National Health (Concession or entitlement card fee) Amendment Determination 2017 (No. 1) (PB 100 of 2017)

Administered by Department of Health, Disability and Ageing

Legislation au F2017L01609 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

  NATIONAL HEALTH ACT 1953

National Health (CONCESSION OR ENTITLEMENT CARD FEE) AMENDMENT Determination 2017

PB 100 of 2017

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 Scheme (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 $9.73 with $9.91 taking effect from 1 January 2018. This reflects an increase 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 has been indexed by the ratio of the Consumer Price Index (CPI) for the September quarter for each of the two previous years.  The 2017 fee of $9.73 will rise by 18 cents to $9.91 with effect from 1 January 2018.

 

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 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 2018.

 

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 2017 (No. 1)   (PB 100 of 2017)

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 $9.73 with $9.91 taking effect from 1 January 2018. This reflects an increase 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.

 

Natasha Ploenges

A/g Assistant Secretary

Private Health Insurance and Pharmacy Branch

Technology Assessment and Access Division

Department of Health

 

Overview

The National Health Act 1953 was enacted to provide for the regulation of the Pharmaceutical Benefits Scheme (PBS), ensuring the supply of listed drugs and medicinal preparations as pharmaceutical benefits. The Act also governs the Repatriation Pharmaceutical Benefits Scheme (RPBS) for eligible veterans under the Veterans’ Entitlements Act 1986. To address the need for a fee structure for the issuance of safety net concession cards and pharmaceutical benefits entitlement cards, the National Health (Concession or Entitlement Card Fee) Determination 2012 was established under the Act. The National Health (Concession or Entitlement Card Fee) Amendment Determination 2017, made under the authority of the National Health Act 1953, updates the fee amount from $9.73 to $9.91 effective from 1 January 2018. This adjustment reflects an increase based on the Consumer Price Index for the September quarter of the two previous years and follows consultation with the Pharmacy Guild of Australia. The policy objective remains to provide financial protection for patients requiring extensive use of PBS and RPBS medicines through the safety net scheme.

Scope and Application

The National Health (Concession or Entitlement Card Fee) Amendment Determination 2017 amends the existing National Health (Concession or Entitlement Card Fee) Determination 2012, which sets out the fee payable to approved pharmacists, approved medical practitioners, and approved hospital authorities for issuing safety net concession cards, pharmaceutical benefits entitlement cards, and their additional or replacement counterparts. These cards are issued under Division 1A of Part VII of the National Health Act 1953 and provide financial protection to patients and their families who require a large number of Pharmaceutical Benefits Scheme (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS) medicines. The Amendment Determination, which takes effect from 1 January 2018, increases the fee from $9.73 to $9.91, reflecting an indexation based on the Consumer Price Index (CPI) for the September quarter for each of the two previous years. The fee is payable only if the card has been issued by an approved supplier in accordance with the relevant provisions of the National Health Act 1953 and the National Health (Pharmaceutical Benefits) Regulations 1960. The amendment is compatible with human rights, as it supports the progressive realisation of the right to the highest attainable standard of physical and mental health by ensuring subsidised access to medicines through the PBS.

Key Provisions

The National Health (Concession or entitlement card fee) Amendment Determination 2017 (PB 100 of 2017) amends the Principal Determination (PB 102 of 2011) concerning the fee payable to approved pharmacists, approved medical practitioners, or approved hospital authorities for issuing safety net concession cards, pharmaceutical benefits entitlement cards, or additional or replacement cards (sections 1 and 2). The fee adjustment, effective from 1 January 2018, increases from $9.73 to $9.91, reflecting the Consumer Price Index (CPI) for the September quarter over the previous two years (section 2). This fee is contingent upon the card being issued by an approved supplier in accordance with the provisions of Division 1A of Part VII of the Act and the regulations (section 3). The Amendment Determination imposes several obligations on the parties involved. Approved pharmacists, medical practitioners, and hospital authorities must adhere to the specified fee structure when issuing the designated cards (section 3). The Minister is bound by the condition that they cannot determine the fee without written agreement from the Pharmacy Guild of Australia (section 4). Furthermore, the amendment stipulates that the fee is only payable if the card is issued by an approved supplier and in compliance with the relevant legislative and regulatory provisions (section 3). Under this Amendment Determination, there are no direct criminal or civil penalties for non-compliance with the fee provisions. However, failure to adhere to the requirements for issuing concession or entitlement cards could potentially lead to complications in reimbursement processes and might indirectly affect the eligibility of patients for the benefits provided by the PBS or RPBS. The primary consequence of non-compliance would likely be financial, as the issuing entities would not receive the increased fee of $9.91 from the Commonwealth (section 3). The determination emphasizes that the fee is contingent upon compliance with the legislative and regulatory frameworks governing the issuance of these cards.

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