National Health (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 4) (PB 30 of 2019)

Administered by Department of Health, Disability and Ageing

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EXPLANATORY STATEMENT

NATIONAL HEALTH ACT 1953

NATIONAL HEALTH (PHARMACEUTICAL BENEFITS – EARLY SUPPLY) AMENDMENT INSTRUMENT 2019 (No. 4)

PB 30 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 May 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. 4)

Section 1 Name of Instrument

This section provides that the Instrument is the National Health (Pharmaceutical Benefitsearly supply) Amendment Instrument 2019 (No. 4) and may also be cited as PB 30 of 2019.

Section 2 Commencement

This section provides that the Instrument commences on 1 May 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

Palbociclib

Capsule 75 mg

Capsule 100 mg

Capsule 125 mg

Tofacitinib

Tablet 5 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. 4)

(PB 30 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. 4) 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.

 

 

 

Sean Lane

Assistant Secretary (Acting)

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. 4) was enacted to amend the National Health (Pharmaceutical Benefits—early supply) Instrument 2015, which specifies the pharmaceutical items for which Pharmaceutical Benefits Scheme (PBS) safety net entitlements will not apply for early supplies. This amendment was introduced to address the need for updating the list of pharmaceutical items that are excluded from PBS safety net entitlements when supplied within a specified period following a previous supply. The changes were made under subsection 84AAA(2) of the National Health Act 1953 by the Parliament of Australia, with the policy objective of ensuring that the PBS remains an efficient and effective scheme that provides appropriate access to medicines for Australians. The Pharmaceutical Benefits Advisory Committee, established under section 100A of the Act, provided recommendations to the Minister, who then specified the pharmaceutical items through this legislative instrument. This amendment reflects changes to the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 and ensures that the PBS continues to function in a manner that aligns with the highest attainable standard of physical and mental health, as recognised by the International Covenant on Economic, Social and Cultural Rights.

Scope and Application

The National Health (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 4) amends the National Health (Pharmaceutical Benefits—early supply) Instrument 2015, which pertains to the pharmaceutical items that are pharmaceutical benefits for which the Pharmaceutical Benefits Scheme (PBS) Safety Net entitlements will not apply for early supplies. This legislative instrument applies to pharmaceutical items and their associated periods and circumstances, specifically detailing which items will not have PBS Safety Net entitlements apply for early supplies. The instrument's reach is national, impacting patients and suppliers of pharmaceutical benefits across Australia, as it operates under the National Health Act 1953. This Act extends its application through subordinate instruments, such as the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, which further specifies the pharmaceutical items and their details. The amendments are machinery in nature and are designed to reflect changes in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012, ensuring alignment and consistency within the legislative framework governing pharmaceutical benefits in Australia.

Key Provisions

The National Health (Pharmaceutical Benefits – early supply) Amendment Instrument 2019 (No. 4) amends the National Health (Pharmaceutical Benefits—early supply) Instrument 2015 (PB 120 of 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. The amendments, detailed in Schedule 1, involve adding, deleting, and altering listed pharmaceutical items, along with associated periods and circumstances. These changes ensure that the list of pharmaceutical items aligns with updates made in the National Health (Listing of Pharmaceutical Benefits) Instrument 2012 (PB 71 of 2012), which also commenced on 1 May 2019. The amendments are categorised by subject matter and include specific details such as drug form, manner of administration, maximum quantity or number of units, and maximum number of repeats. The Act imposes specific obligations on parties and entities involved in the supply of pharmaceutical benefits under the PBS. Pharmaceutical suppliers and healthcare providers must ensure that any supply of a specified pharmaceutical benefit within 20 days of a previous supply to the same person does not qualify for PBS safety net entitlements, unless otherwise specified. This requirement is outlined in subsection 84AAA(1) of the National Health Act 1953. The Pharmaceutical Benefits Advisory Committee (PBAC) has a key role in recommending which pharmaceutical items should be specified in the instrument under subsection 84AAA(2) of the Act. These recommendations are made based on evidence and expert advice, ensuring that decisions about the PBS are well-founded. Any breach of the provisions of the Act can result in significant consequences. For instance, supplying a pharmaceutical benefit that qualifies as an early supply and does not meet the specified criteria can lead to financial penalties or other sanctions. While the specific penalties are not detailed in the text, breaches of the PBS regulations can typically result in fines or other enforcement actions as outlined in the Act. The Pharmaceutical Benefits Advisory Committee (PBAC) plays a critical role in ensuring compliance by making recommendations to the Minister, which are then implemented through legislative instruments like this one. The involvement of PBAC ensures that the PBS operates efficiently and effectively, maintaining its role as a vital component of Australia's healthcare system.

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