National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2021

PB 31 of 2021

made under section 100 of the

National Health Act 1953

Compilation No. 7

Compilation date: 1 June 2025

Includes amendments: F2025L00627

About this compilation

This compilation

This is a compilation of the National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2021 that shows the text of the law as amended and in force on 1 June 2025 (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 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 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 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

Part 1—Preliminary

1 Name

3 Authority

4 Definitions

5 Pharmaceutical benefits covered by this Special Arrangement

6 Application of Part VII of the Act

7 Responsible person

8 No prescriber or prescription

Part 2—Supply for the paraplegic and quadriplegic program

9 Paraplegic and quadriplegic associations

10 Eligible persons

11 Maximum amount

12 Supply

13 Co‑payment etc. not to be made

14 Payment from Commonwealth

15 Charge for delivery

16 Claims for payment

17 Stock of pharmaceutical benefits etc.

18 Internal review of decisions

19 Application of this Special Arrangement

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

Schedule 2—Responsible Person Codes

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Part 1—Preliminary

1  Name

 (1) This Special Arrangement is the National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2021.

 (2) This Special Arrangement may also be cited as PB 31 of 2021.

3  Authority

  This Special Arrangement is made under section 100 of the National Health Act 1953.

4  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.

5  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.

6  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.

7  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.

8  No prescriber or prescription

 (1) 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 PBS 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 NSW (ABN 42 000 355 948); and

 (b) Independence Australia Group (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.

 (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 Chief Executive Medicare.

 (2) The Chief Executive Medicare must determine the amount payable for a claim made under this Part and make any payment relating to the claim.

 (3) 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 Chief Executive Medicare for this section.

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.

18  Internal review of decisions

Application for review

 (1) A person who is affected by a decision of the Chief Executive Medicare under this instrument may apply to the Secretary for review of the decision.

 (2) An application for review must:

 (a) be in writing; and

 (b) be made within:

 (i) 28 days after the day the decision first came to the notice of the applicant; or

 (ii) if the Secretary allows a longer period (whether before or after the end of the 28‑day period referred to in subparagraph (i))—that longer period.

Review of decision

 (3) On receiving an application, the Secretary must:

 (a) review the decision; and

 (b) affirm, vary or set aside the decision; and

 (c) if the Secretary sets aside the decision—make a new decision in substitution for the decision set aside.

 (4) The decision (the decision on review) of the Secretary takes effect:

 (a) on the day specified in the decision on review; or

 (b) if a day is not specified—on the day the decision on review was made.

Notice of decision

 (5) After the Secretary makes a decision under this section, the Secretary must give the applicant a written notice stating the following:

 (a) the terms of the decision;

 (b) the reasons for the decision.

19  Application of this Special Arrangement

  This Special Arrangement applies to a supply of a pharmaceutical benefit that is made the day after registration.

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

(sections 5, 7 and 11)

Schedule 2—Responsible Person Codes

(section 7)

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