PHI 66/10

This circular issued by the Private Health Insurance Branch contains information regarding Benefit Negotiations for New Applications

Page last updated: 11 October 2010

PDF Printable version of 66/10 (PDF 23 KB)

11 October 2010

Benefit Negotiations for New Applications
February 2011 Prostheses List:
Transitional Arrangements

Purpose

The purpose of this Circular is to inform sponsors that benefit negotiations for some new applications for the February 2011 Prostheses List will occur immediately after clinical assessment by a Clinical Advisory Group or the Panel of Clinical Experts.

Background

Following assessment by clinicians, new applications were referred to the Prostheses and Devices Committee (PDC) for consideration. Where the PDC intended to make a positive recommendation to list on the Prostheses List, the applications were referred to the Prostheses and Devices Negotiation Group (PDNG) for benefit negotiations with sponsors.

Following the Health Technology Assessment (HTA) Review, the Government agreed to establish a new advisory committee to replace the PDC.

The establishment of this committee, the Prostheses List Advisory Committee (PLAC), has been delayed due to the Federal election and extended caretaker period, and as a consequence no new applications have been considered by the PLAC to date.

Action

In order to avoid unnecessary delays in negotiation, transitional arrangements will operate for this cycle only. After clinical assessment, some products will be directly referred to the PDNG for benefit negotiation, before consideration by the PLAC.

Early benefit negotiations will not occur where clinicians have not recommended listing, where further clarification is needed on the application, or where the product is in a category that is affected by the implementation of HTA Review recommendations 12b and 12c in this cycle (this is expected to affect hip, knee, specialist orthopaedic and neurosurgical products in this cycle).

Where benefit negotiations occur under these special transitional arrangements, it does not mean listing will automatically follow. There will still be a requirement for PLAC consideration of the clinical and benefit recommendations and listing may also be subject to ARTG listing or approval of an appropriate MBS item number for the implantation of the prosthesis.

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to PrivateHealth@health.gov.au
Internet: http://www1.health.gov.au/internet/main/publishing.nsf/Content/health-phicirculars2010-index1
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