National Health Amendment (General Co-payment) Act 2022

Administered by Department of Health, Disability and Ageing

Legislation au C2022A00053 In force Act

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National Health Amendment (General Copayment) Act 2022

 

No. 53, 2022

 

 

 

 

 

An Act to amend the National Health Act 1953, and for related purposes

 

 

Contents

1 Short title

2 Commencement

3 Schedules

Schedule 1—Amendments

National Health Act 1953

Schedule 2—Special arrangements

National Health Act 1953

 

 

National Health Amendment (General Co-payment) Act 2022

No. 53, 2022

 

 

 

An Act to amend the National Health Act 1953, and for related purposes

[Assented to 9 November 2022]

The Parliament of Australia enacts:

1  Short title

  This Act is the National Health Amendment (General Copayment) Act 2022.

2  Commencement

 (1) Each provision of this Act specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  Sections 1 to 3 and anything in this Act not elsewhere covered by this table

The day this Act receives the Royal Assent.

9 November 2022

2.  Schedule 1

1 January 2023.

1 January 2023

3.  Schedule 2

1 July 2023.

1 July 2023

Note: This table relates only to the provisions of this Act as originally enacted. It will not be amended to deal with any later amendments of this Act.

 (2) Any information in column 3 of the table is not part of this Act. Information may be inserted in this column, or information in it may be edited, in any published version of this Act.

3  Schedules

  Legislation that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.

Schedule 1—Amendments

 

National Health Act 1953

1  Subsection 84(1)

Insert:

eligible for increased discounting: see section 87AA.

general patient charge amount means $30.00.

Note: The figure in this definition is adjusted annually under section 99G.

2  Paragraph 84C(4)(c)

Omit “$28.60” (first occurring), substitute “the general patient charge amount”.

3  Subparagraph 84C(4)(c)(i)

Omit “$28.60”, substitute “if the supply is not eligible for increased discounting—the general patient charge amount”.

4  After subparagraph 84C(4)(c)(i)

Insert:

 (ia) if the supply is eligible for increased discounting—the amount charged for the supply under paragraph 87(2)(e);

5  Paragraph 87(2)(e)

Omit “supplied $28.60 (less any allowable discount)”, substitute:

  supplied either:

 (i) in any case—the general patient charge amount (less any allowable discount); or

 (ii) if the supply is eligible for increased discounting—an amount that is less than the lowest amount chargeable under subparagraph (i), but greater than nil.

6  Subsection 87(2) (note 1)

After “in dollars”, insert “, and the general patient charge amount,”.

7  At the end of subsection 87(2)

Add:

Note 3: For the purposes of subparagraph (e)(ii), the lowest amount chargeable under subparagraph (e)(i) is the amount that would be chargeable under that subparagraph if the pharmacist or medical practitioner gave the maximum allowable discount.

8  After section 87

Insert:

87AA  Meaning of eligible for increased discounting

  A supply of a pharmaceutical benefit by an approved pharmacist or an approved medical practitioner is eligible for increased discounting if:

 (a) the supply is upon a general benefit prescription (other than one relating to a supply to which paragraph 87(2)(b) applies); and

 (b) the supply is not an early supply of a specified pharmaceutical benefit; and

 (c) at the time of the supply, the Commonwealth price in relation to the pharmaceutical benefit is:

 (i) greater than the general patient charge amount; and

 (ii) less than or equal to $42.50.

Note: The general patient charge amount and the figure in subparagraph (c)(ii) are adjusted annually under section 99G.

9  Paragraphs 99(2A)(a), (aa) and (b)

Omit “$28.60”, substitute “the general patient charge amount”.

10  Subsection 99(2A) (note)

Repeal the note.

11  After subsection 99(2B)

Insert:

 (2C) If a supply is eligible for increased discounting, then:

 (a) subject to paragraph (b) of this subsection, paragraph (2)(b) applies in relation to the supply as if the reference in paragraph (2)(b) to the amount (without any allowable discount) that the pharmacist or medical practitioner was entitled to charge under subsection 87(2) were a reference to the general patient charge amount; and

 (b) if an amount is charged for the supply under subparagraph 87(2)(e)(ii)—subsection (2) of this section does not apply in relation to the supply.

Note: Subparagraph 87(2)(e)(i) allows an approved pharmacist or approved medical practitioner to charge the general patient charge amount (less any allowable discount) for certain supplies. Subparagraph 87(2)(e)(ii) allows the approved pharmacist or approved medical practitioner to charge a lower amount if the supply is eligible for increased discounting.

12  Section 99F (definition of general patient charge)

Omit “each amount of $28.60 referred to in paragraph 84C(4)(c) or 87(2)(e) or subsection 99(2A)”, substitute “the amount specified in the definition of general patient charge amount in subsection 84(1)”.

13  Section 99F

Insert:

increased discounting upper Commonwealth price means the amount specified in subparagraph 87AA(c)(ii).

14  Subsection 99G(1)

Omit “after 2005”.

15  Subsection 99G(1) (at the end of the table)

Add:

 

5.

Increased discounting upper Commonwealth price

1 January

September

16  Indexation

General patient charge

(1) The amount mentioned in item 1 of the table in subsection 99G(1) of the National Health Act 1953, as amended by this Schedule, is to be indexed under section 99G of that Act:

 (a) on 1 January 2024; and

 (b) on 1 January in each year after 2024.

Increased discounting upper Commonwealth price

(2) The amount mentioned in item 5 of that table is to be indexed under that section:

 (a) on 1 January 2023 (immediately after the commencement of this item); and

 (b) on 1 January in each year after 2023.

Schedule 2—Special arrangements

 

National Health Act 1953

1  Subsections 100(1) and (2)

After “The Minister may”, insert “, by legislative instrument,”.

 

 

 

 

[Minister’s second reading speech made in—

House of Representatives on 7 September 2022

Senate on 25 October 2022]

 

(88/22)

 

Overview

The National Health Amendment (General Co-payment) Act 2022, enacted by the Parliament of Australia on 9 November 2022, seeks to amend the National Health Act 1953 by introducing a general patient co-payment for certain pharmaceutical benefits under the Pharmaceutical Benefits Scheme (PBS). The primary objective of this Act is to adjust the co-payment amount for patients, thereby affecting the pricing structure of prescribed medications and potentially influencing consumer behaviour and pharmaceutical costs. The changes outlined in the Act include the introduction of a new general patient charge amount, set at $30.00, which is subject to annual adjustments, and the establishment of criteria for supplies eligible for increased discounting based on the Commonwealth price of the pharmaceutical benefit. These amendments aim to refine the financial dynamics within the PBS while ensuring that the co-payment remains a manageable expense for patients. The provisions of the Act are set to commence on 1 January 2023, with specific sections and special arrangements taking effect on 1 July 2023.

Scope and Application

The National Health Amendment (General Co-payment) Act 2022 amends the National Health Act 1953 to introduce changes to the co-payment amounts for general patients under the Pharmaceutical Benefits Scheme (PBS). This Act applies to the conduct and transactions of approved pharmacists and approved medical practitioners who supply pharmaceutical benefits to patients under the PBS. The amendments introduced by this Act are effective from 1 January 2023, with specific provisions coming into effect on 1 July 2023. The Act does not specify any exclusions or exemptions, and its application is limited to the provisions outlined within the Act itself. The Act's application may be further extended or restricted through subordinate instruments, such as legislative instruments, as provided for in the amended National Health Act 1953. The primary change introduced by the Act is the replacement of the fixed general patient charge amount of $28.60 with a new general patient charge amount of $30.00, which is subject to annual indexation. Additionally, the Act introduces the concept of "increased discounting" for certain pharmaceutical supplies, where approved pharmacists and approved medical practitioners can charge an amount less than the general patient charge amount but greater than nil, provided specific conditions are met. The Act also includes provisions for the increased discounting upper Commonwealth price, which is subject to annual indexation starting from 1 January 2023. The amendments made by this Act are intended to provide flexibility in the pricing of pharmaceutical benefits under the PBS while ensuring that patients continue to receive appropriate discounts.

Key Provisions

The National Health Amendment (General Co-payment) Act 2022 amends the National Health Act 1953 to introduce a general patient charge for certain prescription medicines and to alter the method of calculating the co-payment for these medicines. The Act introduces a new concept of "general patient charge amount" (Section 84(1)), which is currently set at $30.00, and will be adjusted annually (Section 99G). The Act also introduces the concept of "eligible for increased discounting" (Section 87AA), which applies to supplies of pharmaceutical benefits by approved pharmacists or approved medical practitioners that meet certain criteria, such as being on a general benefit prescription and not being an early supply of a specified pharmaceutical benefit (Section 87AA(a)-(c)). The Act modifies the co-payment amount charged for certain supplies (Sections 84C(4)(c), 84C(4)(c)(i), 87(2)(e)) based on whether the supply is eligible for increased discounting (Section 87AA). The Act imposes several obligations on parties governed by it. Firstly, approved pharmacists and approved medical practitioners must charge the general patient charge amount for supplies that are not eligible for increased discounting (Section 87(2)(e)(i)), and a lower amount for those that are (Section 87(2)(e)(ii)). Secondly, the Commonwealth price for pharmaceutical benefits must fall within a specific range for a supply to be eligible for increased discounting (Section 87AA(c)(i)-(ii)). Lastly, the Act requires the general patient charge amount and the increased discounting upper Commonwealth price to be indexed annually (Section 99G). The Act does not explicitly state any offences, penalties, or civil/criminal consequences for breach. However, non-compliance with the requirements to charge the correct amount for pharmaceutical benefits could potentially lead to disputes or claims for overpayment or underpayment, which might result in civil consequences. It is important to note that the Act does not specify any maximum penalties for breaches.

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Health Law
Taxation Law
Instrument
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Commencement Provisions
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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.