Macular Disease Foundation Australia (MDFA) has welcomed the Federal Government’s decision to defer the private health insurance reclassification of intravitreal (eye) injections from 1 July 2025 to 1 July 2026 and undertake further consultation. It provides an opportunity to address the wider issue of the lack of access to affordable sight-saving treatment in Australia.
The Government’s proposed reclassification would have resulted in more than 12,200 people no longer being able to use their health insurance to cover the cost of sight-saving eye injections to treat macular disease, if performed in private hospitals and day surgeries. Instead, this large group of people would have needed to start paying out-of-pocket costs in order to continue being treated in private ophthalmology clinics.
MDFA has received more than 100 phone calls from distressed community members concerned about how they would continue to afford their sight saving treatment if this planned change was to go ahead. The voice of the macular disease community has been heard by Government.
While MDFA welcomes the government’s decision to pause this reclassification, it is absolutely vital that the government addresses the wider affordability issues that continue to be faced by the majority of people requiring sight saving injections.
Importantly, the government needs to consider that treatment for neovascular age-related macular degeneration (AMD) is usually frequent (typically every four to six weeks) and lifelong. It’s not a one-off like some other medical treatments, and public eye injection services are either not available or oversubscribed, so for most people the out-of-pocket costs are expensive and ongoing.
There are an estimated 1.9 million people in Australia who live with a macular disease. In 2023, more than 108,000 peopleǂ with a treatable macular disease including neovascular age-related macular degeneration (AMD), diabetic macular oedema, and retinal vein occlusion, received eye injection treatment. In 2022, there were 62,000 people with neovascular AMD who were having eye injections.1,2
Treatment persistence is a significant problem in Australia, with approximately 50 percent of people discontinuing treatment within five years of starting eye injections.3 The main reason for this is cost burden.
Eye injections are primarily delivered in private ophthalmology clinics in Australia, with only around 20 percent of them offering bulk billing,4 meaning that more than 72,000 peopleǂ having eye injections have no choice but to pay expensive out-of-pocket costs to receive their treatment to keep their sight, on top of other costs relating to living with macular disease, such as eye specialist appointments, vision aids and associated travel expenses.
MDFA released new research revealing that the median total cost for people living with macular disease who receive sight-saving eye injections, is 12 percent* ($3,621) of the annual government pension payment. Our research also found that for almost 1 in 10 Australians who receive eye injections, the cost of living with their condition is more than $6,000 every year. This is around 20 percent* of the annual government pension payment.
It is for these reasons that MDFA is recommending the next Federal Government acts to increase the access to bulk billed sight-saving eye injections for pensioners – our most financially vulnerable Australians. We strongly encourage the government to make this a key consideration during their planned consultation on the affordability of eye injections.
To provide financial relief for pension card holders, MDFA has already recommended the Federal Government introduces a Neovascular AMD Treatment Incentive Program.The aim of the program is to encourage ophthalmologists to bulk bill pension card holders having eye injections for neovascular AMD, to support those most at risk of stopping treatment due to burden of cost.
The total annual economic cost of vision loss in Australia is estimated to be $16.6 billion or $29,000 per person with vision loss aged over 40.3 By targeting the most financially vulnerable people who need sight-saving treatment and encouraging more bulk billing, MDFA believes a Neovascular AMD Treatment Incentive Program would cost the government an estimated $11.1 million a year and ultimately save government $140 million annually.
The Australian Government must step-up to improve the access to and affordability of eye injections. As these injections are sight saving and lifelong, more needs to be done to ensure these treatments are more affordable and accessible nationwide.
Fighting for the sight of people with macular disease will always be Macular Disease Foundation’s main priority. Our country’s leadership has an opportunity to save the sight of thousands of people by tackling the broader issues of cost of and access to sight-saving treatment. MDFA welcomes the opportunity to be a part of these critical consultations.
Macular Disease Foundation’s full recommendations to government can be found in our Fight For Sight election agenda.
Media Statement attributable to Dr. Kathy Chapman, CEO, Macular Disease Foundation Australia.
References
ǂ Services Australia data on eye injection services delivered between 01/01/2022 to 31/12/2023 and processed up to 17 February 2025.
* Calculation based on Services Australia information, the current total maximum fortnightly pension for a single person is: $1,144.40. Total annual pension: $1,144.40 X 26 = $29,754.40 and $3,621/$29,754.40 = 12%)] www.servicesaustralia.gov.au/how-much-age-pension-you-can-get?context=22526
1. The Hon. Mark Butler MP (2023, January 1). Media release – Cheaper medicines from today. Accessed at: www.health.gov.au/ministers/the-hon-mark-butler-mp/media/cheaper-medicines-from-today?language=en
2. Pharmaceutical Benefits Advisory Committee – Drug Utilisation Sub Committee (2018). Ranibizumab and Aflibercept: Analysis of Use for AMD, DMO, BRVO and CRVO. Accessed at: www.pbs.gov.au/pbs/industry/listing/participants/public-release-docs/2018-05/ranibizumab_and_aflibercept__analysis_of_use_for_amd%2C_dmo%2C_b
3. Deloitte Access Economics and Vision 2020 Australia (2010). Clear Focus – The Economic Impact of Vision Loss in Australia in 2009. Accessed at: www.vision2020australia.org.au/resources/clear-focus-the-economic-impact-of-vision-loss-in-australia-in-2009/.
4. Macular Disease Foundation Australia, Royal Australian and New Zealand College of Ophthalmologists and PwC Australia. (2019). Impact of IVI rebate changes.
Posted: 13 March 2025
Living with macular disease consumes 12% of age pension payments
Macular Disease Foundation Australia calls on the next Federal Government to bulk-bill sight-saving eye injections for pensioners; with the potential for creating a $140 million cost-saving per year.
