Arthritis - juvenile idiopathic arthritis

The PBS subsidises biological agents for patients with severe active juvenile idiopathic arthritis.

Patient eligibility

The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with biological agents under the National Health Act 1953, sections 85 and 100 for adult and juvenile patients with severe active juvenile idiopathic arthritis (JIA).

Where the term biological agent appears, it refers to adalimumab, etanercept and tocilizumab.

Patients must be eligible for the PBS and meet the relevant restriction criteria.

The Schedule of Pharmaceutical Benefits on the PBS website outlines the restrictions for prescribing biological agents.

Section 100 arrangements

Tocilizumab i.v.

This item is only PBS subsidised for day admitted patients, non-admitted patients, or patients on discharge who are attending either:

  • an approved private hospital
  • a public participating hospital
  • a public hospital.

You must include the hospital name and provider number on the authority application form. This item isn’t PBS subsidised for hospital in-patients.

Toxicity and severity descriptors

When demonstrating a patient’s intolerance to prior treatment, use the juvenile idiopathic arthritis toxicity and severity descriptors with the authority application.

Treatment specifics

To be eligible for PBS subsidised treatment with biological agents for JIA, a patient must be either:

  • a juvenile patients, under 18 year of age, who is treated by a rheumatologist or are under the supervision of a paediatric rheumatology treatment centre
  • an adult patient, over 18 years of age, with a documented history of JIA who is treated by a rheumatologist or clinical immunologist with expertise in the management of rheumatoid arthritis.

Applications

Initial treatment

Apply for authority approval to prescribe initial PBS subsidised biological agents to treat juvenile patients with JIA in writing and either:

All applications must include the completed:

Apply for authority approval to prescribe PBS subsidised biological agents to treat adult patients with JIA in writing and either:

All applications must include the completed:

Changing or recommencing treatment

Apply for authority approval to change or recommence PBS subsidised biological agents to treat juvenile patients with JIA in writing and either:

All applications must include the completed:

Apply for authority approval to change or recommence PBS subsidised biological agents to treat adult patients with JIA in writing and either:

All applications must include the completed:

You can use these authority application forms to submit a demonstration of response to the current PBS subsidised treatment.

Continuing treatment

Apply for authority approval to continue PBS subsidised biological agents to treat juvenile patients with JIA in writing and either:

All applications must include the completed:

Apply for authority approval to continue PBS subsidised biological agents to treat adult patients with JIA in writing and either:

All applications must include the completed:

More information

Call the PBS Complex Drugs Programs enquiry line for more information.

Page last updated: 2 October 2019