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

This information was printed Friday 30 September 2016 from humanservices.gov.au/health-professionals/forms/pb079 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.