Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data
The Australian Government subsidises the cost of prescription medicines through 2 schemes, the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) for eligible veterans and their dependants.
People fall into 2 broad classes: general and concessional. Concessional beneficiaries include pensioners, Health Care card holders, Commonwealth Seniors Health card holders and Veterans card holders. Under the PBS/RPBS, the patient is required to contribute a co-payment which is indexed annually; $31.60 for general patients and $7.70 for those with a concession card as of 1 January 2024. If a medicine is priced below the relevant co-payment threshold the consumer pays the full price and the prescription is classified as ‘under co-payment’. If a medicine is not listed in the PBS Schedule of Pharmaceutical Benefits, the consumer pays the full price as a private prescription, and the data is not included in the presented tables.
The collection of under co-payment prescription data for the PBS and RPBS commenced on 1 April 2012. The data collected is identical to that collected for subsidised prescriptions. Prior to 2012 the only source of under co-payment data was a survey of pharmacies funded by the Australian Government Department of Health and Aged Care (the Department) (refer to the information on the Drug Utilisation Sub-Committee (DUSC) below). Time series presentation of survey data with the under-co-payment data is not possible prior to 2012–13 as the DUSC data may have been an underestimate of prescription volumes.
Most prescriptions for General Schedule medicines (Section 85) are dispensed through community pharmacies, but PBS is also available in private hospitals and through eligible public hospitals to patients on discharge and day patients. In addition, a number of drugs are distributed under alternative arrangements where these are considered more appropriate (Section 100). Examples are the Highly Specialised Drugs program and General Schedule medicines that are supplied directly to First Nations patients via Aboriginal Health Services program in remote areas of Australia (AHS program). Causing the Northern Territory’s PBS/RPBS statistics to be recognised as an underestimate.
PBS/RPBS does not include the following:
- Private prescriptions,
- Over the counter medicines, and
- Medicines supplied to public hospital inpatients.
Services Australia processes all prescriptions dispensed under the PBS/RPBS and provides these data to the Department of Health and Aged Care. The PBS/RPBS data maintained by the Department has been used to produce this report. Information collected includes the characteristics of the person who is provided with the prescription, the medication prescribed (for example, type and cost), the prescribing practitioner and the supplying pharmacy (for example, location). The figures reported relate to the number of mental health-related prescriptions supplied by pharmacies and processed by Services Australia in the reporting period, the number of people provided with the prescriptions and their characteristics, as well as the prescription costs funded by the PBS and RPBS (further information can be found in the Expenditure section).
From February 2020, a range of restrictions on travel, business, social interaction and border controls were introduced to prevent and reduce the spread of SARS-CoV-2, the virus that causes COVID-19 disease. While this report explores the impact on mental health‑related prescriptions, the AIHW has published a report on the Impacts of COVID‑19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme service use more broadly.
Although the PBS and RPBS data capture most of the prescribed medicines dispensed in Australia, these data have the following limitations:
- The number of patients dispensed under co-payment prescriptions cannot be derived by subtracting the number of patients receiving subsidised prescriptions from the total number of patients shown in the tables. Patients may receive both subsidised and under co-payment prescriptions.
- Programs funded by the PBS/RPBS that do not use the Services Australia online processing system include:
- Public hospitals,
- Aboriginal Health Services program, and
- Opiate Dependence Treatment Program.
Only one of these has a bearing on the mental health-related prescriptions data published in the Prescriptions and Expenditure sections: the Aboriginal Health Services program. Most affected are the data for Remote and Very remote areas and the data for the Northern Territory. Consequently, the mental health-related prescriptions data in these sections will not fully reflect Australian Government expenditure on mental health-related medications.
- All data is presented by the date of supply, that is, when the prescription was dispensed to the patient. For demographic tables, patient characteristics are determined at a single point in each year, ensuring each person is only counted once in the year.
- State and territory are determined according to the patient’s residential address as recorded on the Medicare Enrolment file. If the patient’s state or territory is unknown, then the state or territory of the pharmacy supplying the item is reported.
The Anatomical Therapeutic Chemical (ATC) classification version used is the primary classification as it appears in the PBS Schedule of Pharmaceutical Benefits. This can differ slightly from the World Health Organization (WHO) version (WHO 2022). There are 3 differences between the WHO ATC classification and the PBS Schedule classification that have a bearing on mental health data:
- Prochlorperazine is regarded as an antiemetic (A04A) in the PBS Schedule while it is an antipsychotic (N05A) according to the WHO classification. This means that information on prochlorperazine will not appear in the data provided as it is not listed as a mental health drug in the PBS Schedule.
- Bupropion is listed as an anti-smoking drug (N07B) in the PBS Schedule while it is an antidepressant (N06A) according to the WHO classification. This means that bupropion will not appear in the data as it is not listed as a mental health drug in the PBS schedule.
- Lithium carbonate is classified as an antidepressant (N06A) in the PBS Schedule while it is an antipsychotic (N05A) according to the WHO classification. This means that lithium carbonate will appear in the data as an antidepressant rather than an antipsychotic.
Clozapine (N05A) historical data incomplete
Clozapine is PBS listed under the Highly Specialised Drugs (HSD) program, and prior to 2015 was only available through public and private hospital pharmacies. Due to differing HSD funding arrangements over time, historical prescription/patient data is incomplete:
Public hospitals
Prior to 1 July 2010 – no data available.
1 July 2010 to 31 December 2013 - partial data available - gradual transition to prescription-based payments increasing over time, transition complete by December 2013.
1 January 2014 onwards – complete data available.
Private hospitals
Complete data available.
Drug Utilisation Sub-Committee (DUSC) database
Previously mental health-related prescription data products published by the AIHW included data sourced from the DUSC database. From 1 April 2012, following the implementation of the under co-payment data collection, the DUSC-sponsored Pharmacy Guild survey ceased to be the source of under co-payment prescription data. As a result, time series data prior to 2012–13 for under co-payment data has been removed from the tables as the previous survey methodology may be an underestimate of the volumes of under co-payment prescriptions.
