Australian Federal Government Reverses Medicare Reclassification of Intravitreal Injection Procedures
The decision preserves private health insurance coverage for anti-VEGF and other eye injection therapies administered in private hospitals and day surgeries, a significant win for patients and practitioners alike.
The Australian Federal Government has confirmed it will not proceed with a proposed Medicare Benefits Schedule (MBS) reclassification that would have stripped private health insurance cover from intravitreal injection procedures, a decision that will be felt across every ophthalmology practice in the country.
Under the original proposal, recommended by the Medicare Review Taskforce in 2020 and initially slated for implementation on 1 July 2025, eye injections performed in private hospital and day surgery settings would have been reclassified, effectively removing the ability for patients to claim the procedure through their health fund. Following sustained advocacy from Macular Disease Foundation Australia (MDFA), the government delayed implementation to 1 July 2026 and opened further consultation. The government has now confirmed the reclassification will not go ahead.
What the decision means for practitioners
For ophthalmologists and optometrists working within private facilities, the outcome provides certainty that patients receiving anti-VEGF therapy for conditions such as neovascular age-related macular degeneration (nAMD), diabetic macular oedema, and retinal vein occlusion can continue to access treatment without facing the full out-of-pocket burden that the reclassification would have created. Disruption to ongoing injection schedules, which can require monthly or bimonthly attendance, carries well-documented risks of irreversible vision loss.
“While we welcome the decision not to proceed with reclassification, it remains critical to address the broader challenges of affordability faced by the majority of people who rely on sight-saving eye injections.” said Dr Kathy Chapman, CEO, Macular Disease Foundation Australia.
Advocacy campaign a key driver
MDFA credited a community letter-writing campaign, generating more than 500 submissions from patients and carers, as instrumental in demonstrating the real-world treatment impact the reclassification would have caused. The organisation noted that many patients rely entirely on private health insurance to access injection services in timely, clinically appropriate settings, and that redirecting this cohort to the public system would have placed significant additional strain on already stretched public ophthalmology waiting lists.
Affordability agenda continues
Despite the positive outcome, MDFA has flagged that affordability challenges persist for patients who are not covered by private health insurance and who face significant out-of-pocket costs in the public system. The Foundation is now pressing the government on two further reforms:
- Extended Medicare Safety Net reform: MDFA is calling for the Safety Net threshold to stop resetting annually for pension card holders receiving ongoing injections for nAMD from the second year of treatment, recognising that these patients face indefinite, recurring costs.
- Neovascular AMD Treatment Incentive Program: A proposed incentive scheme to encourage ophthalmologists to bulk-bill pension card holders for nAMD injections targeting the most financially vulnerable patients, who are statistically at highest risk of discontinuing treatment due to cost.
Clinical context
Macular disease is the leading cause of blindness and severe vision loss in Australia, with approximately 1.9 million Australians showing some evidence of the condition. Age-related macular degeneration alone accounts for 50% of blindness nationally. Anti-VEGF intravitreal injections remain the standard of care for neovascular forms of the disease, requiring ongoing administration to maintain visual gains making uninterrupted access to treatment a clinical as well as an economic issue.
