EXPLANATORY STATEMENT
NATIONAL HEALTH ACT 1953
NATIONAL HEALTH (PRICE AND SPECIAL PATIENT CONTRIBUTION) AMENDMENT DETERMINATION 2015 (No. 3)
PB 40 of 2015
Authority
This legislative instrument, made under section 85B of the National Health Act 1953 (the Act) amends the National Health (Price and Special Patient Contribution) Determination 2010 (PB 109 of 2010) (the Principal Determination).
Subsections 85B(2), (3) and (4) of the National Health Act 1953 (the Act) provide for the Minister to determine, respectively, determined prices, claimed prices and the circumstances in which the Commonwealth will pay a special patient contribution. The National Health (Price and Special Patient Contribution) Determination 2010 (the Principal Determination) contains determinations of these matters.
Variation and revocation
Unless there is an express power to revoke or vary PB 109 of 2010 cited in this Instrument and explanatory statement, subsection 33(3) of the Acts Interpretation Act 1901 is relied upon to revoke or vary PB 109 of 2010.
Purpose
The Act provides for the Minister and the responsible person to agree a price that is taken to be the appropriate maximum price of a brand of a pharmaceutical item for the purposes of Part VII of the Act (section 85AD). Section 85B of the Act applies if the Minister and the responsible person have been unable to reach an agreement on a price for the pricing quantity. Whether or not an agreement is made for the pricing quantity, section 85B also applies if the responsible person is dissatisfied with the proportional ex-manufacturer prices that will apply to other pack quantities.
Subsection 85B(2) provides that the Minister may determine, by reference to the pricing quantity of a brand of a pharmaceutical item, an amount that is taken to be the appropriate maximum price of the brand for the purposes of Part VII of the Act. This is termed the ‘Determined Price’ in this Determination.
Subsection 85B(3) provides that the Minister may determine, by reference to a pack quantity of a brand of the pharmaceutical item, an amount that is taken to be the price claimed by the responsible person for the pack quantity of the brand, for the purposes of Part VII of the Act. This is termed the ‘Claimed Price’ in this Determination.
The Determined Price is the approved ex-manufacturer price and is used as the basis for working out the Commonwealth price for the brand of the pharmaceutical item (section 98B of the Act); for pack quantities other than the pricing quantity, the proportional ex-manufacturer price is used as the basis. Approved pharmacists are entitled to payment from the Commonwealth equal to the Commonwealth price less the applicable patient co-payment (section 99 of the Act).
The difference between the responsible person’s Commonwealth price for a pack quantity (ie, the price that would be the Commonwealth price if the responsible person’s claimed price had become the approved ex-manufacturer price or the proportional ex-manufacturer price for that pack quantity) and the Commonwealth price for the pack quantity is defined in subsection 85B(5) of the Act as the special patient contribution. An approved pharmacist may charge a patient an amount equal to the special patient contribution, in addition to any other amount that may be charged (subsection 87(2A) of the Act).
Subsection 85B(4) of the Act provides that the Minister may determine the circumstances in which the Commonwealth is to pay the special patient contribution for a brand. In such cases, the Commonwealth payment to the pharmacist is increased by the amount of the special patient contribution (subsection 99(2AA) of the Act) and the pharmacist may not charge the patient this amount (subsection 87(2A) of the Act).
The purpose of making subsection 85B(4) determinations is to enable patients for whom the base-priced brands (the ones without a special patient contribution) are not suitable, to obtain the higher priced brand (the one with the special patient contribution) without the need to pay the higher price. In such cases the Commonwealth pays the special patient contribution.
This instrument (the Amending Determination) amends the Principal Determination by: removing one brand that is no longer PBS listed and reflecting for plain English reasons the price changes and decreases to multiple brand premiums which took legal effect on 1 April 2015 due to price disclosure reductions.
Consultation
This determination affects certain responsible persons with medicines listed on the PBS. Before a pharmaceutical benefit is listed on the PBS, and from time to time thereafter, price negotiations occur between the responsible person and the Minister for the purpose of reaching a price agreement for section 85AD of the Act. Consultation was considered unnecessary (or inappropriate) because this instrument essentially involves a price negotiation between the minister and the responsible persons.
A provision by provision description of the Amending Determination is contained in the Attachment.
This Determination commences on 1 May 2015.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
ATTACHMENT
PROVISION BY PROVISION DESCRIPTION OF THE NATIONAL HEALTH (PRICE AND SPECIAL PATIENT CONTRIBUTION) AMENDMENT DETERMINATION 2015 (No. 3)
(PB 40 of 2015)
Section 1 Name of Determination
This section provides that the Determination is the National Health (Price and Special Patient Contribution) Amendment Determination 2015 (No. 3) and may also be cited as PB 40 of 2015.
Section 2 Commencement
This section provides that the Determination commences on 1 May 2015.
Section 3 Amendment of the National Health (Price and Special Patient Contribution) Determination 2010 (PB 109 of 2010).
This section provides that Schedule 1 amends the National Health (Price and Special Patient Contribution) Determination 2010 (PB 109 of 2010).
Schedule 1 Amendments commencing 1 May 2015
Schedule 1 sets out the amendments to the Principal Determination which commence on 1 May 2015.
SUMMARY OF CHANGES
SCHEDULE 1
Brands with a price change and decreased brand premium
Amlodipine | Tablet 5 mg (as besylate) | Norvasc |
Tablet 10 mg (as besylate) | Norvasc | |
Amoxycillin | Capsule 250 mg (as trihydrate) | Amoxil |
Capsule 500 mg (as trihydrate) | Amoxil | |
Powder for oral suspension 125 mg (as trihydrate) per 5 mL, 100 mL | Amoxil | |
Powder for oral suspension 250 mg (as trihydrate) per 5 mL, 100 mL | Amoxil Forte | |
Tablet 1 g (as trihydrate) | Maxamox | |
Amoxycillin with Clavulanic Acid | Powder for oral suspension containing 125 mg amoxycillin (as trihydrate) with 31.25 mg clavulanic acid (as potassium clavulanate) per 5 mL, 75 mL | Augmentin |
Powder for oral suspension containing 400 mg amoxycillin (as trihydrate) with 57 mg clavulanic acid (as potassium clavulanate) per 5 mL, 60 mL | Augmentin Duo 400 | |
Tablet containing 500 mg amoxycillin (as trihydrate) with 125 mg clavulanic acid (as potassium clavulanate) | Augmentin Duo | |
Tablet containing 875 mg amoxycillin (as trihydrate) with 125 mg clavulanic acid (as potassium clavulanate) | Augmentin Duo forte | |
Atenolol | Tablet 50 mg | Tenormin |
Bisoprolol | Tablet containing bisoprolol fumarate | Bicor |
Tablet containing bisoprolol fumarate | Bicor | |
Tablet containing bisoprolol fumarate | Bicor | |
Candesartan | Tablet containing candesartan cilexetil | Atacand |
Tablet containing candesartan cilexetil | Atacand | |
Tablet containing candesartan cilexetil 16 mg | Atacand | |
Tablet containing candesartan cilexetil 32 mg | Atacand | |
Cyproterone | Tablet containing cyproterone acetate | Androcur |
Tablet containing cyproterone acetate | Androcur | |
Tablet containing cyproterone acetate 100 mg | Androcur-100 | |
Diclofenac | Tablet (enteric coated) containing diclofenac sodium 25 mg | Voltaren 25 |
Tablet (enteric coated) containing diclofenac sodium 50 mg | Voltaren 50 | |
Doxycycline | Capsule 100 mg (as hydrochloride) (containing enteric coated pellets) (pricing quantity 7) | Doryx Mayne Pharma Doxycycline |
| ||
Capsule 100 mg (as hydrochloride) (containing enteric coated pellets) (pricing quantity 21) | Doryx Mayne Pharma Doxycycline | |
| ||
Capsule 50 mg (as hydrochloride) (containing enteric coated pellets) | Doryx Mayne Pharma Doxycycline | |
| ||
Enalapril | Tablet containing enalapril maleate | Renitec |
Tablet containing enalapril maleate | Renitec 20 | |
Escitalopram | Tablet 10 mg (as oxalate) | Lexapro |
Tablet 20 mg (as oxalate) | Lexapro | |
Felodipine | Tablet 2.5 mg (extended release) | Plendil ER |
Tablet 5 mg (extended release) | Plendil ER | |
Tablet 10 mg (extended release) | Plendil ER | |
Fluoxetine | Capsule 20 mg (as hydrochloride) | Prozac 20 |
Tablet, dispersible, 20 mg (as hydrochloride) | Prozac Tab | |
Fluvoxamine | Tablet containing fluvoxamine maleate 50 mg | Luvox |
Tablet containing fluvoxamine maleate 100 mg | Luvox | |
Frusemide | Tablet 20 mg | Lasix-M |
Tablet 40 mg | Lasix | |
Isosorbide Mononitrate | Tablet 60 mg (sustained release) | Imdur Durule Monodur 60 mg |
| ||
Tablet 120 mg (sustained release) | Imdur 120 mg | |
Lamotrigine | Tablet 5 mg | Lamictal |
Tablet 25 mg | Lamictal | |
Tablet 50 mg | Lamictal | |
Tablet 100 mg | Lamictal | |
Tablet 200 mg | Lamictal | |
Lercanidipine | Tablet containing lercanidipine hydrochloride 10 mg | Zanidip |
Tablet containing lercanidipine hydrochloride 20 mg | Zanidip | |
Lisinopril | Tablet 5 mg | Zestril |
Tablet 10 mg | Prinivil 10 Zestril | |
| ||
Tablet 20 mg | Prinivil 20 Zestril | |
| ||
Meloxicam | Capsule 7.5 mg | Mobic |
Capsule 15 mg | Mobic | |
Tablet 7.5 mg | Mobic | |
Tablet 15 mg | Mobic | |
Metformin | Tablet containing metformin hydrochloride 500 mg | Diabex |
Tablet (extended release) containing metformin hydrochloride 500 mg | Diabex XR | |
Tablet containing metformin hydrochloride 850 mg | Diabex 850 Glucophage | |
| ||
Tablet containing metformin hydrochloride 1 g | Diabex 1000 | |
Tablet (extended release) containing metformin hydrochloride 1 g | Diabex XR 1000 | |
Methylprednisolone | Injection containing methylprednisolone acetate 40 mg in 1 mL | Depo-Medrol |
Mirtazapine | Tablet 15 mg (orally disintegrating) | Avanza SolTab |
Tablet 30 mg | Avanza | |
Tablet 30 mg (orally disintegrating) | Avanza SolTab | |
Tablet 45 mg | Avanza | |
Tablet 45 mg (orally disintegrating) | Avanza SolTab | |
Moclobemide | Tablet 150 mg | Aurorix |
Tablet 300 mg | Aurorix 300 mg | |
Omeprazole | Tablet 20 mg (as magnesium) | Losec Tablets |
Perindopril | Tablet containing perindopril arginine 2.5 mg | Coversyl 2.5mg PREXUM 2.5 |
| ||
Pravastatin | Tablet containing pravastatin sodium | Pravachol |
Tablet containing pravastatin sodium | Pravachol | |
Tablet containing pravastatin sodium | Pravachol | |
Tablet containing pravastatin sodium | Pravachol | |
Prochlorperazine | Tablet containing prochlorperazine maleate 5 mg | Stemetil |
Quinapril | Tablet 5 mg (as hydrochloride) | Accupril |
Tablet 10 mg (as hydrochloride) | Accupril | |
Tablet 20 mg (as hydrochloride) | Accupril | |
Ranitidine | Tablet 150 mg (as hydrochloride) | Zantac |
Tablet 300 mg (as hydrochloride) | Zantac | |
Sertraline | Tablet 50 mg (as hydrochloride) | Zoloft |
Tablet 100 mg (as hydrochloride) | Zoloft | |
Sotalol | Tablet containing sotalol hydrochloride 80 mg | Sotacor |
Tablet containing sotalol hydrochloride 160 mg | Sotacor | |
Sumatriptan | Tablet 50 mg (as succinate) | Imigran |
Tablet (fast disintegrating) 50 mg (as succinate) | Imigran FDT | |
Tamoxifen | Tablet 20 mg (as citrate) | Nolvadex-D |
Tramadol | Capsule containing tramadol hydrochloride 50 mg | Tramal |
Tablet (sustained release) containing tramadol hydrochloride 100 mg | Tramal SR 100 | |
Tablet (sustained release) containing tramadol hydrochloride 150 mg | Tramal SR 150 | |
Tablet (sustained release) containing tramadol hydrochloride 200 mg | Tramal SR 200 | |
Trandolapril | Capsule 500 micrograms | Gopten |
Capsule 1 mg | Gopten | |
Capsule 2 mg | Gopten | |
Capsule 4 mg | Gopten | |
Valproic Acid | Tablet (enteric coated) containing sodium valproate 200 mg | Epilim EC |
Tablet (enteric coated) containing sodium valproate 500 mg | Epilim EC |
Deletion of Brand
Mianserin | Tablet containing mianserin hydrochloride 10 mg | Tolvon |
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
National Health (Price and Special Patient Contribution) Amendment Determination 2015 (No. 3)
(PB 40 of 2015)
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, made under section 85B of the National Health Act 1953 (the Act), amends the National Health (Price and Special Patient Contribution) Determination 2010 (the Principal Determination), which provides for price determinations in relation to brands of pharmaceutical items listed on the Pharmaceutical Benefits Scheme (PBS) for which the Minister and the responsible person have not been able to make a price agreement. It also provides for the circumstances in which the Commonwealth will pay the special patient contribution resulting from these price determinations. This instrument (the Amending Determination) amends the Principal Determination by: removing one brand that is no longer PBS listed and reflecting for plain English reasons the price changes and decreases to multiple brand premiums which took legal effect on 1 April 2015 due to price disclosure reductions.
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.
Felicity McNeill
First Assistant Secretary
Pharmaceutical Benefits Division
Department of Health