National Health Act 1953 - Determination under subsection 84HA(1) (07/12/2006)

Administered by Department of Health, Disability and Ageing

Legislation au F2006L04041 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

  NATIONAL HEALTH ACT 1953

DETERMINATION UNDER SUBSECTION 84HA (1)

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. One of the benefits available through the Veterans’ Entitlements Act 1986 for eligible veterans is the Repatriation Pharmaceutical Benefits Scheme (RPBS).

Division 1A of Part VII of the Act provides for a “safety net scheme” in relation to pharmaceutical benefits and repatriation pharmaceutical benefits (as defined in section 84 of the Act).  The safety net scheme is designed to provide financial protection for those patients and their families who require a large number of PBS or RPBS medicines.

At the person’s request, a pharmacist records the supply of PBS and RPBS medicines to that person and the cost of the supply.  When a person reaches a certain spending level on PBS or RPBS medicines (“the safety net threshold”), that person may be eligible for a safety net concession card or a pharmaceutical benefits entitlement card in respect of a relevant entitlement period. The issuing of such a card to a person enables that person to receive PBS or RPBS medicines at a reduced rate or free of charge for the remainder of the relevant entitlement period.  The relevant entitlement period for the safety net scheme is a calendar year, that is, from 1 January to 31 December.

Section 84C of the Act provides for eligibility for a person to receive a safety net concession card, and for a person to receive a pharmaceutical benefits entitlement card.

Section 84DA of the Act provides for the issue of a safety net concession card on application by a person, and sets out the manner in which such applications may be made.

Section 84E of the Act provides for the issue of a pharmaceutical benefits entitlement card on application by a person, and sets out the manner in which such applications may be made,

Applications under sections 84DA and 84E of the Act may be made to:

  • the Secretary of the Department of Health and Ageing;
  • a pharmacist approved under the Act;
  • a medical practitioner approved under the Act;
  • a hospital authority approved under the Act; or
  • a public hospital authority.

Section 84H of the Act provides that additional or replacement concession cards and entitlement cards may be issued in accordance with the National Health (Pharmaceutical Benefits) Regulations 1960, in specified circumstances, including:

  • where a person’s concession card or entitlement card has been lost, stolen, damaged or destroyed; and
  • where members of a nominated family change after being issued with a concession card or entitlement card.

The National Health (Pharmaceutical Benefits) Regulations 1960 require, among other things, applications for additional or replacement concession cards and entitlement cards to be made to the same person who issued the original card.

Subsection 84HA (1) of the Act provides that an approved pharmacist, an approved medical practitioner or an approved hospital authority who issues a concession card or entitlement card (or an additional or replacement concession card or entitlement card) is entitled to be paid a fee by the Commonwealth. The fee for issuing the card is determined by the Minister.  Subsection 84HA (2) of the Act provides that the Minister may not determine this fee without the written agreement of the Pharmacy Guild of Australia.  The Pharmacy Guild of Australia has been consulted on this matter and has agreed, in writing, to the making of this determination.

This fee is intended as a payment to an approved pharmacist, an approved medical practitioner or an approved hospital authority for the duties associated with issuing a safety net concession card or pharmaceutical benefits entitlement card, or an additional or replacement concession card or entitlement card. 

The previous determination in respect of this matter ceases to have effect at the end of 31 December 2006. This determination will commence on 1 January 2007.  Details of the determination are set out in the Attachment.

The determination is a legislative instrument for the purpose of the Legislative Instruments Act 2003.


ATTACHMENT

Paragraph 1 provides that the determination commences on 1 January 2007.

Paragraph 2 provides that the fee payable for issuing each safety net concession card, or pharmaceutical benefits entitlement card, or each additional or replacement concession card or entitlement card, is $7.72.

This fee is only payable if the card has been issued:

  • by an approved pharmacist, approved medical practitioner or approved hospital authority within the meaning of section 84 of the National Health Act 1953: and
  • in accordance with the provisions of Division 1A of Part VII of the National Health Act 1953, and the matters prescribed in Parts IIAA and IIA of the National Health (Pharmaceutical Benefits) Regulations 1960.

Overview

The National Health Act 1953, enacted by the Commonwealth Parliament, addresses the regulation of the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) for eligible veterans. The Act introduces a safety net scheme under Part VII, Division 1A, to offer financial protection to patients and their families who require a substantial amount of PBS or RPBS medicines. This scheme ensures that individuals who exceed a certain spending threshold on these medicines can apply for concession or entitlement cards, thereby receiving reduced or free pharmaceutical benefits for the remainder of the calendar year. The Act outlines the eligibility criteria, application processes, and card issuance procedures through sections 84C, 84DA, and 84E, while also detailing the fee payable to approved entities for issuing these cards under subsection 84HA(1). The Pharmacy Guild of Australia has agreed, in writing, to the terms of this fee, ensuring a collaborative approach in implementing the safety net provisions.

Scope and Application

The National Health Act 1953, particularly as it pertains to the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS), applies to individuals who require PBS or RPBS medicines and meet the eligibility criteria for a safety net concession card or pharmaceutical benefits entitlement card. This applies to Australian citizens, residents, and eligible veterans who have incurred substantial expenses on PBS or RPBS medicines within a calendar year. The Act’s provisions cover the issuance of these concession and entitlement cards by approved entities, including pharmacists, medical practitioners, hospital authorities, and public hospital authorities. The fee for issuing these cards is determined under subsection 84HA(1) of the Act, which requires the Minister’s determination to be made with the written agreement of the Pharmacy Guild of Australia. This determination sets the fee at $7.72 per card issued and applies nationwide, covering all states and territories within Australia. The Act does not specify any exclusions or thresholds beyond the safety net spending levels that trigger eligibility for the concession cards. The application of the Act extends to any subordinate instruments that may further detail the processes and conditions under which these cards are issued and replaced.

Key Provisions

The key provisions of the determination under subsection 84HA(1) of the National Health Act 1953 focus on the fee payable for the issuance of safety net concession cards, pharmaceutical benefits entitlement cards, and additional or replacement concession and entitlement cards. These cards are issued to eligible individuals under the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS). Section 84HA(1) specifies that an approved pharmacist, medical practitioner, or hospital authority who issues these cards is entitled to a fee from the Commonwealth. This fee is determined by the Minister, and section 84HA(2) mandates that the Minister cannot determine this fee without the written agreement of the Pharmacy Guild of Australia. The determination that sets the fee at $7.72 for each card issued comes into effect on 1 January 2007, superseding any previous determination. The Act imposes specific obligations on approved pharmacists, medical practitioners, and hospital authorities. These professionals must issue the cards in accordance with the provisions of Division 1A of Part VII of the National Health Act 1953 and the National Health (Pharmaceutical Benefits) Regulations 1960. The regulations further stipulate that applications for additional or replacement cards must be made to the same person who issued the original card. The Act also mandates that the fee for issuing these cards is only payable if the card has been issued by an approved entity within the meaning of section 84 of the Act. Failure to comply with the provisions of the Act regarding the issuance of these cards and the associated fee may result in various consequences. While the Act does not explicitly detail specific offences or penalties for non-compliance, it is implied that any breach of the statutory requirements could lead to civil or administrative consequences. These may include the withholding of the fee payable for card issuance or other administrative penalties as deemed appropriate by the relevant authorities. The Act’s regulatory framework ensures that the safety net scheme operates smoothly and provides the intended benefits to eligible individuals.

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