Adolescent and adult severe eosinophilic asthma - initial PBS authority application form (PB194)

Use this form to apply for initial Pharmaceutical Benefits Scheme (PBS) subsidised treatment with benralizumab or mepolizumab for uncontrolled severe eosinophilic asthma.

This form is for patients aged 12 years or older.

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: 13 February 2019