Macular Disease Foundation Australia (MDFA) is urging eye care professionals to support advocacy efforts addressing Australia’s growing eye injection access crisis.

MDFA is calling on the government to delay proposed Medicare Benefits Schedule (MBS) changes that will prevent more than 12,200 privately insured patients with macular disease from accessing affordable eye injection treatment in private day surgeries or private hospitals from 1 July 2026.

However, it is not only these 12,200 patients that MDFA is concerned about.

Currently, around 109,000 patients in Australia are being treated with eye injections for neovascular macular degeneration (nAMD) or other macular diseases in the private system. Approximately 12,200 of these are treated in private day surgeries or private hospitals with most of the costs covered by their health insurance. The remaining patients are treated in ophthalmology clinics in-rooms, with about 28% bulk-billed and the rest paying out-of-pocket costs of, on average, AU$140 per injection (depending on state, territory and doctor).

It is estimated that less than 20% of all eye injection patients have their treatments done in an already stretched public system, with a recent MDFA study finding only 40 out of a sample of 286 public hospitals across the country deliver outpatient eye injection treatment services.

CHANGES WILL FURTHER STRAIN PUBLIC SYSTEM

Dr Kathy Chapman, Chief Executive Officer of MDFA, fears a flood of privately insured patients into the public hospital system if the government goes ahead with its plan to reclassify the MBS items (43030 and 43032) from a Type B procedure to a Type C procedure. This will stretch a system that is currently barely coping with demand, putting more patients at risk of not receiving timely sight-saving injection treatment.

“The government is focussed on these people who’ve been using their private health insurance, who are suddenly going to be faced with significant out-of-pocket costs that they’ve not had,” explained Dr Chapman.

“There are a lot of older people who’ve been paying their health insurance in good faith all these years, who have been having their eye injections for a number of years. It’s a huge shock to find out that they may no longer be able to do that.”

Within a financially pressured economy, unexpected out-of-pocket costs may force some to abandon their private health insurance altogether and/or cease treatment. Current data reveals that approximately 50% of patients discontinue eye injection therapy within five years of commencing treatment, with cost burden identified as one of the primary factors driving this concerning trend.

“Patients with macular disease often have other health conditions requiring private healthcare. We don’t want to be creating a new cohort of people who are really feeling this cost of treatment pressure,” Dr Chapman said.

COMPREHENSIVE REFORMS PROPOSED

In November 2025, the Federal Department of Health, Disability and Ageing invited MDFA to participate in a consultation.

Asked for its view on the planned changes to the MBS items for eye injections, MDFA drafted a three-pronged approach to address equitable access to eye treatment for macular disease. MDFA recommended that these comprehensive reforms be implemented before any changes to the MBS items, which limit the use of private health insurance to cover the cost of eye injection treatment. This would ensure capacity to treat the broader community as well as those privately insured who can no longer afford out-of-pocket costs. The three-pronged plan comprises:

Extending the Medicare Safety Net Reform: MDFA proposes stopping the Extended Medicare Safety Net from resetting at the start of each calendar year for pension card holders receiving ongoing eye injection treatment for nAMD, beginning from the second calendar year of treatment. This targeted reform aims to reduce the cumulative financial burden on patients requiring long-term therapy.

nAMD Treatment Incentive Program: Modelled on the successful Practice Incentives Program for general practitioners, this proposal would provide financial incentives to ophthalmologists who bulk bill pension card holders for nAMD eye injection treatment to encourage more bulk billing.

Dr Chapman highlighted the stark disparity in bulk billing rates: “We know that 78% of patients who saw their GP were bulk billed, whereas we’ve only got 28% of patients being bulk billed for their eye injections. We’d love to see that bulk billing rate go up, but ophthalmologists will need to be incentivised.”

Pharmaceutical Reform Agreement Integration: The third recommendation calls for integrating Pharmaceutical Reform Agreements into the National Health Reform Agreement, ensuring PBS-listed eye injection treatments are available and adequately funded in public hospital outpatient clinics across every state and territory.

PUBLIC SYSTEM CAPACITY CONCERNS

Dr Chapman said reforms now are critical because new treatments for different macular diseases – such as geographic atrophy – mean that increasing numbers of people will be looking to access treatments.

“These injections aren’t like a cosmetic procedure. Being able to keep your sight is absolutely vital,” Dr Chapman said.

“However, eye injection treatment for nAMD needs to be considered differently from other health conditions because treatment is regular and often life-long.

“Patients with other serious health conditions, such as cancer or heart attack, can be treated in public hospitals and managed as outpatients. However, there are inadequate public options available for AMD and other macular disease patients.”

In addition to ongoing eye injection therapy, treatment expenses compound other financial burdens associated with macular disease, including specialist consultations, paid care workers, low vision aids, and travel costs for appointments – creating a cumulative cost barrier that proves insurmountable for many patients.

CALL TO ACTION FOR PRACTITIONERS

Dr Chapman stressed the importance of viewing MDFA’s proposed reforms through a health equity lens.

“While stopping claims through private health insurance may address health system expenditure, it is ineffective to focus on making things difficult for these 12,200 patients while ignoring what we’ve been talking about for a long time – how difficult it is for people to have such ongoing treatment.”

While both patients and ophthalmologists are encouraged to discuss financial challenges associated with ongoing treatment, Dr Chapman said individual arrangements cannot substitute for systemic reform. “We’ve got to have a system that recognises this is really important ongoing treatment that people need to have, and the eye injections won’t inject themselves. It’s not like taking a medicine,” she said.

MDFA has developed a supporter letter template, enabling patients to formally register their support for the advocacy campaign. “It’s really about helping demonstrate to government the human stories and the human costs around the huge importance of people being able to save their sight,” Dr Chapman explained.

“This is truly the time for government to look at the cost benefit of being treated and being able to maintain your sight, and to make sure that flows through to the actual community member or the patient,” Dr Chapman said.

Eye care professionals wishing to support MDFA’s campaign can:

• Direct their patients to download the supporter letter at mdfoundation.com.au/news/government-considering-changes-to-private-health-insurance-claiming-for-eye-injections,

• Discuss the campaign with affected patients during consultations, and

• Share information about the advocacy effort within their professional networks.

Completed letters can be submitted to MDFA for collation and presentation to Health Minister Mark Butler in the new year. But be quick. The government closed its consultation period in December 2025 and is expected to respond to the MDFA’s advocacy campaign within the first quarter of 2026.