Severe eosinophilic asthma – mepolizumab adolescent and adult initial grandfather PBS authority application form (PB295)

Use this form to apply for initial grandfather PBS subsidised treatment with mepolizumab for uncontrolled severe eosinophilic asthma.

Download and complete the Severe eosinophilic asthma – mepolizumab adolescent and adult initial grandfather PBS authority application.

This form is for patients aged 12 years or older.

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: 4 June 2020