Severe asthma – adolescent and adult initial and recommencement after 12 months break authority application form (PB075)

Use this form to apply for initial PBS subsidised treatment with a biological agent for an adult or adolescent patient with uncontrolled severe asthma.

Biological agent refers to:

  • benralizumab
  • dupilumab
  • mepolizumab
  • omalizumab.

Download and complete the severe asthma – adolescent and adult initial and recommencement after 12 months break authority application form.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

You can upload this form in HPOS.

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Page last updated: 1 July 2021