PHI 47/11

This circular issued by the Private Health Insurance Branch contains information on Prostheses List Arrangements Update

Page last updated: 01 November 2012

PDF Printable version of 47/11 (PDF 31 KB)

30 June 2011

Prostheses List Arrangements Update

Purpose

To inform stakeholders about progress in implementing Recommendation 12 b-e of the Review of Health Technology Assessment in Australia (HTA Review); and
To inform stakeholders about publication of the August 2011 Prostheses List.

Background Information

Recommendation 12b-e of the HTA Review relates to changing the prostheses listing arrangements to establish and maintain groups of products with similar clinical effectiveness and a single benchmark benefit for each group of products, to remove maximum benefits from the Prostheses List, and to permit the establishment of new product groups into the future.

Previous Circulars 82/10, 90/10 and 27/11 provide further information on the HTA Review and Recommendation 12 b-e.

Phase 1

Final groupings and group benefits for hips, knees, and specialist orthopaedic (arthroplasty and bone cements and bone graft substitutes only) prostheses will be presented to the Prostheses List Advisory Committee (PLAC) for endorsement on 5 July 2011. If endorsed, the changes will be implemented for the August 2011 Prostheses List.

The review of neurosurgical products is continuing; clinicians are considering submissions from sponsors. It is anticipated that the changes arising from this review will be implemented for the February 2012 Prostheses List.

Phase 2

The final grouping scheme and benefits for ophthalmic prostheses will be presented to the PLAC for endorsement on 5 July 2011. If endorsed, the changes will be implemented for the August 2011 Prostheses List.

Clinicians are considering sponsor feedback on vascular prostheses. It is anticipated that the changes arising from this review will be implemented for the February 2012 Prostheses List.

Clinicians have reviewed the grouping scheme for cardiac prostheses. The secretariat will circulate the amended grouping scheme and products in the groups to sponsors for information. It is anticipated that the changes will be implemented for the February 2012 Prostheses List.

The secretariat has received sponsor submissions for specialist orthopaedic external fixateurs, plates and screws and will forward them to clinicians for comment. It is anticipated that changes arising from this review will be implemented in the February 2012 Prostheses List.

The Consultative Committee has considered the draft grouping scheme and benefits for spinal prostheses. The Secretariat circulated the proposed grouping scheme and group benefits and products in groups to sponsors on 27 June 2011. Submissions from sponsors are due back by close of business on 25 July 2011. It is anticipated that changes arising from this review will be implemented for the February 2012 Prostheses List.

Phase 3

The Consultative Committee has considered the draft grouping scheme and benefits for cardiothoracic prostheses. The Secretariat circulated the proposed grouping scheme and group benefits and products in groups to sponsors on 27 June 2011. Submissions from sponsors are due back by close of business on 25 July 2011. It is anticipated that changes arising from this review will be implemented for the February 2012 Prostheses List.

The Consultative Committee has considered the draft grouping scheme and benefits for urogenital prostheses. The secretariat circulated the proposed grouping scheme and benefits and products in groups to sponsors on 21 June 2011. Submissions from sponsors are due by close of business on 22 July 2011. It is anticipated that changes arising from this review will be implemented for the February 2012 Prostheses List.

Work has commenced to review the grouping schemes for general/miscellaneous, plastic and reconstructive, ear, nose and throat prostheses and the remaining specialist orthopaedic prostheses. The secretariat will work with clinicians to refine the grouping schemes and submit them to the Consultative Committee for consideration before consultation with sponsors.

Publication of August 2011 Prostheses List

The August 2011 Prostheses List may be published later in August, due to the implementation of the HTA review groupings and benefits. It is anticipated that a draft of the Prostheses List will be circulated to sponsors for checking on 13 July 2011, with notification of errors due from sponsors by close of business on 27 July 2011.

Part C

Circular 25/10 advised that the Private Health Insurance Act 2007 had been amended to facilitate the implementation of Part C of the Prostheses List. It was anticipated that Part C would be implemented for the August 2011 Prostheses List; however implementation has been delayed. Products that have been identified for listing on Part C (insulin infusion pumps and cardiac event recorders) will remain listed on Part A of the Prostheses List in the interim.

Further enquiries

Further enquiries regarding the work on implementing Recommendation 12 b-e and publication of the August 2011 Prostheses List should be directed to Prostheses.

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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