{"id":"F2019L01703","name":"National Health (Supplies of out-patient medication) Determination 2019 (No. 2)","slug":"national-health-supplies-of-out-patient-medication-determination-2019-no-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":100517,"registerId":"commonwealth-F2019L01703-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"National Health (Supplies of out-patient medication) Determination 2019 (No. 2)","content":"![Commonwealth Coat of Arms of Australia](image.001.png)\n\nNational Health (Supplies of out‑patient medication) Determination 2019 (No. 2)\n\nPB 110 of 2019\n\nmade under section 84BA of the\n\nNational Health Act 1953\n\nCompilation No. 6\n\nCompilation date: 1 January 2026\n\nIncludes amendments: F2025L01524\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the National Health (Supplies of out-patient medication) Determination 2019 (No. 2) that shows the text of the law as amended and in force on 1 January 2026 (the compilation date).\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au).\n\nApplication, saving and transitional provisions\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nEditorial changes\n\nFor more information about any editorial changes made in this compilation, see the endnotes.\n\nPresentational changes\n\nThe Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. Any modifications affecting the law are accessible on the Register.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\n1 Name of Instrument\n\n(1) This Determination is the National Health (Supplies of out‑patient medication) Determination 2019 (No. 2).\n\n(2) This Determination may also be cited as PB 110 of 2019.\n\n3 Authority\n\nThis Determination is made under section 84BA of the National Health Act 1953.\n\n5 Interpretation\n\n(1) In this Determination:\n\nNational Health Reform Agreement has the meaning given in the Federal Financial Relations Act 2009.\n\nout‑patient medication has the same meaning as in subsection 84(1) of the Act.\n\nPharmaceutical Reform Arrangements means arrangements which provide for public hospitals that are Approved Hospital Authorities under Section 94 of the National Health Act 1953 to supply pharmaceuticals funded by the PBS for specific categories of patients including:\n\n admitted patients on separation;\n\n non‑admitted patients; and\n\n same day admitted patients for a range of drugs made available by specific delivery arrangements under Section 100 of the National Health Act 1953.\n\nproportional ex‑manufacturer price has the meaning given in subsection 84(1) of the Act.\n\nthe Act means the National Health Act 1953.\n\nthe amount referred to in paragraph 87(2)(a) of the Act means the amount as periodically adjusted under section 99G of the Act.\n\nthe amount referred to in paragraph 87(2)(e) of the Act means the amount as periodically adjusted under section 99G of the Act.\n\nthe maximum value of the supply of out‑patient medication means the amount specified in section 7, 8, 9 or 10 as appropriate.\n\n(2) Unless the contrary intention appears, a word or expression that is defined in the Act shall be taken to have the same meaning as in the Act.\n\n6 Amount taken to have been paid to a public hospital for the supply of out‑patient medication\n\nThe amount that, for the purposes of Part VII of the Act, will be taken to have been paid to a public hospital for a supply of out‑patient medication to a person is the lesser of:\n\n(a) the maximum value of the supply of out‑patient medication; or\n\n(b) the amount charged.\n\n7 Maximum value of the supply of out‑patient medication to a person who is a concessional beneficiary, a dependant of a concessional beneficiary or a holder of a concession card\n\nThe maximum value of the supply of out‑patient medication to a person who is a concessional beneficiary, a dependant of a concessional beneficiary or the holder of a concession card is an amount that is equivalent to the amount referred to in paragraph 87(2)(a) of the Act for the supply of a pharmaceutical benefit by an approved pharmacist or approved medical practitioner.\n\n8 Maximum value of the supply of out‑patient medication to a person who is a general patient and who is not a holder of a concession card\n\n(1) The maximum value of the supply of out-patient medication to a person who is a general patient and who is not the holder of a concession card is $20.00.\n\n(2) This section does not apply to supplies of out‑patient medication made by:\n\n(a) a public hospital located in the State of Queensland; or\n\n(b) a public hospital that is participating in Pharmaceutical Reform Arrangements.\n\n9 Maximum value of the supply of out‑patient medication by a Queensland public hospital to a person who is a general patient and who is not a holder of a concession card\n\n(1) This section applies to supplies of out‑patient medication made by a public hospital located in the State of Queensland.\n\n(2) For supplies of outpatient medication mentioned in subsection (1), the maximum value of the supply of out‑patient medication to a person who is a general patient and who is not the holder of a concession card is:\n\n(a) where the medication is a drug or medicinal preparation that is a pharmaceutical benefit and the Commonwealth price for that pharmaceutical benefit exceeds the amount referred to in paragraph 87(2)(e) of the Act — an amount that is equivalent to the amount referred to in paragraph 87(2)(e) of the Act for the supply of a pharmaceutical benefit by an approved pharmacist or approved medical practitioner; or\n\n(b) where the medication is a drug or medicinal preparation that is a pharmaceutical benefit and the Commonwealth price for that pharmaceutical benefit does not exceed the amount referred to in paragraph 87(2)(e) of the Act — the price for that pharmaceutical benefit ascertained in accordance with the determination under subsection 84C(7) of the Act as in force from time to time; or\n\n(c) where the medication is a drug or medicinal preparation which is not a pharmaceutical benefit — the amount ascertained by taking as a basis the cost to the hospital of that drug or medicinal preparation and applying, as if that cost were the approved ex‑manufacturer price or proportional ex‑manufacturer price, the determination under subsection 84C(7) of the Act as in force from time to time.\n\n10 Maximum value of the supply of out‑patient medication by a participating public hospital to a person who is a general patient and who is not a holder of a concession card\n\n(1) This section applies to supplies of out‑patient medication made by a public hospital that is participating in Pharmaceutical Reform Arrangements, except if the public hospital is located in the State of Queensland.\n\n(2) For supplies of out‑patient medication mentioned in subsection (1), the maximum value of the supply of out‑patient medication to a person who is a general patient and who is not the holder of a concession card is:\n\n(a) where the medication is a drug or medicinal preparation that is a pharmaceutical benefit — the maximum value of the pharmaceutical benefit ascertained in accordance with regulation 17A of the National Health (Pharmaceutical Benefits) Regulations 2017 as if the pharmaceutical benefit had been supplied by an approved pharmacist or an approved medical practitioner; or\n\n(b) where the medication is a drug or medicinal preparation that is not a pharmaceutical benefit — the amount ascertained by taking as a basis the cost to the hospital of that drug or medicinal preparation and applying, as if that cost were the approved ex‑manufacturer price or proportional ex‑manufacturer price, the determination under subsection 84C(7) of the Act as in force from time to time.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nEditorial changes\n\nThe Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.\n\nIf the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.\n\nIf a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n| ad = added or inserted                         | orig = original                          |\n| ---------------------------------------------- | ---------------------------------------- |\n| am = amended                                   | p = page(s)                              |\n| amdt = amendment                               | para = paragraph(s)/subparagraph(s)      |\n| C[x] = Compilation No. x                       | /sub‑subparagraph(s)                     |\n| ch = Chapter(s)                                | pres = present                           |\n| cl = clause(s)                                 | prev = previous                          |\n| cont. = continued                              | (prev…) = previously                     |\n| def = definition(s)                            | pt = Part(s)                             |\n| Dict = Dictionary                              | r = regulation(s)/Court rule(s)          |\n| disallowed = disallowed by Parliament          | reloc = relocated                        |\n| div = Division(s)                              | renum = renumbered                       |\n| ed = editorial change                          | rep = repealed                           |\n| exp = expires/expired or ceases/ceased to have | rs = repealed and substituted            |\n| effect                                         | s = section(s)/subsection(s)             |\n| gaz = gazette                                  | /rule(s)/subrule(s)/order(s)/suborder(s) |\n| LA = Legislation Act 2003                      | sch = Schedule(s)                        |\n| LIA = Legislative Instruments Act 2003         | SLI = Select Legislative Instrument      |\n| (md) = misdescribed amendment can be given     | SR = Statutory Rules                     |\n| effect                                         | sub ch = Sub‑Chapter(s)                  |\n| (md not incorp) = misdescribed amendment       | sub div = Subdivision(s)                 |\n| cannot be given effect                         | sub pt = Subpart(s)                      |\n| mod = modified/modification                    | underlining = whole or part not          |\n| No. = Number(s)                                | commenced or to be commenced             |\n| Ord = Ordinance                                |                                          |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                               | Registration              | Commencement               | Application, saving and transitional provisions |\n| -------------------------------------------------------------------------------------------------- | ------------------------- | -------------------------- | ----------------------------------------------- |\n| National Health (Supplies of out‑patient medication) Determination 2019 (No. 2) (PB 110 of 2019)   | 23 Dec 2019 (F2019L01703) | 1 Jan 2020 (s 2)           |                                                 |\n| National Health (Supplies of out‑patient medication) Amendment Determination 2020 (PB 41 of 2020)  | 30 Apr 2020 (F2020L00527) | 1 May 2020 (s 2(1) item 1) | —                                               |\n| National Health (Supplies of out‑patient medication) Amendment Determination 2020 (PB 132 of 2020) | 23 Dec 2020 (F2020L01694) | 1 Jan 2021 (s 2(1) item 1) | —                                               |\n| National Health (Supplies of out‑patient medication) Amendment Determination 2021 (PB 136 of 2021) | 24 Dec 2021 (F2021L01900) | 1 Jan 2022 (s 2)           | —                                               |\n| National Health (Supplies of out‑patient medication) Amendment Determination 2022 (PB 128 of 2022) | 23 Dec 2022 (F2022L01764) | 1 Jan 2023 (s 2)           | —                                               |\n| National Health (Supplies of out‑patient medication) Amendment Determination 2023 (PB 134 of 2023) | 22 Dec 2023 (F2023L01750) | 1 Jan 2024 (s 2)           | —                                               |\n| National Health (Supplies of out-patient medication) Amendment Determination 2025 (PB 151 of 2025) | 10 Dec 2025 (F2025L01524) | 1 Jan 2026 (s 2)           | —                                               |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected       | How affected                                                                    |\n| ------------------------ | ------------------------------------------------------------------------------- |\n| s 2..................... | rep LA s 48D                                                                    |\n| s 4..................... | rep LA s 48C                                                                    |\n| s 5..................... | am F2020L00527                                                                  |\n| s 8..................... | am F2020L00527; F2020L01694; F2021L01900; F2022L01764; F2023L01750; F2025L01524 |\n| s 10.................... | am F2020L00527                                                                  |","sortOrder":0}],"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":4,"scope_assessment":{"changed":false,"description":"The Determination appears to be operating within its original scope. The amendment history shows only routine updates to the dollar amounts (particularly the $20 general patient cap in section 8) and minor definitional adjustments. There is no evidence of scope creep — the instrument continues to deal solely with pricing caps for outpatient medications supplied by public hospitals, which was its original purpose in 2019."},"complexity_factors":["Multiple parallel pricing regimes based on patient type (concessional vs general) and hospital location/type (standard, Queensland, Pharmaceutical Reform Arrangements)","Cross-references to external legislation including the National Health Act 1953 (sections 84, 84BA, 84C, 87, 94, 99G), Federal Financial Relations Act 2009, and National Health (Pharmaceutical Benefits) Regulations 2017","Defined terms rely heavily on meanings from the parent Act (section 5(2) incorporates all Act definitions)","Nested conditional logic in sections 9 and 10 with multiple tiers of 'where' clauses determining which pricing formula applies","Dynamic pricing references — amounts are 'periodically adjusted' under section 99G of the Act, meaning the $20 figure and other amounts change without requiring new legislation","Exception to exception structure: Section 8(2) excludes Queensland and Reform Arrangement hospitals, then sections 9 and 10 provide specific rules for those excluded categories"],"plain_english_summary":"This Determination limits what public hospitals can charge patients for prescription medicines supplied on discharge or as outpatients, protecting patients and containing Commonwealth payments. Concessional patients pay no more than the PBS concessional rate; general patients face a higher capped amount (commonly $20.00 for most hospitals, with Queensland and hospitals in special Pharmaceutical Reform Arrangements using different calculations). It prevents unexpected take‑home medication costs and overpayment through PBS arrangements."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"The Determination's scope has been altered since its original registration: endnotes show repeated amendments (Endnotes 3–4) — particularly to section 8 and to rules governing participating hospitals (s10) — which adjusted maximum caps and clarified/expanded exceptions (including Queensland and Pharmaceutical Reform Arrangements). These amendments change which pricing formula applies to which hospital or patient class and therefore affect reimbursement calculations and billing coverage."},"complexity_factors":["Multiple patient categories with distinct caps and exceptions (ss6–10).","State-specific rule for Queensland requiring different pricing formulas (s9).","Separate regime for hospitals participating in Pharmaceutical Reform Arrangements (definition; s10).","Cross-references to the National Health Act 1953 (s84, para 87(2)(a)/(e), s99G) and to regulation 17A and subsection 84C(7) for price ascertainment (ss5, 9(2), 10(2)).","Use of periodically adjusted statutory amounts (the amounts under section 99G) creates indexing and timing complexity (definition in s5).","Calculation rules for non‑PBS medicines require converting hospital cost into an ‘approved’ ex‑manufacturer price equivalent (s9(2)(c); s10(2)(b)), imposing recordkeeping and valuation steps.","Repeated amendments to key provisions (notably s8; Endnotes 3–4) increase interpretive and transitional complexity for administrators.","Limited discretionary elements but significant operational compliance burden on hospitals to apply formulas and reconcile charges with PBS determinations (ss6–10)."],"plain_english_summary":"This Determination fixes, for Part VII purposes, the amount taken to have been paid to a public hospital for supplies of out‑patient medication (s6), by setting maximum payment values by patient class: concessional beneficiaries (s7), general patients (s8) and special rules for Queensland and hospitals participating in Pharmaceutical Reform Arrangements (s9–10). It affects public hospitals' billing and Commonwealth reimbursement and changes hospital revenue, patient out‑of‑pocket exposure and the administrative calculations tied to PBS prices and hospital costs."}},"importantCases":[],"_links":{"self":"/api/acts/national-health-supplies-of-out-patient-medication-determination-2019-no-2","history":"/api/acts/national-health-supplies-of-out-patient-medication-determination-2019-no-2/history","analysis":"/api/acts/national-health-supplies-of-out-patient-medication-determination-2019-no-2/analysis","conflicts":"/api/acts/national-health-supplies-of-out-patient-medication-determination-2019-no-2/conflicts","importantCases":"/api/acts/national-health-supplies-of-out-patient-medication-determination-2019-no-2/important-cases","documents":"/api/acts/national-health-supplies-of-out-patient-medication-determination-2019-no-2/documents"}}