More details of a proposed $11 million-a-year ‘Neovascular AMD treatment incentive program’ that would financially encourage more ophthalmologists to bulk bill for eye injections have been released, in an initiative ophthalmology bodies support.
Under Macular Disease Foundation Australia (MDFA)’s proposed scheme, all ophthalmologists who bulk bill intravitreal injections for age pensioners with neovascular age-related macular disease (nAMD) would be eligible to receive an incentive payment from the Federal Government.
Under the program, which MDFA began advocating for in March 2025, the treating ophthalmologist would receive $100 per eye injection service per patient with a pension card.
If the patient needs injections in both eyes and this is performed on the same day in the same service episode, the reimbursement is estimated to be $50 for the second eye. The total reimbursement for the ophthalmologist would then be $150 under this proposal.
The initiative has been modelled on the incentive payment schemes eligible GPs receive when they bulk bill patients. According to Medicare data for 2023, 67% of people having eye injections were not bulk billed.
In contrast, 77% of people seeing their GP in the same year were bulk billed.
MDFA CEO Dr Kathy Chapman said the organisation welcomed 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,” she said.
People receiving eye injections for nAMD require, on average, six treatments per year, usually for the rest of their lives.
“However, access to public or bulk billed eye injection services is a postcode lottery as services are severely limited. The majority of people therefore have to seek treatment from private ophthalmologists,” Dr Chapman told Insight.
“Whilst there is currently no precedent for specialists to be bulk billed for delivering services, this unique problem demands a unique and unprecedented solution.”
MDFA said it had widespread support for its proposed practice incentive, the aim of which is to increase bulk billing rates “to support the most financially vulnerable Australians to keep having their sight-saving eye injections”.
RANZCO said it was supportive of MDFA’s work to support patients. Meanwhile, the Australian Society of Ophthalmologists said any incentive to increase bulk billing rates for nAMD treatment would be encouraged.
“The most applicable areas would be public hospital side clinics and remote practice,” ASO president Dr Peter Sumich said.
“Practice incentive payments to general practices usually come with many strings attached”, such as eligibility requirements, registrations, and ongoing compliance and audit, so he saw some challenges with a widespread roll-out in the private setting.
Half give up treatment after five years
According to MDFA, 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. By targeting the most financially vulnerable people who need sight-saving treatment and encouraging more bulk billing, the organisation believes the incentive program would cost the government an estimated $11.1 million a year.
Ultimately, it would save taxpayers $140 million annually in disability, aged care and other related health system costs.
New research the organisation conducted with the University of New South Wales has revealed the median total cost for people living with macular disease who also receive eye injections is 12% ($3,621) of the annual government pension payment.
Close to 1,500 Australians with macular disease – Australia’s leading cause of blindness – completed MDFA’s survey, which also found that for almost one 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% of the annual government pension payment.
These costs, which include eye specialist appointments, eye injection treatments and vision aids, were leaving pensioners with less money in their bank accounts for rent, bills, food and other essential life expenses, MDFA said.
If people with certain macular diseases cannot afford to receive eye injection treatments, they will lose their vision. As such, treatment persistence is said to be a significant problem, with approximately 50% of people discontinuing treatment within five years of starting eye injections. The main reason is cost burden.
MDFA’s 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 reported to be a major challenge for people in regional and remote areas.
Dr Chapman said the findings highlighted a critical problem given MDFA research consistently identified cost and access as the two main reasons people delayed or stopped treatment.
“Eye injections are primarily delivered in private ophthalmology clinics in Australia, with only around 20% of them offering bulk billing, meaning that more than 72,000 people having eye injections have no choice but to pay expensive out-of-pocket costs to receive their treatment to keep their sight,” she said.
“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.”
There are an estimated 1.9 million people in Australia with some form of macular disease. In 2023, more than 108,000 people with a treatable macular disease, including nAMD, diabetic macular oedema, and retinal vein occlusion, received an eye injection treatment.
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MDFA calls for $11m ophthalmology bulk billing incentive for eye injections
