Pharmaceutical Benefits Scheme data collection, Australian Government Department of Health, Disability, and Ageing data quality
Pharmaceutical Benefits Scheme
The Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) are Australian Government Health programs that subsidise the cost of a wide range of medicines in Australia. The PBS began in 1948 and is available to current Medicare card holders as well as to overseas visitors from countries with Reciprocal Health Care Agreements with Australia.
The PBS data is a national administrative dataset and contains information on prescription medicines that qualify for a benefit under the National Health Act 1953 and for which a claim has been processed. The database is managed and maintained by the Department of Health, Disability, and Ageing and comprises information about PBS and RPBS prescriptions, payments, patients, prescribers and dispensing pharmacies.
Scope of Pharmaceutical Benefits Scheme statistics
Pharmaceutical Benefits Scheme (PBS) statistics only include prescription medicines that are listed on the Schedule of Pharmaceutical Benefits (PBS Schedule) and have had a claim processed. They do not include:
- private prescriptions, off-label prescribing and over-the-counter medicines
- medicines dispensed to public hospital inpatients, or PBS- subsidised medicines dispensed to day-admitted patients and patients upon discharge from public hospitals in New South Wales and the Australian Capital Territory
- PBS Opiate Dependence Treatment Program prior to 1 July 2023
- any PBS medicines supplied under special arrangements that are not processed through PBS online
- information on reasons for prescribing, prescribed dosage, frequency of administration and intended duration – information on how the patient uses the dispensed medicine once the patient has received the medicine
- PBS medicines and PBS items listed or deleted from the PBS regularly. These changes may cause the apparent dispensing of drugs to change over time, and trends should be interpreted in this context
- some PBS dispensing records, such as those under reciprocal health care agreements do not include patient information and are not included in tables which examine patients. However, they are included in prescription counts as they are valid PBS prescriptions.
Coverage of the PBS Opioid Dependence Treatment program in states and territories
State and territory governments use different services and implement different programs associated with the opioid pharmacotherapy system. These methods are driven by differences between the states and territories in relation to legislation, information technology systems and resources. For example, in most instances, patients in correctional facilities are not reported through the subsidised PBS data as these facilities access different funding streams. Caution should be used when comparing one state or territory with another and due to the differences in the coverage of the NOPSAD collection and the PBS, data should not be compared. Information on these differences in correctional facilities in states and territories is detailed in Table T4.
| State/territory | Administrative features |
|---|---|
| New South Wales | People in NSW prisons are ineligible to use Medicare and most PBS schemes as these are federally funded and public clinics are funded and operated on a state level. NSW Health purchases and provides Methadone outside of PBS arrangements for Justice Health. For buprenorphine, the prescription and remuneration processes are consistent with other PBS medicines under the s100 HSD Program. NSW Health provides funding to Justice Health to account for the increased complexities of providing ODT in custodial settings. This includes a high volume of OTP patients, the ineligibility of their patients to access Medicare during their incarceration, frequent patient transfers between public and private custodial facilities, limited dosing locations, workforce challenges, and more onerous administrative requirements such as ensuring that people receiving ODT medicines have Medicare numbers in preparation for release. |
| Victoria | Following changes from the commonwealth, Justice Health utilises the use of PBS scripts for people who are prescribed LAIB while in custody. Justice Health does not use PBS scripts for methadone at the present time. |
| Queensland | All health services in Queensland correctional centres are funded by Queensland Health and delivered by eight Hospital and Health Services. Queensland Health accesses the PBS for long-acting injection (LAI) ODT medicines, but not necessarily for oral or sublingual ODT medicines. LAI medicines make up the vast majority of ODT treatments for people in Queensland correctional centres. |
| Western Australia | Health services in Western Australia public prisons are funded by the Department of Justice. Clients are not accessing the PBS for ODT medicines and are dispensed privately. In Western Australia’s private prison, clients access PBS where they can through a community pharmacy. If Medicare is not available or if treatment is for methadone, ODT medicines are dispensed privately. |
| South Australia | There are 9 Correctional facilities in South Australia, eligible patients access the PBS for buprenorphine long-acting injections via the use of external pharmacies to dispense prescriptions. |
| Tasmania | In Tasmania, medications dispensed to people in prison are not covered, except for medication that fall under Section 100 of the PBS (known as Highly Specialised Drugs Program), excluding ODT. Correctional Primary Health Services in Tasmania who are responsible for delivering health care in Tasmania prisons are awaiting a system reform process to enable ODT under PBS. |
| Australian Capital Territory | In the Australian Capital Territory, the PBS is accessed for eligible Medicare patients who are prescribed LAIB for OMT in correctional settings. Canberra Health Services fund access to all oral OMT in correctional settings and also fund access to LAIBs for non-Medicare patients. |
| Northern Territory | In the Northern territory PBS prescriptions are dispensed in private and public correctional facilities. This was implemented after the changes in the PBS. Data coverage for 2023–24 may be incomplete. |