Upcoming changes to Pharmacy coverage

As at 9 July 2024, HBF will be removing and reducing benefits for certain non-PBS pharmaceuticals under extras covers.

What is changing with Pharmacy on HBF extras?

At HBF, we regularly evaluate our health insurance products, their coverage, and how they compare to industry standards to ensure that we can continue to provide sustainable and high-value coverage for all our members.

As a result of a recent review, changes will apply to the benefits payable under Pharmaceutical (non-PBS) on our extras covers as at 9 July 2024.

Medication impacted
No benefits will be payable for these pre-manufactured medications.
  • Saxenda
  • Contrave
  • Duromine
  • Wegovy
  • Other medication listed on the Australian Register of Therapeutic Goods (ARTG) with an approved use of weight management/reduction
No benefits will be payable for compounded medications containing any of these active ingredients.
  • Semaglutide
  • Estradiol
  • Minoxidil
  • Liraglutide
  • Tadalafil
  • Finasteride
  • Phentermine
  • Alprostadil
  • Drospirenone
  • Naltrexone hydrochloride and Bupropion hydrochloride (when compounded together)
Benefits will be reduced for pre-manufactured medications containing any of these active ingredients. The new benefit will depend on the level of cover you hold.
  • Semaglutide
  • Dulaglutide
  • Exanatide
  • Liraglutide
  • Tirzepatide

Refer to the FAQ section below for details on this change.


Why is my cover changing?

Our priority is to remain a sustainable, member-focused organisation that continues to provide affordable and valuable health insurance products for all our members.

As the health insurance market changes over time, we need to continuously review and assess the range of products we offer and the coverage they provide.

Our recent review has shown that our extras pharmaceutical coverage needs to change to remain sustainable and keep future premium increases to a minimum.

If benefits are being removed for my medication, what other options do I have?

HBF will no longer pay benefits for this medication. If you need this medication, we recommend that you speak to your healthcare provider about what options you have.

Will these changes impact my premium?

There will be no changes to your premium as a result of these changes.

If you have affordability concerns, please give us a call on 133 423. We'll be happy to talk to you about your health cover options and what is right for you.

What should I do if I have just commenced a course of treatment plan from my doctor?

If you were already undergoing an ongoing course of treatment, as at 1 May 2024, with any medication that has been impacted by this change, your benefits for the medication will not change until 1 August 2024.

You can use this time to have prescriptions filled for your course of treatment, and we will honour your current benefits for medications dispensed up to this date, subject to your annual limit. 

If you were not already undergoing a course of treatment as at, 1 May 2024, the changes for your medication will be effective as of 9 July 2024. 

What is compounded medication?

Compounded medications (also known as extemporaneous) are custom-made by a pharmacist for a unique requirement, for example, customising the strength, altering its form to make it easier to ingest, or adding flavour to make it more palatable.

The intent of compounding is to meet an individual's clinical needs where a commercially manufactured medicine is not suitable.

What is a pre-manufactured medication?

Pre-manufactured medications are pharmaceutical drugs that are readily available for distribution and use once prescribed by your GP. Pre-manufactured medication  is produced in standardised doses and forms.

In Australia, all pre-manufactured medication must be approved by the Therapeutic Goods Administration (TGA) after being evaluated for quality, safety, and efficacy for its indicated use.

What will my benefit be reduced to?

Benefits will be reduced for Semaglutide, Dulaglutide, Exenatide, Liraglutide and Tirzepatide on all extras covers that include Pharmaceuticals (non-PBS), the new benefit depends on your selected level of cover.

  • If you hold Top 70, your benefits will be reduced to 70% of the fee, after the co-payment. 
  • If you hold Complete 60 or Flex 60, your benefits will be reduced to 60% of the fee, after the co-payment.
  • If you hold any other HBF extras cover, your benefits will be reduced to 50% of the fee, after the co-payment.

All other medications will remain at your current benefit amount. 

Will there be an impact to how I get paid my benefit during the grace period?

The way you submit your claim is not changing. However, it may take longer for you to receive your benefit. During the grace period, for each claim that we pay, you may see two amounts on different days that equal your full benefit.