The federal government has announced that from 1 July 2025, health fund benefits will no longer be available for sight-saving eye intravitreal injections performed in private hospitals and day surgeries.#
Macular Disease Foundation Australia estimates that this will impact up to 12,200 patients.*
Instead, these patients will need to start paying out-of-pocket costs to keep accessing eye injection treatment in private ophthalmology clinics, as public hospital eye injection clinics and bulk billing private ophthalmology clinics are either not available, or already at capacity.
At a time when people are already feeling the pressures of a high cost-of-living, the Foundation believes some patients will be forced to give up their treatment altogether because they will no longer be able to afford it.
We know that the cost and affordability of treatment are still huge concerns for many people living with macular disease
Improved Access the Answer
Rather than reducing access, Dr Kathy Chapman, CEO of Macular Disease Foundation Australia has called on the state and territory governments to step up to improve access to eye injections, which she said will ultimately save sight and “billions of dollars”.
“We have previously said we would only support the reclassification of this MBS (Medicare Benefits Schedule) item if there had been a significant increase in the number of public outpatient clinics offering bulk billed eye injections to ensure improved access to affordable treatment. We know that the cost and affordability of treatment are still huge concerns for many people living with macular disease, and there are still limited options to receive bulk-billed treatments,” Dr Chapman said.
“We have raised these concerns with the Minister for Health and Aged Care, Mark Butler’s office and will continue to do so.
“As we head towards 1 July 2025, we must address the ongoing issue of lack of access to affordable sight-saving treatment in Australia, which the government’s recent MBS decision only compounds. Solutions must be found to help all Australians living with macular disease who need eye injection treatment. It’s a significant issue that can no longer be ignored.
“Our message for government is that investing in increased access to eye injection treatment for people with macular disease will not only save the sight of tens of thousands of people, but will also save the government billions of dollars in the long term.”
Governments Must Work Together
Dr Chapman said ensuring adequate and equitable access to affordable intravitreal injection treatment across the country will require the Australian and state/territory governments to work together to:
- Introduce an ophthalmology practice incentive to bulk bill eye injections for age pensioners with neovascular AMD.
- Ensure increased access to eye injection treatment in public hospital outpatient clinics, which can only happen if state and federal governments work together.
- Establish partnerships between the public and private health systems to boost treatment access options for people needing intravitreal injections.
- Provide funding to help establish new ophthalmology clinics in areas of high demand for treatment, with agreements that these clinics will provide bulk billed eye injections.
Notes
# People who have a specific medical reason for having intravitreal injections in a day surgery / hospital setting will not be affected by this change as an alternative MBS item is available in these cases.
* Calculation is based on MBS item data from Services Australia, Drug utilisation sub-committee (DUSC) data (most recent data is May 2018), and information sources from Services Australia, and data provided to Macular Disease Foundation Australia by the Department of Health and Aged Care.
The current estimates of people receiving intravitreal injections in Australia are 62,000 people with neovascular AMD, 18,000 people with diabetic macular oedema, and 11,000 people with retinal vein occlusion.
