Understanding the PBS and how to stay eligible for PBS-subsidised RINVOQ

What is the PBS?

The Pharmaceutical Benefits Scheme (PBS) is an Australian Government program that enables all Medicare card holders and other eligible Australians to have affordable access to the medicines they need. This means that you only pay a small amount rather than the full cost of the medicine.

To remain eligible to receive RINVOQ subsidised by the PBS, there are certain criteria that you and your doctor must meet.

There are two really important things that you need to do:

1. Take RINVOQ as prescribed by your doctor
2. Get your prescriptions filled at the right time to ensure you don’t run out of RINVOQ. If for any reason you feel you need to change or stop taking RINVOQ, consult your prescribing doctor as it may affect your eligibility to continue with RINVOQ on the PBS.

You will need to be assessed by your doctor after your initial treatment with RINVOQ

To keep getting RINVOQ, you will need to fulfil certain PBS requirements.¹

One of these requirements is to show ‘adequate response to treatment’¹, which means you need to be assessed by your doctor a certain number of weeks after starting RINVOQ.

What you need to do for your subsequent appointments?

For your subsequent appointments you will need to have some tests done. Most tests are likely to be completed during your appointment, but your doctor may ask you to get some tests done beforehand. If your doctor asks for any tests beforehand, make sure you allow enough time before your appointment. Don’t forget to take any results along with you. Your doctor will need these results to complete your assessment.

Without all the necessary test results, it’s hard for your doctor to show how you are responding to RINVOQ. If the doctor can’t provide this information to the Government at the correct time, it may risk your eligibility to continue getting PBS-subsidised RINVOQ.

Staying eligible for continuing treatment

After assessing your initial response to RINVOQ, your doctor will send your tests and examination results to Medicare. If you qualify, you will receive a ‘continuing treatment’ script for an additional period of time and from then on you will need to be assessed every 6 months to continue to qualify for subsidised RINVOQ.

Reference: 1. The Pharmaceutical Benefits Scheme. Available from: pbs.gov.au. Accessed: August 2025 AC-005092-00. AU-RNQ-250048. August 2025.