The Prostheses List is a list of implantable medical devices for which Australian private health insurers must pay a specific benefit over and above any payment for the associated hospital admission. While the industry has always been supportive in general of the Prostheses List arrangements, it has always been a grievance to patient advocacy groups, hospitals and the medical device industry, that high value items offering significant clinical benefits have been excluded from the Prostheses list because they are not ‘implantable’ devices. As technology progresses, this has become an increasingly anachronistic definition and arguably has resulted in inferior access for private patients to a number of critical procedures.
The 2017 agreement between the Australian Government and the Medical Technology Association of Australia (MTAA) called for
‘reviewing, through the Prostheses List Advisory Committee, ways of listing new targeted medical devices on the Prostheses List that do not meet the current criteria for listing, but are safe, clinically and cost-effective to support private health insurance reimbursement for a wider range of medical devices taking into account overall costs associated with the listing. These include, but are not limited to, cardiac ablation catheters for atrial fibrillation’.
It seems, at least for the very immediate future that the change has been limited to cardiac ablation catheters with arrangement for other non-implantable technologies to be determined later. There has been some criticism about the process that was undertaken by the Office of Health Technology Assessment to evaluate the cost-effectiveness of cardiac ablation which was completed without significant consultation with the industry. Nevertheless, this is a long-awaited positive policy change which will improve access in private hospitals to cardiac ablation procedures that has been restricted for many years.
There are numerous non-implantable technologies that may be eligible for inclusion on the Prostheses List once the arrangements are in place. There is no published timeframe for this to occur, but an important precedent has been set with the inclusion of cardiac ablation catheters and it is a very positive development for the Australian medical device industry.
Author: Sarah Griffin, Principal at MedTechnique Consulting, Experts in medical device reimbursement and market access in Australia. Sarah is a health economist, reimbursement strategist, health care advocate and experienced speaker. email Sarah: info@medtechnique.com.au