Battle continues over the reform of medical device pricing

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The battle for reform of the Prostheses List continues with private health insurers describing the current arrangements as 'gouging' while the medical device sector has responded by expressing 'disbelief' over the claim.

Private Healthcare Australia says an updated analysis prepared by the Independent Hospitals and Aged Care Pricing Authority shows private patients will be paying $300 million more for cardiac pacemaker devices over the next four years than the cost of the same devices in the public system.

Cardiovascular Implantable Electronic Devices (CIED) include pacemakers, implantable cardiac defibrillators (ICD), and special models of pacemakers and defibrillators, which can provide cardiac resynchronisation therapy (CRT).

"CIEDs are truly lifesaving technologies, but they are not new. These are generic products that have become commoditised around the world. The prices paid by patients are rapidly falling almost everywhere except Australia," said Private Healthcare Australia.

"This financial year, private patients are paying $224 million for these cardiac devices. In the public system, the same devices would cost less than $85 million," it said.

“These devices extend life, and are in many cases, life-changing,” said CEO Dr Rachel David. “However, that does not provide an excuse to gouge Australian families paying private health insurance premiums for no added benefit.”

“Minister Butler inherited a dud deal from his predecessor. However, it is now up to him to determine if he’d prefer this $300 million to go into the pockets of big MedTech multinationals or if premium relief for 14 million Australians will be the priority.”

However, the Medical Technology Association of Australia (MTAA) described the analysis as an attempt by private health insurers to avoid paying claims on cardiac technical support services.

CEO Ian Burgess said, “As the corporate health insurance lobby knows, cardiac technical support services for devices like pacemakers are delivered by the MedTech community through cardiac technicians, who, alongside the cardiologist, service the device for the life of the device. In the public system, these services are provided by hospital-employed technicians,”

Mr Burgess continued, “Comparisons between the public and private prices for the device are therefore unfounded, and dishonest at best.

“The cost of providing these life-long services has been accounted for in the device price listed on the Prostheses List, which corporate health insurers are required, by law, to pay for if their patients require it. These services are currently being assessed by the Medical Services Advisory Council (MSAC).”

Mr Burgess said the claim suggests private health insurers want to deny patients access to health technologies and complementary services. He restated the MTAA's call for regulators to investigate private health insurers over the return of the deferred claims liability they accumulated during the COVID-19 pandemic lockdowns.