Idiopathic thrombocytopenic purpura - continuing PBS authority application form (PB098)

Use this form for an adult patient continuing or restarting PBS subsidised treatment with eltrombopag or romiplostim for chronic immune idiopathic thrombocytopenic purpura.

Download and complete the Idiopathic thrombocytopenic purpura - continuing PBS authority application form.

PBS is the Pharmaceutical Benefits Scheme.

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: 20 February 2020