Minimal impact on patients

The Macular Degeneration Foundation (MDF) is relieved that the Federal Government’s budget announcement to introduce a cap on the Medicare item number for the treatment of wet age-related macular degeneration (AMD), the leading cause of blindness in Australia should have minimal impact on patients, said MDF CEO, Julie Heraghty.

From 1 November 2012 intravitreal injections will have an Extended Medicare Safety Net (EMSN) cap equal to 80 per cent of the Medicare Benefits Schedule (MBS) or $236.12 (based on current fees).

This will mean that for the vast majority of patients there will be no change to their out of pocket costs. No patient who is charged less than $546 for their injection will be worse off.

90 per cent of providers have average fees below the minimum fee for the patient to be affected ($546) and it is estimated that 85 per cent of current out of hospital services will not be affected by the cap.

“The cap has been set at a constructive and workable level so as not to impact on access to affordable treatment for most patients. Without treatment, wet AMD patients will typically lose significant sight within months. Almost 30% will be legally blind within 12 months, and 40% by 24 months,” said Heraghty.

Under the changes, for a small number of patients where the doctor is charging more than $546, there will be additional out of pocket expenses.

Julie Heraghty said, “The MDF is committed to monitoring high fee treatment areas very closely to ensure patients impacted by this cap are able to access sight saving treatment”.

In 2009 the Macular Degeneration Foundation fought hard to ensure patients were not impacted by an unrealistic cap and fortunately in 2012 the Government has taken our messages on board and have set a cap that is workable.

Capping of Item 42740 (used for the injection into the eye of the treatment for wet AMD) was undertaken in the Federal Budget May 2009. This was rejected in the Senate and subsequently the decision was reversed by the Government in September 2009.

Posted: 9 May 2012