Once the patient has qualified for one diagnostic scan, they therefore qualify for Thyrogen for all following scans. To initially qualify, the patient needs to:
Some patients will qualify automatically if they have unstable coronary artery disease, hypopituitarism, or a high risk of relapse of a previous severe psychiatric illness. This decision is ultimately up to the treating physician as to whether the patient will qualify. It is important to discuss with your physician and let him know any concerns you may have with your treatment.
The “once in a lifetime” restriction has been lifted for Thyrogen’s use in ablation. Therefore, if a patient does need to have a second or third ablation, they will still qualify for Thyrogen, provided the patient has no distant disease. This decision is ultimately up to the treating physician as to whether the patient will qualify. It is important to discuss this with your physician and again, let him know if you have any concerns with your treatment.
The Pharmaceutical Benefits Schedule – PBS (reimbursement for ablation) and Medical Benefits Schedule – MBS (reimbursement for diagnostic follow-up) are independent and do not work together. If you have received Thyrogen for ablation, you will no longer qualify for Thyrogen in diagnostic follow-up, as the MBS requires that you have experienced hypothyroidism once previously, as well as other criteria. This will therefore mean that a patient will need to have a withdrawal diagnostic follow up test after the ablation. It is important for your to discuss this with your physician, as it may be required for you to let the physician know of any impact being hypothyroid had on your health and mood in order to qualify for future diagnostic testing. Remember, follow-up is for life, at is important to keep seeing your physician to maintain peace of mind and discuss any concerns with your treating physician.
If you suffer from, or have previously suffered from a psychiatric illness (with concern about relapse and under specialist psychiatric care, you need to tell this to your physician, as you may then qualify for Thyrogen from your first follow up and never have to be withdrawn from thyroid replacement therapy (T4). Hypothyroidism is contraindicated for individuals suffering with a psychiatric illness, which is why you should always be eligible for Thyrogen.
For all other patients, it is a requirement that you have experienced a severe psychiatric disturbance when you were made hypothyroid in order to qualify in the future. There is no clear definition on what such a disturbance is, with many doctors agreeing that anxiety, feeling “down”, depression and severe tiredness being qualifying conditions. For further clarification you should discuss this with your physician.
Does the rebate apply to each time it is used (ablation and follow-ups) and does extra use restrict their qualification for rebate?
If you qualify, Thyrogen will be reimbursed fully. This means if you receive Thyrogen for ablation, you will pay the standard PBS rate and if you qualify for Thyrogen in diagnostic follow-up, the whole amount will be bulk billed. Your physician may request you go and see a GP for the administration of Thyrogen for ablation for your convenience, so you would also need to pay for 2 standard GP visits. There are no restrictions on the number of times you can receive Thyrogen, however, there are restrictions in qualifying and the amount of time between uses, i.e. for diagnostic follow-up, you can only receive Thyrogen once every twelve months. This should not be a problem and is in line with the standard Australian treatment practice.
The ultimate decision is up to your treating physician. Thyrogen is available for ablation to all patients who have no distant disease. Your physician however, may have reasons for not wanting to use Thyrogen, so it is important to discuss this with your physician. The criteria for follow-up is much more restricted and you should openly discuss this with your physician to better understand what treatments are available to you now and in the future.