EXPLANATORY STATEMENT HS/7/1999
SUBJECT: HEALTH INSURANCE ACT 1973
DETERMINATION UNDER SUBSECTION 3C(1) TO PROVIDE MEDICARE BENEFITS FOR 153SM-LEXIDRONAM THERAPY FOR BONE PAIN
Subsection 3C(1) of the Health Insurance Act (the Act) provides that the Minister may, by instrument in writing, determine that a health service not already included in the General Medical Services Table (the table) is to be treated as if it were included in the table. Such a determination specifies a fee in respect of the health service and is subject to the provisions, as specified in the determination, of the Act, the National Health Act 1953, and regulations under these Acts, as if it were a health service included in the table.
The table, which is prescribed by regulations under section 4 and section 133 of the Act, contains item numbers for, descriptions of and fees in respect of medical services which are, among other things, recognised for the purposes of payment of Medicare benefits.
The Medicare Services Advisory Committee (MSAC) recently completed a systematic review of the evidence on the use of the radiopharmaceutical 153Sm-lexidronam therapy for
the treatment of metastatic bone lesions. Medicare benefits are currently payable only for the
treatment of painful bony metastases from carcinoma of the prostate using 89Strontium.
MSAC recommended public funding for 153Sm-lexidronam therapy for the relief of bone pain in patients with skeletal metastases (as indicated by a positive bone scan) from the following malignancies:
(i) carcinoma of the prostate, where hormonal therapy has failed; or
(ii) carcinoma of the breast, where hormonal therapy and chemotherapy have failed; and either:
(a) the disease is poorly controlled by conventional radiotherapy; or
(b) conventional radiotherapy is inappropriate, due to the wide distribution of sites
of pain.
Following the Minister's endorsement of MSAC's recommendation, an appropriate Medicare Benefits Schedule item descriptor and fee for 153Sm-lexidronam therapy has been negotiated through the Medicare Benefits Consultative Committee process, in consultation with the Australian and New Zealand Association of Physicians in Nuclear Medicine and the Australian Medical Association.
This determination in effect introduces a new item for this health service to enable cancer patients who require this therapy for relief of intractable bone pain to have access to a Medicare rebate as quickly as possible. It will provide for the payment of benefits for 153 Sm-lexidronam therapy pending its proposed inclusion in the table when revisions are made to the table by amendment of the relevant regulations.