Key points
- Reforms underway targeted for 1 July 2023 risk patient access if they are rushed
- Legislation has been introduced prior to details of the regulations being available
- Industry and other stakeholders need to see detail before supporting the legislation
The Prostheses List (PL) reform process has already mapped benefit reductions to PL items over the next 3 years and this will not change. However, there are important reforms still underway with a target date of 1 July 2023 which require careful consideration and risk being rushed to the detriment of patient access.
Legislation to implement reform has also been introduced to parliament on 1 December, however MTAA cannot support the legislation unless there is clarity on reforms to be introduced under the subordinate legislation, including the following issues:
Cardiac Technical Support Services
Through device prices, the PL currently funds provision of critical cardiac technical support services by industry to patients with devices such as pacemakers for the lifetime of the device regardless of location. Benefit reductions proposed for 1 July 2023 will see these services disappear if the current Medical Services Advisory Committee (MSAC) process doesn’t result in future funding for these.
Pathway to add non-implantable devices on Part C
The criteria for Part A of the PL does not cover devices that aren’t implanted. This results in an inflexible PL that doesn’t provide patient access to some of the latest non-invasive technology. Stakeholders have been advised that Part C of the PL would be opened up for these devices. So far limited detail has been provided on how this will occur.
Payment for items to be removed from the PL
The Department of Health and Aged Care (DoHAC) has identified a list of PL items that it intends to remove from the PL from 1 July 2023 on the understanding that an alternative funding mechanism will be in place. There are significant concerns from stakeholders whether the funding now being calculated by the Independent Hospital and Aged Care Pricing Authority (IHACPA) will be sufficient and whether insurers will be required to pay or just given guidance which may simply be ignored.
Regrouping of PL items
DoHAC has undertaken a vast exercise to regroup all of Part A of the PL. The Memorandum of Understanding (MOU) signed by the previous Minister for Health and MTAA requires that this process does not result in additional savings. MTAA is concerned that this process may be rushed and eliminate important clinical distinctions between devices or result in further savings.
PL Listing Pathways and Cost Recovery
DoHAC has proposed to introduce new pathways for listing devices on the PL, including a less onerous Tier 1 pathway which is welcome. It is also proposing to introduce increased cost recovery for these pathways. Further detail on the pathways and the cost recovery is required if the legislation is to be supported.
MTAA will continue to work with the government on these issues, but further scrutiny and consultation is required especially before the legislation can be supported.
