EXPLANATORY STATEMENT
NATIONAL HEALTH ACT 1953
SPECIAL ARRANGEMENT UNDER SECTION 100
REMOTE ABORIGINAL HEALTH SERVICES PROGRAM
NO. PB 57 OF 2009
- The purpose of the Australian Pharmaceutical Benefits Scheme (PBS) is to provide timely, reliable and affordable access for the Australian community to necessary and cost-effective medicines.
2. The PBS is regulated by Part VII of the National Health Act 1953 (the Act), which provides for the supply of listed drugs and medicinal preparations as pharmaceutical benefits.
3. “Pharmaceutical benefit” is defined under subsection 84(1) of the Act as a drug or medicinal preparation in relation to which, by virtue of section 85 of the Act, Part VII of the Act applies.
4. Subsection 100(1) of the Act provides that the Minister may make special arrangements for providing that an adequate supply of special pharmaceutical products will be available to persons:
(a) who are living in isolated areas; or
(b) who are receiving medical treatment in such circumstances that pharmaceutical benefits:
(i) cannot be conveniently or efficiently supplied in accordance with Part VII of the Act; or
(ii) are inadequate for that medical treatment.
5. Subsection 100(2) of the Act provides that the Minister may vary or revoke a special arrangement made under subsection 100(1).
6. The Remote Aboriginal Health Service Program improves access to essential medicines for clients of remote Aboriginal Health Services (AHS) by addressing geographic, financial and cultural barriers by removing the need for a Pharmaceutical Benefits Scheme (PBS) co-payment and PBS script.
7. The current formula for the handling fee means that pharmacists now receive a handling fee of $1.14 for supplying under the program, which has not increased since the inception of the program in 1997.
8. The handling fee will now be increased by $1.55 to $2.69. This increase demonstrates a fair reflection of the increased costs to pharmacy under the s100 Remote Program.
9. This is an interim increase until 30 June 2010. Remuneration under the s100 Remote Program is currently being reviewed as part of the s100 Reviews currently in progress under the Fourth Community Pharmacy Agreement, due to report in mid-2009. This review will inform any permanent changes to the level of the handling fee.
Retrospectivity
10. Although the Arrangement is taken to have commenced on 1 January 2009, the effect of this is beneficial as it results in a higher payment being made to those providing pharmaceutical benefits under the Arrangement. There is no adverse impact or obligation imposed on anyone as a result of the instrument being taken to have commenced prior to the day after registration.
11. These Arrangements were remade to give effect to the change to the handling fee under the Remote AHS Program, under section 100, as agreed by Cabinet as part of the 2009-10 Budget.
Consultations
12. These Arrangements have been made following the agreement of the Pharmacy Guild of Australia in December 2008 followed by Cabinet agreement through the 2009-10 Budget.
13. Medicare Australia (MA) has also been consulted to provide advice on the program management aspects for these arrangements because order and payment for the supply of PBS medicines under these Arrangements is managed by Medicare Australian.
14. These Arrangements constitute a legislative instrument for the purposes of the Legislative Instruments Act 2003.
15. Details of the Arrangements are set out in the Attachment.
ATTACHMENT
Paragraph 1 provides that these Arrangements commence on 1 January 2009.
Paragraph 2 provides that the Arrangements made on 14 February 2009, with effect from 17 February 2009, are repealed with effect from commencement of these Arrangements.
Paragraph 3 provides that the Arrangements under paragraph 100(1)(a) of the Act for the supply of pharmaceutical benefits to patients of remote area Aboriginal Health Services are those set out in the Schedule to these Arrangements.
Schedule
Paragraph 1(a) provides that, to be eligible under these arrangements, Aboriginal Health Services (AHS) must primarily function to meet the health care needs of Aboriginal and Torres Strait Islander peoples.
Paragraph 1(b) provides that the health care facility from which pharmaceutical benefits are supplied to patients must be located in a remote zone, as defined in the Rural, Remote and Metropolitan Areas Classification, 1991 Census Edition.
Paragraph 1(c) provides that the AHS must not be a party to an arrangement for which funds from the Pharmaceutical Benefits Scheme have already been provided to the AHS.
Paragraph 1(d) provides that the AHS must employ, or be in a contractual relationship with, health professionals who are suitably qualified under the legislation of the relevant State or Territory to supply all pharmaceutical benefits covered by these arrangements, and must undertake that all pharmaceutical benefits will be made under the direction of such qualified persons.
Paragraph 1(e) provides that the health care facility from which pharmaceutical benefits are supplied must have appropriate storage facilities, namely that:
- Prevent access by unauthorised persons;
- Maintain the quality of the pharmaceutical benefit; and
- Comply with any special conditions specified by the manufacturer of the pharmaceutical benefit.
Paragraph 2 provides that the PBS medicines available through these arrangements will include items contained in Section 2 of the Schedule of Pharmaceutical Benefits, in force at the time of supply, excluding the following:
- Pharmaceutical benefit items supplied to medical practitioners as emergency drug supplies, as described in section 93 of the Act;
- Pharmaceutical benefit items for which special arrangements are in force under paragraph 100(1)(b) of the Act; and
- Pharmaceutical benefits items that are Schedule 8 drugs, as defined by the relevant State or Territory drugs and poisons legislation.
Paragraph 3 provides that each participating AHS must maintain a stock of pharmaceutical benefit items, ordered using an approval form on a bulk supply basis from an approved pharmacist or approved hospital authority, and dispensed through the AHS as appropriate. Pharmaceutical benefit items must be supplied directly by the approved pharmacist or approved hospital authority to the AHS. Approved pharmacists and approved hospital authorities will be reimbursed directly by Medicare Australia.
Paragraph 4 provides that pharmaceutical benefit items must be dispensed to patients by an appropriate health professional, consistent with the law of the relevant State or Territory. A patient who is supplied with a pharmaceutical benefit under these arrangements must not be charged a patient copayment.
Paragraph 5 provides that each AHS will be registered with MA and, if there are several remote area clinics operating under the auspices of a large AHS or a State or Territory Government Agency, a unique approval number will be allocated to each clinic. The approved pharmacist or approved hospital authority will maintain a record of pharmaceutical benefit items supplied to each approved AHS, and will provide this information to MA as the basis for reimbursement.
Paragraph 6 provides that reimbursement by the Commonwealth of approved pharmacists and approved hospital authorities for supplying pharmaceutical benefit items to AHS under these arrangements are the sum of the following:
- The approved price to pharmacists as described in subsection 98B(3) of the Act;
- A mark-up at the rate specified in the determination under paragraph 98B(1)(a) of the Act that is in force at the time of supply; and
- A handling fee of $2.69, effective from 1 January 2009 to 30 June 2010. After this time, the handling fee will revert to a handling fee calculated as the difference between the dispensing fee for the supply of a ready-prepared pharmaceutical benefit, specified in the determination under paragraph 98B(1)(a) of the Act that is in force at the time of supply of the benefit, and the concessional patient copayment applicable under paragraph 87(2)(a) of the Act at the time of supply of the benefit, or $1.14, whichever is greater.
Paragraph 7 provides that the costs of transportation and cold chain maintenance are included in the above reimbursement formula.