EXPLANATORY STATEMENT
NATIONAL HEALTH ACT 1953
National Health (Paraplegic and Quadriplegic Program) Special Arrangement Amendment Instrument 2012
PB 42 of 2012
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 (Paraplegic and Quadriplegic Program) Special Arrangement 2010 (PB 118 of 2010) (the Special Arrangement) to make a change to the special arrangement relating to the Paraplegic and Quadriplegic Program.
This Special Arrangement permits three specified paraplegic and quadriplegic associations (‘authorised associations’) to supply certain pharmaceutical benefits which relate to bowel management to persons with paraplegia or quadriplegia.
To be eligible to receive a supply of pharmaceutical benefits from a specified paraplegic and quadriplegic association under this Arrangement (an ‘eligible person’ under this Arrangement), a person with paraplegia or quadriplegia must be a member of the authorised association. The person must also be an ‘eligible person’ within the meaning of the Health Insurance Act 1973, that is, eligible to receive Medicare benefits.
Supply under this Arrangement does not require a PBS prescription, and the applicable patient co-payment that would apply for general supply on the PBS does not apply. Supply is for a maximum per month that is slightly higher than that permitted for general supply on the PBS.
The paraplegic and quadriplegic association may charge an amount (if applicable) equal to the cost of sending the pharmaceutical benefit to the person. The Commonwealth pays the paraplegic and quadriplegic association an amount worked out in accordance with this Special Arrangement.
This instrument amends the Special Arrangement to provide that if a pharmaceutical benefit supplied under the Special Arrangement has a determined price an additional amount is payable to authorised associations.
On 1 April 2012 an amendment to the section 85B determination under the Act meant that the listed brand ‘Dulcolax’, available for supply under this Special Arrangement, changed from an ‘agreed price’ to a ‘determined price’, and a special patient contribution would normally be payable by the patient under normal PBS supply.
This Instrument has a retrospective commencement from 1 April 2012 to benefit authorised associations making claims for supply of ‘Dulcolax’ on and from 1 April 2012. This Instrument does not breach subsection 12(2) of the Legislative Instruments Act 2003 as it does not affect the rights of a person so at to disadvantage them or impose any liabilities on a person except the Commonwealth.
Consultation
The amendment made by this instrument is minor and machinery in nature.
This instrument commences on 1 April 2012.
This instrument is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Overview
The National Health (Paraplegic and Quadriplegic Program) Special Arrangement Amendment Instrument 2012 was enacted to address a gap in the supply of pharmaceutical benefits for individuals with paraplegia or quadriplegia, specifically relating to bowel management. This instrument, made under the authority granted by the National Health Act 1953, amends the National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010. The policy objective is to ensure that the special arrangement permits three specified paraplegic and quadriplegic associations to supply certain pharmaceutical benefits without the need for a PBS prescription and without the applicable patient co-payment. The instrument aims to rectify an unintended consequence of a change in pricing for the pharmaceutical benefit 'Dulcolax', ensuring that authorised associations are adequately compensated when supplying pharmaceuticals with a determined price. The amendment applies retrospectively from 1 April 2012, ensuring that any claims made by the associations from that date forward are appropriately considered.
Scope and Application
The National Health (Paraplegic and Quadriplegic Program) Special Arrangement Amendment Instrument 2012 applies to three specified paraplegic and quadriplegic associations designated as authorised associations. These associations are permitted to supply certain pharmaceutical benefits relating to bowel management to eligible persons with paraplegia or quadriplegia. Eligibility for these benefits requires membership in one of the authorised associations and qualification as an eligible person under the Health Insurance Act 1973, meaning they must be eligible to receive Medicare benefits. This special arrangement allows for the supply of pharmaceutical benefits without the need for a Pharmaceutical Benefits Scheme (PBS) prescription and without the standard PBS patient co-payment applying. However, an authorised association may charge an amount equal to the cost of delivering the pharmaceutical benefit to the person. The Commonwealth compensates the authorised association according to the terms outlined in the Special Arrangement. The instrument amends the Special Arrangement to account for a change in the pricing of the listed brand 'Dulcolax', ensuring that if a supplied pharmaceutical benefit has a determined price, an additional amount is payable to authorised associations. This amendment ensures that authorised associations are appropriately compensated from 1 April 2012, the date from which this instrument has a retrospective commencement.
Key Provisions
The main operative sections of the National Health (Paraplegic and Quadriplegic Program) Special Arrangement Amendment Instrument 2012 (PB 42 of 2012) pertain to the amendments made to the existing special arrangement under the National Health Act 1953. Specifically, section 3(1) of the instrument amends the existing special arrangement to ensure that if a pharmaceutical benefit supplied under the arrangement has a determined price, an additional amount will be payable to the authorised associations. This amendment is a direct response to the change in the pricing status of the listed brand 'Dulcolax' from an 'agreed price' to a 'determined price' as of 1 April 2012. Section 3(2) of the instrument stipulates that this amendment has a retrospective effect from 1 April 2012, allowing authorised associations to make claims for the supply of 'Dulcolax' from this date without incurring any additional financial burden.
The obligations and requirements imposed by the Act on the parties involved are primarily centred around the authorised associations, who are responsible for supplying the specified pharmaceutical benefits to eligible persons. These associations must ensure that the individuals receiving the benefits are members of the authorised association and are eligible to receive Medicare benefits. Additionally, the Act requires that the associations charge an amount, if applicable, equal to the cost of sending the pharmaceutical benefit to the person. The Commonwealth, in turn, is obligated to pay the authorised associations an amount calculated in accordance with the special arrangement. This arrangement also includes a provision that allows for a supply of pharmaceutical benefits without the need for a PBS prescription and without the application of the general PBS patient co-payment.
The instrument does not explicitly outline specific offences, penalties, or consequences for breach within its text. However, it is implicit that any failure to comply with the provisions of the Act or the special arrangement could potentially lead to legal consequences. Given the nature of the Act, breaches might be subject to the general provisions for non-compliance with statutory requirements, which could include civil or administrative penalties. It is also important to note that the instrument does not disadvantage any individual or impose any liability on anyone except the Commonwealth, thereby ensuring that the rights of individuals are not adversely affected by the amendments.