National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 8) (PB 84 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. 8)

PB 84 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 adds a new pharmaceutical benefit ‘Pembrolizumab’; and the associated circumstances.

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 September 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. 8)

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.8) and that it may also be cited as PB 84 of 2015.

Section 2  Commencement

This section provides that this Instrument commences on 1 September 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 inserts a new listed drug ‘Pembrolizumab’ into Schedule 1 Part 1 of the Special Arrangement by adding new pharmaceutical benefit, which is the listed drug ‘Pembrolizumab’ in the form ‘Powder for injection 50 mg with the manner of administration ‘Injection’ and brand ‘Keytruda.

Item 2 amends Schedule 1 Part 2 of the Special Arrangement by adding the maximum amount and number of repeats for the listed drug ‘Pembrolizumab.

Item 3 amends Schedule 4 of the Special Arrangement by a adding a circumstance code, and the associated circumstances for pharmaceutical benefits with the listed drug ‘Pembrolizumab’.

 

 

 

 

 

 

 

 

 

 

 


 

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. 8) was enacted to amend the existing National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011. The purpose of this instrument is to adjust the special arrangement for the efficient funding of chemotherapy, aligning it with the 2010 budget measure titled ‘Revised arrangements for the efficient funding of chemotherapy drugs’. This legislation facilitates more efficient payments for the supply of chemotherapy medicines to eligible patients undergoing cancer treatment and addresses the supply of related pharmaceutical benefits at public hospitals. The instrument is made under subsections 100(1) and 100(2) of the National Health Act 1953, enabling the Minister to make and vary special arrangements for pharmaceutical benefits. The policy objective of this amendment is to ensure that the funding arrangements for chemotherapy drugs remain efficient and effective, reflecting changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. Additionally, the instrument introduces the new pharmaceutical benefit ‘Pembrolizumab’ and its associated circumstances, further enhancing the scope of funded treatments available under the Special Arrangement.

Scope and Application

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 8) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 to refine the efficient funding of chemotherapy and related pharmaceutical benefits within the Australian healthcare system. This instrument applies to entities and individuals involved in the provision of chemotherapy pharmaceutical benefits and related pharmaceutical benefits, which include medicines used for cancer treatment and associated side-effects, at eligible public hospitals. The legislative changes are designed to enhance the efficiency of funding mechanisms for these essential treatments, aligning with broader health policy objectives to ensure equitable access to life-saving medications. The geographic reach of this Act is national, impacting all states and territories within Australia. The instrument specifies certain exclusions and limitations, including the types of pharmaceutical benefits covered and the conditions under which these benefits are provided. The application of the Act may be further defined or restricted through subordinate instruments or administrative guidelines issued by the relevant health authorities. This legislative amendment reflects broader policy adjustments in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 and takes effect from 1 September 2015.

Key Provisions

The main operative sections of the National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2015 (No. 8) concern the amendment of the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (the Special Arrangement). Section 3 of the Amendment Instrument amends the Special Arrangement to update the list of pharmaceutical benefits, including the addition of the new drug 'Pembrolizumab' under specific circumstances (Section 3, Item 1). It also adjusts the maximum amounts and repeat numbers for certain chemotherapy drugs and introduces new circumstance codes for these drugs (Section 3, Items 2 and 3). This amendment aims to ensure that the Special Arrangement reflects the latest changes in chemotherapy drug listings and their efficient funding. The obligations and requirements imposed by the Act on parties and entities include the establishment of a formal consultation process involving the Pharmaceutical Benefits Advisory Committee (PBAC). The PBAC, an independent expert body, makes recommendations to the Minister about which drugs should be available as pharmaceutical benefits. This committee includes members from various relevant fields such as consumers, health economists, and medical professionals. The PBAC considers factors such as the medical conditions for which a medicine has been approved, its clinical effectiveness, safety, and cost-effectiveness compared to other treatments when recommending the listing of a medicine on the Pharmaceutical Benefits Scheme (PBS). The Amendment Instrument does not explicitly state offences, penalties, or civil/criminal consequences for breaches of the Special Arrangement. However, the National Health Act 1953 (the Act) generally provides that the Minister has the authority to vary or revoke any special arrangement made under section 100(1). Any failure to comply with the provisions of the Special Arrangement or the Act could potentially result in the Minister taking action to revoke or vary the special arrangement, which could impact the funding and supply of pharmaceutical benefits. The consequences of such actions would depend on the specific circumstances and the terms of the special arrangement in question.

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