Key messages
- Co-payments are collected in public hospitals in the same way they are collected in the community.
- The Joint Safety Net Scheme will continue to operate in hospitals, and both PBS and non-PBS items can be added to the Safety Net Card.
- Patients do not need to have their medications dispensed at hospital, but the prescription will still be attributed to the hospital’s ceiling level.
Pharmaceutical Benefits Scheme (PBS) rules around co-payments, safety net and dispensing are clarified for public hospitals.
Co-payments
A co-payment is a charge levied whenever a prescription is dispensed. A co-payment in a hospital is collected in the same way as it is collected in the community. Essentially, the co-payment is being brought forward by a couple of days, from the community to the hospital.
Arrangements need to be made so that patients can pay at multiple locations by credit card, cheque or cash, or so that they can be sent an account.
Collection of co-payments is the responsibility of each individual hospital. A hospital is under no obligation to collect a co-payment. However, it will be reimbursed at the PBS price minus the co-payment.
The Department of Health and Human Services and Medicare Australia will provide hospitals with consumer information brochures and posters.
The current co-payment amounts and Safety Net levels can be found at:
Patients who do not meet the PBS requirements
Where a PBS listed drug is prescribed outside the PBS requirements, Medicare Australia will not reimburse the cost of the drug, and this will have to be fully funded by the hospital or the patient. Hospital prescription forms will contain a tick box for the doctor to declare that the patient's condition meets PBS/RPBS requirements.
Waiving the patient co-payment
Co-payments may be waived for particular patients at the discretion of the hospital. However, the hospital will be reimbursed by Medicare Australia at the ex-manufacturer price plus 11.1 per cent, minus the co-payment. The department will not provide top-up funding when hospitals choose to waive co-payments.
Pharmaceuticals that attract a Brand Price Premium, Therapeutic Premium or a Special Patient Contribution (SPC) will incur an additional charge to the co-payment.
Joint Safety Net Scheme
The Joint Safety Net Scheme will continue to operate in hospitals. This means both PBS and non-PBS items (up to the amount of the applicable co-payment) can be added to a Safety Net Card. Outside the hospital only PBS items can be added to the Safety Net Card. Therefore, there may be financial advantages for patients to get their medication dispensed within the hospital.
The Joint Safety Net Scheme exists to protect patients or their families who spend a lot on medications in a calendar year. Once a patient or their family reach the safety net threshold they can apply for a Safety Net Card.
A family can include:
- a spouse or de facto spouse
- children under 16 in adult care
- full time dependent students under 25.
Dispensing
Patients do not have to have their medications dispensed at the hospital. They may choose to go to a community pharmacy.
Small and rural hospitals may find it viable to send most or all patients to community pharmacies for dispensing. Metropolitan hospitals might also find it convenient to send patients to their local pharmacy for dispensing on weekends and after hours.
Please note that under the National Health Act 1953 public hospital pharmacies are prevented from dispensing PBS prescriptions that originate in the community. Hospitals are able to dispense PBS prescriptions that originate from another participating hospital.
Reviewed 05 October 2015