The TAC Medical Excess may apply to these services
This policy must be read in conjunction with the Surgery Requests Elective policy and the Non-Established, New or Emerging Treatments and Services policy.
The TAC can fund the reasonable cost of OP-1 used in surgery for transport accident injuries where its use is likely to result in a better clinical outcome and assist the client recover from his/her transport accident injuries.
Transport Accident Act 1986 reference: s.3 'medical service' and s.60
Osteogenic Protein 1 (OP-1 or BMP-7) is an implantable bone putty that stimulates natural bone healing by actively recruiting stem cells from the surrounding tissue and blood supply.
OP-1 is indicated as an alternative or adjunct to autograft techniques:
- in long bone fractures where the fracture has not healed (non-union)
- where there is a high risk of non-union or delayed union rate
- in some wrist and ankle fractures and
- in some spinal fusions.
In this policy:
- OP-1 refers to Osteogenic Protein Device also known as Bone Morphogenic Protein-7 (BMP-7).
- an autograft is a surgical procedure where tissue is taken from one part of the body and transferred to another area in the same individual.
What will the TAC fund?
The TAC can fund the use of OP-1 for spinal fusions, long bone and short bone fractures and peripheral joint fusions where implanted by a suitably qualified and registered surgeon. The client must have had a reasonable trial of available, established treatments or a demonstrated high risk of non-union prior to OP-1 being considered.
The TAC strongly encourages prior approval to be sought prior to treatment being provided. This allows the TAC to determine that the treatment is related to the transport accident, is a reasonable treatment option and is the most appropriate service for the client. It will also expedite payment of accounts for accident related treatment.
Will the TAC fund OP-1 in a Public Hospital?
The TAC will not fund the use of OP-1 used in surgery at a public hospital as its cost is covered under Casemix funding under the relevant Diagnosis Related Group (DRG).
Who can provide the service?
The TAC will only fund treatment provided by a suitably qualified and registered surgeon.
What information does the TAC require to consider a request for OP-1?
To assist the TAC in determining its liability for and the reasonableness of OP-1 the following information is required:
- Diagnosis and clinical indications for the requested treatment.
- Relationship to the transport accident.
- Details of all previously trialled treatments (medications, procedures or surgery) for this diagnosis.
- Evidence that the proposed treatment will be safe and more effective than previously trialled treatments. If established treatments have not been trialled, reasons for going directly to a non-established treatment must be given.
- Expected outcomes from the treatment, in particular functional outcomes, eg. return to work, increased independence in domestic chores and future treatments planned if this treatment is successful or unsuccessful.
A request for OP-1 will not be considered without the above information.
The TAC may request the opinion of an independent examiner prior to making a decision on the request.
TAC's decision will be communicated in writing to the requesting provider and the client.
Can the TAC fund surgically implanted prostheses?
Refer to the Surgically Implanted Prostheses policy.
In relation to OP-1 what will the TAC not fund?