Psoriatic arthritis - initial grandfather PBS authority application form (PB184)

Use this form to apply for initial PBS subsidised treatment with ixekizumab for an adult patient with psoriatic arthritis who received non-PBS subsidised treatment before 1 March 2019.

A rheumatologist or clinical immunologist with expertise in the management of psoriatic arthritis must be treating the patient.

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: 1 March 2019