National Health (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 2) (PB 12 of 2019)

Administered by Department of Health, Disability and Ageing

Legislation au F2019L00208 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

NATIONAL HEALTH (PHARMACEUTICAL BENEFITS – EARLY SUPPLY) AMENDMENT INSTRUMENT 2019 (No. 2)

PB 12 of 2019

 

Purpose

The purpose of this legislative instrument, made under subsection 84AAA(2) of the National Health Act 1953 (the Act) is to amend the National Health (Pharmaceutical Benefits—early supply) Instrument 2015 (PB 120 of 2015) (the Principal Instrument).

PB 120 of 2015 specifies the pharmaceutical items that are in pharmaceutical benefits for which Pharmaceutical Benefits Scheme (PBS) safety net entitlements will not apply for early supplies, and to specify the period following previous supply.

The amendments made by this Instrument reflect amendments to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012), which commence on the same day.  The National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012) is made under sections 84AF, 84AK, 85, 85A, 88 and 101 of the Act.

Authority

Subsection 84AAA(1) of the Act provides that a supply of a pharmaceutical benefit (whether or not the supply is of a kind described in paragraph 84C(4A)(a) of the Act) to a person is an early supply of a specified pharmaceutical benefit if:

(a)           The supply is made within 20 days after the day of a previous supply to the person of:

(i)                  the same pharmaceutical benefit; or

(ii)               another pharmaceutical benefit that has the same pharmaceutical item as the pharmaceutical benefit; or

(iii)             another pharmaceutical benefit that is Schedule equivalent to the pharmaceutical benefit;

whether or not the previous supply is a supply of a kind described in paragraph 84C(4A)(a) of the Act; and

(b)           The pharmaceutical item in the pharmaceutical benefit is specified in an instrument under subsection 84AAA(2); and

(c)           The supply does not result from a prescription originating from a hospital.

Subsection 84AAA(2) of the Act provides that the Minister may specify, by legislative instrument, pharmaceutical items for the purposes of paragraph 84AAA(1)(b) of the Act.

Subsection 84AAA(3) provides that the instrument may specify a pharmaceutical item by reference to the circumstances in which a pharmaceutical benefit that has the pharmaceutical item is supplied or any other circumstances in relation to a pharmaceutical benefit that has the pharmaceutical item.

Paragraph 84C(4A) of the Act refers to repatriation pharmaceutical benefits supplied under the schemes established under section 91 of the Veterans Entitlements Act 1986 or section 18 of the Australian Participants in British Nuclear Tests (Treatment) Act 2006 or supplied in accordance with a determination made under paragraph 256(1)(c) of the Military Rehabilitation and Compensation Act 2004.

Subsection 101(3AA) of the Act requires the Pharmaceutical Benefits Advisory Committee (PBAC) to make recommendations to the Minister about what should be specified in the instrument under subsection 84AAA(2).

Changes to PB 120 of 2015 made by this instrument

Schedule 1 to the Principal Instrument is amended by the addition, deletion and alteration of listed pharmaceutical items and associated periods and circumstances.  These changes are summarised, by subject matter, in the Attachment.

The ‘listed drug’, ‘form’, ‘manner of administration’, ‘maximum quantity or number of units’ and ‘maximum number of repeats’ for a pharmaceutical item are the same as declared and determined under the Act for pharmaceutical benefits that have a pharmaceutical item.  These declarations and determinations are made in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012).

Therefore, a supply of a pharmaceutical benefit that has this pharmaceutical item will be an early supply of a specified pharmaceutical benefit providing the requirements of subsection 84AAA(1) are met.

Variation and revocation

Unless there is an express power to revoke or vary PB 120 of 2015 cited in this Instrument and explanatory statement, subsection 33(3) of the Acts Interpretation Act 1901 is relied upon to revoke or vary PB 120 of 2015.

Consultation

The involvement of PBAC constitutes a formal and ongoing process of consultation.  The PBAC is the independent expert body, established by section 100A of the Act, which makes recommendations to the Minister about which drugs and medicinal preparations should be available to Australians as pharmaceutical benefits.  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.  The Committee also includes a pharmaceutical industry nominee.  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 Committee.  The PBAC has provided advice regarding what should be specified in this Instrument.

This amendment is minor and machinery in nature.

General

This Instrument commences on 1 March 2019.

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


ATTACHMENT

PROVISION-BY-PROVISION DESCRIPTION OF NATIONAL HEALTH (PHARMACEUTICAL BENEFITS – EARLY SUPPLY) AMENDMENT INSTRUMENT 2019 (No. 2)

Section 1 Name of Instrument

This section provides that the Instrument is the National Health (Pharmaceutical Benefitsearly supply) Amendment Instrument 2019 (No. 2) and may also be cited as PB 12 of 2019.

Section 2 Commencement

This section provides that the Instrument commences on 1 March 2019.

Section 3 Amendment of National Health (Pharmaceutical Benefits—early supply) Instrument 2015 (PB 120 of 2015)

This section provides that Schedule 1 amends the National Health (Pharmaceutical Benefits—early supply) Instrument 2015 (PB 120 of 2015).

Schedule 1 Amendments

The amendments in Schedule 1 involve additions, deletions and changes to pharmaceutical items listed in Schedule 1 of the Principle Instrument and the associated periods (days) and circumstances.  These changes are summarised below.

 

SUMMARY OF CHANGES

Listed Drugs Added

Bictegravir with emtricitabine with tenofovir alafenamide

Tablet containing bictegravir 50 mg with emtricitabine 200 mg with tenofovir alafenamide 25 mg

Insulin lispro

Injections (human analogue), pre-filled pen, 200 units per mL, 3 mL, 5

Ixekizumab

Injection 80 mg in 1 mL single dose pre-filled pen

Rivaroxaban

Tablet 10 mg

Venetoclax

Tablet 100 mg


Statement of Compatibility with Human Rights

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

National Health (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 2)

(PB 12 of 2019)

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 National Health (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 2) amends the National Health (Pharmaceutical Benefits—early supply) Instrument 2015 which specifies the pharmaceutical items that are pharmaceutical benefits for which the Pharmaceutical Benefits Scheme (PBS) Safety Net entitlements will not apply for early supplies.

Schedule 1 to the Principal Instrument is amended by the addition, deletion and alteration of listed pharmaceutical items and associated periods and circumstances.

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.  The recommendatory role of the Pharmaceutical Benefits Advisory Committee (PBAC) ensures that decisions about subsidised access to medicines on the PBS are evidence-based.

Conclusion

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

 

 

 

Thea Daniel

Assistant Secretary

Pricing and PBS Policy Branch

Technology Assessment and Access Division

Department of Health

Overview

The National Health (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 2) amends the National Health (Pharmaceutical Benefits—early supply) Instrument 2015, which specifies the pharmaceutical items that are pharmaceutical benefits for which Pharmaceutical Benefits Scheme (PBS) Safety Net entitlements will not apply for early supplies. This amendment was introduced to ensure the PBS safety net provisions align with recent updates in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The instrument was enacted by the Australian Government, specifically made under subsection 84AAA(2) of the National Health Act 1953, which empowers the Minister to specify by legislative instrument pharmaceutical items for the purposes of early supply provisions. The policy objective of these amendments is to provide evidence-based recommendations through the Pharmaceutical Benefits Advisory Committee (PBAC), ensuring that decisions about subsidised access to medicines on the PBS are aligned with the progressive realisation of 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 (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 2) amends the National Health (Pharmaceutical Benefits—early supply) Instrument 2015, which specifies the pharmaceutical items for which Pharmaceutical Benefits Scheme (PBS) Safety Net entitlements do not apply for early supplies. This amendment reflects changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012. The changes involve the addition, deletion, and alteration of pharmaceutical items listed in Schedule 1 of the Principal Instrument, alongside their associated periods and circumstances. These amendments ensure that the listed pharmaceutical items align with the updates to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, which govern the classification and scheduling of pharmaceutical benefits under the National Health Act 1953. The instrument applies to all persons and entities involved in the supply of pharmaceutical benefits within Australia, specifically targeting early supplies of specified pharmaceutical items. The amendments are applicable nationally, given that the National Health Act 1953 is a Commonwealth Act. There are no stated exclusions or exemptions in this particular amendment, and it does not introduce new thresholds. The application of the Act is further defined and potentially extended through subordinate instruments, although this particular amendment focuses on minor machinery changes without introducing new authority for variation or revocation beyond the provisions cited in the Act.

Key Provisions

The National Health (Pharmaceutical Benefits – Early Supply) Amendment Instrument 2019 (No. 2) (PB 12 of 2019) amends the National Health (Pharmaceutical Benefits—early supply) Instrument 2015 (PB 120 of 2015) (subsection 3(1)). The principal instrument, PB 120 of 2015, specifies the pharmaceutical items that are pharmaceutical benefits for which Pharmaceutical Benefits Scheme (PBS) Safety Net entitlements will not apply for early supplies. This amendment instrument makes changes to the listed pharmaceutical items, periods, and circumstances specified in Schedule 1 of PB 120 of 2015. These amendments reflect changes made to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012) and aim to ensure consistency across related instruments. The Pharmaceutical Benefits Advisory Committee (PBAC) has an advisory role under the Act, making recommendations to the Minister about which drugs and medicinal preparations should be available to Australians as pharmaceutical benefits (subsection 101(3AA)). The PBAC's recommendations are based on evidence-based assessments of the clinical and cost-effectiveness of pharmaceutical items, ensuring that decisions about subsidised access to medicines on the PBS are informed by the best available evidence. The PBAC consists of members from various relevant professions and interests, including consumers, health economists, community pharmacists, general practitioners, clinical pharmacologists, specialists, and a pharmaceutical industry nominee. The Act imposes obligations on the parties it governs, including the requirement for pharmaceutical benefits to be listed in the Principal Instrument for the purposes of early supply provisions (subsection 84AAA(2)). Pharmaceutical items specified in the instrument are subject to restrictions on PBS Safety Net entitlements if supplied within 20 days of a previous supply of the same or equivalent pharmaceutical benefit (subsection 84AAA(1)). This ensures that early supplies of certain pharmaceutical items do not incur PBS Safety Net entitlements, maintaining the integrity of the Scheme. The Act does not specify any offences, penalties, or civil or criminal consequences for breaches of the early supply provisions. However, the Pharmaceutical Benefits Scheme (PBS) is subject to broader regulatory oversight, and breaches of PBS regulations may result in penalties, including fines and imprisonment. The maximum penalties for breaches of the PBS regulations are prescribed in the Acts Interpretation Act 1901 (subsection 33(3)), which provides for revocation or variation of the Principal Instrument in the absence of an express power to do so. The Minister may also revoke or vary the Principal Instrument if necessary to maintain the integrity and effectiveness of the Scheme.

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