Restricted, unrestricted, and authority benefits
The three PBS benefit categories — what they mean for prescribers and patients, with real-world examples and the consequences of prescribing outside criteria.
The three PBS benefit categories
Unrestricted benefit
Subsidised for any clinically appropriate indication. The prescriber does not need to state the reason for prescribing on the prescription. Pharmacist can dispense without querying the indication.
Examples: paracetamol (500 mg), metformin, salbutamol inhaler, omeprazole (certain doses), atorvastatin (some doses).
Restricted benefit
Subsidised only for specified clinical indications. The prescriber certifies on the prescription that the patient meets the restriction criteria. No prior approval needed, but the prescriber bears responsibility for compliance.
Examples: rosuvastatin for documented hypercholesterolaemia, pregabalin for neuropathic pain, esomeprazole for erosive oesophagitis.
Authority required
Subsidised only with prior approval from Services Australia. The prescriber must obtain an authority number (via streamlined code, telephone, or written application) before the pharmacist can process the PBS claim.
Examples: adalimumab (biologic DMARD for RA), lecanemab for early Alzheimer's, growth hormone for paediatric growth deficiency.
Examples across the three categories
| Medicine | Benefit type | PBS indication / restriction | Prescriber |
|---|---|---|---|
| Salbutamol inhaler | Unrestricted | Any (asthma, COPD, bronchospasm) | Any eligible PBS prescriber |
| Rosuvastatin | Restricted | Documented hypercholesterolaemia with CV risk criteria | Any eligible PBS prescriber |
| Metformin | Unrestricted | Any | Any eligible PBS prescriber |
| Adalimumab (Humira) | Authority required | RA, PsA, AS, Crohn's — strict clinical criteria, DMARD failure for initiation | Specialist (rheumatologist, gastroenterologist, or dermatologist for certain indications) |
| Pregabalin (Lyrica) | Restricted | Documented neuropathic pain or epilepsy | Any eligible PBS prescriber |
| Leuprolide (Lucrin) | Authority required | Endometriosis or prostate cancer with specific staging criteria | Specialist (oncologist, gynaecologist) |
Restrictions change — always check the current PBS Schedule ↗ before prescribing.
Prescribing outside PBS criteria
If a prescriber writes a PBS prescription for an indication that does not meet the restriction or authority criteria, the prescription is not eligible for PBS subsidy. The patient must either:
- Pay full private price — the prescriber should write a private prescription and the patient pays the full dispensed price (which may be significantly higher than the PBS co-payment).
- Seek an alternative PBS-covered medicine — another drug in the same class may have a broader unrestricted listing that covers the indication.
- Apply under compassionate access — for high-cost specialised medicines, some manufacturers or institutions have patient access programs.