Prescriptions and medications. What can I claim?

Prescription claiming. Photo of a man taking a pill from its packaging.

Prescriptions and medications. What can I claim?

We all know that the cost of prescription medications can add up.

That’s why it’s great to know that you may be covered for some of those high-cost prescription medications (medicines, vaccinations and injections) under your Extras cover.

Your RT Health Cover Guide is a good place to start when checking in to see what you’re covered for. Your benefit and benefit limit will be listed under ‘Pharmaceuticals’.

What can I claim?

There are a few things to know about claiming prescriptions and medications (once you’ve served any waiting periods). We’ve listed a few here for you.

So you can claim a benefit for your prescribed medication, it must:

  • Be prescribed to you by a registered medical practitioner in Australia
  • Be a S4 or S8 medication (that means it’s a prescription-only medicine)
  • Be purchased in Australia and approved by the Therapeutic Goods Administration (TGA)
  • Not already subsidised under the Pharmaceutical Benefits Scheme (PBS).  The PBS is a government program that subsidises medicines to make them cheaper. 
  • Cost more than the current PBS co-payment amount of $31.60 per item purchased (the amount set by the government for 1 January to 31 December 2024).

We’ll pay a benefit on your script costs on non-PBS items (after you’ve paid the PBS patient co-payment amount of $31.60). The amount you get back will depend on your level of cover.

What can’t I claim?

It’s also important to know there are medications you can’t claim (and the reasons why). RT Health can’t pay benefits on:

  • Over-the-counter medications that you can buy without a prescription
  • Medicines and pharmaceuticals listed on the PBS
  • Prescriptions and medications that cost less than the PBS amount of $31.60 (the amount set by the government for 1 January to 31 December 2024).
  • Items not prescribed, dispensed and/or purchased in Australia.
  • Pharmaceuticals not approved by the TGA for supply or sale in Australia.

Tips for quick claiming

There are a couple of things that will make paying your claim for pharmaceuticals and prescription medications easier.

  • Send us your Official Pharmacy Receipt with your claim. This is a more detailed receipt provided by your chemist/pharmacist that we need to make sure your claim is payable. Just ask your pharmacist for one when you fill your script. We need this receipt to pay your claim (we’re not able to accept register receipts, packaging or scripts when assessing your claim).
  • Not sure you can claim? We’re here to guide you. If you need some info on how and what you can claim, just give us a call on 1300 886 123 or send a quick email to help@rthealth.com.au
  • Use our app. Making claims on the app is quick and easy. Find out more here.