 2015 to 68 in 2018.
Savings from increasing PBS safety net thresholds will be invested in the Medical Research Future Fund.
Impact on patients
In 2015 a general patient will pay $145.30 more to reach the safety net, after which they can purchase PBS medicines at the concessional rate.
In 2015 a concessional patient will pay $61.80 more to reach the safety net, after which they can receive free PBS medicines.
How will the changes impact patients?
Joyce is an age pensioner. She purchases 80 medicines a year which are listed on the PBS.
In 2015, under current arrangements, Joyce pays $366 in PBS co-payments. She pays $6.10 for 60 PBS medicines, before reaching the safety net, and then receives the last 20 PBS medicines for free.
From 1 January 2015 Joyce will pay $427.80 in PBS co-payments. She will pay $6.90 for 62 PBS medicines, before reaching the safety net, and then receive the last 18 PBS medicines for free. Joyce will pay $61.80 more in 2015 for her medicines.
The Government will pay over $2,500, based on a common mix of medicines for her demographic using this quantity of medicines.
* Co-payments and safety net thresholds are projected from 1 January 2015 based on estimates of indexation by the Consumer Price Index.