Sponsors Given Opportunity To Review Proposed Benefits

Sponsors with medical device technologies on the Prescribed List (PL, formerly the Prostheses List) have four weeks to review their proposed benefits to inform the third and final reduction of PL benefits.

As part of the Prostheses List Reforms, the Independent Health and Aged Care Pricing Authority (IHACPA) has been recalculating the 2022/23 Weighted Average Price (WAP) for medical devices.

The updated WAP, which is calculated by comparing public hospital and private health insurance benefits (price paid to Sponsors by hospitals), will inform the third and final reduction of PL benefits.

The PL sets out the medical devices and human tissue products that private health insurers must pay benefits for to the patients who have appropriate insurance policies, with more than 11,000 items listed.

Sponsors with devices on the PL have been directly sent their latest proposed benefits, and have been given four weeks to review them and raise any concerns with the Department of Health and Aged Care.

The Department will also release a Private Health Insurance (PHI) circular to capture Sponsors that may not have been alerted in recent email communications.

The Prescribed List Reform Taskforce will refine the benefits as required based on issues raised by Sponsors. Sponsors have until the week commencing 22 April to provide feedback on proposed benefits before final refinement and uploading into the Health Products Portal (formerly the Prostheses List Management System).

National peak bodies AusBiotech and Medical Technology Association of Australia (MTAA) have been vocal advocates for industry during the Prostheses List Reform, working in collaboration to provide views on behalf industry.

AusBiotech has also had ongoing conversations with the Department regarding maintaining industry representation on the Prostheses List Advisory Committee, recently replaced by the Medical Devices and Human Tissue Advisory Committee.

The review of PL benefits is required under the Prostheses List Reforms Memorandum of Understanding (MoU) with MTAA.

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