Tips to cut your diabetes costs

Pharmaceutical Benefits Scheme

Firstly, let’s look at prescriptions and pharmacy costs as part of the overall health costs associated with diabetes. In Australia we 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, and the co-payment will be a bit more. This extra amount is paid to the supplier of the specified brand (not the pharmacy or the government).

This extra amount occurs when there are 2 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.

Tip:

Next time you visit your pharmacist ask about less expensive brands of your current medicines. You can then speak with your doctor about prescribing these cheaper brands next time you need a script. This will lessen the health costs associated with diabetes.

Concession cards

Concession cards can also reduce the cost of medicines. If you have a concession card such as a Centrelink 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
• Centrelink 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

Tip:

Look on the various 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 medicines.

Medication	Full Cost	PBS subsidised cost
Metformin	$37	$16
Insulin:  Novorapid, Humalog  Optisulin Ryzodeg	$167 per box  $186 per box  $380 per box	$31.60 $31.60 $31.60
Ozempic	$134	$31.60
Gliclazide	$18	$18
Jardiance or Forxiga	$59	$31.60
Trajenta	$59	$31.60

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/s 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 medicine/s during the year or ask your pharmacist to provide this information to you.

On 1 January 2024, the PBS Safety Net thresholds were increased 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, especially when you take into consideration the health costs associated with diabetes. 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.

Tip:

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:

Thresholds	Threshold amount	What counts towards the threshold	What benefit you’ll get back
Original Medicare Safety Net	$560.40	Your gap amount for the calendar year.	100% of the schedule fee for out of hospital services.
Extended Medicare Safety Net -General	$2544.30	Your out of pocket amount for the calendar year.	80% of out of pocket costs
Extended Medicare Safety for concession card holders	$811.80	Your out of pocket amount for the calendar year.	80% of out of pocket costs or the EMSN benefits caps for out of hospital services.

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 medicines are not included in stage 1 of this program. However, blood pressure and cholesterol medicines are included. Medicines to be included in stages 2 and 3 of this program have not yet been published.

Tip:

Ask for a 60 day script if you are taking blood pressure and/or cholesterol medicines.

Ambulance Cover

Ambulance cover is another important consideration when looking at health costs in general and the health costs associated with diabetes. In Victoria emergency transport within metropolitan areas is over $1300 per trip. These fees are even higher in rural areas. Getting ambulance cover could save you a lot of money if you do need emergency transport. If covered and you need emergency transport you will not be charged a fee for this service.

In Victoria ambulance cover can be purchased either through Ambulance Victoria membership or some private health insurers who include automatic cover for emergency ambulance services with their hospital and extras products. This is not all private health insurers so always check the insurer’s policy. (Centrelink Health Care Card holders have no cost access to ambulance cover).

Tip:

Check whether your Ambulance cover is up to date.

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 $2,000 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.

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.

The Australian Government’s Insulin Pump Program (IPP) can also assist young Australians up to the age of 21 living with type 1 diabetes who may benefit from an insulin pump. Visit JDRF for more information about their insulin pump program.

Tip:

Before taking out private health insurance to help cover the cost of an insulin pump, it is recommended you discuss your suitability for insulin pump therapy with your health care team.

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 subsidises 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.

Product	Cost with no subsidy	Cost with NDSS subsidy
Insulin Pen needles	$17-$29	$0
Syringes	$29	$0
Blood test strips	$24 – $69	$15 ($0-$1.20 with concession)

Tip:

Check that you are registered with the NDSS.

NDSS - Continuous Glucose Monitoring (CGM) and Insulin Pump Consumables (IPCs)

For people living with type 1 diabetes the NDSS subsidises the cost of continuous blood glucose monitoring (CGM) consumables and insulin pump consumables (IPCs).

​Trialling a CGM

Tip:

For people wanting to trial a continuous glucose monitor at a reduced price: Abbott are offering a 14-day trial of the FreeStyle Libre CGM for $15 (no postage costs) until March 31 and AMSL currently have a 30-day trail of the Dexcom G6 CGM for $32.10. Both offers are available for new customers only.

Medicare Chronic Disease Management Plan

These plans can help people with diabetes visit allied health professionals at a discounted rate, therefore lessening the health costs associated with diabetes. They can include access to diabetes educators, dietitians, podiatrists and exercise physiologists. The mix of allied health services you wish to use is up to you and always check with them up front about their fees and out of pocket costs.

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

Tip:

Visit your GP to start a diabetes management plan and discuss which combination of health services would best meet your needs.

Victorian Government Concessions Guide

The Victorian Government offers concessions to make essential services – rates, water, electricity and gas – more affordable for low-income households and to help with bills in times of hardship. Concessions are also available on health, education, transport and other services for eligible people and families.

The Guide is available here. 

National Debt Helpline

The National Debt Hotline is a not-for-profit service that helps people deal with their debt problems. Visit here for more information.

Final tip:

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 conducting an annual review of your health requirements, expenditures, and accessible subsidies. This ensures optimal utilisation of available subsidies, allowing you to get the most value for your money while prioritizing your overall health.

Diabetes Victoria Advocacy Services Team

If you have any further questions or would like to speak to a member of the Diabetes Victoria advocacy services team, please call the NDSS Helpline on 1800 637 700 or send an email to advocacy@diabetesvic.org.au.