Pharmaceutical Benefits Scheme

About the data

The Australian Government subsidises the cost of a wide range of prescription medicines through two separate schemes, the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS). Claims for reimbursement for the supply of PBS- or RPBS-subsidised medicines are submitted by pharmacies through Services Australia for processing, and are provided to the Australian Government Department of Health. Subsidies for prescription medicines are available to all Australian residents who hold a current Medicare card, and overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement. Patients pay a contribution to the cost of the medicine (co-payment), and the Australian Government covers the remaining cost. This remaining cost is referred to as the benefit paid.

PBS data in this report are from records of prescriptions dispensed under the two schemes, where either:

  • The Australian Government paid a subsidy
  • The prescription was dispensed at a price less than the relevant patient co-payment (under co-payment prescriptions) and did not attract a subsidy.

PBS data cover all prescriptions dispensed by approved suppliers, including community pharmacies, public and private hospital pharmacies, and dispensing doctors.

PBS does not cover:

  • Over-the-counter purchases (non-prescription)
  • Private prescriptions
  • Medicines supplied to admitted patients in public hospitals, although prescriptions to patients on discharge and non-admitted patients in all states and territories are in scope, except New South Wales and the Australian Capital Territory.

Medicines dispensed through alternative arrangements where the patient cannot be identified, such as direct supply to Aboriginal health services, are excluded.

Provision of some medicines may be under-represented in those remote areas, particularly for the Northern Territory with a high proportion of Aboriginal and Torres Strait Islander people who can access medicines through Aboriginal health services.

The number of prescriptions represents the total number of times that a prescribed medicine is supplied to a patient. For individual prescriptions where the quantity dispensed varied from the listed maximum quantity, no adjustment was made for increased or reduced quantity supplied. The supply was counted as one prescription.

Prescriptions dispensed and government benefits paid in this report are presented by month which is based on the date the medicine was supplied to the patient.

The Schedule of Pharmaceutical Benefits

The Schedule of Pharmaceutical Benefits (the Schedule) is released monthly and provides information on the arrangements for the prescribing and supply of pharmaceutical benefits under the PBS. The Schedule lists all of the ready-prepared items subsidised under the PBS.

Anatomical Therapeutic Chemical (ATC) Classification

PBS listed medicines are organised into Anatomical Therapeutic Chemical (ATC) classification groups according to the body system or organ on which they act. See the World Health Organization Collaborating Centre for Drug Statistics Methodology (WHOCC) for further information on the ATC classification system.

The ATC Classification used in this report is from the Australian Government Department of Health’s version of the WHOCC ATC Classification, which has some minor differences from the WHOCC version, based upon a particular medicine’s usage in Australia. The Schedule of Pharmaceutical Benefits according to ATC groups can be viewed via browsing by body system.

PBS Programs Types

This web report has categorised PBS listed medicines into “program types” which reflect the groupings in the Schedule and are described below.

Most PBS medicines are dispensed by community pharmacies and used by patients at home. These are known as ‘General Schedule’ medicines.

Section 100 of the National Health Act 1953 provides for an alternative method of medicines supply to patients when normal PBS arrangements are not appropriate.

Section 100 programs include:

  • Highly Specialised Drugs Program
  • Efficient Funding of Chemotherapy
  • Botulinum Toxin Program
  • Growth Hormone Program*
  • In-Vitro Fertilisation Program

Separate sub-schedules exist for specific prescribers or for a specific cohort of the population. These include:

Items annotated with an asterisk (*) were excluded from visualisation titled “Number of scripts dispensed by PBS program”.

Geography

Greater Capital City Statistical Areas (GCCSAs) are geographical areas that represent the functional extent of each of Australia’s capital cities. This geographical area has been developed by the Australian Bureau of Statistics and includes people who regularly socialise, shop or work within the city, but live in the small towns and rural areas surrounding the city. GCCSAs are not bound by a minimum population size criterion.

Medicare enrolment postcode is used as a proxy for the patient residence as it corresponds to most people’s usual residence. If the patient postcode was unknown or invalid, the postcode of the dispensing pharmacy is used instead.