National Health (Concession or entitlement card fee) Amendment Determination 2012 (No. 1) (No. PB 112 of 2012)

Administered by Department of Health, Disability and Ageing

Legislation au F2012L02500 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

  NATIONAL HEALTH ACT 1953

NATIONAL HEALTH (CONCESSION CARD OR ENTITLEMENT CARD FEE) AMENDMENT DETERMINATION 2012 (NO. 1)  

(PB 112 of 2012)

Authority

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 Repatriation Pharmaceutical Benefits (RPBS), in accordance with the Veterans’ Entitlements Act 1986.

 

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) in accordance with the Act and the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations) is entitled to be paid a fee by the Commonwealth.  Subsection 84HA(2) of the Act provides that the Minister must not determine a fee unless the Pharmacy Guild of Australia has agreed in writing to the determination.

 

The National Health (Concession or entitlement card fee) Determination 2012 (PB 102 of 2011) (the Principal Determination), made under subsection 84HA(1) of the National Health Act 1953 (the Act), determines the amount payable for the issuing of each safety net concession card, each pharmaceutical benefits entitlement card, and each additional or replacement card in relation to any of these cards.

 

Purpose

This Amendment Determination amends the Principal Determination to replace the amount of $8.88 with $9.06 taking effect from 1 January 2013. This reflects the annual adjustment to the fee payable to an approved pharmacist, an approved medical practitioner or an approved hospital authority for issuing a concession card or entitlement card (or an additional or replacement concession card or entitlement card).

 

Background

This fee is indexed on 1 January of each year by the ratio of the Consumer Price Index (CPI) for the September quarter for the current year and the CPI for the September quarter for the previous calendar year.  On this occasion, the fee is calculated to be $9.06.

 

This fee is only payable if the card has been issued:

 

  • by an approved supplier, that is an approved pharmacist, an approved medical practitioner or an approved hospital authority within the meaning of subsection 84(1) of the Act; and
  • in accordance with the provisions of Division 1A of Part VII of the Act, and the matters prescribed in Parts IIAA and IIA of the Regulations.
     

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.

 

Consultation

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

 

The Pharmacy Guild of Australia has been consulted on this matter as required under subsection 84HA(2) of the Act, and has agreed in writing, to the amendment made by this Determination.

 

This Determination commences on 1 January 2013.

 

This Determination is a legislative instrument for the purpose of the Legislative Instruments Act 2003.

 

 

 


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

National Health (Concession card or entitlement card fee) Amendment Determination 2012 (No. 1)   (PB 112 of 2012)

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Legislative Instrument

This Amendment Determination amends the National Health (Concession or entitlement card fee) Determination 2012 (PB 102 of 2011) to replace the amount of $8.88 with $9.06 taking effect from 1 January 2013. This reflects the annual adjustment to the fee payable to an approved pharmacist, an approved medical practitioner or an approved hospital authority for issuing a concession card or entitlement card (or an additional or replacement concession card or entitlement card). The amount of the fee is changed but the provision is unchanged.

Human rights implications

This legislative instrument engages Articles 2 and 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) by assisting with the progressive realisation by all appropriate means of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

The PBS is a benefit scheme which assists with advancement of this human right by providing for subsidised access by patients to medicines.

Conclusion

This Legislative Instrument is compatible with human rights because it advances the protection of human rights.

 

Kim Bessell

Assistant Secretary

Pharmaceutical Access Branch

Principal Pharmacy Advisor

Pharmaceutical Benefits Division

Department of Health and Ageing

 

Overview

The National Health Act 1953, enacted by the Parliament of Australia, governs the Pharmaceutical Benefits Scheme (PBS) which facilitates the supply of listed drugs and medicinal preparations. The Act also includes provisions for Repatriation Pharmaceutical Benefits (RPBS) for eligible veterans, as per the Veterans’ Entitlements Act 1986. A notable gap addressed by the Act is the need for a structured system to subsidise the cost of essential medicines for the public, ensuring access to affordable healthcare. Specifically, the Act outlines that pharmacists, medical practitioners, or hospital authorities who issue concession or entitlement cards for the PBS or RPBS are entitled to a fee determined by the Minister, subject to agreement with the Pharmacy Guild of Australia. The National Health (Concession or entitlement card fee) Amendment Determination 2012 (No. 1) was introduced to adjust this fee annually in line with the Consumer Price Index (CPI), ensuring the fee remains current and reflective of inflation. This amendment was made to maintain the financial viability of the PBS while ensuring approved suppliers are fairly compensated for their services.

Scope and Application

The National Health (Concession Card or Entitlement Card Fee) Amendment Determination 2012 (No. 1) amends the National Health (Concession or Entitlement Card Fee) Determination 2012 to adjust the fee payable to an approved pharmacist, approved medical practitioner, or approved hospital authority for issuing a concession card or entitlement card, or an additional or replacement card, from $8.88 to $9.06, effective from 1 January 2013. This adjustment aligns with the annual indexation of the fee based on the Consumer Price Index. The amendment applies to approved suppliers who issue the cards in accordance with the National Health Act 1953 and the National Health (Pharmaceutical Benefits) Regulations 1960. The card issuance fee supports the safety net scheme designed to provide financial protection for patients requiring a significant number of Pharmaceutical Benefits Scheme or Repatriation Pharmaceutical Benefits, enabling them to receive medicines at a reduced rate or free of charge. The amendment reflects a commitment to the progressive realisation of the right to the highest attainable standard of physical and mental health, as recognised in the International Covenant on Economic, Social and Cultural Rights.

Key Provisions

The National Health (Concession or entitlement card fee) Amendment Determination 2012 (No. 1) (the Amendment Determination) amends the National Health (Concession or entitlement card fee) Determination 2012 (PB 102 of 2011) to adjust the fee payable for the issuance of concession cards or entitlement cards under the Pharmaceutical Benefits Scheme (PBS). Specifically, section 1 of the Amendment Determination replaces the previous fee of $8.88 with a new fee of $9.06, effective from 1 January 2013. This adjustment reflects the annual indexation of the fee based on changes in the Consumer Price Index (CPI). The new fee applies to the issuance of each safety net concession card, each pharmaceutical benefits entitlement card, and each additional or replacement card in relation to any of these cards by an approved supplier, which includes approved pharmacists, approved medical practitioners, or approved hospital authorities. The Amendment Determination imposes certain obligations and requirements on the parties involved in the issuance of concession or entitlement cards. Section 1 of the Amendment Determination requires that the new fee of $9.06 be paid by the Commonwealth to the approved suppliers who issue these cards. This requirement is contingent upon the cards being issued in accordance with 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. The approved suppliers must ensure that the cards are issued to eligible individuals who have reached the safety net threshold for PBS or Repatriation Pharmaceutical Benefits (RPBS) medicines, thus qualifying them for reduced-rate or free access to these medicines for the remainder of the relevant entitlement period. The Amendment Determination does not explicitly outline specific offences, penalties, or consequences for breaches within its text. However, general provisions under the National Health Act 1953 and associated regulations may apply to any non-compliance with the requirements for issuing concession or entitlement cards. Typically, breaches of such requirements could result in administrative penalties, fines, or other enforcement actions as prescribed by the relevant legislative framework. The maximum penalties for such breaches would be determined by the specific provisions of the National Health Act and the National Health (Pharmaceutical Benefits) Regulations 1960, which might include financial penalties or other corrective measures to ensure compliance with the scheme's provisions.

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