The PBS subsidises biological agents for patients with severe active rheumatoid arthritis.
Patient eligibility
Treatment with biological agents can be subsidised through the Pharmaceutical Benefits Scheme (PBS) under the National Health Act 1953, Sections 85 and 100 for a patient with severe active rheumatoid arthritis.
Where the term biological agent appears, it refers to abatacept, adalimumab, baritcitinib, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab and tofacitinib.
Patients must be eligible for the PBS and meet the relevant restriction criteria.
The Schedule of Pharmaceutical Benefits outlines the restrictions for prescribing biological agents.
Section 100 arrangements
Abatacept intravenous, infliximab, rituximab and tocilizumab intravenous are only available for a day admitted patient, non-admitted patient, or patients on discharge who are attending:
- an approved private hospital
- a public participating hospital, or
- a public hospital
These items are not PBS subsidised for hospital in-patients. You must include the hospital name and provider number on the authority application form.
Toxicity and severity descriptors
When demonstrating a patient’s intolerance to prior treatment, use the rheumatoid arthritis toxicity and severity descriptors with the authority application.
Applications
All applications must be completed by the treating rheumatologist or clinical immunologist with expertise in managing severe active rheumatoid arthritis.
Initial treatment
Make all initial applications for authority approval to prescribe PBS subsidised biological agents for the treatment of severe active rheumatoid arthritis in writing and:
- upload through Health Professional Online Services (HPOS), or
- post to the PBS Complex Drugs Programs
All applications must include the completed:
- authority prescription form(s)
- rheumatoid arthritis Initial PBS authority application form
- relevant attachments
Initial grandfather treatment
For patients who received non PBS subsidised tofacitinib treatment before 1 October 2015 or baricitinib treatment before 1 September 2018 for severe active rheumatoid arthritis, make all initial grandfather applications in writing and:
- upload through HPOS, or
- post to the PBS Complex Drugs Programs
All applications must include the completed:
- authority prescription form(s)
- rheumatoid arthritis Initial PBS grandfather authority application form
- relevant attachments
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 rheumatoid arthritis in writing and:
- upload through HPOS, or
- post to PBS Complex Drugs Programs
All applications must include the completed:
- authority prescription form(s)
- rheumatoid arthritis Continuing PBS authority application form
- relevant attachments
You can use this authority application form to submit a demonstration of response to the current PBS subsidised treatment.
Subsequent continuing treatment with the etanercept biosimilar is Authority Required (Streamlined) and does not require prior authority approval from us.
Further information
Call the PBS Complex Drugs Programs enquiry line for more information.