Changes to PBS listings for Adalimumab for approved suppliers
31 March 2021
The Pharmaceutical Benefits Scheme (PBS) listings for Adalimumab are changing on 1 April 2021.
These changes may affect how you claim for and supply this medicine.
The PBS now lists the following biosimilar brands in addition to the original brand Humira:
- Amgevita – 40 mg syringe and pen, 20 mg syringe
- Hadlima- 40 mg syringe and pen
- Hyrimoz - 40 mg syringe and pen
- Idacio - 40 mg syringe and pen.
There are also new maximum unit quantities for 11 Adalimumab item codes on the PBS. The maximum quantity for the affected items will change from 1 unit to either 4 or 6 units. This applies to existing scripts written before 1 April 2021 if they’re supplied from this date.
You can find a detailed list of these items and the changes on the PBS website.
What you need to do
If you get a prescription for any of the affected items written and approved before 1 April 2021, you’ll need to:
- change the maximum quantity from ‘1 unit’ to the new unit quantity for that item, either 4 or 6
- annotate the prescription with the new quantity.
You’ll see a warning reason code, but the claim will be paid.
You don’t need to do this if you’re editing and resubmitting a claim for items originally supplied before 1 April 2021. PBS Online will assess and pay these as per the March 2021 Dispensed Price for Maximum Quantity (DPMQ).
If you need to substitute with a biosimilar brand
You can substitute Humira with biosimilar brands Hadlima, Amgevita, Hyrimoz and Idacio when:
- the dosage is of the same strength and dosage form
- there’s an authority approval provided in writing, online, or over the phone.
If a prescription is written before 1 April and you need to substitute with a biosimilar brand after 1 April, you must:
- claim and supply using the existing approved authority prescriptions, you’ll see a warning reason code (due to change in quantity to 4 or 6) but the claim will be paid
- submit your claim with a brand (e.g. Idacio PK). If you don’t do this, PBS Online will reject it and you won’t be paid.
If you see a reason or rejection code
It’s important that you take note of any warning and rejection codes before you submit your claim. Find out more information about PBS reason and rejection codes for online claiming.
Read more about:
- claiming online for PBS medicines
- PBS reason and rejection codes for online claims
- Adalimumab PBS changes on the PBS website.
Call the PBS general line 13 22 90 for assistance.
Page last updated: 31 March 2021
This information was printed 3 June 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/news/changes-pbs-listings-adalimumab-approved-suppliers. 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.