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(1) This instrument is the National Health (Price and Special Patient Contribution) Determination 2022 (2) This instrument may also be cited as PB 98 of 2022.
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Commonwealth legislation
This instrument sets the official prices and payment rules used under the National Health Act for specific PBS medicines. It fixes the ‘determined price’ (the maximum price taken for a pricing quantity) and the ‘claimed price’ for pack quantities for brands listed in Schedule 1, and specifies when the Commonwealth will pay a special patient contribution for brands listed in Schedule 2. It therefore changes reimbursement and administrative steps for manufacturers, pharmacies and patients; Commonwealth payment requires prescription authorisation or Chief Executive Medicare approval (see section 8).
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Direct links to the current provisions in National Health (Price and Special Patient Contribution) Determination 2022.
(1) This instrument is the National Health (Price and Special Patient Contribution) Determination 2022 (2) This instrument may also be cited as PB 98 of 2022.
This instrument is made under section 85B of the National Health Act 1953.
(1) In this instrument:
Act means the National Health Act 1953.
base‑priced drug in relation to a brand of a pharmaceutical item mentioned in Schedule 2 (the relevant brand), means all brands of pharmaceutical items that have:
(a) the same drug as the relevant brand; or
(b) a drug in the same therapeutic group as that drug;
and for which no price is determined under section 85B of the Act.
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 a manufacturer’s PBS packs.
pricing quantity has the same meaning as in subsection 84(1) of the Act.
Note: Subsection 84AK(1) of the Act provides that the pricing quantity of a brand of a pharmaceutical item is the lowest of any pack quantity of any brand of the pharmaceutical item.
special patient contribution has the same meaning as in subsection 84(1) of the Act.
For the purposes of subsection 85B(2) of the Act, the amount that is, for the purposes of Part VII of the Act, taken to be the appropriate maximum price for the pricing quantity of a brand of a pharmaceutical item mentioned in Schedule 1 to this instrument, is the price for the brand mentioned in the column headed “Determined price” for the pricing quantity mentioned in the column headed “Pricing quantity/pack quantity”.
For the purposes of subsection 85B(3) of the Act, the amount that is, for the purposes of Part VII of the Act, taken to be the price claimed by the responsible person for a pack quantity of a brand of a pharmaceutical item mentioned in Schedule 1 to this instrument, is the price for the brand mentioned in the column headed “Claimed price” for the pack quantity mentioned in the column headed “Pricing quantity/pack quantity”.
(1) For the purposes of subsection 85B(4) of the Act, the circumstances in which the Commonwealth is to pay the special patient contribution for a brand of a pharmaceutical item are: (a) the brand of pharmaceutical item is mentioned in Schedule 2 to this instrument; and (b) the brand has been prescribed in a circumstance mentioned for the brand in Schedule 2 to this instrument; and (c) either: (i) writing the prescription has been authorised in accordance with section 19 of the National Health (Listing of Pharmaceutical Benefits) Instrument 2024; or (ii) if the circumstances are not ones in which writing the prescription requires authorisation—the prescription satisfies the requirements of subsection (2). (2) A prescription satisfies the requirements of this subsection if: (a) the prescription or details of the prescription are submitted to the Chief Executive Medicare; and (b) the Chief Executive Medicare authorises the prescription for the purposes of payment of the special patient contribution and allots a number to the prescription; and (c) the allotted number is written on the prescription. (3) For the purposes of this section, the pharmaceutical item is the listed drug mentioned in Schedule 2: (a) in the form mentioned in Schedule 2 for the listed drug; and (b) with the manner of administration mentioned in Schedule 2 for the form of the listed drug.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
(1) This instrument is the National Health (Price and Special Patient Contribution) Determination 2022 (2) This instrument may also be cited as PB 98 of 2022.
This instrument is made under section 85B of the National Health Act 1953.
(1) In this instrument:
Act means the National Health Act 1953.
base‑priced drug in relation to a brand of a pharmaceutical item mentioned in Schedule 2 (the relevant brand), means all brands of pharmaceutical items that have:
(a) the same drug as the relevant brand; or
(b) a drug in the same therapeutic group as that drug;
and for which no price is determined under section 85B of the Act.
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 a manufacturer’s PBS packs.
pricing quantity has the same meaning as in subsection 84(1) of the Act.
Note: Subsection 84AK(1) of the Act provides that the pricing quantity of a brand of a pharmaceutical item is the lowest of any pack quantity of any brand of the pharmaceutical item.
special patient contribution has the same meaning as in subsection 84(1) of the Act.
For the purposes of subsection 85B(2) of the Act, the amount that is, for the purposes of Part VII of the Act, taken to be the appropriate maximum price for the pricing quantity of a brand of a pharmaceutical item mentioned in Schedule 1 to this instrument, is the price for the brand mentioned in the column headed “Determined price” for the pricing quantity mentioned in the column headed “Pricing quantity/pack quantity”.
For the purposes of subsection 85B(3) of the Act, the amount that is, for the purposes of Part VII of the Act, taken to be the price claimed by the responsible person for a pack quantity of a brand of a pharmaceutical item mentioned in Schedule 1 to this instrument, is the price for the brand mentioned in the column headed “Claimed price” for the pack quantity mentioned in the column headed “Pricing quantity/pack quantity”.
(1) For the purposes of subsection 85B(4) of the Act, the circumstances in which the Commonwealth is to pay the special patient contribution for a brand of a pharmaceutical item are: (a) the brand of pharmaceutical item is mentioned in Schedule 2 to this instrument; and (b) the brand has been prescribed in a circumstance mentioned for the brand in Schedule 2 to this instrument; and (c) either: (i) writing the prescription has been authorised in accordance with section 19 of the National Health (Listing of Pharmaceutical Benefits) Instrument 2024; or (ii) if the circumstances are not ones in which writing the prescription requires authorisation—the prescription satisfies the requirements of subsection (2). (2) A prescription satisfies the requirements of this subsection if: (a) the prescription or details of the prescription are submitted to the Chief Executive Medicare; and (b) the Chief Executive Medicare authorises the prescription for the purposes of payment of the special patient contribution and allots a number to the prescription; and (c) the allotted number is written on the prescription. (3) For the purposes of this section, the pharmaceutical item is the listed drug mentioned in Schedule 2: (a) in the form mentioned in Schedule 2 for the listed drug; and (b) with the manner of administration mentioned in Schedule 2 for the form of the listed drug.