The Commonwealth price for the supply of a ready-prepared pharmaceutical benefit will be —
(a) where a quantity of a ready-prepared pharmaceutical benefit is ordered and supplied that is equal to the quantity contained in a standard or non-standard pack, the sum of:
(i) the approved price to pharmacists of that standard or non-standard pack, as applicable, plus mark-up as specified in paragraph 14, taken to the nearest cent, one half cent being counted as one cent; and
(ii) a ready-prepared dispensing fee, except in the case of a ready-prepared pharmaceutical benefit that involves the admixture of ready-prepared ingredients and is specified in Schedule 1 to the determination under paragraph 98C (1) (b) of the Act, in which case an extemporaneously-prepared dispensing fee will apply;
(b) where a quantity of a ready-prepared pharmaceutical benefit is ordered and supplied that is less than the quantity contained in a standard or non-standard pack, the sum of:
(i) the amount worked out in accordance with paragraph 17; and
(ii) a ready-prepared dispensing fee for each supply of ready-prepared pharmaceutical benefits made; and
(iii) an amount for the supply of a container, worked out in accordance with paragraph 15; or
(c) where a quantity of a ready-prepared pharmaceutical benefit is ordered and supplied which is more than the quantity contained in a standard or non-standard pack, the sum of:
(i) the approved price to pharmacists, plus mark-up as specified in paragraph 14, taken to the nearest cent, one half cent being counted as one cent, for each complete standard or non-standard pack, as applicable, contained in the quantity supplied; and
(ii) the amount worked out in accordance with paragraph 17 in respect of that remainder, if any, of the quantity supplied that is less than the quantity contained in a standard or non-standard pack, as applicable; and
(iii) a ready-prepared dispensing fee, except in the case of a ready-prepared pharmaceutical benefit that involves the admixture of ready-prepared ingredients and is specified in Schedule 1 to the determination under paragraph 98C (1) (b) of the Act, in which case an extemporaneously-prepared dispensing fee will apply (an additional amount for a container is not payable);
The mark-up referred to in this Part will be —
(a) 15 per cent of the approved price to pharmacists, where the approved price to pharmacists for the quantity or number of units of the ready-prepared pharmaceutical benefit specified as the maximum quantity in the determination under paragraph 85A (2) (a) of the Act for that ready-prepared pharmaceutical benefit is not more than $30.00; or
Part Part II - National Health Act 1953 - Determination under paragraph 98B(1)(a) (23/06/2006) - Ready-Prepared Pharmaceutical Benefits | Zoe
(b) $4.50, where the approved price to pharmacists for the quantity or number of units of the ready-prepared pharmaceutical benefit specified as the maximum quantity in the determination under paragraph 85A (2) (a) of the Act for that ready-prepared pharmaceutical benefit is more than $30.00 but not more than $45.00; or
(c) 10 per cent of the approved price to pharmacists, where the approved price to pharmacists for the quantity or number of units of the ready-prepared pharmaceutical benefit specified as the maximum quantity in the determination under paragraph 85A (2) (a) of the Act for that ready-prepared pharmaceutical benefit is more than $45.00 but not more than $180.00; or
(d) $18.00, where the approved price to pharmacists for the quantity or number of units of the ready-prepared pharmaceutical benefit specified as the maximum quantity in the determination under paragraph 85A (2) (a) of the Act for that ready-prepared pharmaceutical benefit is more than $180.00 but not more than $450.00; or
(e) 4 per cent of the approved price to pharmacists, where the approved price to pharmacists for the quantity or number of units of the ready-prepared pharmaceutical benefit specified as the maximum quantity in the determination under paragraph 85A (2) (a) of the Act for that ready-prepared pharmaceutical benefit is more than $450.00 but not more than $1750.00; or
(f) $70.00, where the approved price to pharmacists for the quantity or number of units of the ready-prepared pharmaceutical benefit specified as the maximum quantity in the determination under paragraph 85A (2) (a) of the Act for that ready-prepared pharmaceutical benefit is more than $1750.00.
The price for a container for a ready-prepared pharmaceutical benefit will be based on the average of wholesale costs for a particular container, supplied in a quantity of 100, obtained from wholesale drug distributors as agreed between the Minister and The Pharmacy Guild of Australia, increased by a mark-up of 10 per cent. The particular containers will be a 150 millilitres vial for use for injectables and a 25 millilitres vial for use for other ready-prepared pharmaceutical benefits. For this purpose the wholesale costs of containers will be ascertained as at 1 May in each year and will take effect on 1 August in the same year.
The price for a ready-prepared pharmaceutical benefit or container will in each case be taken to the nearest cent, one half cent being counted as one cent.
Where a quantity of a ready-prepared pharmaceutical benefit is ordered and supplied which is less than the quantity contained in a standard or non-standard pack (that is, a broken quantity), the amount referred to in subsubparagraph 13 (b) (i) or 13 (c) (ii) will be worked out by:
(a) adding mark-up as specified in paragraph 14 to the approved price to pharmacists of the standard or non-standard pack, as applicable, and taking the result to the nearest cent, one half cent being counted as one cent;
(b) ascertaining the percentage that the quantity or number of units in the broken quantity bears to the quantity or number of units in the standard or non-standard pack, as applicable;
(c) selecting, in column A of the table set out hereunder, the percentage worked out in accordance with subparagraph (b), or, where that percentage is not specified in that column, the next higher percentage so specified;
(d) taking the percentage set out in column B of the table set out hereunder, immediately below the percentage selected in accordance with subparagraph (b); and
(e) taking that percentage, ascertained in accordance with subparagraph (d), of the amount worked out in accordance with subparagraph (a).
Notwithstanding anything contained elsewhere in this determination, the Commonwealth price in respect of the supply of a quantity of a ready-prepared pharmaceutical benefit will not exceed the Commonwealth price for a greater quantity of that ready-prepared pharmaceutical benefit.
Where a prescription calls for a quantity of one of the pharmaceutical benefits specified in Schedule 4 to the determination under paragraph 98C (1) (b) of the Act as being a pharmaceutical benefit the complete pack of which will be supplied regardless of any lesser quantity ordered, the Commonwealth price will be worked out on the basis that the complete pack was supplied.
Part III — Extemporaneously-Prepared Pharmaceutical Benefits
In this Part:
“wastage” means the combined loss that arises from:
(a) transferring drugs and chemicals from the package in which they are delivered to the approved pharmacist to the dispensing package delivered to the patient; and
(b) deterioration; and
(c) obsolescence.
The Commonwealth price of an extemporaneously-prepared pharmaceutical benefit, including a standard formula preparation, will, subject to paragraph 37, be the sum of the following amounts:
(a) the amount in respect of the quantity supplied of each of the ingredients, worked out in accordance with paragraphs 22 to 25; and
(b) the amount in respect of the appropriate container, worked out in accordance with paragraph 31; and
(c) an extemporaneously-prepared dispensing fee.
For the purposes of paragraph 21 the amount in respect of an ingredient of an extemporaneously-prepared pharmaceutical benefit, where the quantity of the ingredient is equal to the agreed purchase quantity, will be the sum of:
(a) the basic wholesale price of the ingredient;
(b) mark-up, as specified in paragraph 23, on (a); and
(c) an amount where applicable representing mark-up on (a) to cover wastage, ascertained in accordance with Appendix A.
The mark-up referred to in this Part will be —
(a) 15 per cent of the basic wholesale price of the ingredient where the basic wholesale price for the agreed purchase quantity of the ingredient is not more than $30.00; or
(b) $4.50, where the basic wholesale price for the agreed purchase quantity of the ingredient is more than $30.00 but not more than $45.00; or
(c) 10 per cent of the basic wholesale price of the ingredient where the basic wholesale price for the agreed purchase quantity of the ingredient is more than $45.00 but not more than $180.00; or
(d) $18.00, where the basic wholesale price for the agreed purchase quantity of the ingredient is more than $180.00 but not more than $450.00; or
(e) 4 per cent of the basic wholesale price of the ingredient where the basic wholesale price for the agreed purchase quantity of the ingredient is more than $450.00 but not more than $1750.00; or
(f) $70.00, where the basic wholesale price for the agreed purchase quantity of the ingredient is more than $1750.00.
For the purposes of paragraph 21 the amount in respect of an ingredient of an extemporaneously-prepared pharmaceutical benefit, where the quantity of the ingredient is less than the agreed purchase quantity, will be ascertained as follows:
(a) by ascertaining the basic pricing unit to be used for the quantity to be dispensed by reference to the table of basic pricing units in Appendix B;
(b) by ascertaining the cost of the basic pricing unit by reducing the amount ascertained in accordance with paragraph 21 by the quantity factor or factors shown in Appendix B appropriate to the basic pricing unit required and rounding off the resultant amount to the nearest cent, one half cent being counted as one cent; and
(c) by multiplying the cost of the basic pricing unit by the fraction that the quantity to be dispensed bears to the quantity contained in the basic pricing unit, except for:
(i) quantities exceeding 700 milligrams or 700 microlitres but not exceeding 1 gram or 1 millilitre, which will be priced at the amount for 1 gram or 1 millilitre;
(ii) quantities exceeding 7 grams or 7 millilitres but not exceeding 10 grams or 10 millilitres, which will be priced at the amount for 10 grams or 10 millilitres; and
(iii) quantities exceeding 80 grams or 80 millilitres but not exceeding 90 grams or 90 millilitres, which will be priced at the amount for 80 grams or 80 millilitres.
For the purposes of this paragraph the quantity of the ingredient will be calculated to the next higher 50 milligrams or 50 microlitres.
For the purposes of paragraph 21 the amount in respect of an ingredient of an extemporaneously-prepared pharmaceutical benefit, where the quantity of the ingredient is greater than the agreed purchase quantity, will be worked out as follows:
(a) except in the case of drugs which are unstable or packed sterile, as specified in Schedule 2 to the determination under paragraph 98C (1) (b) of the Act, by dividing the quantity dispensed by the quantity contained in the agreed purchase quantity and multiplying by the basic wholesale price of the agreed purchase quantity; or
(b) where the ingredient is one of the drugs which are unstable or packed sterile, as specified in Schedule 2 to the determination under paragraph 98C (1) (b) of the Act, by multiplying the price of the agreed purchase quantity by the number of whole packs of the agreed purchase quantity required to dispense the quantity of the ingredient.
The Commonwealth price in respect of an extemporaneously-prepared pharmaceutical benefit which comprises a vehicle which is specified in the prescription under a particular name and an additional specified ingredient or ingredients will be calculated in accordance with the provisions of paragraph 27 or 28 as applicable.
Where the vehicle is a single liquid ingredient and one or more other ingredients are added, displacement of the vehicle by solids (if any) will be disregarded for pricing purposes and the Commonwealth price for the pharmaceutical benefit as a whole will be calculated in accordance with the provisions of paragraph 21.
Where the vehicle is compounded from two or more ingredients and one or more other ingredients are added, displacement of the vehicle by solids (if any) will be disregarded for pricing purposes and the amounts for the respective ingredients will be the sum of:
(a) the price of each ingredient of the vehicle; and
(b) the price of each ingredient that is added to the vehicle;
worked out in each case in accordance with paragraph 22, 24 or 25 as applicable.
The basic wholesale price of a drug used in the preparation of an extemporaneously-prepared pharmaceutical benefit will be calculated as the arithmetic average of wholesale costs of the drug, in a purchase quantity agreed upon by the Minister and The Pharmacy Guild of Australia and available from wholesale drug distributors. For this purpose the basic wholesale price of a drug will be ascertained as at 1 May in each year and will take effect on 1 August in the same year.
In calculating the amount in respect of an ingredient or the basic wholesale price of a basic pricing unit, the amount so calculated will be taken to the nearest cent, one half cent being counted as one cent, provided that the minimum amount in respect of an ingredient will be one cent.
The price for each size and type of container for extemporaneously-prepared pharmaceutical benefits will be based on the average of wholesale costs for that container, in the purchase quantity agreed upon between the Minister and The Pharmacy Guild of Australia and available from wholesale drug distributors, increased by a mark-up of 10 per cent, taken to the nearest cent, one half cent being counted as one cent. For this purpose the wholesale costs of the particular containers will be ascertained as at 1 May in each year and will take effect on 1 August in the same year.
Where a wholesale drug distributor will not supply containers of a particular size or type in the purchase quantity agreed upon by the Minister and The Pharmacy Guild of Australia, the price of the purchase quantity will be calculated by multiplying the price of the smallest quantity above the agreed purchase quantity, in which the distributor will supply containers of that size and type, by the fraction that the quantity in the agreed purchase quantity bears to the quantity in which the distributor will supply.
In the case of bulk powders the price for the container will be the price for a screw cap jar which is nominally rated to hold at least double the quantity supplied.
Where a prescription orders a quantity of an extemporaneously-prepared pharmaceutical benefit in excess of the capacity of the largest size container of the appropriate type for which provision is made, the price for the container will be calculated as if the pharmaceutical benefit had been supplied in more than one of the containers for which provision is made.
Notwithstanding anything contained elsewhere in this determination, the Commonwealth price in respect of the supply of a quantity of an extemporaneously-prepared pharmaceutical benefit will not exceed the Commonwealth price for a greater quantity of that pharmaceutical benefit.
Notwithstanding anything contained elsewhere in this determination, in calculating the price in respect of the supply of a quantity of an ingredient of an extemporaneously-prepared pharmaceutical benefit, that price will not exceed the price of a greater quantity of that ingredient.
Extemporaneously-prepared pharmaceutical benefits that are not standard formula preparations will be classified for pricing purposes according to the form of preparation in accordance with the Fourth Schedule to the determinations under sections 85, 85A and 88 of the Act. Except in the case of exceptional prescriptions or where the approved pharmacist has made an election pursuant to paragraph 38, the Commonwealth price for such a pharmaceutical benefit will be worked out as follows:
(a) on the sixteenth day of the month or as near as practicable thereto the total number of grams or millilitres, as the case may be, priced during the previous four weeks or period as near as practicable thereto, for each form of preparation will be ascertained together with the total amount (exclusive of container costs and dispensing fee) paid for each total quantity;
(b) the total amount paid (exclusive of container costs and dispensing fee) ascertained in accordance with subparagraph (a) for each type of preparation will be divided by a number equal to one-tenth of the number of grams or millilitres, as the case may be, for that form of preparation, ascertained in accordance with subparagraph (a);
(c) the Commonwealth price will be the average 10 grams or 10 millilitres rate ascertained in accordance with subparagraph (b) calculated at about the sixteenth day of the month prior to the month of supply for the particular form of preparation, multiplied by one-tenth of the number of grams or millilitres, plus an extemporaneously-prepared dispensing fee and an amount for a container worked out in accordance with paragraph 31;
(d) on the sixteenth day of the month or as near as practicable thereto, if no prescriptions have been priced during the previous four weeks or period as near as practicable thereto for any of the standard formula preparations listed for a particular form of preparation, the Commonwealth price will be ascertained by taking the average 10 grams or 10 millilitres rate (exclusive of container costs and dispensing fee) of all the standard formula preparations determined for that form of preparation multiplied by one-tenth of the number of grams or millilitres, plus an extemporaneously-prepared dispensing fee and an amount for a container worked out in accordance with paragraph 31;
(e) the Commonwealth price of an extemporaneously-prepared pharmaceutical benefit worked out in accordance with subparagraph (c) or (d) will in either case be taken to the nearest cent, one half cent being counted as one cent.
An approved pharmacist may elect to calculate Commonwealth prices of extemporaneously-prepared pharmaceutical benefits that are not standard formula preparations in accordance with paragraph 21 instead of receiving payment in accordance with paragraph 37.
Where an approved pharmacist who has not made an election pursuant to paragraph 38 supplies an extemporaneously-prepared pharmaceutical benefit and no there is no standard formula preparation of the form supplied (and an average price is therefore not available), the Commonwealth price of the benefit will be worked out in accordance with paragraph 21.
Where the benefit comprises a standard formula preparation plus an additive, and the approved pharmacist has not made an election pursuant to paragraph 38, the amount payable will be the Commonwealth price worked out in accordance with paragraph 37, unless the approved pharmacist indicates that the benefit is to be priced as if the prescription had specified only the standard formula preparation without the additive, in which case the amount payable will be the Commonwealth price for the standard formula preparation without the additive worked out in accordance with paragraph 21.
Notwithstanding the provisions of paragraph 37, an approved pharmacist who has not made an election pursuant to paragraph 38 may calculate the Commonwealth price for an exceptional prescription in accordance with paragraph 21.
Up to and including 700 milligrams or 700 microlitres 100 milligrams or 100 microlitres price
Over 700 milligrams or 700 microlitres and up to and price as 1 gram or 1 millilitre
including 1 gram or 1 millilitre
Over 1 gram or 1 millilitre and up to and including 1 gram or 1 millilitre price
7 grams or 7 millilitres
Over 7 grams or 7 millilitres and up to and including price as 10 grams or 10 millilitres
10 grams or 10 millilitres
Over 10 grams or 10 millilitres and up to and 10 grams or 10 millilitres price
including 80 grams or 80 millilitres
Over 80 grams or 80 millilitres and up to and price as 80 grams or 80 millilitres
including 90 grams or 90 millilitres
Over 90 grams or 90 millilitres 100 grams or 100 millilitres price
Quantity Factors
To ascertain the 100 grams or 100 millilitres price, divide the 500 grams or 500 millilitres price by 5 or divide the 1 kilogram or 1 litre price by 10.
To ascertain the 10 grams or 10 millilitres price, divide the 100 grams or 100 millilitres price plus 12½ per cent by 10.
To ascertain the 1 gram or 1 millilitre price, divide the 10 grams or 10 millilitres price plus 25 per cent by 10.
To ascertain the 100 milligrams or 100 microlitres price, divide the 1 gram or 1 millilitre price plus 25 per cent by 10.
Notes to the National Health Act 1953 Pharmaceutical Benefits Determination under paragraph 98B(1)(a)
Note 1
Note: The Pharmaceutical Benefits Determination under paragraph 98B(1)(a) as set out in the principal determination (in force under paragraph 98B(1)(a)) of the National Health Act 1953) as shown in this compilation is amended as indicated in the Tables below.
Note: > Note: Table of Instruments
Title
Date of registration in the Federal Register of Legislative Instruments
Date ofcommencement
Application, saving ortransitional provisions
National Health Act 1953 Pharmaceutical Benefits Determination under paragraph 98B(1)(a)
30 June 2006(see F2006L01956)
1 July 2006
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.1
28 July 2006(see F2006L02453)
01 August 2006
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.2
13 October 2006(see F2006L03386)
01 October 2006
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.3
29 November 2006(see F2006L03873)
01 December 2006
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.4
01 March 2007(see F2007L00557)
01 March 2007
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.5
28 March 2007(see F2007L00839)
01 April 2007
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.6
30 April 2007(see F2007L01210)
01 May 2007
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.7
26 June 2007(see F2007L01888)
01 July 2007
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.8
10 July 2007(see F2007L02167)
01 August 2007
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.9
31 July 2007(see F2007L02414)
01 August 2007
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.10
22 November 2007(see F2007L04427)
01 December 2007
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.11
17 June 2008(see F2008L02117)
01 July 2008
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.12
15 July 2008(see F2008L02513)
01 August 2008
National Health Act 1953 Pharmaceutical Benefits Amendment Determination under paragraph 98B(1)(a) No.13