National Health Act 1953 - Determination under subsection 84HA (1) (22/12/2005)

Administered by Department of Health, Disability and Ageing

Legislation au F2005L04251 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 2005. This determination will commence on 1 January 2006.  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 2006.

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 $7.43.

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 was enacted to establish a framework for providing health services and benefits in Australia, particularly focusing on the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS). One significant aspect of this Act is the safety net scheme, which is designed to offer financial protection to individuals and their families who require a substantial amount of PBS or RPBS medicines. This scheme aims to alleviate the financial burden on patients who reach a certain spending level on these medicines, by providing them with concession or entitlement cards that allow them to receive these medicines at a reduced rate or free of charge for the remainder of the calendar year. The Act outlines the eligibility criteria and the process for applying for these cards, as well as the conditions under which additional or replacement cards may be issued. The Commonwealth pays a fee to approved pharmacists, medical practitioners, and hospital authorities for the duties associated with issuing these cards, a matter determined by the Minister with the agreement of the Pharmacy Guild of Australia.

Scope and Application

The National Health Act 1953, specifically through its Division 1A of Part VII, governs the safety net scheme which offers financial relief to individuals and their families who incur significant costs from the use of listed drugs and medicinal preparations under the Pharmaceutical Benefits Scheme (PBS) or the Repatriation Pharmaceutical Benefits Scheme (RPBS) for eligible veterans. The Act applies to all individuals who reach the specified spending threshold on PBS or RPBS medicines within a calendar year, thereby making them eligible for a safety net concession card or a pharmaceutical benefits entitlement card. These cards allow eligible persons to receive PBS or RPBS medicines at a reduced rate or free of charge for the remainder of the year. The Act also outlines the process for the issuance of these cards by approved pharmacists, medical practitioners, hospital authorities, or public hospital authorities, and mandates that the Minister's determination of the fee for issuing these cards must have the written agreement of the Pharmacy Guild of Australia. The fee for issuing each card, currently set at $7.43, is payable under specific conditions and applies nationally across Australia. Any additional or replacement cards must be issued in accordance with the National Health (Pharmaceutical Benefits) Regulations 1960, with applications directed to the original issuer of the card.

Key Provisions

The main operative sections of the determination under subsection 84HA(1) of the National Health Act 1953 establish the fee payable for issuing safety net concession cards, pharmaceutical benefits entitlement cards, and additional or replacement cards. The determination (section 84HA(2)) specifies that the fee is $7.43 for each card issued by an approved pharmacist, medical practitioner, or hospital authority in accordance with the Act and the regulations. This fee applies only to cards issued on or after 1 January 2006, replacing the previous determination which ceased to have effect on 31 December 2005. The obligations imposed on the parties governed by the Act include the requirement for pharmacists, medical practitioners, and hospital authorities approved under the Act to issue safety net concession cards and pharmaceutical benefits entitlement cards to eligible persons. These professionals must ensure that the issuance of these cards complies with the provisions of Division 1A of Part VII of the National Health Act 1953 and the relevant sections of the National Health (Pharmaceutical Benefits) Regulations 1960. Approved entities must also ensure that any applications for additional or replacement cards are handled according to the regulations, which include making applications to the entity that issued the original card. Any breaches of the requirements set out in the Act and the regulations may lead to civil or criminal consequences. While the specific offences and penalties are not detailed in the provided text, it is reasonable to infer that non-compliance with the Act's provisions could result in fines or other legal actions. The maximum penalties for such offences would be determined by the relevant legislation governing administrative and criminal law in Australia. The determination itself does not outline specific penalties but ensures that the approved entities are compensated for their services through the specified fee.

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