Arthritis - juvenile idiopathic arthritis - Written Authority Required Drugs

Patient eligibility

The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with biological medicines under the National Health Act 1953, section 85 and/or section 100 for adult and paediatric patients with severe active juvenile idiopathic arthritis (JIA).

Where the term ‘biological medicines’ appears, it refers to adalimumab, etanercept, tocilizumab and tofacitinib.

Patients must be eligible for the PBS and meet the relevant restriction criteria.

The Schedule of Pharmaceutical Benefits on the PBS website outlines the restrictions for prescribing biological medicines.

Section 100 arrangements

Tocilizumab i.v. (for JIA<18), adalimumab (for JIA<18) and etanercept (for JIA<18)

These items are only PBS-subsidised for non-admitted patients, day admitted patients, or patients on discharge who are attending:

an approved private hospital
a public hospital.

These items aren’t PBS-subsidised for public hospital in-patients. You must include the hospital provider number for the authority application.

For JIA>18, tocilizumab i.v. isn’t PBS-subsidised for public hospital in-patients. You must include the hospital name and provider number on the authority application form.

Toxicity and severity descriptors

When demonstrating a patient’s intolerance to prior treatment, use the juvenile idiopathic arthritis toxicity and severity descriptors with the authority application.

Treatment specifics

To be eligible for PBS-subsidised treatment with biological medicines, patients must be treated by one of the following specialists:

a paediatric rheumatologist or under the supervision of a paediatric rheumatology treatment centre - paediatric patients only
a rheumatologist or clinical immunologist with expertise in the management of rheumatoid arthritis - adult patients only, with a documented history of JIA.

Authority applications

Paediatric patients

Applying for initial treatment

Applications for initial authority approval to prescribe PBS-subsidised biological medicines to treat paediatric patients with JIA can be made either:

in real time using the Online PBS Authorities system
by calling the PBS Complex Drugs Programs enquiry line.

Applying for change or recommencement of treatment

Applications to change or recommence authority approval to prescribe PBS-subsidised biological medicines to treat paediatric patients with JIA can be made either:

in real time using the Online PBS Authorities system
by calling the PBS Complex Drugs Programs enquiry line.

Applying for continuing treatment

Continuing PBS-subsidised treatment with biological medicines is Authority Required (Streamlined). You don’t need authority approval from us for the listed quantities and repeats.

Applying for change of treatment after resolution of critical shortage of tocilizumab

Apply for change of treatment after resolution of critical shortage of tocilizumab to treat paediatric patients with JIA in writing and either:

use HPOS Form upload
mail to PBS Complex Drugs Programs.

All written applications must include the completed:

authority prescription form or forms
juvenile idiopathic arthritis - change of treatment after resolution of critical shortage of tocilizumab authority application form
relevant attachments.

Adult patients with JIA who started PBS treatment before turning 18

Applying for change or recommencement of treatment

Applications to change or recommence authority approval to prescribe PBS-subsidised biological medicines to treat adult patients with JIA who commenced PBS treatment prior to turning 18 can be made either:

in real time using the Online PBS Authorities system
by calling the PBS Complex Drugs Programs enquiry line.

Applying for continuing treatment

Continuing PBS-subsidised treatment with biological medicines is Authority Required (Streamlined). You don’t need authority approval from us for the listed quantities and repeats.

Adult patients with JIA who started PBS treatment after turning 18

Applying for initial treatment

Apply for initial authority approval to prescribe PBS-subsidised biological medicines to treat adult patients with JIA who commenced PBS treatment after turning 18 years of age in writing and either:

use HPOS Form upload
mail to PBS Complex Drugs Programs.

All written applications must include the completed:

authority prescription form or forms
juvenile idiopathic arthritis for adult patients with onset prior to age 18 initial authority application form
relevant attachments.

Applying for change or recommencement of treatment

Apply to change or recommence authority approval to prescribe PBS-subsidised biological medicines to treat adult patients with JIA who commenced PBS treatment after turning 18 years of age in writing and either:

use HPOS Form upload
mail to PBS Complex Drugs Programs.

All written applications must include the completed:

authority prescription form or forms
juvenile idiopathic arthritis for adult patients with onset prior to age 18 change or recommencement or demonstration of response authority application from
relevant attachments.

You can also use this authority application form to submit a demonstration of response to the current PBS-subsidised treatment.

Applying for continuing treatment

Apply for continuing authority approval to prescribe PBS-subsidised biological medicines to treat adult patients with JIA who commenced PBS treatment after turning 18 years of age in writing and either: