Ulcerative colitis

The PBS subsidises adalimumab, infliximab and vedolizumab (adults only) for patients with moderate to severe ulcerative colitis.

For patients with moderate to severe ulcerative colitis, treatment with adalimumab, infliximab and vedolizumab (adult patients only) can be subsidised through the Pharmaceutical Benefits Scheme (PBS). These items are subsidised under Sections 85 and 100 of the National Health Act 1953.

Section 100 arrangements only for infliximab and vedolizumab

These items are only available to a patient who is attending:

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

and is a:

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

These items are not available as PBS benefits for in-patients of the hospital. You must include the hospital name and provider number on the application form.

Patient eligibility

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

The Schedule of Pharmaceutical Benefits on the PBS website outlines restrictions for prescribing adalimumab, infliximab and vedolizumab (adult patients only).

Toxicity and severity descriptors

Use the list of ulcerative colitis toxicity criteria and severity descriptors to make sure you fully assess the patient’s eligibility. Use this list with the application to demonstrate a patient’s inability to tolerate prior systemic therapy.

Applications

All patients must be treated by a:

  • gastroenterologist (code 87)
  • consultant physician, internal medicine specialising in gastroenterology (code 81), or consultant physician, general medicine specialising in gastroenterology (code 82) or paediatrician (paediatric patients only), or
  • specialist paediatric gastroenterologist (paediatric patients only)

Adult patients

Initial, changing or recommencing treatment

Make all initial applications for authority approval to start, change or recommence PBS subsidised adalimumab, infliximab and vedolizumab for the treatment of moderate to severe ulcerative colitis in writing and:

All applications must include a completed:

Initial grandfather treatment

For patients who received non-PBS subsidised vedolizumab treatment before 1 August 2015 or adalimumab treatment before 1 December 2016 for moderate to severe ulcerative colitis, make all grandfather applications in writing and:

All applications must include a completed:

A patient may qualify for PBS subsidised treatment under this restriction once only.

Continuing treatment

Make applications for continuing treatment by calling PBS Complex Drugs Programs enquiry line.

Paediatric patients

Initial, changing or recommencing treatment

Make all initial applications for authority approval to start, change or recommence PBS subsidised adalimumab and infliximab for the treatment of moderate to severe ulcerative colitis in writing and:

All applications must include a completed:

Initial grandfather treatment

For patients who received non-PBS adalimumab treatment before 1 December 2016 for moderate to severe ulcerative colitis, make all grandfather applications in writing and:

All applications must include a completed:

Continuing treatment

Make applications for continuing treatment by calling the PBS Complex Drugs Programs enquiry line.

Further information

For more information call the Complex Drugs Programs enquiry line.

Page last updated: 1 November 2017