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Expenditure and Prescriptions twelve months to 30 June 2017

Page last updated: 20 December 2017

PBS Expenditure and Prescription Report 2016-17

Summary of Pharmaceutical Benefits Scheme 2016-2017

Total Pharmaceutical Benefits Scheme (PBS) government expenditure (both Section 85 and Section 100) on an accrual accounting basis for the 2016-2017 financial year was $12,058 million (excluding revenue), compared with $10,838 million for the previous year. This is an increase of 11.3%.

The majority of the Expenditure and Prescriptions Report refers to PBS Section 85 data reported by date of supply.

The 2016-17 total volume of PBS Section 85 prescriptions decreased by 4.0% to a total of 195.8 million, compared to 203.9 million for the 2015-16 financial year.

The 2016-17 PBS Section 85 Government expenditure amounted to $8,729.2 million (excluding rebates) which was 86.7% of the total cost of PBS prescriptions. The remainder was patient contributions that amounted to $1,338.6 million.

The majority of government expenditure in 2016-17 on PBS Section 85 prescriptions was directed towards concessional cardholders ($6,520.3 million, 74.7% of the total), compared to concessional cardholders expenditure for 2015-16 ($6,081.7 million, 75.6% of the total).

The average dispensed price (Patient contribution plus Government cost) per prescription of PBS Section 85 subsidised medicines increased to $51.45 in 2016-17, compared to $46.15 in 2015-16. The average government cost of these scripts was $44.58 for 2016-17, compared to $39.45 for 2015-16.

Note: The 2016-17 publication is based on the date that the prescription medicine was supplied to the patient.  Previous publications were based on the date that the claim was processed (and the payment finalised) by Services Australia. The historical data from 1991-92 to 2015-16 on pages 30 to 34 remains by date of processing.

Important Information

Please direct enquiries about this publication or requests for complimentary copies via:

Surface mail:  Director
PBS Information Management Section
Pricing and Policy Branch, MDP 900
Department of Health
GPO Box 9848 Canberra ACT 2601

E-mail: pbsstats@health.gov.au

Production:  Rasalinkam Seeniyar, Catherine Wilkinson

Acknowledgments:

Thanks to the following staff for their help in the access and provision of data and information used in this report: Sonja Davis, David Nott , Jane Ranson-Smith, Alison Mo, Chris Parker, Christopher Lee.

Unless otherwise indicated this publication has been produced using data provided to the Department of Health by Services Australia. The figures reported in this publication relate to the value (benefit) or volume of PBS prescriptions that have been processed by Services Australia. They refer only to paid services processed for prescription submitted and claimed via the PBS Online claiming system by the approved suppliers. They do not include any manually paid claims.

PBS Expenditure includes the following patient categories:

  • General - Non-Safety Net (Ordinary)
  • General - Safety Net
  • Concessional - Non-Safety Net (Ordinary)
  • Concessional - Safety Net
  • Doctor's Bag

The patient category refers to the patient's eligibility status at the time of supply of the benefit. General patients hold a Medicare card, Concessional patients hold a Medicare card and one of the following cards from Centrelink:

  • Pension Concession Card
  • Commonwealth Seniors Health Card
  • Health Care Card

There are two safety net thresholds – one for General patients and the other for Concessional patients.

From 1 January 2017, the general patient safety net threshold was $1,494.90. When patients and/or their families reached this amount, they could apply for a Safety Net Card and pay only $6.30 per prescription for the rest of the calendar year. The concessional safety net threshold was $378.00. Once patients and/or their families reached this amount, they could apply for a Safety Net Entitlement Card and receive items free of charge for the rest of the calendar year.

The Patient Contribution, Total Cost and Average Price amounts do not include brand or therapeutic premiums.

Caution should be exercised in referring to the breakdown by patient category in Table 23(a) on page 30 and Table 23(b) on page 32, because of a past problem in data supplied by Services Australia whereby a number of General Safety Net scripts were wrongly allocated to Concessional Non-Safety Net. This problem has been fixed for 2008-09, but the 2006-07 and 2007-08 allocations of scripts and expenditure by patient category were inaccurate and not strictly comparable to the corresponding 2008-09 and later years’ numbers.

The Department of Health has taken every care to ensure the data supplied is accurate but does not warrant that the data is error free and does not accept any liability for errors or omissions in the data.

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