Eye health professionals know better than anyone that sight-saving treatment for macular disease is not optional – it’s essential. Yet, more than 12,200 Australians face the prospect of losing access to intravitreal (eye) injection treatment due to the Federal Government’s proposed changes to the Medicare Benefits Schedule (MBS) items for eye injections.
In early 2025, the Government deferred its decision to reclassify these injections from Type B to Type C for private health insurance purposes by a year, with further consultation held in November.
If the change goes ahead on 1 July 2026, most patients who have been using their private health insurance to cover the cost of eye injections in private hospitals and day surgeries will no longer be able to do so. Instead, they’ll face significant out-of-pocket costs in private clinics.
When news of this reclassification broke, our Helpline received over 100 phone calls from community members concerned about affording treatment if this planned change proceeds. Their concern is valid: cost is a leading reason people stop treatment.
The outcome of this proposed reclassification is not just an isolated change, but another sign of a system which fails to recognise that many Australians are already struggling with the affordability of sight-saving treatment for their macular disease.
The Government has an opportunity to continue to pause the reclassification and address the broader affordability problem before it worsens. That is why Macular Disease Foundation Australia (MDFA) is urging the government to further delay this change until reforms are introduced ensuring adequate access to affordable eye injection treatment across Australia.
As we know, eye injection treatment for macular disease is lifelong and frequent. There are an estimated 1.9 million people in Australia living with a macular disease. In 2023, around 109,000 people with a treatable macular disease, including neovascular age-related macular degeneration (AMD), diabetic macular oedema, and retinal vein occlusion, received eye injection treatments in the private system.
Treatment persistence is a significant problem in Australia, with approximately 50% of people discontinuing treatment within five years of starting eye injections.
A key reason for this is cost burden. In 2023, only 28% of patients nationally had eye injections that were bulk-billed, meaning that more than 72,000 people had no choice but to pay out-of-pocket costs to keep their sight, with more than 12,200 people using their private health insurance to cover costs.
In Australia, public hospital eye injection outpatient services are either unavailable or overstretched across the nation, so for most people treatment in the private system with significant ongoing out-of-pocket costs is the only option.
Add to that the other costs of living with a macular disease, like eye specialist appointments and low vision aids, and it is little wonder that financial burden becomes overwhelming, particularly for people on an age pension.
We recently released research revealing that the median total annual cost for people living with macular disease who receive sight-saving eye injections is 12% ($3,621) of the annual government pension payment. Our research 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.
The financially vulnerable are the last people who should have to pay through the nose to keep their vision.
MDFA has made key recommendations to the government. We propose:
• Reforming the Extended Medicare Safety Net so it does not reset at the start of the calendar year for pension card holders receiving ongoing eye injection treatment for neovascular AMD, from the second calendar year after starting treatment.
• Establishing a Neovascular AMD Treatment Incentive Program to encourage ophthalmologists to bulk-bill pension card holders having eye injections for neovascular AMD, supporting the most financially vulnerable patients who are most at risk of stopping treatment due to burden of cost.
• Integrating the Pharmaceutical Reform Agreements into the National Health Reform Agreement to ensure that PBS-listed eye injection treatments are available and adequately funded in public hospital eye injection outpatient clinics in every state and territory.
We are running an advocacy campaign, asking people to share how treatment costs have impacted them. These stories will be sent to Federal Health Minister Mr Mark Butler.
We would appreciate your support by encouraging patients to contact MDFA to share their concerns. A downloadable letter template is available at www.mdfoundation.com.au/eye-injection-typec-change/.
Sight-saving treatment is essential – not just for those who can afford it. The Government must act now to ensure that access challenges to affordable treatment don’t stand in the way of preserving vision.
Your support can help make that happen.
ABOUT THE AUTHOR
Name: Dr Kathy Chapman
Qualifications: BSc, M Nutr & Diet, PhD
Affiliations: CEO of Macular Disease Foundation Australia
Location: Sydney, Australia
Years in industry: 4 (+30 years in public health).
