Lower PBS Safety Net thresholds: what you need to know

Industry
By
AP Staff
-
medicine shortages

The Pharmaceutical Benefits Scheme (PBS) Safety Net thresholds will be reduced from 1 July. Here’s what pharmacists need to know about the mid-year change.

25% fewer prescriptions needed for concession card holders to reach the PBS Safety Net

From 1 July 2022, the PBS Safety Net thresholds will be reduced by $80–85:

      • General patients (non-concessional): $1,457.10 (currently $1,542.10)
      • Concessional patients: $244.80 (currently $326.40).

In practical terms, this is a reduction of 12 prescription items for concession card holders to reach the PBS Safety Net (i.e. a total of 36 full concessional co-payments, down from the current threshold of 48).

More than 600,000 additional patients expected to benefit

More patients will pay less for their PBS medicines under the changes. Last year, 1.8 million Australians qualified for a PBS Safety Net concession (CN) or entitlement (SN) card. This is predicted to jump to 2.4 million Australians this year, according to Services Australia and the Department of Health.

No refunds if you’ve already passed the new threshold!

The new Safety Net thresholds apply to the first prescription dispensed after 1 July 2022.

There are no refunds relating to co-payments made for PBS medicines dispensed prior to 1 July, even if the patient had technically reached the new Safety Net threshold before 1 July.

Patients who qualify for a Safety Net card under the current (‘old’) thresholds will not be eligible to receive a refund for the gap between the new and old thresholds.

What if a patient has already reached the new lower threshold?

You can’t issue a Safety Net card until the first (‘qualifying’) PBS medicine, on or after 1 July 2022, is dispensed.

Patient circumstance Appropriate pharmacist action on or after
1 July 2022
Patient reached the old (higher) threshold on or before 30 June 2022 and has already received a Safety Net card Patient retains eligibility for the PBS Safety Net; dispense any PBS prescriptions with the patient’s CN or SN card

Concessional co-payment (if applicable) amount remains the same ($6.80)

No refunds to the patient relating to co-payments made prior to 1 July 2022
Patient presents evidence (PRF) of having reached the new (lower) threshold prior to 1 July 2022 and requests a Safety Net card but does not require any prescriptions to be dispensed Advise the patient that they will become eligible for a Safety Net card when their first ‘qualifying’ medicine is dispensed on or after 1 July 2022

A Safety Net card based on the new threshold cannot be issued without the dispensing of a qualifying PBS medicine
Patient has not reached the new (lower) threshold when they present (on or after 1 July) a prescription for two PBS medicines but reaches that threshold upon the first item being dispensed The first item is dispensed as a general or concessional item (whichever applies); PBS co-payment amount remains the same

The second item is the first ‘qualifying’ medicine dispensed; a CN or SN card (whichever applies) can be issued and the relevant PBS co-payment ($6.80 if CN card) applies 

Talk to your patients now

It is important to let patients know about the changes now.

Encourage them to bring in any external PRF stickers before 1 July to add to your records. Patients should not miss out unnecessarily, and most will be unaware of the change.

Stock up on Safety Net cards

Ensure you have enough cards in the dispensary draw to issue from 1 July. And don’t forget to issue a card for each eligible family member, as they may need it to access their medicines.

What happens in 2023?

There will be annual indexation of the new, lower PBS thresholds.

When will the PBS co-payments for general scripts be reduced?

The new Labor government has committed to reducing the PBS general co-payment to $30, down from $42.50, from 1 January 2023.