on this page
Patient eligibility
The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with targeted therapies under the National Health Act 1953, section 85 and section 100 for patients with complex refractory fistulising Crohn’s disease.
Where the term targeted therapy appears, it refers to adalimumab, infliximab and ustekinumab.
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 targeted therapies.
Section 100 arrangements
Infliximab IV and ustekinumab IV
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 with the authority application.
Treatment specifics
To be eligible for PBS-subsidised treatment with targeted therapies, patients must be treated by one of the following specialists:
- gastroenterologist
- consultant physician (internal medicine specialising in gastroenterology)
- consultant physician (general medicine specialising in gastroenterology).
Authority applications
Applying for initial or recommencement of treatment
Applications for initial or recommencement (after a treatment break greater than 12 months) authority approval to prescribe PBS-subsidised targeted therapies to treat complex refractory fistulising Crohn’s disease 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 (after a treatment break less than 12 months) authority approval to prescribe PBS-subsidised targeted therapies to treat complex refractory fistulising Crohn’s disease 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 - excluding infliximab SC
Applications for continuing authority approval to prescribe PBS-subsidised targeted therapies to treat complex refractory fistulising Crohn’s disease can be made either:
- in real time using the Online PBS Authorities system
- by calling the PBS Complex Drugs Programs enquiry line.
Continuing PBS-subsidised treatment with biosimilar brands of targeted therapy is Authority Required (Streamlined). You don’t need authority approval from us for the listed quantity and repeats.
Applying for continuing treatment - infliximab SC
Continuing PBS-subsidised treatment with infliximab SC is Authority Required (Streamlined). You don’t need authority approval from us for the listed quantities and repeats.
More information
Call the PBS Complex Drugs Programs enquiry line for more information.