Age-related macular degeneration

The PBS subsidises aflibercept, ranibizumab and verteporfin for patients with subfoveal choroidal neovascularisation due to age-related macular degeneration.

For patients with subfoveal choroidal neovascularisation due to age-related macular degeneration, treatment with aflibercept, ranibizumab and verteporfin can be subsidised through the Pharmaceutical Benefits Scheme (PBS), under section 85 of the National Health Act 1953.

Restriction details

The Schedule of Pharmaceutical Benefits on the PBS website outlines restrictions for prescribing aflibercept, ranibizumab and verteporfin to patients.

Initial treatment

Applications for treatment must be submitted in writing by the treating ophthalmologist. An initial application must be submitted for each eye.

Application requirements

Verteporfin

A copy of the fluorescein angiogram to demonstrate the subfoveal choroidal neovascularisation is predominantly classic, greater than or equal to 50%, must be provided with each initial application for the affected eye or eyes.

Patients must have a baseline visual acuity of 6/60 (20/200) or better.

Aflibercept and ranibizumab

A copy of the diagnostic optical coherence tomography or fluorescein angiography report must be provided with each initial application for the affected eye or eyes.

Continuing treatment

After an application for initial treatment has been approved, applications for continuing treatment in the same eye may be made in writing or over the phone.

Applications for treatment

All applications for:

  • verteporfin will be limited to 1 treatment only
  • aflibercept and ranibizumab may be for the initial treatment and 2 repeats
  • where both eyes are being treated simultaneously, a quantity of 2 may be requested on the same prescription

Maximum number of verteporfin treatments per eye

The maximum number of verteporfin treatments per eye is 15. This includes treatment administered under both the Medicare Benefits Schedule (MBS) Visudyne Program and the PBS.

The PBS Complex Drugs Programs team must be notified if treatment with verteporfin is stopped before completion of the laser activation step, but after infusion of verteporfin. This won’t count towards the total.

Patient eligibility

Patients must meet the relevant criteria as indicated in the PBS restrictions and be eligible for the PBS.

Lodging an application

Applications for initial approvals must be in writing. They must include a:

Emergency treatments only

To avoid a delay in starting treatment, phone applications for initial approval can be made. The completed application form and authority prescription form must be faxed to the PBS Complex Drugs Programs team, who will contact the prescriber by phone. You must then send the original application form and a copy of the optical coherence tomography or fluorescein angiography to the PBS Complex Drugs Programs address.

Further information

For more information contact the PBS Complex Drugs Programs enquiry line. Send all written applications to the PBS Complex Drugs Programs address.

Page last updated: 8 November 2016

This information was printed Sunday 4 December 2016 from humanservices.gov.au/health-professionals/enablers/age-related-macular-degeneration It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.