EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under subsection 84BA(2)
This determination will commence on 1 January 2009. This determination is made under subsection 84BA (2) of the National Health Act 1953 (Cth) (the Act).
The Act provides for the supply of drugs and medicinal preparations that are declared to be pharmaceutical benefits under Part VII of the Act. 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 pharmaceutical benefits.
Subsection 84BA(1) of the Act provides 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 Part VII of the Act, 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.
This determination sets out amounts for the purposes of subsection 84BA (2) of the Act. The amounts set out in paragraphs 5 and 6 of this determination apply 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 AHCAs’). The amounts for out-patients at public hospitals in Queensland and public hospitals participating in the arrangements specified in clause 21 of the AHCAs are determined in accordance with paragraphs 7 and 8 of this determination.
Paragraph 4 of this determination provides that the amount, which for the purposes of Part VII of the Act, will be taken to have been paid to a public hospital for the supply of out-patient medication shall be the maximum value of the supply of out-patient medication for safety net purposes or the amount charged, whichever is the lesser.
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).
Paragraph 5 of this determination provides that the maximum value of the supply of out-patient medication to a concessional beneficiary, a dependant of a concessional beneficiary or the holder of a concession card shall be the amount referred to in paragraph 87(2)(a) of the Act. Paragraph 87(2)(a) of the Act refers to the charge in relation to supply of pharmaceutical benefits by an approved pharmacist or approved medical practitioner, where they are presented with a concession card prescription (except where the supply is an early supply of a specified pharmaceutical benefit), or a concessional benefit prescription, or an entitlement card prescription where the supply is an early supply of a specified pharmaceutical benefit. These charges are periodically adjusted under section 99G of the Act. Paragraph 5 of this determination does not provide a maximum value for the supply of out-patient medication to those patients who present prescriptions for the early supply of specified pharmaceutical benefits.
Paragraph 6 of this determination provides that except in the case of a public hospital situated in Queensland or a public hospital that is participating in the arrangements specified in clause 21 of the AHCAs, the maximum value of the supply of out patient medication to a general patient who is not the holder of a concession card shall be $26.30. The amount of $26.30 represents an average of the range of co-payments patients would pay if they received their medication from approved pharmacists approved under section 90 of the Act to supply pharmaceutical benefits from particular premises, and is determined in relation to general patients.
Paragraph 7 of this determination provides for the maximum value of a supply of out-patient medication to general patients who are not holders of a concession card in the case of public hospitals situated in Queensland.
Paragraph 8 of this determination provides for the maximum value of a supply of out-patient medication to general patients who are not holders of a concession card in the case of public hospitals participating in the arrangements specified in clause 21 of the AHCAs.
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 Department and the Australian Government. It 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 2009.
This Determination was made on 18 December 2008 and commences on 1 January 2009.
This Determination is a legislative instrument for the purpose of the Legislative Instrument Act 2003.
Signed
PHARMACEUTICAL BENEFITS DIVISION
DEPARTMENT OF HEALTH AND AGEING