Outdated PBS system forces half a million Australians to pay more for essential medicines

Nearly half a million Australians are being denied access to more affordable medicines due to an archaic manual tracking system that urgently needs automation. This reality links to the increasing number of consumers foregoing essential medicines due to concerns over out-of-pocket costs.

The Consumers Health Forum of Australia (CHF) has issued a pressing call for the automation of the PBS Safety Net system after uncovering that in 2024, 495,865 eligible individuals missed out on benefits due to the outdated paper-based tracking method. This means nearly half a million people are paying full price for medicines that should come at a significant discount.

Furthermore, there are clear implications from the recently introduced 60-day dispensing system on the PBS Safety Net which many consumers are not aware of. While patients benefit from spreading their annual medication costs over a longer period with fewer pharmacy visits, it also delays their qualification for the PBS Safety Net.

“The PBS Safety Net is supposed to protect Australians from high medicine costs, but the reality is too many people don’t even realise they’re eligible,” remarked CEO of CHF Dr Elizabeth Deveny.

“We all want to know what benefits we’re entitled to – this should be simple. The current system is failing hundreds of thousands of Australians who simply don’t know it exists, let alone how to track their spending or apply for it.”

Unlike the Medicare safety net, which automatically kicks in when patients reach a spending threshold on medical services, the PBS Safety Net relies on manual tracking by pharmacists and consumers. This often necessitates repeated visits to the same pharmacy, which is impractical for many Australians.

While the government has agreed under the 8CPA to automate the PBS Safety Net system within five years, those plans need to be fast-tracked.

“It’s 2025, surely we can do better than using a manual paper-based tracking system. We wouldn’t accept a paper-based system for the Medicare Safety Net, so why do we accept it for the PBS Safety Net?” questioned Dr Deveny.

“We all know Australians are struggling with the cost of living – fixing this is a no-brainer. We are hearing disturbing accounts of people delaying, skipping or rationing their medication just because they can’t afford it. This leads to poorer health outcomes and higher long-term healthcare costs not only for the consumer but also the healthcare system as a whole.”

Dr Anna Kemp-Casey, formerly of the University of Western Australia and now a Research Fellow with the Medicines and Device Surveillance Centre for Research Excellence at the University of South Australia, highlighted this issue as far back as 2012. She emphasised that “many patients are missing out on the PBS safety net because they either don’t know about it, or are not able to keep the necessary documentation throughout the year to receive its benefits. Automation of PBS spending would ensure that all eligible patients receive their entitlements”. 

While concessional PBS Safety Net recipients rose from 1.2 million in 2019 to 2.2 million in 2024, the number of general population recipients actually declined from 125,964 to 101,605 during the same period.

“We’re worried working families and young professionals who earn just enough not to qualify for concession cards are missing out – simply due to a lack of awareness,” Dr Deveny expressed.

“The government needs to introduce an automated real-time PBS spend tracking system that would automatically apply benefits once consumers hit the threshold, similar to the Medicare Safety Net.”

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