What the reform was about
The purpose of removing Part D, general use items (GUI) from the Prescribed List (PL) was to keep the original purpose and scope of the list. GUI include items not originally intended for the PL, including consumables such as surgical glues.
Part D contains 475 GUI that were to be removed from the PL on 1 July 2024. However, on 1 May 2024, the Minister for Health and Aged Care announced GUI were staying on the PL.
Changes to GUI
As part of the scheduled reduction of PL benefits, we reduced the gap between the public benchmark price and the PL benefit for GUI by:
- 60% on 1 July 2022
- 40% on 1 March 2023.
Timeline
Sponsors can apply to list GUI if there is a comparator GUI already on Part D. Applications will be considered commencing from the November 2024 PL.
We are currently gathering stakeholder feedback to develop an approach to address concerns about the growth in utilisation and expenditure associated with GUI.
Past activities
Date | Activity | ||
|---|---|---|---|
| May 2024 | The Minister announced that GUI will continue to be listed and funded under Part D of the PL after 1 July 2024. This decision was made following stakeholder difficulties with negotiating alternative funding arrangements for GUI. Stakeholders also raised the negative clinical implications and potential adverse outcomes to patients if funding for GUI stopped. | ||
| September 2023 to March 2024 | Private hospitals and health insurers work on negotiations for alternative funding arrangements. Private hospitals continue to raise difficulties with finding suitable arrangements. | ||
| September 2023 | Released updated documents to help private hospitals and health insurers negotiate alternative funding arrangements:
| ||
| 28 June 2023 | Released stakeholder feedback report for bundling of PL benefits for GUIs. | ||
| 14 June 2023 | Notified next steps for GUI:
| ||
| 5 May 2023 | IHACPA released supplementary advice on bundling arrangements. | ||
| 1 March 2023 | Reduced GUI benefits by 40% of the gap. | ||
| 13 February to 27 March 2023 | Consultation about bundling of benefits for GUI. | ||
| 10 February 2023 | IHACPA released GUI bundling tool. | ||
| 25 January 2023 | IHACPA information webinar on their bundling advice. | ||
| 14 December 2022 | Minister for Health and Aged Care announces new funding arrangement for GUI. | ||
| 14 December 2022 | IHACPA released advice on bundling arrangements for GUI on the Prescribed List. | ||
| September to October 2022 | IHACPA undertook consultation to provide advice on bundling arrangements. | ||
| 2022 | Private hospitals and health insurers indicate difficulties with negotiating alternative funding arrangements and suggest a Prescribed List benefit bundling approach. | ||
| 1 July 2022 | Reduced GUI benefits by 60% of the gap. | ||
| June 2021 to March 2022 | Released documents to support private hospitals and insurers to negotiate alternative funding arrangements:
| ||
| November 2021 to March 2022 | The Clinical Implementation Reference Group (CIRG) confirmed that removing proposed products from the Prescribed List would have no clinical implications for patients. Devices would continue to be funded through alternative arrangements. | ||
| 23 August to 24 September 2021 | Consultation on purpose, definition and scope of the Prostheses List. Initial list of groups proposed to be removed from the Prostheses List | ||
| July 2020 | Ernst & Young (EY) – Review of the General Miscellaneous Category of the Prostheses List report | ||