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7 April 2011
Review of Health Technology Assessment in Australia: April 2011 Update on Implementation of Recommendations 12B-E
The purpose of this circular is to provide industry with an update on the implementation of Recommendations 12b-e from the report of the Review of Health Technology Assessment in Australia, 2009
As advised in PHI Circular 90/10 of 20 December 2010, the Department is working through a phased approach to the implementation of Recommendations 12b-e. The three phases are:
- Phase 1: includes hip, knee, some specialist orthopaedic and neurosurgical products, anticipated to be completed for the August 2011 Prostheses List.
- Phase 2: includes cardiac, vascular, ophthalmic, some specialist orthopaedic and spinal products, anticipated to be completed for the August 2011 Prostheses List.
- Phase 3: will include general and miscellaneous, ear nose and throat, cardiothoracic, urogenital, some specialist orthopaedic and plastic and reconstructive products, anticipated to be completed by end of 2011.
Progress to date on reviewing groups and benefits
Proposed groups and group benefits for Phase 1 prostheses (specialist orthopaedic – arthroplasty and bone cement/substitute products only and neurosurgical) were sent to sponsors in mid December 2010. The Department is reviewing the responses from sponsors. It is anticipated that the outcomes of the review of Phase 1 prostheses will be reflected in the August 2011 Prostheses List.
Proposed groups and group benefits for the remaining Phase 1 prostheses (hips and knees) and Phase 2 prostheses (cardiac, ophthalmic and specialist orthopaedic – external fixateurs and plates and screws only) were recently sent to sponsors. Responses from the sponsors are due in late April/early May 2011.
As advised in PHI Circular 90/10, the Department has formed a consultative committee whose role is to provide advice to the Department about the development of grouping schemes and group benefits for the products on the Prostheses List and broader policy issues relating to the funding of prostheses for privately insured patients.
The committee held its second meeting on 8 March 2011 at which it considered the proposed groups and group benefits for cardiac, ophthalmic and specialist orthopaedic (external fixateurs and plates and screws only).
The committee has two further meetings scheduled for June and September 2011.
The Department has commenced work on the Phase 3 grouping schemes, and it is planned that the Consultative Committee will consider the proposed groups and groups benefits for these prostheses at its June meeting.
Overview of benefit setting for new applications and amendments to existing products for the August 2011 Prostheses List
Products in Phases 1 and 2
The groups of products that are part of Phases 1 and 2 will not be subject to benefit negotiations, rather the group benefit will be developed by the Department. This will affect new applications, applications that received truncated benefit offers for the February 2011 Prostheses List and amendment applications.
Products in Phase 3
Benefits for products in Phase 3 (again new applications, truncated benefit offers from the February 2011 Prostheses List and amendments) will be negotiated by the Negotiation Oversight Committee.
Note about applications to amend/duplicate/expand/compress or transfer existing products
Where a sponsor has, for the August 2011 Prostheses List, submitted an application to amend, duplicate, expand, compress or transfer products and they are Phase 1 or 2 prostheses, the changes as a result of these applications will be incorporated into the grouping reviews. Information about this will be provided to sponsors through this review process.
As the review of Phase 3 prostheses progresses, all other applications to amend, duplicate, expand, compress or transfer products that have been submitted will be considered as part of those reviews.
If you have any queries please contact the Prostheses Section on (02) 6289 4998 or email Prostheses Health Technology Assessment
If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch
For more information visit 2011 Private Health Insurance (PHI) Circulars
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