Government Reduces Benefits for Dental Implants
13th Oct 17
The Australian Government will reduce the benefits charged to private health insurers for implanted medical devices from 1 February 2018 as part of a series of reformed intended to support the financial sustainability of the health insurance sector.
Key Issues For The Dental Industry —
Earlier this year the Australian Government announced that, in order to ensure that the private health insurance sector was sustainable over the long-term, a review of the ‘prostheses list’ would be undertaken. This list is managed by the Prostheses List Advisory Committee (PLAC) and outlines the amount that implantable medical device suppliers may charge private health insurers. These charges are referred to as ‘benefits’.
The Government on 30 January 2017 decided to reduce the benefits for some types of devices on the Prostheses List by up to 10%, namely cardiac, hip, knee, and intraocular lenses, from 20 February 2017. Since then, the Government has decided that further reductions to benefits are necessary across a broader range of device types.
Benefits to products listed in the Plastic and Reconstructive Grouping Scheme, a subsection of the Prostheses List which includes the majority of implantable dental devices such as dental implants, abutments, and endosseous graft material, will be reduced by 2% from 1 February 2018 and by a further 0.5% from 1 August 2018. Dental implants will not undergo further benefit reductions in the third reduction period starting on 1 February 2020.
While the reductions will have a negative impact on the dental industry it is worth noting that these reductions are the lowest across all Grouping Schemes. Cardiac implants were the hardest hit with a combined 27.5% benefit reduction across two tranches in 2018 and one in February 2020. In total 10,571 prostheses benefits have been reduced for a total value of $303 million. A full list of rebate reductions by prostheses Grouping Scheme can be found in the Key Downloads section of this update.
The cuts would have been far deeper were it not for the work of industry associations in the medical devices sector, particularly the Medical Technology Association of Australia (MTAA).
To offset some of the cost to industry resulting from these changes the Government will look towards reducing red tape by reducing duplication between the Therapeutic Goods Administration (TGA) and Prostheses List Advisory Committee (PLAC) medical device implant assessments. The Government will also invest $30 million towards the establishment of a medical technology grants program to spur innovation by small to medium enterprises (SMEs).
ADIA will continue to monitor the situation as it relates to the dental industry and engage with the Government to reduce red tape for dental implantable device manufacturers and secure the long-term health of the sector.
Member engagement —
ADIA provides leadership, strategy, advocacy and support. Our members set our agenda, fund our activities and directly benefit from the results. With respect to matters associated with the rebates for dental implants the team in the ADIA national office receive advice and guidance from members serving on the ADIA-IIG Implant Interest Group with updates provided to members at the quarterly series of ADIA State Branch Briefings.
Currency & Disclaimer —
This update was issued on 13 October 2017 and please note that changes in circumstances after the publication of material or information may impact upon its accuracy and also change regulatory compliance obligations. The statements, regulatory and technical information contained herein are believed to be accurate and are provided for information purposes only. Readers are responsible for assessing its relevance and verifying the accuracy of the content. To the fullest extent permitted by law, ADIA will not be liable for any loss, damage, cost or expense incurred in relation to or arising as a result of relying on the information presented here.
This publication is available for your use under a Creative Commons Attribution 3.0 Australia licence, with the exception of the ADIA logo, other images and where otherwise stated.
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