Rheumatoid arthritis Initial PBS grandfather authority application form (PB110)

Use this form to apply for initial grandfather PBS subsidised tofacitinib treatment for an adult patient with rheumatoid arthritis.

A rheumatologist or clinical immunologist with expertise in the management of rheumatoid arthritis must complete this form.

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.

Page last updated: 9 April 2018