National Health Act 1953 - Pharmaceutical Benefits - Amendment determination under subsection 84C(7) No. 4 (11/06/2009)

Overview

The National Health Act 1953 Pharmaceutical Benefits Amendment Determination under subsection 84C (7) No. 4 was enacted to address the need for annual adjustments to the additional fee for pharmacists in the Pharmaceutical Benefits Scheme (PBS). The purpose of this amendment is to reflect the annual increase in the additional fee, which compensates pharmacists for recording the supply of PBS medicines when the Commonwealth price is less than the patient co-payment. This amendment ensures that the fee remains indexed appropriately to account for economic changes, as measured by the Wage Cost Index. The amendment, agreed upon with the Pharmacy Guild of Australia, comes into effect on 1 August 2009 and adjusts the additional fee for ready-prepared pharmaceuticals by two cents to $1.05 and for extemporaneously-prepared pharmaceuticals to $1.38, thereby ensuring the scheme's continued effectiveness in providing financial protection to patients and their families.

Scope and Application

The National Health Act 1953 Pharmaceutical Benefits Amendment Determination under subsection 84C (7) No. 4 applies to the administration of the Pharmaceutical Benefits Scheme (PBS) under the National Health Act 1953, particularly focusing on the adjustments to the additional fee charged by pharmacists for recording the supply of pharmaceutical benefits where the Commonwealth price is less than the patient co-payment. The Act applies to patients, their families, pharmacists, and entities involved in the supply of pharmaceutical benefits under the PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS). The Amendment Determination is concerned with the financial aspects of the PBS, ensuring that the additional fee is indexed annually to maintain its value, and is effective across the Commonwealth of Australia. The Determination does not exclude any specific groups or transactions but instead modifies the fees applicable to ready-prepared and extemporaneously-prepared pharmaceutical benefits. The amendment is a legislative instrument, and its application may be further detailed or extended through subordinate instruments if necessary.

Key Provisions

The main operative sections of the National Health Act 1953 Pharmaceutical Benefits Amendment Determination under subsection 84C (7) No. 4, as outlined in the explanatory statement, focus on the adjustments to the additional fees for pharmaceutical benefits. Specifically, clause 3 of the Determination amends the Principal Determination made on 14 June 2006, by increasing the additional fee for ready-prepared pharmaceutical benefits by two cents to $1.05, and amending the additional fee for extemporaneously-prepared pharmaceutical benefits to $1.38. This amendment ensures that the additional fees are indexed annually using the Wage Cost Index 9. The Determination also reiterates that the price for a pharmaceutical benefit or repatriation pharmaceutical benefit will not exceed the patient co-payment, a provision aimed at protecting patients from excessive costs. The obligations and requirements imposed by this Act on the parties or entities it governs include ensuring that pharmacists comply with the specified additional fees for ready-prepared and extemporaneously-prepared pharmaceutical benefits. This involves pharmacists accurately recording the supply of pharmaceutical benefits and adhering to the maximum price limits to avoid exceeding the patient co-payment. Additionally, the Minister must obtain written agreement from the Pharmacy Guild of Australia before determining any additional fees, as stipulated in subsection 84C (9) of the National Health Act 1953. The Pharmacy Guild of Australia has already agreed to this Determination, ensuring that the amendments proceed without any procedural hurdles. The Determination also outlines the potential consequences for non-compliance with the provisions of the National Health Act 1953. While the explanatory statement does not explicitly detail the specific offences, penalties, or civil/criminal consequences for breach, it is clear that any deviation from the stipulated additional fees could result in financial discrepancies and potential overcharging of patients. The overarching intent is to maintain the integrity of the Safety Net scheme and protect patients from undue financial burden. Given the nature of the amendments, breaches may be subject to review and corrective actions by the relevant authorities to ensure compliance with the legislative requirements.