IV iron use surges but still no MBS item to cover costs

The number of women receiving intravenous iron has surged over the past decade, with research revealing one in 20 women of reproductive age were given the treatment in 2024.
 
Published in the Internal Medicine Journal, the Australian study found a 17-fold increase in intravenous iron use among women aged 18 to 44 years between 2013 and 2024, while government and patient spending on the medication alone rose from $1.1 million to more than $82 million.
 
The rate of dispensed intravenous iron also increased from 0.3 in 2013 to 5.0 per 100 women in 2024.
 
Lead author, Dr Gizat Kassie, told newsGP there are several factors contributing to this.
 
‘Awareness of iron deficiency may have improved over time, and we may also be identifying and diagnosing it more often,’ he said.
 
‘Another important factor could be the availability of newer IV iron products, particularly ferric carboxymaltose.
 
‘These products can deliver a large dose of iron in a relatively short period of time, making IV iron more practical to provide in general practice.’
 
He added that ‘GPs account for around two thirds of all prescriptions for IV iron in Australia’.
 
Ferric carboxymaltose made up almost 94% of total claims in 2024, up from 39.6% in 2014 – the year it was introduced onto the Pharmaceutical Benefits Scheme (PBS).
 
Three other intravenous iron preparations were also available on the PBS during the study period, including iron polymaltose, iron sucrose and ferric derisomaltose.
 
But while its inclusion on the PBS has made intravenous iron more accessible, data shows the proportion of women dispensed IV iron with a concession card reduced from 30.9% in 2013 to 17.2% in 2024.
 
GP Dr Danny Byrne, who has a special interest in iron infusions, said this is an excellent, safe treatment that had increased in access since becoming listed on the PBS, but there are barriers for some patients.
 
‘There is no surprise that since intravenous iron, what we call Ferinject, went on the PBS in 2014, it has become more accessible,’ he told newsGP.
 
‘Where women previously had to put up with unwanted side effects from tablets or you just lived with your chronic iron deficiency, now it’s easily treatable.’
 
However, there is no specific Medicare Benefits Schedule (MBS) item number to cover administration costs involved in the treatment – something the RACGP has been calling for in recent years, he said.
 
This means the cost of the service is absorbed by the public system or passed on to the patient, the study explains.
 
Dr Byrne said this puts poorer communities at a disadvantage.
 
‘The obvious take from this study is that there’s no Medicare item number behind it, so clinics have to charge $150 to $200 or more to recover costs. If you’re attending a 100% bulk-billing clinic then you can’t get an iron infusion.’
 
In some parts of Australia, rates of use were more than three times higher than others, the study found.
 
Dr Kassie said the variation raises important questions about access to treatment and consistency of care.
 
‘We need to better understand what is driving these differences and whether all women are receiving equitable access to the most appropriate treatment,’ he said.
 
‘Some of the variation may reflect differences in clinical practice, but cost could also be playing a role.
 
‘For some women, out-of-pocket expenses can be significant and may influence both access to treatment and whether they complete the recommended course.’
 
The study also showed that almost one in four women did not complete their prescribed treatment course, raising questions about whether some women may be receiving less treatment than intended.
 
‘Possible explanations include women feeling better after an initial dose or the financial burden associated with additional treatment,’ it suggests.
 
Senior author Associate Professor Luke Grzeskowiak said the findings reflect growing awareness of the impact iron deficiency can have on women’s health.
 
‘For women struggling with iron deficiency, particularly when oral iron tablets are ineffective or cause troublesome side effects, intravenous iron can be an important treatment option,’ he said.
 
‘It can replenish iron stores more quickly and help women feel better sooner, which can make a real difference to their daily lives.’

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