National Health Act 1953 - Arrangements under paragraph 100(1)(a) - Aboriginal Health Services (14/02/2003)

Administered by Department of Health, Disability and Ageing

Legislation au F2007B01047 Not in force Legislative Instrument

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COMMONWEALTH OF AUSTRALIA

 

National Health Act 1953

 

PART VII — PHARMACEUTICAL BENEFITS

 

Arrangements under paragraph 100(1)(a)

 

 

I, ALLAN RAYMOND RENNIE, Assistant Secretary, Pharmaceutical Access and Quality Branch, Department of Health and Ageing and delegate of the Minister for Health and Ageing, pursuant to paragraph 100(1)(a) of the National Health Act 1953 (“the Act”), hereby make the following arrangements for the purpose of providing that an adequate pharmaceutical service will be available to persons living in isolated areas, by providing access by patients of remote area Aboriginal Health Services to a range of essential pharmaceutical benefit items:

 

1. These arrangements commence on 17 February 2003.

 

2. The arrangements under paragraph 100(1)(a) of the Act for the supply of pharmaceutical benefits to patients of remote area Aboriginal Health Services made on 11 February 2000 are hereby revoked.

 

3. The arrangements under paragraph 100(1)(a) of the Act for the supply of pharmaceutical benefits to patients of remote area Aboriginal Health Services are those set out in the Schedule to these arrangements.

 

 

Dated this 14th  day of  February 2003.

 

 

 

 

 

 

ALLAN RAYMOND RENNIE

Assistant Secretary

Pharmaceutical Access and Quality Branch

Department of Health and Ageing

Delegate of the Minister for Health and Ageing

 

 


THE SCHEDULE

 

 

Eligibility

 

The eligibility criteria for the purposes of these arrangements are:

 

1. The Aboriginal Health Service (AHS) must have a primary function of meeting the health care needs of Aboriginal and Torres Strait Islander peoples.

 

2. The clinic or other health care facility operated by the AHS from which pharmaceutical benefits are supplied to patients must be in a remote zone as defined in the Rural, Remote and Metropolitan Areas Classification, 1991 Census Edition.

 

3. The AHS must not be a party to an arrangement, such as a coordinated care trial, for which funds from the Pharmaceutical Benefits Scheme have already been provided.

 

4. The AHS must employ, or be in a contractual relationship with, health professionals who are suitably qualified under the legislation of the relevant State or Territory to supply all pharmaceutical benefits covered by these arrangements, and must undertake that all supply of pharmaceutical benefits will be made under the direction of such qualified persons.

 

5. The clinic or other health care facility operated by the AHS from which pharmaceutical benefits are supplied must have storage facilities that will:

 

  • prevent access by unauthorised persons;
  • maintain the quality (eg chemical and biological stability and sterility) of the pharmaceutical benefit; and
  • comply with any special conditions specified by the manufacturer of the pharmaceutical benefit.

 

Scope

 

PBS medicines available through these arrangements include items contained in Section 2 of the Schedule of Pharmaceutical Benefits, in force at the time of supply, excluding:

  • pharmaceutical benefit items supplied to medical practitioners as emergency drug (Doctor’s Bag) supplies, pursuant to section 93 of the Act; and
  • pharmaceutical benefit items in respect of which special arrangements are in force under paragraph 100(1)(b) of the Act; and
  • pharmaceutical benefit items that are Schedule 8 drugs, as defined by the relevant State or Territory drugs and poisons legislation.

 

Obtaining pharmaceutical benefit items

 

Each participating remote area AHS will maintain a stock of pharmaceutical benefit items, ordered using an approval form on a bulk supply basis from an approved pharmacist or an approved hospital authority, and dispensed through the AHS as appropriate.  Pharmaceutical benefit items must be supplied directly by the approved pharmacist or the approved hospital authority to the participating AHS.  Approved pharmacists and approved hospital authorities will be reimbursed directly by the Health Insurance Commission (HIC).

 

Dispensing

 

Pharmaceutical benefit items will be dispensed to patients by an appropriate health professional (either a medical practitioner, or an Aboriginal Health Worker or nurse working under the supervision of a medical practitioner, where consistent with the law of the relevant State or Territory).  A patient who is supplied with a pharmaceutical benefit under these arrangements is not to be charged a patient copayment.

 

Claims system

 

Each AHS will be registered with the HIC and, if there are several remote area clinics operating under the auspices of a large AHS or a State or Territory Government Agency, a unique approval number will be allocated to each clinic.  The approved pharmacist or approved hospital authority will maintain a record of pharmaceutical benefit items supplied to each approved AHS, and will provide this information to the HIC as the basis for reimbursement.

 

Remuneration

 

Reimbursement by the Commonwealth of approved pharmacists and approved hospital authorities for supplying pharmaceutical benefit items to AHSs under these arrangements will be the sum of the following:

 

  • the approved price to pharmacists within the meaning of subsection 98B(3) of the Act; and

 

  • mark-up at the rate specified in the determination under paragraph 98B(1)(a) of the Act that is in force at the time of supply of the benefit; and

 

  • a handling fee, calculated as the difference between the dispensing fee for the supply of a ready-prepared pharmaceutical benefit, specified in the determination under paragraph 98B(1)(a) of the Act that is in force at the time of supply of the benefit, and the concessional patient copayment applicable under paragraph 87(2)(a) of the Act at the time of supply of the benefit, or $1.14, whichever is greater.

 

Costs of transportation and cold chain maintenance are included in the above reimbursement formula.

 

 

Overview

The National Health Act 1953, enacted by the Parliament of Australia, addresses the gap in providing an adequate pharmaceutical service to persons living in isolated areas, particularly focusing on access for patients of remote area Aboriginal Health Services to essential pharmaceutical benefit items. This legislative instrument aims to ensure these services are accessible and available in remote locations. Pursuant to the Act, the Assistant Secretary of the Pharmaceutical Access and Quality Branch, Department of Health and Ageing, has established arrangements to facilitate the supply of pharmaceutical benefits to patients in remote areas, ensuring these services meet the necessary eligibility and operational criteria. These arrangements include defining eligibility criteria for Aboriginal Health Services, specifying the scope of pharmaceutical benefit items available, and outlining the processes for obtaining, dispensing, and reimbursing these items. The policy objective is to guarantee that remote area Aboriginal Health Services can provide necessary pharmaceutical services without financial burden to patients.

Scope and Application

The National Health Act 1953 applies to the provision of pharmaceutical benefits to patients of remote area Aboriginal Health Services, ensuring access to essential pharmaceutical benefit items for those living in isolated areas. This legislation is applicable to Aboriginal Health Services that meet specific eligibility criteria, including having a primary function of serving the health care needs of Aboriginal and Torres Strait Islander peoples and being located in a remote zone as defined by the Rural, Remote and Metropolitan Areas Classification. Additionally, these services must not be parties to arrangements for which funds from the Pharmaceutical Benefits Scheme have already been provided and must have appropriately qualified health professionals to supply pharmaceutical benefits under their direction. The Act excludes certain pharmaceutical benefit items such as those supplied as emergency drug supplies, those under special arrangements, and Schedule 8 drugs. The arrangements are governed by subordinate instruments that detail the specific procedures for ordering, supplying, and dispensing pharmaceutical benefit items, as well as the reimbursement process for approved pharmacists and hospital authorities.

Key Provisions

The National Health Act 1953, through arrangements made under section 100(1)(a), establishes a framework for ensuring that pharmaceutical services are accessible to those living in remote areas, particularly focusing on Aboriginal Health Services (AHS) (s. 1). These arrangements came into effect on 17 February 2003, replacing previous arrangements established on 11 February 2000 (s. 2). The specific details of these arrangements are outlined in the Schedule of the legislative instrument. The eligibility criteria for participating AHSs include having a primary function of addressing the health care needs of Aboriginal and Torres Strait Islander peoples, operating in a remote zone as defined by the Rural, Remote and Metropolitan Areas Classification, 1991 Census Edition, and ensuring that they do not receive funds from the Pharmaceutical Benefits Scheme under other arrangements (Schedule, Eligibility). The AHS must also employ or contract suitably qualified health professionals to supply the pharmaceutical benefits, and must maintain appropriate storage facilities for the pharmaceutical products (Schedule, Eligibility). The scope of pharmaceutical benefits available includes items listed in Section 2 of the Schedule of Pharmaceutical Benefits, with certain exclusions such as emergency drug supplies, special arrangement items, and Schedule 8 drugs (Schedule, Scope). Participating AHSs must order pharmaceutical benefit items on a bulk supply basis from approved pharmacists or hospital authorities, who will then be reimbursed by the Health Insurance Commission (HIC) (Schedule, Obtaining pharmaceutical benefit items). Pharmaceutical benefit items are to be dispensed to patients by qualified health professionals, such as medical practitioners or supervised Aboriginal Health Workers or nurses, without charging the patient a copayment (Schedule, Dispensing). Each AHS must be registered with the HIC, and records of supplied items must be maintained by the approved pharmacists or hospital authorities for reimbursement purposes (Schedule, Claims system). Non-compliance with these arrangements may result in administrative penalties, including fines and potential cessation of funding for the participating AHSs. While specific penalties are not detailed in the legislative instrument, breaches of the National Health Act 1953 generally may result in civil or criminal penalties depending on the nature and severity of the breach. The precise penalties are typically outlined in other parts of the Act or in associated regulations.

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