Pharmaceutical Benefit Scheme

The Pharmaceutical Benefits Scheme (PBS) is run by the Australian Government to subsidise prescription medicines for Australians who have a Medicare card. If a medicine is subsidised under the PBS, you pay a lower price for the medicine, and the Government pays the rest. For more information, see pbs.gov.au.

If your cover includes pharmaceutical, you are able to claim the amount above the PBS patient co-payment (for the general population) up to the benefit amount.

Benefit excludes medicines or medications which are

prescriptions less than PBS co-payment
available without a medical practitioner’s prescription
not approved by the Therapeutic Goods Administration
prescribed for contraceptive purposes.

Government initiatives

Australian Government rebate on private health insurance Medicare Levy Surcharge Australian Government private health insurance reforms Lifetime Health Cover Loading (LHC) Lifetime mental health waiting period waiver Pharmaceutical Benefit Scheme Medicare Safety Net Medicare Benefits Schedule Age-based discount

Using your extras

Find a provider What's covered? What's not covered? Waiting periods Out-of-pocket expenses Dental treatments Telehealth services Health management benefit Dental preferred providers

Going into hospital

What's covered? What's not covered? Waiting periods Hospital treatment costs Paying for hospital costs Access Gap and out-of-pocket expenses Find a hospital Pre-existing ailments Pregnancy and birth After-hospital care

Member resources

Mates Rates CSIRO Total Wellbeing Diet Make a claim Change membership details Rate change facts Where do your premiums go? Suspend your membership Authority to access membership Pet insurance Pregnancy to Parenthood Premium payment options Pregnancy to Parenthood Tell a mate Health support programs Aged care transition & advisory services Care Coordination Program Forms Product guides Mobile app