Azacitidine Initial PBS authority application form (PB079)

You must lodge this form for a patient starting initial Pharmaceutical Benefits Scheme (PBS) subsidised treatment with azacitidine for the treatment of myelodysplastic syndrome classified as intermediate-2 or high risk according to the International Prognostic Scoring System (IPSS), or chronic myelomonocytic leukaemia with 10% to 29% marrow blasts without myeloproliferative disorder, or acute myeloid leukaemia with 20% to 30% marrow blasts and multi-lineage dysplasia, according to World Health Organisation classification.


Page last updated: 15 June 2016

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