What are our pharmacy benefits?

If you buy prescription medication, send us your pharmacy receipt and we’ll let you know if we can pay a benefit for it. Read on below for all the details.

Which medicines can I claim?*

Peoplecare can only pay a benefit on medicines that are:

  • cost more than the government’s $41.30 PBS co-payment amount (as at 1 January 2021);
  • prescription medicines approved by the Therapeutic Goods Administration (you can’t claim medicine you can get without a prescription);
  • not excluded by the health fund (for instance, medicines for contraception are excluded); and
  • were purchased less than two years ago.

The types of medications members typically claim through Peoplecare are immunisations (for instance, the shots you get before you travel) and the many drugs that have been deemed safe by the Therapeutic Goods Administration but haven’t yet made it on to the PBS.

*Peoplecare provides benefits towards pharmacy on all of its extras covers. Waiting periods apply.

What is the Pharmaceutical Benefits Scheme and PBS co-payment amount?

The PBS is a Government subsidy that reduces the cost of a wide range of prescription medications. The PBS co-payment is how much regular Australians pay towards most PBS medications and the Australian Government covers the rest of the cost. The PBS co-payment amount changes on 1 January every year and is $41.30 as at 1 January 2021.

The PBS has its own website with all the lengthy details.

Still wondering what the PBS co-payment amount means for your pharmacy claim? Scroll down to ‘How does a pharmacy claim payment work?’ for a worked example.

Pharmacy benefits

This benefit is paid from the Pharmacy limit for all levels of cover.

Peoplecare cover Benefit Limit per person Limit per family
Premium Extras 80% above PBS up to $80 per script $500 $1000
High Extras 70% above PBS up to $70 per script $400 $800
Mid Extras 60% above PBS up to $60 per script $300 $600
Simple Extras 50% above PBS up to $50 per script $200 $400

How to make a pharmacy claim

You’ll need to send us your pharmacy receipt to make a pharmacy claim (you can’t swipe your membership card to claim). The important info you need is on a receipt which you need to send to us to claim on your Peoplecare Extras cover.

Peoplecare needs the following details on your pharmacy receipt:

  • Patient’s name
  • Pharmacy’s details
  • Medication name & script details
  • Dispense date
  • Amount paid

To claim for pharmacy, send your full pharmacy receipt to us via our app, by email (along with a claim form) or by post (along with a claim form) to Peoplecare, Locked Bag 33, Wollongong NSW 2500.

How does a pharmacy claim payment work?

An eligible pharmacy claim might look like this example for someone who hasn’t yet used any of their annual limit:

  • Medicine cost = $110
  • minus PBS co-payment amount before calculating benefit = $69.00
  Simple Extras Mid Extras High Extras Premium Extras
Benefit rate 50% to $50 60% to $60 70% to $70 80% to $80
Annual limit $200 per person
$400 per family
$300 per person
$600 per family
$400 per person
$800 per family
$500 per person
$1,000 per family
Example benefit $34.50 $41.40 $48.30 $55.20