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23 October 2013
Prostheses List - Review of Grouping and Benefit for Ligating Clips with Disposable Applier
The purpose of this Circular is to inform the health industry of the progress of a review of products in General and Miscellaneous group 3.8 – Closure Devices, 3.8.3 – Ligating Devices, 188.8.131.52 – Clips with Disposable Applier with suffix Endoscopic.
All Prostheses List product groups and benefits were reviewed as part of implementation of the recommendations of the Review of Health Technology Assessment in Australia. The benefit for products in group 184.108.40.206 – Clips with Disposable Applier with suffix Endoscopic was established in accordance with the methodology agreed by the Health Technology Assessment Consultative Committee.
Various stakeholders raised concerns relating to the single group benefit. The Department has been liaising with product sponsors to address these concerns and work towards an equitable outcome.
Feedback from sponsors indicates that there may be differences between products that are not reflected in the current grouping scheme and benefit. More work is needed to investigate the comparative clinical effectiveness of products in the group.
Following consultation with sponsors, the Prostheses List Advisory Committee has agreed that, as an interim measure, the group will be divided into two benefit levels – some products will retain the benefit of $412, whereas others will be listed at $145. This will be reflected in the Amendment to the Private Health Insurance (Prostheses) Rules 2013 (No.1), to be published on 1 November 2013.
All sponsors of products in group 220.127.116.11 – Clips with Disposable Applier with suffix Endoscopic will be provided opportunity to make a submission to support claims of clinical differences, and appropriate grouping and benefits for their products. The review will be conducted for the February 2014 Prostheses List. The Secretariat will write to sponsors advising of the process.
If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch
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