In November 2025, the Federal Department of Health, Disability and Ageing invited Macular Disease Foundation Australia (MDFA) to participate in a consultation.
MDFA is being asked about our view on the planned changes to the Medical Benefits Scheme (MBS) items for eye injections that are planned to come into effect on 1 July 2026.
The proposed change will mean that most people who currently use their private health insurance to cover the cost of their eye injections as a private patient in day surgery facilities or private eye hospitals will no longer be able to do so.
If this change goes through, more than 12,200 people having eye injections will be affected.
As the representative organisation for the macular disease community, MDFA voiced the need for this change to be paused and reviewed. The government listened and the proposal was delayed from 1 July 2025 to 1 July 2026.
The government MUST address the eye injection affordability issues
MDFA is urging the government to address the wider treatment affordability issues faced by more than 109,000 people1 currently having sight-saving injections for a macular disease in the private system BEFORE making this change to the MBS items, which will impact 12,200 people.1
Importantly, the government needs to understand that treatment for AMD and other macular diseases is usually frequent and ongoing, often lifelong, and not like other long-term health conditions where there are adequate public out-patient services available.
In Australia, public eye injection services are either not available, or overstretched across the nation, so for most people the only option is to be treated in the private system with significant ongoing out-of-pocket costs.
This is in addition to the other costs of living with a macular disease, such as eye specialist appointments, paid care workers, low vision aids and treatment-associated travel expenses.
Cost burden is one of the main reasons people stop eye injections
Treatment persistence is a significant problem in Australia, with about 50% of people discontinuing treatment within five years of starting eye injections.2,3
Cost burden is one of the main reasons for people stopping their eye injections.
For this reason, MDFA is strongly recommending that the Federal Government acts to increase access to affordable sight-saving eye injections.
The Federal Government MUST improve access to affordable sight saving eye injections nationwide.
No one should have to stop treatment because of a government decision that makes treatment unaffordable.
Macular Disease Foundation’s key recommendations to government
In addition to recommending that the planned change to the eye injection MBS items be delayed, MDFA has made three additional recommendations that could help improve the affordability of treatment and increase access to public eye injection services.
Recommendation 1: Reform the Extended Medicare Safety Net
The intention of this recommendation is to reduce the financial burden of the out-of-pocket costs for people receiving long-term private eye injection treatment.
MDFA has recommended that the government reforms the Extended Medicare Safety Net, so that it does not reset at the start of the calendar year for pension card holders receiving ongoing eye injection treatment for neovascular AMD, from the 2nd calendar year after starting treatment.
Recommendation 2: Establish a Neovascular AMD Treatment Incentive Program
The intention of this recommendation is to encourage ophthalmologists to bulk bill pension card holders having eye injections for neovascular AMD, to support those most financially vulnerable, and therefore most at risk of stopping treatment due to burden of cost.
This recommendation is modelled after the Federal Government’s successful Practice Incentives Program for General Practitioners, to provide ophthalmologists who bulk bill treatment for pensioners with a financial incentive to encourage more bulk billing.
Recommendation 3: Integrate the Pharmaceutical Reform Agreements into the National Health Reform Agreement
The intention of this recommendation is to ensure that Pharmaceutical Benefit Scheme-listed eye injection treatments are available, and adequately funded, in public hospital eye injection outpatient clinics in every state and territory.
References
1. Services Australia data on eye injection services delivered between 01/01/2022 to 31/12/2023, processed up to 17 February 2025.
2. 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
3. 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
Posted: 2 December 2025
Government defers MBS private health insurance reclassification
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.
