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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 medicine 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
Adalimumab (for JIA<18), etanercept (for JIA<18) and tocilizumab i.v. (for JIA<18 and JIA>18)
These items are only PBS-subsidised for non-admitted patients, day admitted patients, or patients on discharge who are attending either:
- 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 either a:
- paediatric rheumatologist or under the supervision of a paediatric rheumatology treatment centre - paediatric patients only
- 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:
- details of the proposed prescription or prescriptions
- the completed 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
Please note: You don’t need to complete this application in writing when you request PBS authority online.
Applications 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 can be made:
- using the Online PBS Authorities system
- in writing and use HPOS Form upload
- in writing and mail to PBS Complex Drugs Programs.
All written applications must include:
- details of the proposed prescription or prescriptions
- the completed 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
Please note: You don’t need to complete this application in writing when you request PBS authority online.
Applications 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 can be made:
- using the Online PBS Authorities system
- in writing and use HPOS Form upload
- in writing and mail to PBS Complex Drugs Programs.
All written applications must include:
- details of the proposed prescription or prescriptions
- the completed juvenile idiopathic arthritis - for adult patients with onset prior to age 18 - change or recommencement authority application form
- relevant attachments.
Applying for continuing treatment
Please note: You don’t need to complete this application in writing when you request PBS authority online.
Applications 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 can be made:
- using the Online PBS Authorities system
- in writing and use HPOS Form upload
- in writing and mail to PBS Complex Drugs Programs.
All written applications must include:
- details of the proposed prescription or prescriptions
- the completed 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:
- details of the proposed prescription or prescriptions
- the completed juvenile idiopathic arthritis - change of treatment after resolution of critical shortage of tocilizumab authority application form
- relevant attachments.
More information
Call the PBS Complex Drugs Programs enquiry line for more information.