Although the Federal Government has maintained its short-sighted stance on halving the rebate on cataract surgery, it is a different case with Macular Degeneration.
After some heavy lobbying by the Macular Degeneration Foundation, the Senate, on 15 September, overturned an earlier decision by the Ministry for Health and Ageing to drastically lower the Medicare rebate for wet MD once the Extended Medicare Safety Net (EMSN) had been reached.
Originally, the plan was to cap the cost of Lucentis at AUD$80 after the EMSN threshold of AUD$555.70 for concession cardholders and AUD$1111.60 for non concession cardholders had been surpassed. Under the existing system, 80 per cent of the cost of around AUD$300 per injection was refunded by Medicare.
That has now been re-instated and in a media release announcing the maintenance of the status quo regarding the treatment of wet MD, Health Minister, Nicola Roxon said:
“Today (16 September) the Government’s Medicare Safety Net changes passed the Senate. The Rudd Government knows that patients rely on the Safety Net. However, in recent years the Medicare Safety Net has enabled some specialists to charge exorbitant fees – which have resulted in million dollar incomes being paid by taxpayers through Medicare.
“The Government is no longer prepared to provide a blank cheque to specialist doctors to allow them to increase their fees and take advantage of a program designed to reduce costs for patients.
“This was a policy which is unsustainable in its current form – and we are making structural reforms to put expenditure in this area onto a sustainable footing for the future.
“We are maintaining EMSN benefits for all existing procedures – to ensure cancer sufferers and those with serious illness, who the Medicare Safety Net was originally designed to assist, continue to benefit fully from the safety net. I am pleased that this sensible measure passed with the support of the Opposition.
“The Government has agreed that a cap on the benefits for the injection of a therapeutic substance into the eye will not be implemented. In recent years there have been significant advances in therapies to treat macular degeneration, which can hold dramatic results for patients – including saving sight.
“I’d like to acknowledge the important role the Macular Degeneration Foundation has played in securing these changes.”
The MD Foundation welcomed the decision in the Senate to ensure that Item 42740 (injection of a therapeutic substance into an eye) relating to the Extended Medicare Safety Net (EMSN) was resolved positively for thousands of elderly Australians who are diagnosed each year with the aggressive form of Age-related Macular Degeneration (known as ‘wet’ AMD) and require this treatment in order to save sight.
According to CEO of the MD Foundation, Julie Heraghty: “What was of great concern to the Foundation was that patients may exit treatment or not enter treatment due to a shift in costs onto the patient. In addition, the availability of this treatment in public hospitals are limited, in fact in NSW it is not available at all. So no catchment mechanism existed to save those from exiting treatment. This issue relates to irreversible blindness and the cost of blindness on a human, economic and medical basis.
“The outcome was a reflection on the importance of the democratic process of review in the Senate and the ability to arrive at common sense decisions, good policy and the best outcomes for ageing Australians who may be diagnosed with wet Macular Degeneration.
“On behalf of patients with wet MD, their families and carers I would like to say thank you to all members of Parliament from all sides of politics who worked through the issue and made a decision that was the right thing to do.
“I also thank the MD Foundation Medical Committee especially Dr. Paul Beaumont and Dr. Alex Hunyor (Jnr), the Foundation staff and all the patients who helped us gather critical and factual data to mount our case to Government. Access and affordability of treatment is one of the most important aspects of the work of the Foundation.”
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