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Patient eligibility
The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with adalimumab and infliximab SC under the National Health Act 1953, section 85 for paediatric patients with severe refractory Crohn’s disease.
The PBS subsidises treatment with infliximab IV under the National Health Act 1953, section 100 for paediatric patients with moderate to severe refractory Crohn’s disease.
Where the term targeted therapies appears, it refers to adalimumab and infliximab.
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
This item is 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.
This item isn’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 for severe or moderate to severe refractory Crohn’s disease, patients must be treated by one of the following specialists:
- gastroenterologist (code 87)
- consultant physician (internal medicine specialising in gastroenterology) (code 81)
- consultant physician (general medicine specialising in gastroenterology) (code 82)
- paediatrician
- specialist paediatric gastroenterologist.
Authority applications
Applying for initial treatment
Applications for initial authority approval to prescribe PBS-subsidised targeted therapies to treat severe or moderate to severe refractory 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 authority approval to prescribe PBS-subsidised targeted therapies to treat severe or moderate to severe refractory 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
Continuing PBS-subsidised treatments with targeted therapies are Authority Required (Streamlined). You don’t need authority approval from us for the listed quantity and repeats.
More information
Call the PBS Complex Drugs Programs enquiry line for more information.