PBS Legislative Amendments – 1 June 2018

Page last updated: 6 June 2018

Amendments to the National Health (Pharmaceutical Benefits) Regulations 2017 (the Regulations) and the National Health (Subsection 84C(7)) Determination 2010 (the Determination) commence on 1 June 2018.

The changes clarify the values for safety net purposes of charges for pharmaceutical benefits and introduce into legislation the ‘additional patient charge’ provided for under the Sixth Community Pharmacy Agreement.

Details of the changes

Amendments to the Regulations

• provide a definition for ‘additional patient charge’ as being the charge agreed in the Sixth Community Pharmacy Agreement
• set the value for safety net purposes of pharmaceutical benefits where the Government cost is greater than the maximum patient co-payment as being the co‑payment amount charged (excluding any applicable price premiums)
• set the value for safety net purposes of under co-payment prescriptions as being the amount charged according to the subsection 84C(7) determination minus any amount due to the additional patient charge, or the amount charged if less.

Amendments to the subsection 84C(7) determination

• provide for the ‘additional patient charge’ to be included in the calculation of the maximum patient charge for an under co‑payment prescription provided that the addition of the charge, in full or in part, is limited to an amount that does not result in the charge exceeding the maximum patient co‑payment.

Effect of the changes

The amendments do not change the way patient charges or safety net amounts are calculated in practice. The provisions commencing on 1 June 2018 have the same effect and result in the same outcomes as achieved previously using a combination of legislative provisions and relevant clauses of successive Community Pharmacy Agreements.

Further information

The Explanatory Statements to the amendments to the Regulations and the Determination can be accessed via the Federal Register of Legislation. Examples of calculations of patient charges and safety net values for under co‑payment PBS prescriptions are available on the PBS website.