The Federal Government is implementing a controversial recommendation from the taskforce review into ophthalmology Medicare items that will mean macular disease patients can no longer make private health claims for anti-VEGF intravitreal injections performed in private hospitals and day surgeries.
Macular Disease Foundation Australia (MDFA) said the Federal Government had confirmed the measure from 1 July 2025. It estimates the change to impact up to 12,200 patients.
Instead, these people will need to start paying out-of-pocket costs to keep accessing eye injection treatment in private ophthalmology clinics, CEO Dr Kathy Chapman said, as “public hospital eye injection clinics and bulk billing private ophthalmology clinics are either not available, or already at capacity”.
“Many people already feeling the cost-of-living pinch will now have another expense to add to their budget because they will no longer be able to claim their eye injection treatment under their private health insurance,” she said.
“Macular Disease Foundation Australia is concerned that this will force people to give up their treatment altogether because they will no longer be able to afford it.”
The government’s decision stems from the Medicare Benefits Schedule (MBS) Ophthalmology Taskforce Review. Finalised in 2020, it had 19 recommendations, with one of those being the reclassification of item 42738 as a Type C procedure. These don’t “normally need hospital treatment and requires clinicians to fill out a form to justify in-hospital use”.
The taskforce committee said the procedure was being carried out in day surgeries because it is defined as a Type B procedure, which allows regular in-hospital use.
“It was also acknowledged that philosophically, for some surgeons the setting is the preferred clinically appropriate environment for the patient whether they are covered by private health funding or not,” the taskforce report stated.
“In-hospital intravitreal injections for retinal disease such as macular degeneration should occur in fewer than 3% of patients. It currently occurs in 18% of patients, and this number is increasing. The committee felt that this is largely unnecessary and may be due to financial incentives.
“This recommendation focuses on reducing low-value care.”
Decision to ‘compound’ injection access issues
Dr Chapman said MDFA had previously said it would only support the reclassification of this MBS item if there had been a significant increase in the number of public outpatient clinics offering bulk billed eye injections to ensure improved access to affordable treatment.
“We know that the cost and affordability of treatment are still huge concerns for many people living with macular disease, and there are still limited options to receive bulk-billed treatments,” she said.
Dr Chapman said MDFA had raised these concerns with the office of Mr Mark Butler, the Minister for Health and Aged Care, and will continue to do so. Previously, the organisation had successfully prevented another controversial taskforce recommendation that would have slashed the intravitreal injection rebate by 69%.
As 1 July 2025 approaches, the ongoing issue of lack of access to affordable sight-saving treatment in Australia must be addressed, with the government’s recent MBS decision only compounding matters, MDFA stated.
“Solutions must be found to help ALL Australians living with macular disease who need eye injection treatment. It’s a significant issue that can no longer be ignored,” Dr Chapman said.
“The Australian, state and territory governments must step up to improve access to eye injections. As these injections are sight saving, more needs to be done to ensure these treatments are more affordable and accessible nationwide.
“Our message for government is that investing in increased access to eye injection treatment for people with macular disease will not only save the sight of tens of thousands of people but will also save the government billions of dollars in the long term.”
As such, MDFA has called on the Federal Government to ensure adequate and equitable access to affordable intravitreal injection treatment nationwide. This will require the federal and state governments to work together to:
- Introduce an ophthalmology practice incentive to bulk bill eye injections for age pensioners with neovascular AMD.
- Ensureincreased access to eye injection treatment in public hospital outpatient clinics which can only happen if state and federal governments work together.
- Establish partnerships between the public and private health systems to boost treatment access options for people needing intravitreal injections.
- Provide funding to help establish new ophthalmology clinics in areas of high demand for treatment, with agreements that these clinics will provide bulk billed eye injections.
“The health and wellbeing of people with macular disease will always be Macular Disease Foundation’s main priority. Without treatment, people with macular disease will go blind. This is totally avoidable,” Dr Chapman added.
More reading
Liberal and Labor vow to maintain intravitreal injection MBS rebate
Annual out-of-pocket eye injection costs to double to $3,900 under rebate cut – modelling
MBS Taskforce keeps controversial eye injection proposals in final report
