National Health (Highly specialised drugs program for hospitals) Special Arrangement Amendment Instrument 2011 (No. 12) (No. PB 99 of 2011)

Administered by Department of Health, Disability and Ageing

Legislation au F2011L02694 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

Issued by Authority of the Minister for Health and Ageing

 

NATIONAL HEALTH ACT 1953

 

NATIONAL HEALTH (HIGHLY SPECIALISED DRUGS PROGRAM FOR HOSPITALS) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2011 (No. 12)

 

PB 99 of 2011

Purpose

The purpose of this legislative instrument, made under subsections 100(1) and 100(2) of the National Health Act 1953 (the Act), is to amend the National Health (Highly specialised drugs program for hospitals) Special Arrangement 2010 (PB 116 of 2010) (the Special Arrangement), to make changes to the special arrangement relating to the highly specialised drugs program for hospitals.

This instrument makes changes to the pharmaceutical benefits available under the section 100 special arrangement for the Highly Specialised Drugs Program for hospitals.

The pharmaceutical benefits supplied under the Special Arrangement are for the treatment of chronic conditions which, because of their clinical use or other special features, may only be supplied to patients receiving treatment at or from a public or private hospital having access to appropriate specialised facilities.

Section 100 special arrangements and Part VII of the Act

Subsection 100(1) enables the Minister to make special arrangements for, or in relation to, providing that an adequate supply of pharmaceutical benefits will be available to persons:

(a)  who are living in isolated areas: or

(b) who are receiving treatment in circumstances in which generally available pharmaceutical benefits  are inadequate for that treatment; or

(c) if the pharmaceutical benefits covered by the arrangements can be more conveniently or efficiently supplied under the arrangements.

Subsection 100(3) provides that Part VII of the Act, and regulations and other legislative instruments made for the purposes of Part VII have effect subject to a special arrangement made under subsection 100(1).  A section 100 arrangement may thus modify the operation of Part VII, the regulations and other relevant instruments.

Subsection 100(2) provides that the Minister may vary or revoke a special arrangement made under subsection (1). 

Changes to the Special Arrangement made by this Instrument

The changes made by this instrument reflect changes to the National Health (Listing of Pharmaceutical Benefits) Instrument 2010 made under sections 84AF, 85, 85A, 88 and 101 of the Act, which commence on the same day.

This instrument:

  • adds three new pharmaceutical benefits;
  • removes all pharmaceutical benefits with the listed drug ‘Peginterferon Alfa-2b’;
  • fixes a typographical error in the description of one listed drug; and
  • amends the form of one pharmaceutical benefit.

Consultation

The amendments made by this Instrument accord with recommendations made by the Pharmaceutical Benefits Advisory Committee (PBAC). 

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 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.

Pharmaceutical companies were consulted throughout the process of changes to the prescribing circumstances for listings on the PBS and for this Instrument.  This includes consultation through the PBAC process, and agreement to final listing details.

General

This Instrument commences on 1 January 2012.

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

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

 

 

 

 

 

 

 

 

ATTACHMENT

 

PROVISION BY PROVISION DESCRIPTION OF THE NATIONAL HEALTH (HIGHLY SPECIALISED DRUGS PROGRAM FOR HOSPITALS) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2011 (No.12)

 

Section 1 Name of Instrument

This section provides that this Instrument is the National Health (Highly specialised drugs program for hospitals) Special Arrangement Amendment Instrument 2011 (No.12) and that it may also be cited as PB 99 of 2011.

Section 2 Commencement

This section provides that this Instrument commences on 1 January 2012.

Section 3 Amendments to PB 116 of 2010

This section provides that Schedule 1 amends the National Health (Highly specialised drugs program for hospitals) Special Arrangement 2010 (PB 116 of 2010) (the Principal Instrument).             

Schedule 1

Item 1 amends the definition of ‘CAR drug’ in section 4 of the Principal Instrument by changing the description of the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 2 amends paragraph 24(2)(k) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 3 amends paragraph 24(2)(l) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 4 amends paragraph 24(2)(m) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 5 amends paragraph 24(2)(n) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 6 amends paragraph 25(2)(p) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 7 amends paragraph 25(2)(q) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 8 amends paragraph 25(2)(r) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 9 amends paragraph 25(2)(s) of the Principal Instrument by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’.

Item 10 amends the entry in Schedule 1 of the Principal Instrument for the listed drug ‘Epoprostenol to add one pharmaceutical benefit, which is the listed drug ‘Epoprostenol in the form ‘Powder for IV infusion, 500 micrograms (as sodium) infusion administration set with manner of administration ‘Injection’ and brand ‘Flolan Kit.

Item 11 amends the entry in Schedule 1 of the Principal Instrument for the listed drug ‘Epoprostenol’ to add one pharmaceutical benefit, which is the listed drug ‘Epoprostenol’ in the forms ‘Powder for IV infusion, 1.5 mg (as sodium) infusion administration set’ with manner of administration ‘Injection’ and brand ‘Flolan Kit’.

Item 12 amends the entry in Schedule 1 of the Principal Instrument for the listed drug ‘Etravirine’ to add one pharmaceutical benefit, which is the listed drug ‘Etravirine’ in the form ‘Tablet 200 mg’ with manner of administration ‘Oral’ and brand ‘Intelence’.

Item 13 deletes the entry in Schedule 1 of the Principal Instrument for all pharmaceutical benefits with the listed drug ‘Peginterferon Alfa-2b.

Item 14 amends the entry in Schedule 1 of the Principal Instrument for the listed drug ‘Romiplostin by changing the description of the listed drug from ‘Romiplostin’ to ‘Romiplostim’.

Item 15 amends the entry in Schedule 1 of the Principal Instrument for the pharmaceutical benefit that has the listed drug ‘Tacrolimus’ in the form ‘500 micrograms’ by changing the form from ‘500 micrograms’ to ‘0.5 mg’.

Item 16 deletes the entry in Schedule 3 of the Principal Instrument for the listed drug ‘Peginterferon Alfa-2b’.

Item 17 amends the entry in Schedule 3 of the Principal Instrument for the listed drug ‘Romiplostin by changing the listed drug from ‘Romiplostin’ to ‘Romiplostim’

Item 18 amends the entry in Schedule 3 of the Principal Instrument for the listed drug ‘Romiplostin by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’ in the circumstances associated with circumstances code ‘C3852’.

Item 19 amends the entry in Schedule 3 of the Principal Instrument for the listed drug ‘Romiplostin by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’ in the circumstances associated with circumstances code ‘C3853’.

Item 20 amends the entry in Schedule 3 of the Principal Instrument for the listed drug ‘Romiplostin by changing the listed drug ‘Romiplostin’ to ‘Romiplostim’ in the circumstances associated with circumstances code ‘C3854’.

Overview

The National Health (Highly Specialised Drugs Program for Hospitals) Special Arrangement Amendment Instrument 2011 (No. 12) was enacted to make amendments to the National Health (Highly specialised drugs program for hospitals) Special Arrangement 2010, thereby altering the pharmaceutical benefits available under the Highly Specialised Drugs Program for hospitals. This legislative instrument was enacted by authority of the Minister for Health and Ageing under the National Health Act 1953. The primary objective of this instrument is to ensure an adequate supply of pharmaceutical benefits for patients with chronic conditions who require highly specialised drugs and are receiving treatment in hospitals with appropriate specialised facilities. The changes introduced by this instrument were made in accordance with recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC) and involve the addition of new pharmaceutical benefits, removal of certain drugs, correction of typographical errors, and amendment of the form of certain drugs. These changes aim to better align the program with current clinical needs and best practices. This instrument, which commenced on 1 January 2012, is a legislative instrument for the purposes of the Legislative Instruments Act 2003. It reflects changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2010, ensuring that the Highly Specialised Drugs Program for hospitals remains effective and responsive to the evolving healthcare needs of patients. The amendments have been subject to consultation with relevant stakeholders, including pharmaceutical companies and the PBAC, to ensure they are appropriate and well-supported by expert advice.

Scope and Application

The National Health (Highly Specialised Drugs Program for Hospitals) Special Arrangement Amendment Instrument 2011 (No. 12) is a legislative instrument made under subsections 100(1) and 100(2) of the National Health Act 1953, with the aim of amending the National Health (Highly specialised drugs program for hospitals) Special Arrangement 2010. This amendment instrument modifies the pharmaceutical benefits available under the special arrangement for the Highly Specialised Drugs Program for hospitals, which provides treatments for chronic conditions that may only be administered in hospitals with specialised facilities. The amended arrangement applies to patients receiving treatment in such hospitals and aligns with changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2010. The instrument adds three new pharmaceutical benefits, removes all benefits related to the drug Peginterferon Alfa-2b, corrects a typographical error for the drug Romiplostin (changing it to Romiplostim), and amends the form of one pharmaceutical benefit. The changes were made in consultation with the Pharmaceutical Benefits Advisory Committee and pharmaceutical companies, ensuring the recommendations reflect the latest clinical and cost-effectiveness evidence. This instrument commences on 1 January 2012 and is subject to the Legislative Instruments Act 2003.

Key Provisions

The National Health (Highly Specialised Drugs Program for Hospitals) Special Arrangement Amendment Instrument 2011 (No. 12) amends the National Health (Highly specialised drugs program for hospitals) Special Arrangement 2010. This special arrangement pertains to the provision of pharmaceutical benefits for the treatment of chronic conditions, specifically for patients receiving treatment in hospitals with appropriate specialised facilities. The amendment introduces several changes, including the addition of new pharmaceutical benefits, the removal of certain benefits, and corrections to existing entries. Specifically, it adds three new pharmaceutical benefits: Epoprostenol in two different forms (500 micrograms and 1.5 mg), Etravirine (200 mg tablet), and corrects the spelling of Romiplostin to Romiplostim in various sections. It also removes all benefits associated with Peginterferon Alfa-2b and corrects a typographical error in the description of Tacrolimus, changing the form from 500 micrograms to 0.5 mg. The National Health Act 1953, specifically under subsections 100(1) and 100(2), mandates that the Minister for Health and Ageing can make special arrangements to ensure an adequate supply of pharmaceutical benefits for specific groups, including those receiving treatment in hospitals where generally available benefits are inadequate. The Act also allows for the variation or revocation of these arrangements. The obligations imposed by this special arrangement include ensuring that the listed drugs are supplied only to patients receiving treatment in hospitals with appropriate specialised facilities, and that the drugs meet the criteria set by the Pharmaceutical Benefits Advisory Committee (PBAC). The PBAC, established under section 100A of the Act, advises the Minister on which drugs should be available as pharmaceutical benefits, taking into account factors such as clinical effectiveness, safety, and cost-effectiveness. Breach of the provisions set out in this special arrangement could potentially lead to legal consequences, though the specific penalties are not detailed in the explanatory statement. Generally, under Australian law, breaches of legislative instruments can result in both civil and criminal penalties, depending on the severity and intent of the breach. Civil penalties may include fines, while criminal penalties could involve imprisonment, particularly if the breach is deemed to be willful or involves significant harm. The exact penalties would be determined by the relevant courts based on the specific circumstances of the breach.

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