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Patient eligibility
The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with biological agents 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 agent' appears, it refers to adalimumab, etanercept and tocilizumab.
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 agents.
Section 100 arrangements
Tocilizumab i.v.
This item is only PBS-subsidised for non-admitted patients, day admitted patients, or patients on discharge who are attending:
- an approved private hospital
- a public participating hospital
- a public hospital.
This item 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 agents, 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
Apply for initial authority approval to prescribe PBS-subsidised biological agents 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 initial authority application form
- relevant attachments.
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.
Read more about the critical shortage supply of tocilizumab from the Department of Health's website.
Applying for change or recommencement of treatment
Apply to change or recommence authority approval to prescribe PBS-subsidised biological agents 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 or recommencement or demonstration of response authority application form
- 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 agents 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 continuing authority application form
- relevant attachments.
Adult patients with JIA who started PBS treatment before turning 18
Applying for initial treatment
Apply for initial authority approval to prescribe PBS-subsidised biological agents to treat adult patients with JIA who started PBS treatment before turning 18 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 initial authority application form
- relevant attachments.
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 adult 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.
Read more about the critical shortage supply of tocilizumab from the Department of Health’s website.
Applying for change or recommencement of treatment
Apply to change or recommence authority approval to prescribe PBS-subsidised biological agents to treat adult patients with JIA who commenced PBS treatment prior to turning 18 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 or recommencement or demonstration of response authority application form
- 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 agents to treat adult patients with JIA who commenced PBS treatment prior to turning 18 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 continuing authority application form
- relevant attachments.
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 agents 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 agents 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
- relevant attachments.
You can 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 agents 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 continuing authority application form
- relevant attachments.
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 adult 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.
Read more about the critical shortage supply of tocilizumab from the Department of Health’s website.
More information
Call the PBS Complex Drugs Programs enquiry line for more information.