Call to Federal Government to bulk bill eye injections for pensioners

We have released new research in collaboration with the University of New South Wales which has revealed the median total cost for people living with macular disease, who also receive sight-saving eye injections, is 12 percent* ($3,621) of the annual government pension payment.

Close to 1,500 Australians with macular completed our comprehensive survey, which also found that for almost 1 in 10 Australians who receive eye injections the cost of living with their condition is more than $6,000 every year. This is around 20 percent* of the annual government pension payment.

These costs – which include eye specialist appointments, eye injection treatments and vision aids – are leaving pensioners with less money in their bank accounts for rent, bills, food and other essential life expenses. If people with certain macular diseases cannot afford to receive eye injection treatments, they will lose their vision.

Treatment for neovascular age-related macular degeneration (AMD) is usually frequent (typically every four to six weeks) and lifelong. In 2022, there were 62,000 people with neovascular AMD who were having eye injections.¹ Treatment persistence is a significant problem in Australia, with approximately 50 percent of people discontinuing treatment within five years of starting eye injections.² The main reason for this is cost burden.

To provide financial relief for pension card holders, the most financially vulnerable Australians, we are calling on the Federal Government to introduce a Neovascular AMD Treatment Incentive Program.The aim of the program is toencourage ophthalmologists to bulk bill pension card holders having eye injections for neovascular AMD, and support those most at risk of stopping treatment due to burden of cost.   

The total annual economic cost of vision loss in Australia is estimated to be $16.6 billion or $29,000 per person with vision loss aged over 40.³ By targeting the most financially vulnerable people who need sight-saving treatment and encouraging more bulk billing, we believe a Neovascular AMD Treatment Incentive Program would cost the government an estimated $11.1 million a year and ultimately save government $140 million annually. 

Our research also showed the median total annual cost for people living in regional and remote areas is more than $400 higher per person compared with people in major cities ($2,658 vs $2,254). The highest cost was more than $1,700 more per year for people living remotely compared with people living in a metropolitan area ($8,911 vs $7,127). Considering that most ophthalmologists work in metropolitan areas, access to treatment is a major challenge for people living in regional and remote areas. 

MDFA’s CEO, Dr Kathy Chapman, says these findings highlight a critical problem given our research consistently identifies cost and access as the two main reasons people delay or stop treatment.   

“There are an estimated 1.9 million people in Australia who live with a macular disease. In 2023, more than 108,000 people^ǂ with a treatable macular disease including neovascular age-related macular degeneration (AMD), diabetic macular oedema, and retinal vein occlusion, received eye injection treatment,” said Dr Chapman.

“Eye injections are primarily delivered in private ophthalmology clinics in Australia, with only around 20 percent of them offering bulk billing,⁴ meaning that more than 72,000 people^ǂ having eye injections have no choice but to pay expensive out-of-pocket costs to receive their treatment to keep their sight.

“Our research underscores the immense financial pressure that these high costs would have on people living with macular disease who rely on their pension payments to get by. Even when the country is not in a cost-of-living crisis, accessing affordable or bulk billed treatment is an insurmountable problem for too many low-income earners, pensioners, and self-funded retirees.

“We welcome both major parties’ recent commitments to further strengthening bulk-billing incentives in general practice, which will see greater numbers of people saving money when visiting their GP. As people with neovascular AMD require frequent and ongoing eye injections, sometimes up to monthly, it is vital the Government extends bulk billing to older Australians who require sight-saving injections.”

MDFA’s full recommendations to the next Federal Government can be found here.

References

* Calculation based on Services Australia information, the current total maximum fortnightly pension for a single person is:  $1,144.40. Total annual pension:  $1,144.40 X 26 = $29,754.40 and $3,621/$29,754.40 = 12%)] https://www.servicesaustralia.gov.au/how-much-age-pension-you-can-get?context=22526

¹ The Hon. Mark Butler MP (2023, January 1). Media release – Cheaper medicines from today. Accessed at: www.health.gov.au/ministers/the-hon-mark-butler-mp/media/cheaper-medicines-from-today?language=en

² Pharmaceutical Benefits Advisory Committee – Drug Utilisation Sub Committee (2018). Ranibizumab and Aflibercept: Analysis of Use for AMD, DMO, BRVO and CRVO. Accessed at https://www.pbs.gov.au/pbs/industry/listing/participants/public-release-docs/2018-05/ranibizumab_and_aflibercept__analysis_of_use_for_amd%2C_dmo%2C_b

³ Deloitte Access Economics and Vision 2020 Australia (2010). Clear Focus – The Economic Impact of Vision Loss in Australia in 2009. Accessed at https://www.vision2020australia.org.au/resources/clear-focus-the-economic-impact-of-vision-loss-in-australia-in-2009/.

⁴ Macular Disease Foundation Australia, Royal Australian and New Zealand College of Ophthalmologists and PwC Australia. (2019). Impact of IVI rebate changes.

^ǂ Services Australia data on Medicare services delivered between 01/01/2022 to 31/12/2023 and processed up to 17 February 2025.

Posted: 4 March 2025