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Thursday, 20 September 2007
Page: 136


Mr PYNE (Minister for Ageing) (11:25 AM) —I present the explanatory memorandum to this bill and move:

That this bill be now read a second time.

The National Health Amendment (Pharmaceutical Benefits) Bill 2007 contains amendments for two different purposes.

Schedule 1 of the bill proposes changes to the Health Insurance Act 1973 and the National Health Act 1953 to implement a 2007 budget measure. The amendments extend prescribing under the Pharmaceutical Benefits Scheme (PBS) to include optometrists as PBS prescribers, which will allow optometrists to prescribe some eye medicines as pharmaceutical benefits.

The PBS has been providing affordable access to high-quality medicines for all Australians for over 50 years. By subsidising the cost of PBS medicines and limiting the amount that people pay for prescriptions at the point of sale, it delivers benefits directly and immediately for the medicines people need—when and where they need them—through local pharmacies and hospitals in the community. In addition, the PBS safety net protects individuals and families who require a large number of medicines from high cumulative costs. The PBS serves Australians well and is regarded as one of the best systems of its kind in the world.

Under the current PBS legislation, the prescribing of PBS medicines is limited to medical practitioners and dental practitioners. Under state and territory laws, optometrists can be accredited to prescribe certain eye medicines. However, as an optometrist’s prescription cannot be used under the PBS, the cost of the prescription to the patient is the full dispensed price. If the patient is referred by the optometrist to a medical practitioner to obtain a PBS prescription, this can result in inconvenience and cost to the patient, a possible delay in treatment, and additional costs to government under Medicare.

The bill amends the Health Insurance Act 1973 and the National Health Act 1953 to provide for:

  • suitably qualified optometrists to be approved as authorised optometrists able to prescribe medicines as pharmaceutical benefits;
  • optometrists to be regulated as PBS prescribers in a similar way to doctors and dentists;
  • the PBS medicines for prescribing by optometrists to be specified in a separate list; and
  • entitlements associated with pharmaceutical benefits, including subsidies and PBS safety net benefits, to apply for PBS prescriptions written by optometrists.

Optometrists who are accredited to prescribe under state or territory legislation will be able to apply to Medicare Australia for approval to prescribe pharmaceutical benefits as an authorised optometrist.

Applications will be required to satisfy certain criteria to ensure that optometrists are suitably qualified. Approvals will be subject to conditions, as determined by the Minister for Health and Ageing by legislative instrument. Optometrists will need to establish that they have the necessary professional registration and prescribing accreditation under state or territory requirements prior to approval to prescribe PBS medicines.

An approval as an authorised optometrist will be able to be suspended or revoked in the event that the optometrist no longer meets the criteria for approval, breaches a condition of approval or engages in inappropriate practice. Reconsideration and review processes will apply for decisions to reject an application for approval, or suspend or revoke an approval. Optometrists will be subject to the same arrangements under the Professional Services Review Scheme regarding conduct and appropriate practice as those that apply to other practitioners who prescribe pharmaceutical benefits.

The bill introduces a new term, ‘PBS prescriber’, to describe collectively medical practitioners, participating dental practitioners and authorised optometrists as practitioners authorised to prescribe under the PBS. ‘PBS prescriber’ is used in amendments where it is intended that the same provisions will apply to authorised optometrists as for medical practitioners and participating dental practitioners. For PBS prescriptions, this includes the circumstances in which a person is entitled to have a prescription supplied as a pharmaceutical benefit, the patient payment amounts to be taken into account for the purposes of the PBS safety net, and the recording of Medicare card information.

The medicines for prescribing by authorised optometrists will be determined by the Minister for Health and Ageing taking into account the advice of the Pharmaceutical Benefits Advisory Committee. The list of medicines is expected to include a limited range of eye drops and eye ointments and will be specified by legislative instrument separately from other PBS medicines.

PBS prescriptions written by authorised optometrists will be able to be dispensed by community pharmacies and hospitals which supply PBS medicines.

The changes proposed for optometrist prescribing under the PBS also apply to the Repatriation Pharmaceutical Benefits Scheme.

Commencement of these amendments is in two stages. Provisions relating to approval of optometrists as PBS prescribers commence on royal assent to allow application and approval processes to proceed before 1 January 2008. Provisions relating to the writing of prescriptions by authorised optometrists, dispensing, payment of subsidies and application of Safety Net entitlements as pharmaceutical benefits commence on 1 January 2008. Amendments to regulations will also be required to give effect to the new prescribing arrangements.

Subsidies for optometrist prescriptions will make better use of optometrist services, reduce delays in access to eye treatments, reduce costs to consumers and support continuity of therapy for chronic eye conditions. The benefits are expected to be particularly significant for concession card holders and people in rural and regional areas.

PBS prescribing by optometrists may help to free up GP and specialist medical resources for other uses. As a result of consultations with the ophthalmologist profession, the government has decided to allow PBS prescribing based around the range of drugs permitted by the most restrictive state and consistent with the advice of the Pharmaceutical Benefits Advisory Committee.

This component of the bill demonstrates the government’s commitment to having a PBS which reflects developments in professional practice. The new arrangements are sensible and practical, and build on well-established PBS procedures. There are safeguards to ensure that optometrists are adequately qualified prior to approval and that appropriate practice standards are maintained.

Schedule 2 of the bill proposes minor amendments to the National Health Act 1953 to clarify the meaning of section 90 for granting approval to pharmacists to supply pharmaceutical benefits.

Pharmacists are approved under the act for the purpose of supplying pharmaceutical benefits to their local community. It is important that the public can obtain pharmaceutical benefits at the pharmacy of their choice and there are an appropriate number of pharmacies to meet community need.

The act currently uses the term ‘at or from’ premises in relation to the supply of pharmaceutical benefits by approved pharmacists. This means, if an approved pharmacist is conducting a mail order business, there is no need for the pharmacist to have a shopfront pharmacy supplying to their local community.

The proposed amendments provide that an approved pharmacist must supply pharmaceutical benefits ‘at’ their pharmacy—that is, to have a shopfront for people to physically attend the pharmacy. In addition, an approved pharmacist may also choose to supply pharmaceutical benefits ‘from’ their pharmacy to people who do not physically attend the pharmacy—for example, to nursing home residents or to a person by mail order.

The act also uses the term ‘on demand’ to describe how pharmaceutical benefits are supplied. This term does not adequately describe the intent that a pharmacy should be open reasonable hours for the purpose of supplying pharmaceutical benefits to their local community.

The proposed amendments also provide that a pharmacy must be accessible to the public during reasonable times. ‘Reasonable times’ generally means providing pharmaceutical benefits during normal business hours. What are considered reasonable times may vary according to the particular circumstances—for example, in a heavily populated urban area it would be expected that a pharmacy open for at least standard business hours each working week. However, in a small rural town where a pharmacy may be serviced by a pharmacist from another town, something less than standard business hours may be acceptable.

For consistency, the proposed amendments also provide that the secretary may cancel an approval if the approved pharmacist is not supplying pharmaceutical benefits ‘at’ the pharmacy or if the premises are not accessible at reasonable times by the public for the purpose of receiving pharmaceutical benefits.

I commend the bill to the House.