{"id":"F2020L01208","name":"National Health (Commonwealth Price - Pharmaceutical benefits supplied by private hospitals) Determination 2020 (PB 99 of 2020)","slug":"national-health-commonwealth-price-pharmaceutical-benefits-supplied-by-private-hospitals-determinati","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":113591,"registerId":"commonwealth-F2020L01208-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Part 1","sectionType":"part","heading":"Preliminary","content":"## Part 1—Preliminary","sortOrder":0},{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n (1) This instrument is the National Health (Commonwealth Price ‑ Pharmaceutical benefits supplied by private hospitals) Determination 2020.\n (2) This instrument may also be cited as PB 99 of 2020.","sortOrder":1},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"#### 2 Commencement\n\n (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n```html\n

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1. The whole of this instrument

1 October 2020

1 October 2020

\n```\n\n> Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.","sortOrder":2},{"sectionNumber":"2A","sectionType":"section","heading":"Authority","content":"#### 2A Authority\n\n This instrument is made under subsection 99(4) of the National Health Act 1953.","sortOrder":3},{"sectionNumber":"2B","sectionType":"section","heading":"Purpose","content":"#### 2B Purpose\n\n The purpose of this determination is to determine the amount of the Commonwealth payment for pharmaceutical benefits supplied by an approved hospital authority to a patient receiving treatment in or at a private hospital for which the authority is approved.","sortOrder":4},{"sectionNumber":"2C","sectionType":"section","heading":"Schedules","content":"#### 2C Schedules\n\n Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.","sortOrder":5},{"sectionNumber":"2D","sectionType":"section","heading":"Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)","content":"#### 2D Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)\n\n (1) If:\n (a) a thing was done for a particular purpose under the National Health Act 1953 ‑ National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010) as in force immediately before that Determination was repealed; and\n (b) the thing could be done for that purpose under this instrument;\n the thing has effect for the purposes of this instrument as if it had been done under this instrument.\n (2) Without limiting subsection (1), a reference in that subsection to a thing being done includes a reference to a notice, application or other instrument being given or made.","sortOrder":6},{"sectionNumber":"3","sectionType":"section","heading":"Definitions","content":"#### 3 Definitions\n\n In this instrument:\n\n> Act means the National Health Act 1953.\n\n> approved ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.\n\n> approved hospital authority means a hospital authority that has been approved by the Minister under subsection 94(1) of the Act.\n\n> Approved Pharmacists Determination means the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020 (PB 66 of 2020).\n\n> brand has the same meaning as in Part VII of the Act.\n\n> current figure has the same meaning as in section 99G of the Act.\n\n> dangerous drug means:\n\n (a) a pharmaceutical benefit mentioned in Schedule 3 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019 (PB 114 of 2019); or\n (b) a pharmaceutical benefit that, under the law of a State or Territory, is classified as a dangerous drug.\n\n> dangerous drug fee has the same meaning as in Approved Pharmacists Determination.\n\n> determined quantity, of a listed brand of a pharmaceutical item, has the same meaning as in Part VII of the Act.\n\n> dispensed price:\n\n (a) for a ready‑prepared pharmaceutical benefit—has the meaning given by section 9; and\n (b) for an extemporaneously‑prepared pharmaceutical benefit—has the meaning given by subsection 16(1).\n\n> extemporaneously‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.\n\n> extemporaneously‑prepared pharmaceutical benefit means a pharmaceutical benefit that is not a ready‑prepared pharmaceutical benefit.\n\n> listed brand has the same meaning as in Part VII of the Act.\n\n> maximum quantity, of a brand of a pharmaceutical item, means a quantity or number of units of the pharmaceutical item determined under paragraph 85A(2)(a) of the Act in relation to that brand of pharmaceutical item.\n\n> pack quantity has the same meaning as in subsection 84(1) of the Act.\n\n> Note: The Minister may determine one or more pack quantities for a brand of a pharmaceutical item under subsection 84AK(2) of the Act. The quantities determined are the quantities in manufacturer’s PBS packs.\n\n> patient co‑payment means:\n\n (a) for a person to whom, at the time that a pharmaceutical benefit is supplied, paragraph 87(2)(b) of the Act applies—the current figure for the general patient reduced charge, as defined in section 99F of the Act; or\n (b) for a person who is a concessional beneficiary for section 84 of the Act—the current figure for the concessional beneficiary charge, as defined in section 99F of the Act; or\n (c) for any other person—the current figure for the general patient charge, as defined in section 99F of the Act.\n\n> pharmaceutical benefit has the meaning given by section 84 of the Act.\n\n> pharmaceutical item has the same meaning as in Part VII of the Act.\n\n> private hospital means a hospital for which there is in force a statement under subsection 121‑5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.\n\n> proportional ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.\n\n> ready‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.\n\n> ready‑prepared pharmaceutical benefit means a brand of a pharmaceutical item for which there is a determination under subsection 85(6) of the Act.\n\n> Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.\n\n> repatriation pharmaceutical benefit has the meaning given by section 84 of the Act.","sortOrder":7},{"sectionNumber":"Part 2","sectionType":"part","heading":"Rates and conditions of payment—general","content":"## Part 2—Rates and conditions of payment—general","sortOrder":8},{"sectionNumber":"4","sectionType":"section","heading":"Rounding up and rounding down","content":"#### 4 Rounding up and rounding down\n\n If the calculation of a price under this Determination includes a fraction of a cent, the final amount calculated is to then be rounded up or down to the nearest cent, with an amount of 0.5 of a cent or more being rounded up to the next cent.","sortOrder":9},{"sectionNumber":"5","sectionType":"section","heading":"Dangerous drug fee","content":"#### 5 Dangerous drug fee\n\n If a pharmaceutical benefit is a dangerous drug, the Commonwealth must pay, in addition to any other amounts under this Determination, a dangerous drug fee where indicated in this Determination.","sortOrder":10},{"sectionNumber":"6","sectionType":"section","heading":"Repeat supply","content":"#### 6 Repeat supply\n\n (1) If, under subsection 88(6) of the Act and section 49 of the Regulations, a medical practitioner, instead of directing a repeated supply of a pharmaceutical benefit, directs the supply of a quantity or number of units of the benefit on 1 occasion, not exceeding the total quantity or number of units that could be prescribed if the medical practitioner directed a repeated supply, the price for the purpose of this Determination for the supply includes:\n (a) only 1 dispensing fee, that may be:\n (i) a ready‑prepared dispensing fee; or\n (ii) an extemporaneously‑prepared dispensing fee; and\n (b) the price, if any, of only 1 container; and\n (c) if a dangerous drug fee applies, only one such fee.\n (2) For this section, the price, if any, for a container is to be worked out under section 12.","sortOrder":11},{"sectionNumber":"7","sectionType":"section","heading":"Drugs and medicinal preparations to which a subsection 85(6) determination applies","content":"#### 7 Drugs and medicinal preparations to which a subsection 85(6) determination applies\n\n If a determination under subsection 85(6) of the Act applies to a pharmaceutical benefit that is a drug or medicinal preparation, the Commonwealth will only make a payment for the supply of a drug or medicinal preparation of the brand mentioned in the determination.","sortOrder":12},{"sectionNumber":"Part 3","sectionType":"part","heading":"Dispensed price for supply of ready‑prepared pharmaceutical benefits","content":"## Part 3—Dispensed price for supply of ready‑prepared pharmaceutical benefits","sortOrder":13},{"sectionNumber":"8","sectionType":"section","heading":"Amount payable to approved hospital authority","content":"#### 8 Amount payable to approved hospital authority\n\n (1) The amount payable to an approved hospital authority for the supply of a ready‑prepared pharmaceutical benefit to a patient receiving treatment in or at a private hospital for which the hospital authority is approved is the amount by which the dispensed price for the benefit exceeds the patient co‑payment.\n (2) For a person to whom, at the time that the benefit is supplied, subsection 87(5A) of the Act applies, the amount of the patient co‑payment is zero.","sortOrder":14},{"sectionNumber":"9","sectionType":"section","heading":"Dispensed price—general","content":"#### 9 Dispensed price—general\n\n (1) The dispensed price for the supply of a ready‑prepared pharmaceutical benefit by an approved hospital authority to a patient receiving treatment in or at a private hospital for which the authority is approved is:\n (a) if a quantity of the benefit that is ordered and supplied is equal to a multiple of a pack quantity of the benefit—the sum of:\n (i) for each pack quantity:\n (A) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and\n (B) the storage and handling mark‑up under section 10 for the pack quantity; and\n (C) the mark‑up, worked out under section 11; and\n (ii) a ready‑prepared dispensing fee; and\n (iii) if a dangerous drug fee applies, the dangerous drug fee; or\n (b) if a quantity of the benefit that is ordered and supplied is less than a pack quantity of the benefit—the sum of:\n (i) the amount worked out under section 13; and\n (ii) a ready‑prepared dispensing fee; and\n (iii) if a dangerous drug fee applies, the dangerous drug fee; and\n (iv) an amount for the supply of a container, worked out under section 12; or\n (c) if a quantity of the benefit that is ordered and supplied is more than a multiple of a pack quantity of the benefit—the sum of:\n (i) for each pack quantity:\n (A) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and\n (B) the storage and handling mark‑up under section 10 for the pack quantity; and\n (C) the mark‑up worked out under section 11; and\n (ii) for the remainder of the quantity that is less than a pack quantity—the amount worked out under section 13; and\n (iii) a ready‑prepared dispensing fee; and\n (iv) if a dangerous drug fee applies, the dangerous drug fee.\n (2) However, for a ready‑prepared pharmaceutical benefit that comprises the admixture of ready‑prepared ingredients and is specified in Schedule 1 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019:\n (a) the ready‑prepared dispensing fee does not apply; and\n (b) an extemporaneously‑prepared dispensing fee must be paid by the Commonwealth; and\n (c) no amount for the supply of the container is payable; and\n (d) if a dangerous drug fee applies, the dangerous drug fee.","sortOrder":15},{"sectionNumber":"10","sectionType":"section","heading":"Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)","content":"#### 10 Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)\n\n For the purposes of sub‑subparagraphs 9(1)(a)(i)(B) and (c)(i)(B) and paragraph (b) of step 1 in section 13, the storage and handling mark‑up for a pack quantity of a ready‑prepared pharmaceutical benefit is the same as the wholesale mark‑up for the pack quantity of the benefit would have been under section 11 of the Approved Pharmacists Determination if the benefit had been supplied by an approved pharmacist.","sortOrder":16},{"sectionNumber":"11","sectionType":"section","heading":"Private hospital mark‑up","content":"#### 11 Private hospital mark‑up\n\n (1) For sub‑subparagraph 9(1)(a)(i)(C), the mark‑up for a ready‑prepared pharmaceutical benefit is an amount equal to 1.4% of the sum of the amounts worked out under sub‑subparagraphs 9(1)(a)(i)(A) and (B).\n (2) For sub‑subparagraph 9(1)(c)(i)(C), the mark‑up for a ready‑prepared pharmaceutical benefit is an amount equal to 1.4% of the sum of the amounts worked out under sub‑subparagraphs 9(1)(c)(i)(A) and (B).","sortOrder":17},{"sectionNumber":"12","sectionType":"section","heading":"Container price","content":"#### 12 Container price\n\n (1) The price for a container for a ready‑prepared pharmaceutical benefit is the sum of:\n (a) the wholesale cost worked out under subsection (2); and\n (b) the mark‑up worked out under subsection (4).\n (2) The wholesale cost for a container will be based on the average of wholesale costs for a particular container, in a quantity of 100, as agreed by the Minister and the Pharmacy Guild of Australia for the supply of the container, by a wholesale drug distributor.\n (3) The wholesale cost must be agreed on or before 15 June in a year and takes effect on 1 August in that year.\n (4) For paragraph (1)(b), the mark‑up is 10% of the amount agreed under subsection (2).\n (5) For a mark‑up worked out under subsection (4), if the calculation of a percentage of the wholesale cost includes a fraction of a cent, the mark‑up is to be rounded up or down to the nearest cent, with an amount of 0.5 of a cent or more being rounded up to the next cent.\n (6) In this section:\n\n> container means:\n\n (a) for a ready‑prepared pharmaceutical benefit that is injectable—a vial with a capacity of 150 ml; or\n (b) for any other ready‑prepared pharmaceutical benefit—a vial with a capacity of 25 ml.","sortOrder":18},{"sectionNumber":"13","sectionType":"section","heading":"Price for broken quantities","content":"#### 13 Price for broken quantities\n\n If a ready‑prepared pharmaceutical benefit is ordered and supplied in a quantity that is less than a pack quantity (the broken quantity), the amount mentioned in subparagraph 9(1)(b)(i) or (c)(ii) is to be worked out using the following method statement.\n Method statement\n Step 1 Add together, for a pack quantity:\n (a) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and\n (b) the storage and handling mark‑up under section 10 for the pack quantity; and\n (c) the mark‑up worked out under section 11.\n Step 2 Divide the quantity or number of units in the broken quantity by the pack quantity and express as a percentage.\n Step 3 For a percentage up to and including an amount in column 1 of the following table, select the percentage mentioned in column 2 of the previous item in the following table.\n\n| Column 1Up to and including: (%) | Column 2Select amount: (%) |\n| -------------------------------- | -------------------------- |\n| 5 | 10 |\n| 10 | 18 |\n| 15 | 26 |\n| 20 | 32 |\n| 25 | 38 |\n| 30 | 44 |\n| 35 | 50 |\n| 40 | 54 |\n| 45 | 58 |\n| 50 | 62 |\n| 55 | 66 |\n| 60 | 70 |\n| 65 | 74 |\n| 70 | 78 |\n| 75 | 82 |\n| 80 | 86 |\n| 85 | 90 |\n| 90 | 94 |\n| 95 | 98 |\n| 100 | 100 |\n\n Step 4 Multiply the amount worked out under step 3 by the amount worked out under step 1.","sortOrder":19},{"sectionNumber":"14","sectionType":"section","heading":"Ready‑prepared pharmaceutical benefits—limit on the dispensed price","content":"#### 14 Ready‑prepared pharmaceutical benefits—limit on the dispensed price\n\n If the dispensed price worked out for the supply of a broken quantity of a ready‑prepared pharmaceutical benefit exceeds the dispensed price for a pack quantity, the dispensed price for the pack quantity is the dispensed price for the broken quantity.","sortOrder":20},{"sectionNumber":"15","sectionType":"section","heading":"Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act","content":"#### 15 Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act\n\n If a prescription directs the supply of a quantity of a pharmaceutical benefit mentioned in a determination under paragraph 98C(1)(b) of the Act as a pharmaceutical benefit the complete pack of which shall be supplied regardless of any lesser quantity ordered, the dispensed price is the price worked out as if a complete pack was supplied.","sortOrder":21},{"sectionNumber":"Part 4","sectionType":"part","heading":"Dispensed price for supply of extemporaneously‑prepared pharmaceutical benefits","content":"## Part 1—Preliminary\n\n#### 1 Name\n\n (1) This instrument is the National Health (Commonwealth Price ‑ Pharmaceutical benefits supplied by private hospitals) Determination 2020.\n (2) This instrument may also be cited as PB 99 of 2020.\n\n#### 2 Commencement\n\n (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n```html\n

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1. The whole of this instrument

1 October 2020

1 October 2020

\n```\n\n> Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.\n\n#### 2A Authority\n\n This instrument is made under subsection 99(4) of the National Health Act 1953.\n\n#### 2B Purpose\n\n The purpose of this determination is to determine the amount of the Commonwealth payment for pharmaceutical benefits supplied by an approved hospital authority to a patient receiving treatment in or at a private hospital for which the authority is approved.\n\n#### 2C Schedules\n\n Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.\n\n#### 2D Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)\n\n (1) If:\n (a) a thing was done for a particular purpose under the National Health Act 1953 ‑ National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010) as in force immediately before that Determination was repealed; and\n (b) the thing could be done for that purpose under this instrument;\n the thing has effect for the purposes of this instrument as if it had been done under this instrument.\n (2) Without limiting subsection (1), a reference in that subsection to a thing being done includes a reference to a notice, application or other instrument being given or made.\n\n#### 3 Definitions\n\n In this instrument:\n\n> Act means the National Health Act 1953.\n\n> approved ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.\n\n> approved hospital authority means a hospital authority that has been approved by the Minister under subsection 94(1) of the Act.\n\n> Approved Pharmacists Determination means the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020 (PB 66 of 2020).\n\n> brand has the same meaning as in Part VII of the Act.\n\n> current figure has the same meaning as in section 99G of the Act.\n\n> dangerous drug means:\n\n (a) a pharmaceutical benefit mentioned in Schedule 3 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019 (PB 114 of 2019); or\n (b) a pharmaceutical benefit that, under the law of a State or Territory, is classified as a dangerous drug.\n\n> dangerous drug fee has the same meaning as in Approved Pharmacists Determination.\n\n> determined quantity, of a listed brand of a pharmaceutical item, has the same meaning as in Part VII of the Act.\n\n> dispensed price:\n\n (a) for a ready‑prepared pharmaceutical benefit—has the meaning given by section 9; and\n (b) for an extemporaneously‑prepared pharmaceutical benefit—has the meaning given by subsection 16(1).\n\n> extemporaneously‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.\n\n> extemporaneously‑prepared pharmaceutical benefit means a pharmaceutical benefit that is not a ready‑prepared pharmaceutical benefit.\n\n> listed brand has the same meaning as in Part VII of the Act.\n\n> maximum quantity, of a brand of a pharmaceutical item, means a quantity or number of units of the pharmaceutical item determined under paragraph 85A(2)(a) of the Act in relation to that brand of pharmaceutical item.\n\n> pack quantity has the same meaning as in subsection 84(1) of the Act.\n\n> Note: The Minister may determine one or more pack quantities for a brand of a pharmaceutical item under subsection 84AK(2) of the Act. The quantities determined are the quantities in manufacturer’s PBS packs.\n\n> patient co‑payment means:\n\n (a) for a person to whom, at the time that a pharmaceutical benefit is supplied, paragraph 87(2)(b) of the Act applies—the current figure for the general patient reduced charge, as defined in section 99F of the Act; or\n (b) for a person who is a concessional beneficiary for section 84 of the Act—the current figure for the concessional beneficiary charge, as defined in section 99F of the Act; or\n (c) for any other person—the current figure for the general patient charge, as defined in section 99F of the Act.\n\n> pharmaceutical benefit has the meaning given by section 84 of the Act.\n\n> pharmaceutical item has the same meaning as in Part VII of the Act.\n\n> private hospital means a hospital for which there is in force a statement under subsection 121‑5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.\n\n> proportional ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.\n\n> ready‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.\n\n> ready‑prepared pharmaceutical benefit means a brand of a pharmaceutical item for which there is a determination under subsection 85(6) of the Act.\n\n> Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.\n\n> repatriation pharmaceutical benefit has the meaning given by section 84 of the Act.\n\n## Part 2—Rates and conditions of payment—general\n\n#### 4 Rounding up and rounding down\n\n If the calculation of a price under this Determination includes a fraction of a cent, the final amount calculated is to then be rounded up or down to the nearest cent, with an amount of 0.5 of a cent or more being rounded up to the next cent.\n\n#### 5 Dangerous drug fee\n\n If a pharmaceutical benefit is a dangerous drug, the Commonwealth must pay, in addition to any other amounts under this Determination, a dangerous drug fee where indicated in this Determination.\n\n#### 6 Repeat supply\n\n (1) If, under subsection 88(6) of the Act and section 49 of the Regulations, a medical practitioner, instead of directing a repeated supply of a pharmaceutical benefit, directs the supply of a quantity or number of units of the benefit on 1 occasion, not exceeding the total quantity or number of units that could be prescribed if the medical practitioner directed a repeated supply, the price for the purpose of this Determination for the supply includes:\n (a) only 1 dispensing fee, that may be:\n (i) a ready‑prepared dispensing fee; or\n (ii) an extemporaneously‑prepared dispensing fee; and\n (b) the price, if any, of only 1 container; and\n (c) if a dangerous drug fee applies, only one such fee.\n (2) For this section, the price, if any, for a container is to be worked out under section 12.\n\n#### 7 Drugs and medicinal preparations to which a subsection 85(6) determination applies\n\n If a determination under subsection 85(6) of the Act applies to a pharmaceutical benefit that is a drug or medicinal preparation, the Commonwealth will only make a payment for the supply of a drug or medicinal preparation of the brand mentioned in the determination.\n\n## Part 3—Dispensed price for supply of ready‑prepared pharmaceutical benefits\n\n#### 8 Amount payable to approved hospital authority\n\n (1) The amount payable to an approved hospital authority for the supply of a ready‑prepared pharmaceutical benefit to a patient receiving treatment in or at a private hospital for which the hospital authority is approved is the amount by which the dispensed price for the benefit exceeds the patient co‑payment.\n (2) For a person to whom, at the time that the benefit is supplied, subsection 87(5A) of the Act applies, the amount of the patient co‑payment is zero.\n\n#### 9 Dispensed price—general\n\n (1) The dispensed price for the supply of a ready‑prepared pharmaceutical benefit by an approved hospital authority to a patient receiving treatment in or at a private hospital for which the authority is approved is:\n (a) if a quantity of the benefit that is ordered and supplied is equal to a multiple of a pack quantity of the benefit—the sum of:\n (i) for each pack quantity:\n (A) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and\n (B) the storage and handling mark‑up under section 10 for the pack quantity; and\n (C) the mark‑up, worked out under section 11; and\n (ii) a ready‑prepared dispensing fee; and\n (iii) if a dangerous drug fee applies, the dangerous drug fee; or\n (b) if a quantity of the benefit that is ordered and supplied is less than a pack quantity of the benefit—the sum of:\n (i) the amount worked out under section 13; and\n (ii) a ready‑prepared dispensing fee; and\n (iii) if a dangerous drug fee applies, the dangerous drug fee; and\n (iv) an amount for the supply of a container, worked out under section 12; or\n (c) if a quantity of the benefit that is ordered and supplied is more than a multiple of a pack quantity of the benefit—the sum of:\n (i) for each pack quantity:\n (A) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and\n (B) the storage and handling mark‑up under section 10 for the pack quantity; and\n (C) the mark‑up worked out under section 11; and\n (ii) for the remainder of the quantity that is less than a pack quantity—the amount worked out under section 13; and\n (iii) a ready‑prepared dispensing fee; and\n (iv) if a dangerous drug fee applies, the dangerous drug fee.\n (2) However, for a ready‑prepared pharmaceutical benefit that comprises the admixture of ready‑prepared ingredients and is specified in Schedule 1 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019:\n (a) the ready‑prepared dispensing fee does not apply; and\n (b) an extemporaneously‑prepared dispensing fee must be paid by the Commonwealth; and\n (c) no amount for the supply of the container is payable; and\n (d) if a dangerous drug fee applies, the dangerous drug fee.\n\n#### 10 Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)\n\n For the purposes of sub‑subparagraphs 9(1)(a)(i)(B) and (c)(i)(B) and paragraph (b) of step 1 in section 13, the storage and handling mark‑up for a pack quantity of a ready‑prepared pharmaceutical benefit is the same as the wholesale mark‑up for the pack quantity of the benefit would have been under section 11 of the Approved Pharmacists Determination if the benefit had been supplied by an approved pharmacist.\n\n#### 11 Private hospital mark‑up\n\n (1) For sub‑subparagraph 9(1)(a)(i)(C), the mark‑up for a ready‑prepared pharmaceutical benefit is an amount equal to 1.4% of the sum of the amounts worked out under sub‑subparagraphs 9(1)(a)(i)(A) and (B).\n (2) For sub‑subparagraph 9(1)(c)(i)(C), the mark‑up for a ready‑prepared pharmaceutical benefit is an amount equal to 1.4% of the sum of the amounts worked out under sub‑subparagraphs 9(1)(c)(i)(A) and (B).\n\n#### 12 Container price\n\n (1) The price for a container for a ready‑prepared pharmaceutical benefit is the sum of:\n (a) the wholesale cost worked out under subsection (2); and\n (b) the mark‑up worked out under subsection (4).\n (2) The wholesale cost for a container will be based on the average of wholesale costs for a particular container, in a quantity of 100, as agreed by the Minister and the Pharmacy Guild of Australia for the supply of the container, by a wholesale drug distributor.\n (3) The wholesale cost must be agreed on or before 15 June in a year and takes effect on 1 August in that year.\n (4) For paragraph (1)(b), the mark‑up is 10% of the amount agreed under subsection (2).\n (5) For a mark‑up worked out under subsection (4), if the calculation of a percentage of the wholesale cost includes a fraction of a cent, the mark‑up is to be rounded up or down to the nearest cent, with an amount of 0.5 of a cent or more being rounded up to the next cent.\n (6) In this section:\n\n> container means:\n\n (a) for a ready‑prepared pharmaceutical benefit that is injectable—a vial with a capacity of 150 ml; or\n (b) for any other ready‑prepared pharmaceutical benefit—a vial with a capacity of 25 ml.\n\n#### 13 Price for broken quantities\n\n If a ready‑prepared pharmaceutical benefit is ordered and supplied in a quantity that is less than a pack quantity (the broken quantity), the amount mentioned in subparagraph 9(1)(b)(i) or (c)(ii) is to be worked out using the following method statement.\n Method statement\n Step 1 Add together, for a pack quantity:\n (a) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and\n (b) the storage and handling mark‑up under section 10 for the pack quantity; and\n (c) the mark‑up worked out under section 11.\n Step 2 Divide the quantity or number of units in the broken quantity by the pack quantity and express as a percentage.\n Step 3 For a percentage up to and including an amount in column 1 of the following table, select the percentage mentioned in column 2 of the previous item in the following table.\n\n| Column 1Up to and including: (%) | Column 2Select amount: (%) |\n| -------------------------------- | -------------------------- |\n| 5 | 10 |\n| 10 | 18 |\n| 15 | 26 |\n| 20 | 32 |\n| 25 | 38 |\n| 30 | 44 |\n| 35 | 50 |\n| 40 | 54 |\n| 45 | 58 |\n| 50 | 62 |\n| 55 | 66 |\n| 60 | 70 |\n| 65 | 74 |\n| 70 | 78 |\n| 75 | 82 |\n| 80 | 86 |\n| 85 | 90 |\n| 90 | 94 |\n| 95 | 98 |\n| 100 | 100 |\n\n Step 4 Multiply the amount worked out under step 3 by the amount worked out under step 1.\n\n#### 14 Ready‑prepared pharmaceutical benefits—limit on the dispensed price\n\n If the dispensed price worked out for the supply of a broken quantity of a ready‑prepared pharmaceutical benefit exceeds the dispensed price for a pack quantity, the dispensed price for the pack quantity is the dispensed price for the broken quantity.\n\n#### 15 Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act\n\n If a prescription directs the supply of a quantity of a pharmaceutical benefit mentioned in a determination under paragraph 98C(1)(b) of the Act as a pharmaceutical benefit the complete pack of which shall be supplied regardless of any lesser quantity ordered, the dispensed price is the price worked out as if a complete pack was supplied.\n\n## Part 4—Dispensed price for supply of extemporaneously‑prepared pharmaceutical benefits\n\n#### 16 Extemporaneously‑prepared pharmaceutical benefits\n\n (1) For an extemporaneously‑prepared pharmaceutical benefit supplied to a patient receiving treatment in or at a private hospital for which the hospital authority is approved, the dispensed price is the Commonwealth price determined for the benefit under the Approved Pharmacists Determination, as if the benefit was supplied by an approved pharmacist.\n (2) The amount payable to the approved hospital authority for the supply of an extemporaneously‑prepared pharmaceutical benefit to the patient is the amount by which the dispensed price for the benefit exceeds the patient co‑payment.\n (3) For a person to whom, at the time that the benefit is supplied, subsection 87(5A) of the Act applies, the amount of the patient co‑payment is zero.","sortOrder":22},{"sectionNumber":"16","sectionType":"section","heading":"Extemporaneously‑prepared pharmaceutical benefits","content":"#### 16 Extemporaneously‑prepared pharmaceutical benefits\n\n (1) For an extemporaneously‑prepared pharmaceutical benefit supplied to a patient receiving treatment in or at a private hospital for which the hospital authority is approved, the dispensed price is the Commonwealth price determined for the benefit under the Approved Pharmacists Determination, as if the benefit was supplied by an approved pharmacist.\n (2) The amount payable to the approved hospital authority for the supply of an extemporaneously‑prepared pharmaceutical benefit to the patient is the amount by which the dispensed price for the benefit exceeds the patient co‑payment.\n (3) For a person to whom, at the time that the benefit is supplied, subsection 87(5A) of the Act applies, the amount of the patient co‑payment is zero.","sortOrder":23}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"The legislation appears to maintain its original scope as a pricing determination for pharmaceutical benefits in private hospitals. However, there is a significant drafting error where Part 4 repeats the preliminary and ready-prepared sections rather than containing unique provisions for extemporaneously-prepared benefits beyond the single operative section 16. This appears to be a publication error rather than scope creep."},"complexity_factors":["Extensive cross-referencing to external instruments — the Approved Pharmacists Determination (PB 66 of 2020), National Health Act 1953, Private Health Insurance Act 2007, and National Health (Pharmaceutical Benefits) Regulations 2017","19 defined terms in section 3, many of which themselves reference other legislation (e.g., 'approved ex-manufacturer price', 'current figure', 'patient co-payment')","Nested conditional logic in section 9 with three alternative calculation methods (paragraphs a, b, c) depending on quantity ordered, with sub-sub-subparagraphs (9(1)(a)(i)(A))","Complex mathematical calculations involving multiple percentage mark-ups (1.4%, 10%), rounding rules, and a stepped percentage table in section 13 with 20 discrete bands for broken quantities","Method statement in section 13 requiring 4 sequential calculation steps with reference back to previous sections","Exception to the general rule in section 9(2) for admixture preparations that switches the dispensing fee type and removes container charges","Transitional provision in section 2D preserving actions taken under the repealed 2010 Determination","Duplicate content — the entire Part 4 appears to be a copy-paste error repeating Part 1-3 content instead of containing unique extemporaneous preparation provisions beyond section 16"],"plain_english_summary":"This sets how the Commonwealth pays approved private hospitals for PBS medicines by defining the “dispensed price” (drug cost plus handling, mark‑ups and fees) and paying the gap between that price and the patient co‑payment. It covers both ready‑prepared and extemporaneously‑prepared medicines and special cases like broken quantities and safety‑net patients.\n\nIt ensures hospitals receive standardised, capped payments and that patients face consistent co‑payments comparable with community pharmacies."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument replaces the 2010 Determination but preserves actions done under the earlier Determination (continuity in s2D). Its stated purpose remains to determine Commonwealth payments to approved hospital authorities for pharmaceutical benefits supplied in approved private hospitals (2B). It does not expand statutory authority beyond subsection 99(4) of the National Health Act (2A), though it allows schedules to amend or repeal other instruments (2C)."},"complexity_factors":["Extensive cross‑references to the National Health Act 1953 and other Determinations and Regulations (definitions and authority: 2A, 3; multiple provisions referencing Act and Approved Pharmacists Determination).","Two parallel pricing tracks (ready‑prepared vs extemporaneously‑prepared) with different fee rules (Sections 9 and 16).","Multi‑step arithmetic for broken quantities including a stepped percentage table (Section 13) that requires interpolation logic for non‑pack quantities.","Multiple mark‑ups with small percentages and rounding rules (private hospital mark‑up 1.4% in Section 11; container mark‑up 10% and rounding in Section 12; rounding rule in Section 4).","Conditional additional payment for dangerous drugs (Section 5) and single‑fee rules for repeat supplies (Section 6) creating situational complexity.","External negotiation and timing for container wholesale costs between the Minister and the Pharmacy Guild (Section 12(2)–(3)), adding an administrative dependency outside the text.","Dependence on rates and terms set in the Approved Pharmacists Determination for several components (definitions and Sections 10 and 16), so understanding requires reading that instrument too.","Definitions section is dense and imports multiple statutory meanings, increasing interpretation burden (Section 3)."],"plain_english_summary":"This Determination prescribes how much the Commonwealth pays approved hospital authorities for medicines supplied to patients in approved private hospitals. It mechanically defines a \"dispensed price\" and says the Commonwealth pays the dispensed price minus the patient co‑payment. \n\nPayments are built from ex‑manufacturer prices, storage/handling mark‑ups, a 1.4% private‑hospital mark‑up, dispensing fees, container costs (agreed annually with the Pharmacy Guild), and any dangerous‑drug fee."}},"importantCases":[],"_links":{"self":"/api/acts/national-health-commonwealth-price-pharmaceutical-benefits-supplied-by-private-hospitals-determinati","history":"/api/acts/national-health-commonwealth-price-pharmaceutical-benefits-supplied-by-private-hospitals-determinati/history","analysis":"/api/acts/national-health-commonwealth-price-pharmaceutical-benefits-supplied-by-private-hospitals-determinati/analysis","conflicts":"/api/acts/national-health-commonwealth-price-pharmaceutical-benefits-supplied-by-private-hospitals-determinati/conflicts","importantCases":"/api/acts/national-health-commonwealth-price-pharmaceutical-benefits-supplied-by-private-hospitals-determinati/important-cases","documents":"/api/acts/national-health-commonwealth-price-pharmaceutical-benefits-supplied-by-private-hospitals-determinati/documents"}}