National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 6) (PB 49 of 2019)

Administered by Department of Health, Disability and Ageing

Legislation au F2019L00924 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.6)

PB 49 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 July 2019.

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. 6)

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. 6) and may also be cited as PB 49 of 2019.

Section 2 Commencement

This section provides that this Instrument commences on 1 July 2019.

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

Item 1 revises the diluent fee to reflect that due to indexation, the fee is $5.35 on and from 1 July 2019.

Item 2 revises the dispensing fee to reflect that due to indexation, the fee is $7.39 on and from 1 July 2019.

Item 3 revises the distribution fee to reflect that due to indexation, the fee is $27.02 on and from 1 July 2019.

Item 4 revises the preparation fee and note to reflect that due to indexation, the fee is $85.06 on and from 1 July 2019.

Items 5 and 6 provide for the alteration of circumstances for prescribing of the drug Pemetrexed.


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. 6)

(PB 49 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.

 

 

 

Ben Sladic

Assistant Secretary

Pharmacy Branch

Technology Assessment and Access Division

Department of Health

Overview

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 6) (PB 49 of 2019) was enacted to amend the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (PB 79 of 2011), which was introduced to enhance the efficiency in payment for the supply of chemotherapy medicines to patients being treated for cancer. This amendment aims to ensure that the special arrangement accurately reflects changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The purpose of these amendments is to align with modifications in the pharmaceutical benefits listing and to maintain the efficiency and effectiveness of the funding arrangements for chemotherapy drugs and related pharmaceutical benefits in public hospitals. This legislative instrument was enacted by the Minister for Health under the authority provided by the National Health Act 1953, with the policy objective of supporting evidence-based decisions through the Pharmaceutical Benefits Advisory Committee, thereby advancing access to affordable and effective pharmaceutical treatments for cancer patients. The amendment was developed following extensive consultation processes, primarily through the Pharmaceutical Benefits Advisory Committee, which involves experts from various fields including healthcare, economics, and pharmacy. This committee ensures that recommendations for pharmaceutical benefits are based on medical conditions, clinical effectiveness, safety, and cost-effectiveness. Given the nature of the amendments, which primarily involve indexation and updating fees and prescribing conditions, the enacting body deemed additional consultation unnecessary. The Instrument commenced on 1 July 2019, and it aligns with the human rights and freedoms outlined in international instruments such as the International Covenant on Economic, Social and Cultural Rights by facilitating access to healthcare services.

Scope and Application

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 6) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011, which is a measure to achieve greater efficiency in payment for the supply of chemotherapy medicines 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. The Instrument makes changes to reflect amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, which also commence on the same day. The Special Arrangement and its amendments are made under subsection 100(2) of the National Health Act 1953, which empowers the Minister to make special arrangements for the supply of pharmaceutical benefits. This Instrument is a legislative instrument for the purposes of the Legislation Act 2003 and 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. This Instrument applies to the supply of chemotherapy pharmaceutical benefits and related pharmaceutical benefits to eligible patients being treated for cancer at public hospitals, and its amendments reflect changes to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The Instrument applies nationally and is subject to the provisions of the National Health Act 1953. The Instrument does not exclude any persons, entities, industries, conduct, or transactions from its application. Subordinate instruments may be made under the National Health Act 1953 to extend or restrict the application of this Instrument.

Key Provisions

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2019 (No. 6) (the Instrument) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (the Special Arrangement). The Special Arrangement, as amended, aims to provide more efficient funding for the supply of chemotherapy pharmaceutical benefits and related pharmaceutical benefits to eligible patients in public hospitals. The key amendments involve adjustments to fees for diluents, dispensing, distribution, and preparation, which are indexed to reflect changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (the Benefits Instrument). These amendments ensure that the Special Arrangement remains consistent with the changes made to the Benefits Instrument, which also commenced on 1 July 2019. Under the Instrument, the fees for various chemotherapy-related services are updated to reflect indexation. Specifically, the diluent fee is set at $5.35, the dispensing fee at $7.39, the distribution fee at $27.02, and the preparation fee at $85.06, all effective from 1 July 2019. Additionally, there are changes to the prescribing conditions for the drug Pemetrexed. The Instrument mandates these updates to ensure that the financial arrangements for the supply of chemotherapy and related pharmaceutical benefits remain aligned with the current legislative and policy framework. The Instrument imposes obligations on parties involved in the supply of chemotherapy and related pharmaceutical benefits, such as public hospitals and healthcare providers. These parties must adhere to the updated fees and any changes in prescribing conditions as stipulated in the amended Special Arrangement. The requirements include accurate billing and claiming of fees for services rendered, in accordance with the updated rates, and compliance with the altered prescribing conditions for specific drugs like Pemetrexed. Failure to comply with these provisions could result in incorrect payments and potential audits or reviews by the Department of Health. There are no specific offences, penalties, or consequences outlined in the Instrument itself for non-compliance with the updated fees and conditions. However, the broader legislative framework under which the National Health Act 1953 operates includes provisions for penalties and enforcement actions for non-compliance with health-related regulations. The Department of Health may take various actions, including financial penalties, audits, or other corrective measures, against entities that fail to comply with the amended Special Arrangement. These actions are intended to ensure adherence to the legislative requirements and the efficient funding of chemotherapy services.

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