National Health (Supplies of out‑patient medication) Determination 2019 (No. 2)

PB 110 of 2019

made under section 84BA of the

National Health Act 1953

Compilation No. 4

Compilation date: 1 January 2023

Includes amendments up to: F2022L01764

Registered: 20 January 2023

About this compilation

This compilation

This is a compilation of the National Health (Supplies of out-patient medication) Determination 2019 (No. 2) that shows the text of the law as amended and in force on 1 January 2023 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

1 Name of Instrument

(1) This Determination is the National Health (Supplies of out‑patient medication) Determination 2019 (No. 2).

(2) This Determination may also be cited as PB 110 of 2019.

3 Authority

This Determination is made under section 84BA of the National Health Act 1953.

5 Interpretation

(1) In this Determination:

National Health Reform Agreement has the meaning given in the Federal Financial Relations Act 2009.

 out‑patient medication has the same meaning as in subsection 84(1) of the Act.

 Pharmaceutical Reform Arrangements means arrangements which provide for public hospitals that are Approved Hospital Authorities under Section 94 of the National Health Act 1953 to supply pharmaceuticals funded by the PBS for specific categories of patients including:

• admitted patients on separation;
• non‑admitted patients; and
• same day admitted patients for a range of drugs made available by specific delivery arrangements under Section 100 of the National Health Act 1953.

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

the Act means the National Health Act 1953.

 the amount referred to in paragraph 87(2)(a) of the Act means the amount as periodically adjusted under section 99G of the Act.

 the amount referred to in paragraph 87(2)(e) of the Act means the amount as periodically adjusted under section 99G of the Act.

 the maximum value of the supply of out‑patient medication means the amount specified in section 7, 8, 9 or 10 as appropriate.

 (2) Unless the contrary intention appears, a word or expression that is defined in the Act shall be taken to have the same meaning as in the Act.

6  Amount taken to have been paid to a public hospital for the supply of out‑patient medication

 The amount that, for the purposes of Part VII of the Act, will be taken to have been paid to a public hospital for a supply of out‑patient medication to a person is the lesser of:

(a)  the maximum value of the supply of out‑patient medication; or

(b) the amount charged.

7  Maximum value of the supply of out‑patient medication to a person who is a concessional beneficiary, a dependant of a concessional beneficiary or a holder of a concession card

The maximum value of the supply of out‑patient medication to a person who is a concessional beneficiary, a dependant of a concessional beneficiary or the holder of a concession card is an amount that is equivalent to the amount referred to in paragraph 87(2)(a) of the Act for the supply of a pharmaceutical benefit by an approved pharmacist or approved medical practitioner.

8  Maximum value of the supply of out‑patient medication to a person who is a general patient and who is not a holder of a concession card

(1) The maximum value of the supply of out‑patient medication to a person who is a general patient and who is not the holder of a concession card is $24.00.

(2) This section does not apply to supplies of out‑patient medication made by:

(a) a public hospital located in the State of Queensland; or

(b) a public hospital that is participating in Pharmaceutical Reform Arrangements.

9 Maximum value of the supply of out‑patient medication by a Queensland public hospital to a person who is a general patient and who is not a holder of a concession card

 (1) This section applies to supplies of out‑patient medication made by a public hospital located in the State of Queensland.

 (2) For supplies of outpatient medication mentioned in subsection (1), the maximum value of the supply of out‑patient medication to a person who is a general patient and who is not the holder of a concession card is:

(a) where the medication is a drug or medicinal preparation that is a pharmaceutical benefit and the Commonwealth price for that pharmaceutical benefit exceeds the amount referred to in paragraph 87(2)(e) of the Act — an amount that is equivalent to the amount referred to in paragraph  87(2)(e) of the Act for the supply of a pharmaceutical benefit by an approved pharmacist or approved medical practitioner; or

(b) where the medication is a drug or medicinal preparation that is a pharmaceutical benefit and the Commonwealth price for that pharmaceutical benefit does not exceed the amount referred to in paragraph 87(2)(e) of the Act — the price for that pharmaceutical benefit ascertained in accordance with the determination under subsection 84C(7) of the Act as in force from time to time; or

(c) where the medication is a drug or medicinal preparation which is not a pharmaceutical benefit — the amount ascertained by taking as a basis the cost to the hospital of that drug or medicinal preparation and applying, as if that cost were the approved ex‑manufacturer price or proportional ex‑manufacturer price, the determination under subsection 84C(7) of the Act as in force from time to time.

10 Maximum value of the supply of out‑patient medication by a participating public hospital to a person who is a general patient and who is not a holder of a concession card

 (1) This section applies to supplies of out‑patient medication made by a public hospital that is participating in Pharmaceutical Reform Arrangements, except if the public hospital is located in the State of Queensland.

 (2) For supplies of out‑patient medication mentioned in subsection (1), the maximum value of the supply of out‑patient medication to a person who is a general patient and who is not the holder of a concession card is:

(a)              where the medication is a drug or medicinal preparation that is a pharmaceutical benefit — the maximum value of the pharmaceutical benefit ascertained in accordance with regulation 17A of the National Health (Pharmaceutical Benefits) Regulations 2017 as if the pharmaceutical benefit had been supplied by an approved pharmacist or an approved medical practitioner; or

(b) where the medication is a drug or medicinal preparation that is not a pharmaceutical benefit — the amount ascertained by taking as a basis the cost to the hospital of that drug or medicinal preparation and applying, as if that cost were the approved ex‑manufacturer price or proportional ex‑manufacturer price, the determination under subsection 84C(7) of the Act as in force from time to time.

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history