EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under subsection 84BA(2)
- Part VII of the National Health Act 1953 (the Act) regulates the Pharmaceutical Benefits Scheme (PBS), which provides for the supply of listed drugs and medicinal preparations as pharmaceutical benefits.
- Division 1A of Part VII of the Act provides for a “safety net scheme” in relation to pharmaceutical benefits. The safety net scheme is designed to provide financial protection for those patients and their families who require a large number of PBS medicines.
- Subsection 84BA (1) of the Act makes provision for account to be taken of payments made by a person to a public hospital authority for supplies of out-patient medication, when it is being ascertained, for the purpose of the PBS safety net scheme, whether the person is eligible to be issued with a concession card or an entitlement card.
- Subsection 84BA (2) of the Act provides that, before the beginning of the relevant entitlement period, the Minister must determine in writing the amounts that, for the purposes of Part VII of the Act, will be taken to have been paid to a public hospital for supplies of out-patient medication made, against payment, by the hospital during the relevant entitlement period.
- Subsection 84BA (3) of the Act provides that, in making a determination, the Minister may determine: different amounts in respect of a supply of out-patient medication having regard to the State or Territory in which the hospital supplying the medication is situated; and different amounts in respect of supplies made to concessional beneficiaries and their dependants, holders of a concession card, and general patients (other than holders of a concession card).
6. This Determination sets out amounts for the purposes of subsection 84BA (2) of the Act. The amount of $23.60 represents an average of the range of patient co-payments patients would pay if they received their medication from the PBS and is determined in relation to general patients. This applies to out-patients at public hospitals throughout Australia, with the exception of public hospitals in Queensland and public hospitals which are participating in the arrangements specified in clause 21 of the Australian Health Care Agreements (‘the pharmaceutical reforms’). These hospitals have the capacity to individually price medication and therefore apply the pricing structure as the PBS for co-payments below the general patient co-payment of $29.50 (for 2006).
7. The Department of Health and Ageing has consulted with the State and Territory Health Departments through the Highly Specialised Drugs Working Party (HSDWP). The HSDWP is a working party of the Australian Health Ministers’ Advisory Council and is made up of representatives from each State and Territory Health Departments and the Australian Government. If has the responsibility to review the hospital safety net arrangements on an annual basis including the calculation of the general patient average co-payment. The State and Territory Health Departments have agreed to the value of out-patient medication for 2006.
8. This Determination was made on 16 December 2005 and commences on 1 January 2006.
9. This Determination shall cease to have effect at the end of 31 December 2006.
10. This Determination is a legislative instrument for the purpose of the Legislative Instrument Act 2003.
PHARMACEUTICAL ACCESS AND QUALITY BRANCH
DEPARTMENT OF HEALTH AND AGEING
DECEMBER 2005