National Health (Originator Brand) Amendment Determination 2016 (No. 3) (PB 38 of 2016)

Administered by Department of Health, Disability and Ageing

Legislation au F2016L00606 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Select Legislative Instrument No. 38 of 2016

 

National Health Act 1953

 

National Health (Originator Brand) Amendment Determination 2016 (No. 3)

 

Authority

This legislative instrument is made pursuant to subsection 99ADB(6B) of the National Health Act 1953 (the Act).

Purpose

This legislative instrument amends the National Health (Originator Brand) Determination 2015 (PB 100 of 2015) (the Principal Instrument) to:

  • determine the originator brand of a pharmaceutical item for one drug new to the Pharmaceutical Benefits Scheme (PBS) F2 formulary on 1 May 2016;

The Principal Instrument determined originator brands of pharmaceutical items that have a drug on the F2 formulary.  On meeting certain criteria drugs move from the F1 formulary (see s 85AB of the Act), or the single brand Combination Drug List (CDL), to F2.  All drugs on F2 are subject to price disclosure.  The instrument is necessary to implement removal of originator brand data from price disclosure calculations in certain circumstances as set out in the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations).  Removal of originator data will potentially increase price disclosure related price reductions because originator brands tend to maintain higher prices than other brands.

Amendments

An originator brand determination is set out in Schedule 1 of this amending instrument for one drug that is moving from the CDL to F2.

The main criteria used for the determination was:

  • The brand determined as an originator was already PBS listed when the drug was on the CDL, before the move to F2 (supported by available PBS listing history).

Basis for amendments

Subsection 33(3) of the Acts Interpretation Act 1901 is relied upon to vary or revoke the determination made under subsection 99ADB(6B) for the medicines affected by this amending instrument.

Consultation

The company with a PBS listed brand of the drug for which an originator brand has been determined was asked for comments in relation to the potential originator brand determination.  No comment was received.

This instrument commences on 1 May 2016.

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

 

Statement of Compatibility with Human Rights

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

National Health (Originator Brand) Amendment Determination 2016 (No. 3)

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

This legislative instrument amends the National Health (Originator Brand) Determination 2015 (PB 100 of 2015) (the Principal Instrument) to determine an originator brand of a pharmaceutical item for one drug new to the Pharmaceutical Benefits Scheme (PBS) F2 formulary.

The instrument is necessary to implement removal of originator brand data for price disclosure calculations in certain circumstances as set out in the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations).  The removal of originator brand data during price disclosure calculations will potentially increase PBS price reductions as originator brands tend to maintain higher prices than other brands.  Removal of originator brand data means that the Government price would more closely reflect the prices at which generic brands of the medicine are being sold in the market, not the prices of all brands.

The PBS provides Australians with timely, reliable and affordable access to necessary and
cost-effective medicines.  The PBS operates under Part VII of the National Health Act 1953 (the Act) which regulates the listing, prescribing, pricing, charging and payment of subsidies for supply of drugs and medicinal preparations as pharmaceutical benefits.  The Regulations prescribe matters and set out details in relation to the operation of the PBS.

Human rights implications

This legislative instrument is compatible with Articles 2 and 12 of the International Covenant on Economic, Social and Cultural Rights 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 PBS assists with advancement of this human right by providing subsidised access to medicines for Australians.

The removal of the originator brand disclosed data from price disclosure calculations will improve the operation of the PBS by delivering better value for money for PBS medicines through price reductions.  This will assist consumers by reducing out-of-pocket costs for some PBS medicines.

Conclusion

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

 

Adriana Platona

Assistant Secretary, Pharmaceutical Evaluation Branch,

Pharmaceutical Benefits Division

Department of Health

Overview

The National Health (Originator Brand) Amendment Determination 2016 (No. 3) was enacted to address the need for the originator brand of a pharmaceutical item to be determined for one drug that was new to the Pharmaceutical Benefits Scheme (PBS) F2 formulary as of 1 May 2016. This determination was necessary to implement the removal of originator brand data from price disclosure calculations in certain circumstances, as outlined in the National Health (Pharmaceutical Benefits) Regulations 1960. By removing originator brand data, it was anticipated that price reductions would increase, benefiting consumers by lowering out-of-pocket costs for PBS medicines. The amendment was made pursuant to subsection 99ADB(6B) of the National Health Act 1953 by the Australian Parliament, with the policy objective of enhancing the cost-effectiveness and accessibility of medicines through the PBS. The legislation aims to align PBS pricing more closely with the prices of generic brands, thereby improving value for money for PBS consumers.

Scope and Application

The National Health (Originator Brand) Amendment Determination 2016 (No. 3) amends the National Health (Originator Brand) Determination 2015 to determine the originator brand of a specific pharmaceutical item newly included in the Pharmaceutical Benefits Scheme (PBS) F2 formulary, effective from 1 May 2016. This determination is made under subsection 99ADB(6B) of the National Health Act 1953 and is necessary for implementing the removal of originator brand data from price disclosure calculations in certain circumstances as outlined in the National Health (Pharmaceutical Benefits) Regulations 1960. The amendment aims to potentially increase price reductions for PBS medicines by ensuring that the government price more accurately reflects the prices of generic brands, thereby advancing the accessibility and affordability of necessary medicines for Australians. This legislative instrument applies to pharmaceutical entities that supply drugs on the PBS and is designed to enhance the efficiency and effectiveness of the PBS by reducing the cost burden on consumers.

Key Provisions

The National Health (Originator Brand) Amendment Determination 2016 (No. 3) amends the National Health (Originator Brand) Determination 2015 (paragraph 2). The amendment determines the originator brand of a pharmaceutical item for one drug new to the Pharmaceutical Benefits Scheme (PBS) F2 formulary on 1 May 2016. The drug in question moved from the Combination Drug List (CDL) to the F2 formulary. The criteria used to determine the originator brand included the brand being listed on the PBS when the drug was on the CDL (subsection 33(3) of the Acts Interpretation Act 1901). The amendment aims to implement the removal of originator brand data from price disclosure calculations in certain circumstances as set out in the National Health (Pharmaceutical Benefits) Regulations 1960 (paragraph 5). The amendment imposes obligations on the parties involved, such as the company with a PBS listed brand of the drug. They were asked to provide comments in relation to the potential originator brand determination but did not respond (paragraph 7). The amendment also affects the PBS, which provides Australians with access to necessary and cost-effective medicines, and is regulated under Part VII of the National Health Act 1953 (paragraph 9). The Regulations prescribe matters and set out details in relation to the operation of the PBS. The removal of originator brand data from price disclosure calculations aims to increase price reductions for PBS medicines, potentially reducing out-of-pocket costs for consumers (paragraphs 6, 11). Breaching the provisions of the National Health (Originator Brand) Amendment Determination 2016 (No. 3) could result in legal consequences. However, the specific offences, penalties, or civil/criminal consequences for breach are not stated in the text. It is essential to refer to the relevant legislation and regulations for detailed information on potential penalties and consequences. The National Health Act 1953 and the National Health (Pharmaceutical Benefits) Regulations 1960 may outline the specific penalties and consequences for breaches related to the PBS and its operations.

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