Maximising Bang for Buck in managing your diabetes

Understanding the PBS

Firstly, let’s look at prescriptions and pharmacy costs.

In Australia we are lucky to have the pharmaceutical benefits scheme (PBS). This scheme gives Australians who hold a current Medicare card access to many prescription medicines at a reduced cost. The government pays for some, and you pay a smaller amount, called a co-payment.

The maximum co-payment for medicines is usually $31.60. However, some medicines are considered a premium brand, so the co-payment costs a bit more.

This extra amount occurs when there are two or more brands of the same medicine available. The Government subsidises each brand to the same amount (the cost of the lowest priced brand). The additional cost of the more expensive brand is passed onto the consumer (you).

The extra charge does not mean there is any difference in quality between brands – just that one brand is charging more than the other.

Next time you visit your pharmacist ask about less expensive brands of your current medications. You can then speak with your doctor about prescribing these cheaper brands next time you need a script.

Concession cards can also reduce the cost of medicines. If you have a concession card such as a health care card your co-payment for medicines is reduced to $7.70. Current concession cards accepted for reduced co-payments include:

• Pensioner Concession Card
• Commonwealth Seniors Health Card
• Health Care Card
• Repatriation Health Card (benefits available dependant on colour – gold, white or  orange)
• Safety Net Concession Card or Safety Net Entitlement Card — issued by Services Australia.

Look on the government websites to see if you meet the eligibility requirements for these cards.

The table below shows the non-subsidised and subsidised costs of some common diabetes medications. 

These prices may vary slightly between suppliers.

PBS Safety Net

The PBS scheme has additional support for people who spend a lot on PBS medicines during a calendar year – called the PBS Safety Net. When you reach an annually adjusted threshold, you can apply for a PBS Safety Net Card. This card lets you get cheaper medicine for the rest of the year. To access the PBS Safety Net, you will need to keep a record of how much you’ve spent on PBS medicines during the year or ask your pharmacist to provide this information to you.

On 1 January 2024, the PBS Safety Net thresholds were updated to:

• $1,647.90 for general patients and
• $277.20 for concession card holders

Once you reach the threshold, and receive the PBS safety net card, your medicine will then either:

• cost up to $7.70 for general patients.
• be free for concession card holders.

Medicare Safety Net program

This program supports people who spend a lot of money on all their health care. Once you have spent up to a certain amount on out-of-hospital medical appointments or tests, you will get more money back from Medicare than you normally would for these expenses.
The program supports singles, couples and families and allows the pooling of expenses within immediate family members. So, if you are a couple, or a family, you can register as a family to combine your costs. This means you’re more likely to reach the thresholds sooner. Even if all family members are on the same Medicare card, they still need to register as a family unit with Medicare. However, this only needs to be done once.

You can check your current threshold amount through your MyGov account if it has been linked with your Medicare account.

Below is a table listing this years’ Medicare Safety Net thresholds:

60-day Scripts Program

This is another way to save money on medicines. This program allows people to buy a 60-day supply of selected PBS-listed medicines in a single visit for the cost of a single prescription. Unfortunately, diabetes medications are not included in stage 1 of this program. However, blood pressure and cholesterol medications are included. Medications to be included in stages 2 and 3 of this program have not yet been published.

Insulin Pumps

For people living with type 1 diabetes, private health insurance can help off-set the cost of an insulin pump. Without private health insurance an insulin pump can cost $2000 per year for some pumps or an outright purchase of $5,000-$10 000 for others.

Health insurance providers cover insulin pumps as part of their prosthetics cover, however you need to get the right kind of policy in place. This is not necessarily the most expensive plan. With private health insurance the out-of-pocket cost for an insulin pump is usually reduced to the medical excess amount quoted in your policy.

However, before taking out private health insurance to help cover the cost of an insulin pump, it is recommended you discuss your suitably for insulin pump therapy with your health care team. Also be aware that 12 month waiting periods are usually applied to new customers without previous and ongoing private health insurance policies.

If private health insurance cover is not an option for you, speak with your diabetes team about other funding options such as the Insulin Pump Program (IPP) .

The National Diabetes Services Scheme (NDSS) - General

Being registered with the NDSS is another cost saving service available to all people living with diabetes. The NDSS subsides the following products:

• Blood glucose test strips
• Needles
• Syringes

The table below shows the prices of these supplies before and after the NDSS subsidy is applied.

The NDSS also provides access to free educational programs. These are delivered in different formats: face-to-face, virtually and through self-paced modules.

Click to link to access NDSS programs

NDSS - Continuous Monitoring (CGMs) and Pump consumables

For people living with type 1 diabetes the NDSS subsidises the cost of continuous blood glucose monitoring (CGM) consumables and pump consumables.
CGM systems are fully subsidised (no co-payment is required) for:

• Children and young people under 21 years of age 

• People with a valid concession card​

• Women with type 1 diabetes during pregnancy planning, pregnancy and up to 3 months after pregnancy

• Children and young people under 21 years of age with conditions similar to type 1 diabetes

 A co-payment of $32.10 per month is required for all other people living with type 1 diabetes.

​Trialling a continuous glucose monitor

A tip for people wanting to trial a continuous glucose monitor at a reduced price. As of the time of writing this article, Abbott is providing a 14-day trial of the FreeStyle Libre Continuous Glucose Monitoring (CGM) system for $15, with no additional postage costs, valid until March 31. AMSL is also offering a 30-day trial of the Dexcom G6 CGM at a cost of $32.10. It's important to note that both of these promotions are exclusive to new customers.

Medicare Chronic Disease Management Plan

These plans can help people with diabetes see allied health professionals at a discounted rate.  They can include access to diabetes educators, dietitians, podiatrists and exercise physiologists and the mix of allied health services you wish to use is up to you.

The plan provides for 5 appointments per calendar year at a subsidised cost.

Visit you GP to start a diabetes management plan and discuss which combination of health service would best suit your needs.

We are very privileged in Australia to have all of these services and subsidies aimed at reducing the financial burden of managing diabetes. In fact, research shows Australians pay substantially less for medications than residents of countries such as America, Canada, and the UK.

Always remember to consider your own situation and make choices that are both within your budget and take into consideration your current health needs. Consider doing an annual review of your health requirements, expenditures, and accessible subsidies. This ensures optimal use of available subsidies, allowing you to get the most value for your money while making your health a priority.

*All information correct at time of publication, Feb 2024.