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. Eligible veterans are also entitled to additional benefits through the Repatriation Pharmaceutical Benefits Scheme (RPBS), in accordance with the Veterans’ Entitlements Act 1986.
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) in accordance with the Act and the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations) is entitled to be paid a fee by the Commonwealth. The Minister shall seek an agreement from the Pharmacy Guild of Australia prior to determining this fee.
The purpose of the Determination under subsection 84HA(1) of the Act is to determine the fee payable to an approved pharmacist, an approved medical practitioner or an approved hospital authority for issuing a concession card or entitlement card (or an additional or replacement concession card or entitlement card). This fee is indexed on 1 January of each year by the ratio of the Consumer Price Index (CPI) for September quarter for the current year and CPI for September quarter for the previous calendar year. On this occasion, the fee is calculated to be $8.58.
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 subsection 84(1) of the Act; and
- in accordance with the provisions of Division 1A of Part VII of the Act, and the matters prescribed in Parts IIAA and IIA of the Regulations.
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 subsection 84(1) 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.
Consultation
The Pharmacy Guild of Australia has been consulted on this matter and has agreed, in writing, to the making of this Determination, as required under subsection 84HA(2) of the Act.
This Determination will commence on 1 January 2011.
The Determination is a legislative instrument for the purpose of the Legislative Instruments Act 2003.
Overview
The National Health Act 1953, enacted by the Commonwealth Parliament, primarily governs the Pharmaceutical Benefits Scheme (PBS) which facilitates the supply of listed drugs and medicinal preparations. This Act was designed to address the need for regulated pharmaceutical benefits within Australia. The Determination under subsection 84HA(1) of the Act, which sets the fee payable to approved pharmacists, medical practitioners, or hospital authorities for issuing concession or entitlement cards, was introduced to ensure these professionals are appropriately compensated for their role in managing the PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS). The fee is determined annually by indexing it according to the Consumer Price Index. The policy objective is to maintain a structured and financially sustainable system that protects patients who require substantial PBS or RPBS medicines through the safety net scheme. The Pharmacy Guild of Australia was consulted and agreed to the terms of this Determination as required by the Act.
Scope and Application
The National Health Act 1953 applies to approved pharmacists, approved medical practitioners, and approved hospital authorities who issue concession or entitlement cards related to the Pharmaceutical Benefits Scheme (PBS) or the Repatriation Pharmaceutical Benefits Scheme (RPBS). This Act and the accompanying National Health (Pharmaceutical Benefits) Regulations 1960 establish the framework for the PBS and RPBS, which provide for the supply of listed drugs and medicinal preparations as pharmaceutical benefits. Eligible veterans are also entitled to additional benefits through the RPBS, as outlined in the Veterans’ Entitlements Act 1986. The Act’s provisions include a fee for approved entities that issue concession or entitlement cards, which is determined under subsection 84HA(1) of the Act and indexed annually based on the Consumer Price Index. This fee is payable if the card is issued by an approved entity in accordance with Division 1A of Part VII of the Act and the Regulations. The fee payable for 2011 has been determined to be $8.58, following consultation with the Pharmacy Guild of Australia. This Determination, which takes effect from 1 January 2011, is a legislative instrument under the Legislative Instruments Act 2003.
Key Provisions
The main operative sections of this legislation are subsection 84HA(1) and Division 1A of Part VII of the National Health Act 1953. Subsection 84HA(1) allows for the payment of a fee to approved pharmacists, medical practitioners, or hospital authorities who issue concession or entitlement cards. Division 1A of Part VII sets out the safety net scheme, which provides financial protection for patients who require a large number of PBS or RPBS medicines. The fee for issuing these cards is determined by the Minister and must be agreed upon by the Pharmacy Guild of Australia. This fee is indexed annually based on the Consumer Price Index.
The Act imposes several obligations on the parties involved. Approved pharmacists, medical practitioners, and hospital authorities must issue concession or entitlement cards in accordance with the provisions of Division 1A of Part VII of the Act and the matters prescribed in Parts IIAA and IIA of the National Health (Pharmaceutical Benefits) Regulations 1960. The Minister is required to consult with the Pharmacy Guild of Australia and agree on the fee payable before making the determination. The Pharmacy Guild of Australia must provide written agreement to the fee as per subsection 84HA(2) of the Act.
Offences and penalties are not explicitly stated in the provided text; however, failure to comply with the provisions of the Act or the Regulations may result in civil or administrative consequences. The fee payable for issuing concession or entitlement cards is indexed annually, and this Determination sets the fee at $8.58 for the year commencing 1 January 2011. The fee is only payable if the card is issued by an approved pharmacist, approved medical practitioner, or approved hospital authority and in accordance with the relevant provisions of the Act and the Regulations.