Concern about Medicare changes

Recent changes to Medicare have changed the way the ophthalmologist can bill for Avastin injections.

These changes mean that rebates for the procedure may no longer be available to patients.

Avastin is only TGA approved for cancer treatment; therefore its use in eye treatment is “off-label”. Avastin injections have never been eligible for a Medicare rebate for use for the treatment of macular degeneration.

There are certain costs associated with the procedure (i.e. the Doctor’s bill) and there is a separate cost of the drug, regardless of whether this drug is Lucentis or Avastin.

Prior to 1 November 2008, the Government made a payment of $200 towards the cost of the injection procedure, regardless of the type of drug injected (the final fee is up to the Doctor and varies from Doctor to Doctor).

The new changes to Medicare mean that this $200 rebate is no longer available for the administration of Avastin as a treatment for MD. The costs associated with the drug have not changed.

Patients who are outside of AMD or do not have sub-foveal AMD are not eligible for Lucentis. The Macular Degeneration Foundation is advised that Avastin is used for this small group of people who do not qualify for Lucentis.

The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) is negotiating with the Department of Health and Ageing to find a prompt solution to this issue. The Foundation will await this process and the outcome and will work with RANZCO to ensure best patient outcome for this group of patients.

In the meantime, if you have serious financial difficulties meeting your Doctor’s fees, discuss this with your Doctor directly.

The Foundation would like to know if patients are continuing to experience difficulties after discussing the matter with the Doctor. You can contact the MD Foundation on 1800 111 709.

Posted: 13 January 2009