National Health (Highly specialised drugs program) Special Arrangement Amendment Instrument 2020 (No. 5) (PB 46 of 2020)

Administered by Department of Health, Disability and Ageing

Legislation au F2020L00646 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 2020 (No. 5)

PB 46 of 2020

 

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 2020 (No.5) (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.

Schedule 1 to this Instrument provides for the addition of one form of the listed drug mepolizumab to the Special Arrangement.  It also provides for the alteration of circumstances in which a prescription may be written for the supply of the listed drug lenalidomide.  Additionally, this instrument provides for the addition of a brand of an existing pharmaceutical item. These changes are summarised, by subject matter, 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 June 2020.

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 2020 (No. 5)

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 2020 (No.5) and may also be cited as
PB 46 of 2020.

Section 2 Commencement

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

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 1 Amendments

The amendments in Schedule 1 involve the addition of a form and brand and the alteration of circumstances for prescribing various pharmaceutical benefits available under the Special Arrangement.  These changes are summarised below.

 

SUMMARY OF CHANGES TO THE NATIONAL HEALTH (HIGHLY SPECIALISED DRUGS PROGRAM) SPECIAL ARRANGEMENT 2010 MADE BY THIS INSTRUMENT

Form Added

Listed Drug

Form

Mepolizumab

Injection 100 mg in 1 mL single dose pre-filled pen

Brand Added

Listed Drug

Form

Sevelamer

Tablet containing sevelamer carbonate 800 mg (Sevelamer Lupin)

Alteration of Circumstances in Which a Prescription May be Written

Listed Drug

Lenalidomide

Document/s incorporated by reference

Listed Drug

Document incorporated

Document access

Mepolizumab

Asthma Control Questionnaire (ACQ-5) and/or Asthma Control Questionnaire interviewer administered version (ACQ-IA). 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 and the ACQ-IA are widely used tools for measuring how well a patient’s asthma symptoms are being controlled.

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 2020 (No. 5)

(PB 46 of 2020)

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.

The amendments in Schedule 1 involve the addition of a form and brand and the alteration of circumstances for prescribing various pharmaceutical benefits available under the Special Arrangement.

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.

 

 

 

Ben Sladic

Assistant Secretary

Pharmacy Branch

Technology Assessment and Access Division

Department of Health

 

Overview

The National Health (Highly Specialised Drugs Program) Special Arrangement Amendment Instrument 2020 (No. 5) was enacted to amend the National Health (Highly Specialised Drugs Program) Special Arrangement 2010, facilitating changes to the Highly Specialised Drugs program. This amendment instrument was introduced to address the need for updates in the provision of highly specialised drugs, ensuring that the program remains effective and responsive to the evolving needs of patients with chronic conditions. Enacted by the Australian Government under subsection 100(2) of the National Health Act 1953, the primary policy objective of this instrument is to enhance the availability and accessibility of specific pharmaceutical benefits, reflecting changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The amendments include the addition of a form and brand, as well as the alteration of prescribing circumstances for certain drugs, aligning with recommendations from the Pharmaceutical Benefits Advisory Committee and ensuring the program's alignment with the broader goals of the Pharmaceutical Benefits Scheme.

Scope and Application

The National Health (Highly specialised drugs program) Special Arrangement Amendment Instrument 2020 (No. 5) amends the National Health (Highly specialised drugs program) Special Arrangement 2010, to modify the Highly Specialised Drugs program. This Instrument, made under the authority of the National Health Act 1953, enables the Minister to make special arrangements for the supply of pharmaceutical benefits. It specifically addresses the listing and prescription circumstances for certain highly specialised drugs, reflecting amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The changes include the addition of a new form of mepolizumab, a brand of sevelamer, and modifications to the prescription conditions for lenalidomide. These amendments are designed to ensure that the program remains aligned with the latest medical evidence and patient needs. The amendments also incorporate the Asthma Control Questionnaire (ACQ-5) and the ACQ-IA for use in prescribing mepolizumab. The changes come into effect on 1 June 2020 and are subject to the provisions of the National Health Act 1953, ensuring that the Special Arrangement operates within the legislative framework established by the Act.

Key Provisions

The National Health (Highly Specialised Drugs Program) Special Arrangement Amendment Instrument 2020 (No. 5) amends the National Health (Highly Specialised Drugs Program) Special Arrangement 2010 (the Special Arrangement) to modify the Highly Specialised Drugs program. This amendment, made under subsection 100(2) of the National Health Act 1953 (the Act), introduces changes that align with recent modifications to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012). These changes include adding a new form of the drug mepolizumab, altering the prescribing conditions for lenalidomide, and adding a brand of an existing pharmaceutical item to the Special Arrangement. These modifications are outlined in Schedule 1 of the Instrument and are effective from 1 June 2020. The Instrument imposes specific obligations on the parties involved in the Highly Specialised Drugs program. It mandates that pharmaceutical benefits provided under the Special Arrangement be exclusively for the treatment of chronic conditions requiring specialised treatment. The amendment also ensures that any additions or alterations to the pharmaceutical benefits listed in the Special Arrangement are documented and incorporated into the legislation. This includes incorporating the Asthma Control Questionnaire (ACQ-5) and the Asthma Control Questionnaire interviewer administered version (ACQ-IA) for mepolizumab as required documentation for prescribing. Failure to comply with the provisions of this Instrument could result in significant consequences. Although specific penalties are not outlined in the Explanatory Statement, breaches of the National Health Act 1953 can lead to criminal and civil penalties. The Act allows for fines and imprisonment for breaches, with the exact penalties depending on the nature and severity of the offence. Additionally, the Minister has the authority to vary or revoke any special arrangement made under the Act, which could affect the supply and prescription of pharmaceutical benefits. The amendments reflect recommendations from the Pharmaceutical Benefits Advisory Committee (PBAC), which ensures that decisions about which drugs are subsidised under the Pharmaceutical Benefits Scheme (PBS) are evidence-based. The PBAC, composed of experts from various health-related fields, plays a crucial role in advising the Minister on the listing of pharmaceutical benefits. This process involves extensive consultation with stakeholders, including pharmaceutical companies and healthcare professionals. The Instrument's compatibility with human rights is affirmed, as it aligns with the International Covenant on Economic, Social and Cultural Rights by facilitating access to the highest attainable standard of physical and mental health through the PBS.

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