Crohn's disease - fistulising Crohn's disease

The PBS subsidises biological agents for patients with complex refractory fistulising Crohn's disease.

Patient eligibility

The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with biological agents under the National Health Act 1953, section 85 and section 100 for patients with complex refractory fistulising Crohn's disease.

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

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

Infliximab

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 participating public hospital
  • a public hospital.

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

Treatment specifics

To be eligible for PBS subsidised treatment with biological agents, patients must be treated by one of the following specialists:

  • gastroenterologist (code 87)
  • consultant physician (internal medicine specialising in gastroenterology) (code 81)
  • consultant physician (general medicine specialising in gastroenterology) (code 82).

Authority applications

Applying for initial treatment

Apply for initial authority approval to prescribe PBS subsidised biological agents to treat complex refractory fistulising Crohn's disease in writing and either:

All written applications must include the completed:

Applying for change or recommencement of treatment

Apply to change or recommence authority approval to prescribe PBS subsidised biological agents to treat complex refractory fistulising Crohn’s disease in writing and either:

All written applications must include the completed:

Applying for continuing treatment

Apply for continuing authority approval to prescribe PBS subsidised biological agents to treat complex refractory fistulising Crohn's disease in writing and either:

All written applications must include the completed:

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

After we approve the first application for continuing treatment, subsequent continuing applications for PBS subsidised biosimilar brands of biological agents are Authority Required (Streamlined). They don’t need authority approval from us for listed quantity and repeats.

Further information

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

Page last updated: 1 April 2021