National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 12) (PB 107 of 2019)

Administered by Department of Health, Disability and Ageing

Legislation au F2019L01702 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

NATIONAL HEALTH (EFFICIENT FUNDING OF CHEMOTHERAPY) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2019 (No. 12)

PB 107 of 2019

 

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 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.

This Instrument makes amendments to the Special Arrangement to reflect changes made 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.

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.

Pharmaceutical companies are consulted throughout the process for additions and changes to listings on the Pharmaceutical Benefits Scheme (PBS), including consultation through the PBAC process and agreement to final listing details.

It was considered that further consultation for this Instrument was unnecessary due to the nature of the consultation that has already taken place.

This Instrument commences on 1 January 2020.

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


ATTACHMENT

PROVISION-BY-PROVISION DESCRIPTION OF NATIONAL HEALTH (EFFICIENT FUNDING OF CHEMOTHERAPY) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2019 (No. 12)

Section 1 Name of Instrument

This section provides that the Instrument is the National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 12) and may also be cited as PB 107 of 2019.

Section 2 Commencement

This section provides that this Instrument commences on 1 January 2020.

Section 3 Amendment of National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (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).

Schedule 1 Amendments

The amendments in Schedule 1 of this Instrument provide for additions, deletions and changes to drugs, forms and circumstances for prescribing various pharmaceutical benefits (including authority requirements), as detailed in the Special Arrangement.  These changes are summarised below.

SUMMARY OF CHANGES

Brands Added

Listed Drug

Form and Brand

Rituximab

Solution for I.V. infusion 100 mg in 10 mL (Truxima)

Solution for I.V. infusion 500 mg in 50 mL (Truxima)

Trastuzumab

Powder for I.V. infusion 150 mg (Ontruzant)

Alteration of Responsible Person Code

Listed Drug

Form

Brand Name

Responsible Person

Cladribine

Injection 10 mg in 5 mL

Litak

From: OA

To: AS

Deletion of Responsible Person

Responsible Person and Code

Orphan Australia Pty Ltd (OA)

Alteration of Circumstances

Listed Drug

Avelumab

 

 

 


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 2019 (No. 12)

(PB 107 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 purpose of this Legislative Instrument, made under subsection 100(2) of the National Health Act 1953 (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.

This Instrument provides for amendments to the Special Arrangement to ensure that the Special Arrangement accurately reflects 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.

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 the 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.

 

 

 

Natasha Ploenges

Assistant Secretary (Acting)

Pharmacy Branch

Technology Assessment and Access Division

Department of Health

Overview

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 12) (PB 107 of 2019) was enacted to amend the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (PB 79 of 2011) with respect to the efficient funding of chemotherapy drugs. This amendment responds to changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, ensuring that the Special Arrangement aligns with the latest updates to the Pharmaceutical Benefits Scheme (PBS). The instrument was made under the authority of subsection 100(2) of the National Health Act 1953 and is intended to achieve greater efficiency in the payment for chemotherapy medicines and related pharmaceutical benefits for cancer patients. The policy objective is to facilitate the progressive realisation of the right to the highest attainable standard of physical and mental health as articulated in the International Covenant on Economic, Social and Cultural Rights. The Pharmaceutical Benefits Advisory Committee (PBAC) played a crucial role in the consultation process, ensuring that decisions on the PBS are evidence-based and take into account the clinical effectiveness, safety, and cost-effectiveness of the medicines.

Scope and Application

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 12) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 to enhance the efficiency in funding chemotherapy medicines and related treatments. The Special Arrangement applies to chemotherapy pharmaceutical benefits and related pharmaceutical benefits, particularly for patients undergoing cancer treatment at certain public hospitals. This legislative instrument operates within the framework of the National Health Act 1953, under which the Minister has the authority to make special arrangements for pharmaceutical benefits. The amendment ensures the Special Arrangement remains consistent with updates to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, which also take effect on 1 January 2020. The changes include the addition of new drugs, modifications to responsible person codes, and adjustments to prescribing circumstances, all of which are detailed in the attached schedule. The amendments are designed to reflect the most current medical and economic considerations, ensuring that the funding arrangement remains effective and equitable.

Key Provisions

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 12) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (F2011L00799) (the Special Arrangement) to align it with the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (F2012L00717). This amendment ensures that the Special Arrangement accurately reflects the changes made to the listing of pharmaceutical benefits. These changes include the addition, deletion, and alteration of drugs, forms, and prescribing circumstances for chemotherapy pharmaceutical benefits and related pharmaceutical benefits (section 3). The amendments are effective from 1 January 2020 (section 2). Under the Act, the Minister has the authority to make special arrangements for the supply of pharmaceutical benefits, including the efficient funding of chemotherapy drugs (subsection 100(1)). The obligations imposed by this Amendment Instrument primarily involve updating the Special Arrangement to reflect the changes made to the pharmaceutical benefits listings. This includes ensuring that the Special Arrangement accurately lists the drugs, their forms, and the circumstances for prescribing them (Schedule 1). Breach of any provision within the Special Arrangement, as amended by this Instrument, could lead to civil or criminal consequences. The Act itself does not specify the penalties for breaches of the Special Arrangement; however, breaches of similar provisions under the Act can result in substantial penalties. For example, under section 113 of the Act, a person who contravenes any provision of the Act, or any instrument made under the Act, may be liable to a penalty of up to 500 penalty units, which as of 2023 is approximately AUD 57,500. Additionally, in serious cases, criminal proceedings can be initiated, potentially leading to fines and imprisonment. It is crucial for parties governed by the Special Arrangement to adhere to the updated provisions to avoid such consequences.

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