National Health (Originator Brand) Amendment Determination 2021 (No. 3)

Administered by Department of Health, Disability and Ageing

Legislation au F2021L00656 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

National Health Act 1953

National Health (Originator Brand) Amendment Determination 2021 (No. 3)

PB 55 of 2021

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 two drugs new to the Pharmaceutical Benefits Scheme (PBS) F2 formulary on 1 June 2021. 

The Principal Instrument determines originator brands of pharmaceutical items that have a drug on the F2 formulary. On meeting certain criteria, drugs move from the F1 formulary (s85AB of the Act), or the single brand Combination Drug List (CDL), to F2. All drugs on F2 are subject to price disclosure. This instrument is necessary to implement removal of originator brand data from price disclosure calculations (originator removal) in certain circumstances as set out in the National Health (Pharmaceutical Benefits) Regulations 2017 (the Regulations). Originator removal 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 two drugs that are moving from F1 to F2 (bevacizumab and bortezomib) on 1 June 2021. Subsection 99ADB(6C) of the Act provides that when deciding whether to determine originator brands, the Minister (or delegate) must have regard to whether the brand was on F1 or CDL when it was first determined as a brand of pharmaceutical item under subsection 85(6) of the Act.

The main criteria used to determine these brands as originators were that they were the listed brands of the drug when it was on F1.

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 companies with a PBS listed brand of the drugs moving from F1 to F2 were consulted on the potential originator brand determination. No comments were received from affected companies. No additional consultation with experts was undertaken regarding this determination because consultation with the affected company drew on the knowledge of persons with relevant expertise.

This instrument commences on 1 June 2021.

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 2021 (No. 3) (PB 55 of 2021)

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 the originator brand of a pharmaceutical item for two drugs new to the Pharmaceutical Benefits Scheme (PBS) F2 formulary on 1 June 2021. 

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 2017 (the Regulations). Originator brand removal from price disclosure calculations will potentially increase PBS price reductions, as originator brands tend to maintain higher prices than other brands. Originator brand removal 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, 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 engages 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 is a benefits scheme which assists with providing subsidised access to medicines for people. This is a positive and supportive step towards attaining the highest standard of health for all Australians. .

Determining an originator brand will improve the operation of the PBS by delivering better value for money for PBS medicines through price disclosure 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.

 

 

Nikolai Tsyganov

Acting Assistant Secretary

Pricing and PBS Policy Branch

Technology Assessment and Access Division

Department of Health

Overview

The National Health (Originator Brand) Amendment Determination 2021 (No. 3) amends the National Health (Originator Brand) Determination 2015 to determine the originator brand of pharmaceutical items for two drugs—bevacizumab and bortezomib—which will move from the F1 formulary to the F2 formulary of the Pharmaceutical Benefits Scheme (PBS) on 1 June 2021. This amendment is necessary to implement the removal of originator brand data from price disclosure calculations under the National Health (Pharmaceutical Benefits) Regulations 2017, potentially increasing price reductions on the PBS and thereby reducing out-of-pocket costs for consumers. This legislative instrument is made pursuant to the National Health Act 1953 and is intended to ensure the PBS operates effectively by improving value for money through price disclosure reductions, contributing to 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.

Scope and Application

The National Health (Originator Brand) Amendment Determination 2021 (No. 3) amends the National Health (Originator Brand) Determination 2015 to determine the originator brand of two new pharmaceutical items on the Pharmaceutical Benefits Scheme (PBS) F2 formulary, specifically for the drugs bevacizumab and bortezomib, which move from F1 to F2 on 1 June 2021. This amendment is necessary to implement the removal of originator brand data from price disclosure calculations, as outlined in the National Health (Pharmaceutical Benefits) Regulations 2017. The determination of originator brands for these drugs is based on their status when they were first listed on F1, fulfilling the criteria under subsection 99ADB(6C) of the National Health Act 1953. This legislative instrument, which commences on 1 June 2021, ensures compliance with the requirements of the National Health Act and supports the operation of the PBS by facilitating potential price reductions and enhancing the affordability of PBS medicines for consumers.

Key Provisions

The main operative sections of the National Health (Originator Brand) Amendment Determination 2021 (No. 3) are set out in the Schedule 1 of this amending instrument, which determines the originator brand for two drugs, bevacizumab and bortezomib, that are moving from the F1 formulary to the F2 formulary of the Pharmaceutical Benefits Scheme (PBS) on 1 June 2021 (subsection 99ADB(6C) of the National Health Act 1953). This determination is made under the authority of subsection 99ADB(6B) of the National Health Act 1953. The criteria for determining the originator brands include whether the brands were listed when the drugs were on the F1 formulary, as required under subsection 85(6) of the Act (subsection 99ADB(6C) of the Act). The amendment is necessary to implement the removal of originator brand data from price disclosure calculations, as specified in the National Health (Pharmaceutical Benefits) Regulations 2017, with the aim of potentially increasing price disclosure related price reductions for PBS medicines (subsection 33(3) of the Acts Interpretation Act 1901). The obligations imposed by this Act on the parties it governs include the requirement for pharmaceutical companies to provide originator brand data when their drugs move from the F1 formulary to the F2 formulary of the PBS. The determination of the originator brand for bevacizumab and bortezomib is based on the criteria that they were the listed brands of the drug when it was on F1. Companies with a PBS listed brand of the drugs moving from F1 to F2 were consulted on the potential originator brand determination, but no comments were received. Additionally, the instrument ensures that the Government price for PBS medicines more closely reflects the prices at which generic brands of the medicine are being sold in the market, rather than the prices of all brands. There are no specific offences, penalties, or civil/criminal consequences outlined for breach of this legislative instrument. However, the Regulations provide the framework for potential price disclosure related price reductions, which may indirectly affect the pricing and availability of pharmaceutical items on the PBS. The primary consequence of not complying with the determination of originator brands could be the misapplication of price disclosure calculations, leading to potentially higher out-of-pocket costs for consumers and less efficient use of public funds within the PBS.

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