In healthcare, the biggest question isn’t always whether treatment works but who pays for it. Pic: Getty Images <\/p>\n
Securing government or insurer support can help unlock predictable, scalable revenue stream for healthcare companies
\nEmyria has a reimbursement deal with Medibank Private to cover eligible members accessing PTSD and TRD programs at Empax clinics
\nEBR\u2019s WiSE CRT device was approved by the US FDA in April 2025 and locked in Medicare reimbursement by October<\/p>\n
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Gaining government and medical insurer support can be a key catalyst for an ASX healthcare company.<\/p>\n
The funding model not only unlocks a predictable revenue stream but also removes one of the biggest barriers to scaling a medical service \u2013 the question of who pays.<\/p>\n
Morgans\u2019 healthcare analyst Iain Wilkie told Stockhead that for small-cap ASX health companies, solving the payer problem could be the difference between a promising idea and a long-term viable and growing business.<\/p>\n
\u201cOut of pocket expenses and what people have to pay matters,\u201d he said.<\/p>\n
\u201cHaving treatment subsidised by the government or funded by insurance, particularly for expensive treatments, can make a big difference to patients and companies,\u201d he said.<\/p>\n
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Emyria \u2013 the insurer is paying<\/p>\n
Emyria (ASX:EMD)<\/a> operates regulated mental health programs through its Empax clinics for eligible patients under specialist clinical care, including programs relating to post-traumatic stress disorder (PTSD) and treatment-resistant depression.<\/p>\n Emyria has a Brisbane Empax clinic in partnership with Avive Health, alongside two Perth-based clinics, including a site within a private mental health hospital and a community centre.<\/p>\n The company recently established its first Victorian-based Empax clinic within Avive Health\u2019s Mornington Peninsula Private Hospital.<\/p>\n It has also entered an agreement with Matilda Healthcare to establish a clinic at Matilda Nepean Private Hospital in Kingswood, NSW, earmarked to open in Q3 2026, subject to regulatory approvals.<\/p>\n Emyria has secured a reimbursement agreement with Medibank Private (ASX:MPL),<\/a>\u00a0Australia\u2019s largest private health insurer, to cover eligible members accessing its PTSD and TRD programs across its national Empax network.<\/p>\n The Australian government\u2019s Department of Veterans\u2019 Affairs (DVA) is also funding eligible veteran card holders to access Emyria\u2019s programs for PTSD and TRD.<\/p>\n Emyria managing director Dr Michael Winlo noted the cost of serious mental health conditions had been climbing for payers, with Medibank spending more $2 billion<\/a> on mental health hospitalisations alone in just the past decade.<\/p>\n \u201cPayers are taking a genuine interest in new approaches to care for PTSD and TRD,\u201d he told Stockhead.<\/p>\n \u201cHowever, they aren\u2019t just funding activity, they want to track real-world outcomes like clinical and cost effectiveness too.<\/p>\n \u201cIt\u2019s great to see payers leading this kind of innovation and helping to improve new models of care within regulated clinical settings.\u201d<\/p>\n Wilkie said the coverage announcement with Medibank and DVA was more than a revenue unlock.<\/p>\n \u201cThe reimbursement agreement provides additional funding pathways for eligible patients,\u201d he said.<\/p>\n The Therapeutic Goods Administration (TGA) recently announced changes to its recommendations for the Authorised Prescriber (AP) scheme for psychedelic-assisted psychotherapy.<\/p>\n The changes expand the range of clinicians required as one of two therapists in the psychedelic-assisted psychotherapy dyad, which to date has mandated a clinical psychologist or medical practitioner be present during dosing.<\/p>\n \u00a0<\/p>\n Pacific Edge working to reinstate coverage<\/p>\n