Federal Register of Legislation - Australian Government

Primary content

R45/2011 Principles as made
This instrument amends the Repatriation Pharmaceutical Benefits Scheme to enable the Commonwealth (Department of Veterans' Affairs) to reimburse certain co-payments paid by entitled persons for pharmaceuticals under the Repatriation Pharmaceutical Benefits Scheme.
Administered by: Veterans' Affairs
Registered 14 Oct 2011
Tabling HistoryDate
Tabled HR31-Oct-2011
Tabled Senate31-Oct-2011
Date of repeal 19 Mar 2014
Repealed by Veterans' Affairs (Spent and Redundant Instruments) Repeal Regulation 2014

Australian Government

Veterans’ Entitlements Act 1986

 

Veterans’ Entitlements (Veterans’ Pharmaceutical Reimbursement Scheme) Instrument 2011

 

Instrument No. R45/2011

 

 

I, Warren Snowdon, Minister for Veterans’ Affairs, pursuant to subsection 91(3) of the Veterans’ Entitlements Act 1986, approve this instrument made by the Repatriation Commission.

Dated this   6th    day of                   October       2011

Warren Snowdon

……………………….............................................

WARREN SNOWDON

 

The Repatriation Commission, pursuant to subsection 91(2) of the Veterans’ Entitlements Act 1986, varies the Repatriation Pharmaceutical Benefits Scheme (Instrument No.12 of 1995) in accordance with the Schedule.

Dated this    23rd             day of                  September  2011

Ian Campbell……     …Elizabeth (Liz) Cosson            Major General Mark Kelly

……………………………………………………………………………………….

IAN CAMPBELL         ELIZABETH (LIZ) COSSON        Major General Mark Kelly

        PSM                                            AM CSC                                              AO DSC

    PRESIDENT         ACTING DEPUTY PRESIDENT                     COMMISSIONER

 

 

 

[1]     Name of Instrument

This instrument is the Veterans’ Entitlements (Veterans’ Pharmaceutical Reimbursement Scheme) Instrument 2011

 

[2]  Commencement

 

This instrument commences, or is taken to have commenced, on

1 January 2012.

 

 


 

Schedule

 

1.      Part 1 - Interpretation - paragraph 3

 

insert:

 

“Act” means the Veterans’ Entitlements Act 1986;

 

accepted disability” means a war-caused injury or a war-caused disease or a defence-caused injury or a defence-caused disease;

 

Note: war-caused injury etc is defined in the Act.

 

“concessional beneficiary” has the same meaning it has in section 84 of the National Health Act 1953, in force from time to time;

 

“concessional beneficiary safety net” has the same meaning it has in

section 99F of the National Health Act 1953, in force from time to time;

 

“co-payment”, in respect of a Pharmaceutical benefit, means that part of the price of a Pharmaceutical benefit that is borne by the Eligible Person

in relation to a Pharmaceutical benefit made available under the Scheme;

 

 “general patient safety net” has the same meaning it has in section 99F of the National Health Act 1953, in force from time to time;

 

income support payment” is a service pension (defined in subsection 5Q(1) of the Act or an income support supplement (referred to in Part IIIA of the Act).

 

“income support payment under the Social Security Act 1991” means a payment referred to in the definition of “income support payment” in subsection 23(1) of the Social Security Act 1991.

 

“MRCA supplement” means a payment under section 300 of the Military Rehabilitation and Compensation Act 2004;

 

“pension supplement” has the same meaning it has in subsection 5Q(1) of the Act, in force from time to time;

 

“pharmaceutical allowance” means the component of the veterans supplement or pension supplement or MRCA supplement that is to assist with the purchase of Pharmaceutical benefits, the calculated value of which is referred to in paragraph 5 (pharmaceutical allowance component) of Part 5A.

 

“pharmaceutical reimbursement” means the financial amount described in paragraphs 1-3 of Part 5A.

 

safety net ”, in respect of its application to a person under this Scheme, means the concessional beneficiary safety net or general patient safety net, whichever amount first applies to the person for the purposes of section 84C of the National Health Act 1953, in force from time to time;

 

Note: under section 84C of the National Health Act 1953 a concession card or entitlement card is issued when a person reaches their Safety Net.  The card is issued for the “relevant entitlement period”.  The relevant entitlement period is the remainder of the calendar year after the card is issued.

 

“Scheme” means the Repatriation Pharmaceutical Benefits Scheme;

 

“social security pension supplement” means a rate or amount worked out under section 20A of the Social Security Act 1991;

“veterans supplement” means the payment under section 118A of the Act;

 

2.       Paragraph 21 (Financial responsibility)

 

omit, substitute:

 

Financial responsibility

 

21.  (1) In respect of each Pharmaceutical benefit provided to an Eligible Person under this Scheme, the Commission will accept financial responsibility for:
 
            (a)     subject to (b) all of the dispensed price but the co-                           payment that would be payable by the person if the             person were a concessional beneficiary; or
 

Note 1: (a) deems the person to be a concessional beneficiary for the purposes of working out the co-payment.

 

Note 2: co-payments not covered by the pension supplement amount or veterans supplement may be reimbursed under Part 5A up to the safety net amount for a person.

 

(b)     if the safety net applies to the person, all of the                         dispensed price.

 

3.      Part 5 — Payments to Community Pharmacists

 

after this Part, insert:

 
Part 5A — Pharmaceutical Reimbursement

 

1.  The Commission may, subject to this Part, accept financial responsibility for the pharmaceutical reimbursement.
 

Note: if the Commission accepts financial responsibility for a cost in relation to the provision of a Pharmaceutical benefit to an Eligible Person, the Commonwealth pays that cost.

 

2.  The pharmaceutical reimbursement is a financial amount that would compensate an Eligible Person for out-of-pocket expenses the person incurred in respect of a Pharmaceutical benefit provided under this Scheme.

 

Note: under the Acts Interpretation Act 1901 words in the singular number (e.g. Pharmaceutical benefit) include the plural and words in the plural number include the singular.

 

3.  The amount of pharmaceutical reimbursement is worked out under 7.

 

Eligibility for Payment of Pharmaceutical Reimbursement

 

4.  (1)     To be eligible for payment of the pharmaceutical          reimbursement an Eligible Person must:

 

     (a) have rendered qualifying service; and

 

     (b) suffer from an accepted disability; and

 

     (c) receive pension under Part II or Part IV of the Act in    respect of the accepted disability.

 

(2)     For the purposes of paragraph 4(1)(c), a person is taken to receive pension under Part II or Part IV of the Act if, apart from section 25A, Division 5A of Part II and section 74 of the Act, the person would receive a rate of pension greater than nil.

 

 

Calculation of annual value of pharmaceutical allowance component of Pension Supplement, Veterans Supplement, MRCA supplement

 

5.  The annual value of the pharmaceutical allowance component is calculated as follows:

 

(a)              for a veteran in receipt of veterans supplement or MRCA supplement at different times throughout the year, the amount of $6 per fortnight, indexed according to section 198F of the Act since September 2009 (i.e. once annually since 1 January 2010), calculated at a daily rate and valued according to the number of days in the calendar year veterans supplement or MRCA supplement was payable;

(b)             subject to 5(c), for a veteran in receipt of pension supplement, the amount of $6 per fortnight, indexed according to Division 18 of Part IIIB of the Act since September 2009 (i.e. each 20 March and 20 September commencing 20 March 2010), calculated at a daily rate and valued according to the number of days in the calendar year pension supplement was payable;

(c)              for a veteran in receipt of pension supplement who is a member of a couple and whose partner does not receive an income support payment or an income support payment under the Social Security Act 1991 that attracts a social security pension supplement greater than the basic amount of pension supplement50% of the amount in 5(b).

 

Note: the following terms are defined in the Act:

 

“veteran” - 5C(1);

“member of a couple” - 5E(2);

“partner” – 5E(1).

 

Payment of Pharmaceutical Reimbursement

 

6 (1) On and after 1 January 2013 the pharmaceutical reimbursement is payable to a person eligible for it under this Part.

 

(2) The pharmaceutical reimbursement is payable in the first quarter in each calendar year in respect of co-payments the person made for a Pharmaceutical benefit under this Scheme in the previous calendar year – not being a calendar year before 1 January 2012.

 

Note: calendar year is defined in section 2B of the Acts Interpretation Act 1901.

 

Pharmaceutical Reimbursement Calculator

 

7.  The pharmaceutical reimbursement for an Eligible Person is worked out as follows:

 

Step 1 add the co-payments for the Pharmaceutical benefits incurred by the person in the previous calendar year (sum of co-payments) up to the threshold of payments according to the safety net and disregarding any uncounted co-payment.

 

Step 2 compare the sum of co-payments with the sum of the pharmaceutical allowance component of the veterans supplement, MRCA supplement and pension supplement payable to the person in respect of the previous calendar year.

 

Step 3 if the sum of co-payments (amount 1) exceeds the sum of the pharmaceutical allowance component of the veterans supplement, MRCA supplement and pension supplement payable (amount 2), the amount by which amount 1 exceeds amount 2 is the pharmaceutical reimbursement for the person.

 

Note: the amount of any of these supplements may be zero.

 

8.  For the Pharmaceutical Reimbursement Calculator an uncounted co-payment is a co-payment for a Pharmaceutical benefit where the co-  payment is not counted for the purposes of the safety net applying to the person.

 

Note: included here are co-payments for Pharmaceutical benefits dispensed under the “Safety Net 20 Day Rule” (subsection 84C(4AA)) of the National Health Act 1953.

 

4.         The Scheme

 

Renumber provisions consecutively.