Are you on methadone, Suboxone, Subutex or buprenorphine?
From 1 July 2023, most people on methadone, Suboxone, Subutex and buprenorphine (opioid treatment medications) can get their medications cheaper through the Pharmaceutical Benefits Scheme (PBS) co-payment system. The cost is the same as other medications listed on the PBS and:
No extra charges for ‘consultations’, ‘administration’, ‘dosing’ or ‘dispensing’ or ‘new bottles’ can be charged at community pharmacies.
We believe most people who are on opioid treatment in Australia will be better off. For some people, there may be changes to other aspects of how they receive their medications, how often they attend a GP or clinic, or even where they get their medications. For most, there will be almost no change other than making the medications more affordable and equitable.
Your GP will need to write you a streamlined authorised script and write the information about your medications in a particular way that may be new for them.
Your GP may know how to write your script but if your appointment is soon after 1st July 2023, or your GP has very few patients on these medications, they may have trouble following the new regulations about how to write the script:
The PBS co-payment program is an Australian government program that aims to make many medications affordable by:
setting a maximum amount of money a person has to pay for PBS listed medications each year
paying the rest of the cost of the medication to the pharmacist or supplier.
Methadone, Subutex, Suboxone and buprenorphine will all be registered as Pharmaceutical Benefits Scheme (PBS) medications from 1 July 2023.
The PBS safety net is a maximum amount of money or maximum number of PBS registered medication scripts you must pay for per year.
The yearly maximum you can pay for PBS medications is:
$262.80 or about 36 scripts for people who have a concession card
$1,563.50 or about 50 scripts for people who don’t have a concession card.
Once you have paid the maximum amount of money that you are required to pay, your medication costs will be reduced to:
No money for people who have a concession card
Up to $7.30 every 28 days for people who don’t have a concession card.
The year starts on 1 January and ends on 31 December, not when you first pay for a medication on the PBS.
Each person has to be registered in the PBS registry by a GP or registered health care practitioner and you also need to register using the Safety Net prescription form and the Safety Net Card found here: https://www.servicesaustralia.gov.au/pb240.
Every PBS medication you receive counts towards the PBS safety net, even if you are paying for two different dosages of Suboxone or Subutex, or you are receiving completely different medications that are funded through PBS co-payments.
If you access all your PBS medications at the same pharmacy, the pharmacy will need your Safety Net prescription form and Safety Net card the first time you fill a script at that pharmacy.
If you go to multiple pharmacies to get your PBS medications, you will need to keep track of your medication costs by taking the form and card to each pharmacy and monitoring the costs over the year:
To keep track of your PBS spending, you need the Safety Net prescription form and a Safety Net card.
You can combine costs within your family and reach the safety net more quickly. Family can be:
Married or defacto partners
Dependent children who are younger than 16
Dependent children who are under 25 and who attend school, college or university full-time.
Is it different if I get the buprenorphine injection?
If you have been receiving the injectable form of buprenorphine (Sublocade/Buvidal) at a pharmacy, with a script from your GP, you will be charged the same 28-day fee as people who are getting methadone, Subutex or Suboxone.
That means, if you have a concession card you will pay $7.30 every 28 days, and without a concession card, you will pay $30 every 28 days.
In some cases, particularly in the first month of getting the buprenorphine injection, you may need the injection more often than every 28 days.
You will have to pay the 28-day concession or non-concession price for each new script.
If you reach the PBS safety net threshold, you receive the medication for free (concession card holders) or for $7.30 (non-concession cardholders).
At The GP Clinic
If you have been getting your injection of buprenorphine done by the GP or registered nurse at a medical clinic, you may be able to continue to do this until 30 November.
After the 30th of November, your clinic may change the options available or the cost to you for getting the injection.
This is because GPs will have to get the buprenorphine injections through a community pharmacy and providing the injection to you will require following these steps:
You attend your appointment.
Your script goes to the community pharmacy.
The pharmacy delivers the injection to the GP or the clinic.
You receive the injection from your GP in another appointment or get it from a registered nurse who is authorised to administer the injection.
If you want to continue getting the injection from a GP or nurse, you will need to be aware of the following:
You can be charged a fee for the injection of any amount they choose (something the pharmacy is not allowed to do).
You may have to have 2 appointments and if your GP does not bulk bill, you can be charged for both.
You will need to wait for the buprenorphine injection to be delivered to the GP or clinic, something which could take up to 2 days depending on whether the pharmacy has it in stock, how long it takes for the injection to get to the clinic, and how long it takes for you to be able to see the GP or nurse to administer it.
To help you prepare for any possible changes, we recommend you try to find out what to expect before your next appointment at the GP clinic.
NOTE: If a person injects the injectable buprenorphine into their vein, it will kill them.
This risk is the reason pharmacists are not allowed to give people their injectable medication to take to someone else to inject into them. It must be given directly to the GP or clinic where it will be administered by someone who has been trained to inject it correctly.
How will my scripts work?
The PBS system regulates the number of scripts and the amount of medication a GP can normally prescribe.
Under the PBS, there is a maximum number of scripts, the amount of time the scripts can be for, as well as a maximum dosage. For opioid treatment medications, the maximum is:
Three 28-day scripts of any of the medications.
A maximum dose of 150mg per day for methadone.
A maximum dose of 32mg for buprenorphine, Subutex or Suboxone.
Your GP will need to provide you with a PBS streamlined authorised script with specific information about your doses written on the script:
What if I am on a high dose or have extra scripts?
The PBS has guidelines about how medications are prescribed, mainly things like how high a dose a person can receive of each medication.
For methadone, the higher limit is 150mg per day
For Suboxone and Subutex, the higher limit is 32mg per day.
If your script fits within these ‘normal’ limits, your GP can easily write it with the addition of an ‘Authority’ identification:
This is known as a streamlined ‘Authority’ script and GPs do this with all PBS medications.
If your script doesn’t fit within these limits, for example, you are on a higher dose or you are starting on the program and need to see your GP twice or more often for those on the 1 weekly buprenorphine injections, there are some differences including:
Your GP may have to get a ‘PBS Authority’ script rather than a normal ‘streamlined’ Authority script by calling or contacting the committee to get permission.
You may have to pay for more than 1 script in the 28-day time period.
Anyone who has to pay for more than 1 script should not be required to do that on a regular basis without there being an extremely good reason.
Attending private clinics and non-PBS dosing sites
Private ODT clinics are mainly available in NSW and Queensland. The main differences between them and public clinics, community pharmacies and hospital pharmacies are:
These are privately owned and operated and don’t receive government funding for people in who need free or enhanced access to opioid treatment.
They usually have GPs, pharmacists and other staff on site and no access to medications other than opioid treatment medications.
The money that funds their services comes from the people accessing opioid treatment medications; for example, client-paid dosing and administration fees, Medicare rebates from GP appointments GP and sometimes additional tests clients undertake that also incur Medicare rebates such as hepatitis testing and urine drug screen tests.
Private clinics are not community pharmacies and are not eligible for funding through the PBS from 1st of July 2023.
Private clinics will continue to be provided access to free opioid treatment medications until 30 November, so that there is time to transition to one of the following:
Become an approved PBS supplier.
Find a business model that will allow them to continue operating a for-profit private service.
Help their clients find alternative places to access opioid treatment through GPs and community pharmacies.
The options for private clinics to continue operating after 30 November include:
Applying for approval to become PBS approved suppliers and following the same PBS regulations relating to opioid treatment prescribing and dispensing as other community pharmacies.
Passing on the cost of the medications to the people on the program along with the other costs people currently pay.
Absorbing the cost of the medications without passing it on to consumers.
Attending public clinics
Public clinics are available in every state and territory of Australia except Victoria.
People who attend public clinics where they receive free dosing will not experience any change after 1st of July 2023.
Public clinics usually provide methadone, Subutex, Suboxone and buprenorphine free of charge.
Most public clinics have a limited number of places available and prioritise who can attend them, so that you have to meet criteria to attend, such as being:
New to the program.
Recently released from prison.
Not allowed to access other dosing points.
In some other way difficult to place in a community pharmacy.
Many of these public clinics are restrictive in other ways so that they may:
Have limited opening hours.
Not allow takeaway doses.
Dosing in prisons and other correctional settings
The Australian government has committed to continuing to fund the provision of methadone, Suboxone and buprenorphine to people in prisons in the same way as they have been.
Each state and territory has regulations relating to opioid treatment for people who are in prison.
This means, if the prison or correctional centre allows it, opioid treatment medications will continue to be provided to people in it following the regulations of that state or territory.
What can you do if you have problems with your community or hospital pharmacy or pharmacist?
Try to remain calm and polite or walk away and ask for support from someone who can negotiate on your behalf.
This is especially important if you feel like you have had problems discussing issues with your pharmacist in the past.
Most states and territories in Australia have services and support to help you:
Learn about and change to the new system
Advocate or report issues with your GP or pharmacy.
Most states and territories in Australia have services and support that can help you
State or Territory
Drug User Organisation
Australian Capital Territory
Canberra Alliance for Harm Minimisation and Advocacy (CAHMA): (02) 6253 3643
Health Services Commissioner (02) 6205 2222
New South Wales
NSW Users and AIDS Association (NUAA): (free call) 1800 644 413
Health Care Complaints Commission (free call) 1800 043 159
Northern Territory AIDS and Hepatitis Council (NTAHC): (08) 8944 7777
Health and Community Services Complaints Commission(free call) 1800 004 474
QuIHN: (free call) 1800 172 076 or (07) 3620 8111 Alcohol & Drug Information Service (ADIS) 24/7 Support (free call) 1800 177 833 or (07) 3837 5989
Office of the Health Ombudsman 133 646
Hepatitis SA Clean Needle Program Peer Projects: (free call) 1800 437 222 or (08) 83628443
Health and Community Services Complaints Commissioner (free call) 1800 232 007 or (08) 71179313
Health Complaints Commissioner (free call) 1800 001 170
Harm Reduction Victoria (HRVic)/Pharmacotherapy Advocacy Mediation Service (PAMS): 1800 443 844
Health Complaints Commissioner 1300 582 113
Peer Based Harm Reduction Western Australian (PBHRWA): (08) 9325 8387 Community Program for Opioid Pharmacotherapy (CPOP): (08) 9219 1907
Health and Disability Services Complaints Office (free call) 1800 813 583 or (08) 6551 7600
These terms refer to the injectable form of buprenorphine, that is provided in a modified release injection. Any of these terms include any form of buprenorphine including: Buvidal or Sublocade 7-day or 28-day formulations.
Community and hospital pharmacy
Community and hospital pharmacies provide PBS medications regardless of who owns or operates them. If you get your opioid dependence treatment medication at a pharmacy that provides a range of other medications to the public, it is most likely this is a community or hospital pharmacy that will be legislated from 1 July to use the PBS co-payment system to provide your medications and not charge you any other additional costs.
Department of Health and Aging
The Commonwealth or Federal department that governs and funds health related services in Australia including the PBS and the new costs being provided for ODT medications.
General practitioner (GP)
We have used the term general practitioner or GP to refer to doctors that provide ODT scripts at medical clinics and community health services in the community. We also understand there are Nurse Practitioners and Addiction Medicine Specialists involved in ODT prescribing.
Methadone refers to oral liquid methadone prescribed under the S100 guidelines for opioid dependence which includes: Methadone Syrup Biodone.
Opioid dependence treatment (ODT) program or opioid treatment
There are many different terms for what we have called opioid dependence treatment (ODT) or opioid treatment. These terms refer to the program that regulates the use of methadone, Subutex, Suboxone and buprenorphine for people who are prescribed these medications. There are strict guidelines for how GPs may prescribe, and pharmacists deliver ODT medications to people in the community and in other settings such as prisons.
Opioid dependence treatment (ODT) medications or opioid treatment medications
Opioid medications or opioid dependence treatment (ODT) medications refers only to the medications used for opioid dependence in Australia. They include methadone, Subutex, Suboxone, and buprenorphine (injectable form).
Pharmaceutical Benefits Scheme (PBS)
The Pharmaceutical Benefits Scheme (PBS) is a commonwealth (national) government system that aims to make some of the most essential medicines affordable to Australian people. Not all medications are included on the PBS.
Pharmaceutical Benefits Advisory Committee (PBAC)
The Pharmaceutical Benefits Advisory Committee (PBAC) is the governing body of the PBS. The committee is made up of a range of people expert in medicine, health, health economics and consumers. Its main role is advising on which medicines should be added to the PBS. It also contains sub-committees that have roles including providing authority to prescribe a PBS medication outside the limits normally prescribed by the PBS regulations.
Private clinics are mainly found in NSW and Queensland (southern region of Queensland). If you see your GP and get your medication and you pay a fee at the same clinic or location, and this location provides no other types of medications to the general public, you are probably attending a private clinic.
Most states and territories in Australia (apart from Victoria) have public clinics that provide ODT medications to people in the community. They are usually provided free to the person, may be required for people starting on the program, or it may be difficult to get a place in them with places available mainly for people considered a priority such as pregnant women or people recently released from prison.
Suboxone is a film containing buprenorphine and naloxone and is available in a: 2mg sub-lingual film 8mg sub-lingual film.
Subutex is a tablet containing only buprenorphine and is available in a: 2mg sub-lingual tablet 8mg sub-lingual tablet.
Opiate Pharmacotherapy Program- A public program located at the Royal Darwin Hospital for opiate dependant people. The only OPP in Darwin. We have no doctors to refer on to for treatment. Open 6 days a week between 9am and 11:55am. Clinic times are strictly enforced.