Idiopathic thrombocytopenic purpura - initial PBS authority application form (PB097)

Use this form for an adult patient starting initial PBS subsidised treatment with either eltrombopag or romiplostim for the treatment of severe chronic immune idiopathic thrombocytopenic purpura.

PBS is the Pharmaceutical Benefits Scheme.

This form can be uploaded through HPOS. Read more about form upload in HPOS.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
This information was printed Sunday 26 May 2019 from It may not include all of the relevant information on this topic. Please consider any relevant site notices at when using this material.

Page last updated: 10 April 2019