COMMONWEALTH OF AUSTRALIA
National Health Act 1953
PHARMACEUTICAL BENEFITS
DETERMINATION UNDER SUBSECTION 84BA(2)
 
 
I, DECLAN O’CONNOR-COX, Assistant Secretary, Access and Systems Branch, Pharmaceutical Benefits Division, Department of Health and Ageing and Delegate of the Minister for Health and Ageing, pursuant to subsection 84BA(2) of the National Health Act 1953, hereby make the following Determination:
 
1.    This Determination commences on 1 July 2009.
 
2.    The Determination under subsection 84BA(2) of the National Health Act 1953 made on 18 December 2008, with effect on 1 January 2009, is repealed.
 
3.    In this Determination:
 
       (a)   “the Act” means the National Health Act 1953; and
 
       (b)   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.
 
4.    The amount which, 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 shall be the maximum value of the supply of out-patient medication for safety net purposes or the amount charged, whichever is the lesser.
 
5.    The maximum value of a supply of out-patient medication to a concessional beneficiary, a dependant of a concessional beneficiary or the holder of a concession card shall be the amount referred to in paragraph 87(2)(a) of the Act.
 
6.    Except in the case of a public hospital situated in the State of Queensland, or a public hospital that is participating in arrangements under Pharmaceutical Reform Arrangements within the meaning of the National Healthcare Agreement, the maximum value of a supply of out-patient medication to a general patient who is not the holder of a concession card shall be $26.30.
 
7.    In the case of a public hospital situated in the State of Queensland, the maximum value of a supply of out-patient medication to a general patient who is not the holder of a concession card shall be:
 
(a)       where the medication is a drug or medicinal preparation which is, within the meaning of section 85 of the Act, a pharmaceutical benefit and the Commonwealth price for that pharmaceutical benefit exceeds the amount referred to in paragraph 87(2)(e) of the Act — the amount referred to in paragraph  87(2)(e) of the Act; or
 
(b)      where the medication is a drug or medicinal preparation which is, within the meaning of section 85 of the Act, 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 that is in force on the date of supply of the out-patient medication; or
 
       (c)   where the medication is a drug or medicinal preparation which is not, within the meaning of section 85 of the Act, 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 price to pharmacists, the determination under subsection 84C(7) of the Act that is in force on the date of supply of the out-patient medication.
 
8.    In the case of a public hospital that is participating in arrangements under Pharmaceutical Reform Arrangements within the meaning of the National Healthcare Agreement, the maximum value of a supply of out-patient medication to a general patient who is not the holder of a concession card shall be:
 
       (a)   where the medication is a drug or medicinal preparation that is, within the meaning of section 85 of the Act, a pharmaceutical benefit — the maximum value of the pharmaceutical benefit ascertained in accordance with subregulation  9A(5) of the National Health (Pharmaceutical Benefits) Regulations 1960; or
 
       (b)   where the medication is a drug or medicinal preparation that is not, within the meaning of section 85 of the Act, 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 price to pharmacists, the determination under subsection 84C(7) of the Act that is in force on the date of supply of the out-patient medication.
 
 
Dated 19 June 2009
 
 
 
 
 
DECLAN O’CONNOR-COX
Assistant Secretary
Access and Systems Branch
Pharmaceutical Benefits Division
Department of Health and Ageing
Delegate of the Minister for Health and Ageing