Paroxysmal nocturnal haemoglobinuria - eculizumab or ravulizumab - initial, switching, returning or balance of supply authority application form (PB327)

Use this form to apply for initial, switching, returning or balance of supply PBS-subsidised treatment with eculizumab or ravulizumab for paroxysmal nocturnal haemoglobinuria.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

You can upload this form in HPOS.

Please note: You don’t need to complete this form if you use the Online PBS Authorities system.

Download and complete the paroxysmal nocturnal haemoglobinuria - eculizumab or ravulizumab - initial, switching, returning or balance of supply authority application form.

Page last updated: 1 December 2024.
QC 62063