National Health (Payments for prescriber bag supplies) Determination 2012 (No. PB 92 of 2012)

Administered by Department of Health, Disability and Ageing

Legislation au F2012L01959 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

National Health (Pharmaceutical Benefits) Regulations 1960

National Health (Payments for prescriber bag supplies) Determination 2012

PB 92 of 2012

Authority

Regulation 18 of the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations) provides that the Minister may determine the rates and conditions of payments by the Commonwealth to approved pharmacists in respect of the supply of pharmaceutical benefits to practitioners under the prescriber bag provisions of the National Health Act 1953 (the Act). 

Purpose

This Determination sets out the rates and conditions of payment for the purposes of regulation 18.

Details of each section of the Determination are set out in the Attachment.

Background

Part VII of the National Health Act 1953 (the Act) is the legislative basis of the Pharmaceutical Benefits Scheme (PBS) by which the Commonwealth provides reliable, timely, and affordable access to a wide range of medicines for all Australians.

Subsection 85(1) provides that benefits are to be provided by the Commonwealth in accordance with Part VII in respect of pharmaceutical benefits.

The determination made by the Pharmaceutical Benefits Remuneration Tribunal under paragraph 98B(1)(a) of the Act (the Pharmacists Payments Determination) sets out the manner of working out the Commonwealth price for payments to approved pharmacists for the supply of pharmaceutical benefits on presentation of a prescription.  The current Pharmacists Payments Determination is the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2010.

The determination made under paragraph 98C(1)(b) of the Act (the Conditions Determination), sets out the conditions under which such payments are made.  The current Conditions Determination is the Determination – Conditions (PB 109 of 2008).

The prescriber bag provisions of the Act (Sections 93, 93AA and 93AB) provide for the supply of certain pharmaceutical benefits by medical practitioners, authorised midwives and authorised nurse practitioners, respectively, directly to patients, i.e. from their ‘prescriber bags’.

This Determination, made under regulation 18, sets out the rates and conditions of payment to approved pharmacists for the supply of pharmaceutical benefits to practitioners under the prescriber bag provisions of the Act.  The Determination provides for rate of payment to be the Commonwealth price worked out under the Pharmacists Payments Determination plus an amount equal to the special patient contribution, if any.  The Determination provides for the conditions of payment to be the conditions set out in the Conditions Determination.

Consultation

The changes made by this Determination are technical changes which are consequential to amendments to the Act since the previous determination under regulation 18 was made in 1996.  There is no change to current practice as a result of these amendments and therefore no consultation on this determination was considered necessary.

This Determination commences on 1 October 2012.

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


ATTACHMENT

 

Details of the National Health (Payments for prescriber bag supplies) Determination 2012

 

Section 1 Name of Determination

This section provides that the title of the Determination is the National Health (Payments for prescriber bag supplies) Determination 2012 and that it may also be cited as PB 92 of 2012.

Section 2 Commencement

This section provides for the Determination to commence on 1 October 2012.

Section 3 Revocation

This section provides that the Determination under Regulation 18 made on 16 July 1996 is revoked.

Section 4 Definitions

This section sets out definitions of a number of terms used in the Determination.

Section 5 Rate of Payment

This section determines the rate of payment to approved pharmacists for the supply of pharmaceutical benefits to practitioners under the prescriber bag provisions of the Act.  The rate of payment is the Commonwealth price worked out under the determination made under paragraph 98B(1)(a) of the Act, plus an amount equal to the special patient contribution, if any.

Section 6 Conditions of Payment

This section determines the conditions of payment to approved pharmacists for the supply of pharmaceutical benefits to practitioners under the prescriber bag provisions of the Act.  The conditions are the conditions set out in the determination under paragraph 98C(1)(b) of the Act, which would apply if the supply had been made on presentation of a prescription rather than to a practitioner.


Statement of Compatibility with Human Rights

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

National Health (Payments for prescriber bag supplies) Determination 2012

PB 92 of 2012

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

The purpose of this legislative instrument made under regulation 18 of the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations) is to determine the rates and conditions of payments by the Commonwealth to approved pharmacists in respect of the supply of pharmaceutical benefits to practitioners under the prescriber bag provisions of the National Health Act 1953 (the Act).  The prescriber bag provisions of the Act (Sections 93, 93AA and 93AB) provide for the supply of certain pharmaceutical benefits by medical practitioners, authorised midwives and authorised nurse practitioners, respectively, directly to patients, that is, from their ‘prescriber bags’.

Human rights implications

This legislative instrument engages Articles 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 PBS is a benefit scheme which assists with advancement of this human right by providing for subsidised access by patients to medicines.

Conclusion

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

Tanya Plibersek

Minister for Health

Overview

The National Health (Payments for prescriber bag supplies) Determination 2012 (PB 92 of 2012) was enacted to provide clarity and updated specifications regarding the rates and conditions of payments by the Commonwealth to approved pharmacists for the supply of pharmaceutical benefits to medical practitioners, authorised midwives, and authorised nurse practitioners under the prescriber bag provisions of the National Health Act 1953. This Determination was introduced to address the need for technical updates and adjustments following amendments to the Act since the previous determination was made in 1996. It was made under the authority of regulation 18 of the National Health (Pharmaceutical Benefits) Regulations 1960 by the Minister for Health and is intended to ensure that the Pharmaceutical Benefits Scheme (PBS) continues to operate efficiently and effectively in providing affordable access to medications for all Australians. The policy objective of this Determination is to align the payment rates and conditions with the evolving legislative framework and current practices within the PBS.

Scope and Application

The National Health (Payments for prescriber bag supplies) Determination 2012 applies to approved pharmacists who supply pharmaceutical benefits to practitioners under the prescriber bag provisions of the National Health Act 1953. This provision allows medical practitioners, authorised midwives, and authorised nurse practitioners to supply certain pharmaceutical benefits directly to patients from their 'prescriber bags'. The Determination sets out the rates and conditions of payment for these supplies, providing for the rate of payment to be the Commonwealth price worked out under the Pharmacists Payments Determination, plus an amount equal to the special patient contribution, if any. The conditions of payment are those set out in the Conditions Determination. The Determination revokes the previous determination made under regulation 18 on 16 July 1996 and applies nationally, as it is made under the Commonwealth's National Health (Pharmaceutical Benefits) Regulations 1960. There are no stated exclusions, exemptions, or thresholds within the Determination itself, though the broader applicability of the National Health Act and Regulations may impose certain limitations. This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

Key Provisions

The main operative sections of the National Health (Payments for prescriber bag supplies) Determination 2012 (the Determination) under regulation 18 of the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations) are Sections 5 and 6. Section 5 specifies the rate of payment to be provided to approved pharmacists for supplying pharmaceutical benefits to practitioners under the prescriber bag provisions of the National Health Act 1953 (the Act). The rate is set at the Commonwealth price, as determined under the Pharmacists Payments Determination, plus any special patient contribution, if applicable. Section 6 outlines the conditions of payment, which mirror those in the Conditions Determination under paragraph 98C(1)(b) of the Act, applicable to supplies made on presentation of a prescription. The Determination imposes certain obligations and requirements on the parties it governs. Approved pharmacists, who are to receive payment for supplying pharmaceutical benefits to practitioners, must comply with the specified rates and conditions of payment as outlined in the Determination. These obligations ensure that the pharmacists are remunerated fairly for their services in line with the Commonwealth’s pricing structure and that the conditions under which these payments are made are transparent and consistent with those for prescription-based supplies. The Determination also ensures that any special patient contributions are appropriately included in the payment rates. The Determination includes provisions that outline the consequences of non-compliance. While specific offences and penalties are not explicitly detailed within the Determination itself, breaches of the conditions of payment or failure to comply with the prescribed rates may result in legal consequences under the overarching National Health Act 1953 and the National Health (Pharmaceutical Benefits) Regulations 1960. Such breaches could potentially lead to financial penalties or other administrative actions taken by the Commonwealth to enforce compliance. The precise penalties would depend on the specific regulatory framework governing the payment provisions under the Act and Regulations.

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