PHI 82/10

This circular issued by the Private Health Insurance Branch contains information on the review of HTA of Australia: Update on Implementation of Recommendation 12B-E

Page last updated: 19 November 2010

PDF Printable version of 82/10 (PDF 29 KB)

17 November 2010

Review of Health Technology Assessment in Australia: Update on Implementation of Recommendation 12B-E


The purpose of this circular is to provide industry with an update on the implementation of the recommendations 12b-e from the report of the Review of Health Technology Assessment in Australia, 2009 (HTA Review).


As advised in PHI Circular 33/10 of 24 May 2010, recommendations 10, 11 and 12 of the Review of Health Technology Assessment in Australia (HTA Review) report outline specific changes to streamline the administration of the prostheses listing arrangements.

Recommendations 10 and 11 have been fully implemented with the appointment of the Prostheses List Advisory Committee (PHI Circular 69/10 – dated 27 October 2010) and work is underway to implement recommendations 12b-e.

Update on Recommendations 12b-e
These recommendations called for the arrangements for the Prostheses List be changed by 2011, with appropriate consultation, to:
b. establish and maintain groups of products with similar clinical effectiveness;
c. abolish the negotiation of benefits for individual listed products, and instead establish and maintain a single (benchmark) benefit for the products included in each group, with sponsors being required to accept this benefit in order to be listed;
d. abolish the negotiation, setting or publication of maximum benefits, to eliminate the potential for gap payments for patients who have Private Health Insurance (PHI); and
e. permit the establishment of new product groups (or sub-groups) where a sponsor establishes clear superiority of their product compared to those in an existing group.

The Minister for Health and Ageing has approved a phased approach to implementation of this recommendation as follows:
  • Phase 1: includes hip, knee, specialist orthopaedic and neurosurgical products, anticipated to be completed for the February and August 2011 Prostheses Lists
  • Phase 2: includes cardiac, vascular, ophthalmic and spinal products, anticipated to be completed for the August 2011 Prostheses List
  • Phase 3: will include general & miscellaneous, ear nose and throat, cardiothoracic, urogenital and plastic and reconstructive product groups, anticipated to be completed by end of 2011
Further information on the approach to implementation is provided at Attachment A (PDF 29 KB).

The Department is currently liaising with key stakeholders to form a consultative committee and will update all stakeholders as implementation progresses through PHI Circulars, existing committees and ad hoc meetings as necessary.


If you have any queries please contact the HTA Review Implementation Section on
(02) 6289 4998 or email

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to
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