PHI 85/20 Prostheses List: release of 2 reports and a consultation paper regarding reform

Private health insurance announcement about the Prostheses List.

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

This circular is to advise of the publication of 2 reports relating to Prostheses List reviews and options for reform. These reports are the Options for a Revised Framework for Setting and Reviewing Benefits for the Prostheses List and the Review of the General Miscellaneous Category of the Prostheses List.

The department will be seeking stakeholder feedback over the coming 2 months about options for reforms to the Prostheses List in response to a consultation paper which the department anticipates will be published within the next few days. The consultation will be open until mid-February. An additional PHI circular will be issued once the consultation paper is available online.

The 2 reports released today provide context to the reform options that will be described in the consultation paper. Neither of these reports reflect a settled position of the Government. The purpose of their release is to facilitate more complete consultations on potential reform options. This consultation process builds on consultation over recent years through the framework of the government’s 2017 agreement with the Medical Technology Association of Australia (MTAA) and stakeholder discussions over recent months.

Stakeholders who wish to comment on the 2 reports released today should await publication of the consultation paper and provide their comment there.

The report Options for a Revised Framework for Setting and Reviewing Benefits for the Prostheses List has been prepared by the Menzies School for Health Policy, University of Sydney, drawing on material presented to and discussions by the Prostheses List Revised Benefit Setting and Review Framework Industry Working Group (BSRIWG) over 8 meetings held between April 2018 and February 2020. 

The BSRIWG was established as part of the MTAA agreement to develop options for a revised framework for benefit setting and benefit review for the Prostheses List, and was due to be finalised by 30 June 2020. Because of COVID‑19, this did not occur within the anticipated timeframe and the BSRIWG did not arrive at a consensus set of recommendations but instead advised that further consultation should be undertaken.

In late 2019, the department commissioned Ernst and Young to undertake a Review of the General Miscellaneous Category of the Prostheses List. Ernst and Young make recommendations that are both broad and specific to individual product listings. Should changes be required for specific listings, the department will work with sponsors to agree these changes in coming months. If changes are to be made, it is acknowledged that there is a need to ensure that clinically necessary products continue to be funded.

Consideration of the role of the Prostheses List in funding general use items and consumables will be addressed through the wider reform options that will be canvassed in the consultation paper.

The department will continue to provide updates on Prostheses List reviews and reforms through PHI circulars. All queries relating to the reports should be emailed to