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 adult patients with severe Crohn’s disease.
Where the term targeted therapies appears it refers to:
- adalimumab
- infliximab
- upadacitinib
- ustekinumab
- vedolizumab.
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
Infliximab IV, ustekinumab IV and vedolizumab 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 name and provider number on the authority application form.
Treatment specifics
To be eligible for PBS-subsidised treatment with targeted therapies, patients must be treated by either a:
- gastroenterologist
- consultant physician (internal medicine specialising in gastroenterology)
- consultant physician (general medicine specialising in gastroenterology).
Crohn’s disease activity index calculation form
Download and complete the Adult Crohn’s Disease Activity Index form.
Authority applications
Applying for initial treatment
Applications for initial authority approval to prescribe PBS-subsidised targeted therapies to treat adult patients with severe 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 initial grandfather treatment
For patients transitioning from non-PBS-subsidised therapy that was commenced as a paediatric patient for severe Crohn’s disease, apply for authority approval either:
- in real time using the Online PBS Authorities system
- by calling the PBS Complex Drugs Programs enquiry line.
Applying for extended induction period (optional)
Applications for authority approval to prescribe PBS-subsidised upadacitinib or vedolizumab IV for (optional) extended induction period to treat 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 adult patients with severe 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 adult patients with severe 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 therapies is Authority Required (Streamlined). You don’t need authority approval from us for the listed quantities 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.