Commonwealth Consolidated Acts Commonwealth Consolidated Acts(1) In this Part, unless the contrary intention appears:
"12.5% price reduction" : see subsection 99ACA(2).
"16% price reduction" : see subsection 99ACA(2A).
"25% price reduction" : see subsection 99ACA(2B).
"additional member" means an additional member of the Tribunal.
"agreed price" means the amount in force under a price agreement.
"allowable discount" has the meaning given by subsection 87(2AAAA).
"applicable amount" has the meaning given by subsection 84BA(4).
"approved ex-manufacturer price" of a listed brand of a pharmaceutical item means:
(a) if a price agreement is in force in relation to the brand of the pharmaceutical item--the amount in force under the agreement as the amount that is, for the purposes of this Part, taken to be the appropriate maximum price of the brand of the pharmaceutical item; or
(b) if a price determination is in force in relation to the brand of the pharmaceutical item--the amount in force under the determination as the amount that is, for the purposes of this Part, taken to be the appropriate maximum price of the brand of the pharmaceutical item.
Note: See also section 85BA (effect of deemed reductions of, or increases to, the approved ex - manufacturer price).
"approved hospital authority" means a hospital authority for the time being approved, or deemed to be approved, under section 94.
"approved medical practitioner" means a medical practitioner for the time being approved, or deemed to be approved, under section 92.
"approved pharmacist" means a person for the time being approved under section 90 and includes:
(a) a person treated as having been so approved under any provision of a law of the Commonwealth other than section 91 or 91B; and
(b) except so far as subsection 90(3) is concerned--a person treated as having been so approved under section 91 or 91B.
"approved supplier" means an approved pharmacist, an approved medical practitioner or an approved hospital authority.
"authorised midwife" means an eligible midwife in relation to whom an approval is in force under section 84AAF, so far as the eligible midwife provides midwifery treatment in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in a legislative instrument made by the Minister for the purposes of this definition, with one or more medical practitioners of a kind or kinds specified in the legislative instrument.
"authorised nurse practitioner" means an eligible nurse practitioner in relation to whom an approval is in force under section 84AAJ, so far as the eligible nurse practitioner provides nurse practitioner treatment in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in a legislative instrument made by the Minister for the purposes of this definition, with one or more medical practitioners of a kind or kinds specified in the legislative instrument.
"authorised optometrist" means an optometrist in relation to whom an approval is in force under section 84AAB.
"Authority" means the Australian Community Pharmacy Authority established under section 99J.
"brand" of a pharmaceutical item means:
(a) the trade name under which the person who is or will be the responsible person supplies the pharmaceutical item; or
(b) if there is no trade name--the name of the person who is or will be the responsible person.
"Chairperson" means the Chairperson of the Tribunal.
"child" , in relation to a member of a friendly society, means:
(a) a child under the age of 16 years of that member; or
(b) a child of that member who:
(i) has attained the age of 16 years;
(ii) is receiving full - time education at a school, college or university;
(iii) is wholly or substantially dependent on that member or on the spouse of that member; and
(iv) is a person who is to be treated as a child of that member in accordance with the rules of the friendly society.
Note: See also subsection (3B).
"claimed price" means the amount specified in a determination in force under subsection 85B(3).
"co-marketed brands" has the meaning given by section 84AE.
"combination item" means a pharmaceutical item that has a drug that contains at least 2 other drugs or medicinal preparations, at least one of which is a listed drug.
"combination item has a drug" : see subsection 84ABA(2).
(a) the Governor - General; or
Note: See also section 16A of the Acts Interpretation Act 1901 .
(c) a member of the Parliament of the Commonwealth; or
(e) a person who is in the employment of the Commonwealth; or
(f) a person who holds or performs the duties of any office or position established by or under a law of the Commonwealth; or
(g) a member of the Australian Defence Force; or
(h) the Commissioner of the Australian Federal Police, a Deputy Commissioner of the Australian Federal Police, an AFP employee, a special member or a special protective service officer (all within the meaning of the Australian Federal Police Act 1979 ).
(a) in relation to a pharmaceutical benefit supplied by an approved pharmacist--the Commonwealth price for the particular quantity or number of units of the pharmaceutical benefit worked out in accordance with a determination in force under subsection 98B(1); or
(b) in relation to a pharmaceutical benefit supplied by an approved medical practitioner--the Commonwealth price for the particular quantity or number of units of the pharmaceutical benefit worked out in accordance with a determination in force under subsection 98C(1); or
(c) in relation to a pharmaceutical benefit supplied by an approved hospital authority to a patient receiving treatment in or at a hospital in respect of which the authority is approved--the amount of the payment to which the authority is entitled under subsection 99(4) in respect of the supply of the particular quantity or number of units of the pharmaceutical benefit.
"communicated" , in relation to a prescription, means communicated directly or indirectly.
"communicated prescription" means a prescription that is communicated to an approved pharmacist in the circumstances and manner set out in regulations made for the purposes of paragraph 89(a).
"concessional beneficiary" means:
(a) a person who is the holder of a pensioner concession card, a seniors health card or a health care card under the Social Security Act 1991 ; or
(b) a person (other than the holder of the card) whose name is included in a card referred to in paragraph (a); or
(i) who is an Australian resident within the meaning of the Health Insurance Act 1973 ; and
(ii) who is eligible for fringe benefits under section 53A of the Veterans' Entitlements Act 1986 ; or
(i) an Australian resident within the meaning of the Health Insurance Act 1973 ; and
(ii) eligible, under subsection 86(1), (2) or (3) of the Veterans' Entitlements Act 1986 , to be provided with treatment under Part V of the last - mentioned Act; or
(i) an Australian resident within the meaning of the Health Insurance Act 1973 ; and
(ii) entitled to treatment under section 284 of the Military Rehabilitation and Compensation Act 2004 ; or
(i) an Australian resident within the meaning of the Health Insurance Act 1973 ; and
(ii) the holder of a seniors health card within the meaning of the Veterans' Entitlements Act 1986 .
Note: See also subsection (3C) (effect of a person's death on status as a concessional beneficiary).
"concessional benefit prescription" means a prescription that, in accordance with section 84AA, is a prescription in respect of a concessional beneficiary or of a person who, in relation to the concessional beneficiary, is a dependant within the meaning of subsection (4) or (7).
"concession card" means a safety net concession card issued under section 84DA and includes an additional concession card, or a replacement concession card, issued under section 84H.
"concession card prescription" means a prescription that, in accordance with section 84AA, is a prescription for the supply of a pharmaceutical benefit to a person who is a holder of a concession card.
"CTS claim" means a claim made to the Chief Executive Medicare using the procedures of the Claims Transmission System provided for in section 99AAA.
"dependant" has the meaning given by subsections (4) and (7).
Note: See also subsection (7A) (effect of a person's death on status as a dependant of a concessional beneficiary).
"determined price" means the amount specified in a determination in force under subsection 85B(2).
"determined quantity" of a listed brand of a pharmaceutical item: see subsection 84AK(3).
"drug in a combination item" means the drug referred to in paragraph 84AB(a) in the application of that paragraph to the pharmaceutical item that is the combination item.
"drug in a pharmaceutical item" means the drug referred to in paragraph 84AB(a) in the application of that paragraph to the pharmaceutical item.
"drug is on F1" has the meaning given by section 84AC.
"drug is on F2" has the meaning given by section 84AC.
"early supply of a specified pharmaceutical benefit" has the meaning given by subsection 84AAA(1).
"eligible for increased discounting" : see section 87AA.
"eligible midwife" has the meaning given by section 84AAE.
"eligible nurse practitioner" has the meaning given by section 84AAI.
"entitlement card" means a pharmaceutical benefits entitlement card issued under section 84E and includes an additional entitlement card, or a replacement entitlement card, issued under section 84H.
"entitlement card prescription" means a prescription that, in accordance with section 84AA, is a prescription for the supply of a pharmaceutical benefit to a person who is a holder of an entitlement card.
"exempt item" means a pharmaceutical item determined by the Minister under section 84AH to be an exempt item.
"expiry date" , in relation to a medicare number, means:
(a) if the number is recorded on a medicare card that specifies a particular date on which the card expires--that date; and
(b) if the number is recorded on a medicare card that does not specify a particular date on which the card expires but that has recorded on it the month at the end of which the card expires--the last day of that month; and
(c) if the number is not of a kind referred to in paragraph (a) or (b)--such date as the Minister specifies, in writing, in respect of the number.
"friendly society body" means a body (whether corporate or unincorporate) carrying on business for the benefit of members of a friendly society or friendly societies.
"general benefit prescription" means a prescription other than:
(b) a concessional benefit prescription; or
(c) an entitlement card prescription; or
(d) a concession card prescription.
"general patient" means a person who is an eligible person within the meaning of the Health Insurance Act 1973 , but who is not a concessional beneficiary.
general patient charge amount means $30.00.
Note: The figure in this definition is adjusted annually under section 99G.
"hospital" means premises in which patients are received and lodged for the purpose of hospital treatment.
"hospital authority" means the governing body of a public hospital or the proprietor of a private hospital.
"listed brand" of a pharmaceutical item means a brand of the pharmaceutical item in relation to which a determination under subsection 85(6) is in force.
"listed drug" means a drug or medicinal preparation in relation to which a declaration under subsection 85(2) is in force.
(a) a card issued by the Chief Executive Medicare and commonly known as a medicare card; or
(b) a card or written authorisation provided to a person that evidences a person's eligibility for pharmaceutical benefits under:
(i) the scheme known as the Repatriation Pharmaceutical Benefits Scheme established under the Veterans' Entitlements Act 1986 ; or
(ii) a scheme that applies under section 18 of the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006 ; or
(iii) a scheme that applies under section 20 of the Treatment Benefits (Special Access) Act 2019 ; or
(c) any other card that is prescribed for the purposes of this definition.
(a) in relation to a particular person covered by a medicare card--the particular combination of numbers, or letters and numbers, on the card that is applicable only to that person as a person covered by that card; and
(b) in relation to a person who the Chief Executive Medicare is satisfied is, or is entitled to be treated as, an eligible person within the meaning of the Health Insurance Act 1973 but who is not covered by a medicare card--the particular combination of numbers, or letters and numbers, that would be applicable to that person if that person were covered by a medicare card.
"member" means a member of the Tribunal, and includes the Chairperson.
"nurse practitioner treatment" , in relation to a nurse practitioner, means treatment that the nurse practitioner is authorised (however described) to provide under a law of a State or an internal Territory.
"optometrist" means a person registered or licensed as an optometrist or optician under a law of a State or an internal Territory that provides for the registration or licensing of optometrists or opticians.
"out-patient medication" means a drug or medicinal preparation supplied through the out - patient department of a public hospital.
"pack quantity" of a listed brand of a pharmaceutical item: see subsection 84AK(2).
"participating dental practitioner" means a dental practitioner in relation to whom an approval is in force under section 84A.
(a) a medical practitioner; or
(b) a participating dental practitioner; or
(c) an authorised optometrist; or
(d) an authorised midwife; or
(e) an authorised nurse practitioner.
"pharmaceutical benefit" means the following:
(a) if a declaration under subsection 85(2) is in force in relation to a drug or medicinal preparation (the drug ) and paragraph (b), (c) and (d) do not apply--the drug;
(b) if a determination under subsection 85(3) is in force in relation to a form of the drug and paragraph (c) and (d) do not apply--the drug in that form;
(c) if a determination under subsection 85(5) is in force in relation to a manner of administration of that form of the drug and paragraph (d) does not apply--the drug in that form with that manner of administration;
(d) if a determination under subsection 85(6) is in force in relation to a brand of a pharmaceutical item that is the drug in that form with that manner of administration--that brand of the drug in that form with that manner of administration.
"pharmaceutical benefit has a drug" : see subsection 84ABA(3).
"pharmaceutical item" has the meaning given by section 84AB.
"pharmaceutical item has a drug" : see subsection 84ABA(1).
"prescriber bag provisions" means the following:
(a) section 93 (supplies by medical practitioners);
(b) section 93AA (supplies by authorised midwives);
(c) section 93AB (supplies by authorised nurse practitioners).
"price agreement" means an agreement under section 85AD.
"price determination" means a determination under subsection 85B(2).
"pricing quantity" of a listed brand of a pharmaceutical item: see subsection 84AK(1).
"proportional ex-manufacturer price" of a listed brand of a pharmaceutical item: see section 85D.
"record form" means a pharmaceutical benefits prescription record form, or an out - patient medication prescription record form, issued under section 84D.
"refund agreement" means an agreement or arrangement under which a payment may be made by or at the direction of a person to another person in the event of the other person being charged an amount in respect of the supply of a pharmaceutical benefit.
"relevant entitlement period" means:
(a) in the application of this Part before 1 January 1992:
(i) in relation to a pensioner--the period commencing on 1 November 1990 and ending on 31 December 1991; or
(ii) in relation to any other person--the year commencing on 1 January 1990 or 1 January 1991; or
(b) in the application of this Part on or after 1 January 1992:
(i) the year commencing on 1 January 1992; or
"relevant price" : see subsection 99ACF(5).
"repatriation pharmaceutical benefit" means a pharmaceutical benefit within the meaning of:
(a) section 91 of the Veterans' Entitlements Act 1986 ; or
(b) subsection 4(1) of the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006 ; or
(c) subsection 5(1) of the Treatment Benefits (Special Access) Act 2019 .
"responsible person" for a brand of a pharmaceutical item means the person determined by the Minister under section 84AF to be the responsible person for the brand of the pharmaceutical item.
"Schedule equivalent" has the meaning given by section 84AJ.
"special number" , in relation to a particular person who is included within a class of persons identified by the Minister in a determination under subsection 86E(1)--the particular combination of numbers, or letters and numbers, allocated in accordance with a procedure set out in that determination, that is applicable to that person as a person included in that class.
"special patient contribution" has the meaning given by subsection 85B(5).
"State or Territory officer" means:
(a) the Governor of a State; or
Note: See also section 16B of the Acts Interpretation Act 1901 .
(b) the Administrator, an Acting Administrator, or a Deputy Administrator, of the Northern Territory; or
(c) a Minister of a State, a Minister for the Australian Capital Territory or a Minister of the Northern Territory; or
(d) a member of the Parliament of a State, a member of the Legislative Assembly for the Australian Capital Territory or a member of the Legislative Assembly of the Northern Territory; or
(e) a person who is in the employment of a State or Territory; or
(f) a person who holds or performs the duties of any office or position established by or under a law of a State or Territory; or
(g) a member of the police force or police service of a State or Territory.
"Territory" includes an external Territory to which this Act extends.
"therapeutic group" means a therapeutic group determined by the Minister under section 84AG.
"Tribunal" means the Pharmaceutical Benefits Remuneration Tribunal established by section 98A.
"value for safety net purposes" means:
(a) for the supply of a pharmaceutical benefit--the amount prescribed by regulations made for the purposes of subsection 84C(1E); and
(b) for the supply of a repatriation benefit--the amount charged for the supply; and
(c) for the supply of out - patient medication--the applicable amount in relation to the supply.
(1A) Where a refund agreement was entered into before 24 April 1964, and, on or after that date:
(a) the agreement was or is renewed on or before the date on which it would, but for that renewal, have expired;
(b) the period of operation of the agreement was or is extended on or before the date on which it would, but for that extension, have expired; or
(c) the rights and obligations under the agreement of the party by or at whose direction payments may be made under the agreement were or are transferred to another person;
the renewal, extension or transfer shall, for the purposes of this Act, be deemed not to have been or to be an entering into a new agreement.
(a) a prescription directs a repeated supply of a pharmaceutical benefit (the specified benefit ); and
(b) another pharmaceutical benefit (the supplied benefit ) is supplied, on the repeated supply, in accordance with subsection 103(2A);
then, for the purposes of determining whether a repeated supply of the specified benefit has occurred, the supplied benefit is taken to be the repeated supply, upon the prescription, of the specified benefit.
(2) In this Part, a reference to the supply, obtaining or receipt of a pharmaceutical benefit shall, unless the contrary intention appears, be read as a reference to the supply, obtaining or receipt of that pharmaceutical benefit under this Part.
(2A) A reference in this Part to a prescription for the supply of a pharmaceutical benefit to a person who is a holder of a concession card or an entitlement card is a reference to a prescription for the supply of a pharmaceutical benefit to a person who is, at the time when the prescription is written or communicated, or becomes, after the prescription is written or communicated and before the benefit is supplied upon the prescription, a holder of a concession card or an entitlement card.
(3) If the Minister so determines, the Minister of State of a State administering the laws of that State relating to public hospitals shall, for the purposes of this Part, be deemed to be the governing body of the public hospitals in that State.
(3A) A reference in this Part to the governing body, in relation to a public hospital in the Territory of Cocos (Keeling) Islands or the Territory of Christmas Island, shall be read as a reference to the Administrator of the relevant Territory.
(3AA) A reference in this Part to the governing body, in relation to a public hospital on Norfolk Island, is a reference to the person or body specified in the regulations.
(3B) A reference in the definition of child in subsection (1) to a child of a member includes a reference to:
(a) an adoptive child or a stepchild of the person; and
(b) someone who would be the stepchild of the person except that the person is not legally married to the person's de facto partner; and
(c) someone who is a child of the person within the meaning of the Family Law Act 1975 .
(3C) If a person would have been a concessional beneficiary at a particular time on a day except that the person died on that day then, despite that death, the person is taken still to be a concessional beneficiary at that time (whether that time is before or after the time of death).
(4) A dependant , in relation to a person to whom paragraph (c) or (d) of the definition of concessional beneficiary applies, is a person who is an Australian resident within the meaning of the Health Insurance Act 1973 and:
(a) the spouse of the person; or
(b) a child under the age of 16 years who is in the custody, care and control of the person or the spouse of the person; or
(i) has attained the age of 16 years but is under the age of 25 years; and
(ii) is receiving full time education at a school, college or university; and
(iii) is not being paid a disability support pension under the Social Security Act 1991 ; and
(iv) is wholly or substantially dependent on the person or on the spouse of the person.
(7) For the purposes of this Part, if:
(a) paragraph (e) of the definition of concessional beneficiary applies to a person (the seniors health card holder ); and
(b) no other paragraph of the definition of concessional beneficiary applies to the seniors health card holder;
a person who, apart from this subsection, would be a dependant of the seniors health card holder is taken not to be a dependant of the seniors health card holder.
Note: A person who is the holder of a seniors health card within the meaning of the Veterans' Entitlements Act 1986 is a person to whom paragraph (e) of the definition of concessional beneficiary applies.
(7A) If a person (the relevant person ) would have been a dependant of a concessional beneficiary at a particular time on a day except that:
(a) the relevant person died on that day; or
(b) the concessional beneficiary died on that day;
then, despite that death, the relevant person is taken still to be a dependant of a concessional beneficiary at that time (whether that time is before or after the time of death).
(8) A reference in this Part to the provision to a person or body of a medicare number as a number applicable to a particular individual is a reference to:
(a) the production to that person or body of a medicare card having on it a medicare number as a number applicable to that particular individual; or
(b) the provision to that person or body of any other information, whether documentary or oral, that indicates a medicare number as a number applicable to that particular individual.
(9) A reference in this Part to the provision to a person or body of the expiry date in relation to a medicare number provided as a number applicable to a particular individual is a reference to:
(a) the production to the person or body of a medicare card that indicates the expiry date in relation to that medicare number; or
(b) the provision to the person or body of any other information, whether documentary or oral, that indicates the expiry date in relation to that medicare number.
(10) A reference in this Part to a medicare number, or a special number, ultimately supplied to the Chief Executive Medicare in relation to a prescription, is a reference to:
(a) if the number is not inserted in a CTS claim relating to that prescription--the number in the form in which it appears on the prescription (or in the case of a communicated prescription, the written version of the prescription), at the time when the prescription is sent to the Chief Executive Medicare by an approved supplier with a claim for payment; or
(b) if that number is inserted in a CTS claim relating to the
prescription--the number so inserted.