PHI 50/11

This circular issued by the Private Health Insurance Branch contains information on

Page last updated: 01 November 2012

Printable version of 50/11 (PDF 28 KB)

8 July 2011

August 2011 Prostheses List

Purpose

The purpose of this Circular is to inform prostheses sponsors and industry of the recent recommendations of the Prostheses List Advisory Committee (PLAC) regarding the HTA grouping review project.

HTA Grouping Project

At its meeting of 5 July 2011 the PLAC reviewed the proposed final grouping schemes, group benefits and final groupings for products within Phase 1, hip, knee, arthroplasty, bone cement/bone substitute and Phase 2 ophthalmic. With some minor amendments, the PLAC endorsed the reviews with the changes to be implemented for the August 2011 Prostheses List.

Work Completed

Phase 1

  • Hip, knee, arthroplasty and bone cement/bone substitute products have been reviewed in consultation with clinicians and sponsors. As endorsed by the PLAC on 5 July 2011, these changes will be implemented for the August 2011 Prostheses List.

Phase 2

  • Ophthalmic products have been reviewed in consultation with clinicians and sponsors. As endorsed by the PLAC on 5 July, these changes will be implemented for the August 2011 Prostheses List.

Work In progress

Phase 1

  • For neurosurgical products clinicians are currently considering and providing feedback on submissions from sponsors. It is anticipated this review will be implemented for the February 2012 Prostheses List.

Phase 2

  • Proposed grouping schemes are with clinicians for final feedback for vascular and cardiac prostheses.
  • Sponsors’ submissions have been received for plates and screws and external fixateurs.
  • Clinicians have analysed spinal products with proposed groups and benefits. This information is currently with sponsors for comment.
  • It is anticipated that the remainder of Phase 2 will be implemented for the February 2012 Prostheses List.

Phase 3

  • Clinicians have analysed cardiothoracic prostheses with proposed groups and benefits. This information is currently with sponsors for comment.
  • Work is continuing with urogenital, general/miscellaneous, ear, nose and throat, plastic and reconstructive and the remaining specialist orthopaedic prostheses.
  • It is anticipated that Phase 3 will be implemented for the February 2012 Prostheses List.

Release date for the August 2011 Prostheses List

In order to implement the above HTA grouping review changes endorsed by the PLAC, the release date for the August 2011 Prostheses List has been slightly delayed. The publication date for the August 2011 Prostheses List is now anticipated to be 8 August 2011 with an effective date of 22 August 2011.

Changes to the August 2011 Prostheses List

The implementation of Phase 1 (excluding neurosurgical) and Phase 2 ophthalmic products will result in these products attracting a group benefit only, unless the sponsor elects to list at a lower benefit. Products within these grouping schemes will no longer be listed with a minimum and maximum benefit (i.e. gap products). The remainder of the products on the Prostheses List (where HTA grouping reviews have not been implemented) can still be listed with both minimum and maximum benefits.

The format of the Prostheses List will not change for the August 2011 List and group benefits will appear as a minimum benefit with no gap. Once all HTA reviews have been implemented, the format of the Prostheses List will be amended to reflect the group benefit structure.

Grouping Schemes

The Ear Nose and Throat grouping scheme has been updated on the Prostheses Website.

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.

Changing your e-mail address? No longer want circulars? Please email Private Health Insurance Branch