National Health (Highly specialised drugs program) Special Arrangement Amendment Instrument 2018 (No. 10) (PB 102 of 2018)

Administered by Department of Health, Disability and Ageing

Legislation au F2018L01646 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

NATIONAL HEALTH (HIGHLY SPECIALISED DRUGS PROGRAM) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2018 (No. 10)

PB 102 of 2018

 

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

This is the National Health (Highly specialised drugs program) Special Arrangement Amendment Instrument 2018 (No. 10) (this Instrument).  The purpose of this Instrument, made under subsection 100(2) of the Act, is to amend the National Health (Highly specialised drugs program) Special Arrangement 2010 (PB 116 of 2010) (the Special Arrangement), to make changes to the Special Arrangement relating to the Highly Specialised Drugs program.

The amendments made by this Instrument reflect amendments 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.

The amendments made by this Instrument include additions, deletions and changes to drugs, forms, responsible person codes and the circumstances for prescribing various pharmaceutical benefits (including authority requirements).

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

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.  In addition, an industry nominee has been appointed to the PBAC membership.  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 listings on the PBS.  This includes consultation through the PBAC process.

Further consultation for this Instrument was considered unnecessary due to the nature of the consultation that had already taken place in the decision to list the medication.

Details of this Instrument are set out in the Attachment.

This Instrument commences on 1 December 2018.

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


ATTACHMENT

PROVISION-BY-PROVISION DESCRIPTION OF NATIONAL HEALTH (HIGHLY SPECIALISED DRUGS PROGRAM) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2018 (No. 10)

Section 1 Name of Instrument

This section provides the name of this Instrument as the National Health (Highly specialised drugs program) Special Arrangement Amendment Instrument 2018 (No. 10). It can also be cited as PB 102 of 2018.

Section 2 Commencement

This section provides that this Instrument commences on 1 December 2018.

Section 3 Amendment of National Health (Highly specialised drugs program) Special Arrangement 2010 (PB 116 of 2010)

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

Schedule Amendments

The amendments in Schedule 1 provide for additions, deletions and changes to drugs, forms, responsible person codes and the circumstances for prescribing various pharmaceutical benefits (including authority requirements).  These changes are summarised below.

 

SUMMARY OF CHANGES

Listed drugs added

Benralizumab

Dolutegravir with rilpivirine

Midostaurin

Form added

Deferasirox

Tablet 90 mg

Deferasirox

Tablet 180 mg

Deferasirox

Tablet 360 mg

Brands added

Abacavir with Lamivudine

Tablet containing abacavir 600 mg (as sulfate) with lamivudine 300 mg (ABACAVIR/LAMIVUDINE 600/300 SUN)

Alteration of circumstances

Filgrastim (Nivestim & Zarzio brands only)

Infliximab

Lanreotide

Mepolizumab

Octreotide

Omalizumab

Addition of responsible person

AstraZeneca Pty Ltd (AP)

Novartis Pharmaceuticals Australia Pty Limited (NM)

Addition of listed drug to definition for ‘CAR drug’

Benralizumab

Midostaurin

* To make the insertion points for the above two drugs clearer, this amendment instrument instructs the substitution of the entire definition for ‘CAR drugs’. The substituted definition incorporates the above two drugs into the list of drugs included in the definition, and re-numbers that list.

Addition of listed drug to definition for ‘medication for the treatment of HIV or AIDS’

Dolutegravir with rilpivirine

* To make the insertion point for the above drug clearer, this amendment instrument instructs the substitution of the entire definition for ‘medication for the treatment of HIV or AIDS’. The substituted definition incorporates the above drug into the list of drugs included in the definition, and re-numbers that list.

Document/s incorporated by reference

Listed Drug/s

Document incorporated

Document access

Benralizumab

Mepolizumab

Omalizumab

Asthma Control Questionnaire (ACQ-5). The document is incorporated as in force on the day this Instrument takes effect, pursuant to paragraph 14(1)(b) of the Legislation Act 2003.

The ACQ-5 is a widely used tools for measuring asthma control.

Prescribers can contact the suppliers of these asthma medications directly to obtain free copies of the ACQ calculation sheets.  Contact details for the suppliers can be found online at www.pbs.gov.au

 


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

National Health (Highly specialised drugs program) Special Arrangement Amendment Instrument 2018 (No. 10)

(PB 102 of 2018)

This 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 Instrument

The purpose of this Instrument, made under subsection 100(2) of the National Health Act 1953 (the Act), is to amend the National Health (Highly specialised drugs program) Special Arrangement 2010 (PB 116 of 2010) (the Special Arrangement), to make changes to the Special Arrangement relating to the Highly Specialised Drugs program.

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 specialised treatment.

Human rights implications

This 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

This Instrument is compatible with human rights because it advances the protection of human rights.

 

 

 

Julianne Quaine

Assistant Secretary

Pharmacy Branch

Technology Assessment and Access Division

Department of Health

 

Overview

The National Health (Highly Specialised Drugs Program) Special Arrangement Amendment Instrument 2018 (No. 10) amends the National Health (Highly Specialised Drugs Program) Special Arrangement 2010 to make changes to the Highly Specialised Drugs program. This amendment, enacted under the authority of the National Health Act 1953, is designed to update the list of drugs, forms, and prescribing conditions for the program, in line with recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC). PBAC, an independent expert body, recommends which drugs should be available as pharmaceutical benefits, considering factors such as clinical effectiveness and cost-effectiveness. The changes made by this instrument reflect amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, ensuring consistency across related legislation. This legislative instrument is compatible with human rights as it supports the progressive realisation of the right to the highest attainable standard of physical and mental health, as recognised in the International Covenant on Economic, Social and Cultural Rights. The instrument is intended to streamline the Highly Specialised Drugs program, ensuring that patients with chronic conditions receive appropriate and evidence-based treatment. By aligning the amendments with PBAC's recommendations, the instrument aims to enhance the efficiency and effectiveness of the program, ultimately benefiting patients and the healthcare system. The instrument's compatibility with human rights underscores its role in advancing access to essential medications, thereby supporting the right to health.

Scope and Application

The National Health (Highly specialised drugs program) Special Arrangement Amendment Instrument 2018 (No. 10) amends the National Health (Highly specialised drugs program) Special Arrangement 2010, made under the National Health Act 1953. The purpose of this Instrument is to update the Special Arrangement concerning the Highly Specialised Drugs program by reflecting changes to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. This includes additions, deletions, and modifications to drugs, forms, responsible person codes, and the circumstances for prescribing various pharmaceutical benefits, including authority requirements. These amendments align with recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC) and involve extensive consultation with pharmaceutical companies and industry stakeholders. The changes, effective from 1 December 2018, ensure that the Special Arrangement remains current with medical advancements and cost-effectiveness considerations. The Instrument also incorporates specific documents, such as the Asthma Control Questionnaire (ACQ-5), to support the management of certain conditions. The amendments are designed to enhance the availability and accessibility of highly specialised drugs, ensuring they meet the highest standards of clinical effectiveness and safety.

Key Provisions

The National Health (Highly Specialised Drugs Program) Special Arrangement Amendment Instrument 2018 (No. 10) (the Instrument) primarily amends the National Health (Highly Specialised Drugs Program) Special Arrangement 2010 (the Special Arrangement) (sections 1 and 3). The purpose of this Instrument is to modify the Special Arrangement in relation to the Highly Specialised Drugs program, ensuring that the pharmaceutical benefits supplied under the Special Arrangement meet the treatment needs of patients with chronic conditions requiring specialised treatment. The Instrument introduces several changes, including additions, deletions, and modifications to drugs, forms, responsible person codes, and prescribing circumstances (Schedule 1). These changes align with amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 and are based on recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC). The Instrument imposes obligations on various parties, including pharmaceutical companies and prescribers. Pharmaceutical companies are required to ensure that the drugs listed under the Special Arrangement meet the specified criteria, including clinical effectiveness, safety, and cost-effectiveness. Prescribers must adhere to the prescribing circumstances outlined in the Instrument, which include authority requirements for certain drugs. The Instrument also mandates the involvement of the PBAC in the decision-making process for listing drugs on the Pharmaceutical Benefits Scheme (PBS), ensuring that decisions are evidence-based and consider the medical conditions for which the drugs are approved. The Instrument does not explicitly detail specific offences, penalties, or consequences for breach. However, the failure to comply with the requirements set forth in the Instrument could potentially lead to consequences under the broader legislative framework of the National Health Act 1953 and related instruments. For instance, non-compliance with the provisions of the PBS or failure to adhere to the recommendations of the PBAC could result in administrative or legal actions. Additionally, any pharmaceutical company found to be in breach of the requirements for listing drugs on the PBS could face penalties under the relevant provisions of the Act. In summary, the Instrument is a legislative tool designed to refine the Highly Specialised Drugs program by updating the list of pharmaceutical benefits, ensuring they are aligned with current medical evidence and patient needs. The obligations imposed on pharmaceutical companies and prescribers are aimed at maintaining the integrity and effectiveness of the program, while the potential consequences of non-compliance are governed by the broader legislative framework.

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