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.
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.
The purpose of this Determination is to determine the fee payable by the Commonwealth to an approved pharmacist, approved medical practitioner or approved hospital authority for issuing a safety net concession card or a pharmaceutical benefits entitlement card in accordance with the Act and the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations).
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.
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.
This fee is indexed on 1 January of each year in accordance with movements in the Consumer Price Index (CPI) since the September of the previous year. On this occasion, the fee will be increased from $8.25 to $8.35.
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 or entitlement cards may be issued in accordance with the Regulations 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 Regulations 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.
The Fourth Community Pharmacy Agreement makes no provisions relating to determining the fee for issuing these cards.
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 2010. 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 2010 and will cease to have effect at the end of 31 December 2010.
Paragraph 2 provides that the Determination revokes all previous Determinations made under subsection 84HA (1) of the National Health Act 1953.
Paragraph 3 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 $8.35.
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 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.