Can you claim for weight loss drugs on your Extras cover?

Last year, more than 30% of HIF’s pharmacy benefit claims were for weight loss medications. They’re big news, especially with Health Minister Mark Butler’s commitment to listing the weight loss drug ‘Wegovy’ on the Pharmaceutical Benefits Scheme (PBS).  

But are other weight loss drugs available on the PBS? And can you claim for weight loss medications on your Extras cover? Let’s talk about it.  

What is the PBS, and who is eligible to claim from the PBS? 

The Pharmaceutical Benefits Scheme is an Australian Government program that provides subsidised prescription medicines, so Australian residents can reliably access a wide range of medicines at an affordable price.  

To receive a PBS co-payment, you need to have both: 

• A Medicare card (or Commonwealth concession card) 
• A valid prescription for a PBS-listed item.  

Recent changes to the maximum cost of PBS medications. 

On 1 January 2026, the maximum cost of PBS prescription medicines reduced from $31.60 to: 

• $25.00 for Medicare cardholders  

• $7.70 for concession cardholders  

For Medicare cardholders, the cost of prescriptions will continue to be adjusted in line with the consumer price index each year – but the $7.70 cost for concession cardholders is frozen until 1 January 2030.  

Which weight loss drugs are currently covered by the PBS?  

Several medications have been approved by the Therapeutic Goods Administration (TGA) for the treatment of obesity in Australia – but none currently have a PBS subsidy available when prescribed specifically for weight management.  

For example, Ozempic (Semaglutide) only has a PBS subsidy available when prescribed to treat patients with type 2 diabetes. So, having a prescription solely for weight management won’t automatically make you eligible for a subsidised cost. 

What’s happening with Wegovy? 

While Health Minister Mark Butler has committed to listing the weight loss drug Wegovy on the PBS, the Pharmaceutical Benefits Advisory Committee recommends a “slow and managed” roll-out. 

Basically, the subsidy won’t automatically be available to everyone – at least, not at first.  

The initial roll-out would prioritise high-risk groups, such as patients with an established cardiovascular disease. There is also no clear timeline for when the drug will be listed.  

Can you claim for weight loss medications from HIF?  

Yes – if your Extras benefits include Pharmacy cover.  

However, these regulations from the Australian Government apply:  

• Benefits can only be paid on non-PBS prescription items.  

• Benefits cannot be paid on over the counter items purchased with or without a prescription. 

• The cost of the item must exceed the current PBS co-payment. 

• You must match the current PBS co-payment before receiving a Pharmacy benefit from HIF – so if the cost of your item was less the PBS amount, then a benefit cannot be paid.  

How much can I claim on my HIF Pharmacy cover? 

• If you have HIF’s Value, Essential, Advanced, or Top Extras:

You can claim a maximum benefit of $80.00 per script item, up to your annual limit. 

• If you have HIF’s Simple Extras:

You can claim 60% of the cost, up to your annual limit. 

 Compare HIF Extras to learn more about the services and benefits included on every level of cover. 

Have a different question about claiming Pharmacy benefits? 

Send an online claim enquiry.  

We’re happy to provide Extras benefit estimates or answer any other questions you have about claiming. Just send the details via our online form, and we’ll get back to you as fast as we can!