99ADHPrice reduction based on information provided under the price disclosure requirements

99ADH Price reduction based on information provided under the price disclosure requirements

When this section applies (1) This section applies if: (a) under section 99ADB, the Minister determines the weighted average disclosed price of a brand of a pharmaceutical item (the WADP brand) in respect of a data collection period for the brand; and (aa) the Minister, by legislative instrument, determines a day (the reduction day) for the purposes of this section in relation to the brand of the pharmaceutical item; and (b) a price agreement or price determination is in force in relation to the brand of the pharmaceutical item on the reduction day; and (c) the unadjusted price reduction for the brand of the pharmaceutical item is: (i) if section 99ADHC does not apply to the brand of the pharmaceutical item—at least 10%; or (ii) subject to subparagraph (iii), if section 99ADHC applies to the brand of the pharmaceutical item and the approved ex‑manufacturer price of the brand of the pharmaceutical item is more than $4—at least 30%; or (iii) if section 99ADHC applies to the brand of the pharmaceutical item, the approved ex‑manufacturer price of the brand of the pharmaceutical item is more than $4, and the brand of the pharmaceutical item has passed the 12.5% average unadjusted price reduction test set out in subsection (6) of this section—at least 10%. (2) For the purposes of paragraph (1)(aa), the reduction day must be: (a) 1 April or 1 October in any year; or (b) another prescribed day. Price reduction (3) If, on the reduction day, the approved ex‑manufacturer price of the brand of the pharmaceutical item would, apart from this section, be higher than the adjusted approved ex‑manufacturer price of the brand of the pharmaceutical item, then, on the reduction day, the amount of the approved ex‑manufacturer price is taken to be reduced to the amount of the adjusted approved ex‑manufacturer price for the purposes of the price agreement or price determination.

Note: If the pricing quantity of the brand of the pharmaceutical item on the relevant day is different from the pricing quantity on the reduction day, then, for the purposes of subsection (3), the adjusted approved ex‑manufacturer price of the brand of the pharmaceutical item is worked out under subsection (4A).

Claimed price reduction (4) If, on the reduction day: (a) a determination under subsection 85B(3) is in force in relation to a particular pack quantity of the brand of the pharmaceutical item; and (b) the approved ex‑manufacturer price of the brand of the pharmaceutical item is reduced because of subsection (3); then, on the reduction day the claimed price for that pack quantity of the brand of the pharmaceutical item is taken to be reduced by the percentage worked out as follows: Start formula start fraction AEMP minus AAEMP over AEMP end fraction times 100 end formula where: