Arthritis - psoriatic arthritis

The PBS subsidises biological agents for patients with severe active psoriatic arthritis.

Treatment with biological agents can be subsidised through the Pharmaceutical Benefits Scheme (PBS) under sections 85 and 100 of the National Health Act 1953 for adult patients with severe active psoriatic arthritis.

Where the term biological agent appears it refers to adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, secukinumab and ustekinumab.

Section 100 arrangements only for infliximab

This item is available to a patient who is attending:

  • an approved private hospital
  • a public participating hospital, or
  • a public hospital

and is either a

  • day admitted patient
  • non-admitted patient, or
  • patient on discharge

This item is not PBS subsidised for in-patients of the hospital. You must include the hospital name and provider number on the authority application form.

Patient eligibility

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.

Toxicity criteria and severity descriptors

Use the psoriatic arthritis toxicity criteria and severity descriptors in conjunction with the authority application when demonstrating patient’s intolerance to DMARD treatment.

Demonstration of a response

The same indices of disease severity used to establish the baseline must be used 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.

Once a patient has failed or ceased to respond to treatment with a maximum of 3 different biological, they are deemed to have completed a treatment cycle and must have, at a minimum, a 5-year break in PBS subsidised biological agent treatment before they are eligible to commence a new treatment cycle.

Applications

Patients must be treated by a rheumatologist or clinical immunologist with expertise in managing psoriatic arthritis.

Initial treatment

Make all initial applications for authority approval to prescribe biological agents for the treatment of psoriatic arthritis in writing and:

All applications must include a completed:

Initial grandfather treatment - secukinumab only

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

All applications must include a completed:

Continuing, changing or recommencing treatment

Make all applications for authority approval to continue, change or recommence PBS subsidised biological agents for the treatment of severe active psoriatic arthritis in writing and:

All applications must include a completed:

Subsequent continuing treatment with etanercept biosimilar as per the PBS restrictions is Authority Required (Streamlined) and does not require prior authority approval from the Department of Human Services.

Further information

For more information call the PBS Complex Drugs Programs enquiry line.

Page last updated: 5 July 2018