PBS Safety Net for pharmacists

Information to assist pharmacists to manage their customers access to the Pharmaceutical Benefits Scheme (PBS).

The Australian Government subsidises the cost of a wide range of prescription medicines through the PBS. All Australian residents and eligible overseas visitors can access affordable medicines through the PBS.

The PBS safety net reduces the cost of prescription medicines for individuals and families once the PBS safety net threshold has been reached.

About

PBS safety net eligibility

Anyone eligible for the PBS is eligible for the PBS safety net. Your customers can also combine amounts for their family.

A PBS safety net family

A PBS safety net family is:

  • a couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children, or
  • a single person with dependent children

A dependant is someone under 16 years or a full-time student under 25 years attending school, college or university, who is wholly or substantially supported financially.

Examples of groups not considered a family for PBS safety net purposes are:

  • full-time students 25 years and over and their parent(s)
  • separated couples (unless living separately due to illness or infirmity)
  • 2 or more adult siblings, or
  • an adult and their parent(s)

If a family member dies, medicines supplied during the year for that person and recorded on the family prescription record form can still count towards the family PBS safety net threshold.

Regulation 24

If you supply a regulation 24 prescription that puts a customer over the safety net threshold, let them know they can:

  • pay the usual cost for all supplies and ask for a refund from Medicare, or
  • have less repeats supplied, making the remaining repeats void

They will need to return to a prescriber for their next prescription.

PBS safety net thresholds

The thresholds are updated each year on 1 January. 

Rates for 2015General patientsConcession card holders
Patient contributionUp to $37.70$6.10
Safety net threshold$1,453.90$366.00
Safety net patient contribution$6.10Free

If your customer chooses a more expensive brand of medicine, they may need to pay more. The extra amount they pay will not count towards their PBS safety net threshold.

The relevant PBS safety net threshold amount for the customer needs to be recorded on their prescription record form on the top right corner on the reverse page of the PRF prescription record form.

Charging medicine at the PBS safety net rate

The first medicine that puts your customer over the PBS safety net threshold is the one that you need to charge at the reduced PBS safety net rate.

For example:
A customer who is a general patient, not a concession patient, gives you a prescription to fill. Their prescription record form is $10 under the general threshold amount. If the cost of the medicine you supply puts them over the threshold amount, you should issue them with a PBS safety net concession card and charge them the PBS safety net rate.

There are 2 situations where crossover arrangements apply.

Situation 1 - child on a Department of Human Services concession card

There are some families where a dependent child holds a concession card. This card carries a concession entitlement to the PBS for that child. The child only needs to pay the concession amount for their PBS medicine, while other family members pay the general rate. In relation to the PBS safety net, the family can:

  • count their child's expenses towards an individual PBS safety net entitlement card for the child, or
  • count their child's expenses towards a PBS safety net concession card for the family

The family's expenses will not count towards a PBS safety net entitlement card for that child because they aren't the child's dependants.

Situation 2 - a general patient gets a Human Services concession card part-way through the calendar year

If your customer's status changes from general to concession, all their PBS medicines need to be changed from the general rate to the concession rate on their prescription record form, or on their record on your computer.

When they reach the PBS safety net threshold for concession cardholders, you can issue them a PBS safety net entitlement card so they can get free PBS medicine for the rest of the calendar year. They may have to pay if they choose a more expensive brand of medicine.

If your customer has already reached the general PBS safety net threshold during the calendar year, and a PBS safety net concession card has been issued, you need to send their prescription record form to us. If your pharmacy dispensing software shows the number of previous supplies, you can transfer this number to the new prescription record form and endorse it with your signature. If you can't find out the number of previous supplies, contact us.

Claiming

PBS safety net claims

You can claim a payment for issuing PBS safety net cards by completing and submitting the PBS safety net claim for payment form. This needs to be sent to us within 1 month of a PBS safety net card being issued to a customer.

When submitting your claims, make sure:

  • the correct values are recorded and the total is calculated
  • the prescription record forms have been filled in correctly and are signed by your customer or their agent
  • the claim form has been completed and does not have more than 12 applications per form
  • all prescription record forms are attached in the order they appear on the claim form
  • you have signed the prescription record forms, both computer generated and non-computer generated, this is a legal requirement, and
  • the prescription record form and PBS safety net applications list all family members

PBS safety net claims that are not completed correctly will be rejected and will need to be re-submitted.

We keep a record of PBS safety net and concession cards issued to your pharmacy. To make sure you receive the correct payment for the cards issued to your pharmacy, let us know if:

  • the cards issued to you came from another pharmacy, or
  • your pharmacy is sold and a new approval number is issued

The safety net reply paid envelopes are for PBS safety net claims only.

Customer refunds under the PBS safety net

Circumstances where we might provide a refund to your customer.

Read more about customer refunds

Resources

PBS safety net cards

Issuing PBS safety net cards

You need to give your customer a PBS safety net card when they reach the PBS safety net threshold. There are 2 types, depending on the customer's circumstances.

PBS safety net concession card

You need to issue a PBS safety net concession card when general patients have reached the PBS safety net threshold. With this card, their PBS medicines will be less expensive for the rest of the calendar year.

PBS safety net entitlement card

You need to issue a PBS safety net entitlement card when a concession card holder has reached the PBS safety net threshold. With this card, their PBS medicines will be free for the rest of the calendar year. They may have to pay if they choose a more expensive brand of medicine.

Supplementary or replacement cards

You can issue a supplementary PBS safety net card to a customer’s spouse or de facto partner or dependent child at the same time an original card is issued. If your customer wants a supplementary card at any other time, they need to contact us.

Your customers can request a replacement PBS safety net card if their card is lost or stolen.

To receive a new card, your customer will need to complete and submit the Pharmaceutical Benefits Scheme Safety Net amendment, replacement or supplementary card application form (PB018).

They can also write to us. They need to give us their PBS safety net card number and list all family members that are on the card.

Safety net products

We have developed a range of PBS safety net products to help you administer the PBS safety net. A PBS safety net kit is distributed to all pharmacies at the end of each year.

ProductProduct numberProduct description or useHow to order
PBS safety net entitlement cardPB013 (formerly 4011)This card is given to relevant customers when they reach the PBS safety net threshold
The cards are numbered. You need to account for all cards issued to your pharmacy
Call 132 290
PBS safety net concession cardPB014 (formerly 4012)This card is given to relevant customers when they reach the PBS safety net threshold
The cards are numbered. You need to account for all cards issued to your pharmacy
Call 132 290
PBS prescription record form (PRF)PB015 (formerly 4013)This form is given to customers to keep a record of their PBS medicinesLog in to camerons.net/pbs to complete and submit the stationery order form
PBS hospital prescription record form (PRF)PB016 (formerly 4014)This form is given to customers to keep a record of their PBS medicines supplied through a public hospital outpatient departmentLog in to camerons.net/pbs to complete and submit the stationery order form
PBS safety net claim for payment formPB017 (formerly 4015)Use this form to claim a payment for issuing a PBS safety net cardLog in to camerons.net/pbs to complete and submit the stationery order form
PBS safety net envelopesEN348 (formerly 4017)This envelope should be used to submit your claim for payment for the PBS safety net
Only use this envelope for PBS safety net claims. Do not send prescription claims in this envelope
Call 132 290

Contact details

For more information or to submit a claim for refund contact us.

This information was printed from humanservices.gov.au It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.