PBS Safety Net Threshold Changes -Effective Date: 18 January 2025
The Government is making changes to its systems and guidance around ‘threshold prescriptions’ that exactly meet the PBS Safety Net Threshold for 2025. The threshold prescription refers to the prescription that either exactly meets or exceeds the PBS Safety Net threshold amount.
From 18 January 2025, the Government will update guidance to indicate that patients will pay a reduced co-payment amount for the threshold prescription that exactly meets the PBS Safety Net threshold amount. Prior to this change, patients paid a reduced co-payment amount for any subsequent prescriptions after the threshold prescription that exactly met the PBS Safety Net threshold amount was dispensed.
The Guild has been advised that software vendors have been made aware of the change to the threshold and their systems will allow for pharmacists to process.
Key Updates:
- General Patients: The Safety Net threshold for general patients has been adjusted to better reflect current healthcare needs.
- Concession Cardholders: Adjustments have also been made for concession cardholders, ensuring equitable support for vulnerable groups.
Impact on patients:
- Concessional patients:
- Most likely to be impacted, as the PBS Safety Net threshold corresponds to 36 prescriptions.
- The 36th prescription will now be free (if no allowable discounts have been applied to earlier prescriptions).
- General patients:
- Less significantly impacted, as the PBS Safety Net threshold amount ($1,694.00 in 2025) does not correspond to a specific number of prescriptions.
In line with current processes, patients may claim a refund under the PBS if they spent over the yearly PBS Safety Net threshold. To claim a refund, patients must complete the PBS claim form (PB132) available on the Services Australia website.
It is anticipated that this change will likely lead to patient requests for Patient Record Forms (PRFs) as patients seek to claim a PBS refund for previous years threshold prescriptions. Pharmacists are only required to keep records of PBS prescriptions for two years from the date of supply and it may not be possible to provide historical PRFs from outside of this period.
