National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 5) (PB 51 of 2015)

Administered by Department of Health, Disability and Ageing

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

NATIONAL HEALTH (EFFICIENT FUNDING OF CHEMOTHERAPY) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2015 (No. 5)

PB 51 of 2015

 

Authority

Subsection 100(1) of the National Health Act 1953 (the Act) enables the Minister to make special arrangements for the supply of pharmaceutical benefits. Subsection 100(2) of the Act provides that the Minister may vary or revoke a special arrangement made under subsection 100(1).

 

Subsection 100(3) of the Act provides that Part VII of the Act, and instruments made for the purposes of Part VII, have effect subject to a special arrangement made under subsection 100(1). 

Purpose

The purpose of this legislative instrument, made under subsections 100(1) and 100(2) of the Act, is to amend the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (PB 79 of 2011) (the Special Arrangement), to make changes relating to the efficient funding of chemotherapy.

The Special Arrangement achieves greater efficiency in payment for the supply of injected or infused chemotherapy medicines (“chemotherapy pharmaceutical benefits”) to eligible patients being treated for cancer, to reflect the 2010 budget measure entitled ‘Revised arrangements for the efficient funding of chemotherapy drugs’. This Special Arrangement also relates to the supply of medicines associated with the side-effects of cancer and cancer treatment (“related pharmaceutical benefits”) at certain public hospitals.

This instrument makes changes to the pharmaceutical benefits available under the Special Arrangement for the efficient funding of chemotherapy. These changes reflect changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 made under sections 84AF, 84AK, 85, 85A, 88 and 101 of the Act, which commence on the same day.

This instrument:

  • amends the circumstance codes,  purpose codes and the associated circumstances for the listed drugs ‘Bevacizumab’, and ‘Cetuximab’;
  • removes 6 listed brands for the listed drugs ‘Docetaxel’, ‘Oxaliplatin’, and ‘Ondansetron; and
  • adds 4 listed brands to the listed drug ‘Ondansteron’.

 

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

 

 

 

 

 

 

Consultations

An ongoing and formal process of consultation in relation to matters relevant to the Special Arrangement includes the involvement of interested parties through the membership of the Pharmaceutical Benefits Advisory Committee (PBAC). PBAC is an independent expert body established by section 100A of the Act which makes recommendations to the Minister about which drugs and medicinal preparations should be available as pharmaceutical benefits. 

PBAC members are appointed following nomination by prescribed organisations and associations from consumers, health economists, practising community pharmacists, general practitioners, clinical pharmacologists and specialists, with at least one member selected from each of those interests or professions.  Remaining members are persons whom the Minister is satisfied have qualifications and experience in a field relevant to the functions of PBAC, and that would enable them to contribute meaningfully to the deliberations of PBAC.  When recommending the listing of a medicine on the Pharmaceutical Benefits Scheme (PBS), PBAC takes into account the medical conditions for which the medicine has been approved for use in Australia, its clinical effectiveness, safety and cost-effectiveness compared with other treatments.

This instrument commences on 1 June 2015.

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


ATTACHMENT B

PROVISION BY PROVISION DESCRIPTION OF THE NATIONAL HEALTH (EFFICIENT FUNDING OF CHEMOTHERAPY) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2015 (No. 5)

Section 1  Name of Instrument

This section provides that this Instrument is the National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 5) and that it may also be cited as PB 51 of 2015.

Section 2  Commencement

This section provides that this Instrument commences on 1 June 2015.

Section 3   Amendments to PB 79 of 2011

This section provides that Schedule 1 amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (PB 79 of 2011) (the Special Arrangement).

 

Item 1 amends the entry in Schedule 1 Part 1 of the Special Arrangement for ‘Bevacizumab’ in each of the forms ‘Solution for I.V. infusion 100 mg in 4 mL’ and ‘Solution for I.V. infusion 400 mg in 16 mL’ with manner of administration ‘Injection’ by adding the new circumstance codes ‘C4939’ and ‘C4968’.

Item 2 amends the entry in Schedule 1 Part 1 of the Special Arrangement for ‘Cetuximab’ in each of the forms ‘Solution for I.V. infusion 100 mg in 20 mL’ and ‘Solution for I.V. infusion 500 mg in 100 mL’ with manner of administration ‘Injection’ by removing the circumstance code ‘C4771 and ‘C4779’ and adding the new circumstance codes ‘C4902’, ‘C4912’, C4945’, and ‘C4965’.

Item 3 amends the entry in Schedule 1 Part 1 of the Special Arrangement for ‘Docetaxelby removing the pharmaceutical benefit, which is the listed drug ‘Docetaxelin the formSolution for I.V. infusion 20 mg in 1 mL single dose vial’ with manner of administration ‘Injection and brand ‘Dotax.

Item 4 amends the entry in Schedule 1 Part 1 of the Special Arrangement for ‘Docetaxel’ by removing the pharmaceutical benefit, which is the listed drug ‘Docetaxel’ in the formSolution for I.V. infusion 80 mg in 4 mL single dose vial’ with manner of administration ‘Injection and brand ‘Dotax’.

Item 5 amends the entry in Schedule 1 Part 1 of the Special Arrangement for ‘Oxaliplatin’ by removing the pharmaceutical benefits, which is the listed drug ‘Oxaliplatin’ in each of the formsPowder for I.V. infusion 100 mg and ‘Powder for I.V. infusion 50 mg with manner of administration ‘Injection’ and brand ‘Hospira Pty Limited.

Item 6 amends Schedule 1 Part 2 of the Special Arrangement for ‘Bevacizumab by adding the new purpose codes ‘P4939’ and ‘P4968’.

Item 7 amends Schedule 1 Part 2 of the Special Arrangement for ‘Cetuximab by removing the purpose code ‘P4771’ and ‘P4779’, and adding the new purpose codes ‘P4908’, P4912’, ‘P4945’ and ‘P4965’.

Item 8 amends the entry in Schedule 2 of the Special Arrangement for ‘Ondansetron’ by adding the pharmaceutical benefits, which is the listed drug ‘Ondansetron’ in each of the forms ‘Tablet 4 mg (as hydrochloride dihydrate)’ and ‘Tablet 8 mg (as hydrochloride dihydrate)’with manner of administration ‘Oral’ and brand ‘Ondansetron SZ’.

 

Item 9 amends the entry in Schedule 2 of the Special Arrangement for ‘Ondansetron’ by adding the pharmaceutical benefits, which is the listed drug ‘Ondansetron’ in each of the forms ‘Tablet (orally disintegrating) 4 mg’ and ‘Tablet (orally disintegrating) 8 mg’ with manner of administration ‘Oral’ and brand ‘Ondansetron SZ ODT’.

Item 10 amends the entry in Schedule 2 of the Special Arrangement for ‘Ondansetron’ by removing the pharmaceutical benefits, which is the listed drug ‘Ondansetron’ in each of the forms ‘I.V. injection 4 mg (as hydrochloride dihydrate) in 2 mL’ and ‘I.V. injection 8 mg (as hydrochloride dihydrate) in 4 mL’ with manner of administration ‘Injection’ and brand ‘Ondaz’.

Item 11 amends the entry in Schedule 4 of the Special Arrangement by adding the new circumstance code C4939 and ‘C4968’, purpose code and the associated circumstance for pharmaceutical benefits with the listed drug ‘Bevacizumab’.

Item 12 amends the entry in Schedule 4 of the Special Arrangement by removing circumstance code ‘‘C4771 and ‘C4779’, purpose code and the associated circumstance; and adding the new circumstance code ‘C4902’, ‘C4912’, C4945’, and ‘C4965’, purpose code and the associated circumstance for pharmaceutical benefits with the listed drug ‘Cetuximab’.

 

 

 

 

 

 

 

 

 

 


 

Statement of Compatibility with Human Rights

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

National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2013 (No. 4)

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 purpose of this legislative instrument, made under subsections 100(1) and 100(2) of the Act, is to amend the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (PB 79 of 2011) (the Special Arrangement), to make changes to the special arrangement relating to the efficient funding of chemotherapy.

The Special Arrangement achieves greater efficiency in payment for the supply of injected or infused chemotherapy medicines (“chemotherapy pharmaceutical benefits”) to eligible patients being treated for cancer, to reflect the 2010 budget measure titled ‘Revised arrangements for the efficient funding of chemotherapy drugs’. This Special Arrangement also relates to the supply of medicines associated with the side-effects of cancer and cancer treatment (“related pharmaceutical benefits”) at certain public hospitals.

This Instrument:

  • adds 4 new listed brands for the listed drugsDoxorubicin’, and ‘Gemcitabine’;
  • adds 1 new listed form for the listed drug ‘Aprepitant’;
  • removes 2 listed brands for the listed drug ‘Docetaxel’; and
  • adds new circumstance codes and the associated circumstances for  the listed drug ‘Aprepitant’.

Human rights implications

This legislative instrument engages Article 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 Pharmaceutical Benefits Scheme (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.

 

Kim Bessell

 

Overview

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 5) was enacted to amend the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011, addressing the efficient funding of chemotherapy. This legislative instrument was introduced under subsections 100(1) and 100(2) of the National Health Act 1953, empowering the Minister to make special arrangements for the supply of pharmaceutical benefits and to vary or revoke such arrangements. The objective of this amendment is to reflect the 2010 budget measure titled ‘Revised arrangements for the efficient funding of chemotherapy drugs’ and to achieve greater efficiency in the payment for the supply of chemotherapy medicines to eligible cancer patients, as well as related pharmaceutical benefits at certain public hospitals. The changes include amendments to circumstance codes, purpose codes, and associated circumstances for specific drugs, and the addition and removal of certain brands and forms of pharmaceutical benefits. The enacting body for this instrument is the Minister for Health, acting under the authority provided by the National Health Act 1953. The policy objective is to ensure that the funding of chemotherapy and related pharmaceutical benefits is efficient and reflects the latest evidence-based recommendations, achieved through the involvement of the Pharmaceutical Benefits Advisory Committee (PBAC). This committee, comprising experts from various fields, provides recommendations to the Minister on which drugs should be available as pharmaceutical benefits, ensuring decisions are evidence-based and aligned with the progressive realisation of the right to the highest attainable standard of physical and mental health as per the International Covenant on Economic, Social and Cultural Rights.

Scope and Application

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 5) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011, which pertains to the efficient funding of chemotherapy medicines supplied to eligible patients being treated for cancer, as well as medicines associated with the side-effects of cancer and cancer treatment at certain public hospitals. This legislative instrument applies to the supply of pharmaceutical benefits under the National Health Act 1953, specifically to the arrangements for the efficient funding of chemotherapy drugs, thereby impacting healthcare providers and patients who receive chemotherapy treatment within the framework of the Pharmaceutical Benefits Scheme (PBS). The changes made by this instrument reflect updates to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, and include amendments to circumstance codes, purpose codes, and the associated circumstances for specific drugs such as Bevacizumab, Cetuximab, Docetaxel, Oxaliplatin, and Ondansetron. The instrument does not specify exclusions or exemptions but operates within the broader regulatory framework of the National Health Act and is subject to the provisions of the Legislative Instruments Act 2003. The instrument is designed to improve the efficiency of funding for chemotherapy drugs and related treatments, thereby ensuring that patients receive the necessary medications with optimised financial arrangements.

Key Provisions

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 5) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 to reflect changes in the funding and supply of chemotherapy and related pharmaceutical benefits. Specifically, the instrument introduces amendments to the listed drugs 'Bevacizumab', 'Cetuximab', 'Docetaxel', 'Oxaliplatin', and 'Ondansetron'. For 'Bevacizumab' and 'Cetuximab', new circumstance codes and purpose codes are added, while for 'Docetaxel', 'Oxaliplatin', and 'Ondansetron', certain brands and forms are either removed or added. These changes are intended to ensure that the provision of chemotherapy and related medicines is funded efficiently and effectively. The obligations under this instrument primarily concern the specification of pharmaceutical benefits and the associated circumstance codes and purpose codes for chemotherapy drugs listed in the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011. Health care providers, suppliers, and relevant entities must adhere to the updated specifications to ensure that the supply and funding of these medications comply with the amended arrangements. The Pharmaceutical Benefits Advisory Committee (PBAC) plays a crucial role in recommending which drugs and medicinal preparations should be available as pharmaceutical benefits, ensuring that decisions are evidence-based and aligned with public health objectives. The instrument imposes civil and administrative consequences for non-compliance with the amended special arrangement. Specifically, entities that fail to adhere to the updated specifications for the supply and funding of chemotherapy drugs may face regulatory actions, including fines or other penalties as prescribed under the National Health Act 1953. The Minister retains the authority to vary or revoke the special arrangement, further underscoring the importance of compliance with the legislative provisions. In summary, the National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 5) updates the funding and supply specifications for certain chemotherapy drugs, reflecting changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. This instrument places obligations on health care providers and suppliers to ensure compliance with the amended special arrangement, with potential civil and administrative penalties for non-compliance. The involvement of PBAC in recommending pharmaceutical benefits ensures that the decisions are grounded in evidence and aimed at achieving the highest attainable standard of health for eligible patients.

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