Hereditary transthyretin amyloidosis - patisiran or vutrisiran - initial grandfather authority application form (PB369)

Use this form to apply for initial grandfathered PBS-subsidised treatment with patisiran or vutrisiran for adult patients with hereditary transthyretin amyloidosis.

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 or need an interpreter.

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 hereditary transthyretin amyloidosis - patisiran or vutrisiran - initial grandfather authority application form.

Page last updated: 1 May 2025.
QC 74417