Severe chronic plaque psoriasis - change or recommencement or demonstration of response authority application form (PB263)

Use this form to apply for changing or recommencing PBS subsidised biological agent for adult patients with severe chronic plaque psoriasis.

This form can also be used to provide a demonstration of response to current PBS subsidised treatment.

Biological agent refers to:

  • adalimumab
  • etanercept
  • guselkumab
  • infliximab
  • ixekizumab
  • risankizumab
  • secukinumab
  • tildrakizumab
  • ustekinumab.

Download and complete the severe chronic plaque psoriasis - change or recommencement or demonstration of response 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.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 4 January 2021