Acute lymphoblastic leukaemia – blinatumomab Initial (Induction) authority application form (PB210)
Use this form to apply for initial (induction) PBS subsidised blinatumomab treatment for acute lymphoblastic leukaemia.
Download and complete the Acute lymphoblastic leukaemia – blinatumomab Initial (Induction) authority application form.
PBS is the Pharmaceutical Benefits Scheme.
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Page last updated: 10 December 2020
This information was printed 16 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb210. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.