Changes to the PBS general co-payment

Effective 1 January 2026, the PBS general co-payment is now $25.00 for subsidised medication listed on the PBS. This means you’ll save $6.60 every time you purchase an eligible script. While you’ll still pay $20.00 or less for PBS prescriptions that aren’t already subsidised by the Government when you use your Pharmacy benefits, this change could affect the cost of some of your medications.

Costs under $25.00?
There is no change. If your script is under $25.00, you’ll only pay $20.00 or less since your PBS script will still be eligible to claim on your Pharmacy benefits.

Costs more than $25.00 
You may not be eligible to claim your medication through your Health Partners cover, as it could be a Government subsidised script. In this case, you would pay the $25.00 PBS general co-payment.
Much like when you claim certain treatments through Medicare, if a medication is subsidised by the Government, it cannot be claimed on Private Health Insurance. But the PBS is complex and constantly changing, so it’s best to check with your pharmacist so see if your medication is impacted.

No, your yearly Pharmacy limit or benefits have not changed. You’ll still receive the same level of Pharmacy benefits that are available under your current level of Extras cover.

The non-subsidised PBS medications that you can claim on your Pharmacy benefits include: 

• Medications that cost more than the Health Partners co-payment, but less than $25.00
• Eligible 60-day and authority prescriptions

Eligible private prescriptions will also still be covered under your Pharmacy benefits.

The Government has made the decision to lower the PBS general co-payment to help make medications more affordable for Australian residents amid rising household costs.

With this change, it’s hoped more people will be able to afford their everyday medications (especially those who take multiple medications daily) and won’t have to go without them.

The Pharmaceutical Benefits Scheme (PBS) is designed to help lower cost of everyday medications for Australian residents. Many of the medications listed on the PBS are subsidised by the Government. This means you’re only required to pay a co-payment for each PBS-subsidised item you purchase.

You can find out more about the PBS and how it works on their website.

There are two types of co-payments under the PBS:

• A general co-payment that’s now $25.00 (was $31.60).
• A concessional co-payment of $7.70, which applies to those who carry a valid Health Care or Pensioner Concession card (no change).

This change won’t affect your Health Partners Pharmacy benefits but could impact the cost of some of your medications. With our Pharmacy program, there are two types of prescriptions you can claim with your Health Partners benefits up to your annual limits:

• Non-subsidised PBS scripts that you only pay $20.00 or less per script for.
• Private and compounding scripts which have a maximum benefit of up to $50.00 per script after a $40.00 co-payment. 

Now that the general co-payment for PBS medications is lower, there are some prescriptions you may no longer be able to claim on your Pharmacy benefits. This is because they’ll now be a subsidised medication, so you’ll pay the $25.00 general PBS co-payment instead. 

As a health fund, we must comply with Government legislation, which doesn’t allow us pay benefits on items that are already subsidised.

If you paid $20.00 or less for your medication in the past but now pay $25.00, it’s likely your medication is now covered by a Government subsidy and therefore you would need to pay the $25.00 PBS general co-payment.

Before 1 January 2026, your script may not have been eligible for a Government subsidy. With this change your script may now be subsidised, so you can no longer claim it on your Health Partners benefits.

We know everyone’s health and wellbeing needs are different, and we reviewed our Pharmacy benefits carefully ahead of the government’s 1 January PBS changes. After considering the impact for our members, we decided to keep the current benefit structure—including the maximum $20 cost for non-subsidised prescriptions.

We’ll continue to monitor our pharmacy benefits, just as we do with all our covers, to make sure they remain fair and supportive for our members.

As proud South Aussies, we’re all about adding value for our members and supporting our local community. One of the ways we do this is through our network of over 50 Health Partners participating pharmacies across SA.

The Health Partners participating pharmacy network allows us to go the extra mile to help our members manage their everyday health and wellbeing needs. It also means we can pay a benefit for PBS scripts not already subsidised by the Government and offer 20% off on full-price non-prescription items, which is something no other health fund offers.

Even with these changes, there are still other ways you can benefit as a member when you visit a Health Partners participating pharmacy. This includes:

• An on-the-spot benefit for claimable medications on all Extras covers.
• Benefits for eligible PBS prescriptions, 60-day dispensing (when no subsidy applies) and authority prescriptions*
• Benefits for eligible private and compounded medications, including vaccinations – with limited exclusions^
• 20% off on most non-prescription items including beauty products, vitamins and over-the-counter medication (e.g. pain relief)¹
• Free flu jabs during promotional periods²
• Advice from pharmacists who can help you maximise your benefits.

No – you won’t have to do anything to prepare for this change. Your pharmacist will help bring you up to speed on any potential price changes, if your medications are affected. They’ll also be able to provide support with any questions you have about your medication or the PBS in general.

You may also wish to speak with your doctor to determine what medications are right for you and your circumstances.