National Health (Chemotherapy Pharmaceuticals Access Program) Special Arrangement 2011 (No. PB 87 of 2011)

2 Commencement

This Special Arrangement commences on 1 December 2011.

3 Revocation

Instrument PB 117 of 2010 is revoked.

4 Definitions

In this Special Arrangement:

ABN has the same meaning as in the A New Tax System (Australian Business Number) Act 1999.

Act means the National Health Act 1953.

approved hospital means a public hospital that:

(a) has an approved hospital authority; and

(b) is participating in a Pharmaceutical Reform Arrangement within the meaning of the National Healthcare Agreement.

approved hospital authority, for an approved hospital, means the hospital authority for the hospital that is approved by the Minister under section 94 of the Act.

authorised prescriber, for a chemotherapy pharmaceutical benefit, means a kind of person identified by a prescriber code mentioned in the column in Schedule 1 headed ‘Authorised Prescriber’ for the benefit.

benefit card means any of the following:

(a) a PBS Entitlement Card;

(b) a PBS Safety Net Concession Card;

(c) a Pensioner Concession Card;

(d) a Health Care Card (including Low Income Health Care Card and Foster Child Health Care Card);

(e) a Commonwealth Seniors Health Card;

(f) a Cleft Lip and Palate Card;

(g) a DVA Gold Card;

(h) a DVA White Card;

(i) a DVA Orange Card;

(j) War Widow/Widower Transport Card;

(k) a card or voucher approved by the Chief Executive Medicare for this paragraph.

chemotherapy pharmaceutical benefit means a pharmaceutical benefit mentioned in Schedule 1.

circumstances code means the letter ‘C’ followed by a number.

dispensed price, for the supply of a chemotherapy pharmaceutical benefit by an approved hospital authority, has the meaning given by section 31.

eligible medical practitioner, for the prescription of a chemotherapy pharmaceutical benefit under this Special Arrangement to an eligible patient, means a medical practitioner who is affiliated with the approved hospital at or from which the eligible patient is receiving treatment.

eligible patient means a person who:

(a) is, or is to be treated, as an eligible person within the meaning of the Health Insurance Act 1973; and

(b) is receiving medical treatment by an eligible medical practitioner at, or from, an approved hospital as:

(i) a non‑admitted patient; or

(ii) a day admitted patient; or

(iii) a patient on discharge.

entitlement number, for an eligible patient, means the number listed on the patient’s benefit card.

hospital authority means the governing body of a public hospital.

manufacturers’ pack has the same meaning as in the determination made under paragraph 98B(1)(a) of the Act, as in force from time to time.

prescriber code has the meaning given by paragraph 8 (2) (b).

purposes code means the letter ‘P’ followed by a number.

Regulations means the National Health (Pharmaceutical Benefits) Regulations 1960.

Streamlined Authority Code means the code mentioned in section 17.

Note Terms used in this Special Arrangement have the same meaning as in the Act — see section 13 of the Legislative Instruments Act 2003. These terms include:

Note:  Chief Executive Medicare

Note:  pharmaceutical benefit

Note:  pharmaceutical item

Note:  public hospital

Note:  Secretary.

Division 2 Chemotherapy pharmaceutical benefits

5 Pharmaceutical benefits covered by this Special Arrangement

(1) This Special Arrangement applies to each chemotherapy pharmaceutical benefit mentioned in Schedule 1.

(2) Each chemotherapy pharmaceutical benefit to which this Special Arrangement applies is a brand of a listed drug mentioned in Schedule 1:

Note Each listed drug mentioned in Schedule 1 has been declared by the Minister under subsection 85 (2) of the Act. The form, manner of administration and brand mentioned in Schedule 1 have been determined by the Minister under subsection 85 (3), (5) and (6) of the Act respectively.

6 Application of Part VII of the Act

(1) Each chemotherapy pharmaceutical benefit supplied in accordance with this Special Arrangement is supplied under Part VII of the Act.

(2) A provision of Part VII of the Act, or of regulations or other instruments made for Part VII of the Act, applies subject to this Special Arrangement.

Note See subsection 100 (3) of the Act.

7 Responsible person

(1) If a code is mentioned in the column in Schedule 1 headed ‘Responsible Person’ for a brand of a pharmaceutical item, the person mentioned in paragraph (2) (a) is the responsible person for the brand of the pharmaceutical item.

(2) For subsection (1):

(a) the person is the person mentioned in Schedule 2 for the code, with the ABN, if any, mentioned in Schedule 2 for the person; and

(b) the pharmaceutical item is the listed drug mentioned in Schedule 1:

(i) in the form mentioned in Schedule 1 for the listed drug; and

(ii) with the manner of administration mentioned in Schedule 1 for the form of the listed drug.

Note A person identified by a code in the column headed ‘Responsible Person’ in Schedule 1 has been determined by the Minister, under section 84AF of the Act, to be a responsible person for the brand of the pharmaceutical item.

8 Authorised prescriber

(1) Only an authorised prescriber may write a prescription for the supply of a chemotherapy pharmaceutical benefit to an eligible patient.

(2) For this Special Arrangement:

(a) only an eligible medical practitioner is an authorised prescriber; and

(b) the prescriber code for the authorised prescriber is the letters ‘EMP’.

(3) A reference in this Special Arrangement to an eligible medical practitioner is a reference to an authorised prescriber.

(4) For subsection (1), the chemotherapy pharmaceutical benefit is the brand of the listed drug mentioned in Schedule 1:

(5) Subsections 88(1), 88(1A), 88(1C), 88(1D) and 88(1E) of the Act do not apply to the supply of a chemotherapy pharmaceutical benefit under this Special Arrangement.

9 Prescription circumstances

(1) If at least 1 circumstance code is mentioned in the column in Schedule 1 headed ‘Circumstances’ for the chemotherapy pharmaceutical benefit, the circumstances mentioned in Schedule 3 for the code are the circumstances in which a prescription for the supply of the chemotherapy pharmaceutical benefit may be made.

(2) For subsection (1), the chemotherapy pharmaceutical benefit is the brand of the listed drug mentioned in Schedule 1:

Note Circumstances for a code mentioned in the column headed ‘Circumstances’ in Schedule 1 have been determined by the Minister under paragraph 85 (7) (b) of the Act.

10 Methods of prescribing a chemotherapy pharmaceutical benefit

(1) An eligible medical practitioner may prescribe a chemotherapy pharmaceutical benefit under this Special Arrangement by:

(a) writing a prescription for the chemotherapy pharmaceutical benefit in accordance with regulation 19 of the Regulations; or

(b) preparing a medication chart for the chemotherapy pharmaceutical benefit in accordance with section 11.

(2) A medication chart prepared in accordance with section 11 is taken to be a duly written prescription for regulation 19 of the Regulations.

11 Information to be included in medication chart

For paragraph 10 (1) (b), a medication chart for an eligible patient must include the following information:

(a) the name and provider number of the hospital where the chart is prepared;

(b) the name, signature and prescriber number of the eligible medical practitioner;

(c) the Streamlined Authority Code for the chemotherapy pharmaceutical benefit, if applicable;

(d) the patient’s name and address;

(e) a patient’s entitlement number, if applicable;

(f) the letters ‘PBS’ or ‘RPBS’, as appropriate;

(g) the name of the chemotherapy pharmaceutical benefit;

(h) the strength of the chemotherapy pharmaceutical benefit;

(i) the quantity or dosage of the chemotherapy pharmaceutical benefit or both the quantity and dosage of the chemotherapy pharmaceutical benefit;

(j) if the dosage of the chemotherapy pharmaceutical benefit is provided under paragraph (i) — how often the chemotherapy pharmaceutical benefit is to be taken by the patient and the period that the chemotherapy pharmaceutical benefit is prescribed;

(k) the date the medication chart is prepared.

Division 3 Authority required procedures

12 Authority required procedures

(1) This section applies to a chemotherapy pharmaceutical benefit if the circumstances mentioned in Schedule 3 for a circumstances code mentioned in Schedule 1 for the chemotherapy pharmaceutical benefit include any of the following:

(a) Compliance with Authority Required procedures;

(b) Compliance with Written Authority Required procedures;

(c) Compliance with Telephone Authority Required procedures;

(d) Compliance with Written or Telephone Authority Required procedures.

(2) A prescription written in accordance with paragraph 10 (1) (a) for the supply of the chemotherapy pharmaceutical benefit must be:

(a) submitted by the eligible medical practitioner to the Chief Executive Medicare in accordance with section 13; and

(b) authorised by the Chief Executive Medicare in accordance with section 14.

(3) A medication chart prepared in accordance with paragraph 10 (1) (b) for the supply of the chemotherapy pharmaceutical benefit must be:

(a) submitted by a pharmacist employed by the approved hospital authority to the Chief Executive Medicare in accordance with section 15; and

(b) authorised by the Chief Executive Medicare in accordance with section 16.

13 Authority required procedures — submission of paragraph 10 (1) (a) prescription

(1) If subsection 12 (2) applies to a prescription for the supply of a chemotherapy pharmaceutical benefit, the eligible medical practitioner must:

(a) deliver or post to the Chief Executive Medicare a prescription for the supply of the chemotherapy pharmaceutical benefit, prepared and signed by the eligible medical practitioner:

(i) in a form approved by the Secretary and completed by the eligible medical practitioner in ink in his or her own handwriting; or

(ii) in a form, prepared by means of a computer, that is in accordance with the form approved by the Secretary under subparagraph (i); or

(iii) in a form, prepared by means of a computer, approved in writing for the purpose by the Secretary and in the format approved in writing by the Secretary; or

(iv) by a method approved in writing by the Secretary; or

(b) submit to the Chief Executive Medicare, by telephone, details of a prescription for the supply of the pharmaceutical benefit prepared and signed by the eligible medical practitioner in accordance with subparagraph (a) (i), (ii), (iii) or (iv); or

(c) if the eligible medical practitioner has attempted to give details of the prescription to the Chief Executive Medicare in accordance with paragraph (b) but has been unable to do so because the telephone system established by the Chief Executive Medicare for the provision of such authorisations was unavailable — submit the prescription in accordance with the instructions in an emergency telephone message provided to the eligible medical practitioner by the Chief Executive Medicare; or

(d) submit to the Chief Executive Medicare, by means of an electronic communication of a kind approved in writing by the Chief Executive Medicare, details of a prescription for the supply of the chemotherapy pharmaceutical benefit prepared and signed by the eligible medical practitioner in accordance with subparagraph (a) (i), (ii), (iii) or (iv).

(2) If a circumstance mentioned in Schedule 3 for a circumstances code applying to the chemotherapy pharmaceutical benefit includes Compliance with Written Authority Required procedures, the eligible medical practitioner must submit a prescription for the supply of the chemotherapy pharmaceutical benefit to the Chief Executive Medicare in accordance with paragraph (1) (a).

(3) If a circumstance mentioned in Schedule 3 for a circumstances code applying to the chemotherapy pharmaceutical benefit includes Compliance with Telephone Authority Required procedures, the eligible medical practitioner must submit a prescription for the supply of the chemotherapy pharmaceutical benefit to the Chief Executive Medicare in accordance with paragraph (1) (b) or (c).

(4) If a circumstance mentioned in Schedule 3 for a circumstances code applying to the chemotherapy pharmaceutical benefit includes Compliance with Written or Telephone Authority Required procedures, the eligible medical practitioner must submit a prescription for the supply of the chemotherapy pharmaceutical benefit to the Chief Executive Medicare in accordance with paragraph (1) (a), (b) or (c).

(5) For paragraph (1) (a), a prescription prepared and signed by the eligible medical practitioner in accordance with subsection (1) is taken to have been submitted by the eligible medical practitioner if it is submitted by his or her employee.

14 Authority required procedures — authorisation of paragraph 10 (1) (a) prescription

(1) A prescription submitted in accordance with paragraph 13 (1) (a) may be authorised by the Chief Executive Medicare:

(a) signing his or her authorisation on the prescription; and

(b) either:

(i) if the Chief Executive Medicare requires the eligible medical practitioner to alter the prescription — returning it to the eligible medical practitioner for alteration before the eligible medical practitioner gives it to the person in respect of whom it was prepared; or

(ii) in any other case:

(A) returning the authorised prescription to the eligible medical practitioner; or

(B) sending it to the person in respect of whom it was prepared.

(2) A prescription submitted in accordance with paragraph 13 (1) (b) may be authorised by the Chief Executive Medicare telling the eligible medical practitioner by telephone, at the time the Chief Executive Medicare is given details of the prescription, that the prescription is authorised.

(3) A prescription submitted in accordance with paragraph 13 (1) (d) may be authorised by the Chief Executive Medicare sending his or her authorisation by electronic communication, to the eligible medical practitioner.

(4) If the Chief Executive Medicare authorises a prescription under subsection (2) or (3):

(a) the Chief Executive Medicare must tell the eligible medical practitioner by telephone or by electronic communication the number given by the CEO to the prescription; and

(b) the eligible medical practitioner must:

(i) mark that number on the prescription; and

(ii) retain a copy of the prescription for 1 year from the date the prescription was authorised.

(5) A prescription submitted in accordance with paragraph 13 (1) (c) is taken to have been authorised by the Chief Executive Medicare if the eligible medical practitioner completes the prescription in accordance with the instructions given in the emergency telephone message.

15 Authority required procedures — submission of paragraph 10 (1) (b) medication chart

(1) If subsection 12 (3) applies to a medication chart prepared in accordance with paragraph 10 (1) (b) for the supply of a chemotherapy pharmaceutical benefit, a pharmacist employed by the approved hospital authority must, on behalf of the eligible medical practitioner, submit the information mentioned in section 11 to the Chief Executive Medicare by means of an electronic communication of a kind approved by the Chief Executive Medicare.

(2) If a circumstance mentioned in paragraph (3) (a) or (b) applies, an authorisation for the supply of the chemotherapy pharmaceutical benefit may be obtained if the eligible medical practitioner prepares a prescription in accordance with paragraph 10 (1) (a) and submits that prescription in accordance with section 13 for authorisation under section 14.

(3) For subsection (2), the circumstances are:

(a) the pharmacist attempted to submit the information in accordance with subsection (1) but was unable to do so because the system established by the Chief Executive Medicare for the provision of such authorisation was unavailable; or

(b) the pharmacist submitted the information in accordance with subsection (1) but the authorisation was not granted by the system established by the Chief Executive Medicare.

16 Authority required procedures — authorisation of paragraph 10 (1) (b) medication chart

If the information in the medication chart is submitted in accordance with subsection 15 (1), the supply of the chemotherapy pharmaceutical benefit is taken to have been authorised when:

(a) the pharmacist receives a message by electronic communication from the system established by the Chief Executive Medicare indicating that the authorisation has been granted; and

(b) the pharmacist completes the medication chart in accordance with the instructions given by the message mentioned in paragraph (a).

17 Streamlined Authority Code

(1) This section applies to a chemotherapy pharmaceutical benefit if the circumstances mentioned in Schedule 3 for a circumstances code applying to the chemotherapy pharmaceutical benefit include the words ‘Streamlined Authority Code’ followed by a number.

(2) The requirements of section 13 are taken to have been complied with, and the Chief Executive Medicare is taken to have authorised the prescription of the chemotherapy pharmaceutical benefit under section 14, if the eligible medical practitioner has:

(a) prepared and signed a prescription for the supply of the chemotherapy pharmaceutical benefit in accordance with subparagraph 13 (a) (i), (ii), (iii) or (iv); and

(b) has written the Streamlined Authority Code on the prescription.

(3) The requirements of section 15 are taken to have been complied with, and the supply of the chemotherapy pharmaceutical benefit is taken to be authorised under section 16, if the eligible medical practitioner has prepared a medication chart in accordance with paragraph 10 (1) (b).

Division 4 Maximum quantity and maximum number of repeats

18 Maximum quantity

(1) This section applies subject to section 19.

(2) The maximum quantity or number of units of the pharmaceutical item in a chemotherapy pharmaceutical benefit that may, in 1 prescription for the supply of the chemotherapy pharmaceutical benefit, be directed to be supplied by an eligible medical practitioner is the quantity or number of units mentioned in the column in Schedule 1 headed ‘Maximum Quantity’ for the chemotherapy pharmaceutical benefit.

(3) If at least 1 purposes code is mentioned in the column in Schedule 1 headed ‘Purposes’ for a chemotherapy pharmaceutical benefit, the quantity or number of the units mentioned in the column headed ‘Maximum Quantity’ is the maximum for the particular purposes mentioned in Schedule 3.

(4) If no purposes code is mentioned in the column in Schedule 1 headed ‘Purposes’, the quantity or number of units mentioned in the column in Schedule 1 headed ‘Maximum Quantity’ is the maximum for all purposes, other than a purpose for which a different maximum is mentioned for the same chemotherapy pharmaceutical benefit.

(5) For subsection (2), the pharmaceutical item is the listed drug mentioned in Schedule 1:

(6) For this section, the chemotherapy pharmaceutical benefit is the brand of the listed drug mentioned in Schedule 1:

19 Variation to maximum quantity or number of units

(1) If an eligible medical practitioner prescribes a supply of a chemotherapy pharmaceutical benefit that is greater than the maximum quantity or number of units permitted under section 18, the supply of a chemotherapy pharmaceutical benefit must be:

(a) if the prescription was written in accordance with paragraph 10 (1) (a) — authorised in accordance with the procedures mentioned in regulation 13 of the Regulations as modified by subsection (2); and

(b) if a medication chart was prepared in accordance with paragraph 10 (1) (b) — authorised in accordance with the procedures mentioned in section 15.

(2) A reference in regulation 13 of the Regulations to a determination in force under paragraph 85A(2)(a) of the Act is to be read as a reference to the maximum quantity or number of units of the chemotherapy pharmaceutical benefit as described in section 18.

20 Maximum number of repeats — paragraph 10 (1) (a) prescription

(1) If a prescription for the supply of a chemotherapy pharmaceutical benefit is written in accordance with paragraph 10 (1) (a), the maximum number of occasions an eligible medical practitioner may, in 1 prescription, direct that the supply of the chemotherapy pharmaceutical benefit be repeated is the number in the column in Schedule 1 headed ‘Number of Repeats’ for the chemotherapy pharmaceutical benefit.

(2) If at least 1 purposes code is mentioned in the column in Schedule 1 headed ‘Purposes’ for the pharmaceutical benefit, the number of repeats mentioned in the column in Schedule 1 headed ‘Number of Repeats’ is the maximum number for the particular purposes mentioned in Schedule 3 for each code.

(3) If no purposes code is mentioned in the column headed ‘Purposes’, the number of repeats mentioned in the column headed ‘Number of Repeats’ is the maximum number for all purposes, other than a purpose for which a different maximum is mentioned for the same pharmaceutical benefit.

(4) If a prescription is written in accordance with paragraph 10 (1) (a) for the repeat supply of a chemotherapy pharmaceutical benefit that is greater than the maximum number of occasions an eligible medical practitioner may, in 1 prescription, direct the repeat supply of a chemotherapy pharmaceutical benefit under this section, the prescription must be authorised in accordance with the procedures mentioned in regulation 13 of the Regulations as modified by subsection (5).

(5) A reference in regulation 13 of the Regulations to a determination in force under paragraph 85A(2)(b) of the Act is to be read as a reference to the maximum number of occasions an eligible medical practitioner may, in one prescription, direct that the supply of the chemotherapy pharmaceutical be repeated as described in this section.

(6) A reference in regulation 24 of the Regulations to a determination in force under paragraph 85A(2)(b) of the Act is to be read as a reference to the maximum number of occasions an eligible medical practitioner may, in one prescription, direct that the supply of the chemotherapy pharmaceutical be repeated as described in this section.

(7) For this section, the chemotherapy pharmaceutical benefit is the brand of the listed drug mentioned in Schedule 1:

21 Maximum number of repeats — paragraph 10 (1) (b) medication chart

(1) If an eligible medical practitioner prescribes a chemotherapy pharmaceutical benefit in a medication chart in accordance with paragraph 10 (1) (b), the eligible medical practitioner may not direct the repeat supply of the chemotherapy pharmaceutical benefit in 1 prescription.

(2) If the medication chart contains a direction that the supply of a chemotherapy pharmaceutical benefit be repeated, the direction is invalid.

Division 5 Section 100 only

22 Section 100 only supply

(1) If the letter ‘D’ is mentioned in the column in Schedule 1 headed ‘Section 100 only’ for a listed drug, the listed drug may be supplied only in accordance with this Special Arrangement and any other Special Arrangement relating to the listed drug.

(2) A chemotherapy pharmaceutical benefit that has a drug mentioned in subsection (1) is not available for general supply on the Pharmaceutical Benefits Scheme.

Note The Minister has declared, under subsection 85 (2A) of the Act, that the listed drug can only be supplied under a section 100 Special Arrangement.

(3) If the letters ‘PB’ are mentioned in the column in Schedule 1 headed ‘Section 100 only’ for a chemotherapy pharmaceutical benefit, the chemotherapy pharmaceutical benefit may be supplied only in accordance with this Special Arrangement and any other Special Arrangement relating to the chemotherapy pharmaceutical benefit.

(4) A chemotherapy pharmaceutical benefit mentioned in subsection (3) is not available for general supply on the Pharmaceutical Benefits Scheme.

Note The Minister has determined, under paragraph 85 (8) (a) of the Act, that this chemotherapy pharmaceutical benefit can only be supplied under a section 100 Special Arrangement.

(5) If the letter ‘C’ is mentioned in the column in Schedule 1 headed ‘Section 100 only’ for a chemotherapy pharmaceutical benefit, the chemotherapy pharmaceutical benefit may be supplied in the circumstances mentioned in Schedule 3 for the circumstances code in the column headed ‘Circumstances’ only in accordance with this Special Arrangement and any other Special Arrangement relating to the chemotherapy pharmaceutical benefit.

(6) A chemotherapy pharmaceutical benefit mentioned in subsection (5) is not available in the circumstances mentioned in subsection (5) for general supply on the Pharmaceutical Benefits Scheme.

Part 2 Supply of chemotherapy pharmaceutical benefits

23 Entitlement to chemotherapy pharmaceutical benefits

Subject to this Special Arrangement, a person who is an eligible patient is entitled to receive a chemotherapy pharmaceutical benefit under this Special Arrangement without payment or other consideration, other than a charge made under Part 4.

24 Supply of chemotherapy pharmaceutical benefits under this Special Arrangement

This Special Arrangement only applies to the supply of a chemotherapy pharmaceutical benefit to an eligible patient by an approved hospital authority of an approved hospital.

25 Modification to regulations

(1) If the supply of a chemotherapy pharmaceutical benefit is prescribed in accordance with paragraph 10 (1) (b), regulations 22, 26A and 31 and subregulations 25 (2), (3) and (4) of the Regulations do not apply to the supply of the chemotherapy pharmaceutical benefit.

(2) A reference to authority prescription in the Regulations includes a prescription authorised in accordance with Regulation 13 as modified by subsection 19(2) of this Special Arrangement.

26 Acknowledging receipt of supplied chemotherapy pharmaceutical benefits

If the supply of a chemotherapy pharmaceutical benefit is prescribed in accordance with paragraph 10 (1) (b), the eligible medical practitioner or an employee of the approved hospital authority must on the eligible patient’s medication chart:

(a) record the date that the chemotherapy pharmaceutical benefit was supplied to the eligible patient; and

(b) sign his or her name.

Part 3 Claims and payment

Division 1 Claims for payment

27 How claims to be made

An approved hospital authority of an approved hospital may make a claim for payment for the supply of the chemotherapy pharmaceutical benefit to an eligible patient under this Special Arrangement in accordance with section 99AAA of the Act, as modified by this Division.

28 Modifications to claim rules

(1) Subject to subsection (2), if an eligible medical practitioner prescribes a chemotherapy pharmaceutical benefit in a medication chart prepared in accordance with paragraph 10 (1) (b), the approved hospital authority must make a claim for the payment of the supply of the chemotherapy pharmaceutical benefit in accordance with section 99AAA and the rules determined by the Minister under subsection 99AAA (8) of the Act.

(2) For a claim mentioned in subsection (1), the requirements in section 99AAA and the rules determined by the Minister under subsection 99AAA (8) of the Act are modified by the following requirements:

(a) the approved hospital authority is not required to supply the medication chart prepared in accordance with paragraph 10 (1) (b) with the claim;

(b) the approved hospital authority must keep an electronic version of the information supplied with the claim in accordance with the rules determined by the Minister under subsection 99AAA(8) for 1 years from the date the chemotherapy pharmaceutical benefit is supplied;

(c) if requested by the Chief Executive Medicare — the approved hospital authority must give the Chief Executive Medicare a copy of:

(i) the medication chart mentioned in paragraph (a); and

(ii) the information mentioned in paragraph (b).

(3) A reference in the rules determined by the Minister under subsection 99AAA(8) of the Act to an authority prescription is to be read as including a prescription that has been authorised under Regulation 13 as modified by this Special Arrangement.

Division 2 Payments to approved hospital authorities

29 Payments to approved hospital authorities

An approved hospital authority is entitled to be paid by the Commonwealth the amount, if any, by which the dispensed price for the supply of the chemotherapy pharmaceutical benefit is greater than the amount that the approved hospital authority was entitled to charge under Part 4.

30 Method of working out dispensed price

The dispensed price for the supply of a chemotherapy pharmaceutical benefit by an approved hospital authority is to be worked out under Division 3.

Division 3 Dispensed price

31 Dispensed price for supply of a chemotherapy pharmaceutical benefit

Subject to section 33, the dispensed price for the supply of the chemotherapy pharmaceutical benefit by an approved hospital authority is as follows:

(a) if the quantity of the chemotherapy pharmaceutical benefit that is ordered and supplied is equal to the quantity contained in the manufacturers’ pack — the price ex‑manufacturer for the pack;

(b) if the quantity of the chemotherapy pharmaceutical benefit that is ordered and supplied is less than the quantity contained in the manufacturers’ pack — the amount calculated in accordance with section 32.

(c) if the quantity of the chemotherapy pharmaceutical benefit that is ordered and supplied is more than the quantity contained in the manufacturers’ pack — the sum of:

(i) the price ex‑manufacturer for each complete pack contained in the quantity supplied; and

(ii) the amount calculated in accordance with section 32 for the quantity supplied that is less than the quantity contained in the manufacturers’ pack.

32 Where quantity is less than in manufacturers’ pack

If the quantity of a chemotherapy pharmaceutical benefit that is ordered and supplied is less than the quantity contained in the manufacturers’ pack (a broken quantity), the amount mentioned in paragraph 31 (b) and subparagraph 31 (c) (ii) is to be calculated by:

(a) dividing the quantity or number of units in the broken quantity by the quantity or number of units in the manufacturers’ pack, expressed as a percentage of 2 decimal places; and

(b) applying that percentage to the price ex‑manufacturer for each complete pack.

33 Lowest price to be applied

If there are 2 or more chemotherapy pharmaceutical benefits mentioned in Schedule 1 that are different brands but have the same drug in the same form with the same manner of administration, the dispensed price of those chemotherapy pharmaceutical benefits is to be based on the price ex‑manufacturer of the chemotherapy pharmaceutical benefit with the lowest dispensed price.

34 Rounding of dispensed price

The dispensed price for the supply of a chemotherapy pharmaceutical benefit will in each case be taken to the nearest cent, one half cent being counted as one cent.

Part 4 Patient contributions

35 Patient contribution for chemotherapy pharmaceutical benefits mentioned in Schedule 4

(1) This section applies if the chemotherapy pharmaceutical benefit supplied by an approved hospital authority to an eligible patient is:

(a) a listed drug mentioned in the column in Schedule 4 headed ‘Listed Drug’; and

(b) in the form mentioned in the column in Schedule 4 headed ‘Form’ for the listed drug mentioned in paragraph (a); and

(c) administered in a manner mentioned in the column in Schedule 4 headed ‘Manner of ‘Manner of Administration’ for the listed drug mentioned in paragraph (a); and

(d) marketed under the brand mentioned in the column in Schedule 4 headed ‘Brand’ for the listed drug mentioned in paragraph (a).

(2) The approved hospital authority may charge the eligible patient:

(a) an amount not exceeding the amount that the patient could have been required to pay in accordance with subsection 87(2) of the Act if the patient had obtained the chemotherapy pharmaceutical benefit from an approved pharmacist; and

(b) an amount not exceeding the amount mentioned in subsection 37 (1).

36 Patient contribution for chemotherapy pharmaceutical benefits not mentioned in Schedule 4

(1) This section applies if the chemotherapy pharmaceutical benefit supplied by an approved hospital authority to an eligible patient is not mentioned in Schedule 4.

(2) The approved hospital authority may charge the eligible patient an amount not exceeding the amount that the patient could have been required to pay in accordance with subsection 87(2) of the Act if the patient had obtained the chemotherapy pharmaceutical benefit from an approved pharmacist.

37 Additional patient contributions

(1) For paragraph 35 (2) (b), the amount is the amount calculated by subtracting the amount for the chemotherapy pharmaceutical benefit mentioned in the column in Schedule 4 headed ‘Approved Ex‑manufacturer Price’ from the amount mentioned for the chemotherapy pharmaceutical benefit in the column in Schedule 4 headed ‘Claimed Ex‑manufacturer Price’.

(2) However, if the quantity of the chemotherapy pharmaceutical benefit being supplied is for more or less than the quantity mentioned in the column in Schedule 4 headed ‘Quantity or Number of Units’, the amounts mentioned in the columns in Schedule 4 headed ‘Approved Ex‑manufacturer Price’ and ‘Claimed Ex‑manufacturer Price’ must be adjusted proportionally.

Part 5 Transitional arrangements

38 Prescriptions written prior to 1 December 2011

If the supply of a chemotherapy pharmaceutical benefit was prescribed for an eligible patient under the old Arrangements, and the supply was not made prior to the commencement of this Special Arrangement, the supply of the chemotherapy pharmaceutical benefit is taken to have been validly prescribed under this Special Arrangement, and may be supplied to the eligible patient under this Special Arrangement.

39 Old Arrangements

In this Part, old Arrangements means the National Health (Chemotherapy Pharmaceuticals Access Program) Special Arrangement 2010 (PB 117 of 2010).