Having pharmacy on your cover means you can receive benefits
for non-Pharmaceutical Benefits Scheme (PBS) pharmacy items that are prescription-only and prescribed by a medical practitioner.
What is the Pharmaceutical Benefit Scheme (PBS)?
This is a Government scheme that subsidises the cost of prescription medicine.
The PBS sets the amount a patient pays towards the cost of a subsidised drug.
If your extras cover includes benefits for Pharmacy, we’ll pay benefits for non-PBS pharmacy items that are prescription-only and prescribed by a medical practitioner as being essential to treat your condition.
Things we can and can't help with the bill for
We’ll pay benefits up to a set amount, per item, up to your limit. Before we’ll pay any benefits, we’ll deduct an amount equal to the non-concessional PBS co-payment.
We won’t pay any benefits where your non-PBS item costs less than the co-payment amount. Benefits are not payable for oral contraceptives (unless they’re prescribed for purposes other than contraception) or for pharmaceuticals prescribed for cosmetic purposes. No benefits are payable for items available without a prescription, herbal medicines, vitamins or any over-the-counter preparations. The PBS is only available to persons with Medicare eligibility and a prescription will be required for all claims.
If your extras cover includes pharmacy, we’ll pay benefits for non-PBS (Pharmaceutical Benefits Scheme) pharmacy items that are:
- Prescription only and prescribed by a medical practitioner, including contraceptives for medical conditions, travel and other vaccinations, and hormonal implants.
- Essential to treat a particular illness injury or condition.
Please note, you cannot claim pharmacy items that are:
- Available without a prescription including over the counter, off the shelf, herbal medicines and vitamins.
- Already subsidised by the PBS.
For more information, check your product guide.