Pharmaceutical Benefits Scheme (PBS) in New South Wales
Reviewed by the Commoner Law Editorial Team. Sourced from Commonwealth Acts of Parliament, federal regulations, and official government guidance. State-level information reflects each state's own Acts and court decisions. Written in plain language for general understanding — this is educational content, not legal advice. Our editorial standards
What is this right?
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of most prescription medicines in Australia. It is established under Part VII of the National Health Act 1953 and administered by Services Australia.
Under the PBS, you pay a maximum co-payment for each prescription:
- General patients: up to $31.60 per prescription
- Concession card holders: up to $7.70 per prescription
If your total PBS spending in a calendar year exceeds the PBS Safety Net threshold, your costs drop further:
- General patients: once you spend $1,637.20, the co-payment drops to the concession rate for the rest of the year
- Concession card holders: once you fill 48 prescriptions (or spend $369.60), PBS medicines become free for the rest of the year
Not every medicine is on the PBS. A medicine must be assessed by the Pharmaceutical Benefits Advisory Committee (PBAC) and listed on the PBS Schedule before it can be subsidised.
When does it apply?
- You hold a valid Medicare card.
- Your doctor prescribes a medicine that is listed on the PBS Schedule.
- If you hold a Pensioner Concession Card, Health Care Card, or Commonwealth Seniors Health Card, you pay the lower concession co-payment.
What to Do If Your Prescription Medicine Is Too Expensive Under the PBS in Australia
- Present your Medicare card and any concession card at the pharmacy when filling a PBS prescription.
- Ask your pharmacist if a cheaper brand (generic) of your medicine is available on the PBS — the active ingredient is the same.
- Keep records of every PBS prescription you fill to track your progress toward the Safety Net threshold.
- Register your family as a Safety Net family through Services Australia so all family members' prescriptions count toward the same threshold.
- Request a Safety Net card once you reach the threshold — your pharmacist can help you apply.
What should you NOT do?
- Don't assume every medicine is subsidised — only medicines listed on the PBS Schedule are covered.
- Don't forget your concession card at the pharmacy — without it, you will be charged the general co-payment.
- Don't stockpile medicines — PBS rules generally limit you to one month's supply per prescription.
- Don't throw away receipts — you need them to prove your spending if applying for the Safety Net.
How New South Wales differs from federal law
The Pharmaceutical Benefits Scheme (PBS) is a federal program, but NSW pharmacies dispense PBS-listed medicines and NSW Health operates hospital pharmacy services that provide additional subsidised access.
- NSW has the largest number of community pharmacies in Australia (over 2,500). Most are approved PBS suppliers and can dispense subsidised medicines.
- NSW public hospitals provide discharge medicines to patients at PBS-equivalent prices or free of charge under the NSW Health pharmaceutical supply framework.
- The NSW Needle and Syringe Program and Opioid Treatment Program provide additional pharmaceutical services through community pharmacies and NSW Health clinics for people with drug dependencies.
- Rural and remote NSW communities access PBS medicines through the Section 100 Remote Area Aboriginal Health Services supply arrangements and through Rural and Remote Pharmacy initiatives.
Additional Steps in New South Wales
Present your Medicare card and any concession cards at the pharmacy to access PBS pricing. Check the PBS online (pbs.gov.au) for listed medicines. For complaints about pharmacy services in NSW, contact the Pharmacy Council of NSW or the HCCC.
Relevant Law: National Health Act 1953 (Cth), Part VII; Pharmacy Practice Act 2006 (NSW); Poisons and Therapeutic Goods Act 1966 (NSW)
Common Questions
When does pharmaceutical benefits scheme (pbs) apply?
You hold a valid Medicare card.Your doctor prescribes a medicine that is listed on the PBS Schedule.If you hold a Pensioner Concession Card, Health Care Card, or Commonwealth Seniors Health Card, you pay the lower concession co-payment.
What should I do if my prescription costs more than expected or is not covered by the PBS in Australia?
Present your Medicare card and any concession card at the pharmacy when filling a PBS prescription.Ask your pharmacist if a cheaper brand (generic) of your medicine is available on the PBS — the active ingredient is the same.Keep records of every PBS prescription you fill to track your progress toward the Safety Net threshold.Register your family as a Safety Net family through Services Australia so all family members' prescriptions count toward the same threshold.Request a Safety Net card once you reach the threshold — your pharmacist can help you apply.
What mistakes should I avoid with pharmaceutical benefits scheme (pbs)?
Don't assume every medicine is subsidised — only medicines listed on the PBS Schedule are covered.Don't forget your concession card at the pharmacy — without it, you will be charged the general co-payment.Don't stockpile medicines — PBS rules generally limit you to one month's supply per prescription.Don't throw away receipts — you need them to prove your spending if applying for the Safety Net.
Pharmaceutical Benefits Scheme (PBS) in other states
Same topic, different jurisdiction. Pick the one that applies to you.