PHI 46/23 Benefits for Prescribed List products undergoing a post-listing review

This circular describes the benefits for prescribed List products undergoing a post-listing review.

Date published:
PHI circular type:
Prostheses announcement
Audience:
Health sector

Under the Private Health Insurance Act 2007, private health insurers are required to pay benefits for a Prescribed List product when:

  • the product is on the Prescribed List of medical devices and human tissue products
  • the patient receives the product as part of hospital treatment or hospital substitute treatment
  • the patient has appropriate health insurance to cover for the treatment
  • a Medicare benefit is payable for a service associated with the use of the product.

If a product that is being subject to a post-listing review process meets the requirements above, insurers are still required to pay the associated benefits, until the outcome of the post-listing review is implemented. This includes benefits payable for urogynaecological mesh devices (mid-urethral slings); spinal cord stimulators; and surgical guides and biomodels.