National Health Act 1953 - Determination under subsection 84HA(1) - Pharmaceutical Benefits (No. PB 128 of 2008)

Administered by Department of Health, Disability and Ageing

Legislation au F2008L04576 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

  NATIONAL HEALTH ACT 1953

DETERMINATION UNDER SUBSECTION 84HA (1)

PB 128 of 2008

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 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.

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 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. 

Consultation

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. 

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 $7.86 to $8.25.

The Fourth Community Pharmacy Agreement makes no provisions relating to determining the fee for issuing these cards.

This Determination will commence on 1 January 2009.  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 2009 and will cease to have effect at the end of 31 December 2009.

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 $8.25.

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.

Overview

The National Health Act 1953, as supplemented by the determination under subsection 84HA(1) issued in 2008, addresses the financial burden faced by individuals who require a substantial number of pharmaceutical benefits through the Pharmaceutical Benefits Scheme (PBS) or the Repatriation Pharmaceutical Benefits Scheme (RPBS). This legislation aims to provide a safety net scheme that offers financial protection to patients and their families by enabling them to access PBS or RPBS medicines at a reduced rate or free of charge after reaching a certain spending threshold within a calendar year. Enacted by the Parliament of Australia, the policy objective of this legislation is to ensure equitable access to essential medications for those who need them most, thereby alleviating the financial strain associated with chronic or severe health conditions. The legislative instrument, F2008L04576, sets out the fee for issuing safety net concession cards or pharmaceutical benefits entitlement cards, which is indexed annually based on the Consumer Price Index. This fee is payable to approved pharmacists, medical practitioners, or hospital authorities for the services rendered in issuing these cards, reflecting a collaborative approach between the government and healthcare providers to support the scheme's objectives.

Scope and Application

The National Health Act 1953, specifically through the Determination under subsection 84HA(1) and the National Health (Pharmaceutical Benefits) Regulations 1960, regulates the issuance of safety net concession cards and pharmaceutical benefits entitlement cards within the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS). This Act applies to eligible individuals who have reached the safety net threshold for PBS or RPBS medicines, providing them with financial protection for further pharmaceutical expenses within the relevant entitlement period of a calendar year. The card issuance process is overseen by authorised entities including approved pharmacists, medical practitioners, and hospital authorities, who must adhere to the stipulations outlined in the Act and its regulations. The approved entities receive a fee for their services, which is indexed annually based on the Consumer Price Index (CPI). Notably, the fee for issuing these cards is determined by the Minister, subject to the written agreement of the Pharmacy Guild of Australia. The fee for the period commencing 1 January 2009 has been set at $8.25, superseding all previous determinations. This Determination ensures a streamlined process for eligible veterans and patients to access reduced or free pharmaceutical benefits under the safety net scheme.

Key Provisions

The key provisions of this legislation, specifically the determination under subsection 84HA(1) of the National Health Act 1953, establish the fee for issuing safety net concession cards, pharmaceutical benefits entitlement cards, or additional or replacement concession cards and entitlement cards. As stated in the attachment, this fee is set at $8.25 and will apply from 1 January 2009 until 31 December 2009. This fee applies to cards issued by approved pharmacists, approved medical practitioners, or approved hospital authorities in accordance with the requirements of the National Health Act 1953 and the National Health (Pharmaceutical Benefits) Regulations 1960. The fee is indexed annually based on movements in the Consumer Price Index (CPI) since the September of the previous year. Under the National Health Act 1953, certain healthcare professionals and authorities are authorised to issue these concession and entitlement cards to eligible patients. These include approved pharmacists, medical practitioners, hospital authorities, and public hospital authorities. The issuing of these cards provides patients with access to PBS and RPBS medicines at reduced rates or free of charge once they reach the safety net threshold for the year. Additionally, provisions are made for the issuance of additional or replacement cards under specific circumstances, such as loss, theft, damage, or changes in family members, as outlined in the National Health (Pharmaceutical Benefits) Regulations 1960. The Act imposes obligations on the parties involved, such as approved pharmacists, medical practitioners, and hospital authorities, to issue the appropriate cards to eligible patients and to adhere to the regulations governing the process. Furthermore, the Minister is required to consult with the Pharmacy Guild of Australia before determining the fee for issuing these cards. This legislative requirement ensures that the fee is set with the agreement of key stakeholders in the healthcare sector. There are no explicit offences, penalties, or civil/criminal consequences mentioned in the text for the breach of provisions related to the issuance of these cards or the fee determination. However, failure to comply with the requirements of the National Health Act 1953 and the associated regulations could potentially lead to administrative or legal actions, such as fines or other penalties as determined by the relevant authorities. The specific consequences would depend on the nature and severity of the non-compliance.

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