Pharmaceutical Benefits Scheme (PBS)

If you have been diagnosed with FH then all the medications you will be prescribed will be covered by the Pharmaceutical Benefits Scheme (PBS). This does not include over-the-counter medications.

In Australia patients pay up to $38.30 and those on concession cards $6.20 for any medication that is on the PBS. (You and your children may be eligible for a Health Care Card (HCC), call Centrelink on 13 27 17 for more information).

This means regardless of the ‘real’ cost of the medication the maximum you will pay is $38.30 or if you are on a concession card $6.20. Although this is a very generous scheme, the financial burden of multiple medications and multiple people in the family requiring medication (common with FH), may become financially overwhelming.

The Pharmaceutical Benefits Scheme Safety Net reduces the cost of prescription medicines (for the remainder of the calendar year) for individuals and families once the PBS Safety Net threshold has been reached (see table below).

Safety Net thresholds: The thresholds are updated each year on 1 January. The following rates are for 2016.

Rates for 2015 General patients Concession card
Patient contribution Up to $38.30 $6.20
PBS Safety Net threshold $1,475.50
(38 full priced $38.30 scripts)
(60 $6.20 scripts)
When PBS Safety Net threshold is reached $6.20 Free

See Pharmaceutical Benefits Scheme Safety Net for details of eligibility and record keeping (this is very important).

tax-cardHow to save money on your medications:

  • Choosing cheaper generic medications will produce significant savings. Shop around for best prices.
  • If you are on a low dose of a medication it may be possible to buy a higher dose and cut the pill in half so you will only need a prescription every two months instead of monthly. Speak to your doctor to see if this is an option for you.
  • You are entitled to claim on your income tax (for you and your children), over-the-counter medications not covered by the PBS e.g. fish oil, vit D and CoQ 10. Speak to your pharmacist.
  • For other ideas see – Keeping your medicines costs down 

life insurance policyLife Insurance Products and Genetic Testing for FH

All individuals with potential FH should be made aware and understand the implications of genetic testing for certain types of insurance cover.

Family history of cardiovascular disease, a clinical diagnosis of FH, plasma level of cholesterol and predictive genetic testing*¹ information could all potentially be employed by the insurance industry to make decisions about exclusion of specific conditions from insurance coverage and setting an insurance policy premium.

In Australia, premiums for insurance products which include cover for life (term), disability/income protection, trauma, business and bank loans (but not private health insurance*²) are calculated according to the present and past health of the applicant, their family history and any known genetic test result(s) of the applicant, their siblings or their parents.

However, insurers who are members of the Financial Services Council have agreed that they will not ask an individual who is applying for insurance coverage to have a genetic test if it has not been done already.

Better control of high cholesterol levels with statins in FH is likely to lower insurance premiums.

Life Insurance Products and Genetic Testing in Australia fact sheet

*¹Predictive genetic testing refers to testing of an individual who currently does not have symptoms or signs of a condition, but who might be at an increased risk due to their family history.

*²Private health insurance is assessed on community risk and not an individual’s risk; everyone pays the same premium regardless of their health status.

The advice in this website does not replace advice from your GP or healthcare provider.