Medications used for weight loss

Currently, Top Extras lets you claim more than the Pharmaceutical benefit (which is a maximum of $60) for certain high-cost medications.

From 10 October 2025, this ‘high-cost benefit’ will no longer be paid for medication used for weight loss (eg. Ozempic, Mounjaro and Wegovy). Instead, the $60 benefit will apply.

While we recognise this impacts the way you may manage the cost of these medications, it does enable you to claim your $800 annual limit throughout the year, instead of using it up in a few purchases.

This is a higher payment than the $60 benefit for Pharmaceuticals. We pay it for medication that costs more than four times the Pharmaceutical Benefits Scheme (PBS) co-payment amount.

If you have Top Extras, you may be able to claim for prescribed medications that aren’t PBS subsidised. This includes those used for weight loss such as Ozempic, Mounjaro or Wegovy.

Medications that are prescribed (and approved) for treating conditions like diabetes are subsidised by the PBS, so you can’t claim for these using your Extras.

You can continue to claim under the Pharmaceutical benefit for eligible medication.

The change applies to all non-PBS subsidised medicines that are used for weight loss. Some common examples include Ozempic, Wegovy and Mounjaro.

You’ll need to provide an official receipt or pharmacy invoice. You can ask your pharmacist for one when you pick up your meds.

To claim, you can submit a photo or copy of your receipt via the My Teachers Health app or Online Member Services. Or complete a claim form and send it to us:

• By email: submitclaim@teachershealth.com.au
• By post: Teachers Health, GPO Box 9812, Sydney NSW 2001

For Pharmaceutical claims, we cover the cost of the medication – minus the relevant PBS co-payment - up to a maximum of $60 per purchase. You pay the balance of the cost (if any).

In this case, the PBS co-payment is $31.60, we pay a benefit of up to $60 and you pay the rest.

The yearly Pharmaceutical limit is $800.

Your cover is designed to support your health in many ways. That includes help for weight management and looking after your wellbeing. Here are a few more ways you can use your cover: