National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2021 (No. 8)

Administered by Department of Health, Disability and Ageing

Legislation au F2021L01215 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 2021 (No. 8)

PB 92 of 2021

 

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 commences on the same day. 

Schedule 1 to this Instrument provides for the deletion of the drug interferon alfa-2a from the Special Arrangement and the alteration of circumstances in which a prescription may be written for the supply of the listed drug brentuximab vedotin. These changes are summarised, by subject matter, 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.

General

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

This Instrument commences on 1 September 2021.

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 2021 (No. 8)

Section 1 Name of Instrument

This section provides the name of this Instrument as the National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2021 (No. 8) and may also be cited as
PB 92 of 2021.

Section 2 Commencement

This section provides that this Instrument commences on 1 September 2021.

Section 3 Authority

This section states that this instrument is made under subsection 100(2) of the National Health Act 1953.

Section 4  Schedules

Section 4 provides that each instrument that is specified in a Schedule to the Instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to the Instrument has effect according to its terms.

Schedule 1 Amendments

The amendments in Schedule 1 involve the deletion of a drug and the alteration of circumstances for prescribing a pharmaceutical benefit available on the Special Arrangement.  These changes are summarised below.

 

SUMMARY OF CHANGES TO THE EFFICIENT FUNDING OF
CHEMOTHERAPY PROGRAM MADE BY THIS INSTRUMENT

 

Listed Drug Deleted

Listed Drug

Interferon alfa-2a

Alteration of Circumstances in Which a Prescription May be Written

Listed Drug

Brentuximab vedotin

 

 


Diagnostic tools referenced in the Instrument

The following standard medical diagnostic tools are referenced in the Instrument but are not intended to incorporate a document by reference.

Listed Drug

Diagnostic tool

Purpose and use in the Instrument

Reason this reference does not serve to incorporate a document

Brentuximab vedotin

Lugano Classification

The Lugano Classification provides guidance to clinicians on how to objectively assess a patient’s response to treatment for Non-Hodgkin Lymphoma.

 

Patient response must be reported on as part of the authority application for this PBS listed drug.

The Lugano Classification provides guidance to assess a patient’s response to treatment for Non-Hodgkin Lymphoma and does not constitute a written record of information that must be referred to in order to determine whether statutory conditions have been met.

The response criteria has been reproduced within the restriction text for Brentuximab vedotin. This restriction text is included in the current month amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012.

 

 

 

 


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 2021 (No. 8)

(PB 92 of 2021)

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 commences on the same day.

The amendments in Schedule 1 involve the deletion of a drug and the alteration of circumstances for prescribing a pharmaceutical benefit available on the Special Arrangement.

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.

 

 

 

 

 

Mariana Crank

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 2021 (No. 8) was enacted to amend the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (PB 79 of 2011) under subsection 100(2) of the National Health Act 1953. This amendment aims to ensure the Special Arrangement reflects changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The Special Arrangement was introduced to provide more efficient funding for chemotherapy and related pharmaceutical benefits for cancer patients, in line with the 2010 Budget measure titled 'Revised arrangements for the efficient funding of chemotherapy drugs'. The Instrument was developed through consultation processes involving the Pharmaceutical Benefits Advisory Committee (PBAC) and relevant pharmaceutical companies. The Instrument commenced on 1 September 2021 and is compatible with human rights, engaging Article 2 and 12 of the International Covenant on Economic, Social and Cultural Rights by assisting with the progressive realisation of the right to the highest attainable standard of physical and mental health.

Scope and Application

The National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2021 (No. 8) amends the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 to update the efficient funding arrangements for chemotherapy medicines provided under the National Health Act 1953. This Instrument is made under the authority of subsection 100(2) of the Act, which allows the Minister to vary or revoke special arrangements for the supply of pharmaceutical benefits. The changes outlined in the Instrument are designed to reflect updates to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, ensuring that the Special Arrangement accurately represents the current funding arrangements for specified chemotherapy medicines. This Instrument applies to the supply of injected or infused chemotherapy medicines and related pharmaceutical benefits at public hospitals, and it specifically addresses the deletion of interferon alfa-2a and modifications to the prescription conditions for brentuximab vedotin. The geographic reach of this Instrument is national, as it pertains to the efficient funding of chemotherapy medicines across Australia, governed by the provisions of the National Health Act 1953. The Instrument does not introduce any exclusions or exemptions from its application, nor does it specify any particular thresholds. The Instrument is supported by subordinate instruments and processes, such as the recommendations of the Pharmaceutical Benefits Advisory Committee (PBAC), which ensures that the decisions about which medicines are subsidised under the Pharmaceutical Benefits Scheme are evidence-based and consider factors such as clinical effectiveness, safety, and cost-effectiveness.

Key Provisions

The main operative sections of the National Health (Efficient Funding of Chemotherapy) Special Arrangement Amendment Instrument 2021 (No. 8) (PB 92 of 2021) focus on amendments to the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 (PB 79 of 2011), which aims to achieve greater efficiency in payment for the supply of injected or infused chemotherapy medicines to eligible cancer patients, as well as for medicines associated with the side effects of cancer treatment at certain public hospitals (section 1). The Instrument also incorporates amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012) which are effective from the same date. Schedule 1 details these changes, including the deletion of interferon alfa-2a from the list of drugs covered under the Special Arrangement and the alteration of circumstances for prescribing brentuximab vedotin (section 4). The amendments are designed to ensure the Special Arrangement reflects the most recent changes to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The obligations imposed by the Instrument on the parties or entities it governs primarily revolve around the efficient funding and supply of specified chemotherapy drugs and related pharmaceuticals. This includes ensuring that only eligible patients receive prescribed medications through the public hospital system and that healthcare providers adhere to the criteria for prescription and supply as outlined in the Special Arrangement. The Pharmaceutical Benefits Advisory Committee (PBAC) plays a significant role in recommending which drugs should be available as pharmaceutical benefits, taking into account their clinical effectiveness, safety, and cost-effectiveness (subsection 100A). Pharmaceutical companies are also consulted throughout the process for additions and changes to listings on the Pharmaceutical Benefits Scheme (PBS). The Instrument ensures that these processes are transparent and include meaningful consultation with relevant stakeholders. Breaches of the requirements set out in the Instrument can lead to various civil and criminal consequences. While the Instrument itself does not explicitly detail specific offences or penalties, the underlying National Health Act 1953 (the Act) and associated instruments may impose penalties for non-compliance. For instance, unauthorised supply of pharmaceutical benefits or fraudulent claims could result in substantial fines or other penalties as prescribed by the Act. The Act also allows for the variation or revocation of special arrangements in cases of non-compliance or if it is deemed necessary for public health and safety. The exact penalties would depend on the specific nature of the breach and the relevant provisions of the Act. The amendments introduced by the Instrument engage with human rights by supporting the progressive realisation of the right to the highest attainable standard of physical and mental health, as recognised under Article 2 and 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) (Statement of Compatibility with Human Rights). The PBS, by providing subsidised access to medicines, aids in the advancement of this human right. The role of the PBAC ensures that decisions about which medicines are subsidised are based on evidence, thereby supporting the efficient and effective use of healthcare resources to benefit public health. This approach ensures that the legislative framework not only promotes health but does so in a manner that respects and protects human rights.

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