The country’s inadequate understanding and incorporation of the “clunky” drug safety net scheme allows us to miss out on savings of hundreds of dollars each year at the pharmacy.
Both Congress have pledged to reduce the maximum price of scheduled scripts from $31.60 to $25, but attention is also being paid to the Pharmaceutical Benefitness Scheme (PBS) safety net, which operates along with the decline in script prices.
Last year, more than 2.3 million Australians registered with the PBS Safety Net Scheme.
However, new data from the federal Department of Health shows that 495,865 people who qualified for the Safety Net missed their savings because they didn’t use the scheme.
Under this scheme, script prices for general patients drop from $31.60 to $7.70 if they spend more than $1,694 per year on prescription drugs.
Scripts for concession cardholders, such as pensioners and low-income individuals, start from $7.70 after spending more than $277 a year.
The numbers are evidence of serious problems with program administration, indicating that too many patients are missing out, Health Group said.
One important issue was the low awareness of the plan, and patient advocates Elizabeth Devenee of the Australian Consumer Health Forum.
“People often say they haven’t heard of this safety net and have never used it and have no profit,” she said.
Patients must shop at the same pharmacy
Under the current system, patients must shop at the same pharmacy if they are trying to qualify for a safety net.
This is because patient spending data is not centralized and individual pharmacy computer systems calculate when customers reach thresholds.
This is a problem for patients like two Kirsten Eustaces who have immune states and often need prescription medications.
“You have to go to the same pharmacy regularly to qualify, which will be very exclusive and anti-competitive,” she said.
“It’s 2025. You should be able to automatically put all your purchases on your record.”
Loading…
If people want to shop, they should keep handwritten logs using the prescription record form downloaded from the Services Australia website.
If they fail, they can ask the pharmacist to call other pharmacies to harmonize their spending.
Deveny described it as a “clunky” process.
“People shouldn’t have to jump over the hoops to get the medicine they need in an affordable way,” she said.
It is even more difficult for families as families with a single Medicare card are not automatically linked to the pharmacy system and patients need to notify the pharmacist.
But wait, it becomes difficult
What makes it even more complicated is that once people reach the safety net, the pharmacy computer system issues cards with a code that patients use for the rest of the year to get discount scripts.
However, pharmacists must print relevant documents and send them by mail to Australian services to register patients. Service Australia must be processed within 12 weeks. Otherwise, the code will no longer work.
The president of Pharmacy Guild Trent Tomey said that backlogs occurred last year, with many customers suddenly ceasing to qualify for discount scripts.
“Last year, the average processing time for safety net cards was nearly six months,” he said.
“We were looking at the families and households that spent the year on drugs that year, finally getting them to their safety net and getting them off again.”
Deveny said it’s “easy” to fix the system in a cost-of-living crisis.
The government agreed on the latest long-term agreement with pharmacies to automate the system within five years, but Twomey said they hope to quickly track those plans so that “now we can deliver the cost of living that Australians need.”
A spokesperson for the Health and Aging department said there is a lot involved in automating safety nets.
“Costs are expected to include law, ICT systems, processes, communications, educational materials and other flow-on impacts.”
Elderly patients miss out
More than 2.2 million people using safety nets are concession cardholders, some of these are elderly patients who encounter specific issues with the program.
The safety net is calculated by adding all expenditures on all Medicare cards, whether it is an individual, couple, or family.
Older couples who share the same Medicare card often spend their time on enough medication to qualify for the safety net.
However, pharmacists say problems arise when one spouse moves to aging care and the other spouse stays in the community. This is because couples spend their medicines in nursing homes and community pharmacies, so they can’t be added together.
“What we see many times is that when one of our partners gets careful, the medication bill jumps,” Twomey said.
Scripts for the beginning of the 60th affect the safety net
According to the pharmacist, another issue is the interaction with the scheme with the 60-day script.
Under current rules, if a patient needs to fill in a 60-day repetitive script within 50 days of the last script, it will not count in the safety net or receive a discount if he is already entitled.
“So you can miss out on the safety net every two months,” Twomey said.
A health department spokesperson said in these cases that GPS is due to obtain special prescribing permits.
Loading…
General safety nets do not fall in line with price drops
The pharmacist argued that following a reduction in maximum PBS script prices, the general safety net threshold should be lowered.
A threshold was reached when patients pay less for each script, where there were fewer non-assigned cardholders. Between 2019 and 2024, 25,000 general patients qualified for the scheme following a price decline.
Ms Eustace said her family often approached the threshold but never reached it.
“I think it’s probably too complicated for what you need,” she said.
The number of concession patients in the scheme has increased by 1 million, as they have improved much better under the changes. This requires you to reach a $277 safety net, which is about 36 scripts per year.
A health ministry spokesperson said the safety net is designed to support people who have a significant number of scripts each year.
“The government is responsible for ensuring that PBS is managed in a financially responsible and sustainable manner,” they said.
Loading…
