Arthritis - psoriatic arthritis

The PBS subsidises biological agents for patients with severe active psoriatic arthritis.

Patient eligibility

The Pharmaceutical Benefits Scheme (PBS) subsidises treatment with biological agents under the National Health Act 1953, sections 85 and 100 for adult patients with severe psoriatic arthritis.

Where the term biological agent appears, it refers to:

  • adalimumab
  • certolizumab
  • etanercept
  • golimumab
  • infliximab
  • ixekizumab
  • secukinumab
  • tofacitinib
  • ustekinumab.

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

The Schedule of Pharmaceutical Benefits on the PBS website outlines restrictions for prescribing biological agents.

Section 100 arrangements

Infliximab

Infliximab is only PBS subsidised for day admitted patients, non-admitted patients, or patients on discharge who are attending either:

  • an approved private hospital
  • a public participating hospital
  • a public hospital.

You must include the hospital name and provider number on the authority application form. Infliximab isn’t PBS subsidised for hospital in-patients.

Toxicity and severity descriptors

When demonstrating a patient’s intolerance to prior treatment, use the psoriatic arthritis toxicity and severity descriptors with the authority application.

Treatment specifics

To be eligible for PBS subsidised treatment with biological agents, patients must be treated by a rheumatologist or a clinical immunologist with expertise in the management of severe psoriatic arthritis.

Applications

Initial treatment

Apply for authority approval to prescribe initial PBS subsidised biological agents to treat severe psoriatic arthritis in writing and either:

All applications must include the completed:

Initial grandfather treatment

For patients who received non-PBS ixekizumab before 1 March 2019 or non-PBS subsidised tofacitinib before 1 May 2019 for severe psoriatic arthritis, apply for initial grandfather authority approval in writing and either:

All applications must include the completed:

Changing or recommencing treatment

Apply for authority approval to change or recommence PBS subsidised biological agents to treat severe psoriatic arthritis in writing and either:

All applications must include the completed:

You can use this authority application form to submit a demonstration of response to the current PBS subsidised treatment.

Continuing treatment

Apply for authority approval to continue PBS subsidised biological agents to treat severe psoriatic arthritis in writing and either:

All applications must include the completed:

After we approve the first authority application for continuing treatment, subsequent continuing treatment with PBS subsidised biosimilar brands of biological agents are Authority Required (Streamlined). They don’t require authority approval from us for the listed quantity and repeats.

More information

Call the PBS Complex Drugs Programs enquiry line for more information.

Page last updated: 26 September 2019