What is happening?
Currently both general and concessional PBS co-payments are indexed on 1 January each year, in line with the Consumer Price Index.
In 2024, the co-payments were $31.60 for general patients and $7.70 for concessional patients.
From 1 January 2025, the government will introduce:
- a 1-year freeze on indexation for PBS co-payments for general patients
- a 5-year freeze on indexation for PBS co-payments for concessional patients.
Currently, if the total cost of a PBS medicine is above a patient’s co-payment, pharmacists can reduce the co-payment for that patient by applying an allowable discount, up to an amount of $1, for each supply.
From 1 January 2025, the allowable discount (aka ‘$1 discount’) will be phased out (over 1 or 5 years) while annual increases to the general and concessional PBS co-payments are frozen.
The discount will decrease by the amount of indexation that would have otherwise applied to the general or concessional patient PBS co-payment, as relevant, until it reaches zero.
What will this look like for patients?
- For general patients, the general PBS co-payment for the 2025 calendar year will remain at the level applying in 2024 – that is, a maximum of $31.60 for PBS medicines will be payable.
From 1 January 2026 onwards, the PBS co-payment will again be annually indexed in line with the Consumer Price Index (CPI). - For concessional patients, from 1 January 2025 the concessional PBS co-payment will remain at the level applicable for 2024 for the next five calendar years – that is, a maximum of $7.70 for PBS medicines will be payable.
What are the Fee Changes from 1 January 2025?
Fees are mostly remaining the same except for the General Safety Net Threshold.
As part of the 8CPA agreement, there will be a 1- year freeze on PBS copayments for General Patients, and up to a 5-year freeze for concession patients.
Category | Fees | 2024 | From 1 January 2025 |
---|---|---|---|
Dispensing fees | Allowable additional patient charge | $3.45 | $3.45 |
Patient co-payment | General | $31.60 | $31.60 |
Concessional | $7.70 | $7.70 | |
Safety Net threshold | General | $1647.90 | $1694.00 |
Concessional | $277.20 | $277.20 |
What will the new discount caps be?
Copayment discounting is being phased out, with the following discounting rules to take effect from 1 January.
Category | 2024 | From 1 January 2025 | |
---|---|---|---|
Allowable discount | General | $1.00 | $0.10 |
Concessional | $1.00 | $0.80 |