Christopher Pyne (Sturt, Liberal Party, Minister for Ageing) Share this | Link to this | Hansard source

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.

Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

I rise today to also speak briefly about the National Health Amendment (Pharmaceutical Benefits) Bill 2007. The bill has two purposes. Firstly, it amends the National Health Act 1953 and the Health Insurance Act 1973 to allow authorised optometrists to prescribe certain ophthalmic eye medicines under the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme. Secondly, the bill amends the National Health Act 1953 to clarify the intent in relation to the supply of pharmaceutical benefits by approved pharmacists. Labor will be supporting the passage of this legislation through the parliament. Given my and the minister’s other commitments today, I will deal with these issues very briefly.

Let me turn firstly to the extension of the limited prescribing rights to optometrists or, more precisely, the benefits that there will be to consumers that will flow from this change. Those prescribing rights already exist, but the arrangements will enable consumers not to go to a GP or, at least, to receive the benefit from their pharmacist when purchasing these products. Under the current arrangements, only medical practitioners and participating dental practitioners can prescribe pharmaceutical benefits. As the minister has pointed out, this means that patients who need eye medicines are obliged to follow a visit to an optometrist with a visit to a GP for a prescription if they wish to receive subsidised medicines under the PBS. This bill will change that to allow for authorised optometrists to come within the ambit of those provisions that have applied only, in the past, to medical and dental practitioners, and it will allow authorised optometrists to prescribe certain medicines under the PBS and RBPS. I do want to emphasise that this ability has been there already and that this is not giving optometrists new prescribing rights but is removing the inconvenience to patients or the cost to consumers—something that Labor is prepared to support.

Optometrists who are authorised to prescribe certain medicines under relevant state or territory legislation will now be able to apply to the Secretary of the Department of Health and Ageing to be given the authority to prescribe from a limited list of eye medicines under the PBS. According to the explanatory memorandum, the minister may determine any criteria that must be satisfied first before an optometrist is approved, and any conditions that might attach to that approval.

It is clear that the PBS will apply only for certain ophthalmic preparations. This change will not only provide convenience and cheaper medications; in rural and regional areas where GP workforce shortages are acute it will achieve a more efficient deployment of the health workforce and will potentially reduce some Medicare costs.

I want to note that the Optometrists Association of Australia have advised of their strong support for this change, arguing that it will improve access to subsidised medicines for people who cannot afford to pay the full price or for people who live in remote and rural areas. I note that, whilst the optometrists have no concern about this enabling legislation, they are frustrated about restrictions on which medicines will be available for optometrists to prescribe. The Royal Australian and New Zealand College of Ophthalmologists has advised that the college is not, in principle, concerned about these changes to the legislative framework under this bill; however, it does remain concerned that optometrists who are not medically qualified should have access to the full range of legal drugs. The college believes its concerns will be addressed via regulations, which, as we understand it, are not yet available.

We know that some doctors are opposed to this change because they fear it is a sign of increased role substitution to come in the future. The AMA, for example, has previously raised concerns regarding optometrists performing ophthalmological diagnosis and more interventions from a very restricted knowledge base. They are concerned that this will encourage role substitution and potentially sideline the role of GPs and specialists. Whilst we take on board these concerns, these prescribing rights for optometrists have been in existence for a long time. What is changing through this legislation is that patients who previously did not have their prescriptions covered by the PBS will have that, and this change will mean less dual handling or lower costs to patients. We do not agree that any risk exists for patients. In fact, the benefit to patients in terms of both cost and convenience is the reason we support this bill. Obviously, arguments are yet to be had about what will be included in the regulations, and we need to ensure that high standards of appropriate care are maintained while giving maximum benefits of convenience and access to cheaper medicines for the public.

I think, for the benefit of the chamber, I do not really need to go through with these other comments that the minister has covered in his speech. I can indicate that Labor supports the government’s decision to proceed with these changes, despite the resistance of some doctors, on the basis that they will provide a better outcome for patients in terms of convenience and cost, which must be our focus in this House.

Turning briefly now to the second object of the bill, schedule 2 of the bill amends the National Health Act 1953 to clarify the intent in relation to the supply of pharmaceutical benefits at or from approved premises by approved pharmacists. While neither the explanatory memorandum nor the second reading speech nor the minister’s comments today make any specific mention of a recent Federal Court decision or of concerns about the court’s interpretations of section 90 of the National Health Act, it appears that the amendments in schedule 2 are intended to address what is effectively a loophole that was created in relation to the supply of medicines by pharmacists. Whilst we support these changes, it would be helpful if the government could be a little more transparent in its legislative intentions. The rationale for these amendments really only became apparent when we were advised that the amendments are in reaction to the recent Federal Court decision of Holtzberger v the Secretary of the Department of Health, where the term ‘at or from’ in section 90 was interpreted as referring to a supply at or from the premises in question, indicating that the supply of pharmaceutical benefits need not necessarily occur at the approved premises. The department no doubt would be concerned about this interpretation and those concerns have been addressed with provisions that are in this other part of the bill.

I turn to the changes, which we support. I would remind the House that the purpose of the location rules which will be protected by closing this loophole is to ensure widespread community access to pharmaceutical services and to ensure the continued viability of existing pharmacies’ objectives, which Labor strongly support. Once approved, pharmacists must also comply with a range of other conditions in order to continue to be able to supply pharmaceutical benefits—and obviously these sorts of loopholes can threaten those sorts of conditions. For example, a pharmacist can only supply benefits from a pharmacy that he or she is operating and may not supply to anyone any pharmaceutical benefit that attracts a Commonwealth contribution for free or for a price less than the relevant patient contribution. The amendments in schedule 2 will tighten the conditions applying to pharmacists who are approved to supply medicines for which benefits will be paid by the Commonwealth under the PBS. While the government’s explanation for these changes has been a tad ambiguous, we support the pharmacy location rules and legislation which seeks to clarify the intention of the act in relation to those, and the supply of pharmaceutical benefits is supported by Labor. We commend the bill to the House.

Question agreed to.

Bill read a second time.

Ordered that the bill be reported to the House without amendment.