National Health (Concession or entitlement card fee) Amendment Determination 2016 (No. 1) (PB 106 of 2016)

Administered by Department of Health, Disability and Ageing

Legislation au F2016L01789 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

  NATIONAL HEALTH ACT 1953

National Health (CONCESSION OR ENTITLEMENT CARD FEE) AMENDMENT Determination 2016

PB 106 of 2016

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 $9.61 with $9.73 taking effect from 1 January 2017. 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 each of the two previous years.  The 2016 fee of $9.61 will rise by 12 cents to $9.73 with effect from 1 January 2017.

 

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 Sixth 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 2017.

 

This Determination is a legislative instrument for the purpose of the Legislation 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 2016 (No. 1)   (PB 106 of 2016)

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 $9.61 with $9.73 taking effect from 1 January 2017. 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). While the amount of the fee has changed, 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.

 

Julianne Quaine

Assistant Secretary

Pharmaceutical Access Branch

Pharmaceutical Benefits Division

Department of Health

 

Overview

The National Health (Concession or Entitlement Card Fee) Amendment Determination 2016, enacted by the Parliament of Australia, amends the National Health (Concession or Entitlement Card Fee) Determination 2012 to adjust the fee payable for issuing safety net concession cards and pharmaceutical benefits entitlement cards. This adjustment, which takes effect from 1 January 2017, involves increasing the fee from $9.61 to $9.73, reflecting the annual adjustment based on the Consumer Price Index. The National Health Act 1953 governs this adjustment, which is integral to the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS), ensuring that approved pharmacists, medical practitioners, and hospital authorities are appropriately compensated for their role in issuing these cards. This legislative amendment aims to maintain the financial viability of the PBS and RPBS, ensuring continued access to affordable medicines for eligible individuals. The policy objective behind this amendment is to ensure that the fee for issuing safety net concession cards and pharmaceutical benefits entitlement cards remains competitive and reflective of economic changes, thereby maintaining the operational integrity of the PBS and RPBS. By consulting with the Pharmacy Guild of Australia, the amendment process adheres to the statutory requirement outlined in the National Health Act 1953, ensuring that the adjustment aligns with industry standards and the needs of healthcare providers. This amendment not only addresses the economic factors influencing the fee but also supports the broader goal of providing accessible and affordable healthcare to the Australian public.

Scope and Application

The National Health (Concession or entitlement card fee) Amendment Determination 2016 amends the National Health (Concession or entitlement card fee) Determination 2012 to adjust the fee payable for issuing safety net concession cards or pharmaceutical benefits entitlement cards from $9.61 to $9.73, effective from 1 January 2017. This adjustment is made to reflect the annual indexing of the fee based on the Consumer Price Index. The fee applies to approved pharmacists, medical practitioners, and hospital authorities who issue the cards in accordance with Division 1A of Part VII of the National Health Act 1953 and the relevant provisions of the National Health (Pharmaceutical Benefits) Regulations 1960. This change ensures that the fee remains current with inflation and maintains the integrity of the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Scheme (RPBS) by providing necessary financial protection for patients who require a large number of PBS or RPBS medicines. The amendment was made in consultation with the Pharmacy Guild of Australia, as required by the Act, and is compatible with human rights, supporting the right to the highest attainable standard of physical and mental health under international instruments.

Key Provisions

The National Health (Concession or Entitlement Card Fee) Amendment Determination 2016 (No. 1) (PB 106 of 2016) amends the National Health (Concession or Entitlement Card Fee) Determination 2012 (PB 102 of 2011) to increase the fee from $9.61 to $9.73, effective from 1 January 2017 (subsection 1). This adjustment reflects the annual indexing of 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, as outlined in subsection 84HA(1) of the National Health Act 1953 (the Act). This fee is only payable if the card has been issued by an approved supplier and in accordance with Division 1A of Part VII of the Act and the Regulations (subsection 2). The Amendment Determination imposes specific obligations on approved pharmacists, approved medical practitioners, and approved hospital authorities to ensure they are compensated for issuing safety net concession cards or pharmaceutical benefits entitlement cards, as stipulated by the Act and Regulations. These entities must issue the cards in accordance with the legal requirements and only be paid the fee if the cards are issued correctly (subsection 84(1) of the Act). The Minister must not determine a fee unless the Pharmacy Guild of Australia agrees in writing, as required by subsection 84HA(2) of the Act. The Amendment Determination also requires that the new fee of $9.73 be applied from 1 January 2017, replacing the previous fee of $9.61. There are no explicit offences, penalties, or consequences for breach specified in the Amendment Determination itself. However, any failure to comply with the requirements of the National Health Act 1953 or the National Health (Pharmaceutical Benefits) Regulations 1960 could lead to civil or criminal consequences, depending on the nature and severity of the breach. The determination ensures that approved entities are compensated appropriately for their services in issuing the cards, reflecting the annual adjustments based on the Consumer Price Index.

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Area of Law
Health Law
Instrument
Statutory Instrument
Concepts
Definitions & Interpretation
Fee Adjustment
Consultation Requirements

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