Health insurance for non-PBS pharmaceuticals
Get cover for non-PBS pharmaceuticals with high-level extras insurance.
Key takeaways
- Medications on the PBS are subsidised my Medicare, but you'll have to pay a co-payment.
- Non-PBS medications can be partly covered by a private extras policy.
- Private cover will still attract a co-payment, and there'll be per-item and yearly limits.
What is the PBS?
The Pharmaceutical Benefits Scheme, or PBS, is a list of subsidised medicines offered to Australians. It's super valuable, because some medicine costs an ungodly amount of money. However, the PBS doesn't cover every drugs, so you may want to consider health insurance that covers non-PBS items.
PBS co-payments
PBS drugs aren't fully subsidised, there is a co-pay, an out-of-pocket cost you'll need to pay for each drug. It ranges from a maximum of $7.70 for concession card holders, up to a maximum of $31.60 for everyone else. The Medicare Safety Net will kick if you spent a lot in a single year. That means you'll only ever pay a maximum of $277.20 for concession card holders and $1,647.90 for general patients on PBS drugs each year.
How are medications covered in Australia?
Medications can be covered by either Medicare, Australia's public healthcare system, or private health insurance. The details vary though.
- Public health system: Medicare will cover a lot of the cost of drugs on listed the PBS, with a small out-of-pocket cost. Medicare will not reduce the cost of drugs that aren't on the PBS.
- Private health system. Private cover won't do anything for medicines on the PBS, but can help with the cost of non-PBS pharmaceuticals. The health funds will also require a co-pay amount, normally the same amount as the current Medicare PBS co-payment.
What costs will my health fund cover?
Cover for non-PBS medications is included on some medium or high level extras policies from Australian health funds. However, cover is only included if the non-PBS medication:
- Costs more than the current PBS co-payment amount.
- Is dispensed by a registered pharmacist in a private practice.
- Is prescribed to you by a GP, and is only available by prescription.
- Is listed on the Australian Register of Therapeutic Goods.
The exact level of cover provided depends on the health fund and the policy you choose. Most have a per-item claim limit, eg $50, as well as a yearly limit, eg $300. Those limit change a lot between policies.
More resources on Finder
Ask a question
2 Responses
More guides on Finder
-
Are vaccinations covered by health insurance?
While COVID-19 vaccinations are free in Australia, other vaccines with out-of-pocket costs can be covered by private health insurance with some extras policies.
-
Health insurance for psychology
Ensure your health insurance includes psychological wellbeing services when comparing cover.
-
Health insurance for remedial massage
Remedial massage can help ease pain from general wear and tear as well as specific injuries. This treatment isn’t covered by Medicare but is included in private health insurance extras cover. Find out how private health insurance can cover you for remedial massage therapy.
-
Health insurance for acupuncture
Does insurance cover acupuncture? Find out here.
-
When do health insurance benefits reset?
What do the annual benefit limits on your health insurance extras cover actually mean? Find out here.
-
Health insurance for physiotherapy
Physiotherapy services can be beneficial at any life stage, so it could be worth considering and comparing extras health insurance that can cover the cost of this type of treatment.
-
Health insurance for orthotics
This article explains which private health insurance policies cover orthotics and how you can find the right level of cover for your health needs.
-
Optical health cover
To cover the cost of eye tests, glasses, contact lenses and other optical services, you’ll need to take out extras cover from a private health fund.
-
Health insurance for laser eye surgery
finder.com.au explains how the private and public health system in Australia handles optical procedures and services.
-
Health insurance gym membership
This guide takes a look at private health insurance in relation to gym membership and other health-related services.
Hi, question. Do you have a policy with extras that can help cover non pbs / wegovy prescriptions?
Hi Dani, As the guide notes, you’ll need an extras policy to cover this, and most will have limits on how much they’ll pay per year.