PBS/RPBS Under Co-payment Prescriptions Data 2023-24

Page last updated: 19 December 2024

PBS / RPBS Under Co-payment Prescription Data 2023–24 (XLSX 103 KB)

Executive Summary

From 1 January 2024 the Pharmaceutical Benefits Scheme (PBS) general and concessional patient co-payment amounts are $31.60 and $7.70 per prescription respectively. These amounts represent the contributions that patients make toward their medicines.

The government contributes the remaining cost for medicines that exceed the co-payment.

Each year millions of prescriptions are dispensed with patient co-payments that are below the co-contribution amounts. Patients cover the entire cost of these medicines.

Under co-payment prescription data enhances the Department of Health and Age Care’s PBS data set and provides insights about under co-payment medicines.

Key insights for 2023-24 include:

Over 106 million under co-payment prescriptions were supplied under the PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS). Around 8,600 for the RPBS.
The number of under co-payment prescriptions increased by 0.4 per cent compared to 2022-23 (105.6 million prescriptions). This was primarily attributed to a 2.1 per cent (0.5 million) increase in Nervous System related prescriptions and a 2.9 per cent (0.4 million) increase in Anti-infectives For Systemic Use prescriptions^[1].
Most under co-payment prescriptions were claimed by the 40 to 59-year and 60+ year age groups with 40.8 million and 39.5 million prescriptions claimed respectively.
New South Wales, Victoria, Queensland and Western Australia had most under co–‍payment prescriptions with 32 million, 28 million, 21 million, and 11 million respectively.
Total under co-payment PBS patient contributions were $1.59 billion.
Total under co-payment RPBS patient contributions were $63,000.
Aggregate patient contributions in New South Wales, Victoria, Queensland and Western Australia were around $495 million, $385 million, $320 million, and $205 million respectively.
The average national under co-payment amount was $15.00 per prescription.

Recent measures that relate to PBS co-payment amounts include:

The 2022-23 Plan for Cheaper Medicines budget measure reduced the PBS general co-payment amount from $42.50 to $30.00 from 1 January 2023. This measure significantly reduced the number of under co-payment medicines reported in under co-payment data and saved general patients over $243 million in 2023-24. Savings related to this measure are ongoing. It is estimated that indexation of the general patient co-payment amount will take around 12 years (from 2026 to 2037) of indexation to return the co-payment amount to $42.50.
The 2024-25 Securing Cheaper Medicines budget measure introduced a 1-year freeze on indexation for PBS co-payments for general patients, and a five-year freeze on indexation for PBS co-payments for concessional patients from 1 January 2025. General patient co-payment indexation will resume from 1 January 2026 and concessional patient co-payment indexation will resume from 1 January 2030. Freezing co-payment indexation also reduces the number of under co-payment medicines dispensed on the PBS over time. The budget measure description notes that these changes along with the reduction of the $1 optional discount available on patient co-payments for subsidised prescriptions was estimated to require funding of $318 million over five years from 2023-24, most of this amount represents savings to patients.

^[1] Nervous system use includes anesthetics, analgesics, antiepileptics, anti-parkinson drugs, psycholeptics, psychoanaleptics, and other nervous system drugs. Anti-infectives for systemic use include antibacterials, antimycotics, antimycobacterials, antivirals, immune sera and immunoglobulins, and vaccines.

Background

The collection of under co-payment prescription data for the PBS and RPBS commenced on 1 April 2012. The data continues to be successfully collected from both community pharmacies and public and private hospitals.

The data is of a high quality, and it is now being made available to the public on the Department of Health and Aged Care website and in regular PBS publications and reports.

The collection of under co-payment prescription information provides enhanced coverage of medicines that are approved and dispensed under the PBS/RPBS.

The data is a valuable tool for health policy planning, monitoring risk management protocols, pharmacovigilance and monitoring the quality use of medicines in the community. For example, the data has improved the accuracy of information available to the Pharmaceutical Benefits Advisory Committee and others to support evidence-based decision making and policy formulation.

Legislation

The National Health Act 1953 provides for the collection of under co-payment prescription data. Legislative amendments to allow this change were enacted on 23 November 2010 via, the National Health Amendment (Pharmaceutical Benefits Scheme) Act 2010.

Data collection

Data is collected by Services Australia and includes the following fields:

patient name*;
patient Medicare Number*;
information about the prescription (including the date of prescribing and supply, the PBS or RPBS code number, the listed brand, the quantity dispensed and the number of repeats);
PBS prescriber number;
approved supplier number;
price charged by the approved supplier; and
pricing information, has been collected from 1 January 2016.

* For privacy reasons patient name and Medicare number are not provided in the data supplied to Health by Services Australia.

Under co-payment data is being collected and disclosed in accordance with the Privacy Act 1988 and the secrecy provisions of the National Health Act 1953. The Office of the Australian Information Commissioner has been advised of this data collection.

Definitions

Approved supplier: an approved pharmacist, an approved medical practitioner, or an approved hospital authority as prescribed in Section 84 of the National Health Act 1953

Community pharmacy: a pharmacy business carried on, at or from, the particular premises in respect of which a pharmacist is approved under Section 90 of the National Health Act 1953

Co-payment: patient contribution towards PBS/RPBS medicines as shown in Table 1.