National Health (IVF/GIFT Program) Special Arrangement Amendment Instrument 2013 (No. 1) (No. PB 44 of 2013)

Administered by Department of Health, Disability and Ageing

Legislation au F2013L01484 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

National Health (IVF/GIFT Program) Special Arrangement Amendment Instrument 2013 (No.1)

PB 44 of 2013

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 legislative instrument, made under subsections 100(1) and (2) of the Act, is to amend the National Health (IVF/GIFT Program) Special Arrangement 2011 (PB 93 of 2011) (the Special Arrangement) to make changes to the special arrangement relating to the IVF/GIFT Program.

The purpose of the Special Arrangement is to ensure that an adequate supply of the pharmaceutical benefits is available for patients who require in vitro fertilisation or gamete intra-fallopian transfer treatment. Restrictions on the provision of these treatments mean that these pharmaceutical benefits can more conveniently or efficiently be supplied under a special arrangement.

This Instrument inserts a new Schedule 3 into the Special Arrangement with additional treatment conditions, if any; patients are required to satisfy to be able to be supplied a pharmaceutical benefit under the Special Arrangement.  Additional treatment conditions associated with eligibility for supply of brands of Corifollitropin Alfa have been included in new Schedule 3.

This Instrument also makes changes to reflect changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (main listing instrument), which commence on the same day. This instrument amends Schedule 1 of the Special Arrangement to change the brand name for two listed brands of Progesterone from Orion Laboratories Pty Ltd to Oripro.

Consultation

The Special Arrangement was made having regard to advice provided by the Pharmaceutical Benefits Advisory Committee (PBAC), an independent expert body established by section 100A of the Act, which makes recommendations to the Minister for Health 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 making recommendations, the 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.

PBAC members are selected 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 the PBAC, and that would enable them to contribute meaningfully to the deliberations of the PBAC.

Pharmaceutical companies were consulted throughout the process for additions and changes to listings on the PBS and for this Special Arrangement. This includes consultation through the PBAC process, and agreement to final listing details.

This Instrument commences on 1 August 2013.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTACHMENT

PROVISION BY PROVISION DESCRIPTION OF THE NATIONAL HEALTH (IVF/GIFT PROGRAM) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2013 (No. 1)

Section 1  Name of Instrument

This section provides that this Instrument is the National Health (IVF/GIFT Program) Special Arrangement Amendment Instrument 2013 (No. 1) and that it may also be cited as PB 44 of 2013.

Section 2  Commencement

This section provides that this Instrument commences on 1 August 2013.

Section 3   Amendments to PB 93 of 2011

This section provides that Schedule 1 amends the National Health (IVF/GIFT Program) Special Arrangement 2011 (PB 93 of 2011) (the Special Arrangement). 

 

Schedule 1

Item 1 amends the definition of ‘eligible patient’ in section 4 of the Special Arrangement to provide that to be an eligible patient a person has to satisfy the treatment conditions, if any, for the pharmaceutical benefit as specified in new Schedule 3 to the Special Arrangement. This is in addition to having to be an eligible person under the Health Insurance Act 1973 and be receiving treatment under Medicare items 13200, 13201, 13202 or 13203.

Item  2 amends the entry for Progesterone in the form Pessary 100 mg in the Special Arrangement to change the name of the listed brand with that form from Orion Laboratories Pty Ltd to Oripro.

Item  3 amends the entry for Progesterone in the form Pessary 200 mg in the Special Arrangement to change the name of the listed brand with that form from Orion Laboratories Pty Ltd to Oripro.

Item  4 inserts Schedule 3 which sets out treatment conditions.


 

 

 

 

 

Overview

The National Health (IVF/GIFT Program) Special Arrangement Amendment Instrument 2013 (No. 1) was enacted to amend the National Health (IVF/GIFT Program) Special Arrangement 2011 (PB 93 of 2011) under subsections 100(1) and (2) of the National Health Act 1953. This legislative instrument was introduced to address the need for ensuring an adequate supply of pharmaceutical benefits for patients requiring in vitro fertilisation or gamete intra-fallopian transfer treatment. The instrument aims to facilitate the efficient supply of these treatments by introducing additional treatment conditions for eligibility, as outlined in the newly inserted Schedule 3, and to update brand names in Schedule 1 to reflect changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The policy objective is to maintain the availability of essential pharmaceutical benefits for eligible patients, taking into account recommendations from the Pharmaceutical Benefits Advisory Committee and consultations with pharmaceutical companies.

Scope and Application

The National Health (IVF/GIFT Program) Special Arrangement Amendment Instrument 2013 (No. 1) pertains to the National Health Act 1953 and specifically amends the National Health (IVF/GIFT Program) Special Arrangement 2011, primarily concerning the supply of pharmaceutical benefits related to in vitro fertilisation (IVF) and gamete intra-fallopian transfer (GIFT) treatments. This legislation applies to eligible patients who need IVF or GIFT treatments and are receiving such treatments under Medicare. The amendments are designed to ensure an adequate supply of pharmaceutical benefits, facilitating the efficient and convenient provision of these treatments. The changes include new treatment conditions for eligibility, particularly concerning brands of Corifollitropin Alfa, and adjustments to the brand names for certain progesterone treatments. The amendments also reflect changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, specifically the alteration of brand names for progesterone products. This instrument is applicable nationally across Australia, governed under the Commonwealth jurisdiction, and commences on 1 August 2013. The changes are made in consultation with the Pharmaceutical Benefits Advisory Committee, which provides expert advice on pharmaceutical benefits.

Key Provisions

The National Health (IVF/GIFT Program) Special Arrangement Amendment Instrument 2013 (No. 1) (sections 1 to 3) amends the National Health (IVF/GIFT Program) Special Arrangement 2011. The purpose of this amendment is to ensure an adequate supply of pharmaceutical benefits for patients requiring in vitro fertilisation (IVF) or gamete intra-fallopian transfer (GIFT) treatment. Specifically, it includes new treatment conditions in Schedule 3 and updates brand names in Schedule 1 to reflect changes made in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. Under this instrument, patients must meet the treatment conditions specified in Schedule 3 to be eligible for pharmaceutical benefits under the Special Arrangement (section 3, item 1). This amendment ensures that patients must satisfy specific criteria in addition to being eligible under the Health Insurance Act 1973 and receiving relevant Medicare treatments. Furthermore, it updates the brand names for two listed brands of Progesterone from Orion Laboratories Pty Ltd to Oripro, reflecting changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (section 3, items 2 and 3). The obligations imposed by this amendment are primarily on pharmaceutical companies and healthcare providers to ensure that patients who meet the new treatment conditions receive the necessary pharmaceutical benefits. Providers must verify that patients satisfy the conditions outlined in Schedule 3 before supplying the benefits. This includes updating records and information systems to reflect the new brand names and conditions. The Pharmaceutical Benefits Advisory Committee (PBAC) has been consulted, and their recommendations have been considered in making these changes. Failure to comply with the new conditions and brand specifications may result in legal consequences. Specifically, non-compliance could lead to the ineligibility of patients for the pharmaceutical benefits, potentially causing harm or inconvenience to those requiring IVF or GIFT treatments. While the legislation does not explicitly state penalties, non-compliance with similar provisions in other sections of the National Health Act 1953 may result in fines or other administrative actions as deemed necessary by the Minister for Health.

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