Chapter 1Chair's report
1.1On 26 November 2025 the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 (the bill) was introduced in the House of Representatives by the Hon Mark Butler MP, the Minister for Disability and the National Disability Insurance Scheme, Minister for Health and Ageing (the minister).
1.2On 27 November 2025, the Senate referred the provisions of the bill to the Community Affairs Legislation Committee (the committee) for inquiry and report by 26 February 2026.
Conduct of the inquiry
1.3Details of the inquiry were made available on the committee’s website.
1.4The committee contacted organisations and individuals to invite them to make a submission to the inquiry by 30 January 2026. The committee received 47 submissions, which are listed at Appendix 2.
Acknowledgements
1.5The committee thanks the organisations and individuals who contributed to the inquiry by making written submissions.
Consideration by other committees
1.6At the time of drafting, the Scrutiny of Bills Committee and the Parliamentary Joint Committee on Human Rights had made no comment on the bill.
Purpose of bill
1.7The purpose of the bill is to amend the National Health Act 1953 (NH Act) to enable endorsed registered nurses (nurse prescribers) to prescribe certain pharmaceutical benefits under the Pharmaceutical Benefits Scheme (PBS).
1.8The bill also amends the Health Insurance Act 1973 (HI Act) to enable the Professional Services Review (PSR) to review PBS prescribing undertaken by nurse prescribers. This ensures they are subject to the same oversight as other PBS prescribers.
1.9The bill’s Explanatory Memorandum (EM) notes that the bill is the result of extensive research and consultation led by the Nursing and Midwifery Board of Australia (NMBA) and the Australian Chief Nursing and Midwifery Officers.
1.10In December 2024, Commonwealth, State and Territory Health Ministers approved a new registration standard under the National Health Act 1953. The Registration standard - Endorsement for Scheduled Medicines – Designated Registered Nurse Prescriber came into effect on 30 September 2025. The first cohort of registered nurses (RNs) is expected to complete education, receive endorsement, and prescribe medicines from July 2026.
1.11The standard describes the necessary qualifications and requirements that a registered nurse must meet when applying to the NMBA to attain, and retain, the endorsement for scheduled medicines. An ongoing requirement is that a designated registered nurse prescriber will prescribe in partnership with an authorised health practitioner under a prescribing agreement.
1.12Registered nurses comprise approximately half of the Australian health workforce and are the most geographically distributed health profession. Allowing authorised registered nurses to work to their full scope of practice will enhance access to medicines, particularly in rural and remote communities, and in vulnerable populations who have high levels of trust in nurses.
1.13The minister, the Hon Mark Butler MP, noted in his second reading speech that authorised nurse prescribing will ease workforce pressures and build long term capacity and sustainability in the health system. Further, improving access to primary health care will reduce avoidable hospital visits and preventable hospitalisations.
1.14The minister particularly highlighted that as a result of the bill, those who live in rural and regional areas will be able to receive affordable treatment with greater equity.
1.15The EM noted that the bill aligns with the recommendations of the Unleashing the Potential of our Health Workforce: Scope of Practice Review and supports the objectives of the National Medicines Policy, including the equitable access to medicines.
Regulation of the health workforce
1.16In 2008, the Council of Australian Governments (COAG) agreed to establish a single national scheme for registered health practitioners, the National Registration and Accreditation Scheme (NRAS). The NRAS ‘ensures that all regulated health professionals are registered against consistent, high quality, national professional standards’ and can practice across state and territory borders without having to re‑register in each jurisdiction. The NRAS commenced in 2010, and currently covers 16 professions.
1.17Each profession has a national board which regulates the profession, registers practitioners, and develops standards, codes and guidelines. The Australian Health Practitioner Regulation Agency administers the NRAS, and provides administrative support to the national boards.
1.18The national board for the regulation of the nursing profession is the NMBA.
1.19Under section 94 of the Health Practitioner Regulation National Law Act 2009 (Qld) (the National Law) as in force in each state and territory, National Boards may ‘endorse the registration of a registered health practitioner registered in a health profession for which the Board is established, as being qualified to administer, obtain, possess, prescribe, sell, supply or use a scheduled medicine or class of scheduled medicines’. Under the National Law, the NMBA has developed registration standards for nurse prescribing.
Consultation
1.20As noted above, the implementation of nurse prescribing follows extensive consultation and analysis over the past decade, as follows:
2016: the former Australian Health Ministers’ Advisory Council’s Health Workforce Principal Committee requested that the NMBA work with the Australian and New Zealand Council of Chief Nursing and Midwifery Officers to explore potential models of prescribing by RNs;
March 2017: the Commonwealth Chief Nursing and Midwifery Officer convened a national symposium to explore the potential for RN prescribing;
October 2017: the NMBA released a discussion paper on registered nurse and midwife prescribing;
April 2018: the NMBA undertook preliminary consultation;
July 2018: the NMBA released for public consultation a proposed registration standard;
March 2019: the NMBA undertook profession specific consultation;
2023: the NMBA released a consultation regulation impact statement, with options for models to support the proposed registration standard; and
December 2024: Health Ministers endorsed a scheduled medicines and associated registration standard for the designation Registered Nurse Prescriber role.
1.21The EM also notes that consultation with the Department of Veterans Affairs, Services Australia and the PSR conducted to ensure alignment with interrelated work. This consultation informed the inclusion of authorised nurse prescribers in amendments and requirements to facilitate PSR processes.
Key provisions
1.22This section provides an overview of the bill’s key provisions.
Commencement
1.23While Clause 2 provides that commencement will be the day after Royal Assent, the EM notes that a person will not be able to apply for approval as an authorised nurse prescriber, or prescribe pharmaceutical benefits under the PBS until necessary delegated legislation is made or amended.
Amendments to the NH Act
1.24As outlined in the EM, the bill would amend the NH Act to:
Establish a process by which eligible nurse prescribers who meet specified criteria can be approved by the Secretary as an authorised nurse prescriber, and allow approval as an authorised nurse prescriber to be subject to conditions imposed under a legislative instrument;
Provide for mechanisms enabling the Secretary to suspend or revoke approval as an authorised nurse prescriber;
Include authorised nurse prescribers as a kind of PBS prescriber, and allow the minister to specify the pharmaceutical benefits they are able to prescribe;
Ensure that patients receiving treatment from authorised nurse prescribers can be prescribed pharmaceutical benefits on the PBS;
Enable authorised nurse prescribers to supply limited quantities of certain pharmaceutical benefits directly to patients under ‘prescriber bag’ arrangements;
Make a number of consequential amendments to reflect that authorised nurse prescribers are a new type of PBS prescriber.
1.25Item 11 inserts proposed sections 84AAM to 84AAQ into the NH Act, recognising authorised nurse prescribers as PBS prescribers under specific conditions. Proposed subsection 84AAM(1) provides that an ‘eligible nurse prescriber’ is a registered nurse who meets the requirements set out in a legislative instrument made by the minister. These requirements may include, but are not limited to, one or more of the following:
a requirement to hold particular qualifications in nursing;
a requirement to have particular experience in nursing; or
a requirement to be endorsed by a particular body.
1.26The EM explains that one of the requirements that will be determined by the minister ‘is that the person’s registration as a registered nurse includes an endorsement under section 94 of the Health Practitioner Regulation National Law from the NMBA that the person can prescribe schedule medicines as a designated registered nurse prescriber’.
1.27Proposed subsection 84AAN(1) provides for an eligible nurse prescriber to be approved by the Secretary as an authorised nurse prescriber, with criteria to be determined by the minister via a legislative instrument. Proposed subsection 84AAN(4) provides that the criteria may include, but are not limited to, one or more of the following:
the eligible nurse prescriber has an agreement (a nurse prescriber agreement) in place with one or more other kinds of PBS prescribers; and
the nurse prescriber agreement must include specified features.
1.28The requirements listed under proposed subsection 84AAN(4) ensure that authorised nurse prescribers only undertake prescribing in partnership with an authorised health practitioner, such as a general practitioner (referred to as ‘designated prescribing’). The Guidelines for registered nurses applying for and with the endorsement for scheduled medicines outline the requirements of designated prescribing, including the development of a written prescribing agreement between the registered nurse and the authorised health practitioner.
1.29The minister may, by legislative instrument, also impose conditions to which approvals as an authorised nurse prescriber are subject. These may include:
that nurse prescriber agreements are to be retained and produced to the Secretary on request; and
that the eligible nurse prescriber does not prescribe a pharmaceutical benefit under their prescriber agreement that could not be prescribed by a PBS prescriber with whom the agreement is made.
1.30Proposed section 84AAP provides mechanisms for the Secretary to suspend or revoke approvals for authorised nurse prescribers, while proposed section 84AAQ allows for a review of decisions relating to authorised nurse prescribers.
1.31Item 14 inserts proposed subsection 88(1EAA) which provides authority for authorised nurse prescribers to write prescriptions for PBS medicines on or after 1 July 2026, with the minister to determine which pharmaceutical benefits may be prescribed. Item 15 amends subsection 88(1EA) to require the minister to give regard to advice received from the Pharmaceutical Benefits Advisory Committee when deciding which medicines can be prescribed by authorised nurse prescribers.
Amendments to the HI Act
1.32Part VAA of the HI Act establishes the PSR Scheme. The PSR Scheme enables the review and investigation of the provision of services by certain kinds of practitioners to determine whether they have engaged in inappropriate practice. Prescribing pharmaceutical benefits under the PBS is a reviewable service.
1.33Inappropriate practice occurs where a practitioner’s conduct would be such that a PSR Committee could reasonably conclude that it would be unacceptable to members of the practitioner’s profession.
1.34The review or investigation can be by the Director of the PSR, or by a PSR Committee that includes persons in the same profession as the practitioner under review.
1.35The bill proposes amendments to definitions in the HI Act to ensure that nurse prescribers will be subject to review and investigation under the PSR Scheme. These include for example, the definitions of ‘practitioner’, and ‘service’. Item 1, subsection 81(1) also ensures that the definition of eligible nurse prescriber will be consistent between the HI Act and the NH Act.
Support for the bill
1.36The bill received strong support in evidence received by the committee. For example, the Australian Primary Health Care Nurses Association (APNA) told the committee that it ‘strongly supports’ the bill. The Australian College of Nursing similarly stated that it ‘commends and supports’ the bill and endorsed the statement by the minister that the bill is ‘a win for nurses and a win for all Australians’.
1.37Palliative Care Australia told the committee that the bill is ‘welcome legislative reform’. It noted that:
The amendments in the Bill are consistent with, and support the objectives of the National Medicines Policy, by promoting timely and equitable access to medicines. This will assist in addressing persistent systemic barriers to timely quality palliative care experienced by specific population groups including First Nations communities and people living in rural, regional and remote areas.
1.38The Australian Nursing and Midwifery Federation (ANMF) submitted that the bill ‘presents a genuine opportunity to improve access to care across the country, strengthen the role of the nursing workforce and enable a more responsive effective health system’.
1.39The ANMF also highlighted ‘extensive international evidence’ which supports the effectiveness of nurse prescribing, indicating improvements in patient outcomes and health system performance. The ANMF noted that research has found that ‘when compared to physician prescribing, nurse prescribing is associated with positive medication and patient outcomes including patient satisfaction with care’.
1.40APNA noted that nurses are the ‘largest single health profession in Australia, accounting for 54.5 per cent of the health workforce, making them ideal health professionals to expand access to medicines for Australian communities’. It stated:
Nurse prescribing is a cost-effective intervention that offers continuity of care that can reduce the workload for other healthcare team members and improve patient satisfaction by streamlining patients’ health experiences.
1.41APNA also noted that nurses are geographically well-distributed and represented in nearly every community across the country. Further, in remote communities, primary health care nurses are ‘often providing vital health care access that would not otherwise be available to communities’. It concluded:
Enabling designated registered nurse prescribers to access the PBS will make a critical difference in providing timely access to medication, particularly for people in regional, rural and remote communities.
1.42The Rural Doctors Association of Australia similarly offered its support for the bill and noted that ‘without access to the PBS, nurse-prescribed medications would only be available to patients who are able to afford to pay privately’. Further:
Access to the PBS also ensures appropriate system-level accountability for designated registered nurse prescribing, enabling nurses to work to their full scope of practice.
1.43The Australian College of Nursing told the committee that the bill aligns with Article 12 of the International Covenant on Economic, Social and Cultural Rights promoting the right of individuals to the enjoyment of the highest attainable standard of physical of physical and mental health. It noted that this is particularly pertinent to those living in remote and regional areas who may have limited access to healthcare.
1.44Family Planning Australia (FPA) similarly told the committee that it ‘wholeheartedly supports the expansion of scope of practice for nurses as a key factor in equitable health care access, particularly for people living outside of metropolitan areas’. It also noted that:
Prescribing by authorised registered nurses would benefit the wider community in many ways in the context of sexual and reproductive health [SRH]. The availability of authorised nurse prescribers for SRH consultations would result in decreasing delays to commence medications, improving access to urgent or time sensitive health care, and relieving pressure on medical staff… By making SRH care more accessible and affordable, authorised nurse prescribers would be of great benefit for the priority population groups who access FPA for bulk-billed SRH care, who are at risk of poorer health outcomes without access to this care.
1.45The NMBA submitted that:
…allowing designated registered nurse prescribing under the PBS is expected to support viability of the role in public and private health settings and enhance utility within the healthcare workforce and system. Without access to PBS, there is the possibility community members may continue to only engage with health practitioners who can prescribe under the PBS.
1.46The Tasmanian Government offered its support for the bill and noted that extending the scope of practice of endorsed registered nurses will ‘increase people’s access to healthcare in the community and relieve pressure on other primary healthcare providers and hospitals’. It noted:
This is particularly relevant to Tasmania, where we are experiencing increasing demand for health services due to factors such as having the oldest and fastest ageing population in Australia, a highly dispersed population, and high rates of chronic disease in the community.
1.47Palliative Care Australia told the committee that the bill is ‘welcome legislative reform’, which will improve ‘equitable access to timely, safe and affordable medicines for people with life-limiting illnesses, particularly those receiving palliative care in community settings’.
1.48The Working with Women Alliance offered its endorsement of the bill, and noted that it ‘aligns with the Nurse Practitioner Workforce Plan and promotes the utilisation of nurse practitioners to their full capabilities’. Further:
It will play a significant role in ensuring medication is affordable and will reduce accessibility challenges particularly in rural, remote and regional areas and for Aboriginal and Torres Strait Islander women. Expanding [nurse practitioners] NP’s prescribing rights is also a key component of addressing specific access barriers for women seeking contraception.
Opportunities for improvement
1.49While offering their support for the bill, some submitters also made suggestions for improvements to the implementation and management of nurse prescribing, and these are outlined below.
Dangerous medication
1.50The committee heard suggestions that additional clarity and guidance may be required in relation to the prescribing of certain classifications of medicine. For example, the Australian Medical Association (AMA) suggested that stronger safeguards for the prescribing of dangerous medication are required. It submitted:
Although the prescriber agreement limits the pharmaceutical benefits a RN can prescribe (to match their PBS prescriber), the AMA asserts that Schedule 8 medicines should be excluded entirely. These drugs have a high potential of misuse and are under much stricter regulation than other scheduled medicines.
1.51The Australasian College of Dermatologists recommended changes to ensure an alignment between registered nurse prescribing rights and all relevant restrictions under the Therapeutic Goods Administration (TGA) Poisons Standard, particularly for Schedule 4 medicines identified as high risk.
1.52Bupa Australia also noted that nurse prescribing of Schedule 2, 3, 4, and 8 medicines will be subject to state and territory legislation. As such:
Differentiation in state-based legislation could lead to inconsistent or unsafe prescribing in border communities and where services are delivered by telehealth. Different state and territory requirements also create complexity in how different clinical systems that support medication management (such as GP Practice Management Systems, Hospital Electronic Medical Records) would need to be configured or developed to enable potential variations.
1.53It recommended that the ‘Commonwealth Government work with state and territory Governments to ensure uniformity in prescribing by RN prescribers working across state boundaries’.
Prescribing agreements
1.54The committee received suggestions for amendments in relation to prescribing agreements and the supervision of nurse prescribing. For example, Bupa Australia suggested that the bill should be amended to increase the powers of the minister under proposed s84AAN when determining the conditions of approval of nurse prescribers under the instrument. It recommended that this should include ‘placing an additional criterion that limits the RN prescriber to only prescribing medication relevant to the field that they are working in’. For example:
…an RN prescriber working in end-of-life care at an aged care home may have criterion on their approval that enables the prescription of Schedule 8 medication as this is directly relevant to their work. A RN prescriber working in diabetes management at a GP clinic would be able to prescribe Schedule 4 diabetes medication but not Schedule 8 medication. These changes would support the safe prescribing of medications and enable RN prescribers to specialise in areas of care leading to further professional development.
1.55The Australasian College of Dermatologists also suggested that more clarity is required regarding the categories of authorised prescribers who may enter into an active prescribing partnership with a designated registered nurse. It suggested that ‘allowing multiple prescriber types to act in supervisory roles risks increased fragmentation of care and weakened accountability’.
1.56Family Planning Australia suggested that prescribing agreements may require more flexibility, particularly in rural, regional and remote areas where there are a limited number of doctors available as prescribing partners.
Opportunities for expansion
1.57Though outside of the scope of the bill, the committee received a range of submissions calling for an expansion in the professions endorsed to prescribe under the PBS. Of particular note, the committee received over 20 submissions calling for podiatrists to be authorised to prescribe under the PBS. The Australian Podiatry Association noted that authorising nurse prescribers to access the PBS will leave podiatrists and podiatric surgeons as the only nationally endorsed health practitioners whose patients cannot receive PBS-subsidised medicines from their endorsed clinician. The Tasmanian Government also noted that:
…the podiatry endorsement for the scheduled medicines registration standard has been in place for several years, yet podiatrists are not yet recognised as authorised prescribers under the PBS. The benefits of allowing podiatrists to be prescribers under the PBS are the same as for designated registered nurse prescribers. As such, it would be beneficial for the Commonwealth to introduce a similar Bill for podiatrists so they too will be able to prescribe under the PBS, noting any scripts currently prescribed by podiatrists are only able to be filled as private scripts.
1.58The South Australian Health and Medical Research Institute (SAHMRI) noted the importance of podiatric prescribing in the management of diabetes and diabetic foot care, particularly in Aboriginal communities in rural and remote regions where access to care is limited.
1.59The Tasmanian Government suggested that it would be advantageous for all professions endorsed to prescribe to be authorised under the PBS as this would ‘ensure health equity and [a] consistency of approach’. It noted that the Boards for a range of other health professions are developing proposals for the endorsement of scheduled medicines, and it suggest that to:
…avoid the administrative burden of introducing multiple pieces of legislation, the Commonwealth may wish to explore automatically recognising professions with an endorsement for scheduled medicines as prescribers under the PBS. This would mean that podiatry would be recognised immediately, while the other professions would be recognised as soon as their endorsements are in place.
1.60The Australasian College of Podiatric Surgeons noted that ‘incremental legislative reform that focuses on individual professions can unintentionally perpetuate system inefficiencies’. Like the Tasmanian Government, it argued for aligning PBS eligibility with National Board endorsement.
1.61The Pharmacy Guild of Australia submitted that the PBS should be prescriber-agnostic, and that all authorised prescribers should be able to prescribe the pharmaceutical benefit to patients eligible for PBS subsidy, provided it is within the prescriber’s scope of practice. It suggested:
To future proof the legislation, we recommend inserting an additional clause into subsection 88 that authorises any health practitioners with an endorsement to prescribe scheduled medicines under section 14 of the Health Practitioner Regulation National Law to write a prescription for the supply of any pharmaceutical benefits.
1.62The Australian Medical Association however, indicated its opposition to the inclusion of ‘non-medical practitioners in the future, such as pharmacists and podiatrists’. It stated that it is its ‘strong view that supervising prescribers need to be extensively experienced in broad prescribing, and only medical practitioners and nurse practitioners (acting within their scope of practice) are suitably qualified’.
Committee view and recommendation
1.63This bill introduces historic reforms to health legislation that empower nurses to work to their full scope of practice and improve access to medicines for people across Australia.
1.64This bill advances scope of practice reforms identified by the Strengthening Medicare Taskforce and the subsequent Unleashing the Potential of our Health Workforce review.
1.65Enabling prescribing under the PBS by designated registered nurse prescribers ensures the medicines they prescribe are affordable for patients. This reform aligns with the government's commitment to cheaper medicines, and with the National Medicines Policy. It promotes equitable, affordable, and timely access to high-quality medicines and services.
1.66Currently, registered nurses, who are highly skilled and highly educated, remain underutilised in primary care. Allowing them to prescribe under the PBS will boost efficiency, strengthen care coordination, and ensure general practitioners and nurse practitioners can focus on patients with more complex needs.
1.67Designated registered nurse prescribing strengthens the health system by easing workforce pressures and building long-term capacity and sustainability.
1.68Improved access to primary health care reduces avoidable hospital visits and preventable hospitalisations. In rural and remote communities, people often have to travel long distances and face long wait times for even basic care.
1.69This reform allows people, especially those in rural and regional areas, to receive affordable treatment with greater equity.
1.70The committee notes suggested amendments made by some inquiry participants to improve the operation of nurse prescribing but is confident that the NMBA, and state and territory governments are, and will continue to work closely and cooperatively to resolve any issues which may arise.
1.71The committee also notes suggestions to expand access to the PBS to other professions but considers this outside of the scope of this bill. The committee is of the view that this matter should be considered by appropriate National Boards working together with the Australian and state and territory governments.
1.72The committee recommends the bill be passed.
Senator Dorinda Cox
Chair
Labor Senator for Western Australia