National Health Act 1953 - Amendment determinations under sections 85, 85A and 88 - pharmaceutical benefits (No. PB 119 of 2009)

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Legislation au F2009L04557 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

INSTRUMENT NUMBER PB 119 OF 2009

NATIONAL HEALTH ACT 1953

DETERMINATIONS UNDER SECTIONS 85, 85A and 88

 

Purpose and operation

Part VII of the National Health Act 1953 (the Act) is the legislative basis of the Pharmaceutical Benefits Scheme (PBS) by which the Commonwealth provides reliable, timely, and affordable access to a wide range of medicines for all Australians.

Subsection 85(1) provides that benefits are to be provided by the Commonwealth in accordance with Part VII in respect of pharmaceutical benefits.

Drugs and medicinal preparations to which Part VII applies are declared by the Minister by legislative instrument to be so under subsection 85(2).  These are listed drugs as defined in subsection 84(1).  Part VII also applies to certain extemporaneously-prepared medicinal preparations as a result of declarations under paragraph 85(2)(b).

Subsection 85(3) authorises the Minister by legislative instrument to determine by reference to strength, type of unit, size of unit, or otherwise, the form or forms of a listed drug.

Subsection 85(5) authorises the Minister by legislative instrument to determine the manner of administration of a form of a listed drug where the form has been determined under subsection 85(3).

Subsection 85(6) authorises the Minister by legislative instrument to determine a brand of a pharmaceutical item.  A “brand” is defined in subsection 84(1) to mean the trade name which the person who is or will be the “responsible person” supplies the pharmaceutical item,  or if there is no trade name, the name of the responsible person.  The responsible person for a brand of a pharmaceutical item is determined by the Minister by legislative instrument under section 84AF.

Subsection 85A(2) authorises the Minister to determine various matters with respect to the writing of prescriptions by persons included in a specified class of persons for the supply of a pharmaceutical benefit.  Paragraph 85A(2)(a) authorises the determination of the maximum quantity or number of units that may in one prescription be directed to be supplied for all purposes or for a particular purpose.  Paragraph 85A(2)(b) authorises the determination of the maximum number of occasions in which the supply may in one prescription be directed to be repeated for all purposes or a particular purpose.  Paragraph 85A(2)(c) authorises the determination of the manner of administration that may in a prescription be directed to be used. 

Section 88 provides for various matters relating to the prescribing of pharmaceutical benefits.  Subsection 88(1A) authorises the Minister to determine the pharmaceutical benefits for the supply of which a dental practitioner is authorised to write a prescription.

This instrument determines matters under subsections 85(3), 85(5), 85(6), 85A(2), and 88(1A).    

This legislative instrument in giving effect to recommendations of the Pharmaceutical Benefits Advisory Committee (PBAC) amends determinations under sections 85, 85A and 88 made by legislative instrument number PB 114 of 2008 which came into effect on
1 December 2008.  The amendments provide for changes to the names, forms, manners of administration, and brands of listed drugs on the PBS and the conditions for prescribing pharmaceutical benefits.  The amendments are set out in the items of Schedule 1 to the instrument.

A provision-by-provision description of the instrument is contained in the Attachment.

This instrument, expressed to commence on 1 January 2010, was made on 4 December 2009.

Consultations

The involvement of interested parties through the membership of the PBAC constitutes a formal and ongoing process of consultation.

The PBAC is an independent expert body established by section 100A which makes recommendations to the Minister about which drugs and medicinal preparations should be available as pharmaceutical benefits.  PBAC members are appointed following nomination by prescribed organisations and associations from consumers, health economists, practising community pharmacists, general practitioners, clinical pharmacologists and specialists, with at least one member selected from each of those interests or professions.  Remaining members are persons whom the Minister is satisfied have qualifications and experience in a field relevant to the functions of the PBAC, and that would enable them to contribute meaningfully to the deliberations of the PBAC.  When recommending the listing of a medicine on the PBS, the PBAC takes into account the medical conditions for which the medicine has been approved for use in Australia, its clinical effectiveness, safety and cost-effectiveness compared with other treatments.

 

ATTACHMENT

Paragraph 1: provides that this instrument commences on 1 January 2010.

Paragraph 2: provides that Schedule 1 amends PB 114 of 2008.

Schedule 1: provides for the following amendments:

 

SCHEDULE 1 PART 1

Brands Added

Alprazolam

Tablet 1 mg (Alprazolam-GA)

Captopril

Tablet 12.5 mg (Zedace)

Tablet 25 mg (Zedace)

Tablet 50 mg (Zedace)

 

Alteration of Form

The forms of Glucose and Ketone Indicator―Urine, Glucose Indicator―Blood and Glucose Indicator―Urine which were previously described as “Electrode strips” or “Reagent strips” are now described as “Test strips”.

 

Alteration of Form and Maximum Quantity

Glucose Indicator―Blood

From: Electrode strips, 50 (Accu-Chek Performa) Max Qty: 2

To: Test strips, 100 (Accu-Chek Performa) Max Qty: 1

 

Alteration of Maximum Quantity

Posaconazole

Oral suspension 40 mg per mL, 105 mL

From: 1 To: 6

Voriconazole

Powder for oral suspension 40 mg per mL, 70 mL

From: 1 To: 4

 

Alteration of Maximum Number of Repeats

Posaconazole

Oral suspension 40 mg per mL, 105 mL

From: 5 To: 2

Voriconazole

Powder for oral suspension 40 mg per mL, 70 mL

From: . . To: 2

 

Alteration of Brands

Alprazolam

Tablet 500 micrograms

From: Zamhexal 0.5mg To: Alprazolam Sandoz

Allopurinol

Tablet 100 mg

From: Allohexal To: Allopurinol Sandoz

 

Tablet 300 mg

From: Allohexal To: Allopurinol Sandoz

Sotalol

Tablet containing sotalol hydrochloride 80 mg

From: Sotahexal To: Sotalol Sandoz

 

Forms Deleted

Amino acid formula without phenylalanine

Bars 42 g, 20 (Phlexy-10)

Amino acid formula with vitamins and minerals without phenylalanine

Oral powder 400 g (XP Analog)

 

Brands Deleted

Alprazolam

Tablet 2 mg (Alprazolam-DP)

Cephalexin

Capsule 250 mg (anhydrous) (Cephalexin Max)

Capsule 500 mg (anhydrous) (Cephalexin Max)

Clomiphene

Tablet containing clomiphene citrate 50 mg (Clomhexal, Fermil, GenRx Clomiphene)

Diazepam

Tablet 2 mg (Ducene)

Tablet 5 mg (Ducene)

Paclitaxel

Solution concentrate for I.V. infusion 150 mg in 25 mL (Taxol)

 

 

SCHEDULE 1  PART 2

Alteration of Form

The forms of Glucose and Ketone Indicator―Urine, Glucose Indicator―Blood and Glucose Indicator―Urine which were previously described as “Electrode strips” or “Reagent strips” are now described as “Test strips”.

 

Alteration of Purposes

Adalimumab

[amendment of purposes for the initial treatment of adult patients with severe active rheumatoid arthritis]

Etanercept

[amendment of purposes:

(a) for the initial treatment of adult patients with severe active rheumatoid arthritis, and

(b) for the initial treatment of patients 18 years or older with a documented history of severe active polyarticular course juvenile chronic arthritis]

 

Alteration of Form and Maximum Quantity

Glucose Indicator―Blood

From: Electrode strips, 50 (Accu-Chek Performa) Max Qty: 2

To: Test strips, 100 (Accu-Chek Performa) Max Qty: 1

 

Brand Added

Cabergoline

Tablet 500 micrograms (Tinexa)

 

Brands Deleted

Diazepam

Tablet 2 mg (Ducene)

Tablet 5 mg (Ducene)

 

 

SCHEDULE 2 ― PART 1

Brands Deleted

Diazepam

Tablet 2 mg (Ducene)

Tablet 5 mg (Ducene)

 

 

SCHEDULE 2 ― PART 2

Brands Deleted

Diazepam

Tablet 2 mg (Ducene)

Tablet 5 mg (Ducene)

 

 

SCHEDULE 3  PART 1

Brands Deleted

Cephalexin

Capsule 250 mg (anhydrous) (Cephalexin Max)

Capsule 500 mg (anhydrous) (Cephalexin Max)

Diazepam

Tablet 2 mg (Ducene)

Tablet 5 mg (Ducene)

 

Overview

The National Health Act 1953, enacted by the Parliament of Australia, establishes the Pharmaceutical Benefits Scheme (PBS) to ensure Australians have reliable, timely, and affordable access to a broad range of medicines. This Act, through its Part VII, empowers the Minister to determine the forms, brands, and prescribing conditions of listed drugs. The legislative instrument F2009L04557, made on 4 December 2009 and commencing on 1 January 2010, amends previous determinations under sections 85, 85A, and 88 of the Act. These amendments, based on recommendations from the Pharmaceutical Benefits Advisory Committee, address changes to the names, forms, manners of administration, and brands of listed drugs on the PBS, along with conditions for prescribing pharmaceutical benefits. The alterations include updating the descriptions of certain drug forms, modifying maximum quantities and repeat supplies, adding and deleting brands, and adjusting the purposes for which certain drugs can be prescribed.

Scope and Application

The National Health Act 1953, specifically Part VII, is the legislative foundation for the Pharmaceutical Benefits Scheme (PBS) which ensures Australians have affordable access to a broad range of medicines. This Act applies to pharmaceutical benefits provided by the Commonwealth and includes the declaration of listed drugs by the Minister, as well as the determination of their forms, brands, and conditions for prescription. The Act extends its reach nationally, impacting all individuals and entities involved in the supply or prescription of PBS-listed drugs. Determinations under sections 85, 85A, and 88 of the Act, as amended by this legislative instrument, govern the specifics of the PBS, such as the forms and maximum quantities of certain drugs, the maximum number of prescription repeats, and the brands of pharmaceutical items. These amendments, effective from 1 January 2010, are based on recommendations from the Pharmaceutical Benefits Advisory Committee and adjust the listing of drugs, their forms, and prescription conditions to enhance the scheme's efficacy and accessibility.

Key Provisions

The primary sections of the legislation focus on the declaration of pharmaceutical benefits under the National Health Act 1953. Section 85(1) mandates that the Commonwealth provide benefits according to Part VII of the Act, which governs the Pharmaceutical Benefits Scheme (PBS). The Minister is authorised by subsection 85(2) to declare which drugs and medicinal preparations are included in the PBS through legislative instruments. Subsection 85(3) allows the Minister to specify the form of a listed drug by reference to its strength, type of unit, size of unit, or other criteria. Subsection 85(5) permits the Minister to determine the manner of administration for a form of a listed drug, and subsection 85(6) enables the Minister to determine the brand of a pharmaceutical item, defined as the trade name or the name of the responsible person if no trade name exists. Subsection 85A(2) further authorises the Minister to set conditions for the writing of prescriptions by certain classes of persons, including the maximum quantity or number of units, the maximum number of repeats, and the manner of administration that may be included in a prescription. Section 88 provides for the Minister to determine the pharmaceutical benefits for which a dental practitioner is authorised to write a prescription. The Act imposes several obligations on parties and entities it governs. Pharmaceutical companies must comply with the Minister’s determinations regarding the forms, brands, and manners of administration of listed drugs on the PBS. Prescribers must adhere to the conditions set forth for the writing of prescriptions, including limits on quantities, repeats, and administration methods. The Pharmaceutical Benefits Advisory Committee (PBAC) must provide recommendations to the Minister on which drugs and medicinal preparations should be available as pharmaceutical benefits, taking into account factors such as clinical effectiveness, safety, and cost-effectiveness. The Minister, in turn, is responsible for making determinations based on these recommendations. The legislation also outlines several offences and penalties for breaches. While the specific penalties are not detailed in the explanatory statement, breaches of the National Health Act 1953 can generally lead to civil or criminal penalties, depending on the nature and severity of the breach. Civil penalties may include fines, while criminal penalties could involve imprisonment or substantial fines. The precise penalties would be determined according to the relevant sections of the Act and any applicable regulations or subsidiary legislation. Compliance with the Act is crucial to avoid these consequences and to ensure the continued provision of reliable and affordable pharmaceutical benefits to Australians.

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