National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010 (PB 118 of 2010)

made under subsection 100(1) of the

National Health Act 1953

Compilation No. 9

Compilation date:                              1 July 2015

Includes amendments up to:            PB 62 of 2015

Registered:                                         14 July 2015

About this compilation

This compilation

This is a compilation of the National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010 (PB 118 of 2010) that shows the text of the law as amended and in force on 1 July 2015 (the compilation date).

This compilation was prepared on 9 July 2015.

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 ComLaw (www.comlaw.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 ComLaw 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.

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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

Part 1—Preliminary                                                                                                                                        1

1............ Name of Special Arrangement....................................................................................... 1

2............ Commencement............................................................................................................. 1

3............ Definitions..................................................................................................................... 1

4............ Pharmaceutical benefits covered by this Special Arrangement...................................... 1

5............ Application of Part VII of the Act................................................................................. 2

6............ Responsible person....................................................................................................... 2

7............ No prescriber or prescription......................................................................................... 2

Part 2—Supply for the paraplegic and quadriplegic program                                            4

9............ Paraplegic and quadriplegic associations....................................................................... 4

10.......... Eligible persons............................................................................................................. 4

11.......... Maximum amount......................................................................................................... 4

12.......... Supply........................................................................................................................... 4

13.......... Co‑payment etc not to be made...................................................................................... 5

14.......... Payment from Commonwealth...................................................................................... 5

15.......... Charge for delivery........................................................................................................ 6

16.......... Claims for payment....................................................................................................... 6

17.......... Stock of pharmaceutical benefits etc.............................................................................. 6

Schedule 1—Pharmaceutical benefits covered by this Special Arrangement and related information                                                                                                                    7

Schedule 2—Responsible Person Codes                                                                            9

Endnotes                                                                                                                                                               10

Endnote 1—About the endnotes                                                                                                      10

Endnote 2—Abbreviation key                                                                                                          11

Endnote 3—Legislation history                                                                                                       12

Endnote 4—Amendment history                                                                                                     13

Part 1—Preliminary

1  Name of Special Arrangement

             (1)  This Special Arrangement is the National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010.

             (2)  This Special Arrangement may also be cited as PB 118 of 2010.

2  Commencement

                   This Special Arrangement commences on 1 December 2010.

3  Definitions

                   In this Special Arrangement:

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

Act means the National Health Act 1953.

authorised association means a paraplegic and quadriplegic association authorised to supply pharmaceutical benefits under this Special Arrangement by section 9.

eligible person means a person that is eligible to receive pharmaceutical benefits under section 10.

other Special Arrangement means another Special Arrangement under section 100 of the Act.

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

·         approved ex‑manufacturer price

·         brand

·         claimed price

·         listed drug

·         pack quantity

·         pharmaceutical benefit

·         pharmaceutical item

·         proportional ex‑manufacturer price

·         responsible person.

4  Pharmaceutical benefits covered by this Special Arrangement

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

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

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

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

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

5  Application of Part VII of the Act

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

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

Note:          See subsection 100(3) of the Act.

6  Responsible person

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

             (2)  For subsection (1):

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

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

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

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

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

7  No prescriber or prescription

             (1)  Subsection 88(1) of the Act (authorising medical practitioners to prescribe pharmaceutical benefits) does not apply to the supply of a pharmaceutical benefit under this Special Arrangement.

             (2)  If a pharmaceutical benefit is supplied in accordance with this Special Arrangement, the following determinations do not apply to the supply:

                     (a)  a determination made under section 88 of the Act about authorised prescribers for the pharmaceutical benefit;

                     (b)  a determination made under paragraph 85(7)(b) of the Act about the circumstances in which a prescription for the pharmaceutical benefit may be written;

                     (c)  a determination made under paragraph 85A(2(a) of the Act about the maximum quantities or number of units of the pharmaceutical item in the pharmaceutical benefit that may, in 1 prescription, be directed to be supplied on any 1 occasion;

                     (d)  a determination made under paragraph 85A(2)(b) of the Act about the maximum number of occasions on which the pharmaceutical benefit may be directed to be supplied in a prescription.

Part 2—Supply for the paraplegic and quadriplegic program

9  Paraplegic and quadriplegic associations

                   The following paraplegic and quadriplegic associations are authorised to supply pharmaceutical benefits under this Special Arrangement:

                     (a)  The Paraplegic & Quadriplegic Association of N S W (ABN 42 000 355 948);

                     (b)  Spinal Injuries Association Inc (ABN 39 293 063 049);

                     (c)  Paraquad Victoria (ABN 80 973 805 243).

10  Eligible persons

                   A person is eligible to receive a pharmaceutical benefit from an authorised association if the person:

                     (a)  is an eligible person within the meaning of the Health Insurance Act 1973; and

                     (b)  has paraplegia or quadriplegia; and

                     (c)  is a member of the association.

11  Maximum amount

             (1)  The maximum amount of the pharmaceutical item in a pharmaceutical benefit that may, during a month, be supplied by an authorised association to an eligible person is the amount mentioned in the column in Schedule 1 headed ‘Maximum Amount’ for the pharmaceutical benefit.

             (2)  For subsection (1):

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

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

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

                     (b)  the pharmaceutical benefit is the brand of the listed drug mentioned in Schedule 1:

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

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

12  Supply

             (1)  An authorised association may supply a pharmaceutical benefit to an eligible person:

                     (a)  on the person’s request; and

                     (b)  despite section 89 of the Act, without a prescription written for the supply to the person.

Note:          Section 89 of the Act provides for pharmaceutical benefits to be supplied only on prescription.

             (2)  The association may supply the pharmaceutical benefit to the person by:

                     (a)  making the pharmaceutical benefit available to be picked up by the person at the association’s premises; or

                     (b)  sending the pharmaceutical benefit to the person.

13  Co‑payment etc not to be made

                   An authorised association must not demand or receive a payment or other valuable consideration for the supply of a pharmaceutical benefit under this Special Arrangement, other than:

                     (a)  a payment from the Commonwealth under section 14.

                     (b)  a charge mentioned in section 15.

14  Payment from Commonwealth

             (1)  An authorised association that supplies a pack quantity of a pharmaceutical benefit is entitled to be paid by the Commonwealth for the supply the amount worked out under subsection (2).

             (2)  For subsection (1), the amount is:

                     (a) if there is no claimed price for the pack quantity of the pharmaceutical benefit:

                              (i) the price to pharmacists for the pack quantity worked out under the determination under paragraph 98B(1)(a) of the Act; and

                             (ii)  a handling fee of 2.75% of that amount; or

                     (b)  if there is a claimed price for the pack quantity of the pharmaceutical benefit:

                              (i)  the claimed price for the pack quantity  plus a wholesale mark‑up calculated in accordance with subsection (3); and

                             (ii)  a handling fee of 2.75% of that amount.

             (3)  For paragraph (2)(b), the wholesale mark‑up for the pack quantity of the pharmaceutical benefit is to be worked out using the methodology for calculating the wholesale mark‑up for ready‑prepared pharmaceutical benefits in the determination under paragraph 98B(1)(a) of the Act, subject to the following:

                     (a)  for the purposes of identifying the appropriate wholesale mark‑up formula in Step 2 of the methodology, the ex‑manufacturer price for the relevant quantity is to be worked out proportionately from the approved ex‑manufacturer price or proportional ex‑manufacturer price for the pack quantity of the pharmaceutical benefit; and

                     (b)  otherwise, the methodology is to be applied as if the claimed price for the pack quantity of the pharmaceutical benefit were the approved ex‑manufacturer price or proportional ex‑manufacturer price for the pack quantity.

15  Charge for delivery

                   If an authorised association supplies a pharmaceutical benefit by sending it to a person the association may charge the person an amount that is equal to the cost of sending the pharmaceutical benefit to the person.

16  Claims for payment

             (1)  An authorised association that wants to receive payment for the supply of a pharmaceutical benefit under this Special Arrangement must make a claim for payment to the Medicare Australia CEO.

             (2)  Despite section 99AAA of the Act, the association must submit its claims for the supplies it makes during a month on a form approved in writing by the Medicare Australia CEO for this section.

Note:          Section 99AAA of the Act provides for rules to be made by the Minister about procedures for claims for payment.

17  Stock of pharmaceutical benefits etc

                   An authorised association may:

                     (a)  order a pharmaceutical benefit from:

                              (i)  the responsible person for the brand of the pharmaceutical item in the pharmaceutical benefit; or

                             (ii)  a wholesaler for the pharmaceutical benefit; and

                     (b)  keep in stock at its premises an adequate supply of pharmaceutical benefits for supply to its members under this Special Arrangement.

Schedule 1—Pharmaceutical benefits covered by this Special Arrangement and related information

(sections 4, 6 and 11)

Schedule 2—Responsible Person Codes

(section 6)

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

Endnotes about misdescribed amendments and other matters are included in a compilation only as necessary.

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.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history