EXPLANATORY STATEMENT
NATIONAL HEALTH ACT 1953
National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2016 (No. 11)
PB 101 of 2016
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 subsection 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 titled ‘Revised arrangements for the efficient funding of chemotherapy drugs’. The 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.
The Instrument provides for amendments to Schedules 1, 4 and 5 of the Special Arrangement to ensure that pharmaceutical benefits available under the Special Arrangement for the Efficient Funding of Chemotherapy accurately reflect changes 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 associated circumstances and purposes for the listed drug ‘Ipilimumab’; and
Adds a brand premium to the listed drug ‘Ondansetron’ in the forms ‘Wafer 4 mg’ and ‘Wafer 8 mg’, with the manner of administration ‘Oral’ and brand ‘Zofran Zydis’.
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). The 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. Part VII of the Act only applies to drugs or medicinal preparations recommended by the PBAC. When recommending the listing of a medicine on the Pharmaceutical Benefits Scheme, the PBAC takes into account the medical conditions for which the medicine has been approved for use in Australia and its clinical effectiveness, safety and cost-effectiveness compared with other treatments.
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 these interests or professions. Remaining members are persons whom the Minister is satisfied have qualifications and experience in a field relevant to the functions of the PBAC, and that would enable them to contribute meaningfully to the deliberations of the PBAC.
This Instrument commences on 1 December 2016.
This Instrument is a legislative instrument for the purposes of the Legislation Act 2003.
ATTACHMENT
PROVISION BY PROVISION DESCRIPTION OF THE NATIONAL HEALTH (EFFICIENT FUNDING OF CHEMOTHERAPY) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2016 (No. 11)
Section 1 Name of Instrument
This section provides that this Instrument is the National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2016 (No. 11) and that it may also be cited as PB 101 of 2016.
Section 2 Commencement
This section provides that this Instrument commences on 1 December 2016.
Section 3 Amendment of 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).
Schedule 1 Amendments
Item 1 amends the entry in Schedule 1, Part 1 of the Special Arrangement for the listed drug ‘Ipilimumab’ by removing circumstance codes ‘C4254’ and ‘C4261’; and adding circumstance codes ‘C6562’ and ‘C6585’ for the pharmaceutical benefit that is the listed drug ‘Ipilimumab’ in the forms ‘Injection concentrate for I.V. infusion 50 mg in 10 mL’ and ‘Injection concentrate for I.V. infusion 200 mg in 40 mL’ with the manner of administration ‘Injection’ and brand ‘Yervoy’.
Item 2 amends the entry in Schedule 1, Part 2 of the Special Arrangement for the listed drug ‘Ipilimumab’ by removing purpose codes ‘P4254’ and ‘P4261’; and adding purpose codes ‘P6562’ and ‘P6585’.
Item 3 amends the entry in Schedule 4 of the Special Arrangement for the listed drug ‘Ipilimumab’ by:
removing circumstance codes ‘C4254’ and ‘C4261’, purpose codes ‘P4254’ and ‘P4261and associated circumstances and purposes; and
adding circumstance codes ‘C6562’ and ‘C6585’, purpose codes ‘P6562’ and ‘P6585’ and associated circumstances and purposes.
Item 4 amends Schedule 5 of the Special Arrangement by adding a brand premium to:
- the listed drug ‘Ondansetron’ in the form ‘Wafer 4 mg’, with the manner of administration ‘Oral’, brand ‘Zofran Sydis’, quantity or number of units ‘4’, approved ex‑manufacturer price ‘$4.17’ and claimed ex-manufacturer price ‘$6.96’; and
- the listed drug ‘Ondansetron’ in the form ‘Wafer 8 mg’, with the manner of administration ‘Oral’, brand ‘Zofran Sydis’, quantity or number of units ‘4’, approved ex‑manufacturer price ‘$6.54’ and claimed ex-manufacturer price ‘$9.33’.
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 drugs ‘Doxorubicin’, 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