National Health (Commonwealth Price - Pharmaceutical benefits supplied by private hospitals) Determination 2020 (PB 99 of 2020)

National Health (Commonwealth Price - Pharmaceutical benefits supplied by private hospitals) Determination 2020 (PB 99 of 2020) | Zoe

Deep Dive

7,914 words · generated 17/06/2026

What it does

This instrument, the National Health (Commonwealth Price ‑ Pharmaceutical benefits supplied by private hospitals) Determination 2020 (PB 99 of 2020), prescribes how the Commonwealth payment for pharmaceutical benefits supplied by an approved hospital authority to patients in private hospitals is calculated and paid. The Determination is made under subsection 99(4) of the National Health Act 1953 (see s 2A) and commences on 1 October 2020 (see s 2 and the commencement table). Its stated purpose is “to determine the amount of the Commonwealth payment for pharmaceutical benefits supplied by an approved hospital authority to a patient receiving treatment in or at a private hospital for which the authority is approved” (s 2B).

Mechanically, the Determination does the following:

Defines key terms relevant to calculation and payment, cross‑referencing Part VII of the Act, the Regulations, the Approved Pharmacists Determination and related Determinations (s 3).
Prescribes rounding rules for fractional cents in price calculations (s 4).
Requires the Commonwealth to pay an additional dangerous drug fee where a pharmaceutical benefit is a dangerous drug (s 5).
Sets the dispensed price and the Commonwealth payment for ready‑prepared pharmaceutical benefits, including formulas for multiple pack quantities, broken quantities (less than a pack), and mixed quantities (s 8-15). Key elements comprise: approved ex‑manufacturer price (or proportional ex‑manufacturer price), a storage and handling mark‑up (aligned with the wholesale mark‑up applicable to pharmacists under the Approved Pharmacists Determination), a private hospital mark‑up equal to 1.4% of the combined ex‑manufacturer price and storage/handling mark‑up (s 10-11), dispensing fees, dangerous drug fees (if applicable) and container prices (s 12).
Prescribes a step‑by‑step method and lookup table for pricing broken quantities (s 13-14).
States that extemporaneously‑prepared pharmaceutical benefits are priced at the Commonwealth price determined under the Approved Pharmacists Determination, “as if the benefit was supplied by an approved pharmacist” (s 16). The Commonwealth payment to the approved hospital authority is the dispensed price less the patient co‑payment (s 8(1), s 16(2)), and certain patients pay nil co‑payment where subsection 87(5A) of the Act applies (s 8(2), s 16(3)).
Provides transitional continuity for actions taken under the prior 2010 Determination (s 2D) and permits the Determination to amend or repeal instruments specified in its Schedules (s 2C).

Who pays: the Commonwealth pays the amount by which the dispensed price exceeds the patient co‑payment (s 8(1), s 16(2)). Who decides: the Minister certifies approved hospital authorities under the Act (see definitions cross‑referencing s 94(1) of the Act) and is a named party in the container wholesale cost agreement with the Pharmacy Guild (s 12(2)-(3)). The Determination delegates computation mechanics to a combination of statutory rates, cross‑referenced Determinations (Approved Pharmacists Determination PB 66 of 2020) and an annual container cost agreement between the Minister and the Pharmacy Guild (s 12).

This note proceeds to unpack principal concepts, affected parties, duties and rights, enforcement features, statutory interactions, amendment and litigation history recorded in the instrument, technical pitfalls, and practical compliance steps. All references below are to sections of the Determination provided.

Main concepts

The Determination builds on a small set of interlocking concepts that determine how payments flow to approved hospital authorities for supplying pharmaceutical benefits in private hospitals. Key concepts, with their operational consequences under the instrument, are:

Approved hospital authority: Defined by reference to the Act as a hospital authority approved by the Minister under subsection 94(1) of the Act (s 3). Only approved authorities can claim the Commonwealth payment prescribed by the Determination (s 8(1), s 16(2)). The instrument does not set the criteria for approval; those remain within the Act’s approval process.
Dispensed price: The core pricing figure the Determination defines differently for ready‑prepared and extemporaneously‑prepared pharmaceutical benefits. For ready‑prepared benefits, the dispensed price is a composite of (i) the approved ex‑manufacturer price or proportional ex‑manufacturer price for the relevant pack quantities, (ii) a storage and handling mark‑up, (iii) a private hospital mark‑up (1.4%), (iv) an applicable dispensing fee (ready‑prepared or extemporaneous where specified), (v) dangerous drug fee where relevant, and (vi) container price where broken quantities are supplied (s 9, s 10-13). For extemporaneously‑prepared benefits, the dispensed price is the Commonwealth price determined under the Approved Pharmacists Determination “as if the benefit was supplied by an approved pharmacist” (s 16(1)).
Approved ex‑manufacturer price and proportional ex‑manufacturer price: These are statutory price inputs carrying over from the National Health Act Part VII definitions (s 3). They are the baseline on which mark‑ups and fees are calculated for pack quantities.
Storage and handling mark‑up: For ready‑prepared pack quantities, the Determination sets the storage and handling mark‑up to be the same as the wholesale mark‑up that would apply under section 11 of the Approved Pharmacists Determination if the item were supplied by an approved pharmacist (s 10). This links the private hospital pricing structure to the pharmacists’ wholesale mark‑up regime in PB 66 of 2020.
Private hospital mark‑up: A fixed percentage, 1.4% applied to the sum of the ex‑manufacturer price and the storage and handling mark‑up for each pack quantity supplied (s 11). That percentage is an explicit, small incremental margin given to approved hospital authorities.
Container price: For broken quantities (i.e. supplied quantities less than a pack quantity), the Determination prescribes a container price made up of an agreed wholesale cost (based on an average of wholesale costs for a quantity of 100 as agreed between the Minister and the Pharmacy Guild for supply by a wholesale drug distributor) plus a 10% mark‑up (s 12(1)-(4)). The Determination sets an annual process and timetable: the wholesale cost must be agreed on or before 15 June and takes effect on 1 August each year (s 12(3)).

Who it affects

The Determination affects a defined set of actors by operation of its definitions and payment mechanics. The primary affected parties are:

Approved hospital authorities: Entities that have been approved by the Minister under subsection 94(1) of the National Health Act 1953 (s 3). Approved hospital authorities are the only claimants under the Determination; the amount payable to them is the dispensed price less the patient co‑payment (s 8(1), s 16(2)). Hospital authorities therefore receive Commonwealth payments when they supply pharmaceutical benefits to private hospital patients for whom the authority is approved.
Patients receiving treatment in or at private hospitals: The Determination addresses patients receiving treatment in or at a private hospital for which the hospital authority is approved (s 2B and definitions in s 3). Patient liability for a co‑payment is governed by the Determination’s definition of “patient co‑payment” (s 3), which cross‑references section 99F of the Act (current figures for general and concessional charges). For certain patients meeting subsection 87(5A) of the Act, the patient co‑payment is zero (s 8(2), s 16(3)).
The Commonwealth (Department of Health): The Commonwealth, via its payment systems, funds the difference between the dispensed price and the patient co‑payment (s 8(1), s 16(2)). The Determination prescribes the calculation basis for those payments and places administrative tasks (for example, agreeing container wholesale costs with the Pharmacy Guild under s 12(2)-(3)) on the Minister and Department processes.
Pharmacy Guild of Australia and wholesale drug distributors: The Determination requires the wholesale cost for a container to be “based on the average of wholesale costs ... as agreed by the Minister and the Pharmacy Guild of Australia for the supply of the container, by a wholesale drug distributor” (s 12(2)). The Pharmacy Guild is therefore a party to the annual container cost negotiation and shapes the container cost input used in payments to hospital authorities.
Approved pharmacists regime and suppliers: Although approved pharmacists are not direct beneficiaries under this Determination, the Approved Pharmacists Determination (PB 66 of 2020) is a binding input. The storage and handling mark‑up for pack quantities is the same as the wholesale mark‑up under section 11 of the Approved Pharmacists Determination (s 10), and extemporaneously‑prepared items are priced “as if” supplied by an approved pharmacist under that Determination (s 16(1)). Changes in the pharmacists’ Determination alter hospital pricing inputs.

Key duties and rights

This Determination primarily prescribes rights to payment and the calculation methodology, rather than duties in the form of procedural obligations or offences. Relevant rights and actionable duties can be extracted from the provisions as follows.

Rights conferred by the Determination:

Right to Commonwealth payment: An approved hospital authority has the right to be paid by the Commonwealth the amount by which the dispensed price exceeds the patient co‑payment when it supplies pharmaceutical benefits to a patient receiving treatment in or at a private hospital for which the authority is approved (s 8(1); s 16(2) for extemporaneously‑prepared items). That entitlement is the core legal right created or clarified by the Determination.
Right to the dangerous drug fee: Where an item supplied qualifies as a “dangerous drug” under s 3 (either by reference to Schedule 3 of PB 114 of 2019 or State/Territory classification), the Commonwealth must pay a dangerous drug fee in addition to other amounts under the Determination, where indicated (s 5; s 9(1)(a)(iii), (b)(iii), (c)(iv), s 9(2)(d)).
Right to application of specified mark‑ups and fees: Approved hospital authorities can expect application of the storage and handling mark‑up (aligned with the pharmacists’ wholesale mark‑up, s 10), the private hospital mark‑up of 1.4% (s 11) and the ready‑prepared or extemporaneously‑prepared dispensing fee (s 9(1), s 9(2), cross‑referencing the Approved Pharmacists Determination). Where a supply is an admixture listed in Schedule 1 of PB 114 of 2019, the extemporaneously‑prepared dispensing fee applies instead of the ready‑prepared dispensing fee (s 9(2)).
Right to use agreed container wholesale cost: For broken quantities, approved hospital authorities are to be paid a container price composed of the agreed wholesale cost and a 10% mark‑up (s 12(1)-(4)); the wholesale cost is to be based on the average of wholesale costs “as agreed by the Minister and the Pharmacy Guild” for a standard quantity (s 12(2)).

Duties and implied obligations arising from operational mechanics:

Calculation compliance: Hospital authorities must apply the Determination’s formulas when submitting claims. For ready‑prepared items this means assembling the relevant ex‑manufacturer prices (or proportional ex‑manufacturer prices), applying storage/handling mark‑ups as per s 10, the 1.4% private hospital mark‑up (s 11), dispensing fees, container charges if applicable (s 12), and the broken‑quantity steps and table (s 13-14). The Determination does not specify submission formats or documentation but prescribes the calculation method that must be applied to determine the Commonwealth payment.

Penalties and enforcement

The Determination is primarily a pricing instrument and does not itself create offences, penalties or express administrative sanctioning mechanisms within its text. Its provisions set calculational entitlements and processes for Commonwealth payments; they do not contain penalty clauses, criminal offences, infringement notices or express compliance enforcement steps. The instrument is made under subsection 99(4) of the National Health Act 1953 (s 2A), and enforcement of compliance with the Determination’s payment rules therefore sits within the administrative and statutory framework established by the National Health Act, the Regulations, and the Department of Health’s payment and audit processes, although those wider enforcement mechanisms are not detailed in this Determination.

What the Determination does state that is relevant to enforcement practice:

Payment basis: The Commonwealth pays an approved hospital authority the amount by which the dispensed price exceeds the patient co‑payment (s 8(1), s 16(2)). Payments made under this formula will be subject to the Department’s normal payment controls, reconciliation and audit processes. The Determination specifies the method the Department must use to calculate the payment amount; deviations will be procedural errors that may be corrected administratively. The Determination does not, however, set the mechanics for recoupment, recovery, or review of payments.
Transitional application of previously done acts: The Determination provides that things done under the previous 2010 Determination that could be done under this instrument have effect as if done under this instrument (s 2D). This transitional clause preserves the validity of prior approvals, notices or instruments and reduces the risk of enforcement action arising from mere technical repeal; it also signals continuity for administrative enforcement actions initiated under the earlier Determination.
Ministerial and industry agreement inputs: The Determination requires annual agreement by the Minister and the Pharmacy Guild on container wholesale costs (s 12(2)-(3)). Because that input is a specified basis for payment, lack of agreement or disputes about the agreed figure would be resolved outside the Determination and would affect payment calculations. The Determination envisages reliance on that annual administrative process rather than on a statutory enforcement mechanism.

Implications for compliance oversight:

How it interacts with other laws

This Determination is tightly integrated with multiple provisions of the National Health legislative framework and specified Determinations. It does not operate in isolation; rather, it references, depends on and aligns with specific provisions in the National Health Act 1953, the National Health (Pharmaceutical Benefits) Regulations 2017, other Commonwealth price determinations, and the Private Health Insurance Act 2007 for the definition of private hospital. The principal interactions are as follows.

National Health Act 1953

Statutory making power: The Determination is made under subsection 99(4) of the National Health Act 1953 (s 2A). That subsection constitutes the legal authority for the Minister to make Commonwealth price determinations for pharmaceutical benefits.
Definitions and price inputs: Several essential terms used in the Determination are defined with direct reference to Part VII of the Act, including “brand”, “determined quantity”, “list ed brand”, “pack quantity”, “approved ex‑manufacturer price”, and “proportional ex‑manufacturer price” (s 3). Those statutory definitions in the Act supply the ex‑manufacturer price inputs and pack quantity concepts the Determination uses in its formulas (s 9-13).
Patient co‑payment and concession categories: The Determination’s definition of “patient co‑payment” cross‑references section 99F of the Act for the current figures applicable to general and concessional beneficiaries and section 87 regarding who is a concessional beneficiary (s 3). The Determination also refers to subsection 87(5A) of the Act to identify situations in which the patient co‑payment is zero (s 8(2), s 16(3)).
Ministerial approvals: The term “approved hospital authority” references the Minister’s approval under subsection 94(1) of the Act (s 3). The Determination does not displace or alter the approval mechanism; it simply attaches payment consequences to approved status.

National Health (Pharmaceutical Benefits) Regulations 2017

Prescription and repeated supply rules: The Determination relies on the Regulations for the mechanics of prescriptions and repeated supply: s 6 cites subsection 88(6) of the Act and section 49 of the Regulations to describe when a medical practitioner’s direction to supply a larger on‑occasion quantity substitutes for repeated supplies (s 6(1)). The Determination then sets the payment consequence (only one dispensing fee, one container fee, one dangerous drug fee) for such supplies (s 6). Operational compliance therefore requires alignment with the Regulations’ prescription rules.

Amendment history

This Determination contains limited self‑referential amendment mechanics and a short transitional clause addressing the predecessor instrument. The amendment history recorded within the text is as follows.

Commencement and original making: The Determination was made under subsection 99(4) of the National Health Act 1953 (s 2A) and is titled National Health (Commonwealth Price ‑ Pharmaceutical benefits supplied by private hospitals) Determination 2020 (PB 99 of 2020) (s 1). The commencement table in s 2 records that “the whole of this instrument” commences on 1 October 2020; the table itself appears in the instrument and contains the single commencement entry (s 2).
Repeal and transitional continuity: Section 2D deals with things done under the prior National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010). It provides that, if a thing was done under the 2010 Determination and the same thing could be done under this instrument, the thing has effect as if done under this instrument (s 2D(1)). Subsection 2D(2) clarifies that “thing” includes notices, applications or other instruments. This preserves the legal validity of actions taken under the repealed Determination where those actions fit within the new Determination’s scope.
Schedules and consequential amendments: Section 2C provides that each instrument specified in a Schedule to this Determination is amended or repealed as set out in the applicable Items in that Schedule and that any other Item in a Schedule has effect according to its terms (s 2C). The text provided does not include the full Schedules themselves, but s 2C establishes that the Determination may contain Schedule items that amend or repeal other instruments. The introductory note in s 2 states that the commencement table relates only to the provisions of this instrument “as originally made” and “will not be amended to deal with any later amendments of this instrument.” That is a drafting note explaining that the embedded commencement table reflects the instrument as made.
Annual container cost timetable: Section 12(3) establishes an annual administrative timetable for the container wholesale cost agreement: the wholesale cost must be agreed on or before 15 June in a year and takes effect on 1 August in that year (s 12(3)). While this is not an amendment history item, it is an annual timing rule that creates recurring changes in the container cost input.
Cross‑referenced instruments and future interaction: The Determination explicitly relies on and references several other instruments (notably the Approved Pharmacists Determination PB 66 of 2020 and the National Health Determination PB 114 of 2019). Any future amendments to those instruments will change the inputs used by this Determination (s 3, s 9(2), s 10, s 16). The Determination itself anticipates variation in those linked instruments but does not record external amendments within its own text.

Litigation history

The Determination text supplied does not record any litigation history. It contains no references to court decisions, judicial interpretations, or administrative tribunal rulings. The document is a statutory instrument that prescribes payment calculation rules; the Determination itself includes no case law citations, and no appeals or legal challenges are referenced in the text provided.

Practical notes on litigation risk and where litigation would sit:

Subject matter of potential disputes: Disputes likely to lead to litigation or merits review would centre on the application of the Determination’s calculation rules, the correctness of payments made or refused by the Commonwealth, the scope of an entity’s status as an “approved hospital authority” under the National Health Act, or the interpretation and applicability of the broken‑quantity table or container cost inputs. The Determination makes heavy use of cross‑referenced instruments; disputes could also arise over how those instruments interact or whether a particular item qualifies as a “dangerous drug” under the referenced schedule or State or Territory law (s 3, s 5, s 9(2)).
Administrative review channels: Because the Determination is an exercise of the Minister’s power under the National Health Act, disputes about payment calculations are likely first addressed through administrative review mechanisms of the Department of Health, internal review, and possibly merits review avenues or judicial review of administrative decisions, but those remedies and procedural pathways are not specified in the Determination itself. Practitioners must consult the National Health Act, the Regulations and departmental guidance to identify the available review and appeal processes.
No decided cases named in the Determination: The instrument does not name or rely on any court decisions, so it provides no clues about prior judicial construction of its terms. Any judicial interpretation to date would have to be sourced externally by searching case law databases for litigation referencing PB 99 of 2020 or the payment arrangements it prescribes.

Where to look for litigation and precedents:

To identify any litigation that has engaged this Determination, practitioners should search the Federal Court and Administrative Appeals Tribunal decisions, the Federal Circuit and Family Court where applicable, and any State/Territory Supreme Court rulings that touch on related administrative decisions, and then cross‑reference those decisions to PB 99 of 2020. Additionally, departmental statements of reasons and administrative review outcomes may disclose disputes and their resolution.

Gotchas

The Determination contains several technical and operational features that give rise to practical pitfalls for hospital pharmacy managers, finance officers, compliance teams and advisers. The following are concrete “gotchas” grounded in the instrument’s text, together with their mechanisms and likely operational effects.

Reliance on external instruments for key inputs

The Determination repeatedly imports rates, mark‑ups and price schedules from other instruments. The storage and handling mark‑up is the same as the wholesale mark‑up under section 11 of the Approved Pharmacists Determination (s 10). Extemporaneously‑prepared items are priced directly from the Approved Pharmacists Determination (s 16(1)). Dangerous drug and admixture treatment depends on PB 114 of 2019 (s 3, s 9(2)). Gotcha: a hospital must track amendments to those external Determinations and ensure its pricing calculations use the current versions; failing to do so will produce miscalculated claims.

Non‑pro rata broken‑quantity table

The method for pricing broken quantities uses a non‑linear lookup table (s 13 Steps 2-4). For example, supplying 5% of a pack maps to 10% of the pack price; supplying 50% maps to 62% of the pack price; 95% maps to 98% (s 13 table). Gotcha: this produces counter‑intuitive results where a “less than pack” supply can be priced at a higher percentage of the pack than simple pro rata. Systems that attempt to compute broken quantities on a pro rata basis will be incorrect.

Container cost agreement timetable

The wholesale cost for a container must be agreed by the Minister and the Pharmacy Guild on or before 15 June and take effect on 1 August each year (s 12(2)-(3)). Gotcha: the instrument does not provide an alternative if agreement is delayed. Operationally, finance systems must be ready to apply the new container cost from 1 August; failure to do so will result in wrong payments. Negotiation delays could create ambiguity in the interim.

Rounding rules may alter marginal costs

Section 4 and s 12(5) prescribe rounding of fractional cents to the nearest cent (0.5 of a cent or more rounded up). Gotcha: when aggregated across many items, rounding differences can produce material variances between hospital invoicing and Departmental payments. Systems should implement the prescribed rounding rules consistently.

How to comply

The Determination prescribes calculation mechanics and references external instruments and annual agreements. Compliance therefore requires implementing those calculations accurately, maintaining up‑to‑date inputs from cross‑referenced instruments, and aligning finance, clinical and pharmacy operations with the Determination’s rules. Below is a practical compliance checklist and recommended operational controls, grounded in the Determination’s sections.

Confirm approved hospital authority status

Verify that your hospital authority is formally approved under subsection 94(1) of the National Health Act 1953 (s 3 definition). Only approved hospital authorities can claim Commonwealth payments under this Determination (s 8(1), s 16(2)). Keep copies of approval letters and maintain a current list of approved facilities.

Implement the dispensed price calculations

Ready‑prepared items: Implement the stepwise calculation in s 9 for the dispensed price:
- Identify if the supplied quantity is exactly a multiple of the pack quantity, less than a pack, or more than a multiple (s 9(1)(a)-(c)).
- For each full pack quantity, apply: approved ex‑manufacturer price (or proportional ex‑manufacturer price per Act), storage and handling mark‑up (as per s 10, which ties to the wholesale mark‑up in PB 66 of 2020), and the private hospital mark‑up of 1.4% on the sum of the ex‑manufacturer price and storage/handling mark‑up (s 11).
- Add the appropriate dispensing fee (ready‑prepared or extemporaneous where specified) and dangerous drug fee if applicable (s 9(1)).
- For broken quantities, follow the s 13 method: compute pack quantity sum (Step 1), express broken quantity as a percentage of pack quantity (Step 2), map via the s 13 table (Step 3), multiply (Step 4). Ensure the system stores the lookup table as prescribed.
Extemporaneously‑prepared items: Use the Commonwealth price in the Approved Pharmacists Determination as if supplied by an approved pharmacist (s 16(1)). Implement a process to import and apply those prices regularly.

Apply patient co‑payment rules

Determine patient co‑payment using the definitions in s 3, which reference section 99F of the Act for the current figures. Be aware of categories that attract a zero co‑payment where subsection 87(5A) of the Act applies (s 8(2), s 16(3)). Ensure clinical and billing teams identify patient status correctly at point of supply.

Part 1

Preliminary

Part 1—Preliminary

Name

1 Name

(1) This instrument is the National Health (Commonwealth Price ‑ Pharmaceutical benefits supplied by private hospitals) Determination 2020. (2) This instrument may also be cited as PB 99 of 2020.

Commencement

2 Commencement

(1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

<table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><thead><tr><td colspan="3" style="width:407.5pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Commencement information</span></p></td></tr><tr><td style="width:95.65pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 1</span></p></td><td style="width:209pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 2</span></p></td><td style="width:81.45pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 3</span></p></td></tr><tr><td style="width:95.65pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Provisions</span></p></td><td style="width:209pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Commencement</span></p></td><td style="width:81.45pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Date/Details</span></p></td></tr></thead><tbody><tr><td style="width:95.65pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1.</span><span> </span><span>The whole of this instrument</span></p></td><td style="width:209pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1</span><span> </span><span>October</span><span> </span><span>2020</span></p></td><td style="width:81.45pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1</span><span> </span><span>October</span><span> </span><span>2020</span></p></td></tr></tbody></table>

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

Authority

2A Authority

This instrument is made under subsection 99(4) of the National Health Act 1953.

Purpose

2B Purpose

The purpose of this determination is to determine the amount of the Commonwealth payment for pharmaceutical benefits supplied by an approved hospital authority to a patient receiving treatment in or at a private hospital for which the authority is approved.

Schedules

2C Schedules

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)

2D Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)

(1) If: (a) a thing was done for a particular purpose under the National Health Act 1953 ‑ National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010) as in force immediately before that Determination was repealed; and (b) the thing could be done for that purpose under this instrument; the thing has effect for the purposes of this instrument as if it had been done under this instrument. (2) Without limiting subsection (1), a reference in that subsection to a thing being done includes a reference to a notice, application or other instrument being given or made.

Definitions

3 Definitions

In this instrument:

Act means the National Health Act 1953.

approved ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.

approved hospital authority means a hospital authority that has been approved by the Minister under subsection 94(1) of the Act.

Approved Pharmacists Determination means the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020 (PB 66 of 2020).

brand has the same meaning as in Part VII of the Act.

current figure has the same meaning as in section 99G of the Act.

dangerous drug means:

(a) a pharmaceutical benefit mentioned in Schedule 3 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019 (PB 114 of 2019); or
(b) a pharmaceutical benefit that, under the law of a State or Territory, is classified as a dangerous drug.

dangerous drug fee has the same meaning as in Approved Pharmacists Determination.

determined quantity, of a listed brand of a pharmaceutical item, has the same meaning as in Part VII of the Act.

dispensed price:

(a) for a ready‑prepared pharmaceutical benefit—has the meaning given by section 9; and
(b) for an extemporaneously‑prepared pharmaceutical benefit—has the meaning given by subsection 16(1).

extemporaneously‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.

extemporaneously‑prepared pharmaceutical benefit means a pharmaceutical benefit that is not a ready‑prepared pharmaceutical benefit.

listed brand has the same meaning as in Part VII of the Act.

maximum quantity, of a brand of a pharmaceutical item, means a quantity or number of units of the pharmaceutical item determined under paragraph 85A(2)(a) of the Act in relation to that brand of pharmaceutical item.

pack quantity has the same meaning as in subsection 84(1) of the Act.

Note: The Minister may determine one or more pack quantities for a brand of a pharmaceutical item under subsection 84AK(2) of the Act. The quantities determined are the quantities in manufacturer’s PBS packs.

patient co‑payment means:

(a) for a person to whom, at the time that a pharmaceutical benefit is supplied, paragraph 87(2)(b) of the Act applies—the current figure for the general patient reduced charge, as defined in section 99F of the Act; or
(b) for a person who is a concessional beneficiary for section 84 of the Act—the current figure for the concessional beneficiary charge, as defined in section 99F of the Act; or
(c) for any other person—the current figure for the general patient charge, as defined in section 99F of the Act.

pharmaceutical benefit has the meaning given by section 84 of the Act.

pharmaceutical item has the same meaning as in Part VII of the Act.

private hospital means a hospital for which there is in force a statement under subsection 121‑5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.

proportional ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.

ready‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.

ready‑prepared pharmaceutical benefit means a brand of a pharmaceutical item for which there is a determination under subsection 85(6) of the Act.

Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.

repatriation pharmaceutical benefit has the meaning given by section 84 of the Act.

Part 2

Rates and conditions of payment—general

Part 2—Rates and conditions of payment—general

Rounding up and rounding down

4 Rounding up and rounding down

If the calculation of a price under this Determination includes a fraction of a cent, the final amount calculated is to then be rounded up or down to the nearest cent, with an amount of 0.5 of a cent or more being rounded up to the next cent.

Dangerous drug fee

5 Dangerous drug fee

If a pharmaceutical benefit is a dangerous drug, the Commonwealth must pay, in addition to any other amounts under this Determination, a dangerous drug fee where indicated in this Determination.

Repeat supply

6 Repeat supply

(1) If, under subsection 88(6) of the Act and section 49 of the Regulations, a medical practitioner, instead of directing a repeated supply of a pharmaceutical benefit, directs the supply of a quantity or number of units of the benefit on 1 occasion, not exceeding the total quantity or number of units that could be prescribed if the medical practitioner directed a repeated supply, the price for the purpose of this Determination for the supply includes: (a) only 1 dispensing fee, that may be: (i) a ready‑prepared dispensing fee; or (ii) an extemporaneously‑prepared dispensing fee; and (b) the price, if any, of only 1 container; and (c) if a dangerous drug fee applies, only one such fee. (2) For this section, the price, if any, for a container is to be worked out under section 12.

Drugs and medicinal preparations to which a subsection 85(6) determination applies

7 Drugs and medicinal preparations to which a subsection 85(6) determination applies

If a determination under subsection 85(6) of the Act applies to a pharmaceutical benefit that is a drug or medicinal preparation, the Commonwealth will only make a payment for the supply of a drug or medicinal preparation of the brand mentioned in the determination.

Part 3

Dispensed price for supply of ready‑prepared pharmaceutical benefits

Part 3—Dispensed price for supply of ready‑prepared pharmaceutical benefits

Amount payable to approved hospital authority

8 Amount payable to approved hospital authority

(1) The amount payable to an approved hospital authority for the supply of a ready‑prepared pharmaceutical benefit to a patient receiving treatment in or at a private hospital for which the hospital authority is approved is the amount by which the dispensed price for the benefit exceeds the patient co‑payment. (2) For a person to whom, at the time that the benefit is supplied, subsection 87(5A) of the Act applies, the amount of the patient co‑payment is zero.

Dispensed price—general

9 Dispensed price—general

(1) The dispensed price for the supply of a ready‑prepared pharmaceutical benefit by an approved hospital authority to a patient receiving treatment in or at a private hospital for which the authority is approved is: (a) if a quantity of the benefit that is ordered and supplied is equal to a multiple of a pack quantity of the benefit—the sum of: (i) for each pack quantity: (A) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and (B) the storage and handling mark‑up under section 10 for the pack quantity; and (C) the mark‑up, worked out under section 11; and (ii) a ready‑prepared dispensing fee; and (iii) if a dangerous drug fee applies, the dangerous drug fee; or (b) if a quantity of the benefit that is ordered and supplied is less than a pack quantity of the benefit—the sum of: (i) the amount worked out under section 13; and (ii) a ready‑prepared dispensing fee; and (iii) if a dangerous drug fee applies, the dangerous drug fee; and (iv) an amount for the supply of a container, worked out under section 12; or (c) if a quantity of the benefit that is ordered and supplied is more than a multiple of a pack quantity of the benefit—the sum of: (i) for each pack quantity: (A) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and (B) the storage and handling mark‑up under section 10 for the pack quantity; and (C) the mark‑up worked out under section 11; and (ii) for the remainder of the quantity that is less than a pack quantity—the amount worked out under section 13; and (iii) a ready‑prepared dispensing fee; and (iv) if a dangerous drug fee applies, the dangerous drug fee. (2) However, for a ready‑prepared pharmaceutical benefit that comprises the admixture of ready‑prepared ingredients and is specified in Schedule 1 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019: (a) the ready‑prepared dispensing fee does not apply; and (b) an extemporaneously‑prepared dispensing fee must be paid by the Commonwealth; and (c) no amount for the supply of the container is payable; and (d) if a dangerous drug fee applies, the dangerous drug fee.

Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)

10 Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)

For the purposes of sub‑subparagraphs 9(1)(a)(i)(B) and (c)(i)(B) and paragraph (b) of step 1 in section 13, the storage and handling mark‑up for a pack quantity of a ready‑prepared pharmaceutical benefit is the same as the wholesale mark‑up for the pack quantity of the benefit would have been under section 11 of the Approved Pharmacists Determination if the benefit had been supplied by an approved pharmacist.

Private hospital mark‑up

11 Private hospital mark‑up

(1) For sub‑subparagraph 9(1)(a)(i)(C), the mark‑up for a ready‑prepared pharmaceutical benefit is an amount equal to 1.4% of the sum of the amounts worked out under sub‑subparagraphs 9(1)(a)(i)(A) and (B). (2) For sub‑subparagraph 9(1)(c)(i)(C), the mark‑up for a ready‑prepared pharmaceutical benefit is an amount equal to 1.4% of the sum of the amounts worked out under sub‑subparagraphs 9(1)(c)(i)(A) and (B).

Container price

12 Container price

(1) The price for a container for a ready‑prepared pharmaceutical benefit is the sum of: (a) the wholesale cost worked out under subsection (2); and (b) the mark‑up worked out under subsection (4). (2) The wholesale cost for a container will be based on the average of wholesale costs for a particular container, in a quantity of 100, as agreed by the Minister and the Pharmacy Guild of Australia for the supply of the container, by a wholesale drug distributor. (3) The wholesale cost must be agreed on or before 15 June in a year and takes effect on 1 August in that year. (4) For paragraph (1)(b), the mark‑up is 10% of the amount agreed under subsection (2). (5) For a mark‑up worked out under subsection (4), if the calculation of a percentage of the wholesale cost includes a fraction of a cent, the mark‑up is to be rounded up or down to the nearest cent, with an amount of 0.5 of a cent or more being rounded up to the next cent. (6) In this section:

container means:

(a) for a ready‑prepared pharmaceutical benefit that is injectable—a vial with a capacity of 150 ml; or
(b) for any other ready‑prepared pharmaceutical benefit—a vial with a capacity of 25 ml.

Price for broken quantities

13 Price for broken quantities

If a ready‑prepared pharmaceutical benefit is ordered and supplied in a quantity that is less than a pack quantity (the broken quantity), the amount mentioned in subparagraph 9(1)(b)(i) or (c)(ii) is to be worked out using the following method statement. Method statement Step 1 Add together, for a pack quantity: (a) the approved ex‑manufacturer price or the proportional ex‑manufacturer price (as applicable) for the pack quantity; and (b) the storage and handling mark‑up under section 10 for the pack quantity; and (c) the mark‑up worked out under section 11. Step 2 Divide the quantity or number of units in the broken quantity by the pack quantity and express as a percentage. Step 3 For a percentage up to and including an amount in column 1 of the following table, select the percentage mentioned in column 2 of the previous item in the following table.

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100

Step 4 Multiply the amount worked out under step 3 by the amount worked out under step 1.

Ready‑prepared pharmaceutical benefits—limit on the dispensed price

14 Ready‑prepared pharmaceutical benefits—limit on the dispensed price

If the dispensed price worked out for the supply of a broken quantity of a ready‑prepared pharmaceutical benefit exceeds the dispensed price for a pack quantity, the dispensed price for the pack quantity is the dispensed price for the broken quantity.

Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act

15 Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act

If a prescription directs the supply of a quantity of a pharmaceutical benefit mentioned in a determination under paragraph 98C(1)(b) of the Act as a pharmaceutical benefit the complete pack of which shall be supplied regardless of any lesser quantity ordered, the dispensed price is the price worked out as if a complete pack was supplied.

Part 4

Dispensed price for supply of extemporaneously‑prepared pharmaceutical benefits

Part 1—Preliminary

1 Name

(1) This instrument is the National Health (Commonwealth Price ‑ Pharmaceutical benefits supplied by private hospitals) Determination 2020. (2) This instrument may also be cited as PB 99 of 2020.

2 Commencement

<table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><thead><tr><td colspan="3" style="width:407.5pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Commencement information</span></p></td></tr><tr><td style="width:95.65pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 1</span></p></td><td style="width:209pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 2</span></p></td><td style="width:81.45pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 3</span></p></td></tr><tr><td style="width:95.65pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Provisions</span></p></td><td style="width:209pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Commencement</span></p></td><td style="width:81.45pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Date/Details</span></p></td></tr></thead><tbody><tr><td style="width:95.65pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1.</span><span> </span><span>The whole of this instrument</span></p></td><td style="width:209pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1</span><span> </span><span>October</span><span> </span><span>2020</span></p></td><td style="width:81.45pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1</span><span> </span><span>October</span><span> </span><span>2020</span></p></td></tr></tbody></table>

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

2A Authority

This instrument is made under subsection 99(4) of the National Health Act 1953.

2B Purpose

2C Schedules

2D Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)

3 Definitions

In this instrument:

Act means the National Health Act 1953.

approved ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.

approved hospital authority means a hospital authority that has been approved by the Minister under subsection 94(1) of the Act.

Approved Pharmacists Determination means the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020 (PB 66 of 2020).

brand has the same meaning as in Part VII of the Act.

current figure has the same meaning as in section 99G of the Act.

dangerous drug means:

(a) a pharmaceutical benefit mentioned in Schedule 3 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019 (PB 114 of 2019); or
(b) a pharmaceutical benefit that, under the law of a State or Territory, is classified as a dangerous drug.

dangerous drug fee has the same meaning as in Approved Pharmacists Determination.

determined quantity, of a listed brand of a pharmaceutical item, has the same meaning as in Part VII of the Act.

dispensed price:

(a) for a ready‑prepared pharmaceutical benefit—has the meaning given by section 9; and
(b) for an extemporaneously‑prepared pharmaceutical benefit—has the meaning given by subsection 16(1).

extemporaneously‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.

extemporaneously‑prepared pharmaceutical benefit means a pharmaceutical benefit that is not a ready‑prepared pharmaceutical benefit.

listed brand has the same meaning as in Part VII of the Act.

maximum quantity, of a brand of a pharmaceutical item, means a quantity or number of units of the pharmaceutical item determined under paragraph 85A(2)(a) of the Act in relation to that brand of pharmaceutical item.

pack quantity has the same meaning as in subsection 84(1) of the Act.

Note: The Minister may determine one or more pack quantities for a brand of a pharmaceutical item under subsection 84AK(2) of the Act. The quantities determined are the quantities in manufacturer’s PBS packs.

patient co‑payment means:

(a) for a person to whom, at the time that a pharmaceutical benefit is supplied, paragraph 87(2)(b) of the Act applies—the current figure for the general patient reduced charge, as defined in section 99F of the Act; or
(b) for a person who is a concessional beneficiary for section 84 of the Act—the current figure for the concessional beneficiary charge, as defined in section 99F of the Act; or
(c) for any other person—the current figure for the general patient charge, as defined in section 99F of the Act.

pharmaceutical benefit has the meaning given by section 84 of the Act.

pharmaceutical item has the same meaning as in Part VII of the Act.

private hospital means a hospital for which there is in force a statement under subsection 121‑5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.

proportional ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.

ready‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.

ready‑prepared pharmaceutical benefit means a brand of a pharmaceutical item for which there is a determination under subsection 85(6) of the Act.

Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.

repatriation pharmaceutical benefit has the meaning given by section 84 of the Act.

Part 2—Rates and conditions of payment—general

4 Rounding up and rounding down

5 Dangerous drug fee

If a pharmaceutical benefit is a dangerous drug, the Commonwealth must pay, in addition to any other amounts under this Determination, a dangerous drug fee where indicated in this Determination.

6 Repeat supply

7 Drugs and medicinal preparations to which a subsection 85(6) determination applies

Part 3—Dispensed price for supply of ready‑prepared pharmaceutical benefits

8 Amount payable to approved hospital authority

9 Dispensed price—general

10 Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)

11 Private hospital mark‑up

12 Container price

container means:

(a) for a ready‑prepared pharmaceutical benefit that is injectable—a vial with a capacity of 150 ml; or
(b) for any other ready‑prepared pharmaceutical benefit—a vial with a capacity of 25 ml.

13 Price for broken quantities

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100

Step 4 Multiply the amount worked out under step 3 by the amount worked out under step 1.

14 Ready‑prepared pharmaceutical benefits—limit on the dispensed price

15 Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act

Part 4—Dispensed price for supply of extemporaneously‑prepared pharmaceutical benefits

16 Extemporaneously‑prepared pharmaceutical benefits

(1) For an extemporaneously‑prepared pharmaceutical benefit supplied to a patient receiving treatment in or at a private hospital for which the hospital authority is approved, the dispensed price is the Commonwealth price determined for the benefit under the Approved Pharmacists Determination, as if the benefit was supplied by an approved pharmacist. (2) The amount payable to the approved hospital authority for the supply of an extemporaneously‑prepared pharmaceutical benefit to the patient is the amount by which the dispensed price for the benefit exceeds the patient co‑payment. (3) For a person to whom, at the time that the benefit is supplied, subsection 87(5A) of the Act applies, the amount of the patient co‑payment is zero.

Extemporaneously‑prepared pharmaceutical benefits

16 Extemporaneously‑prepared pharmaceutical benefits

Source text: opening excerpt

Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.

Part 1 Preliminary

Part 1—Preliminary

1 Name

(1) This instrument is the National Health (Commonwealth Price ‑ Pharmaceutical benefits supplied by private hospitals) Determination 2020. (2) This instrument may also be cited as PB 99 of 2020.

2 Commencement

<table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><thead><tr><td colspan="3" style="width:407.5pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Commencement information</span></p></td></tr><tr><td style="width:95.65pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 1</span></p></td><td style="width:209pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 2</span></p></td><td style="width:81.45pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 3</span></p></td></tr><tr><td style="width:95.65pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Provisions</span></p></td><td style="width:209pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Commencement</span></p></td><td style="width:81.45pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Date/Details</span></p></td></tr></thead><tbody><tr><td style="width:95.65pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1.</span><span> </span><span>The whole of this instrument</span></p></td><td style="width:209pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1</span><span> </span><span>October</span><span> </span><span>2020</span></p></td><td style="width:81.45pt; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>1</span><span> </span><span>October</span><span> </span><span>2020</span></p></td></tr></tbody></table>

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

2A Authority

This instrument is made under subsection 99(4) of the National Health Act 1953.

2B Purpose

2C Schedules

2D Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)

3 Definitions

In this instrument:

Act means the National Health Act 1953.

approved ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.

approved hospital authority means a hospital authority that has been approved by the Minister under subsection 94(1) of the Act.

Approved Pharmacists Determination means the Commonwealth price (Pharmaceutical benefits supplied by approved pharmacists) Determination 2020 (PB 66 of 2020).

brand has the same meaning as in Part VII of the Act.

current figure has the same meaning as in section 99G of the Act.

dangerous drug means:

(a) a pharmaceutical benefit mentioned in Schedule 3 to the National Health (Commonwealth Price and Conditions for Commonwealth Payments for Supply of Pharmaceutical Benefits) Determination 2019 (PB 114 of 2019); or
(b) a pharmaceutical benefit that, under the law of a State or Territory, is classified as a dangerous drug.

dangerous drug fee has the same meaning as in Approved Pharmacists Determination.

determined quantity, of a listed brand of a pharmaceutical item, has the same meaning as in Part VII of the Act.

dispensed price:

(a) for a ready‑prepared pharmaceutical benefit—has the meaning given by section 9; and
(b) for an extemporaneously‑prepared pharmaceutical benefit—has the meaning given by subsection 16(1).

extemporaneously‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.

extemporaneously‑prepared pharmaceutical benefit means a pharmaceutical benefit that is not a ready‑prepared pharmaceutical benefit.

listed brand has the same meaning as in Part VII of the Act.

maximum quantity, of a brand of a pharmaceutical item, means a quantity or number of units of the pharmaceutical item determined under paragraph 85A(2)(a) of the Act in relation to that brand of pharmaceutical item.

pack quantity has the same meaning as in subsection 84(1) of the Act.

Note: The Minister may determine one or more pack quantities for a brand of a pharmaceutical item under subsection 84AK(2) of the Act. The quantities determined are the quantities in manufacturer’s PBS packs.

patient co‑payment means:

(a) for a person to whom, at the time that a pharmaceutical benefit is supplied, paragraph 87(2)(b) of the Act applies—the current figure for the general patient reduced charge, as defined in section 99F of the Act; or
(b) for a person who is a concessional beneficiary for section 84 of the Act—the current figure for the concessional beneficiary charge, as defined in section 99F of the Act; or
(c) for any other person—the current figure for the general patient charge, as defined in section 99F of the Act.

pharmaceutical benefit has the meaning given by section 84 of the Act.

pharmaceutical item has the same meaning as in Part VII of the Act.

private hospital means a hospital for which there is in force a statement under subsection 121‑5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.

proportional ex‑manufacturer price has the same meaning as in subsection 84(1) of the Act.

ready‑prepared dispensing fee has the same meaning as in the Approved Pharmacists Determination.

ready‑prepared pharmaceutical benefit means a brand of a pharmaceutical item for which there is a determination under subsection 85(6) of the Act.

Regulations means the National Health (Pharmaceutical Benefits) Regulations 2017.

repatriation pharmaceutical benefit has the meaning given by section 84 of the Act.

Part 2 Rates and conditions of payment—general

Part 2—Rates and conditions of payment—general

4 Rounding up and rounding down

5 Dangerous drug fee

If a pharmaceutical benefit is a dangerous drug, the Commonwealth must pay, in addition to any other amounts under this Determination, a dangerous drug fee where indicated in this Determination.

6 Repeat supply

7 Drugs and medicinal preparations to which a subsection 85(6) determination applies

Part 3 Dispensed price for supply of ready‑prepared pharmaceutical benefits

Part 3—Dispensed price for supply of ready‑prepared pharmaceutical benefits

8 Amount payable to approved hospital authority

9 Dispensed price—general

10 Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)

11 Private hospital mark‑up

12 Container price

container means:

(a) for a ready‑prepared pharmaceutical benefit that is injectable—a vial with a capacity of 150 ml; or
(b) for any other ready‑prepared pha

This is an opening excerpt, not the complete document.

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100

Plain English Summary

Deep Dive

What it does

Main concepts

Who it affects

Key duties and rights

Penalties and enforcement

How it interacts with other laws

Amendment history

Litigation history

Gotchas

How to comply

Current sections

Preliminary

Part 1—Preliminary

Name

1 Name

Commencement

2 Commencement

Authority

2A Authority

Purpose

2B Purpose

Schedules

2C Schedules

Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)

2D Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)

Definitions

3 Definitions

Rates and conditions of payment—general

Part 2—Rates and conditions of payment—general

Rounding up and rounding down

4 Rounding up and rounding down

Dangerous drug fee

5 Dangerous drug fee

Repeat supply

6 Repeat supply

Drugs and medicinal preparations to which a subsection 85(6) determination applies

7 Drugs and medicinal preparations to which a subsection 85(6) determination applies

Dispensed price for supply of ready‑prepared pharmaceutical benefits

Part 3—Dispensed price for supply of ready‑prepared pharmaceutical benefits

Amount payable to approved hospital authority

8 Amount payable to approved hospital authority

Dispensed price—general

9 Dispensed price—general

Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)

10 Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)

Private hospital mark‑up

11 Private hospital mark‑up

Container price

12 Container price

Price for broken quantities

13 Price for broken quantities

Ready‑prepared pharmaceutical benefits—limit on the dispensed price

14 Ready‑prepared pharmaceutical benefits—limit on the dispensed price

Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act

15 Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act

Dispensed price for supply of extemporaneously‑prepared pharmaceutical benefits

Part 1—Preliminary

1 Name

2 Commencement

2A Authority

2B Purpose

2C Schedules

2D Things done under the National Health (Pharmaceutical benefits supplied by private hospitals) Determination 2010 (21/09/2010)

3 Definitions

Part 2—Rates and conditions of payment—general

4 Rounding up and rounding down

5 Dangerous drug fee

6 Repeat supply

7 Drugs and medicinal preparations to which a subsection 85(6) determination applies

Part 3—Dispensed price for supply of ready‑prepared pharmaceutical benefits

8 Amount payable to approved hospital authority

9 Dispensed price—general

10 Storage and handling mark‑up (same as wholesale mark‑up for approved pharmacists)

11 Private hospital mark‑up

12 Container price

13 Price for broken quantities

14 Ready‑prepared pharmaceutical benefits—limit on the dispensed price

15 Pharmaceutical benefits mentioned in a determination under paragraph 98C(1)(b) of the Act

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100

Column 1Up to and including: (%)	Column 2Select amount: (%)
5	10
10	18
15	26
20	32
25	38
30	44
35	50
40	54
45	58
50	62
55	66
60	70
65	74
70	78
75	82
80	86
85	90
90	94
95	98
100	100