Changes to annual limits for prescription medicines.


On 1 May 2023, the annual limits for prescription medicines (pharmaceuticals) under ahm OSHC were increased.

 

What's changing?

From 1 May 2023, ahm OSHC members have access to increased annual limits when claiming towards eligible pharmaceuticals, as per the below:

 

  Effective until 30 April 2023 Effective from 1 May 2023
Member contribution (co-payment) $30*
$30*
Amount we’ll pay (maximum per item)
$50
$50
Annual limit - Single membership
$300 $500
Annual limit - Couple/Family membership
$300 per member / $600 per membership $500 per member / $1,000 per membership

The increased annual limits, less any claims with a date of service between 1 January 2023 to 30 April 2023, apply towards claims for pharmaceuticals with a date of service from 1 May 2023. The previous annual limit will continue to apply for claims with a date of service prior to 1 May 2023.

What does this mean for you?

  • If you had not yet reached your previous annual limits prior to 1 May 2023, you don't need to do anything. This change simply means you can continue to claim for eligible pharmaceuticals up to the new increased annual limit.
  • If you had already reached your previous annual limit prior to 1 May 2023, it means you can continue claiming for eligible pharmaceuticals up to the increased annual limit, provided that the date of service is 1 May 2023 or later.

How can I find out more?

An updated Cover Summary detailing the changes will be available via your Online Members Services and the ahm OSHC app by the end of May. If you have any questions in the meantime, get in touch on 134 148 between 8.00am–8.00pm Monday to Friday (AEST). 

 

 

*This amount is equal to the 2023 non-concessional PBS co-payment, which is indexed on 1 January each year. See pbs.gov.au for more information.