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How to help patients save when prescribing expensive medication


Doctors’ Health Fund


18/05/2023 4:05:22 PM

SPONSORED: Depending on their health fund and level of cover, they may have benefits that cover medication not eligible for a government subsidy.

GP talking to patient
Patients may be able to receive a rebate on non-PBS medicine through their private health insurance.

GPs would be familiar with Australian Government programs like the Pharmaceutical Benefits Scheme (PBS), Repatriation Pharmaceutical Benefits Scheme (RPBS) and Life Saving Drugs Program that help reduce the cost of medicines for Medicare-eligible Australians.
 
But while the PBS includes medicine for most conditions, not all medication prescribed by GPs is subsidised by the Government. If a medicine is not covered by the PBS, patients pay full price – a price that is typically higher compared to subsidised medication.
 
Rebates for non-PBS medication are available
The good news is that even if the prescribed medication is not eligible for a Government subsidy, patients can still receive a rebate on non-PBS medicine through their private health insurance.
 
Reminding patients of this benefit could see them save on their otherwise expensive, completely patient-funded medication.
 
Benefits for non-PBS items are usually included under extras cover, otherwise known as general treatment cover.
 
The eligibility criteria and conditions around what kinds of non-PBS medication can be claimed, waiting periods, annual limits and individual item benefits varies across each health fund. For example, whether the policy benefits include coverage for immunisations, such as allergy medication, or any thresholds that need to be met before benefits can be paid.
 
It is important the patient checks with their health fund as to what is available to them, as well as any information requirements needed to process a claim.
 
It can also be helpful to prompt patients to ask for an Official Pharmacy Receipt from their pharmacy when their medication is dispensed, which includes information about the supply of their medication such as patient name and script number. Having this information ready will guarantee a smooth experience when claiming benefits, as it may be a health fund requirement to submit this official receipt as part of their claim.
 
By reminding patients about their potential health fund benefits and helping them to understand the rebates available to them with prescription medication, GPs can help lower the cost of healthcare.
 
Established by the AMA in 1977, Doctors’ Health Fund provides health cover to members of the medical community and their families. To view cover options or get in touch with our expert team, visit the DHF website.
 
Additional resources
www.health.gov.au/topics/medicines/cost
www.pbs.gov.au/info/about-the-pbs
 
*IMPORTANT: Private health insurance products are issued by the Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy.
 
This content was commissioned by the Doctors’ Health Fund and reviewed by newsGP.

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