National Health Determination under paragraph 98C(1)(b) Amendment 2019 (No. 9) (PB 93 of 2019)

Administered by Department of Health, Disability and Ageing

Legislation au F2019L01517 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

NATIONAL HEALTH DETERMINATION UNDER PARAGRAPH 98C(1)(b) AMENDMENT 2019 (No. 9)

PB 93 of 2019

 

Authority

Paragraph 98C(1)(b) of the National Health Act 1953 (the Act) provides that the Minister may determine the conditions subject to which payments will be made by the Commonwealth in respect of the supply of pharmaceutical benefits by approved pharmacists and approved medical practitioners.  The Determination under paragraph 98C(1)(b) of the National Health Act 1953 (PB 119 of 2008) (the Principal Determination) sets out the conditions subject to which these payments will be made.

Purpose

The amendments made by this Instrument reflect amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012), which commence on the same day.  The National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012) is made under sections 84AF, 84AK, 85, 85A, 88 and 101 of the Act.

The amendments made by this Instrument include additions, deletions and changes to drugs and forms in Schedules 1 to 5 of the Principle Determination.

A provision by provision description of this Instrument is contained in the Attachment.

Variation and revocation

Unless there is an express power to revoke or vary PB 119 of 2008 cited in this Instrument and explanatory statement, subsection 33(3) of the Acts Interpretation Act 1901 is relied upon to revoke or vary PB 119 of 2008.

Background

Part VII of the National Health Act 1953 (the Act) is the legislative basis of the Pharmaceutical Benefits Scheme (PBS) by which the Commonwealth provides reliable, timely, and affordable access to a wide range of medicines for all Australians.

Subsection 85(1) provides that benefits are to be provided by the Commonwealth in accordance with Part VII in respect of pharmaceutical benefits.

Paragraph 98C(1)(b) of the Act provides that the Minister may, from time to time, determine the conditions subject to which payments will be made by the Commonwealth in respect of the supply of pharmaceutical benefits by approved pharmacists and approved medical practitioners.

The determination under paragraph 98C(1)(b) of the Act sets out the conditions under which payments will be made in respect of the supply of pharmaceutical benefits by approved pharmacists and approved medical practitioners.

Consultations

The Department consulted with the Pharmaceutical Benefits Advisory Committee (PBAC) during the regular process of its meetings to consider applications in order to recommend to the Minister which medicines should be subsidised through the Pharmaceutical Benefits Scheme.  The Committee is independent of Government and includes members from the following interests or professions: consumers, health economists, practising community pharmacists, general practitioners, clinical pharmacologists, medical specialists and a pharmaceutical industry nominee.  The Committee has received submissions and representations from interested pharmaceutical companies and has recommended the changes to the Minister who has determined the changes to the conditions under paragraph 98C(1)(b) which appear in this Determination.

This Instrument commences on 1 December 2019.

This Instrument is a legislative instrument for the purposes of the Legislation Act 2003.


ATTACHMENT

PROVISION-BY-PROVISION DESCRIPTION OF NATIONAL HEALTH DETERMINATION UNDER PARAGRAPH 98C(1)(b) AMENDMENT 2019 (No. 9)

Section 1 Name of Instrument

This section provides that the Instrument is the National Health Determination under paragraph 98C(1)(b) Amendment 2019 (No. 9) and may also be cited as PB 93 of 2019.

Section 2 Commencement

This section provides that the Instrument commences on 1 December 2019.

Section 3 Amendment of Determination under paragraph 98C(1)(b) of the National Health Act 1953 (PB 119 of 2008)

This section provides that Schedule 1 amends the Determination under paragraph 98C(1)(b) of the National Health Act 1953 (PB 119 of 2008).

Schedule 1 Amendments

The amendments in Schedule 1 include additions, deletions and changes to drugs and forms in Schedules 1 to 5 of the Principle Determination.  These changes are summarised below.

 

SUMMARY OF CHANGES

Listed drugs added to Schedule 4 (complete pack must be supplied)

Lumacaftor with Ivacaftor

Forms added to Schedule 4 (complete pack must be supplied)

Carmellose

Eye drops containing carmellose sodium 5 mg per mL, 10 mL

Hypromellose

0.3% w/v eye drops, 10 mL (preservative free)

Forms deleted from Schedule 4 (complete pack must be supplied)

Aciclovir

Eye ointment 30 mg per g, 4.5 g

Alteration of Form

Listed Drug

Form

Triamcinolone with neomycin, gramicidin and nystatin

From:

Ear drops containing triamcinolone acetonide 1 mg with neomycin 2.5 mg (as sulfate), gramicidin 250 micrograms and nystatin 100,000 units per g, 7.5 mL

To:

Ear drops containing triamcinolone acetonide 0.9 mg with neomycin 2.25 mg (as sulfate), gramicidin 225 micrograms and nystatin 90,000 units per mL, 7.5 mL


Statement of Compatibility with Human Rights

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

National Health Determination under paragraph 98C(1)(b) Amendment 2019 (No. 9)

(PB 93 of 2019)

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

The Determination under paragraph 98C(1)(b) of the National Health Act 1953 (PB 119 of 2008) (the Principal Determination) sets out the conditions under which payments will be made in respect of the supply of pharmaceutical benefits by approved pharmacists and approved medical practitioners.

This Legislative Instrument amends the Principal Determination to provide for changes to those conditions.  Schedule 1 to this Legislative Instrument provides for additions, deletions and changes to drugs and forms in Schedules 1 to 5 of the Principle Determination.

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.  The recommendatory role of the Pharmaceutical Benefits Advisory Committee (PBAC) ensures that decisions about subsidised access to medicines on the PBS are evidence-based.

Conclusion

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

 

 

 

 

 

Thea Daniel

Assistant Secretary

Pricing and PBS Policy Branch

Technology Assessment and Access Division

Department of Health

 

Overview

The National Health Determination under paragraph 98C(1)(b) Amendment 2019 (No. 9) (PB 93 of 2019) amends the conditions under which payments are made by the Commonwealth in respect of the supply of pharmaceutical benefits by approved pharmacists and approved medical practitioners, as set out in the Principal Determination under paragraph 98C(1)(b) of the National Health Act 1953 (PB 119 of 2008). Enacted by the Minister for Health under the authority of the National Health Act 1953, this amendment addresses the need to update the Pharmaceutical Benefits Schedule to reflect changes in medical practices and the availability of new pharmaceuticals. The policy objective is to ensure the Pharmaceutical Benefits Scheme (PBS) continues to provide affordable access to a wide range of medicines for all Australians, aligning with the provisions outlined in Part VII of the Act. This legislative instrument, which commenced on 1 December 2019, includes modifications to drugs and their forms listed in Schedules 1 to 5 of the Principal Determination, ensuring the PBS remains responsive to evolving healthcare needs and evidence-based recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC).

Scope and Application

The National Health Determination under paragraph 98C(1)(b) Amendment 2019 (No. 9) is a legislative instrument that amends the conditions under which payments are made by the Commonwealth for pharmaceutical benefits supplied by approved pharmacists and approved medical practitioners. This amendment, referred to as PB 93 of 2019, is made under paragraph 98C(1)(b) of the National Health Act 1953, which allows the Minister to determine these conditions. The changes specified in this amendment reflect updates to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, impacting the drugs and forms listed in Schedules 1 to 5 of the Principal Determination. The amendment includes the addition of certain drugs to Schedule 4, where a complete pack must be supplied, as well as the deletion of other drugs and alterations to the forms of certain drugs. The changes are designed to ensure the Pharmaceutical Benefits Scheme (PBS) continues to provide timely and affordable access to a wide range of medicines for Australians. This instrument commenced on 1 December 2019 and is compatible with human rights, advancing the protection of the right to the highest attainable standard of physical and mental health through the PBS.

Key Provisions

The National Health Determination under paragraph 98C(1)(b) Amendment 2019 (No. 9) (PB 93 of 2019) modifies the conditions under which the Commonwealth makes payments for pharmaceutical benefits provided by approved pharmacists and medical practitioners. These changes are primarily reflected in the amendments to the drugs and forms listed in Schedules 1 to 5 of the Principal Determination (PB 119 of 2008). The amendments include the addition of new drugs and forms, deletions of certain drugs and forms, and alterations to existing entries to ensure that the Pharmaceutical Benefits Scheme (PBS) remains up to date with the latest medical evidence and recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC). The determination imposes several obligations on the parties involved. Approved pharmacists and medical practitioners must comply with the updated conditions to continue receiving payments for pharmaceutical benefits. These conditions dictate the specific drugs and forms that can be supplied under the PBS, ensuring that the scheme remains aligned with the latest medical advice and cost-effectiveness evaluations. The Pharmaceutical Benefits Advisory Committee (PBAC) plays a critical role by providing expert recommendations to the Minister, who then determines the amendments to the conditions. This ensures that decisions about which medicines are subsidised are evidence-based and reflect the best interests of public health. Failure to comply with the updated conditions set out in the Determination may result in legal consequences. While the specific penalties for non-compliance are not detailed in the Explanatory Statement, breaches of the National Health Act 1953 could potentially lead to administrative penalties, fines, or other enforcement actions. These penalties are intended to ensure adherence to the legislative requirements and the proper administration of the PBS. Additionally, healthcare providers who do not comply with the conditions may face civil or criminal liability, depending on the nature and extent of the breach. Overall, the amendments to the National Health Determination under paragraph 98C(1)(b) are designed to enhance the effectiveness and efficiency of the PBS. By updating the list of pharmaceutical benefits, the changes aim to ensure that the scheme provides access to the most appropriate and cost-effective medications, thereby supporting the progressive realisation of the right to the highest attainable standard of health for all Australians.

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