Arthritis - psoriatic arthritis

The Pharmaceutical Benefits Scheme (PBS) subsidises biological agents for patients with severe active psoriatic arthritis.

Patient eligibility

The PBS subsidises treatment with biological agents under the National Health Act 1953, sections 85 and 100 for adult patients with severe psoriatic arthritis.

Where the term biological agent appears it refers to:

  • adalimumab
  • certolizumab
  • etanercept
  • golimumab
  • infliximab
  • secukinumab
  • ustekinumab.

Patients must be eligible for the PBS and meet the relevant restriction criteria.

The Schedule of Pharmaceutical Benefits on the PBS website outlines restrictions for prescribing biological agents.

Section 100 arrangements for infliximab

Infliximab is only available for day admitted patients, non-admitted patients, or patients on discharge attending either:

  • an approved private hospital
  • a public participating hospital
  • a public hospital.

Infliximab isn’t PBS subsidised for hospital in-patients. You must include the hospital name and provider number on the authority application form.

Toxicity criteria and severity descriptors

When demonstrating a patient’s intolerance to prior treatment, use the psoriatic arthritis toxicity criteria and severity descriptors with the authority application. 

Demonstration of a response

You must use the same indices of disease severity used to establish the baseline for all continuing treatment authority applications. This ensures consistency in demonstrating a response.

You can provide new baseline measurements when applying to change or recommence PBS subsidised treatment with biological agents.

A completed treatment cycle is when a patient has failed or stopped responding to treatment with a maximum of 3 different biological agents. They must have at least a 5-year break from PBS subsidised biological agents before they can start a new treatment cycle.

Treatment specifics

Patients must be treated by a rheumatologist or clinical immunologist with expertise in managing severe psoriatic arthritis to be eligible for PBS subsidised treatment with biological agents.

Applications

Initial treatment

Apply for initial authority approval to prescribe PBS subsidised biological agents to treat severe psoriatic arthritis in writing and either:

All applications must include the completed:

Initial grandfather treatment - secukinumab only

For patients who received non-PBS subsidised secukinumab treatment before 1 October 2016 for severe active psoriatic arthritis, apply for initial grandfather applications in writing and either:

All applications must include the completed:

Changing or recommencing treatment

Apply for authority approval to change and recommence PBS subsidised biological agents to treat severe psoriatic arthritis in writing and either:

All applications must include the completed:

Continuing treatment

Apply for authority approval to continue PBS subsidised biological agents to treat severe psoriatic arthritis in writing and either:

All applications must include the completed:

After we approve the first application for continuing treatment with infliximab, subsequent continuing applications for biosimilar brands are:

  • S100 - HSD (Public) - Authority Required (Streamlined) and you don’t need authority approval from us for the listed quantity and repeats
  • S100 - HSD (Private) - Authority Required (Telephone) - you can call the PBS authority approvals line to request authority approval.

After we approve the first application for continuing treatment with etanercept, subsequent continuing applications for biosimilar brands are Authority Required (Streamlined). They don’t need prior authority approval from us for the listed quantity and repeats.

More information

Call the PBS Complex Drugs Programs enquiry line for more information.

Page last updated: 1 December 2018