I am not too familiar with the PBS as I hardly get medication. So any help would be appreciated.
I went to chemist warehouse and I had a prescription for Loceryl. I asked them if it was part of the PBS and she said no it's private.
But it appears to be on the list.
$55
Do you have a concession card?
Maybe script was marked private?
Edit:
Site says:
Restriction
Restricted Benefit
Onychomycosis
It's a Repatriation Pharmaceutical Benefits (RPBS) item only. You need to have a military health benefits card.
Ah ok that makes sense.
R = Repatriation Care items
It's marked R = Repatriation Care items. So you need one of these cards:
Repatriation Health Card For All Conditions (gold); or
Repatriation Health Card For Specific Conditions (white); or
Repatriation Pharmaceutical Benefits Card (orange);
Furthermore, it's also a Restricted Benefit item, meaning it only qualifies under the PBS if you fulfil the clinical criteria. In this case, you need to have "Onychomycosis" to be eligible. (as per https://www.pbs.gov.au/medicine/item/4010C)
You may have health insurance extras that will pay you the difference between the maximum pbs cost and the cost you paid (aprox $41 is the max pbs cost).
From 1 January 2023, the PBS co-payment for general patients (non-concession card holders) reduced from $42.50 to $30.00
Wow really, thankyou for sharing. I'm sure this is useful to many, including me. I wonder why they did this? Are we not all buying enough medicine?
To
help ease cost-of-living pressures for Australians
https://pbs.gov.au/news/2022/12/pbs-general-co-payment-reduc…
Do you have the pharmaceutical coverage for it? Seems odd considering. Does it mott cover private?. I don't know your circumstances and I don't remember all of mine but years ago I went to the pharmacist to fill a script, they advised just under $200 to which I was shocked by doctor would have prescribed me with. Discussion between pharmacy and specialist found that there was a tick or text of some dort missing, i think it was "psb" or something to make it cheaper. All sorted and only cost the pbs amount.
Maybe the health insurance doesn't pay the difference where it's a private script and not noted on the script as pbs convered. Also is pbs coverage only for certain uses?
I do but only appears to cover prescription only approved items.
Family pays over $600 a month for top cover.
So even though I got a prescription, it's not a prescription only treatment therefore not covered
So their wording is terrible in the app leaving it open to more questions. When the message comes up it should say:
It's an over the counter item not requiring a prescription therefore it's not covered.
I write prescriptions by the dozens all week, and the PBS can be crazily confusing. First off, the Loceryl is not approved to receive a PBS benefit, but yes it's approved on the RPBS, like DVA patients. (Why is this so…I have no idea!)
As a prescriber, if I am prescribing a medication and requesting a PBS benefit for that patient, I have to comply with the PBS restrictions or authorities on that medication.
Yes, there is a difference again between the general schedule, restrictions to be adhered to or authority requirements to be fulfilled. The restrictions might be that a certain infective bug must be present on cultures, that other treatments have failed, etc. An authority requirement means I have to call Canberra, talk to the PBS, explain why I am prescribing a certain medication and gain an authority code. To be fair, some of these codes are now "streamlined", so long as I can demonstrate the fulfilment of the authority, then it is approved and I can add the code to my prescription.
To address private scripts can be confusing. Remember, the PBS allows certain medications to gain a PBS benefit because of clinical need, proven trials, the health benefit to the community, taking in the often huge costs to the PBS, which is ultimately your taxes. A lot of people don't realise that the private cost of a medication can be in the thousands $$$, which is what the manufacturer charges to the pharmacy. The PBS then passes on the $$$ difference down to the schedule fee charge, which yes has just dropped to $30 per script.
So I can write a script for whatever I like, and don't tick the PBS box, and write Private script across it, and you will be dispensed the medication at the private rate. Interestingly, there are a lot of medications (common and older) that are less than the PBS benefit of $30 for the pharmacy to purchase. So they most always will only charge you as if it were a private script, so you might pay $15 instead of $30. Common antibiotics like amoxil etc.
Just to add to the confusion, you might have a commonwealth health care concession card and I believe scripts are around $6, and then once you hit a certain limit all the rest of your scripts are free for the rest of that year.
If you have extras cover on your PHI, then you can claim back the difference on your private script between the PBS price and the pharmacy charge. Not the whole cost of the script.
I always explain to my patients if I am prescribing off label (private script) and what that might mean in terms of price they will pay when they get to the pharmacy. Some prescribers don't, and it's a nasty surprise to be charged $100s for what they thought would be $30.
Having said all the above, I am not a pharmacist, and there may be some extra detail I have skimmed over, but it seems to help patients understand a bit more about the PBS and pricing!
Thanks for the detailed info it's a bit convoluted that's for sure.
Note it appears Bupa (not even top tier) will not cover unless it's a prescription only item. Even though I was prescribed it. It can be bought over the counter, therefore not eligible.
Also before 2014 Loceryl was under the PBS but was taken off.
How much did you pay?