National Health (Concession or entitlement card fee) Amendment Determination 2013 (No. 1) (No. PB 86 of 2013)

Administered by Department of Health, Disability and Ageing

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

National Health (CONCESSION OR ENTITLEMENT CARD FEE) AMENDMENT Determination 2013

PB 86 of 2013

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 safety net concession card or pharmaceutical benefits 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 current Principal Determination

(PB 102 of 2011) to replace the amount of $9.06 with $9.26 taking effect from 1 January 2014. 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 safety net concession card or pharmaceutical benefits 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 $9.26.

 

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 Pharmaceutical Benefits Scheme (PBS) or Repatriation Pharmaceutical Scheme (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 will commence on 1 January 2014.

 

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 or entitlement card fee) Amendment Determination 2013 (No. 1)   (PB 86 of 2013)

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) (Principal Determination) to replace the amount of $9.06 with $9.26 taking effect from 1 January 2014. 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 safety net concession card or pharmaceutical benefits 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.

 

Kimberley David Bessell

Assistant Secretary

Pharmaceutical Access Branch

Principal Pharmacy Advisor

Pharmaceutical Benefits Division

Department of Health

 

Overview

The National Health (Concession or entitlement card fee) Amendment Determination 2013 (PB 86 of 2013) amends the existing fee structure for the issuance of safety net concession cards and pharmaceutical benefits entitlement cards under the National Health Act 1953. The primary objective of this Amendment Determination is to adjust the fee payable to approved pharmacists, medical practitioners, and hospital authorities for issuing these cards from $9.06 to $9.26, effective from 1 January 2014. This adjustment reflects the annual indexation of the fee according to the Consumer Price Index (CPI) for the relevant period. The determination was made under subsection 84HA(1) of the Act, ensuring that the fee aligns with the inflation rate and is consistent with the provisions of the National Health (Pharmaceutical Benefits) Regulations 1960. The amendment was subject to consultation with the Pharmacy Guild of Australia, which agreed to the changes as required by the Act. The National Health Act 1953, enacted by the Australian Parliament, regulates the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits (RPBS) scheme to ensure access to essential medications. The amendment aims to address the need for an annual update to the fee structure to maintain the financial viability of the scheme and the services provided by approved health professionals. The amendment ensures that the scheme remains sustainable while continuing to provide necessary healthcare support to eligible patients and their families. This legislative instrument has been assessed for compatibility with human rights, specifically engaging Articles 2 and 12 of the International Covenant on Economic, Social and Cultural Rights by enhancing access to affordable healthcare.

Scope and Application

The National Health (Concession or Entitlement Card Fee) Amendment Determination 2013 amends the National Health (Concession or Entitlement Card Fee) Determination 2012 to adjust the fee payable for the issuance of safety net concession cards, pharmaceutical benefits entitlement cards, and their additional or replacement variants. This adjustment, which changes the fee from $9.06 to $9.26, reflects an annual indexation based on the Consumer Price Index. The Amendment Determination applies to approved suppliers, including pharmacists, medical practitioners, and hospital authorities who issue these cards in accordance with the provisions of Division 1A of Part VII of the National Health Act 1953 and the associated regulations. This adjustment is effective from 1 January 2014 and is subject to the Pharmacy Guild of Australia's written agreement, as required by subsection 84HA(2) of the Act. The Determination operates under the authority of Part VII of the National Health Act 1953 and is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

Key Provisions

The main operative sections of the National Health (Concession or Entitlement Card Fee) Amendment Determination 2013 (No. 1) (PB 86 of 2013) are concerned with adjusting the fee payable for issuing safety net concession cards and pharmaceutical benefits entitlement cards. Section 1 of the Determination amends the previous fee amount of $9.06 to $9.26, effective from 1 January 2014. This amendment reflects the annual adjustment in line with the Consumer Price Index (CPI) and is made in accordance with subsection 84HA(1) of the National Health Act 1953. The purpose of this adjustment is to ensure that the fees remain in line with inflation, thus maintaining the financial viability of the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS). The obligations imposed by the Amendment Determination on the parties involved, such as approved pharmacists, approved medical practitioners, and approved hospital authorities, include adhering to the stipulated fee for issuing the safety net concession cards and pharmaceutical benefits entitlement cards. These entities must ensure that the card issuance process complies with the requirements set out in Division 1A of Part VII of the National Health Act 1953 and the relevant provisions in Parts IIAA and IIA of the National Health (Pharmaceutical Benefits) Regulations 1960. Failure to comply with these requirements could result in the non-payment of the fee or other administrative consequences. There are no explicit offences, penalties, or civil/criminal consequences mentioned in the Amendment Determination for breaches of the fee determination itself. However, non-compliance with the broader requirements of the National Health Act 1953 and the National Health (Pharmaceutical Benefits) Regulations 1960 could lead to penalties as stipulated in those respective Acts and Regulations. For instance, any fraudulent activity or misrepresentation in the card issuance process could result in fines or other sanctions under the applicable legislative framework. It is important for the parties involved to adhere to all regulatory requirements to avoid any potential legal repercussions.

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