Fistulising Crohn's disease - initial, grandfather, or recommencement (treatment break greater than 5 years) authority application form (PB092)

Use this form to apply for initial, grandfather or recommencing PBS-subsidised treatment with a biological medicine for complex refractory fistulising Crohn's disease, where the treatment break is more than 5 years.

'Biological medicine’ refers to adalimumab, infliximab and ustekinumab.

Download and complete the fistulising Crohn's disease - initial, grandfather or recommencement (treatment break greater than 5 years) authority application form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

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: 1 January 2024.
QC 20811