Payments to approved public hospital authorities

21. An approved public hospital authority that has supplied trastuzumab in accordance with these arrangements is entitled to be paid by the Commonwealth the amount ascertained in accordance with paragraphs 22 to 25.

22. Where a quantity of trastuzumab that is ordered and supplied by an approved public hospital authority is equal to the quantity contained in the manufacturer’s pack, the approved public hospital authority is entitled to be paid by the Commonwealth the sum of:

(a) the price ex manufacturer of the manufacturer’s pack; and

(b) a mark-up of 11.1%.

23. Where a quantity of trastuzumab that is ordered and supplied by an approved public hospital authority is less than the quantity contained in the manufacturer’s pack, the approved public hospital authority is entitled to be paid by the Commonwealth the amount calculated by:

(a) ascertaining the percentage that the quantity or number of units in the broken quantity bears to the quantity or number of units in the manufacturer’s pack; and

(b) applying that percentage to the price for a complete manufacturer’s pack ascertained in accordance with paragraph 22.

24. Where a quantity of a highly specialised drug that is ordered and supplied by an approved public hospital authority is more than the quantity contained in the manufacturer’s pack, the sum of:

(a) the amount calculated in accordance with paragraph 22; and

(b) the amount calculated in accordance with paragraph 23

25. Prices calculated for the purposes of paragraphs 22 to 24 shall be taken to the nearest cent, with one half cent being counted as 1 cent.

Payment arrangements for the supply of trastuzumab by approved public hospitals

26. Where an approved public hospital supplies trastuzumab, the State or Territory Government in which the public hospital is located must make a claim for payment in accordance with the following procedures:

(a) one claim for payment per State or Territory must be submitted to Medicare Australia in respect of all trastuzumab dispensed by all public hospitals within each State and Territory in a calendar month in arrears;

(b) a claim in respect of a calendar month must be submitted within three months of the end of that month;

(c) for each supply of trastuzumab, the claim must include the following information:

(i) the State or Territory;

(ii) the hospital provider number;

(iii) the Medicare Australia Authority Prescription Number;

(iv) the original supply or repeat number;

(v) the supply date; and

(vi) the number of manufacturer’s packs supplied.

Note: Claims by other approved suppliers must be made in accordance with the Act.