How 60-Day PBS Prescriptions Can Save Australians Up to $189 Annually Per Medicine

Introduction to the New 60-Day Prescription System Under PBS

Australia’s Pharmaceutical Benefits Scheme (PBS) is rolling out a new 60-day prescription system.

This initiative aims to make healthcare more affordable and convenient for patients.

Up until now, most patients have had to renew their prescriptions every month, but with this change, they will be able to get a two-month supply of their medication in one go.

Potential Annual Savings

One of the main benefits of the 60-day PBS prescription system is the cost savings it offers.

General patients stand to save up to $189.60 per medicine annually.

For concession cardholders, the savings are up to $46.20 per year per medication.

These cost savings primarily come from reducing the number of dispensing fees.

Instead of paying a dispensing fee every month, patients will pay just one fee for a 60-day supply.

This can make a big difference over the course of a year, especially for those who need multiple medications.

Reduction in Frequency of Doctor and Pharmacy Visits

Another significant advantage of the new system is that it will reduce the frequency of doctor and pharmacy visits.

Patients will only need to see their doctor for prescription renewals half as often.

This can be particularly beneficial for people with chronic conditions who need ongoing medication.

It’s not just the patients who benefit.

Fewer doctor visits free up millions of GP appointments, allowing more time for other patients who might need immediate care.

The new 60-day PBS prescription system is a step forward in enhancing patient convenience and reducing healthcare costs.

By extending the prescription renewal period, it helps individuals save money and time, offering more efficient healthcare services for all.

Cost Structure and Savings

Single Dispensing Fee for 60-Day Supply

One of the significant advantages of the 60-day PBS prescription system is the reduction in dispensing fees.

Under this new system, patients pay a single dispensing fee for a 60-day supply of their medication.

In contrast, previously, they would incur two separate dispensing fees for two one-month supplies.

This change can lead to substantial savings over time, especially for those on long-term medications.

Maximum Prescription Costs

The maximum cost for a 60-day prescription is different from that of a one-month supply.

While patients save on dispensing fees, the total amount paid for a 60-day prescription can be less than if they were to obtain two separate one-month prescriptions.

This difference in maximum costs is an essential factor that contributes to the overall savings patients can experience.

Factors Affecting Potential Savings

Several factors can influence the extent of savings for patients:

• Medication Costs Below Co-Payment Threshold: If the cost of a medication is below the maximum co-payment amount, the potential savings from the 60-day prescription system may be less. Patients only save on the dispensing fee in such cases [Benefits and cost savings.docx].
• Manufacturer Surcharges: Additional surcharges imposed by manufacturers can affect the total cost of medications. These surcharges are independent of the PBS system, and while they do not count towards the PBS Safety Net threshold, they can still impact the final price paid by the patient.

Despite these factors, the introduction of the 60-day PBS prescription system presents a clear financial benefit for many Australians, allowing for lower overall costs and fewer trips to the doctor and pharmacy. This not only saves money but also time and effort, making it a welcome change for patients across the country.

Brand Premiums and Alternative Options

Understanding and navigating the costs of PBS medicines can be tricky, especially when brand premiums are involved.

A brand premium is an additional charge by the pharmaceutical company for a particular brand of medicine, not covered by the PBS.

This extra cost can vary and is separate from the government’s responsibility. Importantly, it doesn’t reflect the quality of the medication.

Impact on Medication Costs

For those on 60-day prescription plans, brand premiums can still apply.

This means, despite the savings from fewer doctor visits and dispensing fees, you could face additional charges if you choose a premium brand.

This aspect can influence the total savings you might enjoy under the new system.

Premium-Free Alternatives

Here’s the good news: in most cases, your pharmacist can help you select a premium-free alternative.

These alternatives are often just as effective as their branded counterparts.

When a prescriber hasn’t restricted substitutions on your prescription, pharmacists have the ability to recommend and dispense a Therapeutic Goods Administration (TGA) registered, premium-free brand.

It’s a great way to keep your costs low while maintaining the efficacy of your treatment.

Role of Pharmacist Consultation

Having a conversation with your pharmacist can be incredibly beneficial.

They can:

• Advise you on available premium-free alternatives.
• Substitute brands to help you avoid unnecessary premiums.
• Ensure you’re getting the best value for your prescription without compromising on quality.

By leveraging your pharmacist’s expertise, you can make more informed decisions about your medication, ultimately enhancing your savings.

This interaction not only promotes better financial management but also helps you understand more about the choices available in your treatment plan.

Navigating the cost structure of 60-day prescriptions is just part of the puzzle.

Up next, we’ll delve into the robust support provided by the PBS Safety Net and how it further enhances the affordability of healthcare for many Australians.

PBS Safety Net Benefits

Starting January 1st, 2024, there’s an important feature of the Pharmaceutical Benefits Scheme (PBS) that every Australian should know about: the PBS Safety Net.

This safety net is designed to help patients manage and potentially reduce their annual medication expenses once they hit a certain spending threshold.

Safety Net Thresholds for 2024

The PBS Safety Net thresholds for 2024 are set at $1,647.90 for general patients and $277.20 for concession cardholders.

Hitting these thresholds means substantial financial relief on your medications:

• General Patients: Once you spend more than $1,647.90 on PBS medicines within the year, you’ll reach the Safety Net threshold. From this point on, these patients will pay a reduced rate for their PBS prescriptions for the rest of the year.
• Concession Cardholders: With a lower threshold of $277.20, once concessional patients reach this limit, they get the rest of their PBS prescriptions for free, although brand premiums and special patient contributions still apply.

Potential Delays in Reaching the Threshold

One of the significant advantages of the new 60-day prescription system is that it may allow you to save so much on your medicines that you won’t need to reach the Safety Net threshold quickly or even at all.

Here’s how:

• Cost Savings: By reducing the frequency of doctor and pharmacy visits and decreasing dispensing fees, patients can distribute their medicine costs more evenly over the year.
• Delayed Threshold Hits: For many, these savings mean they’ll hit the Safety Net threshold later in the year, if at all, which translates to money saved over a more extended period.

Continued Coverage and Benefits

After crossing the Safety Net threshold, the benefits ensure continued affordability:

• For General Patients: Paying the concessional rate for any remaining PBS prescriptions reduces the financial burden for the rest of the year.
• For Concession Cardholders: Receiving free PBS prescriptions after reaching the threshold provides immediate financial relief.

Savings with the 60-day prescription system prolong the time it takes to reach the Safety Net, meaning patients can enjoy reduced costs throughout the year before hitting these thresholds and reaping even more benefits.

The PBS Safety Net is just one piece of a broader system designed to maximize your savings and ensure affordable access to essential medications.

Special Considerations for Different Patient Groups

Specific Benefits for Concession Cardholders

Concession cardholders can experience significant cost savings under the new 60-day PBS prescription system.

Starting in 2024, if their annual spending on PBS medicines exceeds $277.20, they reach the Safety Net threshold.

This allows them to receive PBS medications for free for the remainder of the year, helping manage medical expenses better.

However, it’s important to note that brand premiums and special patient contributions will still apply even after reaching the threshold.

This feature ensures that cost-of-living relief happens sooner, without waiting for the threshold to be met.

Medicare Cardholders Without Concession Cards

Medicare cardholders who do not possess a concession card also benefit from the PBS Safety Net thresholds.

When their annual PBS medicine expenses surpass $1,647.90 in 2024, they become eligible for concessional rates on the remaining PBS prescriptions for that year.

The single dispensing fee for a 60-day supply effectively reduces the number of prescriptions required annually, enhancing affordability and making prescription renewals less frequent.

Ongoing Applicability of Brand Premiums and Special Patient Contributions

Even with these substantial savings opportunities, certain costs stick around.

Brand premiums, which are additional payments set by medicine suppliers and not included in the Safety Net, can still affect patients.

These premiums must be charged by pharmacists unless a generic, premium-free alternative is available and not restricted by the prescriber.

Special patient contributions, often due to certain medications, also remain applicable and need to be factored into overall medication costs.

This nuanced system bolsters the economic health of various patient groups, ensuring that while immediate savings are achieved, essential out-of-pocket expenses are managed efficiently.